Dáil Éireann debate -
Tuesday, 23 Oct 2001

Vol. 542 No. 5

Adjournment Debate. - Mental Health Services.

Mr. Neville

I welcome the opportunity the Ceann Comhairle has given me to raise this issue with the Minister. Again this year the report of the Inspector of Mental Hospitals outlines a series of inadequacies, inefficiencies and lack of progress with regard to the provision of proper men tal health services. It is intolerable that year after year each report speaks about "serious equality failings", "lack of multidisciplinary teams", and "wasteful service provisions". It states: "It should be noted that most Irish services did not meet the community residential and day hospital requirements in 2000". This is a sad and unacceptable comment by the inspector on the state of mental healthcare services which appears on page 2 of the report.

In his overview of the psychiatric services the inspector yet again points out that there are very few multidisciplinary teams in the mental healthcare service. There is a distinct absence of psychologists, social workers and occupational therapists and those who are employed are often professionally isolated in small services. The inspector also identifies that the number of training places for such professionals is inadequate to supply the numbers required.

It is difficult to emphasise how important the true multidisciplinary approach is to effecting an efficient delivery of psychiatric services. The absence of this cohesive ethos at the centre of the system results in often piecemeal and incomplete care planning and treatment. The inspector alludes to the lack of a "disciplined" care programme approach in many instances and states "this is a serious quality failing". What this means in practice is that those who are assessing the psychiatric services may not have an identifiable care plan based on a multidisciplinary assessment of need. The notion of a carefully thought out care plan is now common currency in most healthcare services and a serious omission from the mental healthcare provision.

The inspector comments on the "predominance of drug treatment which is often the only treatment available. Many patients complain that they do not have the option of psychotherapy or psychological treatments which they feel would be of greater help to them." This is a contentious issue in Irish mental healthcare. In the majority of cases the only treatment option offered to people with a severe mental disorder is a prescription of drugs. Drugs are often necessary to the recovery process, but they are by no means the only tool. There is a multitude of research which shows that sustained recovery is based not only on effective drug treatment, but on the availability of a range of allied interventions, such as behavioural therapy, counselling, psychotherapy and other psychological treatments. In addition, services such as access to information and support groups are also an essential part of the recovery process.

The inspector commented on the lack of community based residential accommodation, particularly high support accommodation. This is totally and utterly unacceptable. The number of available places at the end of the year was 2,993. This compares with a figure of 2,382 in 1991. The rate of development is inadequate. Many who are well able and well placed to live in the community are languishing in institutional care because of the lack of places.

Once again, the inspector expresses concern about the rate of involuntary admissions and detentions prevailing in Ireland. Approximately 10% of all admissions are involuntary. This is very high by European standards, where the average rate is 5%. The key contributory factor is the lack of appropriate community based services which can intervene at an early stage to support the person concerned. The inspector expresses considerable concern that in some instances the level of mental health service is wasteful. It is important in times of plenty as well as in more difficult times there is a commitment to effective and efficient service provision.

I wish to congratulate the many groups who are promoting better practice in the mental health services, including Schizophrenia Ireland, the Irish Association of Suicidology, the Mental Health Association and the many other services involved in promoting positive mental health.

Minister of State at the Department of Health and Children (Ms Hanafin)

I wish to thank Deputy Neville for raising this matter on the Adjournment and to respond on behalf of the Minister for Health and Children.

I welcome the publication of the Report of the Inspector of Mental Hospitals for 2000 and acknowledge the important role the inspector plays in providing an accurate and detailed account of services in the mental health sector throughout the country.

The Minister met with the inspector recently to discuss his report and to elicit his views about the areas of the mental health services which need improvement. The inspector informed the Minister that steady progress is being made across the country in the move towards an integrated, community based mental health service but that much remains to be done.

In his report for 2000 the inspector notes the continuing decline in the number of patients in psychiatric in-patient facilities, from 4,768 at the end of 1999 to 4,559 at the end of 2000. There were more than 24,000 admissions to these facilities in 2000 of which approximately 6,750 were first admissions. The proportion of patients being admitted to acute psychiatric units in general hospitals continued to increase and in 2000 accounted for 43% of admissions. A further 13% were admitted to private hospitals. The number of involuntary admissions at approximately 2,450 remained constant at 10%.

A number of welcome developments were reported in many of the health board regions during 2000. One significant development during the year was the opening of the new acute psychiatric unit at the Mercy Hospital, Cork, in April 2000 which represented a major step forward for the north Lee service. Work had also commenced on the construction of the new acute units at St. Luke's Hospital, Kilkenny, and at the general hospitals at Portlaoise, Castlebar and Ennis. In the eastern regional area, the upgrading and improvement of conditions in the admission units in both St. Brendan's Hospital and St. Ita's Hospital were welcomed as was the appointment of a new consultant led liaison psychiatric service at St. James's Hospital. Considerable expenditure had also been provided on upgrading the admission facilities in St. Loman's Hospital, Mullingar.

The inspector paid particular attention in his report to the innovative service developments that have taken place in the Cavan/Monaghan mental health service. This service had embarked on an intensive approach to care delivery for both acute illness and for those with more enduring mental disorders. Specialist teams had been set up to deal with acute illness on a community and domiciliary basis in both counties. At the same time, a specialist rehabilitation team was put in place to deal with more resistant illness. The results of this initiative were already being clearly seen in the reduction in the numbers of patients in both acute units in Monaghan and Cavan. This innovative development was welcomed by the inspector who commented that the service providers in Cavan-Monaghan brought a level of enthusiasm to service delivery which was refreshing. He stated further that the new approaches being developed in Cavan-Monaghan might well be significant for the manner in which psychiatric services will be delivered in this country in the future.

The inspector also reported that community services were enhanced in a number of areas. Developments included the opening of new day hospitals in Swords, Athy, Celbridge and Letterkenny, day centres in Balbriggan, Celbridge and Westport, extensive refurbishment and upgrading of community residences in the St. James's Hospital service and the opening of supported residential accommodation in Newbridge, Rathdowney, Carndonagh and Letterkenny.

Concern was expressed by the inspector at the lack of multi-disciplinary teams in many mental health services, particularly in the area of psychology, occupational therapy and social work services. The Department has provided additional resources to health boards this year for improvements in these services. However, many boards are experiencing problems in recruiting such professionals to the mental health services. A number of initiatives have been taken to deal with this problem. Among them are the commissioning of a work force planning study by Dr. Peter Bacon and Associates, increasing the number of student places in the therapy schools and implementing the recommendations of the Expert Group Report on Various Health Professions.

In his latest report, the inspector also mentions progress on the implementation of the Mental Health Bill. The new Mental Health Act, which was signed by the President on 8 July 2001, provides for the independent and automatic review of each decision to detain a patient for psychiatric care and treatment and puts in place mechanisms by which the standards of care and treatment provided in psychiatric in-patient facilities can be supervised and regulated. A mental health commission is to be set up to act as an independent agency to raise standards and practices in the delivery of mental health services and to ensure that the rights of detained persons are protected. The Minister hopes to appoint the members of the mental health commission within the next few months.

It is the Minister's intention to facilitate health boards in bringing about the necessary improvements and developments identified by the inspector in his report. Capital funding of approximately £150 million has been provided for the development of mental health services over the lifetime of the national development plan. This funding will go towards the development of acute psychiatric units attached to general hospitals and the enhancement of community based residences and facilities.

Additional revenue funding of £18.64 million has been provided this year for improvements in mental health services. Priority is being given to the further development of community based mental health services, the further expansion of child and adolescent psychiatry and the psychiatry of old age and the implementation of the recommendations of the task force on suicide. Provision has also been made for additional funding to voluntary bodies representing the interests of the users of the mental health services and their families and carers, and I wish to join in commending them for their work.

In conclusion, I would like to assure the Deputy that the inspector's report is not being ignored. Significant progress has been made in recent years in modernising the mental health services and the Minister is committed to ensuring that we continue that progress.