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Dáil Éireann debate -
Wednesday, 13 May 1992

Vol. 419 No. 6

Ceisteanna — Questions. Oral Answers. - Mental Handicap Services.

Michael Ferris


59 Mr. Ferris asked the Minister for Health if he will outline the amount of extra money for mental handicap services in 1992 which is being distributed on a service-by-service basis; and if he will make a statement on the matter.

Dinny McGinley


109 Mr. McGinley asked the Minister for Health if he will outline his most recent estimate of the numbers of persons with an intellectual disability who are waiting for residential care; if he will give details of the likely waiting time for a person now diagnosed as being in need of such a residential place; and if he will make a statement on the matter.

Richard Bruton


228 Mr. R. Bruton asked the Minister for Health if he will outline his most recent estimate of the numbers of persons with an intellectual disability who are waiting for residential care; if he will give details of the likely waiting time for a person now diagnosed in need of such a residential place; and if he will make a statement on the matter.

Richard Bruton


229 Mr. R. Bruton asked the Minister for Health if he will give details of the additional 1992 budget with regard to persons with a mental handicap, indicating in particular (a) the additional residential places for adult mentally handicapped, (b) the extra respite care places, (c) the extra day care places for adults, (d) the extra day care places for children, (e) the extra whole time equivalent speech therapists and (f) the extra facilities for those with a mental handicap who are 18 this year and who are not considered suitable for unsupported open employment.

Richard Bruton


233 Mr. R. Bruton asked the Minister for Health the way in which the extra £6 million announced for services for persons with a mental handicap will be divided between capital and current spending.

I propose to take Questions Nos. 59, 109, 228, 229 and 233 together.

I want to assure Deputies that the improvement of services to people with mental handicap is one of my main priorities. I am determined to improve these services and my predecessor outlined details of the Government's commitment in this regard in her statement to the Dáil on 11 December and in the statement issued following the announcement of the Estimates.

The report of the review group — Needs and Abilities — which has been accepted in principle by the Government, sets out the framework for the development of services for persons with a mental handicap and the Government are committed to the improvement and expansion of these services under the Programme for Economic and Social Progress and the Programme for Government. The Programme for Economic and Social Progress envisages a seven-year implementation period and in the past three years an extra £9 million has been allocated for the development of these services.

With the extra £6 million provided this year significant improvements in services will be put in place in 1992. Of the £6 million allocated, £1 million will be allocated to support the capital costs of the new services. When the increases in the allocations to the health board and mental handicap agencies are taken into account, the total increase in cash terms in 1992 over 1991 is £10 million.

Of the £5 million available for additional revenue costs, £1.12 million has been allocated to provide an extra 80 residential places and £1.2 million has been allocated to provide 300 day places for those most in need of such services.

A further 41 respite places will be developed at a cost of £590,000 in a full year. This will mean that about 500 additional families will be able to have a respite break of one month in the year. This is a very significant provision and will provide valuable relief to families and carers. These additional places will be spread over the entire country in proportion to need.

A home care or outreach programme is being developed at a cost of £1.21 million to meet the needs of families with a mentally handicapped member. It is my intention that this scheme will work in a flexible way. The scheme should provide a service for up to 1,000 families and will be targeted specifically at those persons who have no service at present or for whom services are inadequate.

There is a particular need to have an effective and immediate response when crises arise in families with a mentally handicapped member. A sum of £400,000 has been allocated to provide 20 places in the Dublin area to ensure that emergencies can be responded to when they arise. There is also the need to cater for those persons with mental handicap who are also disturbed. The service for these people is being improved and expanded. An additional six places are being put in place in Dublin area at a cost of £150,000 and Unit B, St. Loman's Hospital, Lucan, County Dublin, will be replaced.

Preventive and early intervention services play a significant role in reducing the level and severity of handicap in our society and will receive particular attention this year. A specialist genetic counselling service will be initiated in Our Lady's Hospital, Crumlin, as soon as possible. A separate sum of £250,000 has been allocated for this purpose in 1992. Services for children will be expanded by the provision of three extra early intervention teams and 55 places in child education and development centres at a cost of £220,000 and £280,000 in a full year, respectively. The precise operational details of the additional services to be provided, the staffing requirements, and the people to benefit have been agreed by the mental handicap co-ordinating committees in each health board area.

These developments are a major step forward and will result in a considerable improvement in service provision. I also do accept that more needs to be done but I want to assure Deputies that the service will be maintained at this higher level and it is my intention that this will be built on and further improved in future years.

I recognise the understandable fears of parents who have a son or daughter with a mental handicap. I hope that the special measures being put in place this year will allay their fears to some extent but I accept that they will not be fully satisfied until they are assured of a place for their son or daughter. I hope that the service improvements which are taking place and which are planned as I have outlined will assure them that this Government are determined to resolve this issue.

It is estimated that approximately 1,000 additional residential places are required to meet existing needs among the mental handicap population. The report of the Review Group on Mental Handicap Services Needs and Abilities estimated that there was an annual requirement of 40 additional residential places to meet emerging needs. In the longer term the review group predicted a "break even" situation would not be reached until after 2010. While it is not possible to estimate the likely waiting time for a person in need of a residential place, I wish to assure the Deputy that respite care, which is an integral part of service provision, is available throughout the country and emergency situations are dealt with speedily and effectively. As I have already indicated significant improvements in these services are being put in place this year.

We would welcome this progress were it not for the huge size of the problem that is yet untouched. Would the Minister not agree that the provision of 80 places against a need for 1,000 is not really getting to grips with this problem? Would he not agree that when the review group said that this problem would be tackled by the year 2010, it said so on the basis that the Minister would in this year, 1992, provide a sum of £23 million for these services? Finally, would the Minister not agree that people with mental handicap have a right to treatment, that that is not being honoured and that if we want to have legal underpinning to rights we should be starting with those rights?

I have followed the problems of the mentally handicapped since the time I went, unannounced, to see St. Ita's Hospital many years ago. What I saw there left a very lasting impression on me. There were 96 severely mentally handicapped women in two wooden huts and only two toilets. They were hidden away and I just strayed off the beaten track and went in and was appalled at what I saw there. I recognise that the mentally handicapped did not get the priority they deserved over the years, but I was crying in the wilderness'; there were not many people supporting me in my campaign on their behalf. I can understand the constant anxiety of their parents, and we all meet them in our constituencies. We are making some attempt to solve the problem and this will be done over a seven-year programme which they themselves believe will make major inroads into this area and will go a long way to giving the mentally handicapped their rights.

There are many people who are only mildly mentally handicapped and what we need is up-to-date information of the numbers in the country. I have been trying to get this information today but no census of mentally handicapped people has been done since 1981. However, there are about 25,000 mentally handicapped people in the country. We have already asked for more up-to-date figures.

We spend almost £200 million a year on the mentally handicapped. What we would like to see is a marked decrease in the incidence of mental handicap. The initiative of setting up the genetic counselling service at Our Lady's Hospital will go a long way towards ensuring this.

I would like to be able to give the Deputies a more optimistic outlook but if we make up our minds we can give this problem the priority it deserves. I hope that my many colleagues in this House will give it top priority, as I do, and with their help we will deal with the problem.

The Minister will find he will get a resounding response to that call. Most people in this House would seek to support the putting of mental handicap as the number one priority in health because they are a category in our community whose basic rights have been denied and whose problems have not been addressed by Government for many decades. If we did nothing else today but assert that, we would be doing a good day's work.

I will not quibble with the answer the Minister gave to the question, but because it is so global let me ask him a question in specific terms. We are talking about a limited sum of money when it is put against the scale of the problem. What exactly are the Minister's priorities — training or residential units, employment, day care or respite? How is the money to be spent? Can he tell us where the focus will be in the immediate short term so that we will know how we are to tackle this programme over a number of years? Is the Minister aware of any agencies dealing with mental handicap that are now on the point of bankruptcy? Will he address the problem if these agencies come to him with that dilemma?

There are many degrees of mental handicap. With proper surveillance and early detection of cases the mildly mentally handicapped can, with the proper education, live a normal life. We must, therefore, look first at the mildly mentally handicapped. For the moderately mentally handicapped we can have workshops and provide proper care rather than, as we have been inclined to do, shove them into mental hospitals. Too many are still there. Now we are taking them out of the psychiatric services, desegregating them and putting them in separate places even within the mental hospital campus——

What are the Minister's priorities?

There are three priorities, to provide proper educational resources for the mildly mentally handicapped, to get the moderately mentally handicapped into workshops and to provide a proper environment in the hospitals — not necessarily the mental hospitals — for the severely mentally handicapped. I would like to get them out of the mental hospitals so as not to have this stigma that is still there despite all we try to do.

Many of the moderately mentally handicapped can be accommodated in the community. It is well worth while visiting Peamount where there is a lovely place for the mentally handicapped and they do great work. Not every mentally handicapped person need be put in residential care. This is only for the severe cases. They must be taken out of the mental hospitals, redesignated and put on a rehabilitation programme. That is what is important for the moderately to severely mentally handicapped. For the mildly mentally handicapped, proper education is necessary to prevent the condition progressing.

What about agencies on the point of bankruptcy?

We work closely with agencies. They come to us and cost the service and we pay them. In the case of an autistic person it costs £21,000 a year. The agencies did not complain that what they were getting was inadequate. Very few voluntary agencies complain that funding is inadequate. There was a complaint from some of the agencies who were very upset that the European Social Fund to provide training for the mildly mentally handicapped ran out. The EC rules were that provision should only be for one year but we got them to extend it to three years.

I call Deputy Byrne and ask for brevity, please. I was hoping to dispose of many more questions but obviously this will not now be possible.

I would like to ask the Minister two questions, the first of which is what reassurances can he give the parents of children attending training schemes — they will complete their third year in June of this year — who will demand that alternative training schemes be found for them? How does the Minister propose to address that serious human problem? Second, I am amazed the Minister is asking questions about the lack of statistics, as clearly he is familiar with the central planning committee for the eastern region. Would he agree that the figures are frightening; that instead of the position improving in the eastern region during the past three years, in relation to the need for adult day places and residential places, it has got worse? Finally, given that he has said that this area is a source of concern to himself would the Minister agree that only 45 new residential places have been created this year despite the fact that the central planning committee pleaded that at the minimum they required 100 residential places and 250 day places along with a wide range of training schemes——

I did ask for brevity; obviously I am not going to get it.

Would the Minister not agree that unless he provides finance——

Deputy Byrne ought to desist from any further questioning.

——the position will continue to deteriorate under his leadership as Minister for Health?

I should inform the Deputy that there are 11,846 people in receipt of day or residential services. Furthermore, we have increased the number of residential places considerably. There are 4,548 residential places, 1,515 hostel places and 5,783 day places. In the 1990 budget provision was made for an extra 149 residential places. If, as the Deputy says, the position is getting worse this can only indicate that there has been an increase in the incidence of mental handicap.

(Carlow-Kilkenny): First, I wish to compliment the Minister in relation to the attitude he has adopted towards people with a mental handicap. Second, would he agree that were it not for associations involving the parents and friends of those with a mental handicap who raise funds non stop throughout the year many of the services, despite the backing of his Department, would fold up? These people are the heroes and heroines and help to keep the services going.

If we did not have these voluntary organisations the situation would be chaotic. I do not think the statutory services could provide anything like the level of services they provide. They also serve a very useful purpose in that they highlight the needs of those with a mental handicap and keep them to the forefront. Even though at times they may irk us they are doing a great job and will ensure that it is our No. 1 priority. I meet them regularly and should say that they do tremendous work and are very dedicated. Therefore we could not do without them as the service would collapse. I agree with what the Deputy had to say in that regard. We could not praise them enough in relation to the work they do. We should encourage them because the public have to be made aware that there is a need to make this our No. 1 priority and to have a national debate.