Dáil Éireann debate -
Thursday, 9 May 1996

Vol. 465 No. 2

Written Answers. - Care of the Mentally Ill in the Community.

Seán Haughey

Question:

88 Mr. Haughey asked the Minister for Health whether a structure of communication has been put in place by his Department and the health boards to advise the Garda and, through them, other institutions such as the fire brigade and local authorities of the discharge of patients with psychiatric disorders and other mental illness who could be a danger to the public; if not, if such a structure will be put in place; and if he will make a statement on the matter. [9367/96]

Minister for Health (Mr. Noonan,

Limerick East): As the Deputy is aware, the Report on the Development of the Psychiatric Services Planning for the Future, published in December 1984, recommended a shift in the delivery of sevices for the mentally ill from an institutional to a community-based service. Since then, the report has been adopted as policy by successive Governments and acute units in general hospitals, day hopitals, day centres and community residences have been opened to replace services previously provided in psychiatric hospitals.

Other therapeutic interventions which have altered the delivery of psychiatric services include domiciliary assessment, community nursing and home support, respite care, out-patient clinics and clinical rehabilitation services.

Persons with mental illness are provided with a continuum of care for acute admission through care at home or in the community. Services for patients who are acutely mentally ill are provided in a hospital setting. When a patient has recovered from the acute phase of his/her illness they are discharged to the care of their general practitioner in conjunction, where necessary with the sector mental health team. Discharge from acute care is made on the basis of a clinical decision involving a medical and nursing assessment that the patient does not pose a danger to himself or herself or to the public. It must be emphasised, however that it is not possible to predict the future behaviour of any person, including those with a mental illness. The civil rights of the patient to a normal life in the community must be taken into account by those responsible for his/her care.

Prior to discharge from hospital, each patient is assessed individually to identify his/her psychiatric needs together with his/her personal strengths. Following assessment, a specially designed programme of rehabilitation is drawn up for each patient. Such programmes aim to cultivate the social, communication and vocational skills of a patient. The patient remains under the care of the mental health team for as long as he/she requires.

An advantage of the organisation of care for the mentally ill in this country is that the same authority — the health board — is responsible for medical and nursing care in hospital and in the community, the provision of housing for the mentally ill in the community and the provision of sheltered employment. This has enabled services for the mentally ill to be provided in a more comprehensive way than is the case in other countries where these functions are divided among a number of agencies.

In the light of the arrangements for the discharge of patients and the recognition of their rights to a normal life in the community, I do not believe that a structure of the kind described by the Deputy is either necessary or appropriate.