Seanad Éireann díospóireacht -
Thursday, 24 Nov 2016

Vol. 248 No. 11

Mental Health Services Funding: Statements

Minister of State at the Department of Health (Deputy Helen McEntee)

We will stay for as long as we can. I very much welcome the opportunity to debate this extremely important issue. I take this time to offer my sympathies to families who have been affected by suicide, and particularly recently in Cork. The most important thing is to work together with organisations, communities, schools and those particularly affected in order to work through it.

I welcome this debate as an opportunity to restate the Government’s and my commitment to our mental health policy and to the development of services within the mental health area. Since 2012, an extra €115 million and around 1,150 new posts have been allocated for mental health and suicide prevention initiatives. The budget this year has provided for additional spending for enhanced services of €35 million on a full-year basis to enable further improvements to access across a range of areas. Key priorities for next year's service plan include youth mental health, further improvement to child and adolescent and adult services, older people's services and further enhanced out-of-hours response for those in need of urgent services, along with the delivery of services for people with eating disorders.

Recognising the time lag in new staff taking up posts and the completion of preparations for the introduction of these services, it is estimated that the revenue spend in 2017 associated with this increased allocation will be some €15 million. There will also be a further spend of €9.7 million in mental health associated with increased pay costs. It is my belief the increase in wages will go a long way towards realising the full implementation of A Vision for Change in the coming years. This additional €24.7 million for 2017 will see the mental health budget increase to €851 million, representing an increase of 3% over 2016 and an overall 20% increase since 2012. People are asking why we cannot spend the €20 million this year on one-off projects but the Government has given the go-ahead for the construction of a new national forensic hospital at Portrane. As I did in the Dáil, I urge those who have not visited the Central Mental Hospital to do so or meet staff, family members and patients so they can understand why this major project is needed and how it will benefit the most vulnerable people in our society. It is a significant capital investment for next year and with spending on this new hospital and other minor and mental health projects, it will exceed €50 million.

I am very much focused on modernising our mental health services in line with the national mental health policy, A Vision for Change, and that is why we are spending over €900 million on mental health next year. Again, I know that figure is not enough but we have given the commitment that we will increase this year on year and we will stick to that commitment. In addition to the substantial ongoing financial commitment to service development, we have also commenced the process of updating our current mental health policy, A Vision for Change. My Department has recently commissioned an evidence-based expert review which will focus on the progress made to date in the implementation of A Vision for Change. Some may argue we do not need to update it but rather get working on it. It needs updating, however. The review will take into account international best practice and it will inform the next steps in the development of our mental health policy. It will also provide a solid evidence base to determine the policy direction and a basis to further improve service development in the area while shaping future policy.

In line with the commitment given to Dáil Éireann on 6 October 2016, an oversight committee will be established within three months of the review being finalised to oversee the development of a new policy for mental health based on the outcome of the expert review. It is also envisaged that a successor policy to A Vision for Change will include a multi-annual implementation plan to inform this.

The Health Service Executive, HSE, will be directed to develop a multi-annual approach to that and to the development of mental health services.

The increased investment in mental health services over the past number of years, at a time when funding in every Department was being cut across the board, has helped to facilitate an increase in the staffing levels of both adult and child and adolescent community mental health teams. Of the additional 1,550 new posts approved since 2012, some 1,150 have been or are in the process of being filled.

Increased investment has also funded the development of specialist services recommended in A Vision for Change. That includes forensic, eating disorders, psychiatry of later life and mental health intellectual disability services. We are also seeing continued development of community mental health teams, improved seven day responses and liaison services, perinatal mental health, two new clinical programmes specifically for ADHD in adults and children, which is one of the newer programmes, and dual diagnosis of those with mental illness and substance misuse on which a clinical lead will be appointed in the coming weeks.

We are also advancing the development of counselling services at primary care level and providing considerable extra funding to extend services such as Jigsaw, which offers a more informal environment in which younger people engage with each other and encourage each other to seek help.

A Programme for A Partnership Government recognises the need to further promote awareness and prevention strategies. That is why this year we launched our national task force on youth mental health, which I chair. We have had three meetings to date. We have met with services and engaged with younger people. We held our first forum last week and I hope early in the new year we can identify and bring forward key issues and priorities on which we can begin working almost immediately.

I acknowledge that this area needs continued investment, monitoring and attention. While services are not perfect, we have started from a very low base. As with anything, if we want to get it right and ensure the effects are long-lasting, we must not take a big bang approach but rather take our time and make sure that any changes happen for the right reason.

I welcome today's debate. I hope it will be open and informative. I want to hear Members' suggestions and, if needs be, their criticisms, but I hope we will work together on this because we all have the same goal and want the same end result.

Senator Brian Ó Domhnaill

I am deputising today for our health spokesperson, Senator Keith Swanick. I welcome the Minister of State to the House for this debate which, as she rightly said, should be had above the political discourse.

An important element of a functioning society is that we can deal with the issue of mental health in an adult and structured manner. Having a healthy mind is as important as having a health body. Understanding the link between mind and body is the first step in developing strategies to reduce the incidence of co-existing conditions.

Mental health is defined by the World Health Organization as a state of wellbeing in which every individual realises his or her potential, can cope with the normal stresses of life, work productively and fruitfully and is able to make a contribution to her or his community. Good mental health is a prerequisite for normal growth and development. It enables people to lead a fulfilled life and to relate satisfactorily to those around them.

The common characteristic of mental health disorders is that they all impact the affected person's personality through processes or social interactions. These effects are as debilitating as a physical illness yet we all know they are not treated in the same manner or with the same urgency of care. People with serious mental health conditions are at a high risk of experiencing chronic physical conditions. People with chronic physical conditions are at risk of developing poor mental health. Therefore, they are interlinked.

The number of suicides reported in Ireland has risen enormously over decades from 76 deaths in 1950 to a peak of 554 in 2011. In 2015, some 451 suicides were recorded. In addition to that are those deaths by suicide that are unrecorded. Anecdotal evidence suggests, and we heard reports this week, that there are 1,000 deaths by suicide annually on the island of Ireland. Those stark figures hide an enormous societal shift during which suicide was decriminalised in 1993. Thankfully, other taboos and stigmas around mental health have long gone and it can be dealt with as any other health condition.

Before the enactment of the Mental Health Bill brought forward by Deputy Micheál Martin in 2001, the primary mental health legislation dated back to 1945. It was interesting to note that the third debate on mental health in the current Dáil took place last week. There was also a substantial debate on mental health yesterday during Leaders' Questions in the Dáil. That has to be welcomed and it brings a new focus to mental health.

It is ten years since the publication of A Vision for Change, which was a ten-year framework for building positive mental heath and providing accessible community based specialist services for people with mental health issues. Its terms were meant to be implemented by 2016 but, to date, just over 75% of those have been met. However, in the area of child and adolescent mental health, the figure is barely 52%. For older patients I understand the figure is 53% and for persons with disabilities, the figure is a shocking low of 19%. It is clear that those who are more vulnerable in society are getting fewer supports, and that issue must be addressed.

There was a commitment in the election manifesto to increase the funding for mental health by €75 million, or €35 million per year, in the lifetime of the Government, which the Minister of State referred to in her contribution. That is a step in the right direction but the vision to spend €35 million for additional services in 2017 will not be met, before we even enter that year. In fact, approximately €20 million of that will not be spent. That is worrying and it falls way short of targets identified in the programme for Government.

I want to raise a number of major issues. The staffing for child and adolescent mental health is 48% below what is required. That is a major issue. There may be staffing constraints and recruitment difficulties but the purpose of the additional funding was to meet those challenges. Two thousand children are waiting for their first appointment, with 10%, or 200, waiting for a year or longer. That is far too long and it must be addressed.

I am not sure what the difficulties are with spending the money next year and I would be interested to hear the reason from the Minister. She addressed that to some extent but it is an issue because difficulties are being experienced. If the funding has to be spent on recruitment next year because of difficulties being experienced, why not give the additional funding, for a one year period, to community groups that support mental health activities in the community at the point of contact closest to those who are suffering with mental health difficulties? We need to adopt radical thinking, even for a one year period, to fulfil the Government commitment on the targeted spend. I would be interested to hear what the Minister has to say on that aspect.

I wish the Minister well. She has a very difficult brief. I am aware she brings a lot of knowledge to the table and that she is passionately committed to delivering on this issue. Ministers in her position in the previous Government found it difficult. I am aware the Minister of State is meeting the challenge head-on, and I wish her well with that. Any support we can provide from this side of the House will always be given.

Senator Joan Freeman

I thank the Minister of State for coming to the House. I am sure she is very busy, so I appreciate her taking the time to come here not only to clarify issues and address serious concerns facing the most vulnerable in our society, but because I truly believe she wants to have an effective dialogue about what we can do to help.

We are both new to the roles we find ourselves in, yet we are no strangers to the mental health problems that face many people in our country. We are also aware that these problems begin with the children of our nation.

While we hear that much has been achieved in this area, the Minister of State and I know that in many areas nothing is happening. I am sure that the Minister of State is determined to address as many issues as possible during her tenure, but how can she do this when the budget she has been given is not only paltry, but offensive?

It was announced that mental health would receive €35 million, but it was a most dishonest statement. Not only was it dishonest, it was also underhanded because the statement omitted two very important issues. First, that €35 million is to be spent over two years and only €15 million would be spent in 2017. That €15 million will merely act as a contingency fund to fill in the gaps that inevitably occur in any given year, such as pension and other natural increases. Second, what makes this even more distasteful is that we have not been told how the HSE intends to distribute that €15 million, which backs up my fear that this money will go anywhere and everywhere that the Government and HSE wants it to go. It certainly will not go towards reducing the waiting lists where more than 2,000 children are still waiting to be seen on a never-ending waiting list.

Recently the Minister of State and I attended the very first mental health summit where there was mention of the review of A Vision for Change and the new task force, both of which are merely kicking the can down the road, something this Department is good at. We have had review after review. Ten years ago we had the "Reach Out " document on suicide. It was reviewed nine years later and another new document came about.

At that mental health summit, we heard a woman speak about an 18-year old young man who had been buried that morning because he died by suicide. One of the pallbearers was 12 years of age. This young little fellow was waiting to be seen by CAMHS for over four weeks. This child had suicide ideation and self-harming issues. The director of mental health who said that high-risk children are being seen within a week is also terribly dishonest.

I ask the Minister of State to provide me a breakdown of what has been spent in 2016 - how it was delivered and how it was administered. In addition how many people were truly hired this year and where were they placed?

I beg the Minister of State not to make the mistake other Ministers of State have made by accepting the crumbs from the table as offered by the Government. She must not allow mental health to continue to be the Cinderella of social issues. Many Senators are as passionate as I am about mental health and they also want to help the Minister of State achieve a fair, compassionate and workable mandate. However, she must also be the champion for mental health. That starts with treating her Department with the same respect all other Departments are treated with. The Minister of State needs to obtain for us the status other Departments are given and obtain for us a voice that will stop being a whisper.

Senator Neale Richmond

I am deputising for Senator Feighan, who cannot be here as I believe he is still on paternity duty. I welcome the Minister of State to the House and wish her continued success in a role she has really grasped from the outset.

As we all know, mental health issues can affect any home in the country. The area is a challenge for any government and society to deal with and manage in order to improve awareness and treatments. I commend the Minister of State on her extremely proactive approach to her brief so far. It is welcome that the programme for Government states that the mental health budget will be increased annually during the lifetime of the Government and that the Government is committed to meeting the recommendations of A Vision for Change. I appreciate the Minister of State's comments on a review of that document.

The allocation for the mental health budget for 2017 was subject to many untruths and a lack of understanding online. People often get confused when discussing the annual mental health budget. Many of us were inundated with questions to our offices asking why the entire mental health budget was just €15 million or if it had been cut. We need to be clear and unequivocal that the mental health budget for 2017 will be €851.3 million. Noting that funding of €150 million was secured in this year's budget for the new facility in Portrane, as the Minister of State discussed, I ask her to update us in her reply on the status of the Central Mental Hospital in Dundrum, which is close to where I live. When will that institution be able to move to Portrane? Like the Minister of State, I have also visited that facility and I believe it is no longer fit for purpose.

I fully appreciate that funding alone will not solve our problems. Much of the money cannot be spent without the staff to carry out the work. I also welcome that in this regard, training nursing places will increase by 45% in the next four years. In addition we need to see what approaches in different sectors are best performing.

The importance of team sports and club activities cannot be underestimated in providing a solution to cultivating a healthier approach to mental health. I am heartened to see our leading national sports organisations recognise the ability they have to influence the mental health of their members. They have taken action by launching several campaigns, aimed at not only increasing awareness, but also taking practical steps to improve their players' health and welfare.

The GAA on a national level has partnered with the HSE to support the highly shared and viewed "#LittleThings" social media campaign. Like other organisations, the GAA has seen fit to appoint a full-time community and health manager. The Kilmacud Crokes club in Stillorgan is involved in phase 2 of the award-winning healthy clubs project. It has launched its own "Crokes talks" videos. These brilliant pieces highlight how health and well-being have been integrated into the club's philosophy. It reminds everyone that they can contribute to a positive club experience for all members.

Another club in south County Dublin, Cuala, framed its emotional well-being conversation around a topic that is very real and immediate to every athlete - achieving one's potential and how an injury, be it mental or physical, can hamper one's endeavours to do just that. Its short film "#StoptheStigma" has had more than 10,000 views on YouTube. Both these clubs have drilled this health-awareness-driven practical campaign to the heart of their members and there may be an on-field benefit as these two clubs reached the final of the Dublin county senior hurling championship.

No one could argue that a healthy, happy, supportive and positive team spirit leads to success. Nationally the IRFU has rolled out its campaign, called "Tackle your Feelings." The purpose of that programme is to work towards creating a society where emotional vulnerability is viewed as strength and where being honest with oneself about how one is feeling is brave. It seeks to provide players with the tools to develop their self-awareness, improve their positivity and confidence, and become resilient. My club has signed up to Senator Freeman's "Mind your Buddies" campaign through Pieta House. It has worked really well in this laddish macho environment to have trained people available to talk to those who need it.

I thank the Minister of State for her contribution and look forward to her reply. I wish her the best of luck with the rest of her work.

Senator Máire Devine

I welcome the Minister of State back to the House. She spoke about a review and she knows how I feel about reviews. The review was done adequately and very professionally by the Royal College of Surgeons in Ireland and my union, the Psychiatric Nurses Association, and released in July. Knowledge is no good unless it is followed by action. I implore the Minister of State to forget reviews, but I think I am battling against the wind.

Funding for mental health in this country has always been inadequate. It is just over 6% here, whereas it is 14% in Britain and the North. We have gone from 13% ten years ago to just over 6% now. The impact of the €35 million is not being felt. I highlight my frustration and desperation in addressing the issue of funding. We tried to get 24-7 crisis intervention to be taken seriously in this House and in the Dáil. Since the formation of the Government, Sinn Féin twice introduced a motion and on both occasions Fine Gael and Fianna Fáil voted down the 24-7 measures we sought.

It was voted down in the face of two groups, one from the Liberties and one from Cork, which we had invited to the Gallery. Both groups were families and community groups who had lost their children or loved ones through suicide and had gone through that trauma and were trying to recover from it. It is heartbreaking for them. It felt like a slap in the face when both the Government and Opposition voted it down.

In the 2017 budget, €35 million was announced in new funding. Like other community and advocacy groups, Sinn Féin welcomes the measure as a positive step in implementing A Vision for Change. As a previous, and perhaps future, front-line worker, along with my psychiatry and nursing colleagues, I know this €35 million is being rehashed and promised every year. We never saw it on the ground. Perhaps we will see €15 million of it this year. The extra fund is coming to €15 million. It is an added investment of only 1.8% in new developments for mental health compared to the 2016 budget. This is unforgivable. I would like the Minister of State to directly respond on this point and tell us why this €35 million was masked as €35 million in new funds. The Government is doing nothing to address the sheer neglect of mental health going back decades. The pitiful investments of new funds such as these will do nothing to address the crisis among our communities across the island.

I do not want to play politics with the issue. The people who are dying and crying out for help day after day do not want politics played. They want support, services and to get better. What is it going to take? How can we get 24-7 crisis intervention rolled out? I admire the Minister of State's bravery in taking on the role and the responsibility, given her family's trauma. I recognise her determination to do her best to ensure the services are introduced. However, it is not happening. How can we put billions of euro into banks and millions of euro into water, but cannot find resources to prevent our people dying because they cannot see hope? What brick walls are preventing this? Is there resistance within the power of Fine Gael? Fine Gael and Fianna Fáil can do it. We will support whoever brings this forward, in the interest of nation, our people, families, loved ones and communities.

This morning, on national media, did Fianna Fáil's leader, Deputy Micheál Martin, commit to 24-7 services? I did not hear it. If it is true, I welcome it and I urge the Fianna Fáil Members to talk to their leader and ensure it happens without delay. We need to see the strength of the measures Fianna Fáil is proposing. If they will improve what is on offer, Fianna Fáil can count on our support and we can advance further.

Mental health is the most significant issue facing Ireland and the world, as referenced by the World Health Organization, WHO. Mental health affects housing, education, employment, family life and substance abuse, among many other aspects of life. Let us get this right. The Minister of State must go back to the Taoiseach and the Minister for Health, Deputy Simon Harris, and plead for funding to implement 24-7 crisis intervention. We can then further the other elements of A Vision for Change, over 70% of which have not been implemented. We could do it together on an all-party basis or, even better, an all-Ireland basis. My colleague, Ms Michelle O'Neill, has been in contact and we established an all-Ireland mental well-being initiative. Let us improve the health of our nation and stop the pitiful funding we provide for mental health and the perception that we are saying it is terrible but are not going to do anything about it.

Senator Lynn Ruane

I am out of breath after running here from a committee room, which must be a sign that I am not looking after myself very well. I will talk about some of the lived realities on the ground and how the task force and the Minister of State's work can reach the target groups. Last week, I gave a talk at Alexandra College in Dublin 6. The speaker before me gave an amazing speech and spoke about where in the world her friends were. When my turn came to speak, all I could think of was where my friends were and why I was not able to give the same speech. During the past six months since I was elected, I have lost four people to suicide. The only difference between me and the other speaker was inequality. How are we making the connection between inequality and access to services and help?

Although services exist in communities, there is a lack of cohesiveness between some of the services and the community members. When services were first set up a long time ago, the community people had demanded them, especially regarding addiction. There was upward pressure. Are we missing some sort of link between the services and the community, especially for young men in disadvantaged areas who will struggle to even know how to access services and where to go? This is one of the reasons I am holding the Tallaght Talks next week. It is to try to start the conversation with young men. Some 250 people from west Tallaght are attending it and we have got local faces such as Al Porter and Paddy Holohan, the mixed martial arts, MMA, fighter, to try to act as ambassadors for the services that exist so we can shine a light on them. Although we have plenty of services in Tallaght, such as Pieta and Jigsaw, young men and women in the area cannot name a single service. While the may know Pieta exists as a national organisation, they might not know how to access it in their own locality.

How can the task force begin to address this? While it is a community-led task force in the voluntary sector, it seems to include people who are actively involved in working in mental health in those sectors. Is there a space to develop some sort of task force that could feed the position on the ground into the main task force maybe two to four times per year so it can become more cohesive and the message can filter down to the ground to the people who need it most? In more affluent areas, people have much more social and cultural capital and they know who to ask for help. They might have people in their families who work in specific mental health areas. People from the poorest backgrounds do not have that. They do not have family members who are counsellors, psychiatrists or lecturers who can signpost the way. Is there an element of the Minister of State's work that seeks to address the people at the very bottom?

I include those with dual diagnosis, especially in the homeless sector. As someone who has worked in the homeless sector for so long, it is very difficult to see people turned out of accident and emergency departments and sent back to the street with no co-operation between the health service and the addiction service on devising a dual approach to addiction and mental health in order to avoid people being knocked from one door to another. Our streets have become our asylums. We stopped institutional care of people who are mentally unwell. They are on the streets and in the hostels, where they are not receiving the care they need. Is there something we can do to put more resources into the homeless service and addressing mental health on the street? I met a man in a homeless hostel who had slit his throat and I had to stem the blood. I could not get him sectioned. He had cut his throat wide open and I begged to have him sectioned for his own safety, but I could not do it. Normal project workers with no background in mental health are trying to fire fight all these situations. Is the Minister of State considering those who are the hardest for mental health services to reach?

Senator Jerry Buttimer

Given that we went over time on the vote, I propose that we extend our time by five minutes to allow Senator Maura Hopkins to speak.

Acting Chairman (Senator Michelle Mulherin)

Is that agreed? Agreed.

Senator Maura Hopkins

I thank the Minister of State for talking to us and debating the important issue of mental health and funding. I thank her for her continued genuine hard work in her role as Minister of State with responsibility for mental health. It is important that we are seeing an increased budget for mental health services. The Minister of State rightly said there was a need for definite improvements within the services, and any change must equate to an improvement in the service. I have a raised a number of points with the Minister of State on a number of occasions. While I understand they are operational matters for the HSE, it is very important that we implement A Vision for Change and look at how we implement changes such that they ensure improvements.

If there are changes to day centres or hostels the public, mental health users and staff need to fully understand the reasons. We need to understand the benefit of changes and those changes need to deliver improved services. I emphasise this in the context of recent experience of how the HSE has communicated with the wider public in County Roscommon.

I worked as an occupational therapist within community mental health services and it is crucial that people have confidence in the service. They need to feel they can connect as they need to and that is a challenge for us in County Roscommon. There must be an environment and a structure that supports people, gives them certainty and helps them regain control over their lives and enjoy a good quality of life. The mental health budget spans many different Departments and many different areas of life. Senator Neale Richmond rightly spoke of the importance of sporting and community organisations in helping people to achieve a sense of well-being to face the demands of modern life. The work is cross-departmental and the youth task force is trying to engage as many groups as possible to improve people's lives.

I understand the external report into mental health services in County Roscommon is being finalised and it is really important to have it. It was commissioned because things were not working as they should have been. It will identify weaknesses and make recommendations for change. It will create a space for people in our county to use mental services as they need them.

Senator Jerry Buttimer

I want to raise the issue of suicide in Cork which in the past couple of weeks has gripped the city and county. A total of 16 people from a wide variety of backgrounds are suspected to have died by suicide, and I welcome the fact that the Minister of State is coming to Cork on Friday. It is heartbreaking for communities to lose people aged 18 years, 15, 17, 20 and 44, and I commend the Lord Mayor, Councillor Des Cahill, who is holding a multi-agency forum in Cork city hall on Monday, 5 December to help, alongside the Minister of State's intervention, to bring about structural support to enable us to eliminate this awful scourge from our society. I commend those involved, particularly Senator Freeman and Pieta House, on the way they have increased therapists in Cork. It is about all of us coming together to work, to educate, to empower, to assist and to end this awful tragedy. For any mental health advocate, be it Bressie, Conor Cusack or an ordinary person, it is good to talk and to engage and there is support there for people who need it. I commend the Minister of State on her work and I hope there is action in Cork because it has been traumatic and devastating for people.

Senator Colette Kelleher

I thank the Minister of State for her time yesterday at the dementia awareness training. The mental health reform agenda makes a clear case to me, as it has to other Senators, for the retention of the €35 million funding and some areas have been identified as suitable for the money to be spent, such as an adequate investment in peer support services and a greater availability of other social inclusion supports, like talking therapies. I am a bit late because I was speaking to Dublin Simon whose counselling service is drastically underfunded. They are anxious to extend the service and, as the Minister will know, mental ill health and homelessness go hand in hand. Other areas include the development of culturally appropriate mental health services for people from ethnic minorities and the development of mental health services for particular groups of individuals, such as people with a co-morbid mental health difficulty and addiction. A person may have an addiction or mental health issues but cannot get joined-up services as they have to go through one door or another.

A statutory national advocacy service for both adults and children with mental health difficulties could be set up and there is a need for a dedicated funding stream for tenancy sustainment supports for people with mental health. In my Cork Simon days mental health was often a reason people lost their tenancies. This creates an awful problem for the person but it also creates problems in the Department of Housing, Planning, Community and Local Government. Increased staffing in community mental health services up to the levels in A Vision for Change are also needed, as are access to 24-7 crisis mental health supports. When I was in Cork Simon the dramas happened on Saturdays and Sundays or over the Christmas period when everyone else was on holidays. Mental health crises do not happen on a Monday-to-Friday basis. We need increased investment in in-reach liaison services for people in the criminal justice system as many people in our prison system are mentally unwell and not getting the supports they need.

Acting Chairman (Senator Michelle Mulherin)

The Minister has five minutes.

Deputy Helen McEntee

There is a vote in the Dáil. Perhaps the House could wait until I get back.

Acting Chairman (Senator Michelle Mulherin)

We have other business after this.

Deputy Helen McEntee

I have to go now. I would like to address the issues.

Acting Chairman (Senator Michelle Mulherin)

It has to finish now, Minister.

Minister of State at the Department of Health (Deputy Helen McEntee)

I will have to be really quick as I have to go. We have been accused of allocating money but not spending it, or allocating it for a year ahead but not planning for the following years. There is a very firm commitment from this Government, however, that we will implement A Vision for Change. The figure of €35 million, or €37.5 million each year, has been put out there and whether it is spent year after year or all spent in one year does not make any difference as long as we plan ahead properly. Staffing has been a problem and I can get an exact breakdown of what has been spent this year for Senator Freeman. Some of it has gone in capital and some has moved away from services because of an inability to spend it. This year, €400,000 of the funding has gone to allocate 60 new places for the training of psychiatric nurses. This will increase by over 45%, to 70 over the next four years, to help us tackle the problem. Next year and the year after that we will be able to spend this money. The €35 million will be spent over two years and next year I will look for and expect the same amount. Whether it is spent in one year or over two years, the big issue is that it is spent.

On the task force, three groups are working together at the moment. We are working with younger people and held our first youth forum this week. We had engagement from throughout the country and across the spectrum, from children in college to children in bad areas, to hear exactly what they wanted to say. A body of work is ongoing involving the Departments of Health, Children and Youth Affairs and Education and Skills to identify the services that exist, where they overlap, where they are not working and where we can improve them. Some 155 services have already been identified and many can be amalgamated.

We will not be issuing a report by Christmas. We will issue recommendations, some of which might require legislative change or funding. That is a work in progress and it is hard to identify exactly what will come out of it.

As regards dual diagnosis, in the coming weeks we will be appointing a clinical lead. There is a programme being identified and worked on. Once that clinical lead is appointed he or she will pull together a team which will plan a framework on how to deal with this problem. It is a bit of a chicken and egg situation as to which comes first and how one deals with the two, three or four at the same time.

There is an interdepartmental team working with the Department of Justice and Equality. It has made recommendations, specifically on care for people while they are in prison. The next phase, which will happen in the coming weeks, is to look at the follow-on plan for what happens to people when they leave. More often than not they have more help when they are in prison than when they leave. That is the next body of work that needs to happen.

I have to leave but perhaps I can come back to Senators on some of the issues they have raised. I can address the issues properly then. I thank the House for this opportunity and I apologise that I have to leave.

Sitting suspended at 1.53 p.m. and resumed at 2.20 p.m.