Thank you, a Cheann Comhairle, for accepting this issue as a subject matter for the Adjournment. May I ask who is taking the debate?
Adjournment Debate. - Support Services for Autistic Child.
An tAire Oideachais.
I thank the Minister for Education, but I am extremely disappointed that neither the Minister for Health nor his Minister of State thought it worth their while to come in and take this issue.
At 2 p.m. this afternoon my office rang the mother of a severely autistic 13 year old child in County Mayo, whose case I raised on the Adjournment on 7 October 1993, to tell her we had succeeded in again raising the matter on the Adjournment. On two occasions the telephone was not responded to, when the call was eventually taken the mother of the child was in tears. She had been unable to get to the telephone for the two previous calls as she was in the house on her own struggling with the child and unable to contain her. This is the reality for this mother and indeed for the father. Apart from the three days a week when the child gets limited schooling from 9.30 a.m. to 2.45 p.m., the mother and father are prisoners in their own home.
As I pointed out previously, Pauline will be 14 years old next month. She is mentally handicapped and very emotionally disturbed. Since the age of five she was catered for on a daily basis by the Brothers of Charity, Boyle, County Roscommon, to whom enormous credit is due for the level of service they provided. However, one and a half years ago the Brothers of Charity notified Pauline's parents that they could no longer cope with her. As she was extremely strong and given to tantrums, they could no longer devote the physical resources on a daily basis to cope with her. An arrangement was put in place whereby the Brothers of Charity kindly agreed to employ two women to look after Pauline in their own home on a Monday to Friday basis and they paid for this service. However, eight weeks ago the two women notified the Brothers of Charity and Pauline's parents that they could no longer provide custody and care for her.
As I pointed out in the House, Pauline is literally uncontrollable. She has the strength of an adult and two people are required to contain and restrain her at all times. Everything within reach is in danger, and plates, implements and pieces of furniture regularly become missiles. Some tantrums even lead to biting. Everything I have said has been verified time and again by the social worker. Pauline needs urgent residential care now as she is seriously at risk.
It was acknowledged by the Minister of State in the House that this girl has severe behavioural problems. It was pointed out that a case conference was held on Thursday, 30 September 1993, attended by the health board's area medical officer and social worker as well as the child's parents and representatives of the Western Care Association. It was also pointed out that the Western Care Association was considering placing the child in its new facility in Foxford. On the day I raised the matter in the Dáil a further meeting took place between the Brothers of Charity and the Western Care Association. The Western Care Association has done its work and identified a place where Pauline can go to school. It also identified a residential place where she can stay and be cared for on a one to one basis in the evening and at night. A report and the costing for same was sent by fax from the Western Health Board to the office of the Minister for Health on 15 November. Since then nothing has happened. My office has telephoned the Minister's office almost on a daily basis, but there has been no response.
The result is that apart from the 15 hours 45 minutes Pauline spends in school, she is in the total care of her parents for the remaining 142 hours 15 minutes of each week. This is not acceptable. The Minister for Health is failing in his duty to provide an adequate level of service for this child and her parents. I ask the Minister to personally convey to the Minister for Health that unless finance is provided to the Western Care Association for the necessary facilities, for a place specially identified for Pauline, I will personally deliver Pauline to the office of the Minister for Health so that he can make the necessary arrangements in due fulfilment of his duty as Minister.
On behalf of the Minister for Health it has to be acknowledged that the Deputy has taken a personal interest in this child and has already raised the case in the House. The Deputy will be aware that the child in question who is 13 years of age has a severe mental handicap, autism, and severe behavioural problems.
As I have previously stated, the provision of mental handicap services in County Mayo is the responsibility of the Western Health Board. Services for people with autism in the Western Health Board area are provided mainly by the Western Care Association on an agency basis for the Western Health Board.
A case conference was held on Thursday, 30 September 1993 involving the health board, the child's parents and representatives of the Western Care Association. A further meeting was held on 7 October 1993 between the Brothers of Charity and the Western Care Association to discuss the needs of the child. Arising from the meeting of the case conference, the Western Care Association has identified an appropriate day placement in a special unit within a special school. This placement will require a support person in the school with specific responsibility for the child. In addition, a residential placement has been identified which will require a one to one staffing ratio both day and night, seven days a week.
The Western Care Association submitted an estimate of the cost associated with the child's residential placement and day service requirements to the Western Health Board on 12 November. The cost involved was exceptionally high and the health board is currently involved in intensive discussions with the association in relation to its costings. The health board has asked Western Care to examine its current case-load with a view to redeploying resources to meeting some of the requirements of this urgent case. This would complement the crisis intervention service currently being provided by the Brothers of Charity. A further option in regard to funding of residential placement for this child is also under active consideration.
I appreciate the urgency of this case and the concern of the Deputy about the matter. I would like to assure the Deputy that every possible effort is being made to find a satisfactory solution and the Minister will communicate with the Deputy as soon as he has been informed of progress in regard to the care options. In the meantime, the Brothers of Charity are providing a limited crisis intervention service of 18 hours per week until the end of December. The child is collected from her home at 9 a.m. on Mondays, Wednesdays and Fridays and cared for in Glaneven Child Development Centre until 3.30 p.m. In addition, I understand that the family have availed of a weekend service provided by the Brothers on a number of occasions during the past few weeks.
As I said, the provision of mental handicap services is primarily a matter for the Western Health Board and these services are funded by the board and by a number of voluntary bodies including the Brothers of Charity and Western Care Association. The total allocation from the Department of Health for services for persons with a mental handicap in the Western Health Board area is £27.8 million, this includes a special additional allocation of £158,000 which the Minister for Health made during the year to meet particular difficulties which arose in the area. This funding is in addition to that provided by the Department of Education and from the European Social Fund. In view of this level of expenditure it is hoped that the health board and the agencies involved can come together and make appropriate arrangements for the care of this person.
I would like to assure the Deputy that in association with the development of services for people with a mental handicap, it is intended to ensure that a comprehensive service is provided for people with autism.
Earlier this year the Department of Health's mental handicap adviser prepared a discussion paper on the care of persons with autism. The purpose of this paper was to help clarify thinking on the current and future needs of persons with autism and the development of appropriate services for them within the overall framework of the mental handicap services. The discussion paper was widely circulated for comment to organisations and individuals with an interest in autism in April 1993 and a response has been received from large numbers of groups and individuals, including Western Care and the Western Health Board. The discussion document is now being reviewed in the light of the comments received with a view to producing a clear policy document for the development of services for people with autism. I will, of course, convey to the Minister for Health the sentiments and anxieties expressed by Deputy Higgins.