Address by Mr Tim O´Malley T.D., Minister of State at the Department of Health and Children at the Irish Psychiatric Association´s conference in Galway
I am pleased to be with you this morning and I would like to thank the organisers – The Irish Psychiatric Association – for inviting me here to address you at their second conference. I understand that this conference features several eminent speakers outlining their role in the delivery of mental health services . It is an excellent opportunity to discuss the future direction of the mental health services and it enables us to acknowledge and recognise the importance and value of your work in responding to the needs of the vulnerable and disadvantaged in our society.
Development of Psychiatric Services
The fact that an event such as this is taking place is a reflection of the great changes that have been unfolding in the mental health services in Ireland in recent years. The perception of an institutional style mental health service, standing in isolation and closed from the rest of the community, is thankfully becoming a thing of the past.
Recent years have seen dramatic changes in both the concept and practice of mental health care delivery. Enormous strides have been made and continue to be made in developing a service which is comprehensive, community-based and integrated with other health services.
The shift in the delivery of services from predominantly hospital-based care has been extremely successful and undoubtedly the quality of care for persons with a mental illness has been enhanced by this development.
Many of you here today have not only experienced but have contributed significantly to this shift in the delivery of services, which has brought about critical improvements in patient care.
The Government is fully committed to furthering this process and under the National Development Plan approximately e190m capital funding is being made available for the provision of acute psychiatric units attached to General Hospitals, in-patient child and adolescent facilities, units for the disturbed mentally ill, additional day care, mental health centres and community residences throughout the country.
Additional revenue funding of €24.447m has been provided in 2002 for improvements in mental health services. The main programme areas for the allocation of this funding are as follows:-
- Community-Based Services
- Hospital Services
- Child and Adolescent Psychiatry
- Old Age Psychiatry
- Suicide and Suicide Prevention Programmes
- Voluntary Sector
This funding represents a 350% increase on the additional funding allocated in 1999 (€6.98m) and will further enhance the significant improvements which have been made in recent years.
Child and Adolescent Psychiatry
With the increasing pressures on young people, it is accepted that there is an urgent need to improve responses to their mental health needs. Priority is therefore being given to the development of mental health services for child and adolescent psychiatric services.
In order to prepare a policy document which would deal with the further development of mental health services for children and adolescents a Working Group on child and adolescent psychiatry was established in June, 2000. The Working Group published its First Report in March, 2001 and recommended the enhancement and expansion of the overall child and adolescent psychiatric service as the most effective means of providing the required services. The Report recommended that a total of seven child and adolescent inpatient psychiatric units for children ranging from 6-16 years should be developed throughout the country. Project teams have been established in respect of the proposed units in Cork, Limerick, Galway and one in the ERHA area – at St. Vincent´s Hospital, Fairview.
Additional resources are also being made available by my Department to enable improvements to be made in the delivery of child and adolescent psychiatry services. This year an additional e6m was allocated to further development in Child and Adolescent Psychiatry services. This funding will provide for the appointment of additional consultants in Child and Adolescent Psychiatry and for the development of multi-disciplinary teams to focus on specific areas, such as Attention Deficit/Hyperactivity Disorder (AD/HD).
Steady progress has been made in developing a specialised service for this particular client group and each health board now has funding for a minimum of 3 consultant-led child and adolescent multi-disciplinary teams.
The Working Group has identified a number of issues for consideration. It proposes to examine the needs of persons suffering from an eating disorder and how they can best be developed in the short, medium and long term. The Working Group have already invited submissions from interested parties on how the needs of persons suffering from an eating disorder can best be met.
Mental Health Promotion
At national level, priority is being given to education awareness and to promoting a better understanding among the public towards mental health thereby facilitating a greater and more positive acceptance of the transfer of mental health services from institutional to community based settings. Links with the voluntary sector continue to be strengthened, both at national and local level, and an additional €1.5m has been made available in 2002 to strengthen these links and services. There is ongoing co-operation between the boards and several voluntary organisations such as AWARE, GROW, Schizophrenia Ireland, the Samaritans and local branches of Mental Health Ireland.
The promotion of positive mental health will contribute significantly to combating the ignorance and stigma which often surrounds mental illness. Better understanding of mental illness encourages people to access professional help sooner rather than later, and this facilitates early recovery. Eventually, with time and education, hopefully the stigma will fade away, and when that day comes it will mean that at long last, society will have accepted all people with disabilities, in every form, and they will be treated with human kindness and given the rights they deserve.
As we are all aware, suicide has become a serious social problem; however it is not confined to Ireland but is a growing global problem. Suicide is now the most common cause of death among 15 to 24 year olds in Ireland exceeding deaths due to cancer and road traffic accidents. Apart from the increase in the overall rate of suicide, a disturbing feature is the significant rise in the male suicide rate.
Figures published recently by the Central Statistics Office indicate that there were 448 deaths from suicide in 2001. These figures are disappointing in that they indicate an increase of 35 on the 2000 figure. This increase however, highlights the need to intensify our efforts and to put additional resources in place for suicide research and suicide prevention programmes.
My Department has asked the National Suicide Review Group to examine the 2001 suicide figures in the context of the trends over the past few years and to prepare proposals for further action by health boards and service providers in this regard.
Suicide is in every case a tragedy, both for the life that has ended and the family, friends and community left behind. Through information from relatives, it has become clear that most people who committed suicide had long-lasting emotional problems such as depression, anxiety, unhappy relationships, alcohol and drug-related problems, unemployment, feelings of loneliness and guilt, problems with relatives, and so on.
Depression, a well-established diagnostic concept, is the most common form of mental disorder in the European Community. It catches a lot of people by surprise. Currently there are 300,000 Irish people, or 1 in every 14, who suffer from depression. Depression affects a person’s thinking, feeling, and behaviour. Many of the people affected are successful people, role models, celebrities whom we all know. Depression is a serious illness in the sense that it is disabling and beyond the person’s ability to cope.
On a more encouraging note, depression is an extremely treatable illness, with some 80% of people responding to counselling or anti-depressant medication within a matter of weeks. Counselling services, which form an important part of the treatment of stress and depression, provide an important support structure in helping people recover from a wide variety of distressing situations and ailments.
The Mental Health Act, 2001
Alongside all of these important developments the enactment of the Mental Health Act, 2001 in July 2001 was a very significant achievement. The primary objective of this Act is to address the civil and human rights of the mentally ill. While I am aware that your colleague Dr. John Owens has spoken to you in his capacity as Chairman of the new Mental Health Commission I would like to take this opportunity to touch on a few important aspects of the Act.
The Mental Health Commission which has been established under the Act, includes representatives of the medical, nursing and paramedical professions, members of the voluntary sector and general public thereby providing a range of knowledge and a balance of views on issues affecting the performance and delivery of care in our mental health service. I believe that this diversity of disciplines within the Commission will greatly assist it in its work.
The Mental Health Act will also have major implications for the role of the Inspector of Mental Hospitals. Under its provisions, the existing office of the Inspector of Mental Hospitals will be replaced with the Office of the Inspector of Mental Health Services. The Inspector will be employed by the Mental Health Commission and will thus have complete independence from the Minister and from the Department. I believe that both the Mental Health Commission and the new Inspector of Mental Health Services have the potential to play a pivotal role in the further modernisation of mental health services.
The recently published Health Strategy, “Quality and Fairness – A Health System for You”, includes a commitment to prepare a national policy framework for the further modernisation of the mental health services, updating the 1984 policy document, Planning for the Future. It is the intention to begin this process in the next few months.
I have to say that I am very encouraged by the spirit of co-operation that exists between the many groups and individuals involved in providing psychiatric services throughout the country. In conclusion, I would like to thank you all for the warm welcome that I have received here today and I wish you all continued success in your work.