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Dáil Éireann debate -
Thursday, 3 Apr 2003

Vol. 564 No. 3

Mental Health Services.

I welcome the Amnesty International report, Mental Illness, the Neglected Quarter, which was published last month and which promotes the rights of the one in four Irish people affected by mental illness. I will cite from the report. The report states that Amnesty International is concerned at the inattention paid by the Government of the Republic of Ireland to a series of national and international reports critical of its failure to fully respect the human rights of people with mental illness. It further states that ultimate responsibility for compliance with international law lies with the Government, not with individual Departments, health boards, civil servants or service providers.

The neglect down through the decades of the mental health services is one of the greatest disgraces of our society. The institutionalisation of the mental health services in Ireland has failed to live up to the World Health Organisation standards and there continues to be high admission rates to psychiatric hospitals, both voluntary and involuntary, due to the lack of community-based facilities.

I will make three references to the 2001 report of the Inspector of Mental Hospitals. The report states that the physical health examination of in-patients, as documented in in-patient records is often infrequent, desultory and superficial in nature. It recommends that the occurrence of sudden death of psychiatric in-patients due to asphyxia from inhalation of food and other materials should be investigated and taken care of and refers to suicides among psychiatric patients, which are not subject to any formal audit.

The Government is in breach of Article 20 of the UN Convention on the Rights of the Child by placing children and juvenile offenders in adult psychiatric facilities. This has been referred to repeatedly by the Inspector of Mental Hospitals and is now highlighted by Amnesty International as a breach of the UN Convention on the Rights of the Child.

The total expenditure on mental health services has dropped in the past 15 years from 12% to 7.2% of the overall health budget. That shows the inattention over the past 15 years. One in four people have a psychiatric illness at a certain stage of their lives but the expenditure has almost halved in relation to total health expenditure.

People with intellectual disabilities remain inappropriately accommodated in psychiatric institutions in violation of their human rights. We have repeatedly referred to this in this Chamber. As many as 18% of the child population under the age of 18 will experience significant mental health problems, yet services in Ireland for them are few, infrequent to access and there are long waiting lists. There is a lack of dedicated psychiatric services for adolescents, with most areas seriously short of adolescent psychiatric facilities, and some with none at all despite the fact that psychiatric disorders increase in prevalence in the adolescent years, with incidence of self-harm and suicide also increasing in those years.

There are few specialised mental health teams and outreach services dedicated to the rising number of homeless in Ireland. The report notes that various sources put the proportion of homeless people suffering from mental illness at between 30% and 50%.

There is no special psychiatric unit for prisoners – I am glad the Minister for Justice, Equality and Law Reform is here as well – and the only psychiatric hospital to accept prisoners is the Dublin Central Mental Hospital, which has insufficient beds for the demand, resulting in many mentally-ill patients in need of in-patient care never receiving a transfer.

Within the mental health service clinical resources are concentrated in the least deprived rather than the most deprived areas. The most deprived areas have, subsequently, fewer acute beds, larger sector sizes and a greater consultant staffing rate. I refer to the Irish Psychiatric Association report, which was published two weeks ago.

There is no special neuro-psychiatry service available for brain injury, brain disease or for those with psychiatric disorders as a result of a neurological disease. These patients do not receive any specialised treatment in this State.

Deputy Neville has spoken on several issues. If he wishes to have a response on a specific issue I will be glad to respond to him directly. However, I came prepared to respond to the question which was posed, that is the Amnesty International report, Mental Illness, the Neglected Quarter.

By way of information, everything to which I referred is in the report.

It is a wide-ranging report so my response will be wide-ranging.

The report was launched on 10 February 2003. The report acknowledges the significant advances made in the provision of community psychiatry, nursing services, community residences, day hospitals and day centres since the publication of the landmark 1984 report, Planning for the Future.

While I concur with some of the sentiments expressed by Deputy Neville, like most reasonable people in this House, I believe we have seen the former draconian accommodation of psychiatric patients change. We have seen the large high walls taken down and integration of services in the community leading to a better standard and quality of life for most of the people involved. I was particularly pleased to be associated with the adoption of the Planning for the Future document in 1985-86.

I will address the issue of funding because the Deputy referred to it. In the period 1999-02, an additional €70.7 million was invested in mental health services. In the current year, additional revenue funding of €7.6 million will be provided for ongoing improvements in mental health services—

That is very small in the context of the overall health budget.

—to develop and expand community mental health services, increase child and adolescent services, expand the old age psychiatry services, provide liaison psychiatry services in general hospitals and enhance the support provided to voluntary agencies.

Approximately €190 million capital is being provided over the lifetime of the national development plan to fund the development of acute psychiatric units linked to general hospitals, as a replacement of services previously provided in psychiatric hospitals. Substantial progress has already been made. The Deputy referred to a reduction in funding, but it may be a case of a change in where funding has been allocated. Much of the funding heretofore may have been allocated to psychiatric hospitals or to a psychiatric service, where now it may be going to a community-based service.

It says that it is not.

As I said, if the Deputy wishes to ask a specific question I will be happy to answer it. There are now 19 psychiatric units attached to general hospitals which are operational and a further two units will become available to their mental health services in the near future.

In relation to community residences, there are approximately 400 community psychiatric residences in the country which provide over 3,000 places. This compares to 111 residences, providing less than 1,000 places in 1984. In relation to day hospitals-day centres, there are approximately 200 providing over 3,500 places. This com pares with approximately 1,200 places prior to Planning for the Future.

The Amnesty report also acknowledges the funding which is being made available by Government to support groups and organisations such as Schizophrenia Ireland, Mental Health Ireland, GROW and Aware to heighten awareness and develop support services for service users and carers. In a concrete expression of the Government's commitment in the health strategy to develop advocacy services in mental health, €251,000 was provided by my Department for this purpose in 2002. This figure included €127,000 which was provided to the Irish Advocacy Network. An additional €50,000 has been provided to it for 2003.

I particularly welcome the report's recommendation for a comprehensive review of the mental health services, which reflects a commitment in the health strategy, Quality and Fairness – A Health System for You, to the development of a new national policy framework on mental health. Work on this review is expected to begin in the coming months.

The new Mental Health Commission, established in April of last year under the provisions of the Mental Health Act 2001, has an important role to play in improving the quality of our mental health services. The establishment of the commission was welcomed by Amnesty International in its report. The primary functions of the commission are to promote and foster high standards and good practices in the delivery of mental health services and to ensure that the interests of detained persons are protected. The Mental Health Commission is now working, along with officials from the Department of Health and Children, to put in place the structures required for its new role.

The Minister of State's time is up.

I know Deputy Neville would like to join me in wishing the new commission well in putting such structures in place as soon as possible. I thank Deputy Neville for raising Amnesty's report on today's Adjournment and I assure him that the Government is fully committed to the provision of quality care in the area of mental health.

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