I must now deal with a postponed division relating to amendment No. 1, tabled by Sinn Féin, to the Fianna Fáil motion re mental health services reports. On Tuesday, 2 July, on the question, "That the amendment to the motion be agreed to," a division was claimed. In accordance with Standing Order 70(2), that division must take place now.
Mental Health Services Reports: Motion (Resumed) [Private Members]
The following motion was moved by Deputy James Browne on Tuesday, 2 July 2019:
That Dáil Éireann:
welcomes:
— the recent annual report of the Mental Health Commission and the report of the Inspector of Mental Health Services;
— the comprehensive nature of the reports and their contribution to building a culture of transparency in mental health services; and
— the recognition and reporting given to improvements, as well as deficits, within the services monitored;
notes:
— the findings and warnings from the Mental Health Commission which highlight significant governance and management deficit within mental health services;
— concerns about seclusion, physical restraint and services for young people;
— likely obstacles to the registration of some of the country’s in-patient mental health units without significant improvements in levels of compliance;
— a serious concern with hygiene and maintenance in a significant number of approved centres;
— mental health services where the degree of dirtiness and shabbiness is unacceptable and shows disrespect for patients’ dignity;
— that 70 per cent of approved centres (in-patient mental health services registered by the Mental Health Commission) remained dirty, malodorous and poorly maintained;
— that a number of centres remained unsuitable and not fit for purpose;
— that a significant number of approved centres have, on a consistent and sustained basis, failed to provide the most basic and fundamental aspects of a service;
— that more than 40 per cent of approved centres were non-compliant on the need for individual care plans; and
— that residents in long-term care are not being adequately monitored for serious physical illness and there was widespread lack of access to essential healthcare such as physiotherapy, speech and language therapy, dietetics and seating assessments;
further notes that:
— the Mental Health Commission annual report also highlighted ongoing concerns around child and adolescent mental health services;
— while the total number of admissions of people under the age of 18 to approved centres in 2018 was 408 (down from 439 in 2017), there were 84 admissions of children and adolescents to 18 adult units during the year;
— children and young people in crisis are left with the unacceptable ‘choice’ between an emergency department, general hospital, children’s hospital, or an adult in-patient unit;
— there are only Child and Adolescent Mental Health Services (CAMHS) units in three counties – Dublin, Cork and Galway – and they generally do not take out-of-hours admissions; and
— in April 2019 the number of CAMHS clinical staff nationwide stood at 57 per cent of the level recommended by A Vision for Change;
agrees that:
— while policy creates hope, the evidence gathered by the Mental Health Commission indicates that it is only well-governed, well-managed and well-resourced services that deliver for the public;
— the absence of regulation of State-provided mental health community residences leaves residents open to the risk of abuse;
— there is no justification for some of the low levels of compliance evidenced in the Inspector of Mental Health Services’ report;
— there are significant governance and management deficits within our mental health services;
— it is difficult to see how some of the lowest compliant centres could be registered in the future without significant improvement;
— hope and dignity are key elements of any mental health service and that not all approved centres are providing that, either through the service itself, or the physical buildings in which they operate;
— it is necessary to respect the wishes of service users and their families/carers in facilities such as the Rosalie community psychiatric unit in Castlerea, Co. Roscommon;
— a planned, costed and funded capital investment programme is required to bring a significant number of Health Service Executive (HSE) buildings up to date, make them fit for purpose and ensure that they are registrable;
— the placement of any child in any adult unit indicates a gap in service provision; and
— a child or adolescent’s first introduction to mental health care should not be through a service or building which is not specifically equipped to deal with their needs; and
calls for:
— a system of governance that drives best practice across the whole country;
— measures to ensure that the specialist in-patient approved centres are up to standard;
— the continued movement of the treatment and recovery model to specialist professional community care;
— the introduction of a system of regulation to protect the more than 1,200 people who live in State-provided mental health community residences;
— adult safeguarding regulation to be put on a primary legislative basis;
— a planned, costed and funded capital investment programme to bring a significant number of HSE buildings up to date, make them fit for purpose and ensure that they are registrable;
— an urgent implementation strategy to ensure that the CAMHS services provided match what is recommended under A Vision for Change;
— the recognition of the rights of 16 and 17 year olds to have the equivalent say over their mental health as they currently do over their physical health;
— the establishment of a national advocacy service on a statutory footing for adults and children under eighteen;
— the establishment of a statutory right for patients to information on their treatment;
— the updating of the Mental Health Act 2001 in line with the Report of the Expert Group on the Review of the Mental Health Act 2001 and to include guiding principles for children; and
— the right of involuntary patients to have any advance healthcare directives respected.
Debate resumed on amendment No. 1:
To insert the following after “advance healthcare directives respected;”:
“- the reinstatement of the post of National Director for Mental Health to provide accountability, transparency and strong national leadership for mental health;
- the development of an information system for mental health, starting with basic indicators so that outcomes can be tracked and monitored;
- a statutory footing for the right to a care plan;
- the publication, before the end of 2019, of a costed implementation plan for the provision of 24/7 CAMHS;
- no freeze on recruitment or overtime for psychiatrists, nurses, psychologists and other essential staff;
- an immediate commencement of the Mental Health (Amendment) Act 2018 in whole or in part so that people’s basic rights are protected; and
- an immediate commencement of the sections of the Assisted Decision-Making (Capacity) Act 2015, relating to Advance Healthcare Directives and the extension of that right, through new legislation, to involuntary patients.”
-(Deputy Pat Buckley)
Amendment again put:
The Dáil divided: Tá, 78; Níl, 41; Staon, 0.
Tá
- Adams, Gerry.
- Aylward, Bobby.
- Barry, Mick.
- Boyd Barrett, Richard.
- Brady, John.
- Brassil, John.
- Breathnach, Declan.
- Broughan, Thomas P.
- Browne, James.
- Buckley, Pat.
- Burton, Joan.
- Butler, Mary.
- Byrne, Thomas.
- Cahill, Jackie.
- Calleary, Dara.
- Casey, Pat.
- Chambers, Jack.
- Collins, Joan.
- Connolly, Catherine.
- Coppinger, Ruth.
- Cowen, Barry.
- Cullinane, David.
- Curran, John.
- Doherty, Pearse.
- Donnelly, Stephen.
- Dooley, Timmy.
- Ellis, Dessie.
- Ferris, Martin.
- Fitzmaurice, Michael.
- Fitzpatrick, Peter.
- Funchion, Kathleen.
- Harty, Michael.
- Haughey, Seán.
- Healy, Seamus.
- Kelly, Alan.
- Kenny, Gino.
- Kenny, Martin.
- Lawless, James.
- MacSharry, Marc.
- Martin, Micheál.
- McConalogue, Charlie.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- Mitchell, Denise.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Munster, Imelda.
- Murphy O'Mahony, Margaret.
- Murphy, Catherine.
- Murphy, Eugene.
- Murphy, Paul.
- Naughten, Denis.
- Nolan, Carol.
- O'Callaghan, Jim.
- O'Dea, Willie.
- O'Keeffe, Kevin.
- O'Loughlin, Fiona.
- O'Reilly, Louise.
- O'Rourke, Frank.
- O'Sullivan, Jan.
- O'Sullivan, Maureen.
- Ó Broin, Eoin.
- Ó Caoláin, Caoimhghín.
- Ó Laoghaire, Donnchadh.
- Ó Snodaigh, Aengus.
- Penrose, Willie.
- Pringle, Thomas.
- Ryan, Brendan.
- Scanlon, Eamon.
- Sherlock, Sean.
- Shortall, Róisín.
- Smith, Brendan.
- Smith, Bríd.
- Smyth, Niamh.
- Stanley, Brian.
- Tóibín, Peadar.
- Troy, Robert.
Níl
- Bailey, Maria.
- Barrett, Seán.
- Brophy, Colm.
- Bruton, Richard.
- Burke, Peter.
- Byrne, Catherine.
- Canney, Seán.
- Carey, Joe.
- Corcoran Kennedy, Marcella.
- Creed, Michael.
- Daly, Jim.
- Deasy, John.
- Deering, Pat.
- Doherty, Regina.
- Durkan, Bernard J.
- English, Damien.
- Flanagan, Charles.
- Grealish, Noel.
- Griffin, Brendan.
- Harris, Simon.
- Heydon, Martin.
- Kehoe, Paul.
- Kyne, Seán.
- Lowry, Michael.
- Madigan, Josepha.
- McEntee, Helen.
- McGrath, Finian.
- McHugh, Joe.
- McLoughlin, Tony.
- Mitchell O'Connor, Mary.
- Moran, Kevin Boxer.
- Naughton, Hildegarde.
- Neville, Tom.
- Noonan, Michael.
- O'Connell, Kate.
- O'Donovan, Patrick.
- O'Dowd, Fergus.
- Phelan, John Paul.
- Ring, Michael.
- Rock, Noel.
- Ross, Shane.
Staon
Tellers: Tá, Deputies Aengus Ó Snodaigh and Denise Mitchell; Níl, Deputies Seán Kyne and Tony McLoughlin.
Amendment declared carried.
Normally, amendment No. 2 would fall but, as it adds words to the motion, I ask the Labour Party Deputies to indicate if it is being moved.
I move amendment No. 2:
(a) To insert the following after “dietetics and seating assessments;”:
“ — that according to the World Health Organization (WHO) in 2014, social inequalities are associated with higher rates of mental health difficulties, with more unequal societies experiencing greater rates of mental health distress; and
— over 90 per cent of mental health needs can be successfully treated within a primary care setting;”;
(b) To insert the following after “level recommended by A Vision for Change;”:
“— according to a 2014 WHO report, suicide remains the biggest cause of death among young people in Ireland aged between 15 and 24;
— the 2018 interim report of the National Suicide Research Foundation acknowledges that young people across the country are experiencing unprecedented levels of anxiety and stress in their everyday lives;
— only 11 counties in the State have out-of-hours mental health support services for children; and
— spending on the delivery of mental health services was only 6 per cent of the total health budget in Budget 2019, which is comparatively lower than in countries with better developed and better performing mental health systems such as Sweden, the Netherlands, Germany and the United Kingdom which spend between 11-13 per cent respectively;”; and
(c) To insert the following after “best practice across the whole country;”:
“— a paradigm shift in the delivery of mental health services from an over-reliance on delayed, reactive and comparatively expensive acute services to an increased support for cost-effective proactive, integrated and community based early interventions;
— the Government to proactively engage in the prevention of mental ill-health, as opposed to its current symptomatic response, through the promotion of economic, social and environmental policies which holistically support and prioritise the long-term wellbeing of society over short-term economic growth measures;
— the Government to acknowledge spending on mental health, particularly spending which is focused on the promotion of positive mental health and primary level interventions, as an investment in the prevention of mental health difficulties and societal wellbeing rather than a pure economic cost;
— the Government to ensure that as part of Budget 2020, funding of mental health services as a proportion of the total health budget raises from 6 per cent to 8.24 per cent in line with A Vision for Change; and
— a streamlined, free referral service between different providers (voluntary, public and private) both within and between adult and child mental health services;”.
Amendment put:
The Dáil divided: Tá, 38; Níl, 81; Staon, 0.
Tá
- Adams, Gerry.
- Barry, Mick.
- Boyd Barrett, Richard.
- Brady, John.
- Broughan, Thomas P.
- Buckley, Pat.
- Burton, Joan.
- Collins, Joan.
- Connolly, Catherine.
- Coppinger, Ruth.
- Cullinane, David.
- Ellis, Dessie.
- Ferris, Martin.
- Fitzmaurice, Michael.
- Funchion, Kathleen.
- Healy, Seamus.
- Kelly, Alan.
- Kenny, Gino.
- Kenny, Martin.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Catherine.
- Murphy, Paul.
- O'Reilly, Louise.
- O'Sullivan, Jan.
- O'Sullivan, Maureen.
- Ó Broin, Eoin.
- Ó Caoláin, Caoimhghín.
- Ó Laoghaire, Donnchadh.
- Ó Snodaigh, Aengus.
- Penrose, Willie.
- Pringle, Thomas.
- Ryan, Brendan.
- Sherlock, Sean.
- Shortall, Róisín.
- Smith, Bríd.
- Stanley, Brian.
- Tóibín, Peadar.
Níl
- Aylward, Bobby.
- Bailey, Maria.
- Barrett, Seán.
- Brassil, John.
- Breathnach, Declan.
- Brophy, Colm.
- Browne, James.
- Bruton, Richard.
- Burke, Peter.
- Butler, Mary.
- Byrne, Catherine.
- Byrne, Thomas.
- Cahill, Jackie.
- Calleary, Dara.
- Canney, Seán.
- Carey, Joe.
- Casey, Pat.
- Chambers, Jack.
- Corcoran Kennedy, Marcella.
- Cowen, Barry.
- Creed, Michael.
- Curran, John.
- Daly, Jim.
- Deasy, John.
- Deering, Pat.
- Doherty, Regina.
- Donnelly, Stephen.
- Dooley, Timmy.
- Durkan, Bernard J.
- English, Damien.
- Fitzpatrick, Peter.
- Flanagan, Charles.
- Fleming, Sean.
- Grealish, Noel.
- Griffin, Brendan.
- Harris, Simon.
- Harty, Michael.
- Haughey, Seán.
- Heydon, Martin.
- Kehoe, Paul.
- Kyne, Seán.
- Lawless, James.
- Lowry, Michael.
- MacSharry, Marc.
- Madigan, Josepha.
- Martin, Micheál.
- McConalogue, Charlie.
- McEntee, Helen.
- McGrath, Finian.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- McHugh, Joe.
- McLoughlin, Tony.
- Mitchell O'Connor, Mary.
- Moran, Kevin Boxer.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murphy O'Mahony, Margaret.
- Murphy, Eugene.
- Naughten, Denis.
- Naughton, Hildegarde.
- Neville, Tom.
- Nolan, Carol.
- Noonan, Michael.
- O'Callaghan, Jim.
- O'Connell, Kate.
- O'Dea, Willie.
- O'Donovan, Patrick.
- O'Dowd, Fergus.
- O'Keeffe, Kevin.
- O'Loughlin, Fiona.
- O'Rourke, Frank.
- Phelan, John Paul.
- Ring, Michael.
- Rock, Noel.
- Ross, Shane.
- Scanlon, Eamon.
- Smith, Brendan.
- Smyth, Niamh.
- Troy, Robert.
Staon
Tellers: Tá, Deputies Brendan Ryan and Jan O'Sullivan; Níl, Deputies Michael Moynihan and James Browne.
Amendment declared lost.
Motion, as amended, put and declared carried.