Joint Committee on Health and Children Presentation by Mr. John Moloney, T.D., Minister of State with responsibility for Disability and Mental Health

I wish to thank the Joint Committee for providing me with the opportunity to update the Committee on developments in relation to mental health issues with a particular emphasis on ‘A Vision for Change’.

At the outset I would like to make it clear that I am doing everything in my power to progress the implementation of ‘A Vision for Change’. Since I was appointed Minister of State with responsibility for Disability and Mental Health in May 2008, the implementation of the recommendations in the Report, along with the elimination of the stigma surrounding mental health, have been my main priorities in terms of the mental health side of my brief.

Soon after my appointment I set my own priorities to deliver on mental health reform programme set out in ‘A Vision for Change’.

  1. To provide for the Capital Programme proposed in A Vision for Change by securing government approval for the sale of mental health properties and the ring-fencing of the proceeds for reinvestment in mental health.
  2. The closure of the old Psychiatric Hospitals over the next three to five years and the transfer of patients to more appropriate community-based settings. I have met with the Irish Council for Social Housing and have invited them to engage in this process.
  3. To secure a new site for the Central Mental Hospital and secure the bridging finance necessary to build a new hospital. When the new hospital is completed and the patients relocated, the sale of Dundrum lands can proceed and any surplus funds arising will be reinvested in the mental health capital programme.
  4. Provide for 4 regional Psychiatric Intensive Care Units.
  5. The development of closer links between mental health and primary care including the development of Primary Care Centres with an integrated Community Mental Health facility. Indeed I will perform the sod turning for one such integrated centre in Mountmellick in early December. I am delighted that the new centre will provide a co-ordinated and comprehensive local health service to the population of Mountmellick and the surrounding catchment area.
  6. The appointment of a Lead person within the HSE for Mental Health who will work closely with the new Executive Clinical Directors in order to deliver on the recommendations in ‘A Vision for Change’.
  7. To move to a community based Mental Health Service.
  8. The introduction of Early intervention programmes – including within Primary & Post Primary schools programmes.

I am aware that concerns have been expressed at the apparent lack of progress in implementation of ‘A Vision for Change’ and I accept that progress to date has been somewhat slower than anticipated. In this regard, my intention is to invite public debate on the reform programme in January/February 2010 in order to review progress and to evaluate successes or otherwise to date. I also want to confirm the five year programme for the sale of lands, the reinvestment of the proceeds in mental health and the development of services in line with ‘A Vision for Change’. I think it is important to put together time frames and price tags for each year of this five year programme.

I also think that it is important to recognise that progress has, and is, being made in terms of the implementation of ‘A Vision for Change’ particularly in the development of :

  • Child and adolescent services
  • a mental health information system, and
  • importantly, increased service user involvement.

Consistent with the person-centred ethos of ‘A Vision for Change’, active service user participation is now well established in the mental health services. One of the most significant developments in this regard was the establishment of NSUE, the National Service Users Executive and I had the pleasure to attend their inaugural meeting in Cork last January. NSUE is an independent body, comprising service users and carers which informs the HSE and the Mental Health Commission on issues relating to service user involvement and participation in planning, delivering, evaluation and monitoring of mental health services.

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

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

I am also very pleased to be able to report significant progress in the further development of child and adolescent mental health services which continues to be a priority for the HSE. Additional specialist Child and Adolescent Mental Health Teams have been established in 2009, bringing the total number at present to 57. Furthermore, funding provided in the last Budget will enable the recruitment of 35 additional therapist posts to the Child and Adolescent Mental Health Service. Some of the posts have already been filled and I have been assured that all of the remaining positions will be filled by early next year.

Additional inpatient capacity for children and adolescents has also been provided. Indeed only last week I had the great pleasure to formally open a new 6 bedded adolescent unit at St Vincent’s Hospital in Fairview. The provision of these additional dedicated adolescent beds is both welcome and timely. The Mental Health Act 2001 changed the definition of ‘child’ to include 16 and 17 year olds and ‘A Vision for Change’ recommended that services for children up to 18 years should be provided by the Child and Adolescent Mental Health Service. The Mental Health Commission has also recently issued an addendum to their Code of Practice regarding the admission of children to adult units which seeks to ensure that by 1st December 2011, no child under 18 years will be admitted to an adult psychiatric unit.

Consequently there is a need to increase in-patient capacity for this age group. Along with the additional unit at St Vincent’s, an 8 bed adolescent unit also opened for admissions last week in St Stephen’s Hospital, Cork. I should also mention that I turned the sod for two new 20 bed child and adolescent units, one at Merlin Park, Galway on 21st January 2009 and the other at Bessboro, Cork on 3rd April 2009. Work is advancing on the construction of these units and I understand that the beds will be commissioned in 2010. The completion of these two purpose built units will ensure a significant increase in the bed capacity for children and adolescents by the end of 2010.

The implementation of ‘A Vision for Change’ is a work in progress. In April 2009, the HSE adopted an implementation plan for ‘A Vision for Change’ for the five year period 2009 – 2013. This high level plan addresses the organisational capacity required to implement the 82% of the recommendations for which the HSE has responsibility. The plan takes account of the HSE’s transformation programme which aims to reduce service fragmentation by improving access to a range of integrated health and social care services.

The HSE has also recently appointed Mr Martin Rogan as national lead for mental health. I believe that Martin’s appointment represents an important turning point in the implementation process for‘A Vision for Change’ . In order for us to deliver on the recommendations of the Report, strong leadership within the HSE mental health service is required. Martin has long and proven track record within the service and he has worked well with all the stakeholders. I have no doubt that his wide ranging skills and expertise will enable him to drive implementation of ‘A Vision for Change’ in a more focussed and strategic manner. I congratulate him on his appointment and look forward to developing a close working relationship with him, as I know we share a commitment to the development of a modern, flexible, person centred mental health service. I would also like to extend my congratulations to Hugh Kane on his appointment as Chief Executive Officer of the Mental Commission and to extend my best wishes to the outgoing CEO Brid Clarke, on her retirement.

With regard to the Revised Programme for Government, one of the key priorities for mental health is the use of the proceeds of the sale of psychiatric lands to fund new mental health capital developments. As I have already mentioned this is one of my personal priorities. If we are to advance the implementation of ‘A Vision for Change’ we must close the remaining old institutions and provide more appropriate care settings for service users. I have therefore proposed a 5 year mental health capital programme to be funded from the proceeds of the sale of lands. While no decision has yet been finalised, I am working closely with the Minister for Finance on this issue and discussions are ongoing between my Department and the Department of Finance with a view to the re-voting of the historic funds for approved projects and for the use of funds generated by future sales, for investment in mental health infrastructure.

At the outset I indicated that one of my main priorities is to tackle the stigma associated with mental health. I am convinced beyond all doubt that the way to promote positive mental health and alleviate mental health problems is to make it more socially acceptable for people to present to mental health services for support or treatment. In that context over the past twelve months I have spent time trying to bring forward proposals leading to action to eliminate stigma. I have brought together people from all walks of life, people working in the services and people who have used the services, to discuss how we might tackle this important issue.

I convened meetings which provided a forum for the discussion on the stigmatisation of mental illness. I want to publicly thank all the participants of the discussion group for their input and their openness and frankness in sharing their views. My Department and I are currently focussing on how we might harness the knowledge we have gained and channel the energy and enthusiasm to progress the stigma reduction agenda in a strategic and meaningful way. In this regard my Department has provided Lottery Funding to progress an anti-stigma campaign.

Coming from a rural constituency I am particularly aware of the impact, isolation and loneliness can have on individuals. Of course it goes without saying that this can also hold true for people living in urban areas. Unfortunately, it is a fact of life that people with mental health problems are particularly vulnerable to social exclusion. I firmly believe therefore that we must do all in our power to ensure that those people with mental health difficulties are supported in the community and that they are aware that such support is available. We simply must dismantle the barriers that prevent help seeking. People should not feel stigmatised or ashamed to look for support. They should not feel that their job prospects, promotion, social or home life should suffer because of their need to address their mental health issues. We must, I believe, make concerted efforts to foster a culture where people in distress, at whatever stage in their lives, do not hesitate to seek help; a culture that recognises the signs and signals of distress and is willing to help, and a culture which focuses on developing good coping skills and avoiding harmful practices.

I have always thought that there is much to be gained from organising a local mental health awareness campaign. My idea is that each county would have a campaign involving local people who have used the mental health services and these people would be invited to share the story of their journey to recovery. Service users have a unique insight into the mental health service and we must listen to them, understand from them what is needed to facilitate recovery and in the process learn how we can do things better.

I have now decided to proceed with this campaign which will involve local radio stations, editors and print editors. I envisage a programme per week on local radio and a weekly supplement in local papers, hopefully involving local celebrities in the world of Sport, the Arts, Politics – people who have used the services and are now living fuller lives and are actively participating in society. By inviting people to open up publicly I want the message to get out there that mental illness is like any other illness – if you need help, you should seek it and recovery is possible.

As Minister of State with responsibility for Disability and Mental Health, I accept that I must ensure that adequate services and supports are provided within the available resources. In these straitened times the Government continues to invest heavily in mental health services and a greatly increased funding base has been built up over recent years. Spending on mental health services in 2007 and 2008 amounted to an estimated €1 billion annually. It is also important to bear in mind that some 90% of mental health problems are dealt with in primary care so the funding available for mental health overall is very substantial.

Of course within our communities, many statutory and voluntary groups are providing valuable supports to those experiencing mental health problems. Just last week, I met with the Samaritans to discuss how we can work together to develop a concerted approach to developing support services for those in distress. My Department also works closely with Geoff Day and his team at the National Office for Suicide Prevention and I am pleased to say that we are making progress in promoting positive mental health in our efforts to tackle suicide in this country. Most recently I was delighted to launch an awareness campaign aimed at young people. We know that our youth suicide rates are high and we must tune into what our young people need to support them. In this regard the new campaign hits the right note. Consultations took place with young people throughout the country and so the campaign is FOR young people INFORMED by young people.

Another key issue in the quest to tackle suicide and deliberate self-harm is to develop standardised services throughout the country. I am aware that Liaison nurses at Hospital Emergency Departments work tirelessly to help those who present having self-harmed. Our aim though is to develop a standardised approach to deliberate self-harm presentations, especially with regard to after-care. In this regard I am delighted to say that the National Office for Suicide Prevention along with the National Suicide Research Foundation recently brought together key stakeholders in this area with a view to arranging a Clinical Self Harm Workshop in the near future.

In conclusion I would like to confirm that ‘A Vision for Change’ remains a progressive document and it continues to be our roadmap, charting the way forward for the development of our mental health services. Our current financial difficulties do not in any way dilute the Government’s commitment, nor mine, in the area of mental health reform. I can assure you of my personal commitment and that of the Government to further developing mental health and disability services.

I had hoped that this meeting would not have been convened until January so as to allow me to be further down the road on reform and closer to the review date of ‘A Vision for Change’. I am committed to attending in the Senate at a later date to debate Mental Health Reform. Finally regarding the Disability side of my brief I would like to come back in January to discuss a five year plan for Disabilities to involve proposals:

  1. Housing
  2. Jobs
  3. Independent Living
  4. Direct Payments
  5. Local Authority Involvement