Deputy Ivan Yates gave me notice of his intention to raise on the Adjournment the circumstances surrounding the finding of the bodies of two psychiatric patients of a hospital in County Carlow.
Adjournment Debate. - Deaths of Psychiatric Patients.
I should like to thank the Chair for allowing me to raise this important matter on the Adjournment. Some of the issues I wish to raise are, perhaps, more appropriate to Question Time, but I hope the Minister will be forthcoming in his reply. On Tuesday week in the river Barrow, which is near St. Dympna's psychiatric hospital in Carlow, Anthony Burke was found drowned.
Mr. Burke, who was 28 years of age, came from Rowanville, County Kildare, and I understand he had been missing from the hospital since late March. Last Friday the body of Mr. Christopher Coleman (32), who was a patient in St. Dympna's was found in the river Barrow. Mr. Coleman, who was from Ballymurphy in County Carlow, had been missing from St. Dympna's since 5.30 p.m. the previous Thursday. I understand that the body was found only a few hundred yards from the hospital.
I should like to ask the Minister if he will agree to hold an inquiry into this matter. I do not wish to cast any aspersions on the staff or the standard of care at St. Dympna's hospital. It is a fine hospital and I have no quibble about it. I should like to know whether those patients were voluntary patients or in-patients. I am not understating the case when I say that it is highly unsatisfactory to have the bodies of patients found in these circumstances.
On my travels to different psychiatric hospitals throughout the country, and from studying reports from two health board areas, including the South-Eastern Health Board, I have learned that there has been an increase in the rate of suicides here. Will the Minister say if he is aware of this trend? I note that the coroner for County Kildare, Doctor B. O'Donnell, in the course of his report stated that in his 17 years of preparing such reports he has noted an increase in suicide rates.
A number of national issues arise in relation to psychiatric care. Last November I raised in the House the circumstances surrounding the death of a patient of St. Ita's Hospital, Portrane. The body of that patient was found on Sunday, 6 November, in a ploughed field adjoining the hospital. I am not singling out the hospitals I have mentioned for criticism but they are symptomatic of a wider experience. I was surprised to read the written reply on 15 November from the Minister on this matter. I resent the contents of it. In the course of that reply the Minister said:
In this hospital the archaic, destructive custodial model of care has been replaced by one in which patients are afforded the greatest possible degree of independence. If the arrangements the Deputy refers to mean the return to locked wards and high walls, then I can assure him we will not revert to this.
That was to misrepresent the argument and the point I raised. The concept of planning for the future and changing the whole notion of psychiatric care out of institutions is something I support strongly. However, I am concerned about the level of supervision and community nursing for voluntary patients. They should be watched in their own interests. If they are nervous or depressed special care should be given to them by the community nursing pesonnel but not in a custodial or oppressive way. We should investigate the procedures to see if they need to be reviewed.
It is interesting to look at the national statistics in regard to this subject. In an article in the Irish Medical Times of 17 March it was stated that the number of in-patients in psychiatric hospitals dropped by 3,000 over the last five years — that was according to figures given by the Minister for Health. On 31 December 1983 there were almost 12,000 patients in health board psychiatric hospitals and units and the Minister, Deputy O'Hanlon, has stated that at the end of 1988 the number stood at 8,600, a reduction of 3,400. Those patients are no longer in psychiatric units as in-patients. However, when we look at the alternative care that has been put in place we see 204 hostels were provided with 1,300 places and that day hostels and day centres had 1,300 attenders. There is a big gap between those figures. If we discharge 3,400 patients and provide day places and hostel facilities for about half that number, what has happened to the remainder? I am wondering if those patients have been discharged into the community without adequate community care facilities for them.
That brings me back to the circumstances surrounding the deaths of the patients I mentioned. Were there adequate hostel arrangements in the area for them? Will the Minister ensure that an inquiry is carried out so that the full facts are brought to light? A statement was issued by St. Ita's in regard to the Portrane patient to the effect that that patient was a "liberty" patient.
I am sorry to interrupt the Deputy. I gave the Deputy permission to raise a specific matter on the Adjournment. It was in respect of two patients from a hospital in County Carlow and I urge the Deputy not to deviate from that subject matter.
I appreciate that. The point I am making is that there are circumstances relating to that case that would lead me to believe that overall policies should be examined.
If the Deputy wanted to raise matters globally he would not have been given permission by me. This is a confined subject and I should like to ask the Deputy to stick with it — the issue of the two patients from the hospital in County Carlow.
I will not delay the House unduly, a Cheann Comhairle, but I should like the Minister to give the full facts in relation to these patients, to state what lessons he considers need to be learned from this episode and what steps he will take to ensure that they will not recur both in this psychiatric hospital and in other similar institutions.
The Acting Resident Medical Superintendent of St. Dympna's Hospital notified my Department in a letter dated 19 April that the body of a patient at that hospital, one of the patients referred to by Deputy Yates, was recovered from the Barrow River on 18 April. The patient, who had been admitted on a voluntary basis was found to be missing from his ward at 8.30 p.m. on 27 March. In accordance with normal procedure, the grounds of the hospital and the local area were searched. The family of the patient were notified and the Garda were given a description of the missing person. Some days later a Garda sub-aqua team searched the river and found the body.
In the second case the acting Resident Medical Superintendent notified my Department in a letter dated 21 April that the body of the second patient referred to by Deputy Yates, who had also been admitted on a voluntary basis, was found in the Barrow River that day. The patient had absconded from the hospital on 20 April. Again the normal procedure with regard to missing patients was followed. As a result of a report that a person similar to that of the description of the patient was seen near the river, a search of the river was carried out by the local sub-aqua club. In neither case, according to the hospital authorities, have the families expressed dissatisfaction about the efforts made by the hospital on their relatives' part.
In accordance with normal procedure, these cases have been referred to the Inspector of Mental Hospitals of my Department who will undertake whatever investigations he feels are required under the circumstances. I may say that the evidence from the preliminary investigation which has been made is that the very highest standards of supervisory care is provided and continues to be provided at St. Dympna's Hospital in Carlow. The inspector or his assistant have inspected each of the public psychiatric hospitals and units in the country, apart altogether from this investigation, and from their reports I am satisfied that the standard of supervisory care for all patients, including voluntary patients and the community nursing arrangements, are generally satisfactory.
I want to deal with the questions raised by the Deputy. With regard to the carrying out of an inquiry, as I have said, the Inspector of Mental Hospitals has already made his inquiry and I hope to have a report from him in the near future. I have the preliminary report and it does not appear that there is anything we need be concerned about. As regards the increase in the number of suicides, certainly an increased number of suicides are being reported but whether that is a real increase or increased reporting of suicides is something one would have to look at.
I want to refer to the man who died at St. Ita's Hospital in Portrane and the Parliamentary Question which was answered. I saw the answer to the Parliamentary Question and was very satisfied with it because I think it is very important that all of us in this House would agree that we should not go back to the custodial service which was provided for years. Maybe it was appropriate in its day but it is very important that we accept the open care method which is being provided at present. Unfortunately the only way we can ensure the patients will not abscond from psychiatric hospitals and end up tragically as these patients did is the high wall. It is very important that all of us in this House would commit ourselves to ensuring that we do not go in that direction again. In fact the patient who died in Portrane went out for a walk in the grounds, which I think we would all recommend, but unfortunately he suffered a coronary thrombosis when he was out. Again I do not think we could hold the hospital or the authorities in any way accountable for this incident. It could have happened to him in the building just the same as it happened to him outside.
With regard to the final question raised by Deputy Yates, it is true that the number of in-patients in our psychiatric hospitals has been reducing over the years, and will continue to reduce mainly because of the number of elderly patients. The number of patients who are admitted to psychiatric hospitals nowadays and maintained for their lifetime is minimal. Many of these patients are elderly and some of them pass away in the hospitals. With regard to the 3,400 patients Deputy Yates referred to as having been discharged out into the community, I do not think it would be correct to say that they were discharged out into the community. Many of these patients would have been elderly and would have passed away while in hospital. More of the elderly patients would have been transferred to more appropriate accommodation in residential homes for the elderly and many of them would have been mentally handicapped and would have been transferred to more appropriate accommodation for the mentally handicapped.
As regards these cases the Inspector of Mental Hospitals investigates each case and I should like to assure Deputy Yates that we monitor the situation very carefully to ensure so far as possible that we avoid this type of incident, and any measures necessary to ensure this will be taken.
The Dáil adjourned at 5.15 p.m. until 2.30 p.m. on Tuesday, 2 May 1989.