Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Wednesday, 10 Nov 2010

Vol. 205 No. 10

Effects of Recession on Mental Health: Statements

I thank Members for the invitation to the House to discuss the effects the recession is having on the population in terms of mental health. I propose to deal with this under three headings. One is the capital programme, and I am anxious to confirm that funding is still available for the mental health sector and, more importantly, that the Government programme, A Vision for Change, is alive and well. It is a ten-year programme and we are only four years into it. There is every possibility it will be delivered within the timeframe of the remaining six years.

The overriding demand on the Department is to deal with the issue of the stigma surrounding mental health. I will commence by discussing what has been achieved while also acknowledging what remains to be done. I will be direct and to the point and if Members have doubts about the issues I mention, they are free to question me. The first issue is what we are doing to help the population to understand the difficulty surrounding mental health and the problems that result from the stigma attached to it. In that context, two years ago I decided that the most important thing the Department could do is travel throughout the country and try to deal with the issue of the stigma and, more importantly, encourage as many groups as possible to become involved in this national campaign.

I have always been of the view that if we could encourage people to look after their mental health in the same way as they look after their physical health, it would be a determining factor in dealing with mental health issues before they became difficult and required institutional or community care. The See Change initiative is taking place in that context. So far, we have visited ten county towns and our intention is to travel to all the county towns before the end of March. The objective of the See Change campaign is to reduce the level of discrimination and prejudice. When we travel to the county towns, we bring with us professionals from the area and service users. We open the debate to the floor after the presentations.

We have visited Ennis, Donegal, Dún Laoghaire, Dublin and Tipperary. Next week we are due to visit Mayo, Sligo and Wexford. The important aspect of all the presentations has been the response from the floor. Sadly, many people are reluctant to present and often they speak on behalf of their loved ones or friends. They consistently point to the fear factor involved in presenting for mental health support. That is the result of fear of discrimination in the workplace and — a phenomenon we should deal with as quickly as possible — the fear people suffer when they make an application for a mortgage, personal loan or a job. Often there is a question on the application asking the person if they have ever suffered a mental health disability or issue. People feel discriminated against because if they answer "Yes" to such a question, it will have a negative effect on the application.

These issues are the challenge for us. Even where people apply for local authority housing, there is a huge fear factor. The See Change campaign seeks to deal with that issue which affects many people. It is also trying to educate the authorities, local and central as well as in banking and the private sector, that a mental health issue should be considered in the same way as a physical health issue. I believe we are getting that message across, albeit slowly.

The other aspect of the See Change campaign is to convince people to look after their mental health. It was never more important than in the context of the next budget. The budget for the Department of Health and Children will be reduced by approximately €1 billion, which will pose a serious challenge in ensuring we hold on to the funding we have for mental health and ensuring we use it better and wisely. I am convinced, having met many groups over the past two years, that the priority must be early intervention. Many people have advised me over recent months that 70% of mental health issues begin in childhood and adolescence. It is obvious, therefore, that this is where the funding should be prioritised and I intend to drive that programme forward.

It is also important to discuss the issue of suicide and its prevention. Many groups are making great efforts to impact locally through community organisations and individuals to bring assistance to people. Again, I must examine the budget in the context of ensuring that whatever is provided to the National Office for Suicide Prevention will be targeted at groups that are most vulnerable. That will be the new thinking as we approach this budget.

I do not intend to waste time talking about capital programmes because this discussion is about the effect of the recession on mental health and what the Government should do. It is important because there is so much negative comment to the effect that little happens in the mental health area. That partisan comment does not concern or worry me in the least. What does concern me is that the notion is abroad that because we are in a recession funding is reduced and nothing is happening to drive A Vision for Change forward, but nothing could be further from the truth. I continue to affirm at all times that the level of funding for mental health services should be increased. We have made this case in the past year and will I hope receive the appropriate response. I am not trying to fly the flag for the Department or the Government, but I do recognise that this is consistent with what was promised in A Vision for Change.

Let me give a flavour of what is happening. Under this year's capital programme, there have been significant achievements. For the first time since 1815, there will be no new referrals to Grangegorman and the service at Blanchardstown hospital is now up and running. I have often been asked about what is happening at Portrane. The development of the acute psychiatric unit promised at Beaumont Hospital will commence in February 2011. There have been questions as to whether funding has been committed; I confirm that it is guaranteed. I acknowledge there has been a delay in commencing the project due to the fact that the original site had to be changed to allow for the co-located hospital programme.

I am trying to follow up on the annual report of the Mental Health Commission inspectors on the condition of mental hospitals. In the case of St. Loman's Hospital, Mullingar, I am pleased to say that, as part of the A Vision for Change programme, we visited Mullingar to turn the sod for the new 100-bed unit that will replace the wards referred to so often in the inspectors' report. I expect the new facility to open early in the new year. The inspectors' report also referred to the acute psychiatric services in Letterkenny and called for the closure of the hospital there. That has now happened and construction of the new psychiatric unit is well under way. I visited the site unofficially during the past fortnight in order that I would have some idea of progress and was pleased to see the building was almost three quarters completed.

We have made progress on a child and adolescent day hospital in Cherry Orchard in Dublin and on hostels in Wexford and Tipperary. Deputy Neville, Senator Fitzgerald and many other members of the Joint Committee on Health and Children have often reminded me of the importance of insisting on separate child and adolescent facilities. Yesterday I met Deputy Neville and the Irish Association of Suicidology and once again they impressed on me the need to ensure that whatever we did, we needed to prioritise the provision of child and adolescent supports. We must not just concentrate on the provision of beds but also on the provision of support through mental health teams. A Vision for Change commits us to providing 100 beds by the end of the programme in approximately four years time. We have reached a figure of 55 child and adolescent beds, an important achievement which illustrates that progress has not been parked owing to the recession. A 20-bed child and adolescent unit in Cork which has been commissioned is expected to be up and running by early next year. Day hospitals in Ballyfermot and Inchicore are also in operation, while nursing units are in operation in Senator Prendargast's area, in Clonmel.

All of these works demonstrate how the capital programme for last year has been applied. We must now work out the programme for next year. Much of what will be achieved will be funded by selling assets to the tune of €50 million and reinvesting the funds. We did not realise a full €50 million last year and the spend was in excess of that figure. The extra funding came by way of a transfer from the capital budget of the HSE.

I have dealt with the programme See Change and what it can achieve. It is delivering by involving many groups and encouraging them to embrace and deal with the issue of mental well-being. Some 55 groups are involved. Our next strategy must be to work in primary and secondary schools to involve students and help them to realise the importance of the delivery of services in the community to help change attitudes and help recovery.

I am pleased to be here to discuss the issues raised, in particular the fears about the current economic situation and the impact it is having on people's work and lives. Undoubtedly, it tests the coping skills and emotional resilience of individuals, families and communities. The impact of unemployment and personal financial difficulties on physical and mental health is well documented. Following job loss, people report higher levels of anxiety, stress, depression, anger and loss of personal control and self-esteem. It may also be difficult, at times, to maintain contact with friends and colleagues. There is a strong relationship between unemployment, the economy and increased mental health problems and suicide risk. Of course, there are also people who are in employment and financially secure who may also be in need of support and services. Last year there was a worrying increase of 24% in the number of deaths by suicide on the figure for 2008. This increase is a source of concern for me and the Government. We must redouble our efforts to reduce the incidence of suicide and make every effort to reach out to people in despair.

Yesterday I visited Pieta House in Lucan where I saw at first hand how this group, like many others, worked in a non-hospital setting to provide for early intervention. I was impressed to hear Pieta House had dealt with 1,200 people in the short time it had been open. I am convinced that when sitting down to decide how much of the budget should be devoted to suicide prevention measures, I must take account of the number of groups working in this area. I do not wish to offend any group, but we must take into account whether it would be more sensible to support many small groups or to target the funds available. In the next few weeks I hope to bring clarity to the issue. I was very impressed by what I had seen in Pieta House and by the fact that people were being referred to it from Tallaght hospital, by people such as Dr. Ian Daly and from Beaumont Hospital. This is the way forward. Advice from various professionals, Members, the Joint Committee on Health and Children and service users has helped me to realise that we must bring all the groups involved in suicide prevention together in order that we can target investment to achieve a better outcome.

I am not here only to say the Government has put money aside for this or that. Everyone has a role to play in ensuring the appropriate funds are put aside for mental health services. The Government has provided additional funding of almost €1 million this year from the dormant accounts fund for a programme of suicide prevention measures to help communities to develop integrated local action plans aimed at suicide prevention. I say this to stress that, even though we are in a recession, it is not true that we will park investment, A Vision for Change or the plan to place mental health issues at the top of the health agenda.

The special needs service of the mental health service has also been recognised in the context of the 2010 employment control framework for the health service which provides for an exemption from the moratorium in respect of 100 psychiatric nursing posts. I am aware that some will be surprised at this, given that the moratorium has presented a difficulty in rolling out A Vision for Change.

We were able to secure 40 nurses in the context of the employment control programme. Although it was long overdue, last week the Knockamann development with ten-unit bungalows was opened to replace the Portrane facility and nursing staff have been secured for it by way of an exemption from the recruitment moratorium.

Regarding new ways of thinking in mental health services, I am very much taken by the success of the innovation funding secured last year for disability and mental health services. The fund was established to help support the transition from institutional to person-centred models of care. From it, 50 disability and mental health projects were awarded grants totalling €3.6 million, 15 of which were mental health projects which received funding of €1.4 million.

I recently met Ms Madeleine Clarke and her colleagues from the Genio Trust and believe its approach is the way forward. I also believe it can be supported financially next year. I met some of the service users who had benefited from the Genio Trust. It must be continued, particularly as we try to bring forward new proposals this year as to how we will fund directly mental health service users and those with disabilities.

The Health Service Executive's National Office for Suicide Prevention is supporting organisations which are concerned about the impact the economic downturn may be having on the mental health of the population and providing services for those in need of support. The aim is to inform the general public and organisations on mental health issues related to unemployment and financial difficulties. The office is also supporting the delivery of mental health promotion programmes targeted at unemployed persons.

In the next few weeks the Government will consider the 2011 Estimates for the health service in the context of the strategy for economic recovery and the target to reduce the general government deficit to 3% of GDP by 2014. Our current financial difficulties do not in any way dilute the Government's commitment to mental health services. The challenge we face is whether we should park A Vision for Change until the recession passes or embrace change by involving the Genio Trust, the Health Service Executive, community mental health teams and others. We should always maintain the commitment to A Vision for Change and outline each year what can be delivered under the programme.

Strategies to reduce the impact of the financial crisis should be viewed as an opportunity to improve the way mental health services are financed and delivered. I am confident this can be achieved and that staff at all levels will collaborate and work together to deliver services in a more flexible way. Given the substantial resources already invested in mental health services, the reconfiguring and remodelling of resources will be the main focus for the immediate future. Collaboration is a fundamental principle in A Vision for Change. Solutions to meeting people's mental health needs require effective partnerships where managers, professionals, service users and carers work together in forging relationships, utilising resources and involving service users as legitimate collaborators in their own recovery.

The Health Service Executive must work with limited financial resources. As the health sector accounts for over 27% of public expenditure, the appropriate management of the public finances means the Health Service Executive must operate within the approved budget set out at the start of the year. Under the Health Act 2004, the executive is required to prepare an annual national service plan which must indicate the type and volume of health and personal social services to be provided by it. The plan must be approved by the Minister for Health and Children.

There will be no increase in funding for mental health services and the disability sector. After meetings with the various organisations and Mr. Geoff Day of the National Office for Suicide Prevention, the challenge will be to see how we can better utilise the suicide prevention fund, to which I hope new thinking can be brought. Yesterday I met Deputy Neville and the Irish Association of Suicidology and have invited them to explain their proposals to achieve better results in two weeks.

Progress can be reported in implementation of the Reach Out programme. In recent years the National Office for Suicide Prevention has launched two awareness campaigns with the aim of improving the awareness and understanding of mental health and well-being. The Letsomeoneknow campaign is aimed at young people and was informed by consultations with young people arranged under the auspices of the Office of the Minister for Children and Youth Affairs. In addition, the National Office for Suicide Prevention has produced an information leaflet entitled, Looking After Your Mental Health During Tough Economic Times, which outlines information on the impact unemployment and financial difficulties can have on mental health and well-being and how we can look after our own mental health. An information booklet entitled, Suicide Prevention in the Workplace, provides organisations and workplaces with practical guidance on how staff can respond to and support persons at risk of suicidal behaviour.

To date, some 18,000 people have been trained in the internationally recognised ASIST, applied suicide intervention skills training, programme. In addition, over 3,300 participants have completed the SafeTalk training programme which prepares participants to identify persons with thoughts of suicide and connect them with support services. I am conscious that last year saw the most suicides reported to date and we must ask ourselves if what we are doing is sufficient. Should we be supporting community health groups more or should we be more proactive in encouraging communities to look after themselves?

In these straitened times it is important that we watch out for each other and be mindful of the mental health of those around us. As a society, we need to be able to reach out to others in need and be prepared to offer a shoulder because often that is all that is required to give someone a lift. People are reluctant to acknowledge their mental health difficulties for fear of being stigmatised. Stigma is, undoubtedly, the most damaging factor in the life of anyone with a mental health problem. Recently Senator Fitzgerald and I attended the Suicide or Survive annual conference. In listening to those who have attempted to commit suicide speak about their personal recovery a message is sent that if the required support was available, people would recover. It is important for people to talk publicly and to point to the groups across the country which can give the required support. In the past two years the groups and individuals I have met all say the Department's message should be that early intervention makes recovery not just possible but also a reality.

Many groups also tell us that they need to have fully staffed community mental health teams. I accept they are not often staffed to the level we would wish. Getting these teams in place is important if we want to move from institutional to person-centred care.

People are reluctant to acknowledge their mental health difficulties for fear of being stigmatised. We are however dealing with such issues on a weekly basis throughout the country. The combined efforts of everyone on the See Change campaign, including the HSE, the media and local organisations, work to great effect.

People often say that talking to and encouraging such groups can have a snowball effect. I was recently invited to the launch of the annual report of the Irish Veterinary Association. The IVA's officials have taken it upon themselves to do their bit to make more people aware of mental health issues. Their efforts will impact on their members and customers in the farming community. If, in their opinion, somebody is unwell, the appropriate authorities can be notified in such cases. I spoke about this matter on that occasion and it was reported in the IVA's magazine two weeks later. Some weeks after that, I was contacted by a local vet in my constituency who pointed out a family that was in difficulties. He suspected that a suicide attempt could recur in that family, and his telephone call helped to involve the local agencies.

That is the message we are trying to get out — that regardless of what walk of life one comes from or what profession, people's lives can be impacted by these matters. It is important for us to try to deal with that situation. In an effort to highlight this issue I launched See Change, the national mental health stigma reduction partnership, earlier this year, to reduce stigma and challenge the discrimination associated with mental health problems. Our vision is to achieve a change in Irish social attitudes and behaviour and to reduce the level of discrimination and prejudice. To help make that vision a reality and to change attitudes positively, a range of national and local activities are being developed, aimed at giving focused messages to the general public and target groups.

I recognise the need to develop mental health services, which are well integrated in society. They put the individual at the centre and operate in a way which avoids prejudice and exclusion. I am pleased to say that the task is now in hand and I wish to thank my departmental officials for their work in that regard. Many others were also involved who came out to be a part of the presentation on the night. There are too many to mention individually, but I acknowledge their efforts. When we visit a location to promote the See Change partnership, it is pleasing to see the number of professionals and service users who offer their services voluntarily at such public meetings. I am sure Senators share my view in that respect.

I welcome this debate and I know Senators have the same concerns as everyone to ensure the best level of service is provided. The media are always quick to comment when I do not do something, but when we do something it does not seem to be an issue. I am not interested in that aspect, except to say that when something is achieved in this area the media should try to show the positive aspects, rather than the negative ones. That should be done not just for the sake of political gloss, because that will be seen through quite clearly, but for the sake of those with family members who may be affected by mental illness. We should not create the impression that we are in lock-down and that nothing is happening.

I have spoken about this year's capital programme and I will announce next year's capital programme in January. Early in 2011, I also hope to provide a progress report on the numbers of affiliated groups which are now attached to the See Change campaign. I will return to the House early in the new year to discuss how we intend to involve schools and organisations in the campaign. At that stage, we can also discuss how the suicide prevention budget will be allocated. I am pinning my hopes on the fact that reconfigured funding will focus attention on the urgency of providing early intervention.

I am impressed by the work of Head Strong and Jigsaw, and I am aware that other groups do such work throughout the country. I have seen what is happening in Galway and Ballymun in this regard. I have been invited to Navan where I will shortly launch the programme. We have had talks with philanthropic organisations which are taken by the notion that, if we can provide funding for early intervention through the See Change programme, it can be developed further. I hope to be able to say something more specific about that when I next return to the House.

I welcome the Minister of State. I also welcome his commitment to this area, as well as the work programme he has outlined. This is a time of change concerning the mental health sector, both for politicians and the public at large. That can be seen from the fact that See Change meetings around the country have, for the most part, attracted very good numbers. There is clearly a widespread interest in the campaign. I welcome the changes the Minister of State has outlined in moving some institutional care to care in the community.

Despite this being a time of change for mental health matters, it is also a time of crisis for such services. I agree with the Minister of State that we do not want to deter anyone from availing of existing services; we want to encourage people to use them. They should seek early intervention from their GPs and specialist centres. This is particularly the case with children, but it also applies to adults. Prevention of mental illness is extremely important, so the earlier people seek help the less serious the consequences of their mental health difficulties will be. Every family is affected by mental health issues, which affect one in four people. As the Minister of State said, it is time to draw back the curtain fully and to ensure that people do not feel stigmatised. This is a time of change in that regard, which we must all welcome.

All these positive aspects, however, could easily be put aside by funding cutbacks. The Minister of State and his officials know this better than most. The front page of yesterday's Irish Medical News stated that “providing services with no funding is reckless and unsustainable”. That quote comes from the head of mental health services with the HSE, who expressed serious concern about the ability of service providers to continue to provide safe levels of care in a climate of diminished resources.

I do not underestimate the Minister of State's personal efforts and the changes he has outlined, which I accept. However, this is a time of crisis for mental health services, and I want to outline why I think that is so. It is obviously linked to our overall economic situation and the demands for cutbacks in the health budget. We should put the facts on the record as regards what is happening with health funding.

I will quote some more of what Mr. Martin Rogan has to say, as reported by the Irish Medical News. He says he is still seeking commitments from the Department of Health and Children about securing additional funding next year for implementing A Vision for Change. It is clear that we have the vision and we know where we want to go with mental health services. The question, however, concerns the roadmap, in addition to money, implementation and the progress that has been made. We must analyse that to see where it currently stands. Mr. Rogan says that no extra funding was provided this year for the implementation of the mental health strategy. He stated: “I will deliver the service when it is paid for, otherwise it is reckless and unsustainable”, adding, “Ethically, you can’t start a service with no funding for it to fall over three weeks later when you have invited people to avail of the service”.

If it is not sustainable we definitely cannot go there, but what sort of message is that for services around the country? Mr. Rogan also spoke about the equitable distribution of funding within the health budget. A key challenge for the Minister of State is to get equitable distribution of funding within the overall health budget. We know that mental health services have been the Cinderella of the health sector, so the challenge for the Minister of State is to ensure that changes. At the very least there should be equity within the health budget. If he achieves that, he will be achieving a great deal.

What is the current situation? The Minister of State has painted one picture, but I want to put on record some of the existing challenges. I accept that they have not arisen overnight, but have come about over a long period. It is disgraceful that mental health services have been at the margins for far too long. As the Minister of State knows, there is a new campaign on this issue involving all interested groups. There is more publicity about mental health budgets, which is a good thing. More than 7,000 e-mails have been sent to Deputies, Senators and people interested in this. This shows the stigma has been reduced and people are willing to write to their representatives about mental health and funding.

Let us consider the challenges. The campaign says that since 2006, mental health spending has been reduced by 9.2% and currently 5.3% of the overall health spending goes on mental health. Over half of all HSE staff cuts last year applied to mental health. Many psychiatric nurses have taken voluntary redundancy. This is a real challenge but they only make up 9% of the health workforce. The Inspector of Mental Health Services continues to say some facilities are entirely unacceptable and inhumane. The Minister of State referred to being at Pieta House yesterday, a service I know very well. Many cutbacks are coming at community services level, the more progressive side of the service to which A Vision for Change outlines we need to move. At a time of cutbacks in staffing, this is what is happening. We still have 1,000 people living in institutions that are Victorian despite the major efforts by front-line staff.

Major challenges remain. In 2009, more than 200 children were admitted to adult psychiatric units. Some 14 children have been admitted this year and an investigation is taking place on why nine were admitted in Limerick. I welcome that investigation because we should not admit young children to adult psychiatric or mental health institutions. It is clearly inappropriate.

The Minister of State referred to early intervention, which is a major challenge. What is the price to the individual, the family, the community and the budget of this country if a young child with mental health difficulties must wait up to four years for a diagnosis? It is enormous. Early intervention and early assessment in local areas is the key. I welcome the fact that the Minister of State is focusing on this.

I have indicated the scale of the challenges facing the Minister of State in receiving a budget. We are having this debate because it behoves us all to support the Minister of State in trying to ensure the budget he receives for next year is higher than for this year and is equitable in respect of what is happening in the Department. This week, research published by Red C highlighted the stresses and strains people feel as a result of the economic recession. It is important that the Taoiseach and other Ministers realise that at a time of recession, the need for mental health funding is even greater. International research over many years has shown that in an economic recession, mental health difficulties increase. It is common sense but the research shows this is what happens. We see it with suicide, depression rates and stress on families. The demand for the services increases at a time of recession, which is important to note in terms of the budget.

Services must be resourced. I am sure the Minister of State saw the comments of the Irish Medical Organisation in its pre-budget submission. It pointed out the interesting fact that 25% of people in receipt of illness benefit in 2009 cited mental health issues as the reason they were unfit for work. One sees the cost of not providing services to people. People fall out of the workplace and we know those with mental health difficulties face major stigma in speaking about their difficulties in the workplace. I also welcome the article written by Dr. Muiris Houston in the health supplement of The Irish Times. He outlines the stark economic burden of mental ill-health on the State, which is estimated at €3 billion per year. This is the cost of not having in place the services we need. All of this must be recognised. This is a major challenge, which we must recognise. Everyone will fight their corner. How does one say that mental health is more important than other areas of health? One can only make the best case one can and see if we can get extra money.

A Vision for Change needs money, as the director of services in the HSE commented. Perhaps the Minister of State can provide Members with the implementation plan for the policy and how he sees it developing. What is the Government's funding commitment to the implementation of the plan?

How much money is spent on mental health services? The Department is saying one figure, the HSE is saying something else. It seems extraordinary that the HSE service plan refers to a figure of €600 million to €700 million and the Department of Health and Children suggests it is €977 million. Why do we not have clarity on funding? The Considine working group referred to monitoring and having a framework of accountability between the Government and the HSE. One sees this is missing when one asks a question about HSE funding. There is a game going on and it is to the detriment of mental health services. We need answers and we need to ask the Minister of State if he will put in place a more accountable framework for funding. By doing this, the Minister of State will gain additional resources for mental health.

Amnesty International has made the complex argument that resources should be underpinned by legislation and a statutory right to access services. That raises major legal issues but I welcome the views of the Minister of State on these demands. What is the amount of money that has been received from the sale of residential assets? Have any been sold, has the money come back and has it been ring-fenced? We need to know the baseline figures for funding to assess what can be implemented and what is feasible.

I understand why Senator Fitzgerald went over time because this is a very important debate and there is much to be said. One could spend the day speaking and we would not cover every aspect of it. I welcome the Minister of State to the House. I took great heart from some of what he said. I will endeavour not to repeat what he said or the points made by Senator Fitzgerald.

At the end of her contribution, Senator Fitzgerald pointed out that we are in difficult times. The Minister of State must fight very hard to maintain the level of funding for the mental health services. Across the board, there will be challenges ahead. Senator Fitzgerald questioned how the Minister of State can say that mental health should be prioritised. The survival and recovery of this country in difficult times is dependent on the well-being of people. Our only hope of getting through the challenging times ahead is in the resilience and capacity of people to take on these challenging times and come out at the other end. This is not about mental health services as we have become familiar with them over recent years. The debate we are having concerns the impact of the recession on mental health and well-being of our people. It is in the interest of our people and the recovery of the country that the well-being and mental health of people are supported and nurtured to grow their capacity for resilience. The Minister of State has a very strong case to make for the protection, in so far as possible, of the budget for mental health services, not just as we thought of it until now but for the support and growth of the capacity of the well-being of our people. In these difficult times we are aware of the impact the recession is having on many people and its adverse consequences. It is an increasingly vulnerable time for those with existing mental health problems. It is also an increasingly vulnerable time for people who have never experienced mental health challenges.

This is not just an Irish financial crisis, it is also a global one. At the outset the World Health Organization warned that the economic downturn would spark a rise in the incidence of mental illness and health problems as people turned to alcohol, tobacco and drugs to get them through. With the country being hit particularly hard, it is inevitable that the health and well-being of Irish people will also be adversely affected. There is a proven link between times of economic hardship and an increased demand on mental health services. In The Economics of Mental Health Care in Ireland, the 2008 report of the Mental Health Commission, the overall cost of poor mental health in this country is estimated at €3 billion. One should bear this figure in mind. In the forthcoming budget it is said we need to make savings of €6 billion. The report sets out a compelling economic case for increased investment in mental health services and the point is made that we cannot afford to not invest in them. That is how we should see it, namely, as an investment in people. It is also an investment in our recovery in getting through these difficult times.

While we do not have figures for this country, research has been undertaken recently in the United Kingdom which shows the impact of the economic downturn on individuals. An across the board increase is apparent in all manifestations of mental health difficulties. The impact of the downturn will expose more people to risk factors, including unemployment and other major life changes such as poverty, an unanticipated disruption of income, an uncertain and increasingly stressful work environment and the impact of debt and financial strain. We must bear in mind that the suddenness of the change has had an impact on people and their capacity to adjust. We should also bear in mind the uncertainty of the times we live in and the fear generated.

The Minister of State has outlined the many improvements made in intervention and the goals set out in A Vision for Change and his policy on where we want to go and the direction in which we want to take the intervention services. The See Change campaign is necessary because we must consider what we can do in terms of education, increasing awareness, prevention and boosting people's psychological well-being and mental health. There have been positive developments in that respect in recent years. We must focus on these issues, in particular.

The Minister of State inquired whether we should look at groups or consider the issue on a national level. This is not just about a responsibility to tackle existing levels of mental illness, it is also about preventing an increase and supporting people who might not previously have been vulnerable to the onset of mental health challenges. We are in a time of change and there is an increasing risk posed to far more people than we could have imagined a couple of years ago. Whatever strategy is put in place must take this into account.

Any figure that emerges this year or next year should be treated with caution. The Minister of State has indicated he will look at the figures to consider whether we are effective in what we are doing and if they support the approach taken. However, when the goals and targets were set, times were different. Circumstances have changed. Therefore, when figures are presented, we must interpret them with caution, as they may not necessarily be an indicator of the effectiveness of what we are doing, rather they may be an indicator of what is happening in the difficult times we are experiencing.

We must be clear about a number of issues in terms of prevention and increasing capacity. We are in a time of fear. Uncertainty brings a sense of helplessness which increases one's vulnerability. For that reason, it is important that we show leadership at political level and are clear about having a plan and saying we will get through these difficult times. To that end, we must have an effective national recovery plan.

We must promote a healthy lifestyle. The use of alcohol and other substances is detrimental to one's health. It is possible to promote a healthier lifestyle and resilience by taking exercise, good nutrition, getting a good night's sleep, improving coping skills and tolerance levels and encouraging people to do things they enjoy. We also know how important it is to engage in purposeful activity and to have a reason to get up in the morning. Social contact is essential, as social isolation can result in an increased level of mental illness. This poses a challenge with so many joining the live register. We must say what we can offer people who suddenly find themselves without employment. There are needs in the community that we are not in a position to meet, but many who have a lot to offer are now signing on the live register. They need a reason to get out of bed in the morning and to get out and about. They need a purposeful meaning to their existence and to feel they are contributing. They also need to come into contact with others. We must, therefore, encourage social contact. There is an argument to be made in that regard.

We must consider growing our systems of support and how we can generate positivity. We need to examine the relentless negative messages being received across the board. We all have a role to play in that regard. I do not suggest we should not be honest with people or that we should stick our heads in the sand. We cannot do this, but we all have a responsibility to support people to get through these difficult times. Relentless negative messages increase the sense of fear and helplessness and reduce people's mood and thereby their resilience. While we have limited control over what we say to certain elements of the media, particularly since the media have become such a powerful communicator, we have some control when it comes to the public service element. I feel strongly about the negative messages continuously sent by the public service broadcaster. There is a balance to be struck. I am not blaming anyone or apportioning responsibility. We have as much of a responsibility to show leadership and that we have a plan, but the public service broadcaster must try to meet us halfway when it comes to promoting the well-being of our people. That is not being done.

Ba mhaith liom fáilte a chur roimh an Aire who I acknowledge speaks with great credibility on this issue. Everyone appreciates the work he is doing. It is clear that a lot of good work is being done.

I also compliment Senator Corrigan on what she has just said because it is something on which I also intend to dwell. What she has said about negative messages in the public service media and public debate is important and something I wish to address. We have a serious problem in that regard. Politicians are sometimes afraid to raise the issue because they fear they will be accused of trying to cover up their own failures or wrongdoings or closing down debate on accountability in society.

It is all the more to Senator Corrigan's credit that she raised the issue, since we must insist on a higher quality of public debate. We must find an appropriate balance that allows for the necessary interrogation of public policy, Government decision making and the mistakes of the past, that is, the necessary search for accountability, while not destroying the potential for the uplifting of people's spirits. The media has many questions to answer in this regard.

I have had the good fortune never to have suffered from depression. That said, I went through a difficult period during my first year and a half of college. One might call it growing pains. I experienced something that came close to depression and it took me ages to settle down. My mother told me I should get out, do something for someone else and get involved in a voluntary organisation because, if I did, I would realise how much I had to be thankful for. I recount this with trepidation as I know that there is a great danger in the snap-out-of-it mentality. That is not what I mean to suggest. Mental health difficulties must be taken seriously, so one person advocating positivity when another is experiencing dark times and suffering can do great damage.

Undoubtedly, our society must discuss whether we are living sufficiently for others or whether the individualism that has crept into our community life and our country in recent years has contributed partly to this problem. When conversing with another Senator, he mentioned how mental health does not seem to suffer in war time because people are more cohesive and have a common enemy and a shared sense of struggle. In times of economic recession, people might suffer too much in silence and believe their problems are unique to them. This situation might be made all the worse if our society has lost the habit of its members depending on and living for one another.

The great Viktor Frankl, with whom many people would be familiar and who wrote the book Man’s Search for Meaning, quoted the philosopher Nietzsche when reflecting on how some people in Auschwitz coped well with their suffering while others became rather bestial in their behaviour towards one another. That quote is: “He who has a why to live for can bear with almost any how.” The person who has a reason to live, be it religious faith, a deep religious or spiritual sense of the ultimate meaning of our existence, the love of a family member or a great professional or vocational project, is much better able to cope with the sufferings and challenges of life, especially those found in exceptional times such as those in which we live.

For this reason, I welcomed many of the Minister of State's remarks. For example, I welcomed his mention of breaking down stigma and the work of See Change. I had the good fortune of speaking at the recent awards ceremony of the Lundbeck Art Against Stigma project. People experiencing mental health problems created works of art, including paintings and sculptures. It was uplifting to be among such people and their professional supporters, loved ones and families. Breaking down stigma is important, as is the emphasis on the problems of discrimination and social attitudes. However, it is not enough. Some of the most important words in the Minister of State's speech were his statement of how it was particularly important that we watch out for one another.

We must get to a new point in society at which we not just reflect on our problems as individuals but also revert to thinking as a community about the challenges we face and our responsibilities to one another. I am encouraged by the work of the Applied Suicide Intervention Skills Training, ASIST, workshops, which have trained 18,000 people to help. We have often heard stories about people saying they did not know, had no hint of it or did not recognise the problems. That resources are being used to prepare people to spot problems and look out for others by helping them towards supports and strategies is excellent.

It is important to recognise the good work being done by various private sector bodies, for example, Headstrong. I had the positive experience of attending some events organised by Ms Violet Gavin and Positive Mental Health in Galway. Her good work, arising out of her long experience of life, is about going into schools to get peers to mentor their fellow students and to involve them in group discussions on matters they would not normally discuss with one another. What a wonderful civic contribution this work represents. It is an attempt to try to ensure people's happiness and positive mental health by getting students of psychology or related areas in college to give of their free time by visiting schools and leading debates.

We cannot ignore the statistics. Where suicide is concerned, the statistics of the past two years seem to suggest that the situation is much the same. Some 104 deaths by suicide were registered in the first quarter of 2010 whereas 106 were registered in the same period in 2009. We are trending along the middle range compared with other European states, but this is not the complete picture. The link between suicide, recession and financial hardship is irrefutable and the link between unemployment and suicide is indisputable. The live register figures are constantly rising. The Minister of State cited a 24% increase in suicide figures since 2008. I have spoken to a psychiatrist friend and no one will be surprised to hear the anecdotal evidence, not just of suicide, but of people who have attempted suicide or self-harm presenting. A serious problem, it can be directly linked with the economic recession and the challenges we are facing.

It is somewhat like the nature versus nurture debate. Some people will face mental health challenges because of their genes or personal circumstances, but a significant part of the problem undoubtedly relates to society's anti-nurturing nature. The challenges our society faces make matters worse for people. Therefore, we must be wary of how expenditure cuts might have a profoundly negative effect on people's health. This issue must be tackled.

Economic concerns seem insignificant when we consider the bigger picture. Our collective and individual health must be the utmost priority of Government policy. I am not quite clear on the Government's plans in respect of psychiatric nurses, so I am anxious that there be an exemption from cuts and certainly no disproportionate cuts in the area of mental health staff. As a Galway man, I welcome the improvements in Ballinasloe with 50 community nursing units and 25 day places.

We must consider the greater causes of mental health difficulties. We must examine honestly how family breakdowns and changed family experiences affect people's lives. We must also examine how our culture contributes. Our media is either too serious or too flippant. We need a media that can interrogate the challenges and problems of the day while helping people to find positivity. There will need to be a proper accounting by church and State bodies for past mistakes, but the media must be careful not to destroy the sources of hope in people's lives. I refer not just to sources of spiritual hope but also a sense of the meaning of life that is vital to people's well-being. According to experts in psychiatry and psychology, with a decline in religious belief and practice goes a greater likelihood of mental health suffering and difficulty. I do not want to make a separate case, but the spiritual dimension of life must be addressed. It is important for the media to take account of this and to help people to find sources of hope in the same way it asks hard questions of the Government and public agencies.

We must not have our media driving people into an individualistic, selfish, mé féin mentality where they focus only on how they are likely to be affected by problems but must develop a communitarian response to the challenges we face. We will have to ask the hard questions of our media but we will only be able to ask those questions credibly if we invite the media into a dialogue rather than throw brick-bats at them for what they will perceive as a privilege and a self-interested place in public life.

Gabh mo leithscéal as dul thar fóir ó thaobh mo chuid ama de agus, b'fhéidir, an méid a dúirt mé.

There ends the epistle. Senator Geraldine Feeney has eight minutes. The slot appears to have stretched but I am advised that eight minutes is the time ordered by the House.

I welcome the Minister of State, Deputy Moloney. I listened to his presentation in my office. He never fails to touch me. I am probably embarrassing him because he does not like bouquets being thrown to him for the way he handles his brief and conducts his Ministry. I heard him say he took time out two years ago, equipped himself with what he calls his bible, A Vision for Change, read his brief and proceeded to go around the country. I have heard at first hand from units the Minister of State has visited throughout the country about the hands-on approach he takes. Not alone is he a hard worker but he has great empathy — I would use the word "sympathy" meaning sympathy in a positive way — for people who find themselves experiencing mental health issues. In my eight years in the Seanad I have been associated with the health brief over two terms. I take my hat off to the Minister of State because I have never worked with a Minister who has immersed himself or herself in a brief as much as Deputy Moloney has. I congratulate him and his staff. The Minister of State always tells me it is the good staff he has who make his job that little bit easier.

I draw attention to an article by Sara Burke in The Irish Times of Monday. We have discussed the national broadcaster and the media. The headline on this opinion and analysis article was “The €2 billion health cure that won’t make us sick”, and it was about the €1 billion in the health budget of 2010 that could give us more for less. It is not often we hear or talk about such ideas. Of that €1 billion two thirds of the projected saving was to be achieved by pay cuts and the remaining €400 million could be saved by deals done with pharmacists on prescriptions and contracts made with general practitioners and dentists. That article was well thought out and full of foresight. I congratulate all concerned because it proved such a saving could be achieved.

For the few minutes I have I shall concentrate on adolescent and child psychiatry, if the Minister of State will bear with me. Again, I turn to the media. I was very taken, as I always am, by Jamie Smyth, writing in The Irish Times. He might not always write the article I agree with or would defend in the House but, in fairness to him, he is a very balanced writer, particularly in matters relating to child psychiatry and the hospitalisation of children in adult psychiatric units. Last Monday, Jamie Smyth wrote about nine children who were hospitalised in the adult unit in Limerick Regional Hospital. I am sure the Minister of State is aware of this. An investigation is taking place led by Mr. Hugh Kane, chief executive officer of the Mental Health Commission. If a child presents as a danger to himself or herself, or to the community, we must keep that child in a safe place. There will be times when we have no option other than to hospitalise a young person in an adult unit. When this case is investigated I hope that will be the reason for so doing, even though it was inappropriate, and that the decision was not taken for other reasons.

Of those nine children a number were aged under 15 years; three being 14 and one 13 years of age. I was delighted to read — that is the balance found in writers such as Jamie Smyth — that Mr. Martin Rogan, the assistant national director of the HSE, spoke out to say it was not appropriate for children to be hospitalised in that way. The HSE is doing its level best and I am delighted that next month a new unit will open in Senator Ó Brolcháin's constituency which will provide further beds for children and adolescents. One hopes that will take care of the problem, which may be unique to Limerick. Perhaps social deprivation has a role to play in the reasons children are admitted to psychiatric units when there is nowhere else for them. One hopes Limerick will not experience that situation again because its neighbour in Galway will have a unit that will also include my area in the north west. By the end of the year there will be 52 dedicated beds for young people.

I was delighted to hear the Minister of State state that Grangegorman Hospital is now closed for referrals. Even as I say that name I feel the hair rising on the back of my head. I visited the hospital, as did the Minister of State, in our capacity as members of the Oireachtas Joint Committee on Health and Children. Blanchardstown hospital will have a new unit up and running by February 2011 and Letterkenny General Hospital, just north of Sligo, is to have a new unit. There is progress and I know the Minister of State is doing his level best to ensure this moves on.

I have a matter to bring to the Minister of State's attention about which I will talk to him in private. I have a file that I will copy and give to him concerning a very sad case. Children as young as six and seven years of age are suffering from anorexia nervosa. I have raised this issue on a number of occasions; the Acting Chairman will know I am always calling for debates. I shall take the few seconds that remain to me to ask the Minister of State a question. There is a centre, the Marino Therapy Centre, but it is not in a psychiatric hospital setting. Conventional medicine and conventional psychiatrists might not have much faith in it but my file shows that several young people have been treated in this centre which has proved to be enormously successful. However, it has also proved enormously expensive, costing €2,000 per month for families who have a young person suffering from this condition. At any time that would be a vast amount of money but at this time it is unreasonable to ask anybody to pay even €200 per month, never mind €2,000. It appears that different regions of the country are prepared to fund this cost for families. Naturally, families in receipt of funding from the HSE are slow to divulge what they are receiving to people who are not getting the same kind of funding. One can understand that. I shall copy the file I have which concerns a very sad case and the Minister of State might see his way to talking to me about it.

When children find themselves in adult units self-imposed isolation comes into play. They are less motivated to interact with adults and do not enjoy the pastimes senior psychiatric patients do, playing bingo and suchlike. There is a need to consider a different way of treating young psychiatric patients — that is what the Marino Therapy Centre does. We should create a situation where children can have more access to outdoor facilities, whether with a care worker or a social worker, and can be monitored. Also, they could have access to computers and those types of things. I wish we had more time, but as I always tell the Minister of State, he is no stranger to this House and perhaps if we could do this once a month, things might move on. Instead of being critical of the media, as we have a right to be, we might create a base in this House for highlighting the problems.

I thank the Minister of State for coming to the Seanad once again. As Senator Feeney has said, he is no stranger. Mental health services continue to report an increase in the number of people suffering from stress. This has been linked directly to the recession, as has been identified by other speakers. The report by the Samaritans last year showed one in ten of the calls it received related to the financial crisis and issues relating to debt. There is an unquestionable link between times of economic hardship and increased demands on mental health services which are in need of reform. A failure to act will have long-term consequences.

The impact of the global economic difficulties on mental health has been recognised by the secretary general of the World Health Organization who said, "It is essential to learn from past mistakes and counter this period of economic downturn by increasing investment in health and the social sector." The inadequate funding of mental health services in times of economic prosperity has impacted on the present situation. We cannot neglect these services because they are needed much more than ever before given the scale of the impact of the recession. Mental health services are reporting people visiting them daily who are suicidal, depressed or both because they have lost their jobs or their incomes have collapsed. I know many people who have had the sad reality of suicide visited upon their families. This is always a very difficult subject, and especially difficult is the lack of closure in such cases where it might have been thought possible to have helped someone before he or she took the final, awful step.

Having been a member of the sub-committee on suicide as well as of the Joint Committee on Health and Children when the Minister of State was in the Chair, I am very well aware of his interest in this subject. He recognises that people have a whole change in their sense of self worth and cannot see any way out. Losing a job or having a chronically reduced income can have a major impact on someone suffering from mental illness.

I suggest that to reduce services drastically is not the way forward. People who have never suffered from anxiety or depression are expressing that view to me now at my clinics. A report by the Mental Health Commission, entitled The Economics of Mental Health Care in Ireland, estimates that the annual overall cost of poor mental health in this country is €3 billion or 2% of GNP. That would suggest that cuts which serve to deepen this problem would simply create a false economy and fail to address the forthcoming budget in any meaningful way.

In the middle of economic recession, the enormous cost of mental health problems for the economy cannot be swept under the carpet. We need to enhance investment in mental health care. As the Irish Medical Organisation has pointed out, 25% of people in receipt of illness benefit in 2009 cited mental health issues as the reason they were unfit for work. If we are serious about getting people back to work, we cannot ignore these figures.

Amnesty International, working with people who have directly experienced mental health problems, have offered three proposals for dealing with the current situation. First, it suggests that the Mental Health Act 2001 be reviewed and updated in line with the new UN Convention on the Rights of Persons with Disabilities. It says the relevant Department, not just the Department of Health and Children, should take action on mental health and that new legislation should be introduced to deliver appropriate community-based mental health services. These are all aspirations in A Vision for Change, and I add my support to the proposals.

An issue very close to my heart and on which I have not received any clarity is the decision to close St. Michael's in the constituency of Tipperary South which was announced on 9 January last. This stunned the entire community because there was no consultation with local health users, the staff or management of the unit. It was obvious that a proper assessment of the needs of mental health patients had not been carried out. This was confirmed when I discovered that the option appraisal was, in effect, a collection of random thoughts, riddled with errors and incomplete sentences which did not serve to allay any misgivings I had about that decision. The decision has further impacted because the 49 beds in that acute unit in St. Michael's are part of the general hospital complement and therefore impact on the size of the hospital. It is obvious that to take 49 beds out of the hospital will have a serious impact. Can the Minister of State clarify the matter?

I want to ask as well about the three recently vacated wards in St. Luke's that are undergoing extensive refurbishment. It seems considerable money is being spent on them. Will the Minister for State give the reason and purpose of this? It is a pity this money was not spent when there were patients in those wards because it would have made much more sense. The Minister of State visited the unit and his horror was evident as he discussed the medieval conditions within which these people and the nursing staff had to operate. I would like if he could clarify this issue.

I reaffirm my belief that A Vision for Change, which is supposed to be the blueprint for the future of mental health services, is being used as a propaganda tool. I do not understand how the needs of service users in Kilkenny require greater relevance than those in Tipperary South. Again, I have an issue with clarity and ask the Minister of State how much money has been realised from the sale of HSE lands in Tipperary South. When the Minister of State was Chair of the Joint Committee on Health and Children, he said that any money realised from the sale of mental health facilities or HSE lands would be red circled and reinvested in the mental health services. We were delighted at the time to hear that the money was going to be reinvested in the mental health services.

As regards closing mental health units without the community services being in place, I still have serious concerns about the announcement that the unit in Tipperary South is to close and the services are to be transferred to Kilkenny. Not a block has been laid yet, even though the Minister of State officiated in turning a sod there. South Tipperary has some of the worst employment blackspots in the country. We have seen the reconfiguration of health services there being driven by a group of people whose personal interests seem to be hell-bent on centralising services in Kilkenny. That goal, I believe, is being put before patient welfare.

There is no clarity on how decisions are arrived at. I submitted a freedom of information request last February in this regard which indicated that local stakeholders, including patients, their families, consultants and nursing staff, were told the news by Mr. Pat Healy at a Tuesday executive hospital meeting, which news became a formal announcement the following Friday and without any consultation whatever. It flies in the face of every sort of communication mandate possible, and the people of Tipperary South are still reeling from that decision and asking what is left for the community and patients, where the community facilities are and whether there are home-based treatment teams, crisis houses, their location in the event, how much money has been invested in them, etc.

I have asked the Minister of State a number of questions about the services in Tipperary South and how the geography was divided up. He said it was a matter of some concern to him as Minister of State with responsibility for mental health that "People with a mental illness are a hidden minority who suffer from pervasive discrimination." I do not accept that people with mental health illness, of whom there are as many in south Tipperary as anywhere else in the country, should suffer geographical discrimination. I would like to know how a hospital in Kilkenny, which is operating to full capacity — I have checked this with the staff who tell me the unit is as busy as the unit in south Tipperary — is to deal with patients from south Tipperary. The Mental Health Commission has stated there is in place a legal agreement in regard to services at South Tipperary General Hospital, of which the acute unit is part.

An announcement was made by a director of nursing in the psychiatric service that the night superintendent, a CNM III grade, is to be downgraded to a CNM II grade from January next. Perhaps the Minister of State will set out the reason for this downgrading and the diminution of the management structure within the service. I thank the Minister of State for his attention and ask that if he cannot answer all my questions today, some of which I appreciate are fairly parochial, he do so at a later date. The people of south Tipperary are interested in having the best possible services irrespective of their geography. There should be equity and fairness in respect of mental health services, in particular given there are so many lands and properties within HSE ownership which the Minister of State agreed would be red circled for the future mental health needs of the people of south Tipperary.

Perhaps the Minister of State will explain the reason for the disconnect in respect of past decisions and announcements of which neither he nor the Minister were aware and how people within a regional structure can announce decisions to close services, announcements which came as an absolute surprise to everyone from the top of the structure down to the service user.

I am delighted the Acting Chairman is being generous with time to enable Senators express their angst, thus ensuring their mental health is catered for in the House.

I welcome the Minister of State, Deputy Moloney, who receives much praise, rightly so, in this Chamber. The issue of mental health is important to the Seanad. It is an issue which thankfully all parties are agreed on. A Vision for Change is an important roadmap for the current and future Governments. We all need to get behind it and ensure it is delivered. A Vision for Change is equivalent to the Education for Persons with Special Education Needs, EPSEN, Act. There are in existence a number of important documents that will stand the test of time, one of which is A Vision for Change.

We are facing into a very tough budget and there is much lobbying taking place in regard to mental health services. The Green Party's policy is a rights-based approach to mental health care. However, an issue arises in terms of available resources. The Minister of State cannot implement A Vision for Change to the extent that he would like if he does not have the funding to do so. Currently, less than 7% of the overall health budget is allocated to mental health. Green Party policy is that this needs to be increased to 12%. I support the Minister of State in his ongoing discussions in relation to the budget in terms of ensuring the amount of money being cut or retained in the mental health area is not affected to the same extent as many other areas. We need to increase in this and every subsequent budget the proportion of money being spent on mental health to the extent that we eventually increase it to 12% of overall spending on health.

From a parochial point of view, I commend the Minister of State on the good news he announced today in relation to the opening of a new 20-bed unit in Merlin Park Hospital, which will replace the current psychiatric unit for child and adolescent services. It is important that even in times of recession we continue to open new facilities. The Minister of State also announced the opening of a similar service in Cork, which is good news. A Vision for Change deals with issues such as community and primary care. A pilot project called Jigsaw in Galway, which has been extremely successful, must be continued. We often put in place pilot projects which are enormously successful but when the funding runs out they are discontinued, with the loss of experience gained. I would not like this to happen to Jigsaw.

A Vision for Change has been championed by the Minister of State. However, there willbe enormous changes in our health structure in the coming years. In this regard, weneed to ensure in relation to any changes in the HSE that we focus on the key issue of primary care and of supporting communities, in particular in times of recession. We must support communities in providing good services to their people. There are many ways that this can be done that do not involve Government intervention. Most mental health care is provided by families, communities, including neighbours and so on. There is much we can do. Remaining positive is not easy in recessionary times. When speaking earlier to my wife she mentioned a number of positive measures in this regard, including listening to Lyric FM rather than some of the other channels, eating and sleeping well, which is often difficult to do when one is worried about all the appalling figures being thrown about by the Opposition, the media and often the Government.

I thought the Green Party was against censorship.

We were having a calm debate until Senator Buttimer entered the Chamber.

Yes, we were. Let us hope it can continue. Meditation is important. An over-reliance on tobacco, drugs or alcohol is not good. I am sure the Licensed Vintners Association will not be happy to hear me say that. It is important to focus on what is good. We should be counting our blessings. Many people in this country are stressed and fearful of the recession. While many people are badly affected by this recession, many others are not but are getting caught up in the stress associated with it.

Like other Senators, I too would like to refer to the media. During the boom, when we borrowed a great deal of money which we now have to pay back, we had a wonderful dynamic in that we were constantly hearing on the radio estate agents telling us the boom would go on forever, it was a great time to buy and that while the boom would peak there would be no dip in house prices and that the worst that could happen would be that prices would level off. Why were the media constantly engaging with estate agents? The positive cheerleading of that time has been replaced by absolute negativity, with economists now being invited onto the radio, each trying to outdo the other in terms of stating how bad things are going to get. A newspaper recently quoted that we owe €250 billion, or a quarter of a trillion, to the European Central Bank. Where will all of this stop? All sorts of figures are being thrown about which are frightening people. I am not suggesting these matters should not be reported on, rather that they should be responsibly reported with both sides of the balance sheet being recorded. Balance is important.

Another phenomenon is that of group think on websites such as www.politics.ie where many people who are wound up to 90 are writing all types of vitriolic things. Those involved are purporting to be people representing society. However bad our public broadcaster is, sites such as www.boards.ie or www.politics.ie are creating hysteria in terms of their content in regard to how bad things are and how badly people are being hammered. That is not good for mental health.

In terms of our public service broadcaster, I am not suggesting that RTE start broadcasting nature programmes, play soothing music or show pictures of rabbits and so on. That is not RTE's job in terms of current affairs. Its job is to report the truth but the key is that it gets the balance right and I believe it is very much swayed currently in terms of hysteria and talking ourselves into a state of panic. That is not good for the mental health of our people, especially our children.

The key aspect of which we as adults should always be aware is that the mental health of children is affected by the various negative comments being made. I appreciate the Acting Chairman has been very generous, as he was to the other speakers. We must take special care of our children in this very difficult time.

I wish to share time with Senator Bradford. Cuirim fáilte roimh an Aire Stáit. The debate is on the effects of the recession on mental health. The effects, to quote a friend of mine, are extraordinary. The need to look after our mental health is far more important today than it has ever been in the history of our State. That is the reason it is important we provide adequate funding and the services people need.

Young Fine Gael has a motion before its convention next weekend regarding the spending on mental health but we must put things in context. We must examine the number of cases of suicide in this country in a two to three-year period. They have increased. They were people who were faoi bhrú. That pressure, as the Minister of State is well aware from his work, comes from a variety of different sources but predominantly from the recession, alcohol abuse, unemployment, sexuality and a myriad of other issues. We must allow people the opportunity to go to a safe harbour or refuge and in that respect, the job of Government is very important in providing services for people who are vulnerable.

We are talking about people, not statistics. The suicide rate is increasing by 25% but that means nothing unless we put it in context. It is the number of people that is relevant. In an article in The Irish Times in October, Dr. Conor Farren of St. Patrick’s Hospital spoke about the link between alcohol consumption and suicide. A total of 527 people took their lives last year. That is an increase of 100 on the 2008 figure, which was 427. It is far more important to stress the number of people who commit suicide than the percentage increase because we are talking about people.

The figures are frightening. The quality of life of married couples and partners who are not married is at risk from this recession and in that respect the issue of mental health arises. Senator Fitzgerald spoke about having a roadmap. We have the roadmap, A Vision for Change, but what we need is a willingness to embark upon that journey with resourcing. The embargo on recruitment in certain areas of the Health Service Executive is having a profound impact on the delivery of services.

While we will come out of the recession, thousands of people who are struggling with depression and other mental health illnesses will be mired in the difficulties they are encountering today unless we put in place a structure. Early intervention for young people is vital. The waiting times for assessment are unacceptably high but what stress does to people is extraordinary. We see that every day. Every day all of us in this Chamber meet people who are under pressure and are struggling financially, emotionally and psychologically.

There is an obligation on us as legislators and the Government not to cut mental health funding. We have a cross-party group in this Oireachtas which has done good work. The Minister of State, Deputy Moloney, to give him credit, has been very sincere in his actions as Minister of State but I am genuinely concerned that if we embark upon a negative course of action regarding mental health, we will leave a legacy that will take a generation to change in terms of the policy. I hope we will not do that.

I welcome the opportunity to contribute to the debate. I do not have any professional qualifications in this field but the subject of mental health has been high on the political and health agendas in recent years. That is a welcome development, and the action and involvement of people such as the Minister of State, Deputy Moloney, has helped in that regard.

Mental health is no longer a taboo subject. We all have some words of wisdom on the matter but we are talking about the effect of the recession on mental health. I agree with what my colleague, Senator Buttimer, said about ensuring funding and investment levels continue. We all appreciate that the Government faces a difficult financial position but some areas must be sacrosanct in so far as that is possible, and I hope that mental health funding will be in that area of safety.

I had not intended to speak on this matter but having been in the Chair and listened to my colleagues' contributions, it struck me that we, as politicians, have a duty in these difficult economic times to perform our politics in a way and using language which does not depress the country. Political practice and party political gamesmanship in Ireland and in most European countries over the decades have been practised in a way that is confrontational. In recent times the observer of Irish politics would have noticed that, generally speaking, we are now talking the language of Armageddon. We are going from recession to depression to almost the end of Ireland as we know it. It is frightening for people when they listen to the radio, watch television or read the newspapers. They see nothing but bleak headlines, and an air of almost total despondency, despair and hopelessness is created. That is having a profoundly negative impact on citizens.

Senator Ó Brolcháin mentioned that many people now do not wish to listen to programmes on the radio. They certainly do not wish to listen to news programmes or read the newspapers because it is all bad news. There is a responsibility on every citizen to be at least reasonably aware of the state of difficulties in the country but we have a political responsibility, in highlighting the awful economic plight of the country, to illustrate as well that there is hope, that a way can be found to turn this country around and that the country and its citizens have a future. We all must be more responsible in that regard in terms of the language we use.

It is part of the political and economic challenge we face as politicians to highlight the difficulties but also to highlight the fact that solutions can be found and that there is light at the end of the tunnel. The need for responsible politics does not just mean turning around the state of the economy. It is also important to ensure people have a sense of hope and see there is a future for our country.

When we talk about leadership, we should admit that we must present a type of politics which is not devoid of hope and that shows that there is a future. The number of people who genuinely feel a sense of despair and hopelessness is disturbing, and it is affecting all strata of society and all age groups. Parents see their children emigrating to find work. Children see their parents unemployed. College students see no future. We have a responsibility in conducting our normal political business to ensure we do not present a picture of Ireland devoid of hope because that will not be the case providing the correct decisions are made. I commend the Minister of State on his ongoing efforts. He has the support of every politician and party in the House as he continues to try to ensure services are provided for those in need of mental health facilities.

When I was notified about this debate, I thought it would be an ideal opportunity for Opposition Senators to criticise Government policy and I am so pleased to be able to say not one Senator has used this debate as a political outing. It is right for me to acknowledge that underlying the comments of all Senators has been their proper concern about where we go from here in terms of funding. Wearing my Minister of State hat, it is important for me to be loyal to the commitments made in A Vision for Change, but I will not use this occasion to dress things up as though I were not a member of the Fianna Fáil Parliamentary Party. I say this in the context of the difficulties we face as we move towards the budget.

In the past two years, during which time I have often been in the House or before the Joint Committee on Health and Children, people have been asking whether we will stick to the commitments made in A Vision for Change. Given the fact that four years of this ten-year programme have elapsed, issues have cropped up which must to be responded to. I do not have enough time to address all of them, although I will try my best, and ask to be invited back to the House to deal with any issues I do not have time to speak about today.

Senator Fitzgerald asked whether we would be able to fund the commitments made and properly referred to a person for whom I have a lot of time, Mr. Martin Rogan, assistant national director of mental health at the HSE. At a recent meeting I attended he posed a similar question: can we talk about providing services that we do not have the financial wherewithal to fund? That is the key question. In view of the reduction in the budget of the Department of Health and Children by €1 billion and the proposals we have made to the Government in the past two years which have culminated in this important budget, we will need to — to use a swanky word — reconfigure the spending of the Department on mental health services.

Senator Prendergast asked many questions which I will not be able to answer now, but I will respond directly to her on each one within the next two weeks. I recognise her ongoing concerns and will try to show her that A Vision for Change is based on a concept of delivering mental health support that is not confined to counties but makes use of catchment areas. I have failed to get this message across. A commitment was made that the proceeds of the sale of institutional properties would be ring-fenced for mental health services. The expenditure of the €50 million promised in the last budget was dependent on the sale of properties. Let us be open about these matters. We did not have €50 million because we did not sell €50 million worth of properties. We have spent €15 million so far and received money from the capital budget of the HSE to fund the items I mentioned. I mention this not because I am trying to fly a flag, saying "We are great because we have done this." We have done only what we were asked to do in A Vision for Change and part of this has been the closure of the old hospitals.

Many Senators spoke about the media. I will not go down that road except to say this. I do not believe for one minute that the media should pretend things are happening if they are not, nor should we expect them to. However, there are people who are dependent on the media for their education on what is happening in the area of mental health. As no one asked this question and it will not be taken up by anybody, I am really talking to myself on it. When I embarked on the See Change campaign, I was depending on the media becoming interested, but this has not happened. Members of the media did not attend the opening in the Mansion House or any of the subsequent events. I do not mind this. I attended an event in Donegal two weeks ago as part of the campaign. It was well attended and people spoke from the floor, as did Senators this afternoon, about the need to ensure funding was made available. If we do not do this, people will say it has all been a pretence. On my way home the next morning I bought The Irish Times and was disappointed, although not on a personal level, to see that the editorial referred to the See Change campaign as an overly cynical attempt to pretend we were doing something. That is a sad reaction. I would have preferred if The Irish Times, with others in the media who might have had doubts about what we were doing and our sincerity — not our personal sincerity but that of the Department — had tried to find out before they wrote such columns whether it was a pretence. The evidence was available. I received thank you cards from the organisers and those who had attended which mentioned the benefit to be gained. The See Change campaign involves visits to every county.

Some days later I did an interview with the Irish Independent — I am loath to mention the journalist, as journalists do not like to be mentioned specifically. Rather than drawing down the wrath of the media once again, I gave an interview. The journalist concerned had the idea that when I spoke about capital programmes I was talking through my hat. I explained the six capital programmes that were under way, including the closing of the hospitals referred to in the inspector’s report. However, the sad reality, after I had waited the next day for a hopeful breakthrough in the media which would succeed in conveying to the public that we were going about our business, was that the commentary took the form of a message to patients at these mental hospitals that their stay would be for much longer than they had supposed. I was so disappointed to see that response because I had tried to give hope to them.

The issue of child and adolescent mental health issues was raised by many Senators. Yesterday when I met Deputy Neville and his colleagues from the Irish Association of Suicidology, I asked them what they would do and what they would like to see. I said we could not tackle the issue by way of a quick knee-jerk response to get headlines and asked them the way forward in terms of a proper strategy on mental health. They told me the most important issue was that of mental health support for children and adolescents. I concur. I accept the point made by Senator Ó Brolcháin about Jigsaw. I have been to Galway and seen it. I proposed to the Government that we should fund at least five such projects a year until we had one in each county because that is the way forward. Jigsaw and Headstrong also receive financial support from international sources; however, more important, all outputs are independently assessed.

We do not make a song and dance about the fact that we now have 52 beds in the child and adolescent mental health services, with a commitment to provide 100 beds. The real challenge is not turning sods or achieving media exposure but ensuring we have appropriate community mental health teams available. Early intervention is important. Senator Corrigan advised me that people were presenting with depressive illnesses at much younger ages, including five, six and seven years. It is clear the focus must be placed on this aspect. When a person such as Dr. Tony Bates advises me that 70% of mental health supports should be provided during the child and adolescent years, it is clear that this must be the focus of the reconfiguration of funding.

All Senators mentioned suicide prevention. Of course, Opposition Senators and colleagues in my own party wonder out loud whether we can deliver on the commitments made in A Vision for Change. I have always said the cosy way out of this is to park A Vision for Change, wait until the recession passes and deal with it then, but we are not doing this. We are giving clear and specific commitments to close the old hospitals and drive the development of community supports.

I have been reminded by my officials, whom I thank as they are, as usual, on the ball, that the expected income from the sale of properties is €13 million. At the end of this year we will need to tackle the capital programme for next year.

I ask the Cathaoirleach to invite me back to talk about specific issues raised by Senators.

Clearly we need to clarify publicly the funding in mental health services and how much it will cost to fund A Vision for Change. Our objective is combining the budget for mental health services using the strategic funding for suicide prevention and more importantly changing public attitudes towards mental health. As Senator Ó Brolcháin said, this is not a party political proposal. A Vision for Change is supported across the board by politicians and more importantly by the service users and clinical experts. Regardless of who is in power, we need to drive on this change.

Many people are disappointed that 5.5% of the total budget goes to mental health. I will not ride two horses because one will always fall off two horses; there is no point in me coming to the Seanad and saying what Members want to hear. Of course we all want to see an increase in mental health funding. As we debate the challenge for funding in the cancer programme and other programmes, our argument must be that given the enormous demands placed on us by our commitments in A Vision for Change, of course we must fund it. Although we are talking about funding from, unfortunately, a decreasing pot, nevertheless we have the ability to provide funding through the sale of properties. There are some substantial resources invested in mental health and these can be moved from the old institutions to the community.

In referring to the new thinking in the Department, I thank the officials. Ministers get great credit when something goes right, but it is the officials who advised me about the setting up of specific ring-fenced funding to bring about immediate change. I am talking about the change in bringing people from institutionalised care into the community, which is working well. It is up to us to try to tap into resources in order to continue that funding and I thank the co-funders of that.

I wish to bring a message of hope by saying that at the end of the year we will make our proposal on how the funding on mental health will be spent. Of course, I use the term "I hope" in talking about increased funding. I do not seek to try to separate me from my senior Minister — the pressure must go on her and the Government to provide that funding. It is up to me to make my case within this area on how this budget in health should be spent. Over the past two years I have listened to many people who advised me about the changes that should be made to do that. Next week the Minister, Deputy Harney, who has a significant interest in suicide prevention, has invited Geoff Day and me to talk about what we can do to effect change in that area. I take the points made by Senators Buttimer and Bradford; the fact that in excess of 500 deaths by suicide were recorded last year indicates that we need to prioritise mental health within the funding available.

Senator Mullen raised the issue about the media, which I have addressed. I accept I have given little response to the issues Senator Prendergast raised. I have clarified that the funding is ring-fenced as has been proved by what has been spent this year. That commitment was made in the Budget Statement by the Minister for Finance, Deputy Brian Lenihan, last year. I cannot give the Senator a response on the three wards in St. Luke's or give details on the funding there. However, we asked Dr. Hillery to engage with the staff in the hospital. The day I went there to meet the Senator and other public representatives from the area, I acknowledged that the service providers not being aware of proposals in advance is not the way to do business. I am trying to rectify that which is why I asked Dr. Hillery to engage there in order to ensure this was not an attempt to disregard the demands in south Tipperary. Those were very specific questions the Senator asked and I will arrange to meet her in the next fortnight to give her a clear briefing on those issues.

I fully support the concept of Jigsaw. Senator Ó Brolcháin and others referred to eating disorders. The Marino clinic is also taking referrals from the HSE. I have never come across so many issues pertaining to eating disorders as I have in the past year. It was something foreign to me and I was not aware of it. I recently meet Deputy McEntee and the Minister of State, Deputy Áine Brady, to discuss the enormous demand on services to address this new phenomenon, if I might call it that. I travelled to the UK to ascertain what its service providers were doing to encourage young people with eating disorders to engage with services. I was impressed by what I saw there whereby people are provided with support in a clinical setting while at the same time they have the educational facilities on campus also. In this area we are totally exposed by the lack of public beds to deal with eating disorders. The enormous costs of accessing services in that area are beyond most families' reach. In prioritising we need to recognise that we have to make changes in that area.

Senator Corrigan has often referred to the need to prioritise the needs of children and adolescents. I wish I could say that all her requests would be addressed, but they will not be. My strategy will be to retain the budget I had for last year and there will be changes in how the money is spent. It is important for people to point out to me the areas that have come under the most pressure in order that we can respond to that. Regarding the suicide prevention budget, I have met representatives of many groups in recent months who tell me that it is time to bring people together, spend money more strategically and set targets, similar to the model in Scotland.

I thank the Acting Chairman for allowing me to go over my time. I acknowledge I have left many questions unanswered and I would like the opportunity to come back in the new session to outline specifically the cost of A Vision for Change, what has been spent so far, what remains to be spent and more importantly whether we can deliver on A Vision for Change.

I forgot to answer one very important question on the effect of the moratorium on mental health services. We have been somewhat successful this year in getting from the employment control programme 100 nurses to deliver the service in Blanchardstown. It is not blocked or closed down on the mental health side. I have acknowledged the six capital projects that are in process. They are directly linked to the inspector's report on the conditions of mental hospitals. The message needs to go out that we have funded the closure of Grangegorman — for the first time since 1815 there have been no referrals. We now have a modern facility in Blanchardstown. Deputy Reilly has often quite properly asked me in the Dáil about the plans for the new acute psychiatric unit in Beaumont to allow the closure of the facility in Portrane. The funding is available and the project will begin in February 2011. Senator Prendergast has acknowledged what we are doing regarding nursing in Clonmel. Six months ago we turned the sod for a new 600-bed unit in Mullingar, which will allow us to close those awful wards in St. Loman's. I am happy to say that the acute psychiatric unit in Letterkenny is near completion and will open this year. There are new beds in Cherry Orchard, Galway and Cork for children and adolescents.

I again thank the Acting Chairman for allowing me to go over my time.

I gave the Minister of State indulgence to allow him time to respond. I am sure Members will agree to ask the Leader to invite him to come again to the House.

Sitting suspended at 2.10 p.m. and resumed at 3.30 p.m.