This institution has been in existence for a hundred years. Comments were made about it in the Report of the Commission on Mental Illness in 1966. The comments were universally unfavourable. This hospital should serve a remedial or rehabilitation function for people who are there. I believe the Department of Health, who are directly responsible for this institution with the Department of Justice, have been particularly neglectful and completely complacent in their failure to implement the recommendations of the commission in regard to this hospital.
The Minister and his predecessors have frequently dismissed the need to make any change in this hospital on the plea that when the joint authority took over it would then be a matter for the Dublin Health Authority, and the regional board. That shows an extraordinary lack of responsibility by the Department of Health because the recommendations were the recommendations of a very authoritative body of distinguished psychiatrists from this country and abroad. I gather from reading the commission's report that there was a very definite sense of urgency in regard to the need for changing the conditions in the Dundrum Central Mental Hospital but no significant changes have taken place. I want to emphasise in relation to the therapeutic standards in the hospital that I do not suppose they are any worse or any better than those in any of the other prisons or custodial institutions in the State. I am not inferring any criticism whatever of the three psychiatrists who are in charge of the hospital. I simply say that they have not been provided with a team of specialists, trained psychiatrists in forensic psychiatry, psychologists, psychiatric social workers and nurses with special forensic nursing training.
I cannot understand why these remedial changes have not taken place since 1966. The Minister has repeatedly said that people would not take the posts advertised. He seemed to feel that because it is taken over by the Dublin Health Authority in some remarkable way this will all be changed and people will go to work there. I should like to know his reasons for this assumption because he knows the very great difficulty about recruiting psychiatric service personnel at the present time. The institution is staffed to a dangerously high level with temporary psychiatrists who move around frequently, who certainly have no sense of continuity in their work and that is particularly important in this sphere.
The reasons for this are well known to the Minister. There is dissatisfaction with the conditions of service generally. The Minister must also know that matters are coming to a head between the medical union and himself and between the association and himself. Both bodies are very disturbed at the continuing deterioration in the quality of service in the mental hospitals generally. It is very difficult to get people to work in this kind of hospital. The work is of a type which will not appeal to many people for obvious reasons and, therefore, the Minister will probably have to make a special case for the Dundrum Central Mental Hospital.
Why is it that the Minister was unable to take the same action in regard to anticipating the take-over by the regional board which he took in regard to the setting up of the drug centre at Dundrum? He went to some trouble to have staff recruited for this drug centre so that there would be no delay once the take-over and the amalgamation took place.
The Minister and his Department appear to display apathy or indifference to the conditions for people in this hospital. It is because of the absence of remedial therapeutic facilities there—and I emphasise the word "remedial"—that I have protested here on a number of occasions about a young man, and the Minister knows to whom I am referring, who is in this hospital on charges of incendiarism, and if he is to stay in Dundrum, in fairness to him and his unfortunate family, he should have access to whatever services might help him to recover from the illness from which he is suffering and allow him, when he does leave the place, to be normal in every way.
The Minister knows that if he is to go through the long and difficult machinery of the Local Appointments Commission to make appointments, it will be a long time before he will have a staff in this hospital. Has the Minister any specific plan or have any recommendations been put to him which would give us some hope for these unfortunate people in this hospital? I take the view that they are all people who are ill—I do not accept the concept of criminality at all—and need medical help. The longer this is delayed the more difficult it will be to help them.
I would like the Minister to say a little bit more as to precisely what kind of person will be kept in this hospital. For instance, I am rather doubtful about the idea of drug addicts being sent to Dundrum. The whole project seems rather vague. Apparently they will go there and even though they may be admitted as voluntary patients they may be kept there. I am not quite clear about the conditions under which they may be kept there.
The Minister must know enough about drug addicts to know that if they do not want to stay, unless they are on a temporary form of committal, they simply cannot be kept there. What proposals does the Minister have for seeing that a drug addict who is considered to require this kind of custodial care, but does not opt for it himself, receives it? If the Minister decides to make a person who comes in voluntarily a temporary patient in the hospital, which means the person would not have the right to leave if he wished to do so, the Minister is interfering with the very important principle of voluntary admission to a mental hospital. It is very important to maintain the certainty that a person who voluntarily goes into a hospital may leave if he wishes to do so unless he is either homicidal or suicidal and must be kept for that reason. It is essential to maintain a patient's right to leave, even with this legally debatable right to hold him for an additional 72 hours after he has given notice that he wishes to leave. The Minister must understand that what are involved here are the two approaches to the question of drug abuse in society, whether one tries to encourage people to come for treatment by making conditions of treatment so attractive, which is very difficult, because drug addicts usually do not care so long as they get their drugs, but certainly conditions should not be unattractive so that they will continue to undergo whatever care or treatment is required to make them well again. A number of States in the United States tend to isolate the drug addict in his own interests and the interests of the community.
The difference between these two approaches is that in the second the illness is driven underground. The youngster makes certain he is not caught and consequently the problem becomes a particularly difficult one. In relation to the people who try to encourage drug addicts to come for voluntary care the hope is that they will not be frightened underground and that the relationship between the psychiatrist treating the drug addict and the addict is a trusting relationship rather than the psychiatrist acting as a kind of jailer.
This brings up the question of registration and whether one accepts that the addict——