JOINT COMMITTEE ON HEALTH AND CHILDREN debate -
Tuesday, 29 Jul 2008

Central Mental Hospital Relocation: Discussion.

Chairman

I welcome Ms Bríd Clarke, chief executive officer of the Mental Health Commission, and Dr. Edmond O'Dea, chairman. I also welcome the following delegates from the Irish Mental Health Coalition: Ms Marina Duffy, Mr. John Saunders, chairman, and Ms Caroline McGrath, director. We look forward to hearing their presentations.

I draw attention to the fact that while members have absolute privilege, the same does not apply to witnesses. They must be careful, therefore, not to make charges against a person outside the Houses or an official by name or in such a way as to make him or her identifiable. Members will ask questions at the conclusion of the presentations.

It is good to see Ms Clarke again. Perhaps she would like to commence her presentation.

Ms Bríd Clarke

I thank the Chairman and members for inviting the Mental Health Commission before the joint committee. A presentation has been circulated to members. I do not intend to go through it in full because time is of the essence but I will highlight some of the key points in it.

The Mental Health Commission was established in April 2002 when the Minister for Health and Children signed the commencement order relating to certain sections of the Mental Health Act 2001. Members of the committee are probably aware that all of the remaining sections of the Mental Health Act 2001 came into operation on 1 November 2006. Under paragraph 1.1.2, members of the committee will see the principle statutory functions of the Mental Health Commission. It is important to emphasise that these include the promotion and encouragement of the establishment and maintenance of high standards and good practices in the delivery of mental health services and taking all reasonable steps to protect the interests of persons detained in approved centres.

Our key functions are listed on the second page of the presentation and I will only highlight those that are of particular relevance to the issue under discussion today. The first relates to the appointment of an inspector of mental health services, a function the commission holds. We also license and register all approved centres, or inpatient facilities, like the Central Mental Hospital, and attach and revoke registrations. The commission protects the interests of persons detained in approved centres and runs the independent review system, including mental health tribunals.

The fundamental principle that underpins the Mental Health Act 2001 is the protection of the best interests of the patient and this is a welcome inclusion in the Act. I particularly draw attention to subsection (3), which points out that when the commission makes a decision, under the Act, concerning the care or treatment of a person due regard should be given to the need to respect the rights of the person to dignity, bodily integrity, privacy and autonomy. As the Mental Health Commission is the statutory body responsible for inspecting and registering inpatient facilities and for protecting the interests of people detained and as it also has responsibility to promote high standards and good practices we believe the provision of forensic mental health services is a key issue for the commission. We published a discussion paper in February 2006 on forensic mental health services and it is available on our website. We consulted stakeholders in mental health services and will publish a position paper on forensic mental health services in September.

On page 5 we give a definition of forensic mental health services. They are services that deal with mentally ill people whose presentation has been assessed as requiring a more focused level of expertise and-or increased levels of physical security. I will not go through the entire definition. Some patients are identified at the level of general psychiatry and some via the criminal justice system. In other words, within the Central Mental Hospital there are people who have come through the prison system and have a mental illness and there are also people who have been referred from local mental health services around the country. Comhairle na nOspidéal provides a definition of forensic mental health services but I will not go into it because it is an area with which committee members are familiar.

I emphasise the principles underpinning the provision of mental health services on page 6. I particularly draw attention to the United Nations' principles regarding the protection of persons with mental illness and the improvement of mental health care. A number of the UN principles are very important regarding the location of the Central Mental Hospital. The first is principle 1.1 states that all persons have the right to the best available mental health care, which shall be part of the health and social care system. Every person shall have the right to be treated and cared for, as far as possible, in the community in which he or she lives. Principle 9.1 states that every patient shall have the right to be treated in the least restrictive environment and with the least restrictive or intrusive treatment appropriate to the patient's health needs and the need to protect the physical safety of others. I draw attention to principle 13.2 which states that the environment and living conditions in mental health facilities shall be as close as possible to those of the normal life of persons of similar age.

I will move on to page 8 of the presentation and an area the committee may wish to further examine. In 1999 the Scottish Executive produced a report on forensic mental health services. Scotland is a country at which we look quite closely because its population, at 5 million, is a little larger than that of Ireland, and the demographic structure is quite similar. The report states that users of forensic mental health services should be cared for having regard to the quality of care and proper attention; in the community rather than institutional settings as far as possible; under conditions of not greater security than is justified by the danger they present to themselves or others; in such a way as to maximise rehabilitation and their chances of sustaining independent lives; and as near as possible to their own homes or families if they have them. In the report, considerable importance is assigned to the planning process for forensic mental health services. This is something the Mental Health Commission also wants to emphasise. We have attached at appendix A the Bamford Review of Mental Health and Learning Disability (Northern Ireland), which was published in 2006, in which forensic mental health services are also considered. This report came out a little after the Government report A Vision for Change.

Section 3 of this presentation is about the proposed location of the forensic high and medium-security facility at Thornton Hall. I would like to go through this in full because it is the core of what is being discussed. The Mental Health Commission fully supports the replacement of the current Central Mental Hospital with a purpose-designed modern facility which promotes patient safety and dignity. The commission is of the view that the proposal to site this facility at Thornton Hall, beside a new prison complex, is not in patients' best interests and is not conducive to promoting patient rehabilitation and recovery. The siting of two large institutional complexes in one location will promote isolation and exclusion of the population resident in these facilities. This will increase the stigma already experienced by people with a mental illness. The purposes and functions of both facilities, in the view of the commission, are distinctly separate. A prison has a strong focus on detention and security; however, the primary focus of a forensic mental health high security unit is the creation of a therapeutic environment which will promote patient rehabilitation and recovery.

The proposed location, which I gather the committee visited this morning, is not well served by public transport, thereby placing a considerable additional burden on families to maintain contact with their relatives. This is contrary to the principle of promoting community and family contacts as outlined in the United Nations principles. There will be few, if any, opportunities for local planned external activities such as work experience, which are all essential elements of a managed rehabilitation programme. The commission is of the view that building a new facility on the current site at Dundrum would eliminate all these serious problems. There is an excellent transport system, including the Luas; a wide range of community and social facilities in the locality; and, importantly, the facility is well established in the local community.

The commission wishes to emphasise the importance of planning and delivering an integrated, comprehensive and quality forensic mental health service in Ireland. To do that, the commission's view is that there should be a comprehensive assessment of need for forensic mental health services and this should be undertaken as a top priority. Forensic mental health services should be provided primarily on a regional basis rather than being centralised in Dublin as at present, although it is acknowledged that the medium and high security facility should be situated in Dublin. Forensic mental health services should encompass a wide range of services, including high security care, medium security care, low security care and community-based forensic mental health teams which can provide in-reach services to the local prison population and local mental health services. What we are proposing is in line with Government policy as issued in A Vision for Change in 2006.

It is the view of the commission that it is imperative that the development of a high-security facility is not undertaken in isolation. Our best estimate - although, as I said, we believe there should be an assessment of need - is that there is a need for four regional low security facilities around the country. This will ensure that people with a mental illness are not placed in settings with higher than required levels of security and will guarantee care in a setting as near as possible to the person's family and community. We also believe that regional forensic mental health teams should be working in the community. These would be multi-disciplinary teams providing community assessment and treatment services.

For the conclusion I will hand over to our chairman, Dr. O'Dea.

Dr. Edmond O’Dea

In summary, the view of the Mental Health Commission is that this is not an appropriate location for a facility of this type. In reaching this view we are guided first by our own statutory obligation under the Mental Health Act to inspect and register licensed inpatient facilities, to protect the interests of people detained and to promote high standards and good practice in the mental health services. We are also guided by the United Nations principles regarding the protection of people with mental illness and the improvement of mental health care. In addition, the Scottish Executive and the Bamford Review, as discussed in respect of Northern Ireland, while acknowledging the need for security where necessary, have both strongly supported the provision of forensic mental health services in the community wherever possible and in locations that maximise rehabilitation and recovery. The current proposal would promote the isolation and exclusion of those admitted to the hospital, if relocated, and is not consistent with best practice and thinking, nor with the contemporary view of mental illness. While our view is that regional low security facilities should be developed in parallel with high security facilities we would welcome a broader review and assessment of the State's needs in this area to ensure best planning for the future.

Mr. John Saunders

I thank the Chairman and the committee. I acknowledge the committee has been deliberating this issue for some time and that it had a very comprehensive presentation on 9 July from the carers' group of the Central Mental Hospital. Arising from that meeting the committee visited the present service site in Dundrum and today visited the proposed site at Thornton Hall.

I represent the Irish Mental Health Coalition, a group of voluntary bodies that came together to bring about change in the standard of mental health care in Ireland. The member groups in question focus primarily on policy and service provision within the field of mental health care. The coalition members are Schizophrenia Ireland which currently chairs the group; the Irish Advocacy Network, a group of service users of mental health care services; Grow, a worldwide movement of mental health care service users and their families; Bodywhys, the eating disorders association of Ireland; and Amnesty Ireland, which is part of Amnesty International, the human rights organisation.

Today's presentation will unavoidably rehearse some of the issues that members heard on 9 July. My colleague, Ms McGrath, will present a body of arguments on behalf of the Irish Mental Health Coalition. The coalition welcomes and supports Government policy, as outlined in A Vision for Change, that the Central Mental Hospital be replaced or remodelled to allow it to provide care and treatment in a modern, up to date and humane setting. The replacement or remodelling of the Central Mental Hospital is one of several necessary reforms of forensic mental health care services on a national level for those with difficult to manage behaviours. Such reform includes a development of forensic mental health care teams and intensive care rehabilitation units in each of the four Health Service Executive regions.

I note the Minister of State at the Department of Health and Children is in receipt of a HSE working partner report outlining recommendations for a national forensic mental health care service based essentially on A Vision for Change policy recommendations.

While recognising the urgent need for a new central mental hospital, the coalition opposes the proposed relocation to the Thornton Hall site. The Irish Mental Health Coalition position is informed by the experience of service users, carers and members, as well as by international experience and human rights obligations. The submission that follows outlines the core basis of our concerns.

First, relocation adjacent to a proposed prison at Thornton Hall will serve to reinforce and extend the experience of stigma. Second, relocation is inconsistent with principles outlined in A Vision for Change and international best practice. We note that A Vision for Change has been wholeheartedly adopted by the present Government and by the Health Service Executive as national policy for mental health care services. Third, our view is that there is an alternative economically viable option in existence.

Ms Caroline McGrath

The first of these concerns is that relocating the hospital adjacent to the site of what will be, when complete, the largest prison in the State, would further extend and reinforce the experience of stigma for people using the services of the Central Mental Hospital. The experience of our members and research consistently show people with mental illness are subjected to and experience routine discrimination. This experience will be reinforced further by the stigma of perceived association with prison if the Central Mental Hospital is placed on a co-located site or adjacent to a prison site in Thornton Hall. There have been significant Government efforts to address negative discrimination and the stigma experienced by people with mental illness through such initiatives as the National Disability Authority campaign on mental health awareness and public attitudes, through the work of the National Office for Suicide Prevention and, fundamentally, through legislative reform. The Criminal Law (Insanity) Act 2006 shows, in law and public policy, a recognition of a move to distinguishing clearly between criminality and illness. We have abolished the verdict of guilty by reason of insanity and now have a verdict of not guilty by reason of insanity, which is a progressive and profound move in terms of distinguishing between criminality and mental illness. If we place the Central Mental Hospital adjacent to the largest prison site in a rural location it will undo the progressive work undertaken at Government level.

The experience of stigma is not isolated or experienced only by those with mental illness, but often extends to their families, carers and those close to them. We note the commentary and suggestion that the Central Mental Hospital, if placed at Thornton Hall, will be managerially separate and in a distinct complex. That will not be the lived experience of family members who visit the site to attend the hospital. Those who have been to the Central Mental Hospital will have noted the arrangements in place there for children visiting parents. Imagine what these would be in the Thornton Hall site. A visiting child would be oblivious to separate management structures and separate entrances. Such a child would be concerned by the mode of travel, who to meet on arrival, whether to use the prison shuttle bus or public transport to get there and what he or she will see, hear and observe. It would be a community dominated by a penal institution, not one which provides redress and care and treatment to a mum or dad who needs assistance from a health service and who has done nothing wrong. The experience of stigma is real and lived experience and will not be overcome by artificial changes of address.

The placement of the Central Mental Hospital at a site at Thornton Hall, as the commission has indicated, is not consistent with international best practice, best practice in mental health policy, or with the principles in A Vision for Change. A Vision for Change clearly outlines that forensic health services must be characterised by integration and rehabilitation. This is a challenge and must be provided for people with especially acute needs and security requirements. The fundamental way to ensure that culture of rehabilitation is in place is in terms of the environment in which the Central Mental Hospital is placed. This means geographically moving it so that it is distinct and separate from a penal institution and so that it is not in an urban environment in which the dominant institution will be run by the Prison Service.

A central part of any treatment programme and the experience of people in the current Central Mental Hospital is rehabilitation which includes being a part of the local community. As the commission has indicated, the daily experience of people in the Central Mental Hospital is progressing to be part of that community and includes accessing facilities there. Those facilities are not readily accessible at the proposed location at Thornton Hall. It will be practically impossible to deliver the type of rehabilitative programme currently in place in Dundrum from the proposed site.

The principles outlined in A Vision for Change also include a clear principle of partnership in care. This involves including service users and their families in design and planning of mental health services. It must be noted, as the carers have mentioned, that at no point in the advancement of this decision to move to the Thornton Hall site were any of our members consulted, directly or indirectly, in relation to that move. We would welcome an opportunity to engage in any review of forensic mental health services nationally, and to fully participate as partners in care in that process. The clear position of the Irish Mental Health Coalition is that this move cannot go ahead to the Central Mental Hospital. I will hand back to Mr. Saunders for our estimation that there are other ways forward.

Mr. John Saunders

I will summarise the position. The committee has received, from the last presentation, a copy of Patients Not Prisoners, an analysis of the present position and the viable options. In that document there was an economic analysis presented by the economist Mr. Jim Power. He suggested an economically viable basis for the redevelopment of the Central Mental Hospital on its present site in Dundrum, based on a partial sale of the lands, which would finance the development of the new buildings. This would be a cost neutral exercise in terms of the expense to the HSE and the Government. While the Irish Mental Health Coalition recognise this is just one option, we believe it provides a viable alternative to the proposal to develop on Thornton Hall. Furthermore, the coalition is not aware of any cost-benefit analysis undertaken by Government on the proposed relocation of the Cental Mental Hospital to Thornton Hall. We understand the HSE has commissioned a cost-benefit analysis based on the fact that this is a capital project and we hope the HSE will publish that analysis so we can all clearly see the exact economics around the Thornton Hall site vis-à-vis the present location in Dundrum.

Relocating the Central Mental Hospital to Thornton Hall will inevitably and irretrievably undermine the rights of patients using that service to access quality mental health care services in the least restrictive environment possible. The Irish Mental Health Coalition urges Government to review its decision to relocate the Central Mental Hospital to Thornton Hall and to conduct a review in consultation with all interested stakeholders and within the context of the need to develop a comprehensive national forensic mental health care service.

Chairman

Will Ms Clarke or Dr. O'Dea clarify something? It was mentioned that the commission advocates four regional centres. Is that as an alternative to a Central Mental Hospital or, if not, how much smaller would the new hospital be? There are 84 residents in Dundrum. How many of those patients could theoretically be dispersed to regional centres and how many may need to be in a central hospital?

Ms Bríd Clarke

The proposal from the commission is that within a forensic mental health service, high and medium security care are needed. Due to the size of the population in Ireland, it would be appropriate to combine that in one facility. There should also be low security units around the country. This can reduce the size of the high security unit, because we need to be careful that people are not held in higher levels of security than is required. There needs to be a simultaneous development because otherwise people may be detained in somewhere like the Central Mental Hospital, but could function in a much lower level of security. It is a parallel, rather than an either or, development.

Chairman

Does the commission have a sense of the scale of what is required? In our deliberations to date we know the plan is for a 120-bed unit. It has been suggested that perhaps a 200-bed unit is required. Against a background of four regional centres, what should be the scale of any central mental facility?

Ms Bríd Clarke

That is one of the reasons we have stressed very strongly that there should be an assessment of need before we finalise any of the development plans. That could be done quite readily by looking at existing studies, and at the needs within the prison, the general community and the mental health units to make sure one gets the right balance.

Deputy James Reilly

On that point - Deputy Dan Neville will confirm this - Dr. Harry Kennedy has, in his assessment, said there would be a need for in excess of 200 beds for the current clientele it is trying to deal with given the backlog that is occurring.

I thank the Mental Health Commission for appearing before the committee and for its concise and precise presentation. I find no fault with it. I am in full agreement with it. I would go further and say any right-minded objective person would fully concur with where the commission is coming from. I would add to some of what the delegates have said when talking about the loss to the service of some key people who work with the patients because the movement from where they are currently located across the far side of the city to a rural isolated area is not something people who might have five or six years' service left might fully engage with. That will be a loss to the service.

There is another issue, that is, the number of beds. There is a need for a separate service to assess patients who have been referred by the courts. There are people who have been involved in minor incidents being referred on by the courts for assessment before sentencing. They are not serious crimes, but those people are in the same system. That does not appear to be appropriate, neither is it viewed as appropriate by people who work in the service. The arguments the delegates have made are cogent and relevant and I fully subscribe to them. I will not go over all the issues they have raised. I fully accept what they have said. We were out at the site today and I certainly was not reassured by that visit.

I visited the Central Mental Hospital in Dundrum as did all the members of the committee where we got a very strong message from staff and patients that they did not want to move either. This is the 21st century. At the tail end of the 19th century we were building large institutions, one of which was St. Ita's where I worked. Before St. Ita's was built, consideration was given to building it on Lambay Island; in other words, out of sight, out of mind. The only thing that prevented that happening was the cost.

I have a sense that none of these patients is serving penal servitude but having listened to the delegates and all others who represent patients they are going to be penalised. That is not right or fair.

Communication is more than just speech. It is also the actions that are associated with what one says and the message is clear. It is to maximise the return on property at the expense of patient care. As a doctor I cannot live with that and as an Irish citizen I cannot live with it and I do not want to be associated with the creation of a new generation of mental health facility that will last from 50 to 100 years and have my children ask how I could have stood over this.

Are there plans for the Mental Health Commission to get the inspector of mental hospitals to put his reports on the web as soon as they become available in order that we can access them? At a time when we are talking about transparency and accountability the more transparency we have the better, particularly in the area of voluntary admissions, about which many people are frightened. They like to be reassured that somebody is shining a bright light and making sure everything is done as it ought to be done and that people and their rights are protected.

I thank the delegation for appearing before the committee and reinforcing for me and many others its very real concerns as a group which primarily has patient care at the core of what it is doing. It has also alluded to Government policies which would seem to be in opposition to what is being proposed here. I hope the committee, when in private session, can arrive at a unified position which will reflect the real and serious concerns the delegation and many other groups associated with patients have raised.

Deputy Jan O’Sullivan

I welcome the two groups appearing before the committee. Today and last week and previously when we met the families we have built up a very full picture of what this proposal is about. With the policy document, A Vision for Change, the Mental Health Act and the Criminal Law (Insanity) Act, the United Nations principles, the user groups, the broad coalition of interest groups and the statutorily established commission, we have a picture of very strong opposition in terms of policy, legislation and so on. It is clear this is a wrong decision and that it should be changed. It is about money. What we must focus on is the way by which we can have it changed. Nobody wants to make a political football out of this issue - Senator Mary White was right when she said in private session that it was about people - but we must find a way by which the issue can be examined again. That is possible. The suggestion that there be an assessment of needs and a review is correct and it should be done.

We found out today that the timeframe was not immediate. It appears the prison project is likely to go ahead soon but that is not the case with the hospital project. The economic situation has changed. This can be a factor in terms of the value of land and so on. It is not the most important one but, nevertheless, it is a fact that the money is available, about which there is no doubt. A viable proposal was brought forward by Mr. Jim Power for Mr. Saunders' group. It makes sense to me in terms of selling part of the land in Dundrum and rebuilding an appropriate centre in Dundrum.

I want to ask some questions, one of which is a follow-on from the Chairman's question about the size of what is required and whether, if there was a regional forensic programme in conjunction with the central facility, a smaller central facility would be needed. I want to raise in particular, because I was struck by this when we were in Dundrum last week, the issue of women in Dundrum. There is a staged process for men in that there is a high security unit for those brought in on remand, another unit for those a little further down the line, a beautiful house for those almost ready to leave and a hostel in another part of Dublin. However, it appears the women are all located in one unit. I want to ask about this because it appears to make it more difficult for women to participate in an appropriate staged programme. One of the representatives might answer that question.

We should be demanding that the regional approach be taken, with the central approach. That is what is recommended in the policy. We were all of the view that A Vision for Change was a very good policy document across its various aspects but in this area also. I do not understand the reason the Government would not see it as appropriate to take time to examine the proposal because there is time to do so and circumstances have changed. I hope this can be done in agreement.

I understand there is at least one court case in respect of this issue. I do not know if any of the delegates are aware of it but somebody brought it to my attention that the courts may be making the decision on the human rights aspect of the proposal. All the delegates have a blank look. I do not know if anybody has information on the matter but I understand the decision may well be challenged in the courts. If that is the case, the project may be delayed.

I speak from the heart on behalf of every member of the committee when I say we would like to find a way to have this decision reviewed and the facilities to remain located in Dundrum.

Deputy Niall Blaney

I welcome the groups and thank them for their precise presentations. We now have a very informed view from those on the anti side. With what we have in mind and what is before us, it is important that we now have an opportunity to meet officials of the Department of Health and Children and representatives of the Health Service Executive to hear what they have to say. It is only right that they, like any like-minded group, should have that chance.

I have another question concerning the existing facilities in Mountjoy and Portlaoise prisons. Given the fact that the Mater Hospital is located beside Mountjoy Prison and that the hospital is located beside the prison in Portlaoise, has there been a stigma attached during the years? What is the current position? If there have been difficulties, can the delegates give us any feedback because we have not received any heretofore. It might be helpful to us.

Deputy Kathleen Lynch

I thank the Chairman for convening the meeting. I welcome both groups. Despite the fact that the committee always tries to work by consensus which is probably the correct way to move forward, we must also recognise that this was very much a political decision. It was not made by academics or the medical profession or the result of constant lobbying by groups such as the Irish Mental Health Coalition or others who speak on behalf of people with a mental illness. It was made by a politician who was not re-elected, although as that can happen to any of us, I am not taking any great joy from it. However, as it was made by a politician, it was a political decision. As politicians, it is our job to determine whether it is right or wrong.

We have heard from a variety of groups and visited the service. Clearly, the original buildings are unsuitable to meet today's needs, on which everyone is agreed. The decisions we make now will affect the way people with a mental illness will be treated in the future. The argument has been rehearsed repeatedly that because a hospital is adjacent to Mountjoy Prison there is no stigma attached to those attending the accident and emergency unit of that hospital. I am not certain that is how it would be done if we were planning the hospital today. This is about the future, not the past. It is about how we plan services we will provide in the future for people with a mental illness. We must ask ourselves if this is the right way to do it. We must answer that question truthfully. I believe it is not.

Earlier I was out at the farm known as Thornton Hall, a journey of at least 15 miles on highways and by-ways. If I were coming from outside Dublin I would not find it on my own. We were being driven by an experienced driver who clearly knew where he was going but I would not have found it. I am assuming that people confined to such an institution have few visitors. As that is normally the case, it would be a retrograde step to make it more difficult for people to visit the facility. It is wrong to put it cheek by jowl - it is on the Oireachtas website - with a dominant institution. One hears arguments that it is a huge site and that they will not be located next door to each other, but they will. According to the plans, they will be cheek by jowl with one another. How will people get there? Will visitors to hospital patients who hope to be rehabilitated have to share the same transport as those going to the prison? Decent people end up in prison for various reasons and decent people visit them. I am not saying anything about this, but is that how it will be organised?

Has the Irish Mental Health Coalition been consulted by the Department of Health and Children on the matter? Has its view been sought? Has it been asked for one, or has it been consulted about it? One does not set up commissions of this type and then not bother to refer to them on an issue as important as this. Has it been asked for its opinion? Has anyone asked if it believes this is a good or bad idea?

What is the thinking on transport? If people are to be picked up at a central point, how will they deal with this? I do not believe someone who drives would find his or her way.

Does the commission intend to meet the Minister for Health and Children? A former Minister for Justice, Equality and Law Reform made the original decision but the Ministers for Health and Children and Justice, Equality and Law Reform are pushing the issue. Will the commission meet them and put its point as forcefully as it has today? The notion that one would plan for the future in the same way services were allowed to develop in the past is not feasible; it is allowing something to develop.

Deputy Dan Neville

I, too, welcome the members of both groups and thank them for their presentations. I was very impressed on our visit last week. During our discussion with patients, they expressed concern that those in the final stages of recovery would not be able to walk across the road to the cinema, go to the supermarket or catch the Luas into town. They also expressed concern about the stigma attached to housing them so close to a prison. I do not want to repeat all that was said but during our visit it was clearly stated to us and as the photograph showed that there were 150 acres, 30 of which would be used for eight prison units and 15 for the hospital to be located right beside the prison. In fact, we were told the watch tower would be located beside the dividing wall between the prison and the hospital. It will overlook the hospital as well as the prison.

When I asked about transport, I was told a shuttle bus would bring people who would pass through the prison visiting centre first before going to the prison or the hospital.

I attended the round table meeting in the Mansion House in January at which an international expert who had no agenda, other than the fact he was the most eminent forensic psychiatrist in the world and from down under, stated his strong views on the stigmatisation attached and the difficulties expressed by the delegation and others.

I would like to ask the Mental Health Commission one question. It is the statutory body responsible for inspecting, registering and licensing inpatient facilities for the care and treatment of people with a mental illness or mental disorder. Will it have to license this inpatient facility? Has it indicated to the Government its attitude towards it as the licensing body for the hospital?

Deputy Beverley Flynn

I also welcome the Irish Mental Health Coalition and the Mental Health Commission. Both presentations were excellent and I find myself in agreement with many of the points made.

I have a number of questions for the Irish Mental Health Coalition. Ms McGrath referred to the change in the definition in criminal law legislation from "guilty but insane" to "not guilty by reason of insanity", which we all welcome. Sometimes words may be changed in legislation, but actions speak a great deal louder than words in terms of the perception among the wider community. Change in the words in the Act will not necessarily mean anything if the people making provision for a new Central Mental Hospital do not take it seriously and follow it through.

The second point that really hit home was about children visiting someone in the Central Mental Hospital. This for me is an enormous issue and touches on Deputy Neville's point. I found the visits to both the Central Mental Hospital and Thornton Hall very beneficial. I was surprised by the pros and cons attaching to both visits. In the case of the Central Mental Hospital, I should never have thought it was such a tranquil place within its walls. On the negative side, the facility is ancient and I thought the accommodation for residents was completely unsuitable. There were definitely pros and cons within that experience.

I was surprised at how close Thornton Hall was to the city. We left here at 10 a.m. and had returned after our visit shortly after noon. I was not much impressed by the location of the two separate entrances. The prison part of the facility has all the road frontage, whereas the Central Mental Hospital is boxed into a corner, without much road frontage. I believe this is important, because if the Central Mental Hospital is not built there it might not be easy to dispose of that part of the site. This might not ever be relevant, but having it cornered off in this manner appears to be significant.

Children visiting might have to come in through the prison entrance. The suggestion today was that those visiting people in the prison and the Central Mental Hospital might all meet together in one reception area and then, perhaps, be farmed out in terms of where they had to go. I absolutely cannot accept this in any circumstances, because it would mean that someone visiting a patient in the hospital would be confronted by the signposting for the prison, which is not acceptable under any heading.

I found it very beneficial to hear a definition of forensic mental illness since I am not familiar with this area. It was also beneficial to hear the principles one is looking for when dealing with patients in hospital. We were told at the Central Mental Hospital that there were 74 residents, the vast majority of whom were men. Of these, most were from Dublin. Coming from a county such as Mayo, I am very interested in the regional arguments. However, given that the Central Mental Hospital is located in Dublin, is it really a national facility? Has it not essentially become a facility for just Dublin, by reason of the fact that it is located in an area such as Dundrum? People have made the point that a Government decision has been made in this regard, but as an Oireachtas committee we are free to make any recommendation we like, irrespective of what side of the political fence our allegiance lies - whether we believe Thornton Hall is a good site, the Central Mental Hospital should be left in Dundrum or whether an alternative site should be considered. Would the Thornton Hall site be so unsuitable, for example, if the prison was not there? In terms of proximity to the M50 and accessibility for other people around the country, this is a valid question because the central mental facility is for high and medium security patients, and obviously these are located all around the country, not just in Dublin. Based on what the Central Mental Hospital is dealing with at the minute, it appears to be a facility that caters for Dublin people.

Those essentially are my concerns. I have come to this with a completely open mind. I have no agenda whatsoever in this regard, but I want whatever we decide as a committee to be in the best interests of patients. I hope we shall be able to come to some accommodation among ourselves.

Senator Frances Fitzgerald

I thank the delegates for their presentation which was both clear and helpful. This is one of those Government decisions that really stands out as one that should be reversed. The delegates have provided the arguments for so doing. As someone who worked in the mental health service for many years, I feel the same way. It is sad and disappointing that we are in this place, given the progress made on mental health issues and the efforts to reduce the stigma.

This was a political decision made by four Progressive Democrats Ministers, namely, Michael McDowell, Mary Harney, Tom Parlon and Tim O'Malley. As such, I query whether there is a mandate for this decision. As Deputy Lynch said, there was no mandate given by any group. It seems this decision was plucked out of the air and it is a very bad one. If ever the Government should reverse a decision, in the interests of patients and mental health, this is it.

It has been such a struggle to have mental health issues placed on the agenda, be it funding, services or reducing the stigma attached to such issues. The delegates should explain how this decision will reinforce that stigma. People have not been sensitive enough to this issue.

The question of community rehabilitation and progress for someone in a forensic mental health facility is also emphasised in the delegates' reports. This is provided for at Dundrum, but will be very difficult to achieve at Thornton Hall.

It is disgraceful that neither the Minister nor officials from the Department of Health and Children and the HSE are in attendance. They should have been able to respond to the Chairman's invitation. I am very disappointed that they are not here and hope we can be given a guarantee that they will be.

Deputy Bobby Aylward

I welcome the two representative groups. We have had many hours of debate and hearings on this issue. We met the parents of patients at Dundrum, which we visited last week. It was my first time to visit the facility and I found the experience very interesting. More of us should go to see what is happening there. We visited Thornton Hall today and are now meeting the delegates. We should listen to the other interest groups, namely, the HSE and the Department of Health and Children. Whatever decision we make, I ask that the committee wait and listen to the case they have to make. If we are to have a full analysis, we should hear every side of the story. We can then make a decision.

The cost-benefit analysis is one of the reasons we are here. Like everyone else, I agree patient welfare is the most important one. The facility in Dundrum extends to 32 or 34 acres. While the gardens and so on are good, the building and its facilties are outdated. We need a modern hospital. Would the answer be to sell half the land and build a new hospital there, or to build a new one on a greenfield site?

I do not agree with the comments on centralisation. Nobody would argue that people should not be part of the community. As a representative of a rural area in the heart of the countryside, I can attest that there is a therapeutic gain to be had from living in the countryside. In any case, the Thornton Hall site cannot be regarded as particularly remote. As I said, I am trying to look at both sides of the argument and have an open mind on the issue. I set out by car for the Thornton Hall site today, having missed the bus, and was there in 20 minutes. I knew it was located off the N2, close to St. Margaret's, and there was no difficulty in finding it, even though there is no building there yet. Its location is not a major argument against it. For a person arriving at Heuston Station on the Cork or Kilkenny train, a taxi journey to Thornton Hall will take little longer than it would to Dundrum when one takes traffic into account and so on. Nevertheless, I agree it is important that there should be facilities such as cafés in the locality for patients who are preparing to return to society. Such facilities will begin to emerge in the locality of Thornton Hall once the prison is in place.

I am certain the Government and the Department did not set out to stigmatise or isolate anybody as a consequence of this proposal. It is most likely a question of costs and so on. I understand the site has been given free for the hospital. Can the Mental Health Commission refuse to license the proposed facility at Thornton Hall if it concludes it is unsuitable?

There is an onus on the committee to make some recommendation on this issue and I ask members to consider all the facts before putting any proposal to the Department. This development is not a foregone conclusion and planning permission remains to be secured. It is my understanding this could take a considerable time. There is even the possibility that a material contravention is involved which would prevent it from going through. A definitive decision has not been made and there is a long way to go. It is almost certain that the prison will be built but that is not the case in regard to the proposed hospital. We must consider the matter carefully before making our recommendation. I thank the delegates for their enlightening presentations. I support a review or reassessment of what has been put before us. That is the route we should take before any final decision is made on the new hospital.

Senator Mary M. White

I have a difficulty with the proposal to locate a hospital beside a prison. I understand it was made purely on financial grounds, which is entirely unacceptable. Moreover, the decision was arrived at in an undemocratic fashion, with no consultation taking place with the key stakeholders, so far as we can tell. The committee has an opportunity to show how important our role is within the Oireachtas. We have visited the site at Thornton Hall and the existing facility in Dundrum which is ideal in many ways. Deputy Aylward rhapsodised about the countryside and I will do the same about Dundrum, where I live. It is served by the Luas and a patient told us last week that they could go to school in the college and shop in the town centre. This is important if the patients located there are used to an urban setting. It is also very important to remember that those in the hospital were born with or developed a mental illness during their lives.

My bottom line is that if the decision is implemented, it will be a political failure. I am here to defend the human rights of the patients and the next generation who, unfortunately, may be born with a mental illness and commit a crime. It was made clear by a doctor at the centre last week that the residents were patients rather than prisoners. They are mentally ill and, unfortunately, commit crimes as a consequence. We learned that most of them are schizophrenic.

Senator Phil Prendergast

I have also been very involved in the discussion on this matter. The decision is flawed. Thornton Hall is a greenfield site. It is eminently unsuitable to have a hospital co-located with a prison on the same grounds for the myriad reasons outlined by my colleagues on both sides. It would compound a problem.

On the role the Mental Health Commission might play in allocating a licence, there would be no basis for not allocating a licence if it was a new hospital, unless the commission was to state the location was wrong. Therefore, it is a flawed analogy. The site is what is wrong. It will not be easy to find or commute to. It is not a good idea to locate the two institutions on the same site for all the reasons outlined by my colleagues.

Chairman

There are many questions to be answered. I wish to make a number of comments because all members of the committee are anxious to move towards a unanimous recommendation as soon as possible. It is impossible not to note the fact that the initial announcement gave rise to almost instant concern. The fact that the hospital and prison projects were announced in the same press release caused difficulty, as has the lack of consultation with interest groups. It is difficult for the committee not to have regard for the fact that professionals are almost unanimous in their opposition to the proposal. To that end, committee members and I were anxious to hear from the HSE and the Department of Health and Children today and we are very disappointed that they are not with us. I hope the committee will engage with them as soon as possible.

Many of the arguments we are hearing do not stand up to scrutiny. That does not mean, however, that there are no very important points of principle. Killsallaghan is not in outer Mongolia and not totally inaccessible. Equally, when we talk about the prison environment and the proximity of the hospital to the prison, I suspect the difficulty is that, when presented with a greenfield site, one would not choose to locate a mental hospital adjacent to a prison. That is not to say, however, it would not be possible for them in certain circumstances to operate independently of each other.

When in Dundrum last week I was struck by the gates, locks, keys and barbed wire on the entrance gates. While there was a phenomenal sense that the focus was on patients and having a therapeutic environment within the institution, one was also struck by the fact that there was a strong sense of containment. The delegation might comment on this. Is the issue the greenfield site and the fact that in an ideal world one would not do what is being proposed?

I may have misheard Ms McGrath. While some of the people have done nothing wrong, others have committed heinous crimes and are not guilty by reason of insanity. Nonetheless, their victims have suffered significantly and we cannot state that nothing wrong has been done in certain cases. I may have misinterpreted Ms McGrath's point.

Ms Bríd Clarke

I will address one or two issues that are peripheral to the matter. Regarding Deputy Reilly's question on placing reports of inspections on the website, the commission met yesterday and decided to do so. It will be one month or so before the reports can be cleared, but we intend to place them on-line every quarter instead of making people wait an entire year. We agree that reports should be as instantaneous and transparent as possible.

In terms of capacity, a major issue is court referrals for assessments. The commission made its opinions known, namely, a number of assessments could be done on a community outpatient basis if there were community-based forensic mental health services. One need not detain someone to carry out an assessment, as the nature of the offences and alleged offences vary. The women's facility at the Central Mental Hospital, a single eight-bed unit, is pressurised. A considerable difficulty is the lack of step-down facilities. They would need to be prioritised in any new unit.

All the reports of the commission and the Inspector of Mental Health Services call for the replacement of the Central Mental Hospital. As a facility, it is not suitable given what we know about quality mental health care.

A number of members asked about the commission's role as the licensing and regulatory authority. We are the statutory agency responsible for licensing or registering services, but a legal application process must be undertaken and we cannot pre-empt a decision. Under the provisions of the Mental Health Act 2001, if someone is providing a service that provides inpatient care for people with a mental illness or mental disorder, that person must go through an application process. Any facility must comply with the regulations issued by the Minister of State, SI 551 of 2006.

While size has been discussed in the context of whether we need a 200-bed, 150-bed or 100-bed unit, a comprehensive assessment of need is required and should inform future developments. This is the core issue. The mental health field has seen many positive developments. For example, the 2001 Act made a significant contribution to modernising services and providing important protections for detained patients. Above all, we must ensure our planning and development are based on the assessed need.

Chairman

Deputy Flynn's question is pertinent in this regard. Is there an understanding of the place of origin of current patients? For example, is it the case that they are predominantly from the greater Dublin area?

Dr. Edmond O’Dea

There is an issue in that capacity is limited. Consequently, it is even difficult to move people to Dundrum, particularly so for people from "down the country". We find that people must be maintained in a local community or an inpatient service or in a prison service and cannot get access. This is one of the problems with the hospital in Dundrum. As there are no other regional facilities, it must cater for low, medium and high security at 85 or 86 beds and this does not meet the need. The country loses out more.

Ms Bríd Clarke

I do not know where all the patients in the Central Mental Hospital come from. Inevitably, a greater number will be from the Dublin area because the population is concentrated in that area but there are people from all parts of the country in the facility. This is one of the issues for carers in terms of visiting and maintaining support with families.

Deputy Beverley Flynn

In percentage terms it may be low but I am aware of people from my locality who go to Dundrum from time to time. Generally, it is for a short term, less than 12 months, but of the 74, it is predominantly patients from Dublin. I understand the point about population but in evaluating Dundrum, Thornton Hall or a new green field site, would the latter be a better option?

Ms Bríd Clarke

That question has arisen in terms of a third site. One of the advantages of the Dundrum site is the facilities in the locality. Rehabilitation means having opportunities to be integrated into the community and being able to avail of ordinary facilities. This is important for someone who spent time in secure care and it is one of the advantages of Dundrum. The other is that the facility is well established in the local community. I do not know Dublin that well but I do not know of another location within the environs of the city where one would have the space available in Dundrum and where such a facility is established. That it is established in the community is an asset and a great advantage of which we must be mindful. There may be another site available but there are distinct advantages to having the new complex in Dundrum.

Mr. John Saunders

I wish to provide feedback on the questions. That Deputies are asking these questions points to the fact that there has not been precise analysis of the issues, numbers and demands. Prior to the Government decision on the relocation, groups such as the Irish Mental Health Coalition called for the renovation or remodelling of Dundrum or a greenfield site. The wisdom of the day was that the greenfield site would be in the greater eastern part of the country because the population is heavily weighted towards Dublin and the surrounding counties but the wisdom did not state where exactly it should be. What was shocking and surprising was that it would be co-located on the proposed site.

I am not aware of any court case, although that does not mean there is not one. Perhaps other sources of information are available. In respect of numbers and structure, we must return to A Vision for Change, which states that we need a centralised, modern facility for the Central Mental Hospital. It does not say where it should be and certainly does not say that it should be attached to a penal system.

It also states there should be regional structures - four in the perceived wisdom - to support the Central Mental Hospital service. In addition, well staffed forensic mental health teams could provide specialist services, either at the Central Mental Hospital or at regional locations. In addition, there should be a statutory court diversionary system, which would allow people to be moved away from the court and penal system into the forensic mental health system. It comes as a package, which has been presented to the Minister of State as an option. Included in this is the Central Mental Hospital. Does the address of the Central Mental Hospital matter to some extent? There is a need for a central mental hospital.

Two Deputies asked what have we done to try to reverse the decision. After the decision was taken we had extensive meetings with the then Minister for State, Mr. Tim O'Malley, and he stuck to the point that it was a decision made by Government in the best interests of patients. We made subsequent requests to the Minister for Health and Children who, on at least two occasions, referred us back to the Minister of State. We have not had direct dialogue with the Minister for Health and Children on the matter. We met with the Minister of State, Deputy Devins, who took up the post in the Government and who reiterated the Government position. We are due to meet the Minister of State, Deputy Moloney, and again we will press the case directly.

It is important to point out that we went back to the Health Service Executive which is charged with the implementation of the Government decision. We met various levels of management within the HSE and their response was that the decision is a Government decision and it is charged with carrying out the decision. In a sense, they stated they do not have a moral view about it and the HSE simply carries out the decision and this is where it sits.

With regard to population profiles, I can quote Dr. Harry Kennedy who, at the same public meeting referred to by Deputy Neville, made it very clear that the majority of people using the Central Mental Hospital services at any time are not convicted prisoners. They are people who have been found not guilty by reason of insanity or have been found guilty under the old legislation and technically there is a conviction there. There are also people on remand or people who have come from other areas of the mental health care services which could not provide the type of environment required. A certain number of people have convictions but I am not aware of the exact numbers. However, in Dr. Kennedy's view the majority are not in this category. This is an important point because the perception is that it is only providing for people who have a history of convictions and serious crime.

I will ask Ms McGrath to answer questions on stigma and location.

Ms Caroline McGrath

A number of Deputies raised the issue of the perceived stigma attached to the location. Deputy Blaney raised the issue of other urban areas where one may have general or other hospitals located close to or in proximity to prison services. To our minds, this project and its interaction with and potential to stigmatise is different and distinguishable. It is distinguishable in the first context in that in other areas the projects developed together by accident rather than, as in this case, announced jointly by a Minister for Justice, Equality and Law Reform as a project for two programmes on one site. This distinguishing feature has maintained itself if we review even cursory media coverage of the issue in which they are connected.

The other distinguishing feature is the location. In most instances such as the Mater Hospital and Mountjoy Prison they are in an urban concentrated environment where the prison and hospital are large institutions. Here, the penal institution will dominate and international experience shows that this has an impact on the junior institution on a site. In urban environments, the prison and hospital are part of the wider community. In this site, given the population base - I acknowledge this may change over time - in terms of people using the services the dominant community will be a prison community. This will have an impact.

Critically for us, the experience of people working with and using the services of our members is that the stigma is complicated. It is experiencing discrimination when disclosing a history of mental illness, trying to access employment or filling in application forms and being asked whether one has ever seen a psychiatrist or psychologist and why. However, one is not asked about migraine or asthma. It is institutional stigmatisation but there is also a process of self-stigmatisation. Each of us anticipates how we will be perceived in the community and we react in a particular way as a result of this.

It is a real experience of people who use mental health services that their sense of self-worth and capacity to engage are profoundly impacted by a diagnosis or the need for treatment. One of the benefits of the hospital in Dundrum is the relative anonymity that its urban environment provides. I have struggled with people to bring them to a point where they are ready to return to the community. That may initially require a number of accompanied visits or short trips because of the patient's capacity to engage. Internalisation of stigma is a real issue.

With regard to the issue of anonymity, if I take public transport or the prison bus, I anticipate that I will be perceived by others as a prisoner or a patient of the Central Mental Hospital. Once I step outside the facility in Dundrum, however, there is no knowledge or assumption of who I am or from whence I came. This is as much a matter of perceptions as it is of real discrimination. Research has shown this process to have a profound impact on recovery.

Deputy Flynn referred to the progress that has been made thus far. I concur with her that the change in legislation and the significant investments made in developing public attitudes and informing people on the experience of mental ill health can only be effective if they are reinforced by other policies. I accept there was no intention to stigmatise but we have to be clear in bringing our experience to the committee's attention. Co-location will serve to fundamentally undermine the progress that has been made in addressing and supporting public understanding of the nature, experience, rehabilitation and recovery of people experiencing mental ill health.

Deputy Kathleen Lynch

I asked a question about consultation.

Chairman

Perhaps the Deputy's question can be answered after Deputy Reilly has had an opportunity to contribute.

Deputy James Reilly

I will be brief. I thank the Chairman for organising this meeting and allowing us the opportunity to visit the facilities. I share Senator Fitzgerald's disappointment at the failure of the HSE and the Department of Health and Children to avail of the opportunity to join us today. I understand difficulties can arise in terms of holidays but this meeting was of such importance to me that I gave up my holiday to attend it. We are setting the tone for a new generation. People will ask us why we did not look after the most vulnerable in our society in a more caring manner.

I do not wish to single out Deputy Aylward but while I accept his argument that stigmatisation was not the intention, it will be the net result. This committee has to prevent that from happening. It is not fair to put the responsibility on the Mental Health Commission by saying that it can stop the relocation by refusing to licence it, notwithstanding the cogent reasons why it could not do so.

Deputy Bobby Aylward

I did not say that.

Deputy James Reilly

Fair enough but ultimately, this is a political decision. A poor decision was made by a different Government at a different time and it is up to us to ensure it is reversed in a non-controversial way so that it is easy for people to back away from the positions they have taken in the past.

I concur with Deputy Lynch, who noted while the committee was meeting in private session that the HSE has no role in this other than to implement Government policy. I would be delighted to meet the HSE but I do not think it will be able to inform us any further, irrespective of the Department and its responsibility for policy. I hope this committee will find it possible to reach a unanimous agreement on getting the decision reviewed in the light of the new information presented. A cost-benefit analysis should be done before further action is taken.

Chairman

There are three further speakers who wish to contribute, Deputies Lynch, Neville and Aylward.

Deputy Kathleen Lynch

My question relates to consultation and I was glad that Mr. Saunders pointed out, without fobbing us off, that the HSE's only role in this is to implement Government policy. As was said before we went into public session, I believe that to ask it to reverse a decision that was not its in the first place would be a waste of time.

Deputy Dan Neville

On the physical aspect and how the prison will dwarf the hospital, the prison will, in fact, be a two storey building and the hospital will be a single storey building. This was pointed out today.

Deputy Bobby Aylward

Regarding the four regional back-up services for the Central Mental Hospital that have been proposed, most counties have psychiatric services. In my county, Kilkenny, there is St. Canice's and Outreach, which helps patients to live among the community. There is also a psychiatric unit in St. Luke's Hospital. Will the regional services that have been referred to act as a step-down facility between psychiatric services at county level and those provided in the Central Mental Hospital? What are the regional support services mentioned?

Chairman

We will now take responses to those questions.

Ms Bríd Clarke

I apologise to Deputy Lynch for not covering her question earlier as it is difficult to grasp all of them. The commission was not consulted beforehand but we have made our views known. The commission and the Inspector of Mental Health Services went on record some time ago regarding the need to replace the Central Mental Hospital. I know this has been said but it is important to emphasise it again. We first made our views known to the former Minister of State, Tim O'Malley, and then to the Minister of State, Deputy Devins and, last week, to the Minister of State, Deputy Moloney, as the Irish Mental Health Coalition mentioned.

Regarding Deputy Aylward's query on secure facilities, they are a step down for people who do not require the security of the Central Mental Hospital but whose behaviour requires more attention than is available in an acute unit in St. Luke's Hospital. There have been positive developments and admission units should be available in local general hospitals like St. Luke's and Portlaoise. However, such units should be open units and there may be times when people need a level of physical security and this is the purpose of the units to which Deputy Aylward referred.

Chairman

Have any questions not been answered?

Deputy James Reilly

I want to make a final contribution, if I may.

Chairman

The Deputy has made two contributions.

Deputy James Reilly

I accept that but I failed to mention that I have put a motion before the Chairman that I hope he will accept. I am not suggesting it should necessarily be taken now.

Chairman

We will consider the motion when we go into private session.

Deputy Jan O’Sullivan

In terms of information on consultation, are either of the groups aware of any consultation that was done in advance of the decision, any paper that was drafted or any assessment that preceded the decision?

Mr. John Saunders

I am not aware of any public consultation between the Department of Health and Children or the Minister of State of the time and any external organisation. In our meetings with the then Minister of State, Tim O'Malley, he suggested he was advised that this was the best option but he did not give details.

Deputy Kathleen Lynch

He did not say who advised him.

Chairman

I thank the delegates as the information they have given has been most helpful and we have learned quite a bit. We will now go into private session.

Deputy Kathleen Lynch

I propose that we stay in public session because we will have a vote on this.

Chairman

We will first go into private session.

The joint committee went into private session at 3.20 p.m. and resumed in public session at 3.45 p.m.

Chairman

The proposal from Deputies James Reilly, Jan O'Sullivan, Kathleen Lynch, Dan Neville and Senators Frances Fitzgerald and Phil Prendergast is that the committee ask the Minister for Health and Children to review the decision to relocate the Central Mental Hospital to Thornton Hall. I will now hear members on this matter.

Deputy James Reilly

Thank you, Chairman.

Chairman

I have already decided that this matter is not in order at this stage. It is open to the Chairman to take the motion, but if we wait for submissions from the HSE and the Department of Health and Children, it may be possible for the committee to make a unanimous recommendation for the Minister for Health and Children. It is incumbent on us to hear the position of the Department and the HSE. Natural justice requires that we hear all sides of the argument. The overwhelming body of evidence we have heard to date is from those opposed to the initiative. If we are to be balanced we must hear from those supporting the case for the initiative.

Deputy James Reilly

As proposer I wish to speak on the motion. This proposal has been put to the Chairman today because, in my view and that of many others, this is the last meeting on the issue. Both the Department and the HSE were invited to this meeting by the Chairman and neither saw fit to attend. They gave as an excuse the fact that they did not receive sufficient notice. Other groups invited and given the same notice saw fit to attend. I was supposed to be away this week and intimated this to the Chairman last week. I did not go away because of this meeting which shows how important it is and many here share this view. Nobody in the committee is impressed by the failure of the HSE or the Department to turn up.

The Chairman has made a ruling, as he is entitled to, which I will respect. However, it is not unusual - the Chairman may wish to clarify this - to have a motion put to a committee during the course of a committee meeting, especially when the matter has been at issue for several meetings and in everyone's mind this was to be the final meeting on this issue. The Chairman invited the Department and the HSE to the meeting in the interests of natural justice. It may not be convenient for members of the committee to be here on 9 September, but we will ensure we are here. It would be preferable to have a unanimous decision on this matter and that this committee shows that it is independent and not just a lap-dog of the Minister for Health and Children or her policy, which I believe to be wrong. We have heard from all the groups that believe the policy is wrong. They are independent and their vested interest is the patient. I wish to see a political solution as this is a political problem. I would be pleased if we could reach a unanimous decision that would help the Minister review her decision and get a better outcome for patients. The current decision is not in the best interests of patients.

Without any option, I respect the ruling of the Chairman. However, I record my displeasure at the HSE and the Department of Health and Children for failing to turn up and at what some people would see as the censorship or obstruction by abstention and the fact that we did not see fit to take the motion we could have taken today.

Chairman

Since I am not taking the motion I will not allow lengthy contributions on it. However, out of deference to members I will allow a brief contribution from those who have indicated a wish to outline the circumstances.

Deputy Jan O’Sullivan

I understand the Chairman is not taking the motion. However, I point out the wording of the motion is that the Minister for Health and Children should review her decision. Therefore, it is a motion that can receive the support of everyone around this table. I understand the Chairman's intention is to hold a further meeting on 9 September. While I will not oppose the attendance of the HSE and the Department of Health and Children, I do not believe either will have an opinion one way or the other on this because it was a political decision. As I understand it, there was neither consultation nor professional advice in advance of the decision, therefore, I do not believe either the HSE or the Department had a role in the decision being made. In view of this I do not believe we will be further enlightened by their attending the committee.

Given that this was a political decision, the view of the Minister and the Minister of State should be sought. They should listen to this committee because if they say it is a Government decision and it is not changing we will be in an impossible situation. What I would like to achieve is that the committee would be able to persuade the Minister to review her decision. The only way we can get that result is by inviting the Minister to attend and listen to us rather than have her read from a script in advance of hearing our views. That would be the most productive way to proceed because everyone here wants a review of the decision. I believe we have to do whatever we can to achieve that.

Deputy Bobby Aylward

I agree with what has been said here. I am very disappointed that the HSE and the Department of Health and Children have not been represented here today. They gave a flimsy reason for their non-attendance. They should be here.

We have come a long way since we started to seek a review. Much common ground across all parties has been established since the first deputation of parents of patients in Dundrum visited the committee. We visited the Dundrum hospital and Thornton Hall.

It is right and fitting we should listen to the HSE and the Department of Health and Children at this stage. I would also like to see the Minister for Heath and Children, Deputy Mary Harney, and the Minister of State with responsibility for disability and mental health, Deputy John Moloney, attend the committee and tell us the reasons they believe this new hospital should be situated in Thornton Hall.

We are an independent body with a role to play on health policy. We should listen to all sides of the argument first, reflect on them and then make a decision. We will probably have a unanimous motion seeking a review of the decision and a reassessment of it. That is how I would like matters to proceed.

Deputy Kathleen Lynch

This is our fourth week discussing this issue. I repeat what I said at the outset, namely, that it is the role of the HSE to implement Government policy. It does not have the ability or the right to overturn Government policy. This was a Government decision and only it can overturn it. While we may be more informed we have made no progress in having the decision overturned.

It seems that the Minister for Health and Children floats above all of this and does not listen to anyone. It was not her decision in the first place; a different Minister made this decision, but she is now charged with ensuring the policy is implemented. Meeting the HSE and the Department of Health and Children in September will take us no further along the path we wish to pursue.

There are relevant bodies who know the circumstances much better than anyone else. The Mental Health Commission, which the Government set up to advise it on mental health issues, was never asked for its opinion. It is now of the view that this hospital should not be developed adjacent to a prison. I would not be a great fan of quangos, but if they are set up they should, at the very least, be listened to.

Everyone we have heard who has an in-depth knowledge of this area has been opposed to this decision and we should listen to them. We will meet the people in question in September and if that is the way it works, so be it. This motion sought a review of that decision. It did not ask the Minister to overturn it, but simply to review it so that the people who should have been listened to on the first day, such as the Mental Health Commission and the other groups could be asked for their opinion. That is it, no more, no less. That the motion will not be taken today has done those patients a disservice, but it was not my decision.

Senator Frances Fitzgerald

The committee should have an independent voice and an independent opinion. To call for this review would show that and it would be the right thing for the committee to do if it is to represent the interests of patients effectively. There is enough common ground and enough common concern about the issues that have come to light to date for us to call for a review. I do not see any obstacle to this committee calling for a review today and it should be done cross-party.

There are several points I wish to make on that review. We have heard very clearly today that there is great deal inherently wrong with this decision from a stigma point of view and from the point of view of mental health and developing an understanding of mental health. There are also several other reasons for a review. The forensic report that will be presented to Government in October, the assessment of figures which has been called for today by the Mental Health Commission, assessment of need in the area of forensic services, the inherent difficulties around the decision, the way it was made, the lack of consultation, plus these other factors make a review necessary at this stage.

Deputy Niall Blaney

I heard the words "independent body" articulated a number of times by previous speakers. How independent is any body that sits on any board, no matter where it is, and listens to only one part of the argument and makes a decision? We have been pleading as a committee for a review of the decision. We gave all those parties whom we met a chance to speak on Thornton Hall and we have heard their views. It would be premature if we were to make a decision or to look for anything until we hear all the views. We will all be much better informed if we meet Department officials, with all the information we have from those we met, to ask any questions we may have and then meet the relevant Minister and see where she stands? I do not see what this issue is about. It is just a rush to blood because there is some media attention about today. What is the big rush on this? There may not be a decision on this issue for up to four years. We need be level-headed about this. We want to work with the Opposition on this matter. Let us make a formal decision after we meet the Department of Health and Children, the HSE and the Ministers involved.

Chairman

Each of us is motivated by the concern for patients' welfare and no individual has a monopoly on concern in that area. Several weeks ago we began a process of investigation to inform ourselves on this Government decision. I reject the idea that we are no further on now than we were at the start of the process. My thinking on this issue has evolved over the weeks because of what we saw today and what we heard from today's witnesses.

Having begun a process we owe it to the committee, if we are to be effective and efficient, to complete the process we began and we can do that on 9 September. I hope that on 9 September we will get a clear and unequivocal recommendation we can all sign up to unanimously. If that recommendation is unanimous, it can have far more impact on Government policy than anything arrived at in advance of the process we have engaged in being fully complete. Some people may be impatient for a decision but it is often better to wait to complete the process and get a decision that will have a lasting impact rather than something that would pre-empt any decision.

The meeting is now adjourned until 3 p.m. on 9 September when we will meet to discuss the work programme and meet representatives of the Health Service Executive and the Department of Health and Children.

Deputy Bobby Aylward

Unfortunately, Chairman, I will be unable to attend on that day. I have a holiday booked for that week.

The joint committee adjourned at 4.05 p.m. until 3 p.m. on Tuesday, 9 September 2008.