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Topical Issue Debate - Mental Health Services

Tuesday, 7 February 2012

Dáil Éireann Debate
Vol. 754 No. 3

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Deputy Patrick Nulty: Information on Patrick Nulty Zoom on Patrick Nulty Before I begin, I would like to acknowledge the Minister of State’s strong personal commitments on the issues covered in her own brief.

I would like to talk today about the cuts to community-based counselling services. They provide family therapy, counselling to youth work and marriage guidance and support to families in crisis. There are about 29 of these community-based projects throughout the country. In 2009 they received about €8 million in funding. What is unique about these services is that they developed organically within our communities. The drive to set up these counselling services came from people living in their communities such as community development workers, people from religious orders and people involved in all sorts of community activities. They recognised that there was a huge gap in family support and that there was a need for access to quality counselling for families, many of which are on a low income and which simply could not afford to access this type of support in the private sector. These facilities were established within communities. They have boards of directors that are set up within the communities as well. They provide a vital service to those communities.

In recent months, these community-based services have received notice from the Family Support Agency that they will receive a funding cut of 12% this year, 12% next year and 12% the year after. This is on top of a 10% cut they received last year when Fianna Fáil was in power, and this makes up a 46% cut over four years. These services simply cannot sustain such cuts. If the cuts go ahead, many of them will close.

The Genesis counselling service in my own constituency of Dublin West was established in 1993, based on a needs assessment of the community. It is located in the Corduff, Mulhuddart and wider Dublin 15 area. Its establishment was a recognition that there was a huge gap in [309]supports for working class communities to ensure that people get access to counselling services. The service provides counselling for parenting and for relationships in difficulty. It receives referrals from organisations like Women’s Aid, the Garda Síochána, child protection agencies and legal aid. It plays an incredibly important role in providing support to people.

I met the board of directors of Genesis counselling service a few weeks ago. The people on the board are not prone to histrionics or grandstanding. They are rooted in working class communities throughout this country and they are saying that if the cuts go ahead, these services may close and this will have a devastating impact on the communities that we serve and seek to represent in the Dáil. We need to review the cuts urgently.

If families do not get access to support and assistance for young people experiencing difficulties, what will be the outcome? More young people will become involved in criminal activity. There will be more family breakdown, more drug use and alcohol abuse. It will lead to a range of social problems. It will also cost the Exchequer far more than the cost of the provision of services in the community. Crude cuts of this nature do not equal savings for the taxpayer. They do nothing to address the economic crisis in which we find ourselves. They do nothing to address the 14% unemployment rate.

I implore those making these decisions not simply to look at a balance sheet. I appreciate the Minister for Finance may have other commitments, but it is a pity he was not able to stay to listen to this debate. The decisions that have been made on spending cuts are impacting locally. They are greatly affecting community services, youth projects, and community development programmes. That will undermine the progress that has been made in our communities. I cannot see how that is in anyone’s interest.

I know the Minister of State has a very strong track record on these issues over many years. I ask her, through her office, to bring any support she can to have these cuts reviewed.

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch I thank Deputy Nulty for raising this issue. The mental health of the population plays a vital role in the vibrancy and economic life of the country. Investing in the promotion of positive mental health and in early intervention is an investment not only in the individual’s quality of life, but also in that of his or her family and even the community in general.

Expenditure reductions in 2012 will challenge all areas of the health system to provide continuity of services that are both appropriate and safe for patients. Like other care areas, efficiency savings and other savings will be required from the mental health service nationally, which will necessarily involve some rationalisation and reorganisation of services at local and regional level. We have shifted the emphasis in mental health service delivery in recent years from the old model of institutional care to community-based multidisciplinary services which necessarily engage with service users at local level and often in their own homes. As a result, in many instances the family will also benefit through supports appropriate to the individual’s needs. Such services assist families in coping with what is often a very difficult and stressful environment.

Cuts to services have not been targeted at this particular area. We have in fact prioritised mental health services for children and adolescents and have sought to expand inpatient provision as well as extending the reach of the service in this area to the community level, including home based treatment where possible. An example of the improvement in the child and adolescent area is the planned relocation of the Warrenstown inpatient service to recently vacated and redecorated facilities at St. Loman’s Hospital in Palmerstown — I know the Deputy is familiar with this — which will involve more efficient use of staff resources available and the [310]delivery of a higher standard of service overall, including additional inpatient beds. Further down the road, these services will transfer to the new facilities in Cherry Orchard.

Despite all the cuts that have had to be applied across the board in health, I am glad to say that it was possible in the 2012 budget to announce a special new allocation of €35 million for mental health services in line with our programme for Government commitments. This funding will be used primarily to strengthen community mental health teams in both adult and children’s mental health services by ensuring, at a minimum, that at least one of each mental health professional discipline is on every team. It is intended that the additional resources will be rolled out in conjunction with a scheme of appropriate clinical care programmes. Approximately 400 additional staff will be recruited to support these initiatives. In addition, further inpatient child and adolescent beds will open this year, something that for a long time has been a critical gap in the spectrum of mental health services.

Some of the new funding will also be used to advance activities in the area of suicide prevention and response to self harm presentations, and to improve access to psychological and counselling services in primary care, specifically for people with mental health problems. Some provision will also be made to facilitate the relocation of mental health service users from institutional care to more independent living arrangements in their communities in line with the health document, A Vision for Change.

It is imperative that the Government gets the best value for money for our available resources in these most difficult of economic times. The duplication of mental health services needs to be avoided to provide a more streamlined service. We need to co-ordinate our efforts and work together to develop our mental health services in line with the recommendations in A Vision for Change. In essence, we need to provide more with less and this has already been achieved in mental health service provision in many areas.

I am fully committed to working closely with the HSE and voluntary agencies to introduce programmes and services which will deal more effectively and appropriately with the issue of mental health.

Deputy Patrick Nulty: Information on Patrick Nulty Zoom on Patrick Nulty I agree that there is a need for value for money on every item of public expenditure and that the people we represent expect this. This is the annual report of the Genesis psychotherapy and family therapy service which gives value for money. If there is a 12% cut in services such as this this year and in the two following years, value for money will not be achieved. It will result in a higher level of family breakdown in our most vulnerable communities. As an example, the Genesis service has a waiting list of 100. It costs money to provide mortgage interest supplement, rent supplement and send people to prison. I do not believe reductions in expenditure of this nature help us to bridge the gap between income and expenditure. It is a case of moving the furniture around the house when we should be investing in the provision of early support such as that provided by the Genesis service. I welcome the Minister of State’s personal commitment and invite her to visit the service to see the work being done. I appreciate she is not in a position to give a commitment today, but I ask her to ask her departmental officials about the cut to this service. The people who raised the issue with me are dealing with mental health issues on the ground in working-class communities and deeply concerned about the closure of such facilities.

Deputy Kathleen Lynch: Information on Kathleen Lynch Zoom on Kathleen Lynch I have no doubt that the service to which the Deputy refers is an excellent one and doing an exceptional job. The difficulty from our perspective is that we need to provide an exceptional service in all areas of the country. We hope to do this by means of the community mental health teams which, in combination with primary care teams, will give [311]us a bigger bang for our buck. While I acknowledge that groups such as Genesis provide an excellent service in particular areas, we must ensure a service is delivered to everyone. That is our objective. It will be a nationwide service. I am confident that the expertise of the Genesis service will be well utilised because additional personnel will be needed to staff the community mental health teams. We need to be cautious about saying young people with mental health or personal difficulties automatically end up in prison because that is not necessarily the case. I have no doubt that Genesis is providing an invaluable service.

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