Dáil Éireann debate -
Wednesday, 11 Nov 2009

Vol. 694 No. 2

Adjournment Debate.

Mental Health Services.

Deputy Pat Breen

I thank the Ceann Comhairle for facilitating this debate. While attitudes to mental health have changed over the years, a recent national survey undertaken by St. Patrick's University Hospital, which examined the attitudes to, and perceptions of, mental health, found that even in 2009 there continues to be a stigma against people who suffer from mental illness. More than one third of people surveyed believe that those suffering mental illness are of below average intelligence and a further one third said they were not willing to accept someone with a mental health illness as a close friend. A total of 40% of respondents would discriminate against someone with a history of mental illness when it came to hiring him or her and 40% felt seeking help and undergoing treatment was a sign of failure.

These findings are an eye opener and they are disturbing. Considering that on average one in four people will suffer from a mental health issue in his or her lifetime, it shows how important it is to dispel these myths. Former US President Bill Clinton once said, "Mental illness is nothing to be ashamed of, but stigma and bias shame us all." The best way of dispelling this stigma is to move away from institutionalising people with psychiatric issues and to integrate them into our communities.

In 2002, when Our Lady's Hospital in Ennis closed, the Orchard Lodge Hostel, a high support unit was set up in Kilrush. The unit currently supports 17 people, 11 of whom are over the age of 65 years. They have all settled into Kilrush and for the first time in their lives they have a place they can call home. They can go about their daily business, they have freedom, they can go into the local shop to collect their newspaper, have a pint in the local pub or sit and chat over a cup of coffee with their friends. The freedom these people quite rightly now enjoy is being made possible by the care and attention they receive from the team of dedicated staff who look after them. Reports in recent days suggest that these people, who are the most vulnerable in our society, are now going to pay the price for the failure of the Government and the HSE to fund the provision of mental health services in County Clare, that the Orchard Lodge in Kilrush is going to close down and that these people are going to be forced into other facilities where they will not have the same freedom. I cannot understand this. It is a backward step. Does the Minister realise the anguish this will cause to these people and the trauma they will suffer if they have to leave their familiar surroundings?

I understand that a review of the entire provision of mental health services in Clare is under way and that this review is driven by the 21.3% decline in the number of nurses working in the service in the past 22 months. Surely any review of psychiatric services should be driven by what is in the best interest of patients and their families.

Last February, more than 20 geriatric patients were moved from unit 6 of St. Joseph's Hospital in Ennis to a private nursing home in the town and now there is concern that another unit is about to close at St. Joseph's to accommodate patients from Cappahard Lodge in Ennis. Gort Glas in Ennis is also closing I understand, and patients from there will be transferred to Cappahard.

Depression has increased as the recession takes hold in this country and I have been inundated with pleas for help from many families who are finding it more and more difficult to access basic help for mental illness because of the lack of resources. A local eminent psychiatrist recently warned that the reduction of €4 million in funding for the Clare mental health service, down from €26.7 million in 2008 to €22.85 million in 2009, will mean there will be no money for capital projects such as hostels or rehabilitation programmes for a number of years. He also warned that some patients could be forced to wait up to six months to attend a public psychiatrist or counsellor. Some of the multi-disciplinary teams in Clare are not fully staffed, in spite of the Government's commitments under the Vision for Change programme and the reality is that the acute psychiatric unit at Ennis General Hospital is stretched to the limit with no step-down facilities in place and we are still without proper 24/7 access to social workers to help families in crisis.

Short-sighted cuts in mental health care for the most vulnerable members of our society will cost the Government more in the longer term, not to mention the cost to those with mental illness and their families, who continue to suffer in silence.

I am delighted to see the Minister of State with responsibility for mental health in the House this evening. I ask him to clarify here in this House tonight, first of all, what is the situation regarding the Orchard Lodge facility, second, when will the review of mental health services in County Clare be completed and, as part of that review, will the Minister ensure that adequate resources are allocated to the Clare mental health service in the forthcoming budget?

Minister of State at the Department of Health and Children (Deputy John Moloney)

I thank Deputy Breen for raising this matter as it provides me with an opportunity to outline the plans for further development of mental health services in County Clare. To put the issue into context I should recall that A Vision for Change, the report of the expert group on mental health policy has been accepted by Government as the basis for the future development of our mental health services. While much has happened and much has changed economically in the three years since the report was launched, it remains a progressive document and our road map, charting the way forward for our mental health services. A Vision for Change proposes a new model of service delivery which is patient-centred, flexible and community based. The report proposes a holistic view of mental illness and recommends an integrated multi-disciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems. Extensive consultation with service users, their families and service providers informed this policy.

The most pressing priority voiced during the consultation process was the need for an accessible and user-friendly mental health service where service users can be respected as active partners in their own recovery and where they can avail of interventions to enable them remain meaningfully involved in their own communities.

Of course mental health services are provided in many settings, including acute inpatient facilities, day hospitals, day care centres, low support and high support community accommodation. While A Vision for Change recognises that acute hospitalisation will be always required to serve a minority who need intervention in safe, therapeutic settings, it also acknowledges the desire among service users, their families and carers to see an expansion of mental health service options established in local communities so that comprehensive care can be provided.

To turn to Orchard Lodge, in line with best practice, the HSE is currently engaged in a review of mental health services in County Clare with a view to ensuring that the most appropriate services are provided for service users, in the context of their changing needs. The HSE has consulted and engaged with carers, families and clinical and nursing staff and provided opportunities for them to put forward their views and to have a constructive input in the review process. At present there are 16 residents in Orchard Lodge and following individual clinical assessments it has been concluded that 11 of the residents, given their changing needs, would be more appropriately cared for in an older persons setting. It is therefore proposed to refer these residents to the older persons placement panel for consideration as to the most appropriate care setting for each individual. The remaining five residents who at this point require ongoing mental health care, will be accommodated in appropriate rehabilitation facilities.

While it is proposed to discontinue the residential facility at Orchard Lodge, I should clarify that there are no plans at present to change other services provided on this site, including the day service and the west Clare catering service. I should also explain that the closure of the residential facility will release mental health nursing staff and allow for their re-deployment to other areas where nursing staff are required and thus ensure best use of our valuable resources.

While I accept that the prospect of change can be daunting for service users and staff alike, we need to look at the bigger picture and recognise that the change which is proposed by the HSE is for the better. If we want to implement our national mental health policy, A Vision for Change, we need to be able to move forward and embrace change. Our major driver must be to meet the changing needs of individual service users and improve the quality of their care.

The residents of Orchard Grove have been clinically assessed and it has been determined that their needs would be better served in a different therapeutic setting. The HSE, to its credit, is proactively responding to the changing needs of these clients and is trying to provide the best possible care to them in the most appropriate setting. I am confident that the HSE will continue to engage actively with stakeholders and that notwithstanding the considerable challenges it faces, a satisfactory solution will be devised to the ultimate benefit of all concerned.

I fully appreciate Deputy Breen's concern regarding the stigma attached to mental illness. I intend putting forward a national programme to deal with that issue in January. I also intend to take an overview of the Vision for Change. With six years remaining for the programme, it is timely that we review its successes and acknowledge that the original reform has not been what we hoped it would be.

Deputy Pat Breen

The facility to which these people will be transferred is outside the town. They will not have the freedom of movement they enjoyed in Kilrush. Tonight's news is very disappointing in that regard. They integrated very successfully in Kilrush.

Deputy John Moloney

I thank the Deputy.

Death of Irish Citizen in Bolivia.

Deputy Máire Hoctor

Go raibh maith agat, a Chathaoirligh. Tá áthas orm an seans a bheith agam labhairt faoi Mhicheál Ó Duibhir as Contae Thiobraid Árainn, a fuair bás ins an Bholaiv.

I am grateful to the Ceann Comhairle for giving me the opportunity to speak about the tragic death of Mr. Michael Dwyer of Brockagh, Ballinderry, Nenagh, County Tipperary, which happened on 16 April of this year. Michael Dwyer was a young man of 24, a carefree and loving son and grandson. The terrible news of his tragic death came to County Tipperary, shocking his parish and the entire hinterland of Ballinderry. Many questions surround the circumstances of his death.

Michael had completed studies in construction management and always had a good work ethic. He was well admired and loved by his companions at college and at school. He attended Borrisokane community college. However, he undertook this journey as he wanted to see the world. He headed off on 17 November 2008 to Bolivia initially intending to stay for a short period of time, approximately eight weeks. He felt this trip would start the trip of a lifetime. He intended to return within a short period of time but in late January 2009, he decided to extend his stay in Bolivia until the end of April or so due to the fact he did not believe there was work available in the areas of construction or security in which he had worked in Ireland previously.

On 16 April 2009 he was tragically murdered in Bolivia, a cause of deep sorrow to his parents, Martin and Caroline, and his siblings, Aisling, Ciara and Emmett. His family have been traumatised but softening that tragedy is the support they have received from their local community, their friends and, indeed, the Members of this House. I pay tribute to the Minister for Foreign Affairs, Deputy Martin, and his staff, Deputy O'Hanlon, Chairman of the Joint Oireachtas Committee on Foreign Affairs, Deputy Woods, and all the Members of this House who met the Dwyer family and listened intently to their case, which was excellently presented to them recently.

On 13 October, the Dublin county coroner held the inquest into Michael's death. The coroner, Kieran Geraghty, was present along with members of the Dwyer family and other people, including Dr. Marie Cassidy, the State Pathologist. According to the report, Michael had a single bullet wound to the chest which went through his heart and lungs and killed him. The Bolivian autopsy stated that his heart was intact and that there were six bullet entry wounds, one to the front and five to the back.

The report of Dr. Cassidy confirms that there was no bullet exit wound whereas the Bolivian report states there were three bullet exit wounds. While there is conflict and discrepancies in the reports in regard to Michael's death, there will always be questions. We acknowledge the support from the Department of Foreign Affairs but questions will remain if not answered. The Dwyer family is extremely anxious that progress is made in the communications with the Bolivian authorities, which have been initiated by the Minister for Foreign Affairs and by Deputy O'Hanlon through the Oireachtas Joint Committee on Foreign Affairs.

Other discrepancies have been also mentioned in regard to the forensic swabs taken as part of the autopsy at the morgue following a 15-hour delay at the hotel where the shooting took place. The delay and the subsequent handling of Michael's body call into question the integrity of the reports which emerged from that investigation in Bolivia.

The ballistics report also states that the examination on 22 April took place six days after the shooting when the rooms had been cleaned and when the evidence had been removed. There are many unanswered questions and there is much more to be said about this case.

I put on record my unwavering support for the Dwyer family in this tragedy. I look forward to hearing the response in regard to the family's call for a well-resourced international inquiry into the death of Michael Dwyer.

Deputy John Moloney

I apologise that the Minister for Foreign Affairs cannot be here. I acknowledge Deputy Hoctor has raised this issue often not only with the Minister but with the officials. I fully appreciate her concern and commitment to secure transparency and honesty. I also thank her for raising the issue on the Adjournment and I join in conveying my condolences to the Dwyer family on the death of their son and brother, Michael. I recognise the trauma and difficulty for the family.

Michael Dwyer was shot dead by the Bolivian state security services on 16 April in Santa Cruz. After hearing of his death, the Minister for Foreign Affairs, Deputy Martin, immediately instructed the Irish embassy in Argentina, which is also accredited to Bolivia, to send a diplomatic officer there to represent the Government and also to look after the concerns of the family. The officer initially travelled to Santa Cruz and then to the Bolivian capital.

Following extensive contacts between the Irish embassy representative and officials in Santa Cruz — I acknowledge the involvement of Deputy Hoctor in this process — it was possible to secure the timely release of the remains and arrangements were made for the body to be repatriated to Ireland for burial. Constant updates from officials and the Minister were given to the Dwyer family at this tragic time.

The embassy representative also had meetings with the Bolivian Vice President, the acting Minister for Foreign Affairs, the Vice Minister of the Interior, the investigating attorney in charge of the case and the investigating officer from the anti-crime special force. He expressed the Government's concern at reports on the circumstances surrounding the death and inquired as to the steps the Bolivian authorities were taking to discover the facts of the case.

The Minister then spoke to Acting Foreign Minister Quintana by telephone and emphasised that our interest in this case related entirely to protecting the consular rights of our citizens abroad. The Irish Government has a duty to seek the facts in a case where one of our citizens has been killed in a violent incident by the security forces in another state.

The Minister emphasised that the Government would welcome an official explanation of what occurred in Santa Cruz and stated that the Government was ready to participate in, and assist with, an international investigation. The Minister then wrote to Minister Quintana to reiterate our consular interest in the case and to welcome his commitment to working with the Government to establish the full facts of the case.

Through our embassy in Buenos Aires, a number of reports have been received by the Minister, namely, the official position of the Bolivian Government on the break-up of a terrorist group, copies of the report of the autopsy carried out on Mr. Dwyer in Santa Cruz, the toxicological and chemical analysis reports and the ballistics report. These have been shared with Mr. Dwyer's family.

On 15 October, an inquest was held into Mr. Dwyer's death in the coroner's court in Dublin. In this case, the jury delivered an open verdict in the absence of evidence strong enough for any other finding to be made. The State Pathologist, Dr. Marie Cassidy, who had carried out an autopsy on Mr. Dwyer directly after the return of his remains to Ireland, testified to the court that Mr. Dwyer had been struck by a single bullet. This testimony was at variance with the Bolivian autopsy which noted six points of impact by gunshot.

Her Excellency, Beatriz Souviron, the Bolivian ambassador-designate to Ireland, who also gave evidence at the inquest, stated that the Bolivian Government's investigation into the causes of Mr. Dwyer's death was ongoing. She also indicated the Bolivian Government's willingness to welcome any assistance which would make the facts of the case clear and she agreed to refer to her Government the request for an international investigation.

Following the inquest, the Minister for Foreign Affairs wrote to his Bolivian counterpart, David Choquehuanca, asking for clarification of the discrepancies between the autopsy carried by Dr. Cassidy and the autopsy which took place in Santa Cruz. The Minister inquired as to progress in the Bolivian Government's investigation of the events surrounding Mr. Dwyer's death.

The Minister urged the Government of Bolivia to hold an international investigation into the events surrounding Mr. Dwyer's death and the death of two other foreign nationals. He reiterated that Ireland is available to provide assistance to, and co-operate with, the Bolivian Government in an international investigation of this matter. We await Minister Choquehuanca's reply.

I assure the Deputy that the Department of Foreign Affairs will continue its efforts to establish the facts surrounding the death of Michael Dwyer and will provide all possible consular assistance to Mr. Dwyer's family.