Dáil Éireann debate -
Thursday, 10 Oct 2002

Vol. 555 No. 1

Adjournment Debate. - Report of the Inspector of Mental Hospitals.

Mr. Neville

I thank the Ceann Comhairle for allowing me raise this issue. I congratulate the Minister of State, Deputy Tim O'Malley, on his appointment. We served as colleagues on the Mid-Western Health Board for many years and I know that his heart is in the right place in respect of the issue of mental illness. I have some doubts, however, that his political masters will support him in all he will want to do.

There is no doubt that the mental health services are the most neglected area of our health provision since the foundation of the State. The report of the inspector of mental hospitals for the year ending 31 December 2001 again highlights how neglected those suffering from psychiatric illness are. The inspector has, time and again, been struck by the number of psychiatric in-patients who are homeless and who are accommodated in acute or long-stay hospital wards, despite their being suitable for community and residential placements. There is hardly a service in Ireland where this situation does not exist. Such people have not moved to the community domestic scale residential or multiple accommodation because, in some cases, suitable property is not available. In other cases, especially in Dublin and other metropolitan areas, premises have become expensive. Surely the State should facilitate those who are at present in a psychiatric institution who do not need to be there and should be returned to the community. Even from a financial point of view it makes sense that such provision be made.

Will the Minister of State outline when community based centres of psychiatric activity will be introduced? Without such functioning presence away from the patient base, there is a serious failure of the health care delivery system in adhering to the Government's health strategy goals and objectives. In a majority of instances, such premises do not exist or are of inadequate structure and size for the identified purpose of their activity. In addition, there is, in many instances, a reluctance on the part of mental health professionals to centre their activities and working days in a community setting. The Government must immediately address this issue, which can be achieved without neglecting the professional's in-patient commitments.

Similar difficulties arise in relation to the concept of hospital assessment and treatment. The inspector informs us that health professionals are confused in their conceptualisation of what a day hospital should be about, which patients should be treated and what treatment should be available. This is surely an indictment of the delivery of the services. Other difficulties arise in connection with the concept of day hospital assessment and treatment. The experience of the inspector country-wide is that health professionals are confused about which patients they should treat and what treatments should be available. In many instances, so-called day hospitals do not deal with a broad range of psychiatric disorders, especially the more serious ones, and do not provide a broad range of treatments. Ideally, a day hospital should provide every treatment that is available in an in-patient setting. Many premises are too small or do not have sufficiently large internal space to deal with more serious illnesses.

Will the Minister of State outline the results of a study of community psychiatric services by the health boards' research unit, which is due to be published this year? The treatment of the elderly in our psychiatric institutions is a disgrace and cannot be defended. Currently, almost 40% of persons resident in psychiatric units in hospital are over 65 years of age. In some instances, especially among long-stay patients, this figure exceeds 50%. Not all such patients show signs of behavioural disturbance related to psychiatric disorder and among the more elderly especially, their needs and disabilities are related to their age rather than any psychiatric disorder. The inspector points out that the continuing residence in long-stay psychiatric facilities is neither appropriate nor best suited to their needs. Their remaining on the psychiatric register is neither helpful clinically nor appropriate from a civil rights point of view. The inspector is saying the civil rights of elderly long-stay patients are being denied. Will the Minister of State outline the programme to transfer their care to either the community residence, which is possible, or suitable in-patient continuing care facilities for older people in psychiatric institutions?

A very disturbing aspect of the report outlines that in 2001 there were nine cases of suicide among psychiatric patients. Will the Minister of State indicate if it is planned, as recommended by the inspector, to undertake an in-depth review of all deaths by suicide of patients under psychiatric care with a view to scrutinising existing clinical management and risk assessment of patients for the possibility or likelihood of self-injury, including the periodic review of procedures relating to absence when in the community?

In May 2000 a 16 year old boy died by suicide while in the care of the Mid-Western Health Board. At the time I raised the issue with the Minister and he promised an early report. I submitted a parliamentary question for reply yesterday and the Minister has informed me that he understands the Mid-Western Health Board expects to be in a position to issue a final report on this matter within weeks. Will the Minister of State explain the reason it has taken two years and five months to produce a report on the suicide of a person in the care of a health board?

In the last week of September a young student in the Mid-West Regional Hospital died by suicide. The family of this victim has requested that a report on her death, independent of the Mid-Western Health Board, be completed. I ask the Minister of State to facilitate this.

Minister of State at the Department of Health and Children (Mr. T. O'Malley)

I thank the Deputy for raising this matter on the Adjournment. I welcome the publication of the report of the Inspector of Mental Hospitals for 2001 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. I met the inspector recently to discuss his report and elicit his views about the areas of the mental health services that need improvement. The inspector informed me 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 2001 report the inspector notes the continuing decline in the number of patients in psychiatric in-patient facilities, from 4,522 at the end of 2000 to 4,256 at the end of 2001. There were 26,037 admissions to these facilities in 2001. The number of involuntary admissions, at approximately 2,597, remained constant at 10%.

The inspector refers to the ongoing replacement of old institutional mental hospitals with acute psychiatric units attached to general hospitals. During 2001 new acute psychiatric units were completed or nearing completion at St. Luke's Hospital, Kilkenny; Mayo General Hospital, Castlebar, and Portlaoise General Hospital. It is expected that each of these units will become available to the respective mental health services shortly. The construction of new acute psychiatric units is also well under way at James Connolly Memorial Hospital, Blanchardstown, and St. Vincent's Hospital, Elm Park. At the time of inspection the few remaining patients at Our Lady's Psychiatric Hospital in Cork were due to transfer to the new St. Anne's unit in Shanakiel in Cork city, facilitating the final closure of Our Lady's Psychiatric Hospital. I am pleased to report that this process has now been completed.

The inspector also noted that several significant developments had taken place during 2001. These included the enactment of the Mental Health Act, 2001, which was signed into law in July 2001. The Act provides for the establishment of the Mental Health Commission, which was established with effect from 5 April 2002. The commission is an independent statutory body whose primary functions are to promote, foster and encourage the establishment and maintenance of high standards and good practices in the delivery of mental health services and protect the interests of people detained for psychiatric care and treatment. While the detailed work programme of the commission is a matter for it to determine, I understand one of its priorities over the next year will be to put in place the structures required for the operation of mental health tribunals.

The first report of the working group on child and adolescent psychiatry was published in March 2001 and provides the blueprint for the development of these services in the coming years. The group is now focusing on the particular needs of 16 to 18 year olds. The new national health strategy document, Quality and Fairness – A Health System for You, was also published in 2001 and includes a commitment to prepare a national policy framework for the further modernisation of the mental health services, updating the 1984 policy document, Planning for the Future.

While the inspector expressed concern at the inadequate skill mix and lack of flexibility within many mental health services, he welcomed the introduction of new measures aimed at attracting and retaining nursing staff and the development of higher level courses for nurses wishing to follow a clinical career path. It is my intention to facilitate the service providers in bringing about the improvements and developments identified by the inspector as quickly as possible.

Substantial capital funding under the national development plan has been allocated to the development of mental health facilities. Approximately €190 million is being provided over the lifetime of the plan, which will enable the further provision of acute psychiatric units attached to general hospitals and the provision of additional community based facilities. Additional revenue funding of €24.4 million has been provided this year for improvements in mental health services. The main development programmes for 2002 include community based services, hospital services, child and adolescent psychiatry, old age psychiatry, suicide and suicide prevention programmes and the continuing support of the voluntary sector. I am committed to ensuring the recommendations contained in the inspector's report for 2001 are implemented as soon as possible.