JOINT COMMITTEE ON HEALTH AND CHILDREN debate -
Tuesday, 20 Apr 2010

I welcome the Minister of State at the Department of Health and Children with special responsibility for equality, disability and mental health, Deputy John Moloney. Before we begin, I draw attention to the fact that while members of the committee have absolute privilege, the same privilege does not extend to witnesses appearing before it. I remind members of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House, or an official by name or in such a way as to make him or her identifiable.

The Minister of State has some interesting information for us and I am sure members will have many questions. Our format will be to hear his presentation and a presentation from his officials before taking a round of questions. I hope to be able to finish by 5 p.m. but if we finish earlier that is all the better.

I thank the Chairman and members for the invitation. I do not intend to read through the script because it has been furnished to members. I asked the committee secretariat to invite officials from the Department to attend this meeting. I am not using them as a screen to keep me safe, but to help me to respond to the direct questions that members may wish to ask. I will not respond from a prepared script.

Ms Bairbre Nic Aonghusa is the director of this policy area in the Department of Health and Children. She is free to take questions. Mr. Brian Gilroy, who is involved in the national management of the HSE, is heading up the capital programme. It is fair to say he has been most proactive in that regard. In a few minutes, I will have great pleasure in outlining the details of the capital programme as announced on 1 March last. All of the issues that seem to bedevil us will be put to bed today. I will comment on whether the fund, which was worth €40 million last year, will be worth €43 million or €50 million next year. I would welcome questions on the capital programme.

Mr. Martin Rogan, who is the HSE's newly appointed director for mental health, was introduced the last day. We are delighted to have him in place. His brief is to drive the A Vision for Change reform programme. Rather than doing a presentation, I will invite members to ask questions. Mr. John Saunders is in charge of Shine. He has been a shining light in the Department in trying to deal with the stigma associated with these issues. I take great pleasure in mentioning that he did a great deal of work in recent months in advance of last week's launch of the See Change campaign.

I thank the committee for giving me an opportunity to update members on the progress made with the A Vision for Change reform programme. I acknowledge that the National Service Users Executive, the establishment of which was first recommended in A Vision for Change, has publicly recognised that progress has been made with the reform programme. I hasten to add that it would like more progress to be made. That is what we are about. I am pleased to say that since our last meeting, Mr. Rogan has started to engage with the 14 regional directors who have been appointed in the mental health area. It is important that Mr. Rogan and the 14 regional directors are working together to ensure the commitments and recommendations set out in A Vision for Change can become a reality within the relevant timeframe.

The last time I addressed this committee, a number of members, including Deputies Kathleen Lynch and Jan O'Sullivan, asked about child and adolescent mental health beds. It is important for me to clarify that matter. Deputy Neville asked why Limerick was left out. I would like to try to bring some clarity to that area. The issue of child and adolescent beds is recognised within the Department as a priority. It is fair to point out that the briefing document I have supplied, which I do not intend to read in its entirety, makes it clear that 55 child and adolescent mental health teams are in place and a further eight teams are in development.

The number of inpatient beds for children and young people has more than doubled, to 30, since 2007. New 20-bed child and adolescent units are under construction in Cork and Galway. The target we have set is to have 20 beds in each of Galway, Cork, the Dublin-Leinster region and the north-west region. I appreciate that the number of such beds will not add up to 100, as previously envisaged. When those 80 beds have been put in place, we will see where the demands are. I do not envisage the development of 20 child and adolescent mental health beds in Limerick. I am sure Deputy Neville will have something to say about that. It is possible that the 80 beds I have mentioned will meet the need that exists. I should mention that shorter episodes of inpatient care have been achieved and 50% of discharges occur within two weeks of admission. There are fewer involuntary admissions.

I would like to speak briefly about the future of the Central Mental Hospital, which is important. We laid down a marker in that regard when we met Professor Kennedy and his colleagues. We indicated to them that we intend to proceed as quickly as possible with the development of a new hospital. I accept that certain interests in the Portrane-Donabate area were concerned that we had made a decision without telling them about it. I recently took the opportunity to make it clear to local Members of the Oireachtas and representatives of the local community council that no decision on the location of the new facility has been taken. Some time ago, the Cabinet gave us clearance to pursue the provision of a new Central Mental Hospital by means of public private partnership, PPP. When the PPP is stacked up later this year, as I hope it will be, we will be in a position to make an announcement on the location of the hospital. I do not see any point in going down that road until the arrangements have been firmed up.

Executive clinical directors have been appointed to lead reforms in catchment areas with populations of between 350,000 and 400,000 people. There have been significant improvements in the national forensic mental health service. It now offers consultant-led inreach clinics to all prisons within reach of Dublin. It also provides an assessment and liaison service for all prisons across the State. The prison inreach and court liaison service won the overall prize, an duais mhór, and the prize for best hospital project at the 2009 Irish health care awards. The service actively seeks to divert people from the criminal justice system to local psychiatric services.

In the context of child and adolescent facilities, it is important that we start to reconsider how funds are spent within the Department. I agree that we need to prioritise funding to facilitate early intervention. As we all know, 70% of mental health issues begin in the child and adolescent years. I am pleased to say that a number of submissions have been received from people like Dr. Tony Bates, who heads up the Headstrong and Jigsaw service, and Professor Éadbhard O'Callaghan of the DETECT programme. Last week, the Department sanctioned the development of a Jigsaw project in Roscommon, in addition to the existing projects in Galway and Ballymun. It is important to emphasise that Jigsaw projects are seen as popular, successful and working interventions. Young people and others who present themselves to Jigsaw projects are dealt with in an open and warm forum that is working well. When they present their issues in a cosy environment — they might not do so until their second or third day there — they receive professional care that is co-funded by the HSE. The figures in Galway prove not only that people are attending the Jigsaw facility there, but also that they benefit from constant follow-up services.

I thank Mr. Declan Ryan, of the Tony Ryan aviation group, for that company's involvement as the main proposer and sponsor in this regard. The project might not be as successful without that financial help and commitment. I assure the committee that the Department is equally committed. In that context, we have been invited to make a presentation to the Cabinet sub-committee on health shortly. I hope we will be able to put in place five similar Jigsaw projects throughout the country next year. We will try to reach the target of providing 20 similar facilities throughout the country by 2016. The clear outputs associated with these projects are recognised. More importantly, all of the Jigsaw activities are independently gauged and their success or otherwise is checked.

It is clear that the old mental hospitals — one can call them psychiatric hospitals or whatever else one wants — are creating huge problems for the public. As far as I am concerned, they will be mental hospitals until they are closed. They remind us all of a bygone day. When we came before this committee last November, we promised we would make an announcement at Farmleigh on 1 March. We have done that. I have proposed that on 1 March each year, the relevant Minister or Minister of State should set out the multi-annual programme for the year to come. While it is obvious that the permanent people — Mr. Gilroy and his colleagues — will definitely be here, I cannot say that about ourselves. Last March, we made a commitment to ring-fence a multi-annual figure of €15 million with regard to the sale of properties. I suppose the concept of ring fencing is often challenged, but we are satisfied that last year's Budget Statement provided for closure of the remaining hospitals within a three-year timeframe.

We went to Clonmel a few weeks ago to announce the closure of St. Luke's Hospital. We are spending €10 million. The contracts have been signed. We went to Letterkenny two weeks ago to sign the contract for the turning of the sod and the construction of a new acute psychiatric unit there. We are pleased to say that both projects are in train, in line with commitments made last year. An application for planning permission for a new acute unit at Beaumont Hospital will be made in June. We should be pleased that all acute services will be transferred to the new unit when it is up and running. That will signal the end of new intake into St. Ita's Hospital in Portrane.

I am particularly pleased to say that later this year, there will be no new admissions to Grangegorman for the first time since 1815. I pay particular tribute to the staff of the Department of Health and Children, who have worked around the moratorium, or embargo, to make these changes happen. Later in this meeting, Ms Nic Aonghusa will speak in detail about our successful discussions with the Department of Finance, which will ensure that nurses will be provided as required to work in the new facilities. There will be no further admissions to Grangegorman in 2010, as we prepare to move to the new purpose-built unit at Blanchardstown.

I refer to part of the inspector's reports. One thing that damns us all is the lack of progress in mental health reform. Quite properly, the inspector each year lists the hospitals that are not fit for habitation. It is up to us to make progress with that. I am pleased to mention St. Loman's Hospital and Grangegorman. We can now put Mullingar into the mix. We are aware that St. Brigid's ward in Mullingar was mentioned in last year's report. We are pleased to say that a contractor will be on site shortly to construct new nursing units at St. Mary's Hospital in Mullingar, thereby bringing an end to the difficulties associated with St. Brigid's ward in line with the commitment we made last year under the capital programme. We all wish to assist those living in older hospitals, who deserve nothing less than their closure. Our commitment is to ensure we drive the programme on. It can be done by means of the capital programme, the sale of assets and the use of voluntary and social housing, on which we are presently working in conjunction with the Minister of State, Deputy Finneran. A presentation will be made at Cabinet level shortly. The next time we address the committee, we will have further progress to relate.

I am delighted to announce the creation of a €3 million innovation fund for disabilities and mental health to support the transition from institutional to person-centred models of care. When facilities are being closed but accommodation has not yet been found for a small number of people, the innovation fund will help us to meet ongoing costs until alternative accommodation can be provided. I should mention that although my brief relates primarily to mental health, I have a clear brief with regard to disabilities. I am looking forward to producing an equivalent to A Vision for Change in the disability sector by December of this year. We will make commitments on employment, housing, jobs, transport and access. We hope to come before the committee in September to outline our three-year plan for the delivery of the commitments in Towards 2016 and the national disability strategy.

The €3 million funding I mentioned a moment ago has been allocated to Genio, which is a non-profit organisation that supports self-determination, inclusion and equality for disadvantaged and vulnerable people. I attended its conference yesterday at the Mansion House. I pay particular tribute to Ms Madeleine Clarke, whom I met yesterday. She has worked on this initiative with officials, including Ms Nic Aonghusa, from my Department. Genio has established a fund with assistance from Atlantic Philanthropies to support the transition from traditional group-based services to more effective individualised person-centred supports. The €3 million allocation reflects the importance of the partnership that has developed in recent years between the Government and the philanthropic sector in driving the reform of our disability and mental health sector. In addition to managing the fund, as part of the project Genio will provide learning opportunities for those interested in leading and managing change and support people with disabilities and mental health problems to advocate for services which meet their demands. Before I start the final part of the presentation, it is fair to make the point that as a result of the combined work of the HSE, the Department of Health and Children and the voluntary sector, new streams of funding are being sourced and put to proper use.

I will conclude by speaking about the See Change campaign. I thank those members who attended the launch of the campaign, about which I spoke at a meeting of this committee some months ago, including Deputy Neville, Deputy Ó Caoláin, Deputy O'Connor, Senator Mary White and Deputy Conlon. Regardless of the amount of funding secured from the Government and the capital programmes that are put together, we are on a hiding to nothing if we do not break the stigma that attaches to mental health. In advance of last week's launch, we worked for a number of months to bring the See Change programme together. I publicly thank the many people who were involved in that process. When people look back in years to come, they will learn that many people came together of their free will and on their own time to change our attitude towards mental health. Not only will this programme succeed within two years, but it will generate sufficient interest over the following years to ensure it is seen as a major attempt to reduce the number of people who die by suicide here. That is really what the plan is about.

The second issue is to try to help people to understand that a mental health problem is not really a big issue. It is a matter of having the cop-on, in the first instance, to get looked after. Our challenge is to ensure people do not have a hang-up about that. That is what we are trying to do.

I thank Mr. John Saunders, in particular. I cannot thank him enough for all the work he has done in recent months. I will not waste the committee's time by mentioning everything he has done — members can check the See Change website if they wish. The work involved is there to be seen. Mr. Saunders developed many contacts and made a great effort to bring all the groups together with one goal in mind — to reduce suicides and normalise the issue of mental health. I applaud him on the invaluable contacts he made, many of whom came on board to help us. I pay particular thanks to Miriam O'Callaghan from RTE. When we rang her, she had no difficulty with fronting the campaign. Eileen Dunne of RTE also spoke on the day. I also thank Paddy McGowan, who is a lecturer in DCU, and Deputy Neville, who is the president of the Irish Association of Suicidology.

The campaign video, which will continue to be in place for years to come, will create huge awareness and offer a platform for people to become involved. I thank those who feature in the video, including Claire Byrne, who is a broadcaster with Newstalk 106; the comedian Barry Murphy; the actor Risteárd Cooper; the Olympian and world champion, Eamonn Coughlan; the Olympic boxer, Mick Dowling; the RTE Gaelic games commentator, Micheál Ó Muircheartaigh; the RTE sports reporter, Colm Murray; the champion jockey, Johnny Murtagh; and the BBC golf broadcaster, Shane O'Donoghue. I thank other people in my Department who worked almost every second Wednesday to bring this programme together. I refer to Ms Bairbre Nic Aonghusa, Ms Dora Hennessy, Ms Sandra Walsh, Ms Elizabeth Heffernan, Ms Margaret McGuinness and Ms Pamela Carter.

I thank the group of people I brought together almost 15 months ago at the start of this campaign. I refer to those who gave us the ideas. They worked privately and did not look for public notice. I refer to Ms Fiona Crowley of Amnesty, Ms Karol Balfe of Amnesty, Dr. Tony Bates of Headstrong, Mr. John Treacy, Mr. Ossie Kilkenny, Dr. Justin Brophy, Mr. John Saunders, Mr. Martin Rogan, Mr. Anthony Muldoon of the Union of Students in Ireland, Dr. John Hillery, Mr. Geoff Day, Mr. Tom Kelly, Mr. Ruairí McKiernan of SpunOut, Professor Kevin Malone of the three Ts campaign, Dr. Freda O'Connell, Mr. Noel Smith, Mr. John Fitzmaurice, the singer, Ms Frances Black, Mr. John McCarthy and Mr. Martin McGinn. I hope the joint committee will promote all aspects of the See Change programme, the objectives of which are to reduce the stigma associated with mental health problems; to challenge discrimination; to create an environment in which people are more open and positive in their attitudes and behaviour towards mental health; to promote greater understanding of, acceptance of and support for people with mental health problems; and to empower individuals with experience of mental health problems to gain equality, respect and rights.

The campaign has been launched. It is on the website. We intend to have town hall meetings across the country to get people involved. I do not refer to amateurs but to people like Mr. John Saunders. It will not be people like me. Professional people will explain to the public that it should be normal to look after oneself. We will involve local radio and local media and tap into certain resources. It is important for us to rise to this challenge. Attitudes can be changed. As an undertaker, I have been aware of so many funerals following suicides over the years that I feel this is important. I am not being flippant when I say that politicians are accused far too often of not addressing issues like suicide. People all around me have a huge interest in all of this. We cannot bring about a change unless the media acts as a partner in this regard. The launch was excellent and I was banking on the media who were present to publicise it. However, there was not a line of comment on the overall challenge and I am disappointed at that. Unless we all partner on this initiative we will have little effect and will bring about little change. See Change can transform attitudes to mental health and provide the people who have suffered over the years with the comfort of knowing that they need not suffer in silence and need not take the ultimate step, which creates great hurt and torment in families.

I thank the Chairman for giving us the opportunity to come before the committee every few months. We always hope members ask us rigorous questions so that it is made clear that what we are talking about is not made up. It is important for people to challenge us so that we can respond.

I welcome the Minister of State and his officials. I congratulate all those who were involved in the launch of See Change. Mr. John Saunders has done a great deal of work in this area over a period. I hope the programme will be a success because it needs to be a success. We need to remove the stigma from mental ill health because people will not seek help until then. They will be able to receive help because the system will respond to demand, which is the way our democracy has operated. I would like to see more leadership in identifying needs and providing responses.

I attended a conference on suicide bereavement and some of the discussion revealed how important it was to ensure people in crisis know where to obtain help and have the will to look for help without seeing it as a stigma. A young person in Limerick told me he would be labelled if he sought help. I suggested going to Dublin but he said that would mean he would "self-label". We must try to overcome that and See Change will make a contribution. However, it needs the involvement of all sections of society.

I have identified another problem Mr. Rogan may be able to address. It relates to the psychiatric profession and I have brought it up with the College of Psychiatry of Ireland. There are many very good and progressive psychiatrists here but the majority are reluctant to look at putting in place recovery plans with families or sharing the needs of patients discharged from hospital. Recently, a father took his son to hospital but the son was immediately discharged back into his care and the son later died by suicide. In general health treatment, whether it involves geriatricians, paediatricians or other consultants, there is a full discussion with the family on the subject of after care but many psychiatrists tell the family that the patient's details are confidential and cannot be discussed, even when the patient can waive confidentiality. Families experience a great deal of distress when bringing home very ill patients without any advice other than that given by their GP. In other circumstances families would meet the consultant who dealt with the patient but there is a culture in psychiatry which originates in the past. It is slowly changing but people tell me that even new psychiatrists have the old attitude. In America, as soon as a person is identified as having a psychiatric problem the family is brought in and a recovery plan put in place.

The Minister of State touched on the repeal of the Mental Health Act 2001. Amnesty International recently produced a brilliant, progressive report on the Act and on the subject of ECT. Will the legislation be amended to deal with ECT? There is a great deal of uncertainty about the issue and there is no consistency in its application across the country.

I wish to raise a matter I raised before concerning geriatric patients in psychiatric hospitals. Some elderly patients are no longer in need of inpatient psychiatric treatment but need nursing home care. A similar thing applies to people who are mentally challenged rather than psychiatrically ill. In the old days we used to call it "mental disability" and some people who have family with that condition still want us to use that term. It is totally inappropriate that such people remain in psychiatric hospitals. Are there plans to change this? If so, when will they be introduced?

The figures have been published for the first three quarters of last year and in the first half of the year there was a 37% increase in the levels of suicide. Are there any plans to address the effect of the recession on people who have been made unemployed, who are under financial pressure or who may be in danger of losing their homes? People are experiencing interpersonal difficulties arising from their new circumstances. Is anything being done to deal with that by making people aware of the services that are available? Voluntary groups are beginning to assist people in crisis but the State also has a duty to help. There has been another reduction this year to the contribution towards NGOs, some of which do much good work on suicide prevention by providing self-support groups for people with depression. Has the Department looked into what initiatives can be taken to respond to this newly created need?

Can Mr. Gilroy say how much has been realised from the sale of lands around the country, in particular in south Tipperary? Does the Minister of State still stand over the option appraisal relating to the announcement of the closure of St. Michael's? I ask him to suspend the decision pending a proper option appraisal. I have not received the answers to these questions to date. It is not enough for the Minister of State to say that Members of the Oireachtas for Tipperary South will be informed about any decision. I want to know how many times the Minister of State was informed and when he was briefed before the decision was taken to close St. Michael's on 12 January 2010. We are very unhappy that there was no consultation with any of the stakeholders on the closure of St. Michael's. I welcome the proposals for St. Luke's contained in A Vision for Change, as do all the stakeholders.

I compliment the Minister of State on his innovative measures to change the attitude to mental illness. As he said, if all the organisations work together, it is possible to remove the stigma attached to mental ill health. This is what politics is all about and it will be a tremendous achievement to deliver this social change. I found Mr. Rogan's presentation very satisfying and it would be good if more people were made aware that people can recover from mental illness with appropriate medication or counselling. It offers great hope to know that most people can get better.

Like other politicians I meet people with financial worries. I was asked yesterday if there is a group that families can join that will give them a space to discuss in confidence the stress they are experiencing as a result of the collapse of their business, for example modest builders. Group therapy can be helpful and I would appreciate if the Minister of State or somebody could help me identify support for such families. Is there a schedule for the meetings to be held around the country?

On the lands in south Tipperary, we agreed early last year on the sale of the lands in Clonmel to South Tipperary County Council but, unfortunately due to the level of cutbacks experienced across the public sector, South Tipperary County Council had to inform us that it could not stand over the figures we had agreed. We have since re-engaged with it and we are still in discussions but there is no conclusion on the issue.

To date, we have realised €5 million which is in line with the profile we expected. We started the process of selling in January and expect it to ramp up during the course of the year.

It was our belief that this would happen. The only reason I asked about the €5 million was to find out where the money was realised and how much land was sold to realise that money?

In regard to care in the community I understand that eight community care teams were to be established, I would like to know the stage of development they have reached. Have the teams their full complement or partial complement of staff? I am especially interested in the teams to be located in the Cork city and county area. We had a ten-bed unit located in St. Stephen's, Cork city for adolescent children but I understand that when the proposed 20-bed unit is completed, the ten-bed unit will no longer exist. I think that is foolish as there is a need for it.

To return to my hobbyhorse on discharge policy, and the discharge of patients from psychiatric units, the last time I asked this question, the Minister of State undertook to consider it further. I asked that the relatives of an adult patient in psychiatric care would be notified about the proposed discharge. This connects to Deputy Neville's interest in suicide. I would like to know if this suggestion has been acted upon and whether it will happen. I thought we agreed that there was a possibility that it would happen. Will the Minister of State consider asking the tribunals who are asked to decide on the discharge of people involuntarily admitted to psychiatric care to give a written report rather than what we are told at the moment, which is that if somebody is capable of requesting a tribunal then he or she is capable of living independently and is not in need of psychiatric help within the confines of a psychiatric unit. We all know of people who have been discharged who clearly needed additional psychiatric help within a psychiatric setting. A written report, even if it was to the effect that the person does not need to be there any longer, would ensure more responsibility.

In regard to the €5 million realised from the sale of an asset in Cork, when will it be spent and will it be an additional allocation or will it be the only money available? When will we see supported or assisted living units that adolescents discharged from psychiatric units need? We are starting from such a low base in the area, it is important to get a handle on a holistic service for those suffering from psychiatric illness.

I welcome the Minister of State and his team. I have a number of questions and then I wish to comment on See Change. Is it possible for the names of the regional and clinical directors to be made known to the committee so that we will be able to get a handle on the people from our own areas?

I welcome all the positive changes in terms of models of care in the Minister of State's presentation. When we visited Virginia, we saw what could happen and how a service should be delivered when people who have a mental illness are treated in their own community. It normalises the illness and it provides support from within the community. My fear is that where we have day services delivered — I am thinking of St. Davnet's hospital in Monaghan where there are excellent day services and there is some talk about moving that service to primary care teams — the rug will be pulled from under these people before the primary care teams are fully functioning and that people will not have the confidence in them. It is very important that does not happen.

In the transition from institutionalised care to person-centred models of care, it is very important that the transition is managed properly. The institution has been their home for many years. It is all they know and they are institutionalised. It is very important that there is a great deal of consultation between all of the stakeholders and the service users as this will be a significant change for those people who have lived in the institution. While I welcome the change, it must be done in a very carefully managed way to ensure they do not suffer a major setback when their day-to-day life changes dramatically.

I attended the launch last week of See Change. The presentations were very powerful and the DVD was excellent. The most compelling moment during the day came when Ms Eileen Dunne stated that one in four of us will suffer from breast cancer and one in four of us will suffer from some form of a mental illness episode during our lives but that the media portrayal and image of both issues is so different. Mental illness is not featured in the same was as breast cancer, which is compelling. We must try, in so far as we possibly can, to normalise the illness and to allow people to see that if it happens one gets treatment, one recovers and moves on and does whatever one intended to do before. The DVD and any supporting information should be sent to all schools especially for those in transition year, who are always looking for new modules and different courses to do. Promoting positive mental health should be a model in transition year whereby people could see that it is a normal part of life, it is normal to have it but it is also normal to talk about it.

Last week, I met a father who lost his daughter to suicide last year. I did not know the man but I happened to meet him on the street and we started to talk. He informed me that he has all the questions and none of the answers. She thought she had the answer but, unfortunately, she did not know the question. It was so sad. If See Change prevents one person from taking his or her life then we have done a good job and changed a mind set.

I share the concerns of some people about accessing services in buildings that have a great stigma attached. One hears people say that so and so has gone up to the Mental. Who would want to attend for a service with such a stigma attached to a building? We must make the service more patient-friendly and patient-centred. Several weeks ago, I met a father who was very concerned about a young fellow but he said he would not bring him up to "that place" to get treated, which is symptomatic of where we stand and the problems that exist. I agree that we all have a significant role to play, including the media. I was disappointed when I sent several statements to the local radio but obviously what I had to say was not important enough for the stations to carry. I was disappointed that none of it was carried because it is such a significant issue. We all know of families and people that have been affected and we all have a role to play. I will play my part. We should have some idea of when the meetings in the local communities will begin because that is the next step and it is a very important step.

I will try to be brief. I refer to some of the documentation we received, I understand, from Mr. Rogan, which informs us that spending on mental health has gone down to 5.24% of total health spending. In A Vision for Change the proportion was meant to increase from 6.7% in 2006 to 8.4%. The figures are going in the wrong direction in terms of the percentage of overall spending on mental health, which is the root of many of the problems related to the lack of progress on A Vision for Change. What is the Minister of State's comment in this regard? The Minister of State held two good briefings on ECT in the audio visual room of the Parliament. As it happened, the time clashed with the health committee meetings on both occasions and I was only able to attend a small part of one of the meetings. However, a man representing service users made the point that no one represents mental health issues at the top table in the HSE where the major decisions are made. Will the Minister indicate whether that will be rectified? Until that is rectified the percentage of spending on mental health will continue to go in the wrong direction. There must be representation fighting its corner at the most senior levels in the HSE.

I welcome the progress in the area of stigma and the various plans in place. However, because there is not enough money the development of the teams and so on is very slow. I am especially concerned about child and adolescent mental health teams and their development. Major gaps remain throughout the country. If a parent is concerned about a child in respect of mental health problems and he or she considers that child urgently needs help and may be suicidal, what should the parent do? A person may go to an accident and emergency department but I do not believe he or she would have ready access to a community team in most parts of the country. It is a simple question: what should that person do?

Deputy Neville raised the question about ECT and whether the Minister of State is planning to amend the Mental Health Act. I attended some of the briefings. The act must be amended. I refer to an e-mail I received, although I am unsure whether others received it. I was asked to raise an issue on behalf of a Ms Irene Alger. She has already been contacted because her name came up in the discussion on correspondence earlier. She wishes to know if child and adolescence mental health teams have a role in assessing children suspected of suffering from autism. It is a straightforward question, although there may not be a straightforward answer to it.

I express my disappointment at the Minister of State's remarks to the effect that child and adolescent beds in Limerick is no longer on the agenda. It was on the agenda when Deputy Neville and I were on the health board several years ago. It is a long way to have to go to Galway or Cork for those with a child with a mental health problem so serious that the child must be hospitalised. Will the Minister of State reconsider this matter?

I thank the Minister and I welcome the improvements that have been made. I compliment the Minister of State on the way in which he was able to secure money in a very difficult year for many improvements in the mental health services. I welcome the developments in child and adolescent services because I have raised this issue time and again at the committee. I am pleased that good progress has been made because a serious gap exists in the services available to people.

The Minister of State referred to the establishment of a cross-sectoral team. While I welcome this, we need a cross-sectoral team at local level with a rapid response time. One encounters constituents that need services more than most but who are denied the services because of the number of agencies involved with the result that the person falls between the different agencies. It is very easy to solve such issues if people sit around the table and respond rapidly. There is a genuine problem in this regard. I am unsure whether others have encountered this problem, but I have. Now that there is a cross-sectoral team at national level perhaps the Minister of State could use his influence with the Health Service Executive the local authorities, the Probation Service, the Department of Justice, Equality and Law Reform, the Prison Service and the Department of Social and Family Affairs. It is very unfortunate to see people out on the margins who are denied what it takes to survive in the community.

I welcome the advent of See Change. I am curious about the links with the Mental Health Association. I understand the role of the association varies from place to place around the country. My home county is particularly fortunate to have a very active mental health association, which does a great deal of work. I wonder where such associations fit into the new See Change arrangements. I welcome the phasing out of the psychiatric hospitals, which is long overdue. When I started to practice in Monaghan, there were 700 inpatients, most of whom were never expected to get out. While it is marvellous to see what has been done over the years, it is now time for the final push. I am glad to support the Minister of State, Deputy Moloney, in his efforts. People should be treated in modern psychiatric units in general hospitals or, preferably and if it is possible, in the community.

My final question relates to the links with Northern Ireland. Some people from this jurisdiction are being supported in the high-support hostels that are available in Northern Ireland to cater for those who are unable to cope. Are there any plans to establish such units in this State? These hostels, which are mainly run by nursing staff, assist people who are unable to cope with ordinary day-to-day living. I am aware that people are supported at The Beeches in Northern Ireland, for example.

I cannot wait to hear the Minister of State's reply, unfortunately, as I have to make a statement in the Dáil Chamber on the Polish tragedy. I commend the Minister of State and his team on the launch of See Change last week. It is a fine initiative that merits the support of everyone who can help to ensure its success. Despite the involvement of many high-profile people on the day in question, including two prominent faces from RTE, Ms Miriam O'Callaghan of "Prime Time" and Ms Eileen Dunne of the news service, I am concerned that I did not notice any report on the launch on that evening's RTE television news. I may be corrected in that regard. By contrast, a smaller event in the adjacent room, which was organised by the significantly less supported and less funded Parkinson's Association of Ireland, was the subject of a report on that evening's "Six One". This either confirms everything we have been saying, or——

I will leave the Minister of State respond to the "or". It disappointed me. We should not cod ourselves. The following day, The Irish Times, which prides itself on being the national newspaper of record, did not publish a report about the event. I was there to observe the launch and to give it my support, rather than to participate in it. I felt it absolutely deserved to be publicised. I was greatly disappointed when that did not happen.

I would like to raise two issues, the first of which is the tragedy of suicide. Are statistics available for 2009 and the first quarter of 2010 to indicate whether there is a clear association, which cannot be questioned, between the incidence of suicide and attempted suicide and the depressed economic situation? Deputy Neville referred to this issue earlier. I am sure each of us knows of cases of people who tragically have chosen to end their own lives because their lives, and those of their families, have been seriously affected by the terrible downturn in the economy. We need to ensure it is not ignored, swept aside or brushed under the carpet. It needs to be spoken about and highlighted. Just as See Change is endeavouring to address another aspect of this issue, there is a huge need to be conscious of this aspect of it. Historically, serious levels of suicide have been a consequence of calamitous economic downturns here and in other countries. Society at large needs to be alerted to this danger.

The second issue I would like to raise relates to a letter I wrote to the Minister of State on 25 February last. I concluded by saying I eagerly awaited his response. I remind the Minister of State that I am still eagerly awaiting that response. In the letter, I raised certain issues pertaining to St. Davnet's Hospital in Monaghan. I am not necessarily at variance with Deputy O'Hanlon in relation to the structural presence of psychiatric facilities at the hospital. I am anxious to ensure that psychiatric and mental health support services continue to be made available in Monaghan, preferably at the wider St. Davnet's campus. I am concerned about the proposed transfer of the admissions unit from the hospital to Cavan General Hospital. I am absolutely baffled by reports that it is proposed to close the day centre, which is an integral part of care in the community. It has also been reported that funding for mental health services across the constituency will be cut by €5 million. I raised all of those issues with the Minister of State in my letter. I am not asking for a response from the Minister of State today, but I would appreciate a considered response at the earliest opportunity.

Of the €5 million that has accrued from the sale of lands so far this year, €3.5 million has come from the sale of the St. Loman's Hospital lands in Mullingar. The balance is spread across four small residential sales in the earlier months of the year. We have spent €7 million to date on mental health services. In addition, we have entered into commitments worth €27 million — €6 million in Letterkenny, €8 million in Clonmel, €8 million in Mullingar and various other smaller projects spread throughout the country. Over the coming months, we expect to enter into another €20 million worth of commitments.

I wish to address the question of whether funds accruing from a sale in a certain area will be spent in that area. If we were to take that approach, we would only build in south-west Dublin, because the only land sales to date have been at St. Loman's Hospital. That is not a sustainable approach. We have got buy-in across the country for our plan, whereby all the sales will be accumulated over the years and the distributed investment programme will be backed against that. Every parish will benefit from investment, in a way, although it might not happen in the year in which lands are sold. The programme of investment, which has been published and made publicly available, will be honoured.

Do members have any final questions for Mr. Gilroy before he leaves? I thank him for assisting us with our deliberations today. I do not want to delay the meeting. I concur with what other members said about the work being done by the Minister of State, Deputy Moloney, and his team. It is clear from programmes like A Vision for Change and See Change that positive changes have taken place in the mental health sector since he took over this brief. I wish to ask him about the budget of €3 million that has been allocated to Genio for innovation. I compliment him on his plans for the old mental health institutions, which are to be closed. The last time we embarked on a programme of this nature we moved towards care in the community, but that became abandonment in the community for a small cohort of people. How can we be absolutely sure there will not be individuals who fall through the net? How can we be sure the innovation fund will pick up everybody so that we are not disgraced in the future by finding people on the streets who should not be there?

I will ask some of the people who headed up the programme to comment and Mr. John Saunders will talk about the specifics of when the programme will go to the country. I will ask Mr. Martin Rogan to answer the question put by Deputy Neville on psychiatry but I will take the questions put directly to me.

One of the most important things to come out of this meeting is that members recognise what happened last Thursday. I take Deputy Ó Caoláin's point in this regard. I have attended many a public meeting at which people criticised the political process as regards suicide, which I consider one of the greatest difficulties facing the political, as well as the medical, world. Public servants, volunteers and politicians have spent 15 months putting together a programme to directly engage in trying to reduce the figures and come up with a mechanism to achieve that. I told Mr. John Saunders that while I would have liked to front the programme I would hate people to think I was using it as a political opportunity. I stood back lest the media thought it was a one-man show or a solo run. Having done that, we hoped the media would pick up on what I consider is a very important intervention to deal with mental health problems and the stigma associated with suicide. I am aware that I may sound like the empire striking back but it struck me as a conspiracy when, the next day, there was not even a mention of the programme. I asked myself whether we had been in the Mansion House at all. I had the idea of not involving politicians but getting high-profile media people on board but I wonder to whom we would turn if we were to try this again, given that people of great popularity and esteem were assembled to drive the programme throughout the country.

As Deputy Ó Caoláin said, this is not a once-off effort. It is a two-year programme for which we have secured funding and expertise and have a clear campaign plan. I remind those public commentators who criticise politicians of what actually happened last Thursday in the Mansion House. I do not do so to annoy them but as a serious observation.

Deputy Neville asked about ECT and I thank the people who made the presentations on that subject. The Bill was being discussed on Second Stage in the Seanad last November and I felt that, rather than make changes to ECT treatment there and then, it was important to involve people on both sides of the debate by asking them to come into the Oireachtas to meet Members. The mental health (amendment) Bill is in preparation in the Department. It will include proposals regarding ECT and other minor amendments to the Mental Health Act 2001. A major review of the Mental Health Act 2001 is due for completion some time in 2011. We held a debate on ECT to inform us as to what decision to take as proposed in the debate on Second Stage.

Deputy Neville also asked about overall funding for mental health. At the next meeting of this committee I intend to be specific about the funding for mental health. I will not throw back the standard answer to the effect that much of the funding is hidden in the primary care sector because of the fact that 90% of people present to primary care units. I find it difficult to convince people about what we are doing when they come up with statistics that show there has been a reduction of 5% over so many years. In the 1960s, 1970s and 1980s there were 12,000 people in the old psychiatric hospitals and most of the funding went directly into them from the mental health budget. There are now 1,200 people in 14 psychiatric hospitals and they are part of the funding mechanism. There is a debate about this and people are of the view that a percentage of the overall budget should be earmarked specifically for mental health so, at the next meeting, I will bring clarity on where the funding is going. A reduction in funding of 5% is not as dramatic as it sounds because there is funding through other channels such as the mental health support programme.

Senator Mary M. White asked about MABS. The See Change programme is trying to identify the major problems as they affect the individual rather than the company. We have heard from building societies and other sources about the level of suicides and self-harming related to mortgage arrears.

I was asked when and how often I was briefed on the situation in Clonmel. I was not briefed. On the one hand people say they are in favour of A Vision for Change but, on the other, they do not want it where they are. I am all for A Vision for Change, no matter where it is but the service cannot be delivered in every county. For example, in my constituency Offaly will not have the service but Laois will provide it. There seems to be a suggestion that I am allowing something to happen without consultation but I was asked by Oireachtas Members for Tipperary South, at a meeting some time ago, not to proceed until they met with the senior Minister, Deputy Harney. That meeting has now taken place. Some of the members in question have had to leave early, unfortunately, to go the Dáil. I appealed to the group not to hold up the reform of mental health, which is particularly important for inpatients, by confusing it with the separate issue of the reconfiguration of hospital services. I have attempted to involve those who have a serious role to play in the reform of mental health services. I have asked a respected psychiatrist to engage with the psychiatrists and service providers in Clonmel to ascertain what has been done since the decision was made. This person will build up a picture of what has happened in the months since my meeting in Tipperary. I cannot say I intend to halt the progress being made. I will not do that. However, I will await a response from the psychiatrist in question. The people in Clonmel with whom he will work are already aware of it so I do not think I need to enter his name into the public forum. I do not intend to give a commitment to delay progress. All the commitments in A Vision for Change will not be accepted across the board. There will be some difficulty with the change in types of service. I will work with the clinical directors to support what is proposed, which is in the best interests of patient care. I will take further questions later if members wish, but I will move on to the next part of my response now.

Deputy Kathleen Lynch asked about people being discharged. I am regularly asked about this issue by service users and various advocates. I am not trying to hide behind legal jargon when I say the tribunals must act in a judicial manner. I have to accept that. I am conscious of the concern this issue can cause to families and communities. I will take up the Deputy's recommendation. When we deal with the overall Bill in the Seanad, which will be before 2011, I will see if I can deal with these concerns. The Deputy has suggested that the tribunal should give a written account, observation or recognition of why somebody is being discharged.

A number of areas have been covered. I will try to answer the various questions as best I can.

Deputy Neville spoke about the response to See Change. It has been difficult to raise the profile of, awareness of and interest in mental health issues. People's responses to this issue are often ambivalent, at best. I am not sure whether it relates to the coverage issue. We have run a number of programmes to increase awareness of mental health issues. An advertising agency with which we worked on a television campaign suggested that we should speak about matters like "wellness", "confidence" and "resilience". As it could not sell the concept of mental health, it suggested we should abandon it. More than 40 non-governmental organisations were involved in that process. They were firmly of the view that we need to rehabilitate the concept of mental health.

More than 350 young people contributed to last year's major engagement with young people, which was facilitated by the Office of the Minister for Children and Dáil na nÓg. It is encouraging that their understanding of the concept of mental health is much more balanced and mature than that of my generation. They know it is very much about relationships, resilience, coping, getting by, working with each other, supporting each other and self-confidence. I do not suggest that they airbrush away the more difficult end of the spectrum. Many of them have experience, at first hand or through school colleagues and others, of issues like self-harm, suicide, anorexia and other significant mental health needs. Questions of self-labelling and self-stigmatising often arise in this respect. An individual's self-confidence is often damaged.

Deputy Neville asked whether psychiatrists are open to change. More than 300 consultant psychiatrists work in the mental health service. The individuals I meet on a day-to-day basis are encouraged by the A Vision for Change concept and have subscribed to it as a model. People have found it more difficult to change in a number of other areas. They lack the confidence to change or to adopt more dynamic service models. One of the HSE's difficulties is making progress with A Vision for Change across the whole country. Many areas are already close to what A Vision for Change has described — they are essentially there. Other areas have found it much more difficult, however, for a range of complex reasons. Problems with resources, leadership, opportunities, socioeconomic factors and community readiness may be hindering their attempts to adopt more modern service formats.

I am encouraged by the fact that our mental health services have gone through a radical change since 2006. My professional background is in psychiatric nursing. I have worked in this area for almost 30 years. I have never seen such a significant change or jump forward as I have in the past five years. The enactment of the Mental Health Act has changed practices radically and brought much more transparency and openness to the system. There are further expectations as a result of A Vision for Change. Perhaps the greatest movement has been the arrival and activation of the service users movement. This culminated in the establishment of the National Service Users Executive, as recommended in chapter 3 of A Vision for Change. There has been a major mobilisation of service users and there is a new expectation of mental health services.

I wish to speak about where people avail of mental health care. We know that 90% of mental health need presents in primary care. Under a programme we have developed with Dublin City University, 27 staff of primary care teams are using their skills and capacities to recognise and address mental health needs in primary care, where appropriate, and to make referrals in a more effective manner. As primary care teams develop, a number of service protocols and models are enabling them to work more closely with their community mental health team colleagues. We are very encouraged in that regard.

I will discuss sharing of information about an individual's clinical care. I suppose the term "confidential" means one has confidence in one's care provider. If one is a competent adult, one's care is ultimately one's own decision. We have devised a major programme, in collaboration with the Health Research Bureau, to develop a mental health ICT system. A significant part of that programme involves working with service users represented by the National Service Users Executive, STEER in County Donegal and the Irish Advocacy Network. Sharing of information by team members is a major issue. If I divulge my most intimate details to a social worker, can I be sure he or she will pass it on to the psychologist in a confidential manner? This is a major issue for family members. The Irish Advocacy Network undertook research on this issue in Waterford before producing an excellent and accessible document, Every Mother's Son. Last year, the HSE worked with the National Service Users Executive and other partners to prepare a document, The Journey Together, which provides information for family members. We have also worked with the National Library Council on a bibliotherapy approach, whereby individuals can get quality information on mental health needs. Family members often look to the Internet for such information. The quality of the data on the Internet can be uneven, at best.

Our professionals are encouraging those who cannot speak about the diagnosis, treatment and care plan of a family member to listen to others. We are encouraging professionals to meet family members, where they wish to do so. Some families are overwhelmed by this acquired disability. They feel they have suddenly been cast into complex situations and roles. For example, under the Mental Health Act family members have an opportunity to seek treatment for an individual who does not care to have such treatment. The extent of that phenomenon — the detention issue — has been reduced to just 8% of admissions today. The vast majority of people who use the mental health services do so of their own wish and actively encourage family members to be involved. The best outcomes are achieved when quality therapies and good information are used with active involvement on the part of family members and service users.

Many people have grown old in the mental health service, unfortunately. In the past, the expectation of leaving the hospital was a remote possibility in some instances. I met my equivalent official dealing with the care of older persons, Mr. Noel Mulvihill, yesterday afternoon. He told me it appears that many people are using the Fair Deal model to move from psychiatric care to more appropriate service models. The Fair Deal approach does not work for individuals who might need an approved centre. The case of an individual who is detained, for example, is outside the scope of the Fair Deal. Under our capital programme, which was mentioned by Mr. Gilroy, we are aiming to provide a much better standard or calibre of care — in single en suite rooms — for individuals who have grown older. Our expectation is that the mental health service will not require these adapted community nursing units as they are currently being built over the longer term and they will ultimately be returned to mainstream older person care.

To sell and dispose of the old hospitals we need to provide an upgrade in service quality. That is happening at Clonmel and Ballinasloe, which has already been built. St. Senan's in Wexford will be replaced under that model and an upgrade is taking place at Mullingar in what is a major investment. We have to attend to our most loyal customers — those who have spent many years and sometimes their entire lives in institutional care as children, adolescents, adults and, now, as older persons.

I was asked about suicide data. Unfortunately, Mr. Geoff Day, the director of the National Office for Suicide Prevention, is trapped overseas because of the difficulties arising from the Icelandic volcano. Data relating to suicide, self-harm and parasuicide are often time delayed but the Lancet published a piece in July 2009 that suggested that for every 1% in unemployment there could be a corresponding 0.79% increase in completed suicides. In Ireland, approximately 11,000 individuals present to accident and emergency units with self-harm and there is a suggestion that up to a further 60,000 individuals may self-harm but not present. We do not have the data telling us why an individual adopts that approach and we need further information.

I was also asked about developments in child and adolescent mental health. We are starting from a low base as a quarter of the population are children. There has been less recognition of the mental health needs of children and it used to be suggested that young children did not become depressed and did not tend to develop psychosis. When I was training it was suggested that psychosis in children was very rare but research today suggests we can see the seeds of psychosis in children as young as 12.

When A Vision for Change was published in 2006 we had 39 teams and today we have 55 but very few are fully developed as set out in A Vision for Change. As an exercise in transparency and openness we published a full and detailed breakdown of all our teams on the HSE website on 10 October 2009, including waiting times and details of diagnostic groupings. Every month, every child and adolescent team contributes to the database and in November we give further detail to provide a more in-depth view of the progress of young people using the services. In a short space of time there has been a significant reduction in waiting times and waiting numbers. One of the reasons waiting lists move slowly is that, in urgent care cases, family members are encouraged to go to their general practitioner and if the GP feels the child needs an urgent referral an urgent referral is facilitated immediately.

There has been regional unevenness in terms of team development, team numbers and the professional make-up of teams but we are addressing that in a progressive way. In 2009 we received additional funding for 35 new professional posts and they have been recruited in various regions.

Mr. Gilroy addressed the question of whether money from the sale of lands was invested in the area concerned. I trained at St. Loman's and we held a strong interest in the funds realised by that sale being reinvested. However, we are conscious that several counties have no facilities to sell. There never was a large mental health infrastructure in County Longford, in north Tipperary, Wicklow or Meath and those counties would have to be overlooked if we took that approach. It is a multi-annual investment programme and the Minister of State is to be congratulated on securing €50 million in a difficult year.

On 1 March we announced 12 major projects which would advance this year. The projects are about creating A Vision for Change, new service capacity and a radically improved service quality in terms of accommodation, as well as addressing some of the concerns raised in the reports of the inspectorate of mental health services in the Mental Health Commission. In the next couple of weeks we will see a major joint report by the Mental Health Commission and the University of Limerick, prepared by Professor Stiofán de Burca and his colleagues, on adult mental health teams, the function of those teams and how and where they operate.

Several questions related to the area of suicide post-discharge. It is well recognised internationally that the first 48 hours post-discharge are always difficult. Individualised care planning is also a responsibility of the health services and we are working in collaboration with the Mental Health Commission to pilot improved designs in that area. A strong follow-up on the day of discharge is important and we have learned that discharging on a Friday is not a good idea because community provisions are quite limited at weekends. However, we are working on protocols to produce a satisfactory model.

It was said that 25% of the population will develop a mental illness and at the launch of See Change it was pointed out that 25% of women can expect to have breast cancer. Not so long ago breast cancer was referred to as "cancer of the outer chest wall" because there was a reluctance to use the word "breast" and a reluctance to use the words "mental health" has often limited us in a similar way. We need people to be comfortable with the language and our research shows young people are much more positive in that regard.

There has been huge interest in our on-line developments, our television, poster and billboard campaigns and our Bebo page. There has also been interest in our Let Someone Know and Your Mental Health campaigns. In 1966 we spent 23% of the health budget on mental health care but it was an enormous structure and almost 20,000 people were accommodated and lived out their lives in the mental health arena. Our service models are much more efficient and agile now. In the past year, because of the public service pay reductions and significant retirement numbers, there has been a significant saving in the mental health spend but 88% of the mental health budget is spent on labour. Good quality mental health care is labour intensive and is about building quality relationship with skilled professionals. We do not tend to use expensive high-end technologies such as MRI scanning or other invasive techniques. The basis of a good quality mental health service is quality staff working in the right space at the right time and intervening with people at the earliest opportunity.

Mr. Gilroy responded to questions about the Central Mental Hospital. The executive clinical directors were appointed last June and I met them last Friday, as we do every month. In Dublin north east the three executive clinical directors are Dr. Anne Jackson, Dr. Mary Cosgrave and Dr. Margo Wrigley and we can supply contact details to members if they wish. In Dublin mid-Leinster they are Dr. Ian Daly, Dr. Justin Brophy, Dr. Maurice Gervin and Dr. Harry Kennedy, the executive clinical director of the national forensic service. In HSE south they are Dr. Noel Sheppard, Dr. Maeve Rooney, Dr. Frank Kelly and Dr. Eamonn Maloney and in HSE west they are Dr. Kieran Power, Dr. Owen Mulligan and Dr. Jack O'Riordan. We will circulate all contact details and I am sure the directors will be happy to meet local representatives.

On cross-sectoral working, on Thursday afternoon we will meet colleagues from the Department of Justice, Equality and Law Reform. We have a protocol in the new disability housing piece with the Department of the Environment, Heritage and Local Government and have had good collaboration with a number of Departments, including some not referred to in A Vision for Change such as the Department of Agriculture, Fisheries and Food. The farm animal welfare advisory council, FAWAC, was set up to enable district veterinary officers to go on to farms to check on livestock which have been neglected because the farmer has become depressed.

I am sorry I arrived late. Not being a member of this committee I was not aware the meeting was taking place. I wish to raise the closure of St. Senan's Hospital in February 2011. The staff, the families of patients and politicians across the political divide have bought into the closure of the hospital but want a proviso that there will be an admission unit at Wexford General Hospital. Several Ministers over the past seven or eight years promised that there would be such a unit when St. Senan's closed but we are now told that, arising from some emergency, St. Senan's must close next February and the admission unit will be based in Waterford General Hospital. There is uproar in Wexford over this, rightly so, because we were given an assurance in recent months and years by different Ministers and the HSE that there would be a new state-of-the-art admission unit in Wexford. We understand we might meet the Minister of State tomorrow night to discuss this issue. It is important to state clearly the total dissatisfaction of the nursing staff, the psychiatrists, the medical people and, particularly, the families of patients. They do not see as a runner the suggestion that they might have to go to Waterford. It is another example of the HSE wanting to divert everything to Waterford. The Minister of State knows, having been to St. Senan's Hospital, that a significant amount of land is available at the grounds of the hospital. We were given an assurance to the effect that when the hospital is sold, the moneys will be ring-fenced and spent in County Wexford to provide mental health services to people who have attended St. Senan's Hospital. I am old enough to remember when the hospital had walls around it. The walls have come down and the patients have come out into the community. They have always been made very welcome. It is a retrograde step to consider transferring the admissions unit to Waterford and to leave Wexford aside. I ask the Minister of State to intervene on this issue. He will hear from other politicians across the political divide about the disharmony and annoyance that exists in Wexford at present.

I am conscious of the comments that have been made about See Change. I thank the joint committee for its positive support. I am very aware of the media issue. The lack of media coverage last week is an indication of the challenge we face. The media often reflects broader social opinion. If the media is not interested, it is clear that we have a huge job to do. We are up to that. See Change is a cross-sectoral organisation with 28 member partners in a variety of different sectors, including those of sport, health, business, arts and culture. We are in discussion with 25 more organisations. I assure the committee that by the middle of the summer, we will have made arrangements with approximately 50 organisations. Over the next two to five years, the organisations will develop local and national messages and projects. They will give people information about mental ill-health. They will ask, persuade and cajole them to change their attitude, their behaviour and their response to the world of mental ill-health. We will use the national media, obviously. We have to plug away at that. We will use local radio and print media too. A number of projects are in the pipeline to that end.

I was asked about presentations. We will make a variety of presentations, featuring people who use mental health care services. Some of them may be celebrities and others may not. They will tell their stories honestly to give a sense of hope about recovery to those who are living with mental health problems. We will have meetings with local organisations and use the networks they provide. For example, the Irish Sports Council has signed up to our approach. We will use the council to access organisations, networks and connections across all sports and thereby get the message across. We will use rural and urban organisations. Mr. Rogan referred to rural environments. The Irish Farmers Association has given us a commitment that it will allow us to use its network to access rural farm families across the country. That will enable us to access people who may not be accessed through ordinary methods. It is a question of using local organisations to spread local messages in towns and in the countryside.

Deputy O'Hanlon asked about mental health associations. I am glad to say that Mental Health Ireland is one of See Change's partner organisations. Mental Health Ireland will work with up to 40 local mental health associations. We work with some or all of the organisations over time. It is fair to say that stigma is a cross-sectoral issue. Therefore, the response is to work cross-sectorally. Messages, projects and programmes will come from all aspects of society. I thank the committee for its support. We hope to return to look for support across the political spectrum in the future.

It is obvious that the issue raised by Deputy Browne has a certain significance. It has been cropping up in other counties as well. I hope I will get as long to answer questions at the next meeting as the Deputy was given to ask questions today. I am not sure what commitments have been made by other Ministers. All I can say is that St. Senan's Hospital was one of the first three hospitals I visited, along with the hospitals in Clonmel and Letterkenny. I particularly remember that the meeting in St. Senan's Hospital was the first time I heard a phrase on to which I have held since. It was said that this should not be about closure plans — it should be about development plans. It was the first time I witnessed the huge demand for change. On the day in question, the local authority and the executive were in favour of rezoning. I have not been privy to any discussions on changes to what has been promised.

I assure Senator Prendergast and Deputy Browne that I am committed to driving the reform programme, as they are. Rather than focusing on the difficulties in each county, perhaps the time has come to meet all Oireachtas Members to explain how the national picture will affect people on the ground. We need to explain how we will deliver a proper reform structure that will not place any county at a greater disadvantage than any another county. We need to try to win support for this programme. It should be taken into account that when the reform programme was first announced, it achieved absolute buy-in from the medical people, the service users and the service providers. I acknowledge that public representatives on the ground are being questioned about where we will go from here. I will facilitate a meeting with them.