Vol. 380 No. 4
asked the Minister for Health if he will outline regarding the psychiatric services (a) whether Planning for the Future remains the policy of his Department and (b) the progress which has been made towards the targets laid down in that report, showing bed numbers planned and achieved by hospitals.
19.
asked the Minister for Health his plans for the future development of the psychiatric services.
I propose to take Questions Nos. 7 and 19 together. The development of the psychiatric services along the lines recommended in the report Planning for the Future remains the policy of my Department. The major recommendations of the report relate to the development of a range of services in the community so that people may receive treatment without admission to hospital and the rehabilitation of long-stay patients so that they may return to normal settings. The inevitable result of this approach is that large psychiatric hospitals will not be required. In-patient numbers which have been falling for years continue to do so. When the study group which prepared the report was set up in 1981 there were 12,500 patients in the public psychiatric hospitals. The number at present is 8,900.
Would the Minister agree that the thrust of the report entitled Planning for the Future was the putting in place of community-based services prior to the loss of beds in institutional care? Furthermore, perhaps the Minister would indicate what practical resources have been released in the different health boards to assist in rehabilitation? Is it not a fact that community-based services have been cut back?
The extent to which the services have been developed depends in part, on the level of services at the time the report was published in 1985. In some areas developments were already taking place much along the lines recommended in the report while, in others, they were moving more slowly. I would be concerned at the lack of commitment in some areas to implementing the recommendations of the report. I do not accept that there has been any major reduction in the level of community services available to those who are psychiatrically ill.
The Eastern Health Board have been quite diligent in pursuing this policy which I support. Can I ask the Minister if there is any in-built review process in place in light of the fact that there is a concern that a number of people have been discharged into the community without being ready to cope adequately? There have been reports from within the profession of suicides which have occurred as a result of this. Perhaps there should be a review to ensure that a balance of service is being provided. We might need to review also the numbers proposed. Can I ask the Minister if there is any review ongoing or would he anticipate the need for such a modification of the plan?
We review the situation all the time and, as the Deputy is aware, the inspectors who are over mental hospitals are also available to advise us. The situation needs to be reviewed but I do not accept that people are being discharged indiscriminately into the community.
First, would the Minister not accept that community services by and large are non-existent because of the lack of adequate funding? Secondly, is the Minister aware of statements made recently by one of his party's Deputies with regard to the conditions in which patients were being discharged into the community?
No, I do not accept that the services are non-available. In the Deputy's health board area, £100 million has been allocated and I am satisfied that the Western Health Board have sufficient funding to provide the necessary community services.
Can I ask the Minister if, because of the severe cutbacks in resources in all health board areas, the very proper thrust of this report will be used as an excuse for closing psychiatric beds where totally inadequate provision has been made to receive patients into the community and whether we can learn from the experience in Britain where, as a result of pursuing this policy, many mentally handicapped people ended up in bed and breakfast accommodation without proper care and acclimatisation to normal society?
I am particularly concerned that those who need residential care in psychiatric hospitals will have it available to them and I am satisfied that that is the case.
Would the Minister——
A brief question, please.
Will the Minister, in relation to the second part of my question which was not encompassed in his answer, arrange to send me the statistical information from the hospitals referred to? Can I ask the Minister if it was not the centre point of the report that community-based services would be developed prior to the loss and scaling down of institutionalised beds?
The community services have been developed over the years and, as I have pointed out, the number of patients had reduced from 21,000 in 1958 to 12,500 at the time the committee who prepared the report Planning for the Future were set up. The number now stands at 8,900 so there has been a gradual reduction in the numbers during the past 20 years. I will certainly send the Deputy the statistical information. The Deputy's question asked us to show the bed numbers planned and achieved by hospitals. We would not be planning any beds in psychiatric hospitals. The move is towards having psychiatric beds available in general hospitals and I will send the Deputy the relevant statistical information.
