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Dáil Éireann debate -
Thursday, 17 Jun 2004

Vol. 587 No. 4

Adjournment Debate.

Mental Health Services.

Gabhaim buíochas leis an Cheann Comhairle as ucht an deis a thabhairt dom an cheist thábhachtach seo a ardú inniu. Is trua gur gá dúinn teacht go dtí an Teach seo chun na ceisteanna seo a ardú. Ba chóir go ndéileálfaí leo roimh ré. I represent the constituency of Dublin South-Central, which is an urban area in great need. This fact is recognised by the Government in its official designation of the majority of this area as a RAPID area requiring increased investment because of the depravation and poverty existing there. Drugs task forces operate there and high rates of homelessness are also a feature. All these factors demonstrably lead to an increased risk of mental illness and an increased concentration of those with mental illness in need of care and assistance in the area. The location of a major hospital in the area is another factor for consideration.

The area is the second most densely populated deprived area in the State. In spite of that, funding for mental health services for this community is the lowest in the State, which is a scandal. This matter needs to be both exposed and addressed. We cannot allow the situation to continue any longer.

I wish to focus on the chronic underfunding of mental health services at St. James's Hospital, which up to now served just the Dublin 8 area but in recent months has also begun to serve the Drimnagh area. The underfunding of the hospital is criminal. The area has only half the per capita funding of a similar sized rural area such as that of Cavan and Monaghan. Parts of Galway receive three times the funding received by this area.

An under-resourced service such as this cannot properly deal with its workload. Adding to it another under-resourced area such as Drimnagh further exacerbates the problem which was already at crisis point. Doctors at St. James's Hospital have said an additional €2.5 million is required just to maintain the service as it was prior to the amalgamation because of the previous shortfall in funding. The needs of the Drimnagh area were added to that of an already struggling service without the provision of an additional psychologist, occupational therapist or rehabilitation service. Neither is there any assertiveness outreach or supportive accommodation. Drimnagh lost out in the amalgamation, as did the mental health services at St. James's Hospital because no additional funding was given to ensure the service could expand. As a result of the lack of resources prior to the amalgamation with the Drimnagh area, the entire area has lost out.

The South Western Area Health Board has less acute psychiatric beds than any other health board. Tallaght Hospital is also in need of more in-patient beds. If the beds issue is not addressed, there will be a shortfall in the capacity to deliver the comprehensive service that is required. The current threshold demands a population of 25,000 before a psychiatrist is provided. All health professionals agree that figure should not be adhered to in deprived urban areas and that more psychiatrists should be provided in those areas.

The chronic under-provision and underfunding of mental health services is a major human rights issue and is the subject of an Amnesty International campaign. I demand to know what plans the Government has to rectify the situation, particularly in the Dublin 8, Drimnagh service.

I thank Deputy Ó Snodaigh for giving me the opportunity to respond on this Adjournment matter.

The Deputy is incorrect in saying there is chronic underfunding of mental health services at St. James's Hospital or that it has the lowest national funding despite the high level of need. I will go down the road some way with the Deputy and agree there are gaps in services and variances in the regions. We recognise that and the health reform package should address that.

However, a reform package will not resolve everything. We need to pull the package together through the right skill mix and the assistance of outreach workers. It is important the mix is right but it is not easy to get the appropriate multidisciplinary approach required at the same time and within a timeframe the Deputy and I would like to see it in situ. It takes some time to get a team working together to maximum capacity. If a member leaves suddenly or is moved, it takes time to build up the team again.

I hope the Deputy understands the need to pull different people together. A mix of people is required to participate in the provision of services in the section of the city to which he referred. Some of these services are statutory and some voluntary but they must work together. How we see this depends on how we count the number of beds. Is the Deputy talking about the total number of beds or the number provided by the health board? Is he counting the number of beds provided by the health board and the voluntary services and others working in the system? The Deputy has a perception or understanding that there is chronic underfunding and that funding in St. James's Hospital is the lowest nationally. However, if he looks at the overall picture, he will find the picture is changed.

Most Members of the House appreciate there has been tremendous change in recent years in the provision of services for people with a mental illness, especially since publication of the Planning for the Future policy which promotes integration in society. We should not lose sight of the fact that there has been tremendous change and that the quality of people's lives has improved greatly. People previously kept in an institutionalised setting are now being given opportunities in the community that heretofore they did not receive.

The health board accepts the funding for St. James's Hospital is the lowest.

The Deputy should allow the Minister of State to speak without interruption.

The responsibility for the provision of mental health services at St. James's Hospital is a matter for the Eastern Regional Health Authority and the South Western Area Health Board, SWAHB. According to figures supplied to the Department, St. James's Hospital and area three mental health services will receive in excess of €9 million this year.

South Western Area Health Board mental health services are provided in partnership with St. Patrick's Hospital and St. James's Hospital on behalf of the South Western Area Health Board. The Dublin south city service caters for a population of approximately 130,000 across two sectors. Camac serves the south inner city and Owendoher serves the outer sector as far as Rathfarnham.

Community mental health services are provided by St. Patrick's Hospital. In-patient care is provided at the Jonathan Swift clinic at St James's Hospital which has 50 beds, including nine specialist beds for psychiatry of old age. This is in line with the bed ratio as recommended in the policy document, Planning for the Future.

They do not cater for Drimnagh.

The Deputy raised the issue of St. James's Hospital on the Adjournment.

Drimnagh has been allocated to St. James's Hospital. The Minister of State has misrepresented——

The Adjournment allows a Deputy five minutes, but the Deputy took more than that. He cannot use the Minister of State's five minutes to which a Minister is entitled to put his answer on the record without interruptions.

Some people in the House recognise that many mental health services have had the benefit of a legacy budget associated with a large institutional base. However, the service in this part of the city has not had this advantage and, as a result, all resources require additional allocation from the central Exchequer.

It is intended to create a day hospital and sector headquarters for this area and a site has been identified by the South Western Area Health Board for this purpose. The service has four consultant-led teams and works in close collaboration with the specialist service of psychiatry of old age and St. James's Hospital. A new consultant-led team has been allocated to this service to cater for the needs of clients in the Drimnagh area. I mention that specifically as the Deputy mentioned Drimnagh, although not in his Adjournment matter.

On capital funding, the Eastern Regional Health Authority will be investing proceeds from the sale of the lands at St. Loman's Hospital into the development of the mental health services on the St. Loman's site and in other locations in the South Western Area Health Board.

I suggest to Deputy Ó Snodaigh that he should contact the chief executive of the South Western Area Health Board. He or his assistant chief executive will make themselves available. I would like the Deputy to come back to me, if he is happy and satisfied, with the proposals and plans it has for the Deputy's area. I assure him that further development of our mental health services, including those in the South Western Area Health Board area, will be considered in the context of the Estimates process for 2005 and subsequent years.

The Dáil adjourned at 5 p.m. until 2.30 p.m. on Tuesday, 22 June 2004.
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