Vol. 448 No. 2
12 Mr. E. Byrne asked the Minister for Health if he has satisfied himself with the level of accommodation available to Health Boards to cater for young adolescents requiring secure residential accommodation with therapeutic and psychiatric services; and if he will make a statement on the matter. [1658/95]
(Limerick East): I am aware that certain difficulties exist in relation to the provision of appropriate accommodation for certain adolescents whose behaviour is such that they cannot be cared for within the existing range of child care facilities. These difficulties relate both to the availability of suitable facilities and the lack of statutory powers to deal with such children.
With regard to the availability of facilities, action is being taken to provide more residential places and other appropriate services. For example, during 1994 approval was given to develop the following initiatives.
In the Eastern Health Board a "Carers for Young People Scheme", involving the selection of 50 families who will be trained to care for and manage difficult adolescents has been initiated and an eight place special therapeutic unit which will cater for children with behavioural problems who require intensive care will be developed.
The Midland Health Board has been given approval to develop a new sixeight place short term residential unit for children in Moate in association with the Sisters of Mercy. This unit will cater for children who are in need of crisis intervention, assessment or rehabilitation respite care. An outreach programme to support children and their families will also be operated from the new facility.
In the Mid-Western Health Board approval was given to an extension to the Good Shepherd Sisters' Hostel for Homeless Girls. The North-Eastern Health Board is developing short term flexible living accommodation for children who are out-of-home. In addition, the board is developing an "on-the-street" outreach service aimed at children at-risk. The North-Western Health Board is increasing the level of funding to a hostel for young homeless at John Street, Sligo. The South-Eastern Health Board is working with a local group on the development of a new hostel for homeless boys and girls in Waterford.
The Southern Health Board has been given approval to develop a short-stay eight bed assessment unit as well as a new residential unit for six-seven girls in Killarney by arrangement with the Mercy Child Care Services. The board will also provide four additional emergency beds for homeless boys in Cork and a hostel for homeless boys in Tralee.
Finally, in the Western Health Board, work is proceeding on the development of a new eight bed unit for boys and girls at St. Joseph's in Lower Salthill replacing the existing old and inappropriate building. Work on this project will be completed in 1995.
The full year cost of the developments I have outlined is of the order of £2 million and, taken with the expansion of our community care and family support services, will go a long way towards filling the gaps in our current level of provision.
On the legislative front, the Child Care Act was never designed to confer powers of custody or other forms of compulsory intervention on the health boards. This was accepted recently by the High Court in judicial review proceedings brought against the Eastern Health Board regarding the provision of services to certain homeless youngsters.
There is clearly a need for changes in the law to enable the State to cope with such children. As the House will be aware, the Government has given my colleague, the Minister of State, Deputy Currie, special responsibility for co-ordinating the activities of the Departments of Health, Education and Justice in the child care area. It is intended that the provision of services to this group of children will be addressed in the context of these new co-ordination arrangements.
In recent years there has been significant expansion in child and adolescent psychiatric services in each health board with additional recruitment of child psychiatrists, psychologists, social workers, etc. Services for adolescents, whose primary need is for psychiatric and therapeutic care, are generally provided by child and adolescent psychiatric services. A family-centered approach is adopted and the vast majority of cases are dealt with on a non-residential basis, with support being provided to families with whom the patient continues to reside. In a small number of cases, adolescents with psychiatric problems may require in-patient treatment in a hospital or residential setting.
My Department is in discussion with the health boards concerning their priorities for the further development of child and adolescent psychiatry. Some health boards have indicated that residential accommodation for children and adolescents with psychiatric disorders is among their priorities and my Department will be pursuing the matter with the boards in question.
Will the Minister agree there has been a pathetic response by previous Governments to this issue in that to date the capital city, through the Eastern Health Board, has only eight beds — for males and females — for such children aged between 12-16 years? Will he also agree that instead of seeking 50 foster families to look after these hardened, difficult, disruptive and often violent children we should be looking for 50 saints to fill a gap which the Department of Health has failed to fill to date? Will he give a commitment that the policy of placing these 12-16 year old children in cells in local Garda stations or, worse, in wards in the Crumlin Children's Hospital — these are known as welfare placements — will cease immediately? Is he aware of this practice, that recently a child was placed in Our Lady's Hospital for Sick Children and that the hospital authorities had to engage two psychiatric nurses on 24 hours prison guard service to look after this child who was drugged?
This gives an indication of the number of these children who, because of a lack of services, end up in prisons and hospitals. Instead of finding their way to the therapeutic and psychiatric services provided by the health boards they are going to jail. This has been caused by the complete failure of the policy of successive Governments for dealing with those adolescents.
(Limerick East): As Deputy Byrne said, this is a serious problem. I think it is fair to say that the efforts being made to alleviate the problem and provide appropriate accommodation have been more successful in other health board areas than in that of the Eastern Health Board. It is also true that the problems are very difficult to remediate under current statute. One of the reasons the Minister of State, Deputy Currie, was assigned responsibility at the Departments of Health, Education and Justice is that it is recognised that an interdepartmental and multi-disciplinary approach must be adopted to this problem and that someone must formulate the policy across the various Departments. The Minister of State must have responsibility in these Departments if he is to give effect to what the Deputy suggests.
Apropos his last comment, if the Minister checks the files in the Department of Health I think he will find that I was the first Minister of State operating out of the Department of Health assigned responsibility to co-ordinate child care services between the Departments of Health, Education and Justice. In fact, I was responsible for the eight bed facility at Glen House.
Notwithstanding the progress made in the provisions of child care in conjunction with the implementation of the Child Care Act, will the Minister agree it is important to draw a clear distinction between the provision of facilities for young children who find themselves without a home for a variety of social reasons and the provision of facilities for children with behavioural and other problems? Is the Minister aware that a number of young people — sadly this number seems to be growing — cannot be accommodated in the ordinary school system and that they come under the auspices of the health board? As part of the substantial resources made available by the previous Government for the implementation of the Child Care Act, will the Minister endeavour in so far as possible to provide special therapeutic accommodation for young people with serious behavioural problems in each health board area? This will give young people who are disturbed for a variety of reasons the sort of services to which they are entitled and which may prevent them becoming involved in confrontations with the law, their families etc. The resources are there and committed by his predecessor.
(Limerick East): I accept the points made by the Deputy but we should try to pinpoint the problem — the focus is too wide. There is a small but growing number of youngsters who are so unmanageable that they cannot be catered for within the existing range of residential centres. In some cases children as young as ten and 12 years of age are sleeping rough and have been expelled from a series of children's homes because their behaviour cannot be controlled, they pose a threat to the other residents and staff. The behaviour of these children might appear to be bizare to many people but, under medical examination, the majority of them are found not to be psychiatrically disturbed and they are certainly not disturbed so as to allow the authorities detain them under the mental treatment Acts.
It is true also that because they have committed no offences, they cannot be detained under the auspices of the Department of Education and responsibility for putting a roof over their heads falls back on the health boards under sections 3 and 5 of the Child Care Act. This is not an easy problem to solve and attempts have been made to do so, for example, by putting individual children into houses and providing staff to look after them. It would frighten the Deputy to know what the maintenance of a child in those circumstances has cost health boards on an annual basis.
I will continue to pursue the initiatives taken by my predecessor and I hope a wider range of facilities can be put in place but there is no ready-made solution. Deputy Byrne is wrong to throw cold water on the idea that foster families could be encouraged to take some disruptive youngsters because one should not discount the impact of tender loving care, even on the most wayward child, and that will be found more readily, in my view, within a family than within an institution.
To suggest those people would be saints does not equate to throwing cold water on it.
Is the Minister aware that a recent Eastern Health Board report on homelessness in the Dublin area indicated that more than one-third of the children presenting as homeless to hostels and bed and breakfast premises had previously been in the care of the State? We must examine the quality of the residential care centres we offer. We have nobody else to blame if the children who are presenting as homeless at 17 were, at the age of 15, in the care of the State. There is a failure somewhere.
(Limerick East): I am aware of the problem and I will continue to progress the situation with a view to establishing better facilities.
