I propose to take Questions Nos. 149, 166 and 167 together.
The homeless preventative strategy, published in February 2002, stems from Homelessness – An Integrated Strategy, which makes a commitment that the Departments of Health and Children, Education and Science and Justice, Equality and Law Reform each will develop and publish strategies to prevent homelessness amongst those leaving institutional care.
The objective of the strategy from my Department's viewpoint is to provide guidance to health boards to ensure that policies and procedures are in place to reduce the risk of people becoming homeless on leaving institutional care. The strategy focuses on the following three principal groups: people leaving mental health residential facilities; people leaving acute hospitals; young people leaving care (both foster and residential).
The information set out below is the most recent update received from the Eastern Regional Health Authority and the health boards in relation to the implementation of the health aspects of the preventative strategy.
Eastern Regional Health Authority (ERHA)A protocol for people being discharged from acute and psychiatric hospitals has been developed and is being rolled out throughout the region. In relation to young people leaving care, research has been undertaken with a view to establish a more detailed analysis of aftercare requirements. The Youth Homeless Forum convened by the ERHA, with wide representation from the statutory, voluntary and community sector is overseeing the development of a regional leaving care policy.
Mid-Western Health BoardNew protocols have been developed and agreed in relation to the acute sector, the mental health area and for young people leaving care. All three protocols are expected to be implemented by the end of October 2003.
South-Eastern Health BoardPreventative protocols have been agreed and are being implemented in respect of acute hospitals and mental health residential facilities. I have been informed that existing child care policy in this board includes provisions for the prevention of homelessness for those leaving care.
Western Health BoardEach of the acute and mental health facilities has its own discharge policy and links have been established with the local authorities. Work is continuing on the development of a regional policy document. The recommendations contained in the strategy are being implemented for young people leaving care.
Southern Health BoardProtocols are in place to support the prevention of homelessness amongst those leaving acute care. Protocols in relation to those leaving mental health facilities and young people leaving care are currently being finalised.
Midland Health BoardPeople leaving acute services – while the board's hospitals have relatively few attendances of homeless people, when they do present to the hospital, a procedure to ensure that key individuals, (such as social workers, community welfare officers and liaison public health nurse), are informed is followed.
People leaving mental health facilities – a regional discharge planning framework and policy which provides for all patients, including homeless people is in place. In addition a pre discharge planning checklist is being piloted and will be extended in due course. Post discharge care is planned and appropriate accommodation is sought for individuals prior to discharge.
Young people leaving care – aftercare support plans have been developed and are being implemented for all young people leaving care. A written aftercare policy is currently being drafted.
North-Eastern Health BoardPeople leaving acute services – a comprehensive admission and discharge protocol is in place.
People leaving mental health facilities – a formal written discharge policy is in place.
Young people leaving care – An aftercare service was established in 2001 with the appointment of three aftercare workers. A written aftercare policy is in place.
North-Western Health BoardThis information is not readily available in my Department. Therefore I have asked the North-Western Health Board to respond directly to the Deputy on this matter.
In line with the strategy, my Department receives regular updates from the Eastern Regional Health Authority and the health boards in relation to the implementation of the homeless preventative strategy. My Department reports on progress through the cross-Department team on homelessness, that operates under the aegis of the Department of Environment, Heritage and Local Government, to the Cabinet Committee on Social Inclusion.
In relation to the establishment of multidisciplinary mental health teams throughout the country, two multidisciplinary primary care teams operate in Dublin city. These teams comprise social workers, nurses, community welfare officers, drug outreach workers, a community psychiatric nurse, an occupational therapist and general outreach workers. Their main role is to identify homeless people who are not accessing necessary health services, assess their need and link them into mainstream services.
An outreach psychiatric team for homeless people is operating in the East Coast Area Health Board since April 2003. Staff have been recruited for a further team to operate in the South-Western Area Health Board and it is expected that this team will be operational from November. These teams will operate on an outreach basis, working across catchment areas and will deal with people with dual diagnosis and behavioural problems.
In addition to the above, a dedicated multidisciplinary team for homeless people operates in the Southern Health Board. This team comprises a sessional psychiatrist, a sessional GP, two mental health nurses, a public health nurse, a general registered nurse, an addiction counsellor, a health promotion officer and four community welfare officers. This team operates in Cork city and south Cork.
A multidisciplinary team (comprising two community welfare officers, a public health nurse, a community psychiatric nurse, and a psychiatric social worker) operates from the homeless person's centre in Limerick.
