Mental Health Issues: Discussion with Minister of State at Department of Health and Children.

We will now have our discussion with the Minister of State at the Department of Health and Children with special responsibility for equality, disability and mental health matters, Deputy John Moloney. I welcome the Minister of State to the committee. The Minister of State intends to speak primarily on his mental health brief today.

Before I begin, I will introduce the people with me. Mr. Martin Rogan was appointed within the past fortnight as the new director for mental health. I will speak more about him later. I am delighted to be joined too by Ms Dora Hennessy, principal officer in the Department of Health and Children, who deals with the area of mental health. I thank the Chairman and members for the opportunity to come before the committee. I had hoped our discussion would take place post the budget, so that I could be quite definite with regard to my commitments. However, I will take the opportunity before me today. I will deal with specific issues and am prepared to take questions. I do not intend to read through my full 14-page submission, but will deal with specific issues.

In my 18 months in the Department I have set myself a number of priorities and I will deal with those now. One of my main priorities is the delivery of the recommendations and commitments in A Vision for Change. My first priority in this area has been the issue of the closure of the old mental or psychiatric hospitals and the sale of these properties. I have mentioned on other occasions that the ring-fencing of funds from the sale of such properties is a concern. I understand people may be sceptical about this if no firm commitment is made, as has happened so often. Therefore, I will be specific in this regard and provide timeframes.

I also hope to deal with other commitments, recommendations, the capital programme and how we can fund A Vision for Change. An important part of the mental health brief is the issue of the increasing number of suicides. Over the past 12 months I have worked in a private capacity on my brief, but it is now time to come forward with precise proposals on how to deal with the stigma attached to mental health issues and reduce numbers of people in institutions. I also reaffirm the commitment I made some time ago when I last appeared before the committee with regard to my plans for a new central mental hospital, how it will be funded and how soon it will be delivered.

I wish to discuss in specific terms the issues I feel it is important to deliver under the reform programme. The first commitment must be to deliver on A Vision for Change. We are now four years into this six-year reform programme, but let me be first to acknowledge that the pace of reform has been slower than hoped for. The director for mental health, Mr. Martin Rogan, is available to answer questions if any committee members have a direct question for him. However, I suggest that the committee take the opportunity to bring him back in January with a full presentation on mental health. By that time, he will have had the opportunity to work with the 14 regional directors and will be better able to tell the committee how the programme can be delivered.

To get to the specifics, my first intention with regard to the capital programme proposed in A Vision for Change is to secure Government approval for the sale of mental health properties and to ring-fence the proceeds for reinvestment in mental health. I am committed to this. When I mentioned this issue on a previous occasion, there was some ambiguity with regard to these proceeds. People felt it had all been said before. Since my appointment, I have visited all of the psychiatric hospitals. I have done this privately without notifying the press or political colleagues, as I felt it was important to build up credibility with the staff and the service users. I see it as my role to help progress the closure or development plans in all of the hospitals and am happy to be able to say that all of the properties have now been visited. I compliment Mr. Brian Gilroy, who heads up the procurement area in the HSE, on the fact we have current asset values.

As part of the commitment I have made with regard to the capital programme, I am now dealing directly with the Minister and officials from the Department of Finance on this issue. I had the opportunity recently at the bilateral meeting on health to explain that I cannot see how we can deliver on the reform programme unless there is a five-year capital programme put forward for mental health services no later than January 2010. It is very important to deliver on the commitment and to do so requires that five-year capital programme.

I am pleased to note that in the renegotiated programme for Government, the commitment to ring-fence funds obtained through the sale of properties is retained. In the past property was sold and the funds did not return to the mental health area — I mention specifically funds received from the sale of St. Loman's in Dublin and associated properties. I intend to secure that funding back from the Exchequer to begin the capital programme in January.

Closure of old mental hospitals should continue and much has been done in this regard in recent years. However, a number remain, all of which I have visited. I intend involving the Irish Council for Social Housing in this area. I have invited the council to meet me and have given it a list of the locations of the priority properties to go on the market. I have invited the council to join in partnership with the Department to co-operate in transferring patients from institutional care to community housing. I fully accept the advice given to me some time ago not to follow the British model, where people who moved into community care returned to the streets afterwards. It is important for every patient who will live in the community to have a commitment from the HSE in advance to ensure all the protocols by way of home help and mental health nursing are in place in advance of any housing programme. I am pleased that my colleague the Minister of State, Deputy Michael Finneran, also a former psychiatric nurse, has recognised a priority need within the social housing programme to deal with people with special needs.

On the issue of the Central Mental Hospital, within weeks of my appointment I met Professor Kennedy and his colleagues in Dundrum. I have always been taken by the notion that we could reconsider that particular location. I made recommendations to the Government about changing the location from Thornton Hall and I am pleased that has happened. I made it clear to Professor Kennedy and his colleagues that the new central mental hospital would not be relocated in Dundrum. It is my intention to seek bridging finance to provide for a new central mental hospital, the details of which I will give to the committee at its meeting in January or February. I intend to use the funding secured from the sale of the property in Dundrum to provide for mental health supports in this region. There is also a commitment from the sale of property to provide for the four regional psychiatric intensive care units. Rather than go through the full brief, I am depending on the commitment from the HSE to provide 100 community mental health teams in the 200 primary care centres.

One of the most important parts of the reform programme, which I have recognised from the day of my appointment, is the need to have somebody appointed to head up the mental health reform programme. At my first meeting of the monitoring group I made it clear that for any programme to become a reality, it needed a lead director. Subsequently I had a meeting with Professor Drumm and the board of the HSE and I am pleased to say I convinced him and his colleagues of the importance of having somebody in that position. I am pleased that Mr. Martin Rogan, whom I have already mentioned, has come through the interview process and is now the lead director. I will say more about that later. The intention is to move from institutionalised services to community services. The introduction of an early intervention programme, including primary and post-primary programmes, is very important.

All of the foregoing depends on funding. I am committing myself publicly at this committee that the vehicle to drive this reform programme has to be the securing of the aforementioned funds. It is important when a Government programme is in place that the Minister involved should come before the public to explain the progress, or lack of progress, and outline the commitments for the remaining six years. I intend to do that in January or February at a public forum where I will carry out a public review of A Vision for Change. I will be in a position at that time to outline the properties coming to market and, more importantly, the capital programmes proposed in A Vision for Change. While that is important in itself it will also be an opportunity for the director, working with his 14 regional directors, to bring forward an implementation plan for the remaining six years. I do not believe in backloading everything on to the last year. It is important to line out, during the next six years, the properties that will come on the market, where they are and what they will do within the context of the capital programme and, more important, how we will deal with the issue of child and adolescent facilities, early intervention, acute psychiatric units and all the support structures as proposed. I intend to do that in January or February.

Many deputations to the Department have made the point that it is important for service users to be involved in the policy aspect of the reform programme. I was pleased to attend the inaugural meeting of the national service users group in Cork in January 2009. and to welcome its advice and support. The lack of information for service issues continues to crop up.

I am pleased to report that the web-based mental health information system, Wisdom, is currently being piloted in Donegal. A Vision for Change drew attention to the lack of timely, high-quality data on community-based activity, on outcomes for service users and on the prevalence and incidence of mental health problems. Wisdom is a joint HSE and Health Research Board information system which will create a comprehensive, detailed record of service users within the mental health services structure. This will improve efficiency and will facilitate access to real-time service user information. The information collected will ultimately be used for national reporting on mental health services in Ireland and for research to inform mental health policy, planning and practice.

As I mentioned, Wisdom is currently being rolled out in an 18-month pilot programme in Donegal. This phase is due to be completed in June 2010, following which the system will be independently evaluated. I look forward to receiving the results of the independent evaluation and I am delighted that early indications are that the system, which has been fully endorsed by service users, has been embraced well by Donegal staff.

I turn to the matter that causes the greatest concern within the mental health programme, namely, facilities for child and adolescent services. I am pleased to report significant progress in this area but I recognise that the targets set in A Vision for Change have not been realised. At the same time I wish to explain to members what has been done and what remains to be done. I am pleased to report some progress in the further development of child and adolescent mental health services which continues to be a priority for the HSE. Additional specialist child and adolescent mental health teams have been established in 2009, bringing the total number at present to 57. Furthermore, funding provided in the last budget will enable the recruitment of 35 additional therapist posts to the child and adolescent mental health service. Some of the posts have already been filled and I have been assured that the remaining positions will be filled by early next year.

Some additional capacity has been provided. I do not wish to over-emphasise what has been achieved. Additional inpatient capacity for children and adolescents has been provided. Last week I had the great pleasure to formally open a six-bed adolescent unit at St. Vincent's Hospital in Fairview. The provision of these additional dedicated adolescent beds is welcome and timely. The Mental Health Act 2001 changed the definition of "child" to include 16 and 17 years olds and A Vision for Change recommended that services for children up to 18 years of age should be provided by the child and adolescent mental health service. The Mental Health Commission has also recently issued an addendum to its code of practice regarding the admission of children to adult units which seeks to ensure that by 1 December 2011, no child under 18 years of age will be admitted to an adult psychiatric unit.

Consequently there is a need to increase inpatient capacity for this age group. Along with the additional unit at St. Vincent's Hospital, an eight-bed adolescent unit also opened for admissions last week in St. Stephen's Hospital, Cork. I should also mention that I turned the sod for two new 20-bed child and adolescent units, one at Merlin Park, Galway, on 21 January 2009 and the other at Bessboro, Cork, on 3 April 2009. Work is advancing on the construction of these units and I understand that the beds will be commissioned in 2010. The completion of these two purpose-built units will ensure a significant increase in the bed capacity for children and adolescents by the end of 2010.

I do not intend to go through much more of my brief, which I think members have read, except to make a few points before moving on to stigma and the suicide programme.

The HSE has recently appointed Mr. Martin Rogan as national lead for mental health. I believe that Mr. Rogan's appointment represents an important turning point in the implementation process for A Vision for Change. I have always argued the point that a director should be there not to provide cover for the Minister or for the Minister to deflect to the director's department. I believe an implementation plan that has a timeframe must have as its lead somebody from a professional background. I do not have that background. It is important that the director sits down with the 14 regional directors and works out the barriers to implementation of the recommendations in A Vision for Change and, more important, how the programme can be implemented for the six remaining years. On the political side it is important for me to provide the capital support for it. That is the reason I attach such importance to ensuring that the funding required will come from the sale of assets. It is important that this is the first plank in any delivery of mental health reform.

I welcome Mr. Rogan's appointment and the fact that he has a proven track record. He is a former psychiatric nurse. In these days of public criticism of jobs for the boys he is not somebody who has been brought in from outside. He is a person with great credibility. I am confident that working in conjunction with his 14 regional directors he will drive forward the reform programme. This has all been reaffirmed in the programme for Government.

I wish to refer to the stigma of suicide and suicide statistics. I commend people like Geoff Day and Pamela Carter who continually lobby for funding for dealing with this issue. All Deputies will be aware of the significant problem of suicide in both rural and urban areas. Over the past year I have considered it important to bring together prominent people in different walks of life such as politics, the arts or business and I met with people whom I considered would be helpful. I wish to thank them and I will name them. I brought together approximately 15 people who would have a significant impact when it comes to dealing with the issue of stigma.

In this regard I recognise the great advantage of local radio. I intend bringing forward a local radio campaign on a national basis to include a weekly programme on the subject of mental health well-being and dealing with the issue of stigma. In that context I have invited members of the media to a meeting. I recently saw Michael Murphy being interviewed by Ryan Tubridy and I was very impressed by his honesty and his directness. I was invited to speak at his book launch. I acknowledged the courage of people like Michael Murphy who have the ability to influence events. I invited Michael Murphy and other newscasters such as Eileen Dunne, to help me with the programme. They took up that invitation and joined me here in Leinster House a fortnight ago.

It is my intention to front load funding, so to speak, to deal with different aspects of mental health. Public finances are stretched in these times and one must list priorities. I have been impressed by many groups in the past 15 months. I intend to prioritise funding for child and adolescent mental health. I have been impressed by submissions from Dr. Tony Bates and others. I do not operate on statistics but I refer to the statistic that 70% of mental health issues begin in childhood and adolescence. I intend prioritising funding for the jigsaw phenomenon, in other words the proposal from Headstrong. I visited centres in Ballymun and Galway where the jigsaw proposal is being implemented. Young people presenting at the centres are dealt with in a warm, friendly atmosphere and they discuss issues over a cup of tea. They can then be referred to professional help. I note the statistics for the success rate of the Galway and Ballymun centres and I am confident this model is the way forward. I thank Headstrong, the philanthropic organisation which is funding the programme and which hopes to have 30 centres in place by 2016. This programme will be prioritised for funding. I am also impressed by the proposal from Dr. Edward O'Callaghan who explained the Detect programme which includes early intervention. The outcomes have been proven and this will need to be prioritised.

With regard to my media programme I intend involving the editors of all the local media. I met with the Samaritans last week along with other similar groups. I will be involving people from sports, politics and the arts who have availed of mental health services at some point in their lives. I refer to the recovery model in A Vision for Change. People well known in County Offaly, my county, will come forward to say they have used the mental health services and that there is no big deal about having a mental health problem.

It is often a criticism of politicians that they do not do enough to help in the area of suicide prevention. I am conscious that politicians should not be to the fore lest it be regarded as self-promotion. In that context I have not decided whether I should personally front a programme. I have asked John Saunders who is the new chairperson of the monitoring group of A Vision for Change, to organise not Barack Obama-style town hall meetings but rather to arrange for people to go out to the regions with support from people like Martin Rogan and Dora Hennessy who have the expertise of the HSE and the Department of Health and Children. I will also involve Dr. Tony Bates, Dr. Edward O'Callaghan and many more. They will meet people at public fora to explain the existing supports and to help deal with the issue of mental health.

I have noted change as I have gone around the country. I was in Ballinasloe recently and I dropped in, unannounced, to St. Joseph's in Ballinasloe. I was particularly impressed with what are very simple things such as the assessment form for new patients. I take this opportunity to congratulate Mr. Gerry Blake on his initiative. The assessment application form ensures that all the contacts of the patient such as neighbours, friends and colleagues are included on the assessment form to be consulted in the event of a patient not attending for an appointment. This is a basic but very important detail. I asked the Department to arrange a discussion with accident and emergency services on uniform strategies for dealing with self-harm incidents. This meeting has taken place and it is intended to invite representatives from accident and emergency units to work together on this strategy.

I acknowledge I have not dealt with all the measures in A Vision for Change in my opening remarks. I do not believe for one moment that I will be in this job for the next five years but I hope that whoever is in the job will be able to continue what I will introduce in January, the six-year development programme and commitments.

I thank the members of the group dealing with the issue of stigma for their deliberations. I also thank Pamela Carter from the Department of Health and Children who headed this project. I thank Dr. Justin Brophy, Dr. Tony Bates, John Saunders, Martin Rogan, Dr. John Hillery, Geoff Day, Tom Kelly, Kevin Malone, Noel Smyth, Jonathan Fitzmaurice, John McCarthy, Kieran Fitzpatrick and others. I met John Treacy and Ossie Kilkenny in Beijing and discussed with them how they could help with my brief and I acknowledge their significant input. I met singer, Frances Black, at a function and I discussed the issue of mental health with her and she agreed to help. I thank Frances Black and Carol Balfe and many others.

This has been a brief submission but I ask the committee for its indulgence to allow me return at a future date to inform it of our proposals following the public reappraisal of A Vision for Change. I also look forward to returning to deal with disability issues.

I thank the Minister of State for his submission. We appreciate that he wishes to return when he has more definite information about his budget.

I thank the Minister of State for his presentation. Will he agree there is increased demand on psychiatric services due to the recession, the downturn in the economy? The expert advice is that there is a higher level of mental illness, especially depression, in times of recession. Would the Minister of State agree that there has been an increase in suicide rates, as indicated in the first quarter of this year when the rate rose by 43%, and this had been expected?

The McCarthy report recommended that €50 million be taken out of the budget for mental health and disability services. It had been accepted that these services were totally under-resourced long before the Minister of State took office. I know the Minister of State's heart is in the right place, but I am putting it to him whether the resources will be allocated to meet the extra demand on psychiatric services in times of recession. Last year the core funding of the suicide prevention office was reduced by 12.5%, which reduced the level of activity in the National Office for Suicide Prevention and in the non-governmental organisations it supports, such as Console — living with suicide. Will the Minister of State deal with the core funding for 2009 in the current context?

Who knows where money is being spent on mental health services. Apart from the global figure of €1 billion for the mental health service, there is little detailed knowledge of where the money is being spent. A recent report from Indecon consultants has found a continuing failure of accountability in expenditure and human resource allocation across mental health services at national and sub-national levels. This lack of information prevents groups and individuals from being able to determine whether inequity in expenditure in mental services is continuing.

The dangerous practice of placing elderly patients with dementia in the same adult wards as younger patients was criticised severely. Has progress been made in dealing with that issue? There are persons also with intellectual disabilities who are inappropriately placed in psychiatric hospitals and are a call on the funding of the psychiatric services. In regard to the 247 children who were placed in adult hospitals in 2008, I did not pick up the point the Minister of State made on that issue in the course of his contribution.

The then Minister of State, the former Deputy Tim O'Malley, promised that by 2008 construction of a unit with 20 child and adolescent psychiatric beds would start in Limerick for the mid-west region. That firm commitment was made by the then Minister of State and his successor the former Minister of State, Deputy Devins. I understand that has been abandoned. Has a decision been made that no child or adolescent beds will be constructed in Limerick?

I welcome the Minister of State, Deputy Moloney, and thank him for his contribution. It is clear he is committed to this area. If the Minister of State has his way, things will improve under his stewardship.

I hope the Minister of State will consider the Indecon report, which is an evaluation of A Vision for Change which was done at the behest of Amnesty International Ireland. It is nice to see it got an outside body to do its report. It is an excellent report. The first pivotal point it makes is on capital expenditure and it states that a detailed multi-annual capital programme for mental health services infrastructure does not exist and projects are approved on anad hoc basis depending on service requirement, specific policy decisions and the overall funding context. If the document, A Vision for Change, is to have a meaning it must be about putting in place a multi-annual capital programme. If that does not exist after A Vision for Change, that must be tackled as a matter of urgency. The report presents a graph which gives us a high of 7% of the overall health budget in 2000. The expenditure decreased in the boom years to a low of 6.1% and, amazingly and for no obvious reason, it rises to 7% but falls again after that. That makes the point that if one is dealing with a service without having the necessary infrastructure and a plan, one will have highs and lows in funding. The Minister of State referred to ring-fencing the funding, but I am not certain where that is at. I would like to know if all the money we are supposed to spend in the seven-year period will be spent. What will happen to it?

I tabled a question on people who were admitted to a psychiatric unit with psychiatric illness who clearly must have spent a considerable time there but are no longer considered to be unwell and are still within the units. I got an astonishing reply with a reference to St. Vincent's Hospital in Dublin which stated that 13 people were still there and that they were looking for rehabilitation or alternative accommodation for them. I have not received a reply on this issue from HSE south region yet. I know the Minister of State said he was talking to Respond! and other voluntary agencies, which may be slightly different. The long-stay residents, as Deputy Neville said, may have an intellectual disability and are still in psychiatric units throughout the country. At the last count, the number was 500 such people. The then Minister of State, the former Deputy Tim O'Malley, promised that this task would be completed by 2010. That clearly will not happen and it is another milestone lost.

The lack of the accountability for the money spent in the service is very worrying. This theme runs all the way through the report which identifies the lack of accountability and the lack of a multi-annual plan.

In the course of his remarks, the Minister of State referred to introducing new community mental health teams. What this report clearly shows is that where community mental health teams are in place, they are poorly staffed. We might be better to concentrate on staffing the community mental heath teams, where they exist, to a proper level. For instance it states in the report that the number of teams exceeds the recommended number based on the current population. This reflects the fact that the majority of teams have only one consultant-led psychiatrist instead of the recommended two consultants per team and do not possess the overall recommended number of staff or the staff skills mix. It may be great to be able to state that we have exceeded the number of teams, but when one looks at the detail, it is very clear that the teams are not properly staffed.

To return to my bugbear, I am very concerned about the protocol for people who present themselves at a psychiatric unit, declaring that they have suicidal tendencies but who are not admitted. I know this is not an easy problem to resolve, but I know of two people who were sent home from the hospital with an appointment for the following week. They received a prescription for the usual items but ended up committing suicide. Deputy Neville knows more about suicide than anybody present. If a person presents at a psychiatric unit and says he or she feels suicidal it should set off alarm bells everywhere. We talk about putting a psychiatric assessment nurse in accident and emergency units to spot people who might harm themselves but these people present themselves. What are the protocols around that?

We also need a protocol for people who have been patients in psychiatric institutions and are released. When I raised this recently I was told that it would be an invasion of a patient's privacy but the relatives of these people are very concerned about them. It is no good to wring our hands in response to this issue.

These are not easy questions but I would be grateful if the Minister of State would attempt to answer them.

I welcome the Minister of State. We are very quick to highlight the negatives when things are not done properly and that is part of our job. However, we should give credit where credit is due. The Minister of State made a very honest presentation and was frank about the pace of reform. Since this time last year several processes have been put in place and he is moving in the right direction.

I welcome the appointment of Mr. Martin Rogan. I am a great believer in having a person who will drive a project, who is committed and dedicated and who has the knowledge and experience to effect real change. His appointment will bring all the pieces of the jigsaw together to improve service delivery to those who need it most. When I first joined this committee an issue that regularly came up in meetings with the Minister for Health and Children was the inappropriate admission of children to adult psychiatric units and Senator White, Deputy O'Hanlon and others were very critical of that practice. I welcome the opening of the child and adolescent unit — it is a great start. The beds due to be commissioned in 2010 will aid the treatment and recovery of those people.

I have no doubt about the Minister of State's commitment in this area, which is exemplified by his decision to ring-fence funds when the sites are sold. Monaghan led the way in community mental health facilities for many years before it was even heard of in other parts of the country. However, some people are in institutions for their whole lives and there will be huge challenges when we move them into the community. We need to be careful about how that process is managed, for the sake of the patients themselves, their families and the social implications of moving them.

I welcome the moves to anti-stigmatise mental illness. The most important line in the Minister of State's submission was the one in which he said that mental illness should be treated like any other illness. It is an illness that people can suffer from but from which, with help and support, they can recover. The local campaign will help greatly to promote positive mental health. Service users have much to share. The Minister of State spoke about his involvement with Michael Murphy which illustrates that, when people are asked, they are willing to share information about their experiences to help others in a similar position.

In both primary and second level schools there has to be focus on positive mental health. It is important to engage with Dáil na nÓg or transition year co-ordinators, guidance counsellors, chaplains or anybody in schools with responsibility for helping young people who have nobody else to listen to what they say. For far too long we lived with the idea that young people should be seen and not heard and we have seen the consequences of that. That is not an appropriate approach if we want to effect change, especially as regards young boys, who find it difficult to communicate. Girls tell each other everything whereas boys keep things to themselves and we need to break down the barriers by telling them it is acceptable to share their problems with other people.

The Minister of State talked about assessment forms and there is no reason they should not be standardised in every hospital and accident and emergency unit so that all the relevant staff can elicit the same information. The Minister of State has done much in the past year but there is much more to be done. I am reassured of his commitment to moving the situation forward with the help of Mr. Martin Rogan.

I welcome the Minister of State and his colleagues. I welcome the progress made in the area of child and adolescent mental health but share Deputy Neville's concerns. When we were on a health board the resident unit project in Limerick was on the table but it appears to have drifted and I strongly support calls to restore it. It is important that people affected by child and adolescent mental health issues and requiring an inpatient bed should not have to go too far away from their home area.

I welcome the commitment that no child under 18 will be admitted to an adult psychiatric unit but December 2011 is two years away and I urge the Minister of State to bring the date forward. I recently dealt with a family which was very distressed about the fact that its young child was in an adult psychiatric unit, which is a totally inappropriate situation. Under the 2001 Act people aged 16 or 17 are included as adults but there should be no question of anybody under 16 being so included. Under-16s are the priority.

Everybody will welcome the decision not to move the Central Mental Hospital from Dundrum to Thornton Hall. We visited both sites and met delegations from the families affected. I urge the Minister of State to take on board the views, expressed in this committee and elsewhere by the residents and their relatives, that whatever is put in place is in an established community rather than an isolated area.

My final point also relates to child and adolescent mental health. While I welcome the fact additional teams are to be put in place, there was a PCCC briefing in my area recently and we were told that while there may be teams in name, as with the issue Deputy Lynch has just raised, many people are missing from those teams and there is a great deal of pressure on the people working in them. Will the Minister of State clarify whether the moratorium is having an effect in terms of recruitment to those teams? While there are exemptions to the moratorium, it seems to be causing a problem with recruitment of people to some of the child and adolescent teams.

I thank the Minister of State for his contribution. When we look at needs into the future, it is no harm to remind ourselves where we came from. There is no discipline in health care that has developed and improved to the extent that the treatment of mental illness has improved over the years. When I started in practice, there were 700 inpatients in the local psychiatric hospitals and most never got out, practically, and were kept there until the day they died. Today, apart from a very small number of patients who need to be in long-term care, mainly those to whom the Minister of State referred, most are more appropriately placed out in the community. We must recognise the tremendous improvement. We in Cavan-Monaghan were fortunate to have pioneer psychiatrists, including Dr. Owens, who for 35 years led the development of community care services, including the establishment of community psychiatric nursing as far back as 1966.

The other point that runs through A Vision for Change is the whole question of partnership. We have to recognise the role organisations such as the Mental Health Association play in the community in promoting positive mental health and in dealing with the stigma to which the Minster of State referred. Working with the HSE, they provide a very good service to the community.

I have two issues to raise as I do not want to go back over issues that have already been raised. The first concerns the question of child and adolescent services. I welcome very much the developments that have been announced but, in the short term, there is a problem of access in a number of areas, particularly for young people between the ages of 16 and 18. We need to find a way to address that issue.

The other area, which should not involve increased funding, is that of co-ordination of, co-operation between and integration of services. For example, if children are a risk to themselves, their parents or anybody else in the community, there seems to be a difficulty in having them seen by a forensic psychiatrist. While the HSE will provide a fairly rapid response, there can be very long delay in access to the forensic psychiatrist. We need to examine the whole area of co-ordination of services.

The Minister of State also has responsibility for intellectual disability, to which a chapter is devoted in A Vision for Change. This raises again the question of the provision of respite care and residences for adults in the community, another area where there has been phenomenal change in the past generation.

Another area which is worth considering — again, funding would not be involved — is that of early diagnosis and early intervention. There is a good case to be made for integrating the educational psychology service with the health service. I accept they are two different disciplines with two different functions. However, very often the child who is not performing in school has a health problem, which might be as simple as wax in their ears. If we had more early diagnosis and early intervention, it would be very beneficial to the child but also to the parents. I am sure that, like ourselves, the Minister of State knows that parents would like to have the very best management available for their child with an intellectual disability. However, by the time the child comes to the health service providers, the parents may have already talked to their neighbours or somebody else and have very fixed ideas of what they would like to see for their child. It would be much better if they talked to professionals early on.

While I referred to all the things that could be done without funding, my final point concerns the question of funding. In the initiative outlined by the Minister of State the funding from the sale of facilities within the mental health service should be ring-fenced and provided to develop the services in the way outlined today.

I welcome the Minister of State. I suppose we could begin the conversation by saying the road to hell is paved with good intentions. The Minister of State outlined many of the things he would like to do and hope to do. Unfortunately, several of his predecessors gave the same undertakings and they have not come to pass. He will forgive me, therefore, for being a little cynical about the likelihood of——

It is not a question of being cynical. I am questioning maybe, but cynical is a bit strong.

I am not calling the Minister of State cynical. I am saying that I must be a bit cynical about the reality of his being able to deliver on this. I hope he does. He will certainly get support from this side of the House to achieve what he is trying to achieve. I commend the Minister of State on destigmatising mental health and taking that issue to the roads, byways and highways of the country, because it is very important. Very often people do not realise they have a mental health issue until they start discussing it, and when they then realise they have it, they can do something about it. The first thing that must be done is to realise one has a problem.

I welcome the appointment of Mr. Martin Rogan and wish him every success. It is important to have an identifiable individual to lead the service, so it is a positive move.

With regard to child and adolescent mental health teams, while 54 teams have been put in place since 2006, how many are fully staffed? How many children are waiting more than six months from referral to accessing treatment? In 2007, 218 children were admitted to adult facilities; in 2008, that had risen to 260. As I noted, we were promised on 4 December 2006 by the Minister of State's predecessor, former Deputy Tim O'Malley, that by the end of 2007 we would have four new units of 20 beds each for children in need of admission. However, at the end of 2007, these were not delivered. A HSE official said in 2007 that 60% of these beds would be delivered by April 2009 but on 19 May, the Minister of State, Deputy Moloney, said that these beds would not be delivered until 2010.

To be fair, the Minister is addressing the truth of the matter, but we must address the matter itself, namely, we must provide for these children. How we will do that with a cut in the Government's capital budget from €425.45 million to €370 million remains to be seen.

On the issues around the Central Mental Hospital, I recall the Minister of State saying that the most important thing was to get a new hospital for the patients. Now, it appears the most important thing is that it not be built on the Central Mental Hospital site, where it could be built. We are all delighted that Thornton Hall has not worked out as I do not believe it would have been appropriate, so the recession brings some silver lining occasionally. When will the hospital be built and where will it be located? Who is in charge of that process? These are three key questions.

I agree completely with the concept of mental health care being incorporated into primary care and accessible in the same way as facilities for other illnesses. The problem is that the services are so few and far between that at the rate our primary care initiative is rolling out — it has been ongoing since 2001 — it will be 2070 by the time they are rolled out.

I was struck by Deputy O'Hanlon's comments on how far we have come. In St. Ita's, as we sit here today, there are still 23 women in one ward and 23 men in another acute admission ward for psychiatry. They have two or three feet between their beds and there is a block of two or three toilets to be shared, along with one or two showers. That is not progress. We were promised a new psychiatric unit at Beaumont Hospital for admissions 25 years ago and having applied for planning permission and paid architect fees and so on, in 2004 it was decided that a wonderful collocated hospital would be put in position.

I know collocated hospitals are not the responsibility of the Minister of State and despite being a supposed fast track for this Government delivering more beds into the system they have not even delivered a single bed. Not alone have they not delivered a single bed but they are obstructing the development of our psychiatric service for the people of Dublin North and Dublin North-East. It is a disgrace that in this day and age we are asking people to be admitted to the conditions in St. Ita's.

I understand there are now four or five units for intellectual disability on the grounds of St. Ita's, which have not been occupied due to a lack of staff. Will the Minister of State comment on that?

I have two other questions. I accept the Minister of State's bona fides and his undertaking that he will ring-fence the money from the sale of lands but the Government is giving mixed messages on that. We need to hear it from the Minister for Health and Children, who controls the budget, and the Department of Finance.

The last question is on the funding for suicide prevention, which Deputy Neville has so eloquently raised already. We have had a 43% rise in the number of suicides in the first three months of the year and it should be of great concern.

I apologise for arriving late but there was a vote on the Order of Business. I welcome the Minister of State and apologise as I did not hear his presentation, although I have been flicking through it. I know Deputy Kathleen Lynch has said that the Minister of State is committed and hard-working.

I may embarrass him by saying that not alone does he talk the talk and walk the walk but he gives evidence of that. I am referencing in particular all the visits he has made to mental health facilities around the country without any great hype, fanfare or rolling of drums. It was done in a private capacity with perhaps one official in attendance. He wanted to hear first-hand what was going on, spoke to staff as well as patients and looked at some of the facilities. I am sure the Minister will agree that some of these places are harrowing and people would not like to be in them if they had a physical ailment, let alone a mental health issue.

As with other speakers I welcome the appointment of Mr. Martin Rogan, as it is particularly timely. I know A Vision for Change has been around for a while and it is no criticism of his predecessors but he has picked up on A Vision for Change and decided that it is time for change. He has brought about great change, particularly in the stigma area.

The same kind of issue has gone through every speaker's mind and we have all spoken about the same matters. It is like a state of mind that has been there for a lifetime has been broken down. From the time I was a child, we had a county home in Tullamore and I do not know why the people were in there but they all seemed to have suffered mental health issues. It always seemed very lonely. Children ran by it, in effect, because of fear.

I am glad to see links are being made. I know Mountmellick because I grew up seven miles away in Tullamore. I would not call it a one-horse town because it is not, but it is progressive. I am delighted to see that the sod will be turned, perhaps next month, on a new primary care unit which will have a community mental health facility within it. That is the way to go. The Minister of State has a wonderful mental health hospital in the grounds of the general hospital in his own county. It is a beautiful hospital and on walking in, one would ask if it is a psychiatric hospital. It is a beautiful facility.

Another area on which everyone spoke is child and adolescent psychiatry where nothing really is being done. I am delighted to see that six new beds have been opened in St. Vincent's in Fairview. It is very important to stress that this area really needs to be worked on. Barriers are being broken down and the HSE will speak with primary and post-primary school students. Links are being made to schools as well as to the community. If we get into schools and start breaking down perceptions that may be there from parents or grandparents that would be the way to go.

A few weeks ago a young hurler announced that he was gay and I wondered why it took an hour on the national airwaves to say that this was great. That is the society in which we live. Mental health issues almost need to go through such a revival so that people will not be afraid to talk about it.

By 1 December 2011, no child under 18 will be admitted to an adult psychiatric hospital and although I wish it could be sooner, the Minister of State has made great inroads into the matter. I have great faith in the Minister of State and I know that as long as he is in his present post, he will continue to make great strides. I know the Minister of State will come to the Seanad later this month or early in December and I look forward to continuing the debate there.

I welcome the Minister of State and thank him for his presentation. I know he met some people interested in progressing the issues of mental health concerned with younger people and the opportunity to use an interactive programme. Resources are not available to prioritise the exploration of new avenues for treating people but I am sure we will revisit that in future.

In February this year the CEO of the HSE, Professor Brendan Drumm, announced a €20 million investment in the modernisation of the south Tipperary hospital and the closure of St. Luke's, which is to be completed by 2010. What is the progress on the high-support residential units and the rehab programmes and has there been any progress on the crisis houses which will each provide six places? The project is to be completed quite soon. Will the Minister of State comment on the community nursing unit in Clonmel, which will accommodate adults retained after the old campus in St. Luke's closes?

What has been realised from the sale of significant amounts of lands in the ownership of St. Luke's Hospital in Clonmel? Currently, there is 100% bed occupancy in St. Michael's unit all of the time and frequently more than the usual amount of younger people are admitted to that unit. How will the Minister of State ensure that after 2010 those under 18 will not be admitted to such units? Where will they go? I do not mean to be critical of the plans, but I am aware that many young people who are very distressed cannot access services or even be seen by a psychologist, not to mind by a psychiatrist. There seems to be an issue with regard to access to services for younger people in my part of the country. Will the Minister of State comment on that? I thank him for his presentation.

It is very easy to be critical and cynical but somebody must take up the cudgels and do the task as needed. I welcome the Minister of State to this committee. We know from his previous role as Chairman of this committee how committed he can be and do not doubt he is committed to this cause. He has demonstrated that today through being so open in his presentation. He has illustrated on the one hand the difficulties facing him in the task before him, but on the other has shown he is willing to take on that task and deliver on it to the best of his ability.

In his presentation the Minister of State alluded to mental health issues that have their origin in early childhood. I believe that the majority of mental health issues arise because of parenting problems. Many such issues arise because of parent-child relationships and the lack of knowledge of proper parenting. I said previously in this committee, in the presence of the Minister of State with responsibility for children, Deputy Barry Andrews, that I would love to see the day when a programme would be developed nationally for parents and children. A programme operates currently in my county that provides supports to parents from the birth of their child to the age of six years. Parents start new families, but nobody is an expert in parenting. When the child arrives, parents get to know how to manage as they go along. Many parents struggle during the early years of bringing up their children and I believe many of the mental health issues that arise for young people are a result of those early years of poor parenting. Perhaps it is wrong to call it "poor parenting". What I refer to is the lack of knowledge on proper parenting. We could do much in that area to help resolve many mental health issues before they arise.

I would like to raise some of the issues we have in Donegal in the mental health area. The Minister of State alluded to some of the programmes that are being piloted there. I fear mental health services have been stepped down in Donegal in recent weeks and months, especially in the northern part of the county. Services have been reduced rather than promoted as expected from A Vision for Change. Much work was put in over recent decades into training and centres of excellence to try to move people out of care into communities. Many of the services that existed to do that are now being reduced at a rapid rate and this will undermine mental health services in Donegal. I know the Minister of State has committed some extra funding to this area, but I hope the Department will give serious attention to Donegal because of the concerns in this regard.

Cuirim fáilte roimh an Aire Stáit. Ní raibh mé ábalta a bheith anseo roimhe seo mar bhí orm freastal ar an Order of Business. Having looked at the Minister of State's plans, I believe he has a tremendous opportunity to make his mark in the area of mental health services. I recognise he has a plan for the closure of the old psychiatric hospitals over the next five years. If he achieves that, it will be a tremendous achievement.

I was one of those who passionately believed the Central Mental Hospital in Dundrum should not move to Thornton Hall and I am delighted that did not happen. I presume Dr. Harry Kennedy will be part of the discussions on the location of the new hospital. When members of this committee visited the hospital, he told us the new hospital could be built on the Dundrum site, which would be ideal because the hospital is so well grafted into the community in Dundrum. As mentioned previously, the people unfortunate enough to be patients in the hospital are accepted in the community and when in rehabilitation can go out and visit the village and the Dundrum shopping centre, which has been such a success. I am very pleased the hospital is not moving to Thornton Hall because I passionately believe mental illness should not be associated with crime.

I wish the Minister of State luck in the delivery of his programme. However, I must raise the issue of suicide. We have seen a dramatic drop in the number of people being killed in road accidents because of the work of the Road Safety Authority. It keeps a high profile and receives the funding it requires. The leadership of Gay Byrne, who said he would quit the job if the Government did not do what was necessary, is a tremendous asset and is part of its success. When I began my study on suicide, it was clear there was an epidemic. However, it has got worse and, because of the economic crisis, there is an increase in self harm.

Reference was made to an increase of 43% in suicide in the first three months of this year, but that may not be quite accurate because of the way the statistics are compiled. The National Suicide Research Foundation does not agree there is an increase of 43% in suicides. However, there is a definite increase in the number of people who self-harm. We need an authority with more force than the National Office for Suicide Prevention. We need an authority like the Road Safety Authority, one that in the public mind will be seen as being there to deal with all the issues and reasons people die from suicide. We must have an organisation that is driven and appropriately funded. The Minister of State should put his heart and soul into that. That is what is missing in this area.

The recession has led to a great increase in self harm because people are terrified of the financial situation in which they find themselves. We heard yesterday about the number of children who are depressed and affected because of the atmosphere at home. We need a much larger and well-funded organisation. I am aware that millions of euro are being put into the mental health area. In the case of the Road Safety Authority the number of deaths has been reduced because it is being driven and everybody is involved. I am tired talking about suicide and find it frustrating and the newspapers constantly refer to it but we need to take action as in the case of road deaths. I have no doubt the people involved are very good and are committed but a dedicated authority is needed to deal with stigma and the reasons people die by suicide.

There is also the attitude to alcohol. We do not know the effect of drinking at home which is a serious issue. We see people taking home cans of drink instead of going into the pubs. What on earth is that doing to their brains? I do not want to continue in this vein. I am not being negative. I wish the Minister of State well in this ministry about which he is very sincere. Given that he was chairman of this committee in the past he has first-hand experience of the problem. We have to get our act together on the whole issue of suicide.

I would have thought the Minister of State had already made his mark. I would like to be associated with the welcome extended to the Minister of State. I apologise that I had to watch his presentation from my office because of a crisis in my constituency which I think I have solved. It is important that we offer the Minister of State support at a time when everybody is paranoid about what will happen in three weeks' time. Everybody is getting upset about what is going to happen on 9 December. I am not saying I am not anxious either. Everybody has a view on Government funding and Government cuts and the adjustments that should take place. We would all say, among a number of remits, that health is very important. Even within the Department of Health and Children, the responsibilities of the Minister of State, Deputy John Moloney, in the area of disability and mental health are very important. I am concerned that it might not end up being the most important part of his brief. As one walks around the streets, people say all kinds of things about health, accident and emergency units, hospital appointments, etc. I am concerned to see Government support for disability and mental health continue.

Every time I drive past Tallaght Hospital, which is several times every day, I am reminded that great efforts were made by the Department and successive Ministers to provide a first-class facility for mental health victims there. As a member of the Eastern Health Board and the Eastern Regional Health Authority, I visited all the institutions in the region and saw the poor state of many of those facilities, despite the best efforts of staff in many cases. I have strong views about the Central Mental Hospital in Dundrum. I hope the Minister of State will give these matters special attention and continue to look after those facilities.

In his presentation the Minister of State referred to a number of people who have been very helpful to me in recent years. I am pleased that Mr. Martin Rogan is present. I do not wish to draw attention to him because my praise might get him into all kinds of trouble but he has always done a remarkable job and has been very open to us. I note also the appointment of Mr. Hugh Kane as chief executive officer of the Mental Health Commission and wish the outgoing chief executive officer, Ms Brid Clarke, well.

I hope the Minister of State will understand the continuing need for matters within his remit to receive special attention so far as Government funding is concerned. I am aware he has to fight a corner and I am happy to help him in that regard.

May I be parochial for a moment and mention one organisation, Teen-Line Ireland, which operates out of Tallaght. It provides services for young people at risk. Deputy Dan Neville and I are among the patrons of that organisation. I support what he and Senator White have said on this issue. I know Senator Prendergast also understands that suicide is still a major issue. Despite our best efforts people in all our communities take their life and self harm. I hope the Minister of State will continue to give this matter special attention because it requires it. Senator White made the point as she often does that if this was something else, we would all run around and try to do something about it. Suicide is much more difficult. We all deal with it fairly regularly in our communities. We know the difficulties that families experience. It is important that we continue to support initiatives in this area.

There was a reference to alcohol. While I do not wish to cross the remits of different Ministers I am glad the drugs task forces, including the drugs task force in Tallaght, have been told by the Minister of State, Deputy Curran, that alcohol abuse needs to be tackled. I welcome that move. I am not a prude about alcohol but it causes much harm and, as the previous speaker said, crops up in all reports about self harm. I am glad we have availed of the opportunity to have the Minister of State appear before the committee. I note he has offered to return to the committee in January when I look forward to welcoming him again for a more extensive debate on the disabilities sides of his remit which is just as important.

Some 11 members have contributed to the debate. The length and sincerity of the contributions indicate very clearly the high level of priority that the committee gives to the mental health agenda and to the implementation of A Vision for Change. I wish to join in the chorus of people who have congratulated the Minister of State on the work he has done to date. It is clear that members on all sides would agree from speaking with him privately and from his contribution today he is sincere and has a genuine human feel for the issues that surround the mental health agenda. We wish him well. I compliment him on his work in dispelling the stigma that surrounds mental health. I was struck by his travelling around the country visiting hospitals and centres and recruiting media personalities and respected public figures to support him in that work. The work he is doing is almost ambassadorial rather than ministerial.

I join with those who have welcomed the appointment of Mr. Martin Rogan. As a committee we have seen the very considerable success in cancer services achieved by having somebody of the calibre of Professor Tom Keane lead the campaign for change in that area. The task facing Mr. Martin Rogan is equally challenging. I do not want him to be lulled into a false sense of security by the warmth of the welcome he has got here today because I suspect when he comes back in the future he may be severely challenged. He has a major task to undertake and we wish him well.

I would like the opportunity to respond for as long as possible given that at least 30 to 40 questions have been posed. If it takes too long I invite the Chairman to call me to order.

Very specific points have been made by Deputy Neville. I recognise in a genuine sense his huge involvement in this area and that of Senator White in her area. I will take up four of the most dominant themes of the past two hours. I can understand that many people have great difficulty in accepting commitments by way of the sale of properties. For too long there has been so much talk of that hackneyed cliché "ring fencing". I have already stated that I wish to return to the committee in January which is one month after the budget. If I am unable to obtain the support for a copper-fastened and unambiguous five-year capital programme I would not see the sense in pretending we have a mental health reform programme called A Vision for Change.

There are 800 mental health properties in the country. I acknowledge those who are never recognised for their work. I refer to people such as Dora Hennessy and Bairbre Nic Aongusa, Brian Gilroy, Pamela Carter and others who have been available for many Ministers for Health and Children over the years. They are a little fed up hearing about commitments and the hopes for a Vision for Change. Every member of this committee is as interested in mental health reform as I am, and the only difference being that I have the opportunity to drive it forward. I wish to be quite definite because the last time I made this statement it was contradicted in the media. To be real and honest with the people who expect us to reform mental health, a five-year capital programme has to be put in place. Anything less means we are not sufficiently committed.

I understand there is cynicism and scepticism being expressed. I am the one who suggested a public reappraisal next January or February of A Vision for Change. If I had any doubts about the ability to deliver those commitments I would not be out there saying this. A timeframe for the public appraisal will be over the six remaining years and it will be price-tagged. It is not good enough to say we will sell off the properties over the next six years. My intention is to suggest that properties will be put on the market every year of the six years. To use that hackneyed phrase, there will be a money trail from the sale of the properties and tied directly back into the recommendations in A Vision for Change. I do not think I can make the point more forcefully than that. If I am unable to deliver then it is clear I am unable to deliver on the reform programme.

I have never believed that a director should be in place just to be a mudguard for the Minister. I have always believed that the person in authority should be able to draw together all the forces for good in mental health reform. I am glad that person is in place and that person is Mr. Martin Rogan. He will have his say at this committee some day and he will have to account for his work with the 14 regional directors. His responsibility is significant. Commentators will come and go but the director is there to work with the 14 regional directors and over a period of the next six years to set out how A Vision for Change can be implemented. This means putting hard questions to the 14 directors about the funding stream and the outputs. If the outputs happen to be less than desirable we hope this will come to the fore.

Once the sale of properties is clarified and assets are ring-fenced, the implementation of the next stage of mental health reform will be down to the director and his 14 regional directors. Another point may have been overlooked in the negotiations for the position of director. I went hell for leather on those negotiations because I believed it was vital to have a director in place. The director should not need to report back to the Minister as Ministers come and go. The director should report to the body charged with the implementation of A Vision for Change. This is the second tier of the reform programme.

I will deal with specific details later but I wish to give an initial overview. If every euro raised in the budget was directed towards mental health services unless the issue of stigma is dealt with we are going nowhere. Dr. James Reilly said that many people with mental health issues do not even realise they have such problems. That comment made an impression on me. The people I have been working with in recent months are well known in each county and are happy to speak publicly. They are from the world of politics and it may be surprising to hear them say that they have experience of mental illness. I have seen the reform taking place in the mental health services including the move away from the old psychiatric hospital model to that of the acute model. My father was an alcoholic in the 1960s but thankfully he was dry for 20 years before his untimely death at 58 years of age. He was not a man to say much about things but health board members will confirm his great interest in trying to secure facilities in acute or general hospitals for the treatment of alcoholism. That day has come. I recognise the involvement of Deputy Brendan Howlin as Minister in those years. I remember he came to Portlaoise years ago to talk at a meeting in the old mental hospital about reform of mental health services. I was a county councillor and a member of the health board. He talked about the possibility of a new acute psychiatric unit in Portlaoise and this has now happened.

I have travelled around the country. I was in County Sligo recently and I met nurses who are now for the first time prescribing medications for those who are ill. I visited County Cavan where I met Vincent Russell, a psychiatrist. County Monaghan was the first psychiatric service in the State to have a community service beginning in 1973. My local hospital in Portlaoise is headed up by P. J. Lawlor. I do not say this as a means of securing Mr. Lawlor's vote but rather to make the point that we have an excellent modern acute psychiatric service. The reform programme must take account of this. We must be definite and specific and stop this pretence of being interested in mental health. When it is raised as an issue we respond but we never take the initiative to drive it forward. I have visited all the psychiatric hospitals. I am not a professional in this area but I was an undertaker by profession before I came a politician and I have been in many such hospitals. As a result I know the conditions in which people live. The ambition of any Minister of State with this responsibility should be to ensure that policies and funding are in place.

Deputy Reilly made the point about good intentions. The way to achieve the destigmatisation of mental health is to ensure that people are no longer living in mental hospitals. This is my first commitment in this regard. There is an average of 100 patients in each of the main psychiatric hospitals. I thought naively that about ten or 15 people of those patients could live in the community. I met excellent people such as doctors in Tallaght one of whom suggested that about 80 or 90 patients could live in the community. This is the reason I invited in the Irish council for social housing. This is not the road of good intentions but rather specific policy proposals I have put before the council for social housing. I will give the council the list of properties coming to market and in return the council will announce how it will cater for the people who are in psychiatric hospitals. I am not foolish enough to think it is as simple as giving a person the key to a front door and wishing them the best of luck. There must be a clear commitment that HSE protocols and supports will be structured to ensure that the people will be able to look after themselves with the support of the HSE.

It is very important to nail down how the capital programme will be progressed, how it will build the acute psychiatric units and the intensive care rehabilitation units. It is crucial that when we come to give that commitment in January or February we announce where these will be located.

I will deal with the issue of suicide as more than 40 questions were asked. I fully accept the points made by Deputy Dan Neville and Senator Mary White. Deputy Neville is a person with a track record and he gave a presentation in Limerick recently. He must be frustrated that things are not happening as fast as we would like. I recognise the huge suicide numbers and it is clearly important to dismantle the stigma attaching to suicide. In my home area there have been seven recent deaths by suicide. At one funeral the priest said people should be aware of the support which is available but people are reluctant to seek that support. In that context, I congratulate the HSE on the fact that, of the 200 primary care centres, 100 will have community mental health teams. That is the beginning of the process.

I accept that Senator Mary White is frustrated but it is not easy to put together a programme that will make a drastic cut in suicide numbers. The problem needs to be addressed at county level and people from the services, as well as those who have used the services, need to go on to local radio programmes to discuss the issues. I particularly thank Mr. John Treacy and Mr. Ossie Kilkenny, who have committed themselves to getting people from the sports world to talk about how they recovered. It is also important for business people to get involved. I know of many politicians who had reason to use the mental health services and who have been well able to come back into this House or on to local councils to continue where they left off.

I acknowledge the commitment of Senator Fitzgerald and Deputy Chris Andrews. I was impressed by the contribution of Mr. Bondevik and particularly noted that he was back at work within 12 weeks of a depressive incident. That is a huge message for us to get out to people. I was in the Mater Hospital two years ago and that led to a certain level of stress. I was advised to attend services and I have no difficulty in saying, as a Minister of State, that I did so on four occasions before coming back to work the same person as I was before the problem.

It is up to us to get the message across that there are supports to help people recover. The main building block of A Vision for Change is the recovery model. I thank Senator Fitzgerald and Deputy Chris Andrews for bringing to my attention the nonsensical fact that we in this House have allowed section 51 of the Local Government Act, which prevents people of unsound mind from sitting in this House, to lie on the statute book. On reading their report I wrote to the Minister for the Environment, Heritage and Local Government, Deputy Gormley, to have it removed. The fact that a person can have a stroke and return to the House after 15 years, but cannot do so if he or she is of unsound mind, is contradictory.

We can resolve certain problems. It is important to get out into the community, not with a Barack Obama-style campaign but in town halls. Politicians are accused of doing nothing about suicide but when we get involved we are accused of promoting our own profiles. I will soon announce funding for a national programme headed up by Shine, among others. I thank all the groups who came to see me, such as the Smashing Times theatre company who have been to schools to tell young people why mental health support exists and about the professional advice that is available. I met the Samaritans some time ago and was struck by the work they were doing. It is very important that we fund people on the front line of mental health so I gave them a commitment on funding and asked them and other organisations how I could help in that regard.

Deputy Neville made several points. I do not want to throw figures back at him and I want to arrange a meeting with this committee to have a full debate on the specific issues without being interrupted by Dáil business. I do not want to say €1 million was spent on mental health in 2007 and 2008 or that 95% of mental health supports occur at primary care level. I do not believe for a second that the recommended cuts in the McCarthy report could be sustained in the area of mental health because the financial support for mental health in the overall health budget has already declined over the years. The commitments for mental health reform in A Vision for Change could not be implemented if funding was reduced.

I will not go into commitments made by previous Ministers and will only account for myself. We have given commitment to 100 places in child and adolescent facilities and, though the figure is not high enough, we have achieved 50 places so far. I am not party to any decision to take from previous commitments over services on the west coast, particularly in Limerick. It is not a very specific response to Deputy O'Sullivan but I have already outlined the programme for child and adolescent services so I ask her to bear with me until I return in January with specific details on how I intend to fund the remaining places, which are the subject of commitments in A Vision for Change. Places were envisaged for Limerick and Tallaght and others in Galway but the turning of a sod happens only rarely so I do not want to exaggerate the position.

We have dealt with dementia and intellectual disability and have visited services throughout the country. Dealing with inappropriate placing is the first priority of the 14 directors.

Deputy Kathleen Lynch mentioned the Indecon report and Amnesty International has called for a realistic reappraisal of funding. However, I am sticking with the commitment in A Vision for Change because to dismantle it and create a new reform programme would be reverse steps. The 800 properties in question have been valued and we will accept current market value but we should be able to respond positively to the challenges in the policy.

Deputy James Reilly said in the Dáil that the decision on the Central Mental Hospital was the quickest U-turn he ever saw. I went to meet Professor Kennedy within a month of my appointment. I strongly support Government policy and I support my party when it is in Government. The Government's commitment was to relocate the Central Mental Hospital to Thornton Hall. The Minister for Health and Children said she would support me in whatever I thought was appropriate for this issue. I made it clear to Professor Kennedy that the hospital would not be in Dundrum and I do not intend to change my mind on that. I did not want to change Government policy on the hoof so I made it clear to Professor Kennedy and his colleagues that he would not wake up one morning to learn that JCBs were digging on the Thornton Hall site. I asked him to give me some space until I could get back to him. I discussed the matter with the Minister and we decided we would not relocate the hospital in Thornton Hall.

I cannot tell members of the committee where it will be yet but I will do so in January. I am looking at three separate locations. In answer to Senator White's question, they are not at a remove from population centres but are consistent with notions of the therapeutic value of living in a community.

I was pleased to be invited to my first Cabinet meeting some time ago to discuss the issue. Deputy Reilly said my priorities had changed. I said some time ago that my first priority was a central mental hospital and my second was ring fencing. If I could, I would have said that my two priorities were the central mental hospital and the capital programme. As with any capital programme, funding for a central mental hospital has to be secured by way of bridging finance.

I did not say "priority" but "certainty".

I am sorry. The Deputy is right to look for clarity. For the benefit of the people who attended the meetings in Dundrum, the value of the Central Mental Hospital site, recession or no, is quite substantial. I put a proposal to Cabinet for bridging finance to build a new central mental hospital and to release the funding from the sale of the site at Dundrum to invest in mental health services. Everything has progressed in respect of the new hospital except that we have not yet lined up a specific site. That state of affairs cannot continue and I will come back in January to tell the committee where it will be located and how it will be funded. It is important to be clear on how it will be funded and I do not blame anyone for being cynical when they hear about ring fencing and set-aside funding and so on. Unless I can provide a five-year capital programme, beginning in January, there will be no point in pretending we have a reform programme known as A Vision for Change. I would see no point in being Minister of State with the mental health brief if I did not have a clear process with no ambiguity about how it was to be funded, because that would mean there was no such thing as A Vision for Change. That would be regrettable because I regularly meet young nurses who have trained abroad and come back looking forward to a modern mental health system. They depend on us to give clear signals so there has to be a public appraisal of A Vision for Change. I have targeted the January-February period and have asked the Minister to provide a location so that people who have made a contribution can see whether there has been progress.

As Deputy Conlon suggested, we intend to meet Dáil na nÓg. People often think mental health issues belong to an older generation but Dáil na nÓg picks an issue it wants to develop each year and last year it picked mental health. It has picked it again this year and that proves there is a huge need for the issue to be tackled. Young people had very little opportunity to have an input into A Vision for Change so this will provide that opportunity.

It is important that whoever is in this job should outline each January the programme for the year. Deputy Jan O'Sullivan asked a question about Dundrum, which I have answered. She also asked about Limerick and I will come back to her with details of how we intend to provide child and adolescent services there.

I acknowledge that the mental health teams are not complete. Deputy Kathleen Lynch asked why we should go forward with half teams. I believe in working with the nursing unions, such as the PNA, and SIPTU. I agreed with them long ago that if I could appoint a director and put in place a capital programme they would move from the institutional to the community model and I thank them for that. Nevertheless, I have to admit that we have not fully compiled the mental health teams. If we are to deal with mental health issues in a community model the full composition of those teams will be essential. I will deal with it and come back to the community to give specific details.

Child and adolescent services have been raised by several members and we have provided 50 of the 100 in total. I would never say that the director should take all the flak but the job of the director and his regional team will be to come forward with proposals for the remaining 50. It will then be up to me to come back with a commitment on funding. I am not trying to put this on the back burner but the director has been in place for less than a month. The budget is due in three weeks' time and I will be back before the committee in January or mid-February to tell members about the composition of mental health teams and the relevant capital programmes.

Deputy Kathleen Lynch asked about the admittance or otherwise of people who present for mental health support. There is ample evidence of people who presented in a suicidal state but, regrettably, were not offered support. In that context it is important to put together a system for identifying people who self harm. Somebody must take responsibility for these matters in each of the accident and emergency units and in the psychiatric units in each area.

Senator Prendergast asked me about Clonmel. I have been in Clonmel twice recently and am aware that there have been difficulties. My priority is to secure the €42.5 million received for land at St. Loman's and I believe properties that have been sold since A Vision for Change came into being are my responsibility, though I will not be able to get money related to sales prior to A Vision for Change. The priority in the first €50 million spend will be the modernisation and upgrading of facilities at Clonmel.

Members have expressed huge concern about the 2011 target for child services. My colleagues have tried to bring the date forward but I am not in a position to do so. Deputy Blaney asked about step-down facilities and the leasing of mental health properties. I agree that it is an absolute waste of money so if we can secure appropriate homes for people in psychiatric hospitals, such as St. Fintan's in Portlaoise, and modernise the facilities it would dispense with the need to spend money on leases. All child and adolescent services are in Portlaoise and its former wards now make up the administrative block. I have asked Mr. Brian Gilroy to prioritise this process within the five-year programme.

If one is to have an open and frank discussion, there is not much point in rattling off figures. I ask the Chairman to arrange a further meeting in January. I will ask Mr. Brian Gilroy to accompany me to provide details of the various properties and their values. I did not come before the joint committee with a view to trying to get out the door again in one piece. I want to show that we are trying to drive forward the reform programme as quickly as possible.

A number of pertinent questions were asked on the issue of funding. A representative of the Irish Farmers Association used the words "By your deeds we will know you" at a meeting I attended last night. These words are equally valid in this case. We cannot have a reform programme if we start cutting back expenditure.

Deputy Neville referred to the cut in last year's budget for suicide prevention. I fully acknowledge that not enough is being done. Senator Mary White noted that Gay Byrne chairs the Road Safety Authority. We have, in Mr. Martin Rogan, our own Gay Byrne and I do not say that glibly. The Road Safety Authority correctly takes a different approach from the Health Service Executive. The former has people on the ground trying to prevent the loss of life. It is not as easy to achieve that objective in the area of mental health. Senator White is shaking her head. I am not trying to conceal anything.

Many more people die from suicide than from road accidents but the issue does not appear on the radar.

I listened to the Senator without interruption.

I am not personalising the issue.

Nor am I. I am not an expert in the field and, as such, I cannot make pronouncements on this issue. We are all affected in some way by suicide, whether in our families or in another way. I understand every suicide directly affects 50 people. I am not a professional person but as the owner of a small funeral business, I have seen at first hand over the years the difficulties caused by suicide. It is one of the greatest challenges facing all those involved in politics. The greatest challenge in my job is to try to ensure we produce proposals that will address this challenge.

I am often surprised by the argument that one cannot prevent someone from committing suicide. I do not share that view. The essential building block is to remove the stigma attached to those who present with mental health problems.

I do not propose to speak for much longer as people will become fed up. I thank members for the opportunity to discuss this matter, on which I hope to provide greater detail at a subsequent meeting.

The Minister of State has made a comprehensive, forthright contribution to the meeting and I thank him for addressing the wide range of questions put to him. The joint committee will consider his proposal to have a further meeting in January or February when he will be in a position to provide greater detail.

I propose to bring with me officials who have a brief in the area in question and will be able to discuss the detail of the capital programmes, from where the money comes, how the programmes stack up and our approach to child and adolescent services. I am not seeking to have them provide cover for me.

The Minister of State should bear in mind that people in Dublin North have been waiting since 1984 for a new psychiatric unit in Beaumont Hospital.

The joint committee extends an open invitation to the Minister of State to attend a further meeting accompanied with anyone he believes will be able to make a case.

The joint committee adjourned at 5.35 p.m. sine die.