JOINT COMMITTEE ON HEALTH AND CHILDREN debate -
Tuesday, 8 Jul 2008

Relocation of Central Mental Hospital: Discussion.

Chairman

I welcome Ms Susie Doheny, Ms Kaye Marshall, Mr. Tony Francis and Mrs. Margot Francis of the carers' group at the Central Mental Hospital. I also welcome Mr. John Saunders, chairman of Schizophrenia Ireland.

I draw witnesses' attention to the fact that members of the committee have absolute privilege but the same privilege does not apply to witnesses appearing before the committee. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against any person outside the Houses or an official, either by name or in such a way as to make him or her identifiable.

Ms Susie Doheny

We thank the Chairman for this opportunity to express our views. We believe that the Central Mental Hospital should not be located on or adjacent to the new prison site in Thornton Hall. We are here to explain to the committee the reasons for our opposition to this decision. We ask members to listen to us and to the increasing chorus of professionals and experts in mental health care who also oppose this decision.

As members will be aware, the Government has decided to move the Central Mental Hospital, CMH, to Thornton Hall at St. Margaret's in north County Dublin. It intends to site the hospital beside the relocated Mountjoy Prison in one large new complex. The map, in Appendix 1 of our submission, illustrates the relative size and location of the hospital and the prison. As the families of patients, we are deeply opposed to this decision. There is an alternative, which we also detail and which we are urging the Government to consider.

I will explain who we are. We are a voluntary group of relatives and carers of patients in the Central Mental Hospital, Dundrum. We are ordinary parents, not professional lobbyists. We have received no professional training in mental health, lobbying or public relations. Our presentation may be amateur but please understand that our testimony is honest, heartfelt and passionate in defence of the interests of patients in the Central Mental Hospital. Our only objective is to work towards the best possible care for our relatives who are among the most vulnerable in the health care system. We meet monthly and work with hospital staff on a regular basis to improve the lot of patients and their families. We work with hospital management in improving communications with carers and patients.

Providing support for each other in sharing experiences and listening to each other is an important part of our activities. With our families, we have experienced at first hand the trauma and stigma of mental illness. We have experienced the very real practical difficulties of getting appropriate help for a family member who developed a serious and enduring mental illness. In many cases, had appropriate psychiatric help been available to our children, they might not have had the psychotic episodes that caused them to become patients in the Central Mental Hospital. We are not, however, looking for members' sympathy, nor are we making an emotional plea. Our argument against the location of the hospital on or adjacent to a prison site is firmly based on the principles of best international therapeutic practice and the Government's own policy on mental health.

The Central Mental Hospital was established in 1850 as a result of recommendations of a parliamentary committee set up in 1843 under Lord Sugden, the Lord Chancellor. The hospital was built on a 34-acre site, four miles from Dublin city centre. It was located on a large parkland site because the Victorians realised that people who were seriously mentally ill needed space and seclusion in order for their condition to improve. Mountjoy Prison was developed at around the same time and located in Dublin city centre. In the 1850s it was decided not to co-locate the hospital with a prison, in recognition of the distinction between mental illness and criminality. It is ironic that the Victorians could make such an enlightened decision when, 150 years later, modern Irish politicians can decide to co-locate the proposed new hospital with a prison facility. If a wrong decision is made now, it will have to be endured by the patients and families for the next 150 years at least. Therefore, politicians must get it right, not just for current patients, but for the generations to come.

Today the hospital provides treatment in conditions of high, medium and low security. Patients come from either the prisons, the courts, either having been found not guilty by reason of insanity or under sentence, or local psychiatric hospitals. A detailed breakdown of the referral source of current patients is attached in Appendix 2. The hospital currently has approximately 82 patients.

Ms Kaye Marshall

A new facility is needed. The Central Mental Hospital in Dundrum is outdated and in urgent need of repair and renovation, despite ongoing improvements. We support the position taken by the expert group on mental health policy in its report, A Vision for Change, which stated: "The Central Mental Hospital should be replaced or remodelled to allow it to provide care and treatment in a modern, up-to-date humane setting, and the capacity of the Central Mental Hospital should be maximised". The report which was published in January 2006 was accepted by the Government as policy on mental health care and it remains Government policy.

The inadequacies of the physical conditions in the Central Mental Hospital in Dundrum were highlighted in reports on inspections carried out by the Council of Europe Committee for the Prevention of Cruel and Inhuman Treatment and Torture in 1998, 2002 and 2006. We agree on the need for an improved facility but do not agree with the Government's decision to locate the hospital adjacent to a prison.

I will address the relationship between illness and criminality. The Government has argued that the Central Mental Hospital should be located beside a prison, as many of the patients come from prisons or through the courts system. This thinking is, at best, based on administrative convenience. It fails to acknowledge the fact that it is because of their mental illness that such patients come into the criminal justice system in the first place. They are patients first because it is their illness which has caused them to transgress or which prevents them from understanding the charges put to them, leaving them unfit to plead. We know this is fact because it has happened to our children. We have watched as a mental illness such as schizophrenia took control and altered their reality. Their illness caused many of them to commit crime or harm themselves or others. We have experienced the lack of understanding of serious mental illness and the lack of secure units in both general and psychiatric hospitals.

Locating the hospital adjacent to a prison would result in further stigmatisation of patients. Those with mental illness are already stigmatised in our society. Locating the national forensic psychiatric hospital beside a prison would, in effect, be a public policy endorsement of this stigma. It would serve to further stigmatise the mentally ill. Locating the hospital adjacent to a prison would inevitably and irreversibly associate its patients with criminality. This surely is against the ethos of acceptable mental health care in any civilised society and against the Government’s own stated policy. There is no possible therapeutic reason to associate the hospital with the new prison.

I will deal with the implications of the move for patients' rehabilitation. The social isolation of the proposed new site would effectively impede rehabilitation. The proposed new complex at Thornton Hall is in a rural location with a dispersed population. Such a location is not suitable for a hospital the ethos of which is treatment and rehabilitation in the community. At its current location in Dundrum, the Central Mental Hospital is easily accessible by car, bus and the Luas. The complex at Thornton Hall, while relatively close to the M1, will be far from readily accessible with no public transport except, perhaps, for a prison shuttle bus service. More importantly, the socially isolated location proposed would impede the rehabilitation of those who have to use the hospital's services. For years low security patients at Dundrum and patients who are well on their way towards rehabilitation attend training, college courses and such facilities in Dundrum and Dublin city centre. Attendance at these activities would not be possible from the complex at Thornton Hall.

The lack of community support at the complex at Thornton Hall would further impede rehabilitation. Over a period of 150 years the hospital in Dundrum has become integrated into the local community. The local community grew up around the hospital. An early step in a patient's rehabilitation is to take a short visit to the local shop or café. Local shops and cafés are only five minutes from the hospital. On such visits patients are immediately in a community that accepts them and supports their recovery. This is a vital part of the rehabilitation and reintegration of patients into the community and society in accordance with Government policy.

On a practical level, the remote location of Thornton Hall will make the rehabilitation of patients extremely difficult and that is before one considers the acceptance of the hospital and its patients by a small dispersed rural community at St. Margaret's. The scale of the area will not be conducive to integration since it is too small to allow recovering patients to grow in confidence and to re-establish social skills.

Chairman

I thank Ms Marshall.

Mr. Tony Francis

The proposed relocation is against best international therapeutic practice and will alter the ethos and culture of the hospital. Moving the CMH to the site of the prison goes against best international practice. Professor Paul Mullen, a professor of forensic psychiatry at Monash University in Australia and clinical director of the Victorian Institute of Forensic Mental Health, in a presentation in our report given to the committee, makes a compelling argument based on best international practice and his own personal experience.

Professor Mullen described the necessary elements for a secure and properly-functioning hospital. These include the following: a context able to retain, restore and establish patients' social connections and functions; the ability to recruit and retain staff with the skills and knowledge to deliver the appropriate required care; and a therapeutic culture. The CMH has a strong therapeutic culture and ethos. Prisons operate on a custodial culture and ethos. This difference is a critical point regarding the CMH relocation plans. A therapeutic culture in the hospital is paramount to therapeutic best practice.

I will take the committee through the table on page 6 of our submission for a comparison of the therapeutic versus the custodial culture. In a prison prisoners are observed whereas in a hospital patients are encouraged to interact. In prison there is reward for conformity, whereas in a hospital there is reward for engagement. In a prison there is emphasis on behaviour; in a hospital there is emphasis on psychological readjustment. A prison is orientated towards immediate goals of institutional functioning, whereas a hospital is orientated towards a long-term goal of good social functioning. In a prison there is a unified approach and the perspective is authoritarian, in a hospital multiple professional approaches and perspectives are used. In a prison the physical structure constrains unwanted behaviour, in a hospital therapeutic interventions, and social and personal expectations constrain unwanted behaviour. In a prison the ultimate goal is prevention of anti-social and self-damaging behaviour during incarceration. In a hospital the ultimate goal is effective autonomous functioning. There are custodial staff in a prison — prison officers. In a hospital there are therapeutic staff — nurses.

The culture and ethos of a hospital are fundamentally different to that of a prison. Professor Mullen noted that despite the fact that the two facilities on the proposed Thornton Hall site will be separate, the custodial philosophy of the large prison would take over the therapeutic philosophy of a hospital. Practical issues such as staffing shortages in the hospital would lead to staff sharing facilities and the dominant culture will prevail. This is a negative lesson learned from international experience. We should learn from this experience and not repeat the mistakes made by others.

The loss of social and intellectual capital of CMH staffing is a critical factor to consider. The CMH facility in Dundrum comprises physical assets — its land and buildings. A more important asset is its social and intellectual capital, the human resources of the hospital which is its staff. This asset must be taken into account in any policy decision on relocating the hospital. The human resources of the hospital cannot be uprooted and relocated without serious loss.

The task of providing safe treatment for high risk patients in conditions of therapeutic security involves much specialised knowledge and skills. Over the years such expertise has been developed in Dundrum by clinicians, psychiatric nurses, social and care workers, occupational therapists and psychologists. These professionals work in multidisciplinary teams in the hospital to provide the range of specialist care needed. Forensic psychiatric care is specialised. It can be anticipated that a large portion of this intellectual capital will be lost with the proposed move to Thornton Hall. This is borne out by the experience of some specialised Government services which have been decentralised. We believe it is likely that at least 50% of the clinical and nursing staff in Dundrum may leave as a consequence of the relocation of their place of work to the other side of County Dublin. Such intellectual capital cannot be quickly replaced.

We also have concerns that the proposed move is in contravention of human rights obligations in the Constitution. We do not have time to fully explore human rights issues. We refer the committee to the United Nations International Covenant on Economic, Social and Cultural Rights which refers to "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health". Ireland has ratified this covenant which means that under international law the State is obliged to ensure the rights enshrined are guaranteed for all persons on its territory. These rights are now protected by the Constitution and the courts. We also refer the committee to the UN Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care which outlines the basic rights and freedoms of people with mental illness that must be secured if states are to be in full compliance with the covenant.

The Thornton Hall decision is contrary to Government policy outlined in A Vision for Change. The Government's template for mental health states "priority should be given to the care of individuals with severe and enduring mental illness in the least restrictive environment possible". Locating the hospital in the same complex as the country's largest prison is surely in direct contradiction to this stated principle.

The policy further states "forensic mental health units need to be clearly identified as being intervention and rehabilitation facilities that operate in particular conditions of security rather than facilities offering mainly containment". Locating the hospital in the prison complex sends signals of containment rather than treatment and rehabilitation, thus directly contravening the Government's own stated policy.

A Vision for Change states that forensic mental health services should have a strong community focus. Uprooting the hospital from the community where it is now naturally embedded and relocating it to a small dispersed community will deny that community focus to the country's only specialised psychiatric hospital. I refer to the maps at the back of the presentation which show the dispersed rural community in Thornton Hall. This represents a further discrepancy between the Government's stated policy and the likely outcome of its decision to relocate the hospital.

Chairman

There is a vote in the Seanad, so some members may have to leave us.

Ms Margot Francis

There are feasible alternatives. We suggest there is a feasible alternative to relocating the CMH to either another urban location or the Thornton Hall complex. Redeveloping the Dundrum site is a cost-neutral option. The current hospital site in Dundrum is 34 acres in size. It is located in what is now a prime residential area. A conservative estimate values the site at €5 million per acre, or €170 million in total. A true valuation could be up to €400 million. This valuation was given by Mr. Jim Power, economist with Friends First.

The Government does not need the entire proceeds of the sale of the 34 acre site to finance the building of the new CMH. If ten to 14 acres to the front or rear of the site were sold for residential development, the remaining 20 acres would be sufficient to facilitate the provision of a new state-of-the-art hospital. The sale of 14 acres could raise up to €140 million. This would be more than adequate to construct a new facility which could be provided at the estimated cost of €100 million. This option would deal with all the aforementioned problems and objections associated with the proposed move to Thornton Hall. This outcome could be achieved at no cost to the Exchequer. Most importantly, it would be the best outcome for patients, their families, carers and the medical and nursing staff in the hospital. With this option, the sale of lands at Dundrum would have to be reinvested in mental health services without asset stripping on the part of the Government. I thank the committee for listening and we will attempt to answer members' questions.

Chairman

I thank all the delegates for setting out their views. I am sure members will have quite a number of questions. Does Mr. Saunders wish to speak at this point?

Mr. John Saunders

No.

Chairman

We will come back to Mr. Saunders during the question and answer session.

Deputy Kathleen Lynch

I welcome the group, some of whom I know. Could I ask one very straightforward question first? The photo supplied appears to show a difference in size between the current large site and the smaller Thornton Hall site. Is that a difference in the Google site or a difference in the area? What size is Thornton Hall?

Mr. Tony Francis

It is 120 acres.

Chairman

Let us first ask questions and then try to answer them because we will be all over the shop.

Deputy Kathleen Lynch

I am sorry, Chairman. I was puzzled by the size of the sites in the two pictures.

This committee spends a lot of time discussing mental health. It is usually considered in terms of budgets and is considered a Cinderella service. If mental health and all of its components, such as suicide and day-care facilities, are considered a Cinderella service, the element of mental health that the group here today represent is probably further down the scale. I congratulate the group for speaking out because I am sure its members have enough on their plates without having to engage in this type of process to ensure the people represented are heard.

I was surprised to read that there were so few people in the CMH. A type of stigma has grown up around the hospital itself rather than around the patients. Many people are under the impression that more people are being treated in the facilities than is actually the case. It should be possible to accommodate a modern facility at a more appropriate site. The dominant structure would be the prison. We know that prison space is increasing. I am not certain we are going down the right road by building a superprison but that is a different argument.

Has the group spoken to the Minister for Health and Children, Deputy Harney, about accommodating a new, modern facility on the present site? There is enough space to build and sell off some land if that is required. We keep hearing that land is being sold off so the money can be invested in other mental health services. I do not think it is a good idea to sacrifice one group to facilitate another group, however worthy the cause.

The Department of Justice, Equality and Law Reform bought this land but I think the Minister for Health and Children should make a decision such as this because it is fundamental to care. Does the group believe that it is the victim of a botched land deal? Does it believe that because Thornton Hall cost more than it should have cost, the rest of the site is going to be sold off to ensure the financial fallout will not be as great? I do not understand how this decision was made when there is enough land on the present site to build a modern facility in an area where the community is used to the facility, there is no difficulty bedding it in or with the people treated there attending courses or going shopping. One would have to start all over again on a new site far removed from "normal" community. Was there any explanation given as to why it is going to happen?

Mr. Tony Francis

The Minister for Health and Children was not willing to meet us.

Chairman

The normal format is that we take all the questions, bank them and they can be addressed at length.

Deputy Rory O’Hanlon

I thank the group for coming before the committee and for the comprehensive view it has given. We are agreed there is a need to create new facilities for the national forensic mental health service. The present facilities date from the 1850s and need to be replaced. I understand the concerns regarding the new facilities proposed because there is a debate raging about where the children's hospital should be. I take it that when the Government selected the site it got the best advice on it and the decision was made.

There are a couple of points in the presentation about which I am concerned. First, a location adjacent to a prison irreversibly and inevitably associates patients with criminality. I would not like to think that would happen in this day and age. I thought we had moved on from that. There was undoubtedly a stigma attached to mental illness in the first half of the last century. However, no branch of medicine has developed in the interests of the patient as much as mental health care over the last 50 years. I remember that 50 years ago there were 700 patients in the local psychiatric hospital. Today there are about 70, and if the geriatric patients who would be equally at home in a facility for the elderly were taken into account, there would be about 20 patients in it. There have been improvements and I believe we have moved away from the stigma that existed 50 years ago.

I am interested in the table on page 6. Does the table come from Professor Mullen? Reference is made to custodial practice in a prison and therapeutic practice in a hospital. I thought that in this day and age one would not find the same demarcation lines between the therapeutic elements of a prison and a hospital. I do not have a difficulty with the location and I do not regard it as co-location. There will be two separate premises. Successive Ministers have referred to this matter in the Dáil on numerous occasions. For example, during the Adjournment debate on 26 June 2007, the then Minister of State at the Department of Health and Children, Deputy Smith, said:

The new hospital will be a separate capital project, independent of the prison complex. It will be managed and directed by the Health Service Executive. The new hospital will be built on its own campus and will retain its identity as a separate, therapeutic health facility. It will have a separate entrance and a different address to the prison complex. The cost of developing the new hospital will be met from the proceeds of the sale of the existing site of the Central Mental Hospital in Dundrum.

The Health Service Executive has established a project team to progress the redevelopment of the Central Mental Hospital. The design of the new hospital will take into account new standards for secure mental health facilities emerging in the UK and Canada. A new governance structure for the hospital is being finalised at present.

This indicates that the new hospital will be a separate facility to the prison and will have nothing to do with the prison other than the fact that it will be beside it. The same is the case with the Mater Hospital and Mountjoy Prison.

I have no problem with this development but I will be happy to convey the views expressed by the delegation to the Minister.

Deputy James Reilly

I apologise to the group for being late but I am on the rota in the Chamber, so I have to be there at 4.15 p.m. I thank the group for coming here today and the manner in which its members have spoken out clearly in the past and again today. I read the original report written by the CMH Carers' Group and Friends of Dundrum CMH and I read it into the record of the Dáil because it was written in such a fashion I felt I could not say it better myself. I put on the record of the Dáil the list of illustrious groups that have raised concerns in relation to the location of this hospital. As a doctor and somebody who has worked as a visiting GP for 20 years with people with intellectual disability, I abhor this decision. I vehemently disagree with Deputy O'Hanlon.

I visited the COPE Centre in Cork last weekend and they were at pains to point out the different needs of patients with intellectual and psychiatric illness versus those who reach normal retirement. They feel it is inappropriate to have them in a standard nursing home. I accept that point.

I know we have gone through all the issues in the document and I have gone through them myself on the floor of the Dáil. I see no merit in this decision. All I see is an exercise in saving face and money rather than treating patients in the most appropriate setting and according to best practice. All the issues have been covered already. I abhor the stigmatisation, the rural isolation, the possible loss of skill sets that may occur as staff decline to travel across a city, the loss of opportunities for rehabilitation and the loss of a sense of community. Dundrum has grown up around the CMH and that is not going to be the case with Thornton Hall. I offer the group my support and the support of those in Fine Gael who have spoken against this decision and will continue to do so. There are Fine Gael councillors on Fingal County Council. Even though the prison does not require planning permission the hospital does. I will endeavour to ensure that this does not get planning permission.

Chairman

I thank Deputy O'Reilly.

Deputy Jan O’Sullivan

I thank the delegates for their presentation. I attended the meeting in the Mansion House and signed this document on behalf of the Labour Party, with a number of other organisations. A large number of different organisations have signed the document opposing the move to Thornton Hall. I believe this is all about money. It does not appear to be about patient care. The site in Dundrum is extremely valuable and that has been shown in the presentation. I listened to Jim Power, an independent and respected economist, at that event in the Mansion House and he made a tight and accurate case for the CMH staying in Dundrum because a portion of the lands could be sold to pay for the building of a new hospital on the site. That seems to be the appropriate way to proceed.

I take the point about the therapeutic aspect of being in Dundrum, the fact it has been there for 150 years, and that people in the area are totally comfortable and accepting and interact with people in the CMH. There have not been many questions asked of the group present. Ms Marshall outlined the aspects of people going out to the shops and so on. When answering the questions, the group might describe what it will be like for people if they have to go to Thornton Hall. I hope we will be able to stop the move. We will do everything we can to stop it going ahead.

I can image what it will be like if there is no local community as is the case in Dundrum. The group might elaborate on this when replying. I suspect that Deputy Lynch might be right regarding the question of money being needed because of the large amount of money that was paid for the site in north Dublin. There is an argument for putting more money into mental health services. There are very large sites already around the country. In my own constituency there is a large acreage of land that is no longer needed for the old psychiatric hospital. There is the capacity to sell off these lands and reinvest in mental health services, which is the stated Government policy. There is no reason the site in Dundrum is required for that when there are plenty of other sites around the country. The site in Dundrum should be used to raise money to build a new CMH in Dundrum. There is no logical argument that suggests that it is more appropriate in Thornton Hall, and I give the group our full support in preventing it from happening. The sod has not yet been turned, so there is a real opportunity of retaining the CMH in Dundrum.

Chairman

I thank Deputy O'Sullivan.

Deputy Niall Blaney

I too welcome the delegation and the presentation. I would not know a lot about the background to this case. I would like to ask some questions based on what I have observed today. I am aware the Mater Hospital and Mountjoy Prison are close together, as are Portlaoise hospital and prison. Is the delegation aware of any stigma relating to those two locations? Has there been a history of complaints regarding those locations? I am concerned that this may be a problem we are creating ourselves. I am not aware of this issue existing before, even though there was co-location. Would the delegation clarify that for me?

I disagree with the comments on page 4 regarding the stigmatisation of the mentally ill by locating a hospital adjacent to a prison and associating its patients with criminality. I cannot accept that because I feel the hospital would have to be run by the Prison Service before we would come to that analysis. As far as I am aware that is not the case. They are two distinctly separate premises run by two organisations. They are not as close as some would assume. On page 6 it is stated "Practical issues such as staffing shortages in the hospital will lead to staff sharing across the facilities and the dominant culture will prevail". I do not understand what is meant by "staff sharing". Could the delegation develop that further? I have not heard of a situation where prison staff would be sharing with a hospital. Could the delegation analyse it further and tell the committee what is meant by that?

I also disagree with the last paragraph on page 7 where it is stated "[the] Thornton Hall decision is contrary to Government policy". It is stated "Priority should be given to the care of individuals with severe and enduring mental illness, in the least restrictive environment possible". The prisons of which I am aware are very much enclosed. The area developed will be the only restricted area. The rest will be very much open. I must, therefore, disagree with the point being made. I would like the point I have made clarified. I agree with my colleague that some new issues have arisen, on which I seek clarification from the HSE.

Deputy Joe Behan

I join the Chairman and members of the committee in welcoming the deputation from the Central Mental Hospital carers group, some of whom I know. It is welcome that the group has the opportunity which it has taken to express its views as carers and family members of patients in the Central Mental Hospital. I understand a Government decision has been made on the issue. I heard the Minister of State, Deputy Moloney, reaffirm this on "Morning Ireland". However, it is important that the concerns of the carers' group are listened to carefully by everybody across the political spectrum and that, as Deputy O'Hanlon said, those concerns are relayed to our colleagues to see if there can be a meeting of minds on the issue. I would welcome further consideration of it. It may be the case that the Government, having made a decision, is not willing to do so. However, I would like more consideration to be given to the concerns genuinely raised by the carers group.

It is proposed that a new hospital be built at the location of the existing hospital while, at the same time, the existing hospital continue to operate and function. In the "Morning Ireland" interview the Minister of State expressed concern about how that could be managed. I would like an answer in that regard.

Chairman

We will go to the panel for some responses. There may be some supplementary questions. I again thank the delegates for the manner in which they have made their presentations. I ask them to clarify one or two points. The first relates to the business of co-location which members have raised and about which we need to be very clear because there is a significant difference between the sharing of roads, footpaths and sanitary services and the sharing of other resources. The point raised by Deputy Blaney regarding the interchangeability of staff between the hospital and the prison, which I would have thought would be virtually unthinkable, certainly needs to be clarified.

I also seek clarification of Mr. Francis's belief that at least 50% of the clinical and nursing staff in Dundrum might leave as a consequence of the relocation. That would be a source of grave concern for all of us. In addressing the questions raised, will Mr. Francis indicate the basis of that contention?

Mr. John Saunders

I would like to respond to a number of the views expressed and make an analysis. Deputy Lynch asked about the basis for the decision. Without going through history, the decision was made in 2006 by the Minister for Health and Children, Deputy Harney, and the then Minister of State with responsibility for mental health services, Deputy Tim O'Malley. There was no recommendation to the Department or the Ministers and no expert group which advised them. There was no professional advice given and no report which suggested this course of action. The decision came out of the blue in the same timeframe that the policy document, A Vision for Change, was accepted by both the Minister for Health and the then Minister of State and by the Cabinet. In A Vision for Change there is no recommendation or statement on the positioning of a new Central Mental Hospital on a prison site.

There has been no explanation as to why a Department and, ultimately, the Government, signed up to this decision. It is interesting — again, this is a point of history — that the public announcement was made at the same time as that for the replacement of Mountjoy Prison by the then Minister for Justice, Equality and Law Reform, former Deputy Michael McDowell. The record will show that the first public statement on the CMH relocation decision was made in the last paragraph of a press release by the then Minister for Justice, Equality and Law Reform on the decision on Mountjoy Prison, despite the fact that decisions regarding the Central Mental Hospital and all forensic mental health care services are the prerogative of the Minister for Health and Children and, ultimately, the HSE in its operations.

The policy rationale is very unclear. When pressed on the matter at the time, the former Minister of State responded to me in my capacity as a representative of Schizophrenia Ireland that most of the individuals who used the Central Mental Hospital were prisoners of the State and that it would be convenient for them to be located near what was to become a superprison. The facts that we know are that that is not true.

Other issues have been raised. Deputy O'Hanlon commented on the likelihood of one culture influencing the other. It has been shown clearly, primarily in Australia and some states of the United States of America, primarily Texas, Florida and Arkansas, that where one relocates forensic mental health services close to or adjacent to large penal systems, the dominant culture of the penal system eventually overtakes them, despite all the best efforts to prevent this happening. It is simply human behaviour that this happens. To come back to Deputy Blaney's point in respect of shared services such as catering, health and other facilities which all people require, there is a tendency because of economics to develop shared services by a dominant partner which will be used by the minor partner, in this case the Central Mental Hospital attached to a larger prison. That further concretises the dominant culture of security, custody and so on.

There was a point made about the Mater Hospital and Mountjoy Prison. Without being a historian, I can tell the committee they both grew in different circumstances. It is a matter of accident and coincidence that there is a large hospital originally developed by a religious order, now an essential part of Dublin's medical services, beside a prison approximately 100 yards away. The point made is as preposterous as saying Mountjoy Motor Cycles which is 200 yd. from the prison is in some way associated with the prison. Wherever one goes in Dublin services are located beside each other. The decision on the Central Mental Hospital is a purposeful one, mistaken in my belief, to relocate a forensic mental health care service near a penal system on the grounds that in some way those using the Central Mental Hospital are part of a prison population. That is the point that needs to be made.

Mr. Tony Francis

One of the points mentioned is that there are only 82 patients in the Central Mental Hospital. There are only 82 because we only have facilities for that number. Last week Professor Harry Kennedy stated in a newspaper article that 300 would be an optimum number. I believe the policy document, A Vision for Change, suggested a figure of 150 or so.

Deputy O'Sullivan asked how we would visit the community. That is a very important point. The community in Dundrum is literally 50 yd. from the front gate. As a consequence, as and when patients obtain security clearance to leave the hospital premises, they can walk to the local shop and buy cigarettes or they can go for a coffee in a restaurant where they can meet us. Their first contact outside the hospital is an enormous moment for them.

We cannot envisage how they will manage this at Thornton Hall. As of now it can be done on an impromptu basis. It takes 30 minutes to go and come back on a 15 minute pass. At Thornton Hall it will be a two-hour process at a minimum. They would need a vehicle, a driver and a nurse to go with them. We cannot see how such arrangements could be made there.

Ms Kaye Marshall

How many members think the co-located hospital at Thornton Hall will be separate from the prison? Let us take as an example my son who is in the Central Mental Hospital. He is very well and can look forward to coming out. However, should the Central Mental Hospital be relocated to Thornton Hall, when he comes out and looks for a job, he will be asked where he has been for the past two or three years. He will have to reply that he has been at Thornton Hall. What will the majority think? Will they think he was in a mental hospital or that he was in prison? We have to make a distinction between patients and prisoners.

My son comes home to me as part of his rehabilitation. He gets on the bus and comes home on a Wednesday and we spend the day together. This is what families are for. He comes home to me at weekends and just says: "Mum, I love it when you hug me. I only have to get on the bus to come here and I am home." Now let us think of what will happen if the Central Mental Hospital is relocated to Thornton Hall. It will be my grandchildren's children who will ask: "Where were those affected when the wrong decision was made to place a mental hospital on a prison site?" Let us remember mental illness can come knocking on one's door and it might be one's grandson who will ask: "Dad, Mum, what did you do? Where were you?" I am speaking because I love my son who will get better. He will get better only because of what is happening in the Central Mental Hospital, Dundrum, not when it will take half the day to get there and half the day to get home when the hospital is located in a rural setting.

Senator Frances Fitzgerald

Ms Marshall has given a very moving description of the problems that she and her son face. There are times when a Government has to admit it has made the wrong decision. This is one of those times. As Mr. Saunders said, there was no particular rationale for it; it was an administrative decision. I fully support the case made by the carers' group. I do not believe the two facilities should be located together. It is against international best practice. There are significant problems in respect of the stigma attached to mental health issues, a source of major concern for me. People with a mental health problem or illness are stigmatised. They need care, rehabilitation and treatment. It sends a very confusing message. It is explained well in the presentation in which the relationship between illness and criminality is addressed. The proposed relocation is based on administrative convenience. I quote: "It fails to acknowledge the fact that it is because of their mental illness that such patients come into the criminal justice system in the first place". The group has made its case extremely well. I am not sure whether there is scope but a number of members have stated that we, the members of the committee, should present the case made to the Government.

I was in the Seanad and apologise if this point was raised. Did Ms Marshall have a meeting recently with the Government and has the group received an indication that this decision may be reconsidered? Does she have any reason to hope it will be? Will she give the joint committee the most up-to-date information?

Senator Geraldine Feeney

My apologies; as I had to vote, I missed part of the presentations.

I too welcome the delegates from the carers group. Most members of the committee are parents and one cannot but be moved by the delegates' stories. We all have sons and daughters and know that Ms Marshall is right when she states mental illness can touch any of our families. We have all been touched by pain that one never thinks will knock on one's door, but it does.

What is the profile of the patient population at the Central Mental Hospital? How does the number of males compare to the number of females? I seem to associate the hospital with males and do not know if there are any female patients. Could we have a insight into the lives of patients when they are ready to come out for a day or weekend? Before a person reaches that point, what happens?

Are patients up to speed about what is going on? Do they know there are plans for a new hospital and where it is to be located?

Approximately six or seven years ago, before I was a Senator, I sat as a representative of lay people on the Medical Council. I visited the Central Mental Hospital and was absolutely blown apart at what patients had to put up with and how staff had to work in such an antiquated building. I do not think anybody would want to see a loved one in it. I am also familiar with the unit at Tallaght Hospital and the new relocated mental hospital on the site of Portlaoise General Hospital. They are absolutely beautiful and one would not know one was anywhere but in the best nursing home in the country.

I feel there is a responsibility on me as a politician to go back and talk about our meeting today and that there is an onus on us all to distinguish between a patient and a prisoner. Ms Marshall states her son will come out in a couple of years and I wish him well. When he goes for a job, he will have to say he was at Thornton Hall. To keep it distinct, every member should call it the Central Mental Hospital or St. Margaret's; it should never be called Thornton Hall. One feels for the mothers and fathers of prisoners also. They never sent their children out to cause trouble. We hope our children will never become ill. One has to marry the two together.

I would like to know what is the patient profile and hear about the day-to-day lives of patients before they are ready for release.

Deputy Kathleen Lynch

I have a brief supplementary question. I thank the group for appearing before the joint committee and its succinct presentation but nobody has answered the following question. A huge stigma is attached to mental illness. Some may not realise this, perhaps because they do not deal with it frequently. The delegates are preaching to the converted in the shape of the members of this committee because we do not have an instinctive disconnect in that regard. However, it is not something one volunteers when sitting down for lunch with someone because one knows what the reaction will be. Locating the Central Mental Hospital on the same site as a prison would compound the stigma but we should work to get rid of it. There is a notion that a stigma no longer attaches to mental illness and that we are all enlightened now and do not look on sufferers as different but that is not true.

Deputy Margaret Conlon

I too welcome the delegation. I listened very carefully to the presentations and a number of points struck home. Senator Feeney asked about the male-female profile but can the delegates tell me about the age profile of patients?

When I was growing up, I felt a huge stigma was attached to mental health. There is a hospital in County Monaghan and I remember my parents and grandparents talking about people who went into that facility as young people and never saw the light of day again. They were effectively left in a box and inappropriately treated and detained. I would like to think we have moved on and made huge strides from those dark days. The patients in question never got the chance they deserved or proper treatment. In defence of their families, they probably did what they thought was right at the time because there was no alternative and they did not know how to deal with the situation which faced them. The delegates rightly say we do not know whose home mental illness will visit, of which, as a parent of young children, I am very aware. The pressures in those days were different from those of today, although that is not to say there are no pressures on people today. I would like to think those who suffer from mental illness would be treated in an appropriate facility.

I have not been in the Central Mental Hospital but would like to visit. According to speakers today who have visited the site, it is certainly not an appropriate place in which to treat people. Each and every one of us who has children and families and who knows people who suffer from mental illness feel they deserve to be treated in the best, most appropriate and comfortable facility.

I wish Ms Marshall's son well. I understand what she means when she says there is a stigma but would like to think we are moving in the right direction. At one time people did not talk about mental illness and it was a taboo subject but they are now becoming more aware. As we recognise the importance of positive mental health, we are moving in the right direction.

I agree with Senator Feeney in hoping Ms Marshall's son comes out within a couple of years. I abhor anybody who discriminates against anybody else on any grounds and the thought that people are discriminated against when they go for a job on the grounds of where they have been. We have heard of people being advised not to give certain addresses if they want a job. Those who discriminate in that manner deserve to be met with the full rigours of the law. There is legislation in place to stop people being discriminated against. I would hate to think discrimination would take place and that somebody who had come out on the other side of a mental illness would not get a chance in the outside world, like those in the dim and distant past, of whom I spoke. I wish for such an outcome for Ms Marshall's son and the many other sons and daughters who find themselves in that position.

I thank the delegates for their presentation.

Senator Phil Prendergast

I thank delegates for their presentation and offer my apologies for not being present. I was detained in the Seanad for some time.

The hospital in which I worked for 23 years is located beside a psychiatric hospital. Part of the treatment for the patients of St. Luke's Psychiatric Hospital in Clonmel involves being allowed to walk to the shops and mass. Some of them may be identifiable as being from the psychiatric hospital but for most they are characters who are known and loved. There is great respect and appreciation for what happens in old-style facilities such as St. Luke's Hospital. As my husband has worked in such a hospital for the past 30 years, I see both sides of the story.

Until somebody such as Victoria Beckham suffers from acute psychosis and sexes up mental illness, we will not achieve the same level of acceptance as there is for other illnesses. There are many types of psychiatric patient. In the acute setting we see young people admitted after taking soft drugs such as cannabis and having a psychotic episode as a result. They can be mentally unstable for a while but then recover. Research will show whether another type of treatment will emerge.

I listened to Ms Marshall detail what had worked for her and I totally concur. I see from the maps where the hospital is located and where it is proposed to be located and the latter is totally at variance with what we want. I have worked in the health service for a very long time and know very well that if resources become scarce, there will be a pooling of facilities and personnel. That can lead to ambiguity as to whether a person is a prisoner or diagnosed as a psychiatric patient and there will be a blurring of the distinction. My Labour Party colleagues and I will support the case of the delegates in any way we can.

Deputy Bobby Aylward

I welcome the presentations and have sympathy for some of what was said. Overall, when I voted with the Government last week, I did not vote to stigmatise anybody in the context of the relocation of the Central Mental Hospital. Co-location is not the issue. Instead, the issue is creating a modern facility for the Central Mental Hospital. Under the regulations, it will move to Thornton Hall but creating a modern facility is the overriding factor. It is currently located in an antiquated building which needs to be modernised. I will not go into whether it should be relocated but the decision has been made by the Government to relocate to Thornton Hall.

I do not agree with some of the statements made. I come from the constituency of Carlow-Kilkenny, a very rural constituency. While I accept the argument about letting psychiatric patients out into the community for a cup of coffee, there are also advantages to be had from the rural setting, especially for those with mental illness. A rural setting with wildlife, walks and recreation may have a greater effect than bringing them back into the community for a cup of coffee in a cafe and meeting people. There are also advantages to rural life and scenery, as just looking at it is of help. That can be argued both ways. The argument that 50% of staff will leave because the hospital is moving to a rural area does not stand up either. This seems to be Dublin-oriented. Many of the staff come from all over the country and wherever the CMH is placed, people must adjust, be it a hospital, a psychiatric unit or a prison.

I do not accept that there will be sharing of staff. I understand the prison and the psychiatric hospital will be separate. There may be sharing of laundry and food services but I cannot see prison officers, doctors, nurses and psychiatric staff sharing the facilities, being in the prison one day and the CMH the next. That does not make sense.

Every family has problems; and mental illness could affect anyone any day. We all know people who have psychiatric problems. When I voted for this proposal I did not intend to stigmatise anyone. My intention was to provide for a facility. Co-location happened to be an aspect of the proposal, whether for environmental or financial reasons. This facility will be of the highest standard available. Whether it is located in Thornton Hall or Dundrum, patients and the services available to them are the most important issues.

Deputy Beverley Flynn

I welcome the delegates and thank them for the presentation. I listened to some of it in my office and apologise for my late arrival. I grew up in Castlebar which had a psychiatric hospital which was a dominant influence in the town. It was part and parcel of community life in the town. As a youngster I was intimidated by it as it was an old-fashioned, horrible building. It was beautiful on the outside but very bad on the inside. Over the years there was a great effort to organise open days so as to involve the community. This was positive for patients, staff and people from the town. I understand the importance of involving the community in the life of the hospital. Having experienced it myself I would not talk it down.

Listening to the delegation, I have some concerns about the location of the two facilities on the one site. Chairman, it would be important for the committee to visit the site. I have never been to the CMH or Thornton Hall and I think the least we can do as a committee is to go and see what the delegation is talking about.

Having come from Mayo, and taking Kaye's point, the CMH is for people from all over the country. People from all over the country have to travel long distances to get to Dundrum. For people travelling from Donegal, Mayo or Sligo it is a very long journey, and sometimes it is a long journey into the city centre with traffic and all the hassle that goes with that. Sometimes a modern facility on a greenfield site might be more attractive.

In Mayo when the psychiatric services were brought out into the community and people were located in modern houses around the town, and more modern facilities were built for those unable to integrate into the community, the quality of life of patients and staff improved. They were still close to the community when that happened. I have listened and taken on board the valid points made. If the committee were to visit the two sites we could perhaps revisit this issue for further discussion.

Chairman

I thank Deputy Flynn. Does the delegation wish to respond?

Ms Kaye Marshall

I want to respond to what Deputy Flynn said. One example I can give is of a lady who comes from Cork. She gets up at 5.30 a.m. and she gets the first train from Cork to Heuston Station. When she gets to Heuston Station she takes a taxi to get up in time for visiting. She can only visit for a little while and then she has to return by taxi to Heuston Station, go back to Cork and then to the countryside. Can anyone tell me how she will get to Thornton Hall? What station will she get off at?

Mr. Tony Francis

That is not a one-off example. Many carers are pensioners who are taking public transport and coming from Kerry, Cork, Portlaoise and Wexford. The fact that it is close to the M1 is a red herring for a lot of the people who are coming in.

Mr. John Saunders

May I pick up on that point and attempt to answer some of the other questions raised by members? The Minister of State with responsibility for mental health has a plan from the HSE for a regionalised national forensic mental health care service, which is composed of four units, one in the east, one in the south and two in the west and south west, which would provide the type of service now provided by a centralised service, and would deal with some of the issues concerning travel. This plan also includes a centralised mental hospital situated at Thornton Hall. To some extent the debate about Thornton Hall and the location of the CMH has clouded the fact that what is needed is a 26-county regionalised national forensic mental health care service. That plan is with the Minister. To my knowledge there has been no response to it from the Minister's office after 12 months.

The first question asked by Senator Feeney concerned who the delegation had talked to. When the decision was made in May 2006 a number of groups, including those present, made representations to the Minister for Health and Children, Deputy Harney. The Minister was not open to discussing any change in the decision. We had a number of meetings with the former Minister of State, Deputy Tim O'Malley, who stood by the decision.

After the formation of this Government we met the Minister of State, Deputy Devins, who also stood firmly behind the decision, and we have no reason to think the new Minister of State, Deputy Moloney, will have a different view. We will meet him in the next two to three weeks. There has been a steadfast resolve on the part of all concerned in government not to revisit, review or reverse the decision. That is against the background of total opposition from the professional forensic mental health care world and many other organisations. They were shocked at the decision made.

I am not sure if anyone has precise information regarding the number of places. My information is that there are about 12 places for women and the rest are for men. That is a fairly static figure over time. The population is obviously adult, mostly in the early 20s to late 40s, with a smaller number beyond that. An important point is that the population is transitory. There is an image that the CMH is a long-term, secure unit from which one never moves, but the population goes through a process of development, recovery and a step-down facility, leading to community-based facilities and onwards. They are all under HSE jurisdiction and have a therapeutic environment. Despite the criticism of the physical layout of the CMH in Dundrum, it must be acknowledged that in recent years there has been a huge amount of work carried out to improve the physical structure and the expertise of the professional teams. Given its location, it has the best possible service. The problem is presented by the address of Thornton Hall. There is no logical reason the Government cannot consider a redevelopment on-site in the light of all that has been said to date. If it insists, another greenfield site could be found with no connotations with the penal system.

Ms Susie Doheny

What was lacking in the making of this decision was consultation with any mental health group, staff in the hospital, patients or their families. It was stipulated in A Vision for Change that in the care of a patient the family should be included or consulted. We have not found compassion; instead a decision has been made to move the Central Mental Hospital, although there is a planning process that must be gone through. The point has been made many times that it is nothing short of arrogance — whether we like it, it is going to happen. However, the planning process has not yet come into play.

It is very sad that the hardship of families and those who use the Central Mental Hospital is being completely ignored. From a humanitarian stance, these are probably the sickest people in society and the Government will be judged on how it treats the most vulnerable in society. The attitude is out of sight, out of mind. One can call the Thornton Hall complex what one likes, but what is in Dundrum is working very well and the only reason the hospital is being moved is that it is a valuable site. For a long time there have been helicopters which we see in every area every day of the week scouting for land. There has been no cost-benefit analysis in the three years since the decision was announced by the then Minister for Justice, Equality and Law Reform. This is a HSE baby; it has nothing to do with the Department of Justice, Equality and Law Reform.

There is total disregard and a lack of compassion for families, patients and the great work done in Dundrum. The attitude is to ignore it and locate the Central Mental Hospital beside the prison. It does not matter how it is worded; there was an association made in the minds of those who made the decision between mental illness and criminality. A wall can be built or the address can be different but that is only camouflage. We are not fools; we have been through an awful lot over many years with the HSE to get what we have got. We were very glad that the hospital was available in Dundrum for our children because I do not know what we would have done without it. The care provided and the effort made in my child getting well would not be found elsewhere. It has required years and hundreds of staff who make huge efforts to get patients to the stage where they can walk out the gate to go to the local shop. One might minimise this but for someone who has been in an institution such as the one in Dundrum for two or three years, to take that first step takes an enormous amount of effort and money. While the walk may only be a few yards, it is a huge achievement for many patients.

A question was asked about whether the patients knew about the move. Some are terrified. There has not been an analysis of this but my son said he would hate to move to the Thornton Hall complex. He said, "People will think we are prisoners and not people with a mental illness. I could not go outside because I would be frightened. It would be in the middle of nowhere. Where would we go?"

Someone spoke about the birds and nature. In Dundrum there are the most beautiful gardens, lands and trees. All one needs while recovering is in Dundrum and immediately outside the gate. That is all I wish to say. As members can see, I am angry. I have had enough.

Chairman

It is very important that the delegation understand nobody here would diminish in any way the concerns expressed. An emotional chord has been struck with members who do empathise and realise the enormity of the difficulties, as well as the changes to come, for the delegates and their family members. The task of the committee is to work collegiately and with the Government to try to move forward in the best manner possible. Deputy Flynn and Senator Prendergast suggested the committee should act on the proposals of the delegation and go to Dundrum to meet patients and staff. The Thornton Hall complex could also be visited. To a certain extent, a mixed message may be coming across. Some members of the delegation have made it clear that the proximity of one facility to another is not the difficulty. Like others, they have instanced the Mater Hospital and Mountjoy Prison. From the way it was first mooted, they are afraid of and frightened by institutional linkages between a hospital and a prison. Is that the real concern, as distinct from the geography?

Ms Kaye Marshall

That is only one concern.

Chairman

It is the principal one.

Ms Kaye Marshall

I would not say it is the principal concern. It has to do with community, society and rehabilitation. We are trying to get our children back into society. The best place to do this is in Dundrum where the patients are part of the community and accepted. On Saturday, when the weather forecast was bad, the director, Professor Harry Kennedy, and the staff — the nurses — had organised a garden party. If committee members could see the gardens, wildlife and walks at the hospital, they would be amazed. My son said, "Mum, they have called it off. We have pipers in and dance in the afternoon." It is wonderful. It is the essence of getting better. I have to say what Susie has said; in the last four or five years, since Professor Kennedy has come, I have almost witnessed a miracle. With the ethos, it is a totally different place. If this was lost, I do not know what we would do.

Ms Margot Francis

Someone asked about building a new hospital on the same site. If one looks at the map at the back of the presentation, one will see that there is lots of space to rebuild on the same site. There would be no interference with patients and their security would still be provided for. It would be possible to do both.

Someone else asked what would be our main concern. For me, the patients and many carers, it is the following. The Central Mental Hospital was built and people chose to live in Dundrum. It is not the case that people have not chosen to live beside the hospital. It is like living beside a school. One cannot complain about the traffic because one chose to buy a house there. People chose to live in Dundrum. The patients will be taken to a place where people have not chosen to live beside the Central Mental Hospital. When a Garda car arrived to pick up a patient at the hospital, a prisoner asked not to be transported in the same vehicle as the patient from Dundrum. Prisoners do not want to be stigmatised either and do not wish to be next door to the patients.

In addition, when our patients graduate and leave the hospital they do not find themselves in the same situation as patients in other mental hospitals. If I had the latter type of patients I could collect them when they are ready to leave and take them home. In this hospital leaving is done very gradually. Patients can go out for a cup of coffee but must be accompanied by trained nurses. Even if they go down the road to meet their parents, trained staff must be with them and they must return afterwards. There might only be a 15-minute or 30-minute break involved but that is nursing staff time that must be accommodated. If we were to be in Thornton Hall I cannot see how two nurses might take the time to bring a patient into Dublin to meet relatives.

If the process is in place, the patient may not get another outing for two weeks but this time extended to an hour, dependent on the staff and the patient. Leaving operates in a very gentle manner, not over a single week when all at once the patient must return home or go somewhere else to live. It happens over months and, in some cases, over the course of a year. There might be a fall-back in the patient's condition resulting in the whole process starting again.

People talk about the Mater Hospital and Mountjoy Prison being next to one another but I do not know of anyone in that hospital who is there for mental illness reasons. They have a physical illness which is totally different. If a person's legs are cut off it is easier to get over that problem than over one of mental health. A mental health issue goes on and on. One thinks the patient is getting better but then all goes back to square one leaving the patient even worse off and more drugs to be tried. The situation continues in that fashion, affecting not only the patient but family and friends and everyone around. Do we talk to them or not? At what stage? People simply do not understand mental illness until they have it themselves. Even at that, everybody's situation is different and every family is unique, even in the mental hospital. The only reason the patients are there is because of their mental illness. They are not there because on an occasion when they were well they did something to somebody. They were so sick they did not know what they were doing and had no control over it. That is the reason they are in hospital. A physical illness might arise if one goes out and has an accident of one's own making but I assure members that nobody asks for a mental illness.

Deputy Dan Neville

I apologise for being late. I was at another meeting but I have the full presentation of the delegates and will see the full report when it is issued. I have been to all the meetings organised by Mr. Saunders and other meetings on the matter. I am completely au fait with the issue and support the delegates 100%.

Deputy Andrew Doyle

I was in my office watching the proceedings of the committee and felt compelled to come to the meeting and put something on the record. Like the Chairman, I was a member of the former ERHA but I also served on the East Coast Area Health Board and was its chairman at the time when President McAleese came to visit — the first and only time a President of Ireland came to the Central Mental Hospital.

I agree with what one of the speakers said. During my time of service, from 2000 to 2004, I saw a transformation take place in the hospital. We held regular meetings there, including our annual general meetings. Dr. Harry Kennedy saw to it that every care attendant got nursing training and a diploma so that instead of being prison wardens people became carers and nursing attendants.

On the day of her visit, President McAleese unveiled a plaque to a deceased member who had lived in the lodge of the hospital. Four women were there whose gardens had been tended by this man. Although his psychosis had ended over 30 years before he had become institutionalised and had stayed in the hospital for years, cycling as far as Blackrock to do this work. The hospital was his home.

That puts into context what Dundrum is, what it means to people and the dignity it accords to patients. The late Martin Gallagher, who was CEO of the health board, was deeply involved in trying to redevelop the central mental facility in Dundrum. When the health board was abolished that unfortunately lapsed. A number of rational proposals have been put forward that if acted upon would leave the Central Mental Hospital in its present location on an almost cost-negative basis.

Politics apart, I cannot understand why anyone would wish to move the hospital to Thornton Hall. Even if there had been no question of co-location with a prison and the accompanying stigma, there is no logic in the move. The hospital works where it is and has done so for years. I do not deny that it needs improvement. I have been through the building and the old and new parts of the entire facility and it is my view that the progress made in the past five years will be thrown out the window if the move takes place. I especially implore Government members present to try to stop this happening. It does not make sense and will do nothing for the dignity and the overall well-being of the patients in Dundrum.

Chairman

Notwithstanding the fact there is a Government decision on this matter, a proposal has been made that the committee should visit the Central Mental Hospital. Such a visit would be useful and would help inform us further. Is that agreed?

Deputy Margaret Conlon

It is but there should also be a visit to the co-location site. That would be a good idea.

Chairman

I do not see any difficulty with including the latter. We might have to visit on different days. I shall ask the clerk to make the necessary arrangements as soon as possible.

I thank the members for their questions and I thank the delegates for their forthrightness and the manner in which they challenged us on this issue. Have they any further remarks or are they content they have made their case?

Ms Kaye Marshall

I am content but I wish to tell to all the members how much we appreciate coming to the House. It is heartening. Sometimes we, the parents, get so down that we need things to uplift us. This has been a good day for mental health and it will be a better one if we can persuade those in power to alter their decision. We thank everybody.

Chairman

The delegates are very persuasive.

The joint committee adjourned at 4.50 p.m. until 3 p.m. on Tuesday, 15 July 2008.