Vol. 455 No. 3
6 Mr. M. McDowell asked the Minister for Health when the White Paper and new legislation on mental health will be published in view of the fact that the mental health services are operating under an Act that is 50 years old; if he will adopt and implement a specific mental health strategy geared to the monitoring, prevention and treatment of mental health problems particularly as they effect women; and if he will make a statement on the matter. [12048/95]
(Limerick East): I am committed to the early introduction of new mental health legislation to provide a modern framework within which the relatively small number of people with mental disorder who refuse or who are incapable of seeking treatment or protection in their own interest or in the interests of others can be cared for and treated. As a prelude to the introduction of new legislation I will be publishing the White Paper on mental health legislation in the very near future outlining the Government's intentions with regard to the content of new legislation in this field.
I was also pleased last week to launch a discussion document "Developing a Policy for Women's Health" which I see as a first step towards the definition of a women's health plan. This document, the first of its kind in the European Union, looks at the health services from a female point of view and suggests ways in which these services could be made more responsive to the needs of women. It notes that women's experience of mental health is different from men's and includes a commitment to the commissioning of research on the factors associated with mental illness in women in Ireland following consultation with women's health groups and mental health organisations.
In reply to an earlier question the Minister said that mental health treatment has changed considerably over the last decade. However, as we are dealing with a 50 year old Act, does he accept much needs to be done? I welcome the forthcoming legislation.
Does the Minister agree that given the figures stated, we have a bad record on mental health? At any one time 200,000 people in the State suffer from depression. Given these figures and the different types of mental disorders men and women experience, is his Department considering putting together a public relations campaign on depression and enhancing the primary treatment of depression via GP services, which has been proven quite successful in other jurisdictions in terms of recognising depression at first point of contact?
(Limerick East): All those suggestions are part of the manner in which the mental health services are now being delivered. The White Paper involves putting a new legislative framework in place because, as the Deputy rightly said, the 1946 Act is not only outdated but means we no longer accord with the European Convention on Human Rights, more specifically the case law flowing from it.
The context is that the White Paper will be published in a couple of weeks, there will be a short consultative process and the heads of the Bill will go to Government. It is the legal framework which is being dealt with; the changing patterns of care are already within the system and what the Deputy refers to is being treated. It is difficult to assess whether we have a higher incidence than other countries. Before the changes, when mental illness was treated in hospitals behind high walls in locked wards, significant numbers of geriatric patients and persons with mental handicap were kept in those hospitals. The statistics were not accurate when one simply relied on the complements in the hospitals.
That is not to diminish the problem; the admission to psychiatric hospitals and units in 1993 for all diagnoses were 14,567 males and 12,438 females, although many of those would be short stays.
The Minister will note from these statistics that alcoholism is heavily represented in the figures for males, as are depression and other psychotic disorders in the figures for females. So there are separate profiles in terms of mental health difficulties. He indicated there would be a short consultative process before the publication of the Bill. Who will be consulted and will there be a corresponding consultation with the psychological as well as the psychiatric services? Does he agree that when the new Bill is introduced there will be a need to redress the imbalance in the old legislation, which was in favour of the medical-psychiatric approach as distinct from the under-utilised and under-appreciated psychological services, which are unevolved and under-resourced in this country?
(Limerick East): There is some evidence in the statistics of gender bias in alcoholic disorders. The figure for males is 4,405 and for females 1,313, a very big discrepancy. For depressive disorders, the figure for men is 3,141 and for women 4,688 and for schizophrenia the figures are 3,257 for men and 2,363 for women, so the gender bias is not as pronounced as suggested, except in relation to alcoholism.
On the consultative process, a Green Paper on mental illness was published. Anyone with a particular interest was consulted and the White Paper is the distilled wisdom of all those involved in that process. When the White Paper is published submissions will be invited and people who feel they have a contribution to make will be free to do so. I will invite submissions from people who consider themselves relevant. We will then draft the heads of the Bill and when they are accepted by the Government I hope to bring it to the House in 1996.
It is complicated legislation and it does not impinge on treatment, it is more concerned with the committal of those who either refuse to be committed or are unable to make the decision; and an appeals process and review system which will be necessary to bring legislation into line with international provisions.
I am concerned that the Minister has said the legislation will be more focused on the legalities rather than the treatment. Why? Is this not an opportunity to introduce radical changes in how we deal with mental disorders and depressive illnesses, rather than just the legalities of detention? Will the Bill not deal with treatment?
(Limerick East): No; no more than any other illness treatments would be enshrined in Statute. If they were made a matter of Statute, when treatments and medical procedures changed no doctor could apply the new treatment without a change in the law. Treatment is a matter of practice and practice changes. That is happening in any case because there has been a high level of practice change in the last few years and that has been effective. The most dramatic changes in the health service have been in respect of mental illness.
The legal framework will deal with some elements of treatment, for example, if elements of restraint were involved. It would be along the lines of protecting the rights of patients, rather than getting into the area of what the appropriate medical treatment should be.
The Minister may have answered this in his last reply. Will the White Paper primarily deal with involuntary detention of persons rather than reviewing the whole corpus of psychiatry in the last ten years? It is at least that long since the last review.
(Limerick East): That is correct.
