I move:
That Dáil Éireann is of the opinion that present facilities in this country for the treatment, care and education of mentally handicapped children are deplorably inadequate and calls on the Government immediately to ensure that adequate facilities are made available so as to remedy the present unjust situation.
The object of this motion is to draw attention to a national scandal, to awaken a dormant consciousness in our society to a great social evil and to urge the Government to take action to alleviate a gross injustice in our midst. It has, let me stress, no political overtones. Considerations of Party politics do not motivate it. For too long have the plight and condition of mentally handicapped children and of their parents been neglected and their tragic situation been avoided. For too long have apathy and indifference contributed to official inactivity.
There are too firm official statistics dealing with the extent of the problem but reliable estimates have been made and the facts which there estimates demonstrate are eloquent and require little embroidery. There are approximately in this country 2,000 beds available for mentally handicapped children. It has been reliably estimated that 7,000 more are needed. There are approximately 500 to 600 places in special schools for mentally handicapped children. It has been reliably estimated that 5,000 are needed. It has also been reliably estimated that approximately 10 per cent. of all our children are either mentally handicapped or educationally retarded and need special care and treatment.
There is in this whole country one child guidance clinic. There was up to recently only one qualified educational psychologist. There is no psychologist attached to any local authority. There is no official or one body responsible anywhere in the State for dealing with this problem. There is no proper system of diagnosis. There is no after-care system for children who may benefit from education and treatment at special schools and there is no placement system for such children after they leave school to ensure that they get adequate employment. These are the facts of the situation. This is the neglected system which for one reason or another has been permitted to develop in this country over the years.
I have said at the outset that this has no political overtones and it is not my intention to apportion blame to any one Government, to any one Administration, to any one group of local authorities, but it is my intention that the Dáil should put on record its grave concern at this situation and endeavour to see that the Government takes action to deal with it.
I do not want to minimise the problems which the Government and local authorities may have to face but I do believe that those problems could be, at any rate to some extent, minimised if a favourable body of public opinion were behind the Government taking those measures. One of the objects of this motion is to try to foster a public opinion of that sort which would in itself assist the Government in the steps and in the measures which it must, I believe, take.
One of the things urgently needed in this country is proper legislation to deal with the problem. I do not for a moment accept the statement in the White Paper published recently by the Government that our existing legislation is sufficient to deal with the problem. I feel certain that there was some debate in the Cabinet as to which Minister would be responsible for this motion; was this a health problem or was it an education problem; should the Minister for Health or the Minister for Education deal with it? In the White Paper recently published by the Department of Health reference is made to the fact that there are educational problems involved in this subject.
What has happened is that neither the Department of Education nor the Department of Health has any direct single responsibility for this matter, that the responsibility is diffused through these Departments and through local authorities and as a result the situation has not been properly dealt with.
I suggest we need legislation in this country, legislation similar to that which exists under the provisions of the Education Act, 1944 in England. I would suggest that the Parliamentary Secretary should have a look at that Act. He will see there that, under Section 34, the educational authorities throughout England—and this applies to Northern Ireland also—are given a statutory obligation to inquire into the mental health of the children in their area and to provide special educational facilities where they are required. No such legislation exists in this country. There is no legislation in this country requiring any local authority to give special education to our mentally handicapped children. I would suggest that it is a sine qua non of progress in this regard that a proper legislative framework be established to deal with the problem.
Legislation, of course, will not cure it and legislation is only the framework in which the problem will be tackled. What is urgently needed in this country is a proper system of diagnosis, treatment and after-care. It would not be a difficult task to set up immediately a diagnostic clinic, for example, in the City of Dublin. Suggestions have been made by a responsible person intimately connected with this problem that such a central diagnostic clinic could be attached to one of the Universities in the City of Dublin where a qualified staff could be present, where the extra facilities needed would not be very great and where general practitioners could send for diagnosis and report children with special problems with which they are not qualified to deal. It should be possible to establish such centres in other parts of the country also.
One of the important aspects of proper diagnosis of children is in relation to those suffering from suspected mental disturbances, mental illness or mental defects. That problem could be solved comparatively easily, in the City of Dublin at any rate, and not at any great cost. From my own knowledge I can say there is great need for a proper system of diagnosis of children suffering from mental handicap, mental disease or mental defect. The tragedy of this situation is that a number of these children, not of course all, can be cured or at any rate have their condition considerably alleviated but because of lack of diagnosis they go through life handicapped, wrongly handicapped, because of inadequate diagnosis.
I do not think we should wait until a committee is set up, until a committee has sat for two or three years and has sifted all the evidence, to know what any of the experts on this question will tell the Minister and the Government tomorrow, that the first thing that would help in a material way would be the establishment of an adequate system of diagnosis and that such a system could be started without too much difficulty, in the City of Dublin and elsewhere.
Up to recently, as I have said, we have had one educational psychologist. There was a course started recently in educational psychology and it is in my information—and I understand it to be fairly reliable—that a small group of people who qualified from that course could not get jobs and had to leave the country. That is a deplorable situation. I see no reason why groups of local authorities should not have the assistance and service of one education psychologist. It would be a simple matter to work out according to area and population how many groups of local authorities should combine and how one could serve several areas at the same time. The courses are available; I think the applicants are there but the jobs have not been created.
The problem goes beyond mere legislation and more diagnosis. Treatment is necessary and I think it would be proper if a tribute was paid by me and by this House to the voluntary organisations who have been dealing with this problem, particularly the Religious Orders, the Hospitaller Order of St. John of God, the French Sisters of Charity and the Brothers of Charity who have brought their own vocation to this problem and who have given such tremendous assistance in the past. There have been also a number of voluntary organisations who have alleviated the problem to some extent. The fact remains that the efforts which have been made by the Religious Orders and by the voluntary organisations have been entirely inadequate. We need a great increase in the number of people teaching and nursing mentally handicapped children.
The problem can be divided into two sections: the problem of children who need institutional care and the problem of children who do better in day centres. It is generally accepted that at a certain level of intelligence quotient it is better for a mentally handicapped child to attend a day school or a day centre rather than get institutional treatment. Up to a few years ago there was no day centre in the whole of this country. There has been one started recently in the City of Dublin which copes very inadequately with an appalling problem. There has been one started recently in Cork and also in Waterford. Beyond that and beyond the efforts of some voluntary organisations there has been no proper system of day centres. It has been estimated—again on a perfectly reliable basis—that at least six day centres are needed in the City of Dublin and there should be at least one in Cork, Limerick, Waterford, Galway and Sligo in order to start dealing with this problem.
The teachers who deal with mentally handicapped children require a special vocation and special training. It has been said in an endeavour to excuse official inactivity that it might not be possible to get the necessary recruits for this work. I do not accept that. I know of people involved in this work who would gladly take it up as a career, who would gladly undertake it as a vocation if it was organised on a proper basis, if they knew there were going to be schools and that they could make their career out of it. However, there has been no opening and no career. I should say, however, that the Department of Education has been endeavouring to get some of its national teachers to interest themselves in this problem and to undertake training in England. There has been some response to this appeal, a response which has been entirely inadequate.
At present we have a tremendous percentage of persons qualified to deal with mentally handicapped children, and the point I wish to make is that this is not one of the insuperable problems, that I believe there are people who would come forward to follow this vocation and who would be qualified to do so if, in fact, the machinery of the system were properly developed. Of course the low grade mentally handicapped children require institutional care and treatment. I know there is not a Deputy in this House who does not know of parents with mentally handicapped children and of the terrific struggle they have to get them into one or other of the institutions. These institutions are appallingly overcrowded. There is an appalling shortage of beds for mentally handicapped children and the position is that many of these children will not get into institutions because the accommodation is just not there for them.
The provision of hospitals and an adequate number of beds would cost money. It has been estimated it would take between £5,000,000 and £7,000,000 to produce the facilities which would be needed to deal adequately with the institutional side of the problem. Is that an insuperable difficulty? Can we not find £5,000,000 to £7,000,000 to provide proper accommodation? If the public were informed that it might have to put up with a penny extra on income tax in order to provide this, do you think would it accept that? If the public had to do without some item of capital expenditure in order to provide this £5,000,000 to £7,000,000 do you think the public would willingly forgo some item of, perhaps, a luxury type of capital expenditure? I think the public would.
I think our people, if they were informed of this, would be willing to make whatever sacrifices would be necessary in order to provide the money needed to supply this extra accommodation, and we are fortunate in that we are not approaching the problem without any resources. We have already the resources offered and given by the religious societies which are dealing with a certain percentage of mentally handicapped children and, therefore, our problem is not one of extraordinary difficulty. It is one in which, perhaps, sacrifices would be required but I, for one, feel confident that if the situation were adequately explained to our people and public opinion informed, whatever sacrifices were needed would be forthcoming.
Of course the problem continues after a child has grown up and left a special school. The experience elsewhere has been that a child who gets proper treatment, who is fortunate enough to be attended by a qualified teacher, who is fortunate enough not to be too greatly retarded can, in fact, become a useful citizen and can fulfil himself or herself in a way which would be impossible and it not got this treatment, but we have no proper system of after-care treatment. We have no proper system for placing them in jobs. Young boys and girls who have gone to one of our special schools and who come out at the ages of seventeen or eighteen, without having anybody to look after them adequately for after-care treatment, are in a bad position. Part and parcel with the legislation which I suggest is necessary, there should be a system of after-care for children who are attending special schools, and a placement system which would see to it that suitable jobs are made available for them so that they can play a useful role in society.
The plain truth is that 70 or 80 miles from here, across the Border, mentally handicapped children are much better cared for, and the same is the case in Great Britain. That is because somebody, some central organisation, has been made responsible and because the necessary funds have been made available. I would suggest that this is something of which we cannot be proud in this part of the country but it is something which should spur us to greater effort. The tragedy of the situation is that many of the children, who to-day are deprived of the services they could get in other countries, could have their lives bettered, could fulfil themselves to a much greater extent if they were given the treatment and care that is necessary, and some hope and happiness could be brought into the lives of parents who have to shoulder this great burden.
We should not forget the problems of parents of mentally handicapped children. One of the matters to which I wish attention directed is the fact that mentally handicapped children are somewhat in the position of persons suffering from tuberculosis some years ago. At that time tuberculosis was a dreaded disease which people were afraid to discuss, were even afraid to admit, and because of that its onslaught was made all the worse. I am sure Deputies know of parents— I know of several to my own knowledge—who have had mentally handicapped children and who have been afraid to admit it to themselves. I know of one mother of a boy of five who did not know he was a mongol child who would be permanently mentally handicapped and the shock to her, following her unstinted devotion and personal training of this little child, was made all the more appalling when she learned that the child would be permanently mentally handicapped. Following on that I think the position of parents could be greatly relieved by a proper system of approach to this problem, a system of education of the parents, a system which could have the assistance of qualified people.
I want to deal briefly with the terms of the amendment that has been tabled. I regret that the amendment has been put forward. I feel it is bringing into the discussion an element of contention, if you like, an element of Party politics which should be absent from it. First of all, the amendment suggests that Dáil Éireann:
while conscious of the fact that due to historical causes present facilities for the treatment, care and education of mentally handicapped children are inadequate, realises that it has been the constant purpose of successive Governments within the limits of the resources in money, personnel and accommodation available to them to remedy this situation...
I regret that I must differ from that statement. I do not think it has been the constant purpose of successive Governments, within the limits of their resources, to deal with it. I believe it is a problem which has been largely ignored for one reason or another, a problem which people have not been concerned with for one reason or another. As I say, I do not wish to apportion blame but I do not think there has been a public consciousness in this country among people in public life, among Deputies, among journalists, among editors of newspapers, among teachers, among those responsible for guiding public opinion or dealing in public affairs, of the greatness of this problem until comparatively recent years. That is something we should try to remedy.
The amendment suggests that we should welcome the Government's White Paper entitled The Problem of the Mentally Handicapped Children which outlines the chief aspects of the problem and the progress which has been made in regard to it. I do not see there is any reason to welcome the Government's White Paper. I do not think it is a White Paper at all in anything but the name. As I understand it, a White Paper is an official statement of Government policy in dealing with a given subject. There is no policy in this so-called White Paper. It is a statement of a very serious situation. Information is given to the public on this problem in the form of an official document. In the words of the White Paper itself it is stated that “the primary object of this paper is to outline what is involved in the problem, what has been accomplished already and to inform the public as to the salient difficulties involved in making provision for further expansion of the services of the mentally handicapped.”
There is no statement of Government policy, no statement of what the Government proposes to do. There is in this White Paper a statement of the number of beds available, the deplorable shortage of accommodation and the statement that it would cost many millions of pounds to remedy. There are a number of questions at the end dealing with the problem, how to deal with such-and-such a problem, but, as a statement of Government policy, it is certainly inadequate. I do not think this White Paper is something the Dáil should recommend.
The amendment suggests that the Dáil "should note with satisfaction the accelerating rate at which deficiencies in institutional accommodation are being made good." I do not note with satisfaction the accelerating rate at which deficiencies in institutional accommodation are being made good. I would suggest that no reasonable Deputy would note with satisfaction what is a deplorably slow rate of progress. I am not denying for a moment that extra beds are being made available, but I would say the rate of progress is entirely inadequate and that certainly this Dáil should not note with satisfaction the present rate.
We are also, the amendment suggests, to note with satisfaction the attention which is being given to the development of day training centres. What the White Paper says is that a day training centre has been set up in Cork. Dealing with how many children? Ten. What the White Paper says is that a day centre has been established recently in Waterford, a sort of créche rather than a day training centre. It notes also that a day centre is being established in Dublin. I do not note with satisfaction that the Government have attended to these facts. If in fact there was an indication that legislation was to be introduced to give power to establish day centres and to man them adequately. I would certainly note that fact with satisfaction. But it does seem to me that we are using diplomatic language in a very extreme form if we are to suggest that we should note with satisfaction the fact that the Government have noted the developments of private organisations.
The amendment also proposes that the Dáil should endorse the policy which the Government has outlined and is confident that it will be given effect with all possible speed. I do not know what policy the Dáil is to endorse. I know Ministers have said: "This is a serious problem and we are doing everything we can to deal with it." I know we have official statements from Ministers replying to debates from their Departments saying: "Yes, this is a serious problem. Officials of my Department are considering it and, within the limits of our resources, we are doing everything we can." That is the sort of official statement which a Government or a Minister will make to excuse inactivity. I do not see why the Dáil should be called upon in this amendment to endorse the policy the Government have outlined. I do not think the Government have outlined any policy in this subject.
May I just refer to the only recent statements I have been able to find in this matter by different Ministers? The Minister for Education very briefly dealt with it when replying to the debate on the Estimate for his Department. In a very short paragraph at Column 402, Volume 182 of the Official Report, he said:
The question of the mentally retarded child as an educationaly problem is always before our minds in the Department of Education. We have at present provision in eight centres for such children and the full accommodation available in these centres is not being used. In spite of that, plans are in train for increasing the accommodation, for making more educational provision for mentally handicapped children.
He left it at that. I have no doubt the Minister for Education, as a responsible person concerned with this problem, has asked that plans be put into operation to deal with this problem. However, we are not told what progress has been made. We are not told how many national school teachers have gone to be trained in England. Is it half a dozen, a dozen or 20? I would suspect it is probably the middle figure. If that is so, then the number being trained at present are entirely inadequate for our needs.
The Minister made a statement on that which, if one interpretation is put on it, is certainly not accurate. He says that we have at present provision in eight centres and that the full accommodation in these centres is not being used. If that is to be interpreted as meaning we have enough day centres, that is certainly not correct. If it is to be interpreted as meaning that the people for lack of transport or knowledge, for one of many reasons, are not sending those children to one or other of those institutions and that that there are places available, that may be true. It is not true to say or imply—I do not know whether the Minister so intended— that we have adequate facilities to deal with day centres and accommodation. The Department of Health White Paper establishes that beyond any doubt.
The Minister for Health also dealt with this problem. In answer to a Parliamentary Question on the 25th May this year, at Column 232, Volume 182, he said:
I have been giving considerable thought to the general problem of the mentally handicapped and have recently had a White Paper published on the subject. As the Deputy may see from reading that Paper, the subject as a whole needs a great deal of study. As regards accommodation, there are 2,620 beds now available, and a further 600 beds are in prospect. It is estimated that as many as 4,000 further beds may be needed, the capital cost of which might come to between £5 million and £7 million. It would be quite impossible at the present time or in the foreseeable future to make funds of this order available for the purpose.
I do not know whether that is the statement of Ministerial policy referred to by the persons putting forward this amendment—"the whole problem needs a great deal of study." I do not think that is a statement of policy. Or does the statement of policy refer to the fact that we need £5 million or £7 million and that it would be quite impossible at present or in the foreseeable future that funds of this order would be available for the purpose? If that is the statement of Ministerial policy, I disagree violently with it. If that is the sum necessary to make institutional treatment available. I think it should be provided and that it is not exorbitant in current circumstances. May I say that if you were to sell the jet aeroplanes, you would get very nearly £5,000,000.
