asked the Minister for Health if he accepts that in relation to psychiatric services, institutional care should remain until community care facilities have been properly developed; the additional finances which have been allocated to the health boards for the provision of community care facilities; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Community Care Facilities.
7.
I am committed to the development of a comprehensive, community based psychiatric service. The report, Psychiatric Services — Planning for the Future, outlines the steps needed in order to achieve this. The health boards are now working on implementation plans based on the report's recommendations. New community services will in many instances replace existing hospital services. This means that the build up of community services and the scaling down of institutional services will occur simultaneously.
Community psychiatric facilities do not necessarily need to be purpose-built. Many hostels for the mentally ill are provided by the local authorities and existing buildings can be adapted for use as day centres. The health board's plans will include their requirements for new community psychiatric services. The detailed proposals will be examined in the context of the health board's overall plan and a decision as to funding will then be made.
I put down this question because of the widespread concern about the closure of two psychiatric hospitals. What exactly is meant by "community based care"? Does the Minister accept that the experience in other countries indicates that simply the closure of hospitals and failure to provide adequate community based care has resulted in a demand for the re-opening of these institutions and that we should avoid that at all costs?
I have no intention of contributing to such a situation. We will and we can avoid it. There is no comparison whatsoever between the position here and, for example, in the US and Italy which we hear cited so frequently. I have met the Italian Minister for Health and I know that the position there is totally different from ours. It is possible to provide community services which would not be additional to existing institutional services but, as far as possible, replacements for them. We are doing that in consultation, in particular, with the two health boards concerned. We will work unceasingly this year to bring that about.
In relation to his plans for Clonmel, the Minister will be aware that there are many patients in Clonmel from the Eastern Health Board area and that the health board have indicated they have nowhere in which to place those patients in institutional or community care. Is this not the danger most people fear, that the closure of large institutions will result in numbers of people being thrown on to inadequately developed and funded community based care? Indeed, they would be thrown on communities who would be unprepared to deal with psychiatric cases. On that basis is there not an immediate need for a review of how he will proceed with the implementation of his plans?
I will approach those problems on a positive basis. At any time in Ireland one will receive most articulate and comprehensive reasons for not doing something. I am sure the Deputy was referring to Carlow rather than Clonmel. In relation to Carlow, I have given approval for immediate design work for the 30-bed acute psychiatric unit in Naas General Hospital. Phase 2 has been brought forward to the middle of this year. That, to an extent, will take care of the catchment area of Kildare with its approximate 70,000 population. I am reviewing admissions to Carlow and the provision of resources there for supervised and unsupervised hostels in Kildare and Carlow. I am examining the possible provision of day care facilities in the area. The Deputy will share my view that a number of mentally handicapped patients in Carlow and in the other hospitals should be taken out as quickly as possible and put into alternative care. I am not including in my references the prospect of the immediate opening of a 50-bed psychiatric unit in Beaumont Hospital, adjacent to the Deptuy's constituency. A great deal of work can be done during 1986 but it will be done in a sensitive basis.
Is the Minister familiar with Planning for the Future which states that no psychiatric unit would be closed without the provision of facilities in the community? In relation to the proposed closure of Castlerea psychiatric hospital in Roscommon, has the Minister made any real finance available for the provision of facilities in the community for the 250 patients who will be dislodged in 1986 if he has his way?
I have directed officers of my Department to visit, for example, Roscommon General Hospital this week and I look forward to receiving their report. We have several ideas, notably the prospect of building a 30-bed acute psychiatric unit in Roscommon County Hospital using existing facilities or constructing the unit within the framework of that hospital, so that nobody — and I repeat nobody — goes into Castlerea unless they have gone through the acute general hospital psychiatric assessment unit. That is of critical importance whether it be in respect of Carlow or Castlerea. In Roscommon town there is an unopened mental handicap workshop day care centre. I am examining these matters and we are having discussion with the health board with a view to developing all these structures. The work is going ahead quite rapidly and I will be in consultation with the Deputy and his colleagues in that regard. My only request is that we approach this in an orderly way, having concentrated our minds on these very important matters.
I would not recommend that the Minister have consultations with me or with my colleagues because we are opposed to the closure of Castlerea. There is no way 250 patients from Castlerea can be accommodated in a unit provided for 30 patients in Roscommon town. The Minister has made no financial provisions in 1986 for the community care of the 250 patients in the Castlerea hospital.
That is not a question.
My question concerns the allocation of resources to the development of community-based psychiatric facilities. Would the Minister accept that there will be a need for greater resources in the psychiatric area because of the need to maintain a level of institutional care while the community-based care is being developed? Would the Minister confirm that he does not see the scaling down of institutional care as simply a cost cutting exercise?
I am not convinced of that. In relation to Carlow, there is a provision of £3.8 million for psychiatric resources for 1986 and £4 million for Roscommon. Within the framework of that money an alternative treatment model can be provided — and God knows it should be provided in many other parts of the country as well. I agree that there may be a need for additional capital resources but in terms of the number of persons working, they must come from behind the institutional structures and into the community and the nursing and ancillary staff must work within that framework. On that basis there is no great need for additional revenue moneys. Capital moneys for buying hostels and buildings, using alternative facilities and so on, are readily available. They are once-off capital moneys. I am convinced this can be made to work with the support in particular of the Eastern Health Board, and I hope, the responsible support of some senior psychiatric consultants although I despair of some of the statements they have made, with due respect to the profession. I hope we will make considerable progress in that regard.