Dáil Éireann debate -
Thursday, 25 Oct 2001

Vol. 543 No. 1

Ceisteanna–Questions. Priority Questions. - Mental Hospitals Report.

Dan Neville

Question:

4 Mr. Neville asked the Minister for Health and Children his views on the report of the Inspector of Mental Hospitals for the year ending 31 December 2000; his further views on whether it is acceptable that year after year, the inspector's report identifies serious quality failings, lack of multidisciplinary teams and wasteful services provision; his further views on the predominance of drug treatment without the availability of psychotherapy or psychological treatments; and if he will make a statement on the matter. [25730/01]

Mr. Martin

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

The inspector paid particular attention in his report to the innovative service developments that have taken place in the Cavan-Monaghan mental health service. He stated:

Very few mental health services in Ireland are truly innovative or willing to attempt new approaches to delivering mental health care. It is therefore refreshing to cite one example where considerable progress has been made in departing from convention. The Cavan-Monaghan mental health service has developed community outreach programmes for new patients and a rehabilitation service for those with enduring mental illnesses in the past few years.

The inspector noted that the results of the initiative were already being clearly seen in a reduction in the numbers of patients in the acute psychiatric units in both Monaghan and Cavan. I fully endorse the inspector's views on this service, and the Cavan-Monaghan model provides a most encouraging example of what can and should be achieved in a modern mental health service.

A number of other welcome developments were reported by the inspector in many of the health board regions during 2000. A 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 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 in upgrading the admission facilities in St. Loman's Hospital, Mullingar.

Community services were enhanced in a number of services. Developments included the opening of new day hospitals in Swords, County Dublin; Athy and Celbridge, County Kildare and Letterkenny, County Donegal; day centres in Balbriggan, County Dublin; Celbridge, County Kildare and Westport, County Mayo; extensive refurbishment and upgrading of community residences in the St. James's Hospital service; and the opening of supported residential accommodation in Newbridge, County Kildare; Rathdowney, County Laois; and Carndonagh and Letterkenny, County Donegal.

Additional information.

Concern was expressed by the inspector in his report at the lack of multidisciplinary teams in many mental health services, particularly in the area of psychology, occupational therapy and social work services. Additional resources were provided for health boards this year for the recruitment of paramedical staff for multidisciplinary teams. Many of these additional posts are now in place. However, some health boards have been experiencing problems in recruiting such professionals and a number of initiatives have been taken by my Department to deal with this issue, including the commissioning of a workforce 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. Increased availability of multidisciplinary teams around the country will serve to address the problem noted by the inspec tor, that drug treatment was often the only treatment option available to patients.

In relation to the issues of quality and efficiency, guidelines on good practice and quality assurance in mental health services were produced by the inspectorate of mental hospitals in 1998 and distributed to all service providers. Under the new Mental Health Act, signed by the President in July, the Mental Health Commission will be established to act as an independent agency to promote, foster and encourage the achievement and maintenance of high standards and good practice in the delivery of our mental health services. I hope to appoint the members of the Mental Health Commission within the next few months.

Mr. Neville

Does the Minister agree that while his approach to answering these questions is to highlight the few improvements that have been made, in general, the mental health service is in a diabolical state? While the inspector noted the exceptions, the Minister must agree that the current piecemeal approach to service delivery is detrimental to the well-being and recovery of people with mental illness. Outlining the Cavan-Monaghan issue highlights the problems in the rest of the country. If it can be done in two counties, why can it not be done in 26 counties? Highlighting the Cavan-Monaghan case exposed the problems elsewhere in that little development has taken place. The Minister must accept that the lack of a nursing care plan in many hospitals and acute units means that targets are not set in terms of recovery for someone with mental illness. Outside of Cavan-Monaghan, the lack of a community based multi-faceted service is totally unacceptable. Urgent action is required.

Mr. Martin

I was not in a position to read out the latter half of the reply because of time constraints, but it deals with the areas of concern to which the inspector drew our attention in his report.

Mr. Neville

The Minister dealt with those first.

Mr. Martin

No. It is important that in the national Parliament we highlight a particular service that others could emulate, but the key point about Cavan-Monaghan – the Deputy asked the reason this could not be done elsewhere – is that it came from within the existing service in a truly multidisciplinary way, with the consultant taking a team rather than a hierarchical approach to organisation of service. People have different perspectives on how to develop mental health services in various localities and many of the inspector's recommendations during the years, particularly in relation to sectorisation, have not been taken on board by professionals in certain areas. That is changing and we are moving towards a community based model, but all the partners within the service need to embrace it. There are difficulties in some areas. Industrial relations issues, in terms of moving from institutions out into the community, have ended up in the Labour Relations Commission and are now in the Labour Court. Patients are awaiting transfers into community facilities because of these intractable IR issues which are not justified; there are particular areas in question.

I accept the point about multidisciplinary teams, but the funding we put in place this year – a record increase in terms of additional funding for mental health services – is facilitating the provision of such teams. I suggest that the lack of these teams was one factor in the over-emphasis on the prescribing of medicine alone.

Mr. Neville

I accept that the initiative in Cavan-Monaghan came from within that service, but the Minister and his Department should give leadership—

Mr. Martin

Yes.

Mr. Neville

—and make a multidisciplinary and community based approach a firm policy throughout the country. Rather than waiting for the various services to take the initiative, the leadership should come from the Minister and the Department. Does the Minister agree that there is a difficulty with multidisciplinary teams because of the lack of certain professionals like psychologists, psychotherapists and so on?

Mr. Martin

I accept there is a major issue in terms of allied health professionals – psychologists, social workers, occupational therapists and physiotherapists. I have put in place the manpower policies that will deliver them in time. In the short term we are recruiting people from abroad. I am not responsible for the lack of manpower planning in this area over the past 20 years in terms of only one school in many areas. In some cases we did not have any schools in terms of some of the allied health professionals. That has changed. We have put in place the policies that will bear fruit.