I remind Members that this debate will conclude after one hour and 40 minutes, if it does not conclude before that.
Central Mental Hospital (Relocation) Bill 2020: Second Stage
I move: "That the Bill be now read a Second Time."
I am here to introduce the Central Mental Hospital (Relocation) Bill 2020. The Central Mental Hospital currently operates from a facility in Dundrum which was built in 1850. That building is no longer fit for purpose. Construction of a new hospital is a long-standing Government policy and a priority in the programme for Government. A significant and historic development will occur in 2021, with the opening of the new National Forensic Mental Health campus in Portrane, County Dublin. This facility is made up of three psychiatric centres, including a new state-of-the-art hospital to replace the Dundrum hospital. Legislation is needed to move to the new Central Mental Hospital site.
For 170 years, the Central Mental Hospital has provided secure care, specialist treatment, and rehabilitation for people at high, medium and pre-discharge levels of security. At present, it is providing inpatient treatment to 94 people. Most of those people are detained under various provisions of the Criminal Law (Insanity) Act 2006, with smaller numbers under the Mental Health Act 2001, as well as a small number of people who are wards of court.
The current hospital was built on a parkland site, as the Victorians believed that people with mental ill health could benefit from space and nature. That belief was a progressive one, and, indeed, more enlightened than the name of the facility, which was a product of its time. Today, the language of that time is inappropriate, outdated and offensive. Unfortunately, as some of it is written in law, I will need to quote from it at times during this debate.
In that context, I note that the current legal definition of the Central Mental Hospital comes from the Central Criminal Lunatic Asylum (Ireland) Act 1845. This Act provided for what was defined as a "criminal lunatic asylum" to be built. It was constructed in Dundrum and later, under the Mental Treatment Act 1961, was renamed the Central Mental Hospital. The provisions from those two Acts are what combine to link the hospital to its current location in Dundrum. This Bill is needed to allow the hospital to operate from a new location.
The Bill is short and technical. Its purpose is to provide a lawful basis for the relocation of the Central Mental Hospital from Dundrum, County Dublin, to a new facility at Portrane, County Dublin. It also provides for the transfer of persons detained in Dundrum to Portrane and provides for an ongoing lawful basis for their detention. It provides for the closure of the Dundrum facility, and repeal of section 39 of the Mental Treatment Act 1961, which links the Central Mental Hospital to the location in Dundrum.
I will now take the House through the Bill to clarify its provisions. Section 1 deals with definitions. It defines the meanings of some of the terms used for the purposes of the Bill, including '"relocation day", "closure day" and "former Central Mental Hospital".
Section 2 sets out procedures for fixing a date by ministerial order for the relocation of the hospital. The date shall be agreed after consultation with the Minister for Justice and the Mental Health Commission. From the relocation day, the new hospital in Portrane shall be known as the Central Mental Hospital. A copy of a map marking the location of the new hospital will be included in the ministerial order, with the original map deposited in the Department of Health. From the relocation day, references to the Central Mental Hospital or Central Mental Hospital Dundrum in any enactment, court order or other document made before the relocation day will be read as meaning the new hospital.
Section 3 provides that persons lawfully detained in Dundrum before the relocation day will continue to be lawfully detained in Dundrum on and after the relocation day, pending their transfer to Portrane. During the transitional period between the relocation day and the closure of the Dundrum facility, persons lawfully detained in Dundrum will be transferred to Portrane and will continue to be lawfully detained during that transfer.
The specific provisions under which persons may be lawfully detained in the Central Mental Hospital are included in this section. These are: section 202 of the Defence Act 1954, where a person is unfit to stand trial by court martial; section 203 of the Defence Act 1954, where a person has been found guilty of an offence at a trial by court martial but was, as defined by the legislation, insane at the time of the offence; section 14 of the Mental Health Act 2001, which allows for the involuntary admission of a patient suffering from a mental disorder for their reception, detention and treatment; section 15 of the Mental Health Act 2001, which allows for the period of involuntary admission of a patient to be extended; section 21 of the Mental Health Act 2001, which allows for a patient detained in another approved, psychiatric centre to be transferred to the Central Mental Hospital either for their benefit or for the purpose of obtaining special treatment; section 4 of the Criminal Law (Insanity) Act 2006, which allows the detention of a person who is accused of an offence, is suffering from a mental disorder, is in need of inpatient care or treatment for that disorder, and is not fit to stand trial; section 5 of the Criminal Law (Insanity) Act 2006, which allows the detention of a person who has been held to be not guilty of an offence by reason of insanity, is suffering from a mental disorder and needs inpatient care or treatment for that disorder; and section 15 of the Criminal Law (Insanity) Act 2006, which allows that a person, who is detained in a prison and suffering from a mental disorder for which he or she cannot be afforded appropriate care or treatment within the prison, can be transferred to the Central Mental Hospital to receive care or treatment for the mental disorder.
Section 4 sets out procedures for fixing a date by ministerial order for the closure of the Dundrum facility as a psychiatric centre. This date will be no later than the relocation day made under section 2. The date shall be agreed after consultation with the Minister for Justice and the Mental Health Commission.
Section 5 confirms that several existing entitlements for people detained under the Mental Health Act 2001 and the Criminal Law (Insanity) Act 2006 are unaffected by the changes in the Bill. These are entitlements for a person to have his or her detention reviewed, to appeal against it, to have his or her detention revoked, where appropriate, or to be transferred from the Central Mental Hospital.
Section 6 allows approved expenses associated with the administration of the Bill to be paid for from public funds.
Section 7 repeals section 39 of the Mental Treatment Act 1961. That section renamed the building commissioned in Dundrum under the 1845 Act as the Central Mental Hospital. It must be repealed to allow the hospital to operate from its new location.
Section 8 is the Bill’s final section, and makes standard provisions setting out the Short Title of the Bill and arrangements for its commencement.
For a long time now, the Central Mental Hospital in Dundrum has been unfit for purpose. While efforts have been made to refurbish and maintain the buildings, the permanent solution can only be a move to the new, purpose-built facility. There are acknowledged capacity pressures on the hospital, of which Members of the House will be aware. The opening of the new national forensic mental health service campus will help to address these pressures. Bed capacity in the existing hospital is 93. The new hospital will have 130 inpatient places. It will be supported by the phased opening of both an intensive care rehabilitation unit, with 30 places and a ten-bed child and adolescent mental health services, CAMHS, unit. The new facility will provide additional bed capacity for women, which will allow for the development of a care pathway for women.
Relocation to the new facility will allow for a world-class service and will ensure that modern, intensive services for those with the most complex mental health needs will be delivered to international standards of quality and excellence and to greater numbers of individuals. I recently visited the sites of the current and future central mental hospitals and I am hugely impressed and optimistic for the future of forensic mental health services in this country. Finally, I commend this Bill to the House and ask for the support of Members in passing it in a timely way.
Sinn Féin will be supporting this Bill because it is technical in nature but I wish to raise some issues regarding the move of the Central Mental Hospital from Dundrum to Portrane. I am aware that one of these issues is not within the remit of the Minister of State, but I need to address it today. A significant land bank will be freed up when the Central Mental Hospital moves from Dundrum. We are and continue to be in a housing crisis and it is important that this land is used to provide public housing. I refer to affordable and social homes for workers and families in order that they can afford to live in Dundrum and surrounding areas.
I have seen reports stating that the Land Development Agency has indicated that only 30% to 40% of the properties in this development site would be for social and affordable housing, with as little as 10% allocated for social housing. If the Land Development Agency factors in the cost of land, then, the chances of these homes being affordable for ordinary workers and their families are slim to none. Public land must be for public homes, social and affordable purchase and affordable rental. This will be a real test to see if the Government is serious about solutions to the housing crisis, solutions which will put workers and families before developers.
I also am concerned that the increase in the capacity in the new Central Mental Hospital will not be enough. In Portrane, the Central Mental Hospital will form one element of a broader national forensic mental health service campus, as the Minister of State noted. It will, however, only have 26% more beds than at present. I have a different figure regarding the present spaces available from that given by the Minister of State. My figure is 103 beds, which I got from the Bill Digest of the Oireachtas Library and Research Service, while the Minister of State referred to 93. The current number, however, will expand to 130 beds. The Minister of State will know that the nature of these beds means they do not become vacant as they would in a standard hospital. These 130 beds could become full very quickly with patients who could be in the hospital for a long time. We need an urgent plan to increase the capacity and staffing levels in the hospital.
The relocation of the Central Mental Hospital will free up spaces in our prisons, which are not the place for the mentally unwell.
The bail system also needs to looked at because mentally unwell people are being released into society without treatment. They are often a danger to themselves and to others. Currently, one third of the people entering our prison system have mental health issues and others develop such issues while incarcerated. Many prisoners released early from prison often have worse mental health problems than they had on entering. As I said, prisons are not places for the mentally unwell. The Minister needs to develop a mental health plan for all prisoners.
A recent report on Irish prisons by the European Committee on the Prevention of Torture described conditions, including a mentally unwell man lying naked in his own faeces and urine in a cell. On every level, this is wrong. I spoke to several people who work within the Irish Prison Service who said that they do their utmost for prisoners. I have no doubt that they do but prisons are not equipped to house the mentally unwell.
Earlier this year, the documentary "The Guards: Inside the K" highlighted the Garda dealing with mental health. Gardaí featured in the programme called on the Government to put more resources into mental health services for those who may not have access to them. Chief Superintendent Finbarr Murphy said that many people who end up prison have mental health issues and be believed there is a need for more support around those people, not from a criminal justice perspective, but a health perspective. I have spoken to gardaí in my area and they have said the same. People are who are mentally unwell and in distress can act outside the norms of society and come to the attention of the Garda. We need to put in place a more humane procedure than that available under the current judicial system. The imprisonment of people in cells who need wraparound supports is a failure. I have stated many times that we need 24-7 emergency access to mental health supports. This would take pressure off the Garda and society and it would help people in need of supports.
Provision is made in the new Central Mental Hospital for ten beds specifically for children and young people. This will be known as the forensic child and adolescent mental health unit. We must ensure that these beds remain separate from the main facility. I have previously raised the draconian practice in this country of children being admitted to adult psychiatric units, in respect of which there were 54 in 2019. We must ensure that this practice ceases immediately.
I welcome the opportunity to speak on this Bill. As mentioned by the previous speaker, Sinn Féin will be supporting it. I am happy with the Minister of State's honesty in her opening speech in regard to the existing hospital not being fit-for-purpose. She is spot-on. It is archaic. An article I read recently states:
It is sobering to think that the brand new, and long-awaited, national psychiatric hospital will be full within a few years, such is the demand.
The new Central Mental Hospital, located in Portrane, in north Co Dublin, will increase the number of beds by two-thirds ...
In anyone's books that seems like a substantial increase.
However, because it is coming from such a low base and because the beds are being taken up by a constant stream of people being sent by the courts as a result of being found not guilty by reason of insanity ... its increased capacity will be soon swallowed up.
Over recent years, the ability of the existing Central Mental Hospital, CMH, to take offenders from the prison system - of convicts who have been assessed as having serious psychiatric disorders - has fallen significantly.
That is serious because we are well aware that the prison service is oversubscribed when it comes to people with mental health issues.
I want to return to the Minister of State's comment that the existing hospital is not fit for purpose. I read the Inspector of Mental Health Services 2019 report, which found that only one compliance with regulations was rated as excellent and that the hospital scored only 69% in terms of overall compliance. That is a shocking indictment of a hospital in which our most vulnerable patients are resident. In the section dealing with compliance and risk, the report refers to people wearing clothing that was rated as non-compliant as being high risk. In the context of searches, people going missing was rated as non-compliant and a high risk. In regard to privacy, people had no privacy and, as mentioned by the Minister of State, the premises was deemed not fit for purpose. It has failed all of the inspections. Staffing is also an issue.
Anything that is an improvement is always welcome. We have had a lengthy wait for this new hospital. I am curious to know if we will have enough resources to staff it. No doubt, there will be another inspection report in respect of the existing facility next year. In the context of the maintenance of records, operating policy and procedure, the rules governing the use of seclusion and the code of practice for the use of physical restraint, the facility was found to be non-compliant or moderately compliant. I suspect that much of this is down to staffing issues. Staffing is a matter about which I am very worried.
The Garda was mentioned. I remember when I lost my brother. I spoke to the Bean Garda at the door and I apologised for what was happening that night. I asked her if she was going home and if she had a family. She told me she had two young children. I asked her if she received any training or counselling in respect of mental health and she said "No". That was in 2002. I am glad that has changed and things have moved on but I believe we should be putting a lot more into education for An Garda Síochána, the Ambulance Service, the Fire Service and the Irish Prison Service and into resourcing them as well. They are the first point of contact with these people. Whether they are in or out of the prison system these are the first four services they will meet.
I want to touch on resources. It was mentioned at the meeting of the Sub-Committee on Mental Health this morning that 114 assistant psychiatrists were taken on last year. I know of a person who left a post because there was nothing to do. One or two other people have since moved into the Irish Prison Service. They are very happy and that is welcome.
I am pleased that we have moved forward. I appeal to the Minister of State to ensure that, when this transition occurs, there will be some follow-up to make sure that staff are fully resourced and that patients are protected. If we can get the new facility off the ground properly, we can be proud of what could prove to be a decent legacy.
The Labour Party welcomes this Bill and will be supporting it. In 1903, St. Ita's Hospital, Portrane, was built. It was the most expensive building constructed by the British Government in Ireland. In 2014, it was announced by the then Government and the former Minister of State at the Department of Health, Kathleen Lynch, that the National Forensic Mental Hospital would be built on the same campus and that it would be the most expensive hospital ever built up to that point. I am sure not sure if the children's hospital has superseded that. In 2014, a public meeting was held in Donabate, which is located near Portrane and on the same peninsula, to discuss this building. It was fascinating to be there that night. There were a number of questions from the floor about the building and the impact it would have on traffic on the Donabate peninsula . I recall that one individual mentioned the relocation of the Central Mental Hospital as being a negative. It was unbelievable to see the room rise up to a man and a woman and announce that the community welcomed it and that it had a long tradition of caring for people with mental health issues through the St. Ita's Hospital.
The meeting that night was not about NIMBYism or people not wanting the hospital in their area. It was about welcoming the investment and the hospital and the opportunity to care for people again on the peninsula. From the 1980s onwards, St. Ita's went into a state of decline as we moved to deinstitutionalisation and, thankfully, people began to develop a more enlightened approach to those with mental health issues. Therapies improved and the whole medical fraternity improved its care for people with such issues.
For an asylum-era facility such as St. Ita's, to use the language of the time to which the Minister of State referred, that meant mental health was taken away from it. The community wanted to continue to help, to be at the forefront and to continue that tradition and move with the times and the care. It is most welcome that that investment will come back to Portrane and to the peninsula, and that those people will again be at the vanguard of an improved and ever more caring approach to mental health. For the people of north County Dublin and the peninsula, and Portrane in particular, this is a proud time where the centre of their community is coming back to them. They are ready, as a community, to care as they have done to the best of their ability over the years. This Bill before us, which will hopefully be passed in short order, is another positive step in that direction.
The next slot is a Government slot. Is there anyone from the Government side here?
I am right down here in front of the Ceann Comhairle.
Gabh mo leithscéal. The nearer the church, the further from God.
We will have to get the Ceann Comhairle a bigger chair so he can see me sitting here.
If I had grown quickly, I might have been able to see out over the top.
We will get the Ceann Comhairle a few phone books to sit on.
Like everyone else, the Green Party welcomes this Bill. It is a much-needed modernisation, expansion and improvement of necessary services that work with very vulnerable people. There are a few interesting things to note in the Bill. The improvement of the child and adolescent mental health side of things is more than welcome. This is a very specialist service within the child and adolescent mental health services. It is excellent to see that. I will avoid my usual rant about how child and adolescent mental health services are just not up to scratch and not fit for purpose. I will bore the Minister of State with that some other time.
There is a wider conversation to be had about mental health in the Prison Service. The Central Mental Hospital operates in that grey area between mental health and prison. As we have learned from the recent Council of Europe report on our prison services, as well as many other reports, there is a huge problem with failing to provide mental health services for vulnerable prisoners in the Prison Service. Along with the mental health services in the National Forensic Mental Health Service, that vulnerability for mental health for prisoners is something we need to address. Maybe the National Forensic Mental Health Service and the Prison Service can link up and there may be a chance for shared resources and knowledge.
There is a commitment in the programme for Government to a high-level, cross-Department, interagency forum that would look at the issue of mental health and addiction for those in prison. Issues with mental health and addiction can lead people down a path that will end in prison but equally, people can experience those issues for the first time when they go into prison. We need to ensure that our prisons are able to handle these challenges and that they are not causing the problem. We need that working group to be up and running as soon as possible. I just wanted to take this opportunity to present that matter to the Minister of State and encourage it to be done as soon as possible.
There is also a commitment in the programme for Government, about which I am talking to the Minister for Justice, to ratify the optional protocol of the UN Convention Against Torture, which would go a long way to supporting the quality service that I have no doubt both our prisons and the new National Forensic Mental Health Service will deliver.
I welcome the opportunity to speak on this legislation. I have had some experience of the Central Mental Hospital in my capacity as a union organiser. Very few people in this House have ever been in it. Not only have I been in it, but I have been in it on many occasions. When conducting a ballot for industrial action with shift workers, I have had occasion to be in it until 3 o'clock in the morning. I should point out, however, that I have never been in it for reasons other than work.
The hospital is not fit for purpose and has not been fit for purpose for a very long time. It is welcome that the people in it will be moving to this new facility. However, this is not just a place where people are cared for or a place for the residents; this is also a place of work. The people who work in the Central Mental Hospital are some of the best people and workers the Government has working in the health service. They give 110%. They give their all and they do so in circumstances that are inhumane for both the people who have to live there and endure them and the people working there. This is very welcome and is also welcomed by people in Portrane. There are some concerns about additional traffic, which I am sure can and will be addressed. People want to keep the additional road that was put in there.
I am concerned about the potential industrial relations aspects of the move. A committee is meeting at the moment under the auspices of the Workplace Relations Commission, WRC. While the move is only 31 km on paper, it will take workers much longer to get to the hospital because they will have to travel along the M50. I know from representing them that an awful lot of these workers live outside Dublin, in Wicklow and Wexford, and commute to Dundrum. This is an additional burden on them and I hope they will be adequately compensated for that. I also hope the phased opening can be accelerated. As the Minister of State and I both know, that can only be done if additional staff are appointed and my understanding is that there has not been much luck in appointing those staff. I hope the 200 additional necessary staff can be recruited and that this facility can be up and running as quickly as possible. The place these people are leaving is not appropriate and we hope the place they are going will be much better.
I am glad to have an opportunity to make a few brief comments on this legislation. The Social Democrats welcome the Bill and support it fully. We have been talking for a very long time about the relocation of the Central Mental Hospital from Dundrum to Portrane. It is very good that we have gotten to this point where we are about to pass legislation to provide for that relocation and to provide the legal underpinning of that very important move.
There are a few issues about which we just do not have full information, such as some of the practicalities of the move and the implications for the local Portrane area. Deputy Duncan Smith spoke about the welcome in that part of north County Dublin for this decision and the very supportive role the community has played. My colleague, Councillor Paul Mulville, has been very involved in the local community in support of the move and in putting in place all the necessary provisions to enable it to happen in a smooth and satisfactory way.
There are a few outstanding questions and it might be helpful if the Minister of State was in a position to answer them. Some local people have raised questions about issues associated with any kind of disturbance or problems with people detained in the new facility. The nearest Garda station is in Swords, which is a bit away, and people are keen to know what exact provisions are in place for liaison with local gardaí. The community liaison has been very successful to date in facilitating and teasing out all the implications of the relocation. It is important that we know if the community liaison with local residents will continue after the hospital becomes operational. It has worked very well so far during the planning stages. It would be a good move for that community liaison to continue and I hope that is what is intended.
There is a long-running issue in respect of which we have not had adequate clarification or commitment. There was a realisation many years ago that the big mental institutions needed to be wound down. I have been in politics a long time. I was involved with the health board and made several visits to the facility, a Victorian building which was far from the ideal in the context of modern standards. Those huge institutional facilities were built around the country and housed many thousands of people. Over time, however, there was a realisation that this was not best practice by any means and that people with psychiatric problems should be catered for in the community as far as possible or if it had to be in a group setting, that it would be in smaller settings in domestic-sized houses or smaller units. It was always stated that when decisions were taken about closing any of the big institutions, the revenue raised from their sale and that of the land around them would be reinvested in mental health facilities. Many of the buildings involved were very valuable in themselves and were situated on very large and often extremely valuable tracts of land. A great deal of money has been raised over the years from the sale of these properties. What will happen to the proceeds from the sale of St. Ita's and its lands, some of which have already been disposed of? Where have the proceeds from the disposals that have already taken place gone? The earlier commitment to reinvest the funds has not be carried through fully. Will the Minister of State clarify the position in the context of the lands around St. Ita's? The Psychiatric Nurses Association, PNA, has been very vocal on this. It recognised the need to move away from the big institutions but, equally, it is keen that the money that is realised stays within mental health and psychiatric services and is invested, in its entirety, in more appropriate and modern facilities for the residents themselves but also the staff, for whom the Dickensian or Victorian conditions were equally bad.
What will happen to the old St. Ita's building in Portrane? It is an enormous building and its various parts are in different states of repair. It would require some investment. Instead of the HSE leasing many buildings across county Dublin, for example, in Balheary, Naas and other areas, could it centralise some administration in the St. Ita's building? One block has already been converted into office space. Were other parts of the complex converted and used to centralise administration, there might be significant savings compared with paying for expensive leases in other areas around Dublin. Large sums will be spent on leases for call centres. A lease is being entered into for a test-and-trace call centre at the old Eir headquarters near Heuston Station. Why not use parts of the building at Portrane to house this centre? It is important that we bring all the existing accommodation into use.
The Bill does not provide for all the regional intensive care units. Four units have been proposed, the first in Portrane, while the other three are not part of the Central Mental Hospital project. Will the Minister of State clarify the status of the other three?
Finally, I turn to technical issues. There are two spellings of the town to which I have been referring, namely, Portrane and Portraine. Will both versions continue to be used? What is the legal position on the spelling? Is clarification necessary? The Minister of State indicated that a map would be provided and laid before the Dáil. Can that map be made available now and circulated to me and anyone else who is interested? Given that we are passing the legislation, it would be reasonable to have possession of the map now. I am happy to wholeheartedly support the Bill.
Deputy McAuliffe is next. It is very difficult to see him in his dark corner.
I think the bulb blew but the best referee in Croke Park might not see me, I am so far back.
I welcome the publication of the Bill. Previous speakers described it as technical legislation, and in some ways it is, but it underpins the vision for the relocation of the facility. I acknowledge the improvement in services and facilities it will bring about. I also acknowledge the provisions relating to child and adolescent mental health facilities that Deputy Costello mentioned. Anyone who has been to the campus for the Technical University in Grangegorman will have seen how the built heritage of some of these former institutions can be incorporated into a very modern facility.
The second part of the relocation is what is being left behind. In common with others, I am concerned and excited about the opportunities for the site in terms of the provision of housing under the Land Development Agency. I look forward to the legislation underpinning that agency coming before the committee on housing, of which I am a member, because there is an opportunity to embed affordability and the option of affordable housing in a part of the city that desperately needs it. In addition, this can be an example of how we can use these sites across the city to embed that affordability. We have talked a great deal about the social impact of our housing crisis, which is undoubtedly stark and has a great impact on individual's lives. It also impacts on the economic life of the city. Almost three quarters of most multinational companies' budgets are spent on staff salaries. If people should not spend more than one third of their salaries on housing, then, on the basis of one formula, approximately 25% of the cost of doing business in Dublin is connected with housing in the city. The argument for providing affordable housing is as much economic as it is social. There is potential to provide 1,200 homes at the current site in Dundrum in order to help meet the demand. The programme for Government refers to building public housing on public land. I look forward to this being reflected in the details of the scheme, and reflecting a more ambitious target than the figures of 30% or 40% I have seen. Many of those who might benefit could be supported in shared accommodation units provided by the State, as well as in affordable and cost-rental housing. This site offers a unique opportunity to deliver on the second part of the vision relating to this Bill, namely, a really important legacy in the context of the provision of social, cost rental and affordable purchase housing.
The Minister of State has kept me and the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien, apprised of the developments relating to of the first part of the Bill. I hope the Minister of State and I will work with the Minister in delivering the second part of that project.
Like Deputy Ward, I wish to raise the cases that were brought to light by the Committee for the Prevention of Torture. It is embarrassing, at the very least, for the State that people should be treated in this way in our country. It is especially embarrassing that such treatment should only come to light through the visit of a delegation from an international body. It is unacceptable that, in this century, people would be treated in the ways that were identified, including, in one case, being found lying in their own excrement. This harks back to previous times. In fact, such treatment was deemed unacceptable by the Victorians, to whom the Minister of State referred in her introduction.
I welcome the proposal to move the Central Mental Hospital, finally, from the facility in Dundrum, which was built long before the State was founded, to a new purpose-built facility in Portrane. That is very much to be welcomed. However, what we need more than a change in bricks and mortar is a change in attitudes to mental health, particularly in prisons. I am talking about the attitudes from on high, which may include people in this House and certainly includes the Minister of State's Department and the Department of Justice. The Committee for the Prevention of Torture noted in its report:
The CPT's delegation received hardly any allegations of ill-treatment of patients by staff in the establishments visited. On the contrary, patients mainly spoke highly of staff and the delegation observed their commitment to provide care and treatment to patients, often in difficult circumstances.
It is important, when the ill treatment of patients and prisoners has been highlighted to the extent that it has and when we are discussing the issue, that we acknowledge that it is not the fault of the staff in the institutions. It is also important to note that what the situation highlights is a lack of attention to mental health within the Departments of Justice and Health.
There has been much talk about data on mental health and the lack thereof. I was glad to receive a communication from the HSE, based on the issues I raised yesterday in the Dáil and which I also posted on social media, apologising for not responding before now and saying that it would welcome any interaction with me. If it had welcomed interaction with me, I would not have raised the matter in the Dáil. Every single question I have asked, and I have asked many since being elected to the Dáil, has been met with an exercise in obfuscation by the Departments of Health and Justice. I am sorry to say that but I invite the Minister of State to look at the correspondence for the evidence of it. I do not think any reasonable person would conclude otherwise. When one asks specific questions, one gets general answers. If one asks more specific questions, one gets no answer. It is simply not good enough. There was an attitude to many areas of health in the past - I daresay we still have it in some quarters - that doctors know best and they cannot be questioned. I accept that doctors know best but I do not accept that they cannot be questioned. Whether it is the National Public Health Emergency Team, the Central Mental Hospital or the College of Psychiatrists of Ireland, they are all funded by means of taxpayers' money. It is the duty and role of this House to question what is being done with taxpayers' money and whether the public is receiving a service. It clearly will not be receiving a proper service until such time as we have adequate data.
I would like to know more about the man, identified by his initials only, who was found lying in his own excrement. I understand he had been there for days and was there for weeks afterwards before the situation was dealt with by the High Court - not the executive, the High Court. On the broader issue of mental health provision generally, I had the opportunity, not under the current President of the High Court but the previous one, to visit the wards list. I am mindful of the need to observe the separation of powers but as the individual in question is no longer President of the court, I think I can say that it was very much to his credit how he dealt with the wards list. It should not necessarily come to the very difficult decisions that have to be made at times in regard to that list. I have digressed in talking about it. Going back to the particular prisoner to whom I referred, where was he registered? How is the State recording such incidents or is it recording them at all? I do not know the answers to those questions. I would really like a collaborative response rather than the usual exercise in hiding information. We all accept that unless we get information out there and unless we know what the problems are, they will not be dealt with.
I had the misfortune to say that I did not think that mental health data were being considered by public health doctors during the Covid crisis. I received a barrage of criticism from doctors for daring to suggest that. Of course that information was being considered, I was told. In fact, it was not being considered, because it was not being collated at the time. There are two State agencies the role of which is to collate the data. One of them, the National Self-Harm Registry Ireland in Cork, could not do so because its staff were not considered essential workers during the first lockdown. They have since resumed collating the data, both retrospectively and prospectively. The other agency is jointly run by the HSE and the College of Psychiatrists of Ireland and we were told that it was collecting fantastic data. However, when I looked for the information, it was not there. Maybe it is there and perhaps my inability to access it is a consequence of obfuscation by the HSE or the Department of Health or their refusal to provide the data. If the data are not there, why not just admit that is the case? Why does the State not admit that it is pretending to run a modern psychiatric service in this country based on empirical data when, in fact, what it is doing is relying on findings and research from other countries because it could not be bothered - that would be the polite word to use - to collect the data itself or it does not have the resources to do so? If we do not have the resources, then that needs to be highlighted.
This House, empty it is this evening, decides how resources are allocated in this State. There has been a sea change in attitudes to mental health, by the general public if not by the people who occupy Larry Goodman's fine edifice on Baggot Street Lower in Dublin. I say that because the mental health budget has repeatedly been plundered. I supported a Government for five years that was very proud to say it was the first to ring-fence money for a mental health budget. In fact, when one drilled down into it, there was an amount allocated for the first time, just as there is an amount allocated in the recent budget, but that was not spent on mental health and neither is the new allocation being spent on mental health. Even this year's budget was an exercise in obfuscation. There was a large amount of money allocated for additional services but only 50% of what it costs to provide the existing level of services was allocated. One does not have to be a mathematician or accountant to figure out that if existing services cost twice as much as is allocated for them, they are going to eat into the additional budget for new services.
Having said that, I welcome the allocation for additional services. I would welcome even more an assurance that those funds will, in fact, be spent on mental health and that when we look back this time next year, we will be able to see how they were allocated. Looking into the HSE's budget and how it spends its money can be a little like trying to find data from NPHET or data on mental health. There is a lot of obfuscation and one gets led around in a lot of circles and, at the end of it all, one goes from being told that there are fantastic data from all over the country to finding out that there is a representative sample, which I understand is what we have up the end of August. That is what I was provided with when I asked for all of the data, namely, a representative sample of 12 emergency departments out of the 36 which, in normal times, would be recording presentations of self-harm.
My time is almost up. I will conclude by saying that there is a great deal of talk about an increase in suicides, but we do not know whether there has been such an increase.
Even if there has been an increase, I fully accept that not every suicide is a result of mental health problems. Some certainly are but others are not. There are people without any mental health problems who make what could be considered a fully rational decision to end their own lives. That is tragic but it is even more tragic and more damning of this State if recurring mental health problems are not treated, leading to someone ending his or her own life.
I welcome this Bill. I welcome the fact that we are moving this service from Dundrum to Portrane. However, we have to change attitudes as well as the physical locations of certain facilities. We need much greater data collection and greater clarity in the provision of that data. We also need data to be provided in a timely manner, not after two years.
From one Waterford representative to another, I would like to remind the Minister of State that the Government accepted the recent Regional Group motion on mental health. One of the key requests called for a national lead on mental health issues. I hope the Minister of State can implement that as soon as possible. I also wish to highlight the significant deficiencies in mental health services in University Hospital Waterford, of which the Minister of State will be aware.
Since the beginning of the Covid-19 lockdowns there has been a lot of public discussion on the challenges of mental health and the need for renewed Government emphasis on resourcing and prioritising the sector. The legislation before the House, which seeks to relocate the Central Mental Hospital from the 170-year-old facility in Dundrum to a new purpose-built centre in Portrane in north Dublin, is to be welcomed. The buildings at the current Dundrum premises have been unfit for their modern purposes for many years. They have had capacity and waiting list issues and cannot continue to provide the level or scale of services required of a modern national forensic mental health centre. I refer for example to the Central Mental Hospital's Irish Prison Service remit. A 2019 report noted significant problems with holding prisoners in secure observation cells, sometimes for weeks or months at a time, while awaiting transfer to the Central Mental Hospital. For several years the Irish Prison Service has raised safety concerns about managing mentally ill prisoners while they await transfer to the CMH. The increase in bed capacity at Portrane will add 67 additional beds to the capacity on offer in Dundrum, which is to be welcomed.
Significant questions, however, must be asked. Will this expansion be enough to cover the growing trend of prisoners being found not guilty by reason of insanity in the courts? This fear was expressed by the executive clinical director of the CMH, Professor Harry Kennedy, who has noted that the proposed additional capacity in Portrane might be overtaken in the near future if the present sentencing trends continue. He also points out that Ireland's national forensic mental health service has two secure beds per 100,000 people. Most modern European states have more than ten secure beds per 100,000, five times our national figure. He points out that even with the full complement of 170 beds that is to become operational at Portrane, Ireland's ratio of forensic mental health beds will increase to just 3.5 per 100,000 people, which is still just a third of the average for modern European states. We have to hope that Professor Kennedy's reservations will be assuaged by the Government's stated intention to expand other elements of the National Forensic Mental Health Service at the former St. Ita's Hospital in Portrane.
It has long been observed that a society can be judged by how it treats its most vulnerable. Included in this category are those who have come through the courts and face committal to the Central Mental Hospital. However, society also has a responsibility to all its other citizens to ensure that those requiring such help receive it and that their detention and subsequent release is managed to the highest standards of forensic psychiatric medicine and in accordance with Irish Prison Service rehabilitation protocols.
St. Ita's Hospital is to be legally renamed as the new Central Mental Hospital. I presume the proposed legislation has been rigorously legally reviewed to ensure that those presently resident within the service cannot appeal or interfere in any way with their original committal orders or the duration or terms of their sentences as a result of this change to the legal name, to governance orders or to their place of domicile. One hopes too that the new facilities and environment that inmates will live in at Portrane will help with their treatment and improve their quality of life.
The lawful transfer to and future detention of patients at Portrane, County Dublin, raises another very important issue for Dublin residents, namely, the redevelopment of the Dundrum site after the hospital move. This has long been known as a fashionable and desirable precinct, adjacent to many fine amenity opportunities. The 11.3 ha site at Dundrum must present a very significant opportunity for badly needed housing development. In reviewing the site, the Land Development Agency has suggested that up to 1,300 homes can be created in an entirely new neighbourhood here. Significant financial benefit will accrue to the State as a result of the repurposing of this land. Perhaps the Government should consider ring-fencing a significant portion of this windfall for the future development of forensic mental health services in Ireland. This would signal a changing perspective on the priority of the needs of those resident in the Central Mental Hospital. It would also allow the ethos of providing care, treatment and rehabilitation to mentally ill offenders ,which began in Dundrum 170 years ago, to continue for years to come. With the relocation of the CMH and the possible residential development of the Dundrum site, the State can hopefully close the door on the use of Victorian-era facilities, which are mostly unsuitable for the provision of modern medical services to the people of Ireland.
I hope the proposal being discussed today will deliver significant medical and clinical improvement to the lives of vulnerable and disadvantaged people who may find themselves residents of the CMH. I also hope it will help staff and clinicians to continue to achieve the highest standards of service delivery at the new Central Mental Hospital, the National Forensic Mental Health Service at Portrane, County Dublin. Medical advances in recent months have opened a door where the challenge of Covid-19 is concerned. Hopefully with the opening of the doors at Portrane, we are witnessing a newfound perspective in Government circles, with new priority placed on providing resources to meet the needs of those faced with mental health challenges, regardless of how or where they present.
I apologise for missing my slot earlier. I have not yet mastered the skill of bilocation. The traffic is very heavy so I ran the last part of the journey. I will be as fit as Ronnie Delany for the Olympics.
I wish the Minister of State, Deputy Mary Butler, well in her portfolio. I know she will make genuine efforts to help with mental health in a caring way and will budget accordingly. I welcome the Central Mental Hospital's move from the site we have known to the new Portrane site. I know the Land Development Agency is also involved. Any moves we can make to offer some empowerment, respect and a listening ear to people who have psychotic tendencies or mental health issues are very welcome. I listened to Deputy McNamara's comments on the journey here. I often listen to him on these issues because since the first months of the pandemic, he has consistently called for data to be collated. I have done so too but he is far more eloquent and in tune with the issues than am I. Some mental health workers have not been deemed "essential" and their work was halted for that reason. Some others, including specialists who do a wonderful job in their own right, were taken away from services and facilities that are very important to young and old. Removing staff from these services could actually create mental health issues. Specialist therapists are especially important for adolescents. Last night I spoke to a colleague who was aware of a 14-year-old child at a boarding school who is in a very distressed state. That case could traumatise everyone around him.
Trying to get any information from the National Public Health Emergency Team, NPHET, is like trying to get the third secret of Fatima. Trying to get information about mental health should not be that difficult. The conglomerate of the HSE and the Department of Health tells people to go around the house and mind the dresser. These bodies keep the circle going by keeping the paper replies going and most of them are meaningless. They seem to invent new adjectives and words. They must have scriptwriters experienced in thinking of long words that say nothing. As referenced by Deputy McNamara, the 2007 to 2011 Government ring-fenced funding with great aplomb. There was a blaze of glory but drilling down into it revealed that the money went to other parts of the HSE.
I am not saying we in Tipperary know better than anybody else about this, but one of our hospital institutions, St. Michael's, lost its long-stay beds on the same grounds as St. Joseph's, now South Tipperary General Hospital, another nice name dreamt up by the HSE. Whatever was wrong about being under the watchful eye of St. Joseph I do not know. He looked after many of us who appreciate him or pray to him and he still does. We have to get rid of all this. We lost our hospital. We were promised the sun, the moon and the stars by the former Minister of State, John Moloney, at the time and I railed against it. Then the former Minister of State, Kathleen Lynch, put the tin hat on it and we lost our hospital. We were promised the Rolls Royce of service in the community.
I salute the people involved in the community teams but they do not have enough members, time or facilities. We are trying to get upgraded works carried out to our crisis house. They have been going on for ever. They will now start, I hope, in the first quarter of next year. However, we need long-stay service beds in Tipperary because the people of south Tipperary, which is a big area, have to travel to Kilkenny. People in the north of the county have to travel to Ennis. Those two places are overfull already. I am not saying they do not want Tipperary people but they just cannot cope with them. In Kilkenny they have the south-east region of Carlow-Kilkenny and Wexford to look after as well as Waterford. We in Tiobraid Árann are, pardon the expression, on the hind tit and we do not ever want to be on the hind tit. We are entitled to our rightful place in the queue for services, especially for people with mental health issues.
The Minister of State, Deputy Butler, has visited us, met us twice and listened to us. She has also visited the facility in Kilkenny, which was brought through an atrocious court case. Atrocious things happened there because the facility is understaffed, poorly managed and lacks resources. That has changed. The Minister of State said something to us that I dispute furiously, as do all of us; she found it was under-capacity. It is not under-capacity. All my stories are from mental health service users and their families and the consultants and doctors. They say it is almost impossible to get in there and that when people get in they are not halfway through their treatment before they are out.
There have been some awful incidences in Waterford as well. I read and heard about the court cases. The Minister of State delivered beds recently for Waterford, and rightly so. I would not deny any county more beds. All counties are entitled to fair play, but vulnerable people are especially entitled. We need our long-stay beds back. The former Minister of State, Jim Daly, said in the House several times to me and others that we had a deficit of 15 beds in south Tipperary and we would get them. HSE officials held meetings. Now, however, the current Minister of State is saying something different to us, trying to convince us there are enough beds and saying we will not get any beds in Tipperary. That will not be accepted. People in Tipperary are entitled to these beds because we have no public transport. From Emly down to Kilkenny is an awful distance. From Monard to the famed Limerick Junction there are huge areas and distances. Then there is the other way, from north Tipperary up into Ennis. When a loved one, friend or whoever else goes into one of these institutions, they need help, they are down and they are low, but they will recover with the support of the medical and specialist services. They also want buddies, by which I mean families, friends, partners or whoever else, to support and visit them, but those buddies cannot visit them in Kilkenny. They have to get a taxi out from the bus station adjacent to the hospital, St. Luke's, which is just not possible.
Then there is the enormous amount of money it costs the Garda, with Garda cars carrying people, whether they go voluntarily or involuntarily, to be transferred to Kilkenny. It is unbelievable. There is an enormous waste of time and money in the consultants travelling to and fro, from Tipperary to Kilkenny and from Tipperary to Ennis. There is huge waste in the system. I appeal to the Minister of State this evening as we are bringing this out and shining a light on the mental health services here and the facilities in Portrane. We need to deal with the waste. Part of the Rolls Royce model was a taxi service. Two or three taxis were hired. Then there was a row with the Psychiatric Nurses Association, PNA, nurses because if it was an involuntary case, I think they wanted three nurses. The next thing, one Friday evening, at about 6 o'clock, a wonderful driver rang me. He had got an email at 5.20 p.m. telling him his services were no longer required. People either walk, run or swim to Kilkenny or they get a Garda car but they cannot get other transport.
There are huge deficiencies, and it is unfair to these people. After all, they are our siblings, friends, family and community members and they need those services and have to get them. I appeal to the Minister of State, along with what she is doing in Portrane, along with her compassionate attitude, to ensure that long-stay beds are put back in Clonmel. We are not looking for them forever, but when people need a couple of weeks or a month, perhaps, they need them to be there. The crisis house is fine but it is small and needs to be extended, and the community teams' work will be easier because they will have continuity and a place to treat patients if they have to be treated.
This is very serious, as I said, and there are the pressures that Covid has now added on top of even students, including sixth-year students. I have a daughter who was in sixth year last year. She is a wonderful girl, thank God, but the uncertainty was so difficult for students. Students who are now in college are sent to work from home. Families try to save up the money, and they did so for the first semester, but now they are getting calls and demands for rent for a second semester when the students are not living there. They are living at home and have to use all the facilities there. They are not able to use the facilities in college. There are all those pressures.
There are the pressures on businesspeople. Businesses have been shut by Government diktats and draconian measures, as I call them. We are the best country in Europe at managing Covid, we are told regularly by the Minister. That is because we have the most severe restrictions. I ask the House to consider what has been done to the publicans, hairdressers and dancing teachers. Thank God we are fighting to get them back and they are slowly getting back, but it is nothing short of a tyranny, and these sweeping powers will go on until next July. We wanted a review in February but we did not get one. The moratoriums on the banks were lifted. We let them ride into the Wild West, all guns blazing, terrorising people. That is what they are doing. We have institutions supported by the State that are terrorising people. We almost own one of the banks. They are doing this to people when they should not be doing it.
I appeal to the Minister of State's better judgment and kind disposition and ask her to try to empathise with these people. I am not an expert on this, but my late mother was in St. Michael's and availed of its services, as did many other people. It was a wonderful institution. I will never forgive the former Minister of State, Ms Lynch. She said it was set in stone, written in blood, that it was to close. Now €1.9 million has been spent on upgrading it for Covid. We are told it will not be suitable when Covid is gone - and we hope it will be gone - for any mental health patients. That kind of lack of joined-up thinking and disgraceful and wasteful spending should not be allowed to go on.
I wish the Minister of State well with this project. I thank the Ceann Comhairle for allowing me in because I could have missed my slot. I look forward to the Minister of State's response.
Does the Minister of State wish to respond now or proceed to Committee Stage?
Whatever you think is suitable, a Cheann Comhairle.
If the Minister of State wishes to respond to the Members, she may.
Yes, please. An awful lot of issues were raised. I thank everyone who came in and spoke. I know they will support this legislation. I will try to answer the questions raised about the legislation specifically.
Deputy Ward started off and asked what will happen to the Dundrum site. The site is owned by the Commissioners of Public Works. It is an 11.3 ha site. The Dundrum Central development is to be located on the site of the former Central Mental Hospital after it relocates. It will be progressed by the Land Development Agency. A planning application for the Dundrum site is expected to be submitted in mid-2021, with construction to start in 2022, subject to planning approval. That is all the detail I have to date.
There were questions from all sides of the House as to whether the new Central Mental Hospital will address the waiting lists. It will, to some extent. It will increase capacity from 93 to 110 places immediately, increasing to 130 at full capacity. The 30 places in the forensic intensive care and rehabilitation unit on the campus, which will open on a phased basis, will also help to alleviate pressures. However, the increased bed capacity of the new campus will not entirely keep pace with the trends in demand for places.
Deputy Buckley, I think, asked what exactly this new campus will look like. I have visited both facilities. The Dundrum facility is no longer fit for purpose. Moving to a new facility will make a huge difference to the welfare of those who have been treated both in practical terms and in quality of care. Each inpatient unit is centred around a series of courtyards and secure perimeter gardens. The courtyard arrangements facilitate therapies, collective activities and direct access for patients from each ward to fresh air. Each unit has internal gardens, exercise facilities and shared communal spaces. The hospital is laid out as a series of pavilion buildings around a village green or village centre. The village centre includes primary healthcare facilities, sporting and exercise facilities, educational and vocational facilities and social facilities such as a café, shop and library. There is a landscaped village green. It is hoped that patients will be able to sit out there with their families and visitors at appropriate times. There is also a large horticultural area, including polytunnels and animal pens, where patients can become involved in gardening and looking after the animals. It is a fantastic facility. I was delighted to visit it.
There has been a lot of talk about child and adolescent mental health services. I addressed that issue yesterday during the motion on mental health policy and in responding to oral questions this morning. It will be fantastic to have this ten-bed facility for youths and adolescents who needs these types of supports.
Deputy Costello stated that he was present at the very first meeting at which Portrane was suggested as a location. He and Deputy Duncan Smith spoke about the history of the hospital and how it is a very proud time.
Deputy O'Reilly made the valid point that this is not just about the patients and residents in the Central Mental Hospital, it is also about the staff. It is a place of work. That has all been taken into account and the staff have been engaged with at all stages of this process.
On the issue of the arrangements for relocating patients to Portrane, there are no plans to close the M50 to facilitate the transfer of patients to the new location for the Central Mental Hospital. Doing so has never been a consideration, although it was mooted in a recent newspaper article. Detailed arrangements for the transfer of patients to Portrane are an operational matter for the HSE in conjunction with other relevant State authorities.
Deputy Shortall asked about the community and the fact that the fact that the nearest Garda station is in Swords. The Garda has been in consultation with the HSE throughout the process. HSE estates has set up a National Forensic Mental Health Service community group. It is a representative group for local community interests. It has been inclusive and supporting people.
She also raised an issue of which I had not heard previously, that is, whether there is need for clarification regarding the spelling of "Portrane". The Attorney General stated that the correct spelling is that which we used throughout the process, and the spelling I knew of, that is, "Portrane". There are no issues in that regard.
Deputy McAuliffe referred to the housing issues which I have addressed already.
Deputy McNamara raised issues relating to the European Committee for the Prevention of Torture. I was absolutely appalled to hear about how the patient to whom he referred was treated. My section of the Department, which has responsibility for mental health, has been in consultation with the Minister for Justice, Deputy McEntee. A committee is being set up. Obviously, mental health does not stop at the Department of Heath. That is why Sharing the Vision looks at a cross-departmental approach, which is very important.
The Deputy has raised issues relating to data on several occasions. I will check that out for him. Obviously, data are very important. There may have been a lag during Covid when services were under pressure. I will certainly raise that issue.
I thank Deputy Shanahan for his contribution and for tabling the motion on mental health policy which the House dealt with yesterday. He asked whether the expansion will be sufficient. It is certainly a step in the right direction. It will build extra capacity. He raised issues local to our constituency of Waterford. There have been issues relating to bed capacity in the south east.
Deputy Mattie McGrath also raised the issue of bed capacity. He is very passionate about long-stay beds. As I stated in my opening remarks, the national implementation monitoring committee will hold its inaugural meeting tomorrow morning. One of the first things at which it will look is mental health bed capacity throughout the country. If the report indicates bed capacity is needed in certain areas, that will be the way we have to look at it. I too consider it a very important issue. I am aware of the challenges being faced in County Tipperary in terms of people having to travel. When I visited the mental health facility at St. Luke's Hospital in Kilkenny, I was given data indicating it was at 85% capacity throughout the year in question. I can only work with what I have been given. We will consider the issue of capacity.
I thank all those present for supporting this move. It will make such a difference for all the patients in the Central Mental Hospital and it is not before time.