Ms Dora Hennessy is principal officer in the mental health division of the Department of Health and Children and Ms Joan Regan is the assistant principal officer. I am the director of the office for disability and mental health which is part of the Department of Health and Children.
I thank the committee for the invitation to me and representatives from my office to appear before it to put into context the Government's decision to relocate the Central Mental Hospital to Thornton Hall. I am aware that the joint committee has met several interest groups regarding the redevelopment of the Central Mental Hospital. While some of those groups are opposed to the Government decision to locate the new hospital in Thornton Hall, it is fair to say that all of us, the members of this committee, the Government, the officials charged with implementing Government policy, the clinical director and staff of the hospital and all the various stakeholder groups share a common concern. We want and strive for the best possible care to be given to the residents of the Central Mental Hospital.
I am the director of the recently established office for disability and mental health. I also served as principal officer in the mental health division of the Department of Health and Children from July 2000 to January 2006. In that role I was involved in some of the considerations and consultations that led to the Government's decision to relocate the Central Mental Hospital.
The office for disability and mental health was established by the Government in January of this year to support the Minister of State with responsibility for disability and mental health in exercising his responsibilities across four Departments. The office is based in the Department of Health and Children.
With regard to mental health, the office focusses on driving the implementation of the recommendations of A Vision for Change, the report of the expert group on mental health policy which was accepted by Government on its publication in 2006 as the basis for the future development of the mental health services. A Vision for Change recommended 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 and that the capacity of the hospital be maximised. The office for disability and mental health, therefore, is clearly charged with the responsibility to ensure that the Central Mental Hospital is redeveloped.
In May 2006, the Government approved the development of a new national forensic mental health facility at Thornton Hall, County Dublin. Since then, the focus of the Department of Health and Children and more recently, of my office, has been the implementation of this Government decision.
I will set out the chronology of events that led to the Government's decision. In February 2003, the then Minister for Health and Children, Deputy Martin, visited the Central Mental Hospital. This was the first visit to the hospital by a Minister in 50 years and it signalled the desire on the part of both Minister and Department to address the needs of the hospital, which had been neglected for many years. During his visit, the Minister referred to his recent establishment of a project team, chaired by the then East Coast Area Health Board, to progress the redevelopment of the hospital. The project team consisted of a broad range of stakeholders including the clinical director of the hospital — Professor Harry Kennedy, the director of nursing at the hospital — Paul Braham, myself representing the Department and representatives from the National Development Finance Agency, the Irish Prison Service and the other health boards.
The project team worked intensively, meeting on ten occasions over the course of a year and holding numerous additional meetings of sub-groups set up to examine specific tasks within the remit of the team. Various options were examined for the provision of an appropriate facility for the hospital, including refurbishment of the existing facilities at Dundrum; building a new facility on the existing site at Dundrum; building on a new greenfield site; and a combination of these options. In its final report, delivered to the Minister in May 2004, the project team recommended that the most appropriate option for the optimum delivery of patient care was for a new hospital to be built on a greenfield site with ready access to the M50 motorway. It recommended that a site of 20 acres be acquired to provide capacity for 300 admissions per year and to provide conditions of high, medium and low security for acute, medium and longer-term treatment and rehabilitation. The Minister accepted the recommendations of this report and the officials in the Department, including myself, set about considering how it might be implemented.
At approximately this time, the Department of Justice, Equality and Law Reform was engaged in a search for a suitable site on which to build a replacement facility for the Mountjoy prison complex. It must be emphasised that, at this point, no specific site had been identified, but the Department of Justice, Equality and Law Reform was concentrating its search around the M50 radius. It was suggested by that Department, with the support of the Department of Finance, that locating the new prison and the new Central Mental Hospital on the same site would deliver considerable operational and cost benefits. The Department of Health and Children responded cautiously to the proposal, suggesting that further study was required. Accordingly, when the Government agreed, in November 2004, to purchase the site at Thornton Hall for the new prison, it was agreed that the proposal to locate the Central Mental Hospital on the same site should be subject to further study.
There was no doubt in my mind at this time that it was open to the Minister to decline to locate the Central Mental Hospital at Thornton Hall if the official advice indicated that it was not the best available option. Two key elements informed the advice that was given to the Minister and to the then Minister of State, former Deputy Tim O'Malley. The first was the reality that an alternative site in the greater Dublin area, which would meet the criteria set out by the project team, was not readily available. Furthermore, it appeared that planning permission would be required for the new hospital and this would be difficult to obtain in any urban location, but might be less difficult for the Thornton Hall site.
The second key element informing the official advice given to the Minister was the opinion of the clinical director of the Central Mental Hospital, Professor Harry Kennedy. On 1 February 2005, a meeting took place between Minister of State, former Deputy Tim O'Malley, and Professor Kennedy, at which I was present. The Minister of State informed Professor Kennedy of the proposal to locate the new hospital at Thornton Hall and asked him for his views. Professor Kennedy's response, as I recall it, was that while the location of the hospital adjacent to a prison complex was not ideal, the key priority was that a new hospital be provided as soon as possible.
The following week, on 8 February 2005, the Minister of State, Professor Kennedy and I travelled in the Minister of State's car to Thornton Hall and we walked the site together. At that time, Professor Kennedy was optimistic that the difficulties posed by having the hospital adjacent to the prison could be overcome by ensuring that a clear boundary existed between the two facilities. He proposed that they should be managed separately and that the hospital should have a separate entrance and a separate address from the prison. He suggested that new governance arrangements be put in place to strengthen the independent identity of the hospital.
The then Minister of State, Tim O'Malley, issued a press statement in February 2005 to respond to concerns about the proposal to locate the Central Mental Hospital at Thornton Hall. The statement made it clear that the concerns expressed by Professor Kennedy, who had asked for certain safeguards to be put in place, had been fully taken on board by the Minister of State and the Department. The then Minister of State emphasised that the hospital would retain its identity as a therapeutic health facility and would remain under the management of the HSE. He stated that the Department would commence discussions with the HSE about governance arrangements for the hospital. He repeated such reassurances in a press statement in May 2006, following the Government's final decision to approve the Central Mental Hospital development at Thornton Hall.
The Government's decision to locate the new hospital beside the new prison complex has received much attention since it was made. Concerns have been expressed that the proximity of the prison to the hospital will lead to the criminalisation of the hospital's client population and the further stigmatisation of the mentally ill. It has been suggested that the decision to locate the Central Mental Hospital beside the prison is the first step towards subsuming the hospital into the criminal justice system. I assure the committee this is not the case. As most admissions to the hospital come from within the prison service, the location of the hospital adjacent to the prison will have operational benefits. Having acknowledged that, I emphasise that the new hospital will retain its identity as a separate therapeutic health facility. There will be clear boundaries between the Central Mental Hospital, the primary function of which is to provide care and treatment, and the prison, the primary functions of which are incarceration, correction and rehabilitation.
I endorse the view of Professor Kennedy that the Central Mental Hospital is not a prison but a hospital. My office supports his position, which is that the hospital must retain its culture of care, consent, engagement, rehabilitation and recovery, as well as its patient-centred focus. In this regard, I refer the committee to the UN principles for the protection of people with mental illness and the improvement of mental health care, which state that "all persons have the right to the best available mental health care, which shall be part of the health and social care system". The principles apply to everyone who needs mental health care, including those who are serving sentences or have been detained in the course of a criminal investigation.
I am aware that members of this committee visited the Central Mental Hospital in July. They have seen for themselves the conditions that pertain there. There is no need for me to go into great detail about the hospital's unsuitability as a location for the provision of modern psychiatric care. Many eminent authorities, including the Office of the Inspector of Mental Health Services and the European Committee for the Prevention of Torture and Inhumane or Degrading Treatment or Punishment, have repeatedly criticised the facility at Dundrum, specifically its unsatisfactory physical environment and sanitary conditions.
It is easy to understand that many people feel a certain attachment to the hospital in its current location. As it has been there for well over 150 years, some people think "Why fix it, if it is not broken?". Unfortunately, it is broken. A strong case has been made that it cannot be fixed. As the new hospital will be built on a green field site, it will be substantially different to the existing facility, which has become part of the fabric of the community in Dundrum over the years. The issue of access to the community, as part of a programme of rehabilitation for patients, will present a challenge at the new location. I am confident that the highly qualified, highly skilled and deeply committed staff of the hospital, including its clinical director, will respond to this challenge in innovative ways to ensure that patients receive the best possible care. I assure the joint committee that my office will work with our colleagues in the Health Service Executive to support them in this regard.
We all agree on the need to build a new hospital. While we engage in ongoing debate on its location, there is a danger that the immediate needs of the patients residing in poor conditions in Dundrum are forgotten. There is a danger that we will also lose sight of those people in our prisons who are urgently in need of admission and treatment and cannot be accommodated in Dundrum owing to a shortage of beds. I know the Minister is concerned that a prolonged debate regarding the location of the new hospital could result in the development of a modern, much needed facility being unnecessarily delayed and the opportunity to develop a new hospital quickly could be lost. My wish is that we can all somehow embrace the change and move forward together to secure, at the earliest possible date, an appropriate facility for the hospital.
The position of the office for disability and mental health is that the decision to locate the Central Mental Hospital in Thornton Hall, while not ideal, constituted the best option available to the Government at the time. We see our task as one of ensuring the decision is implemented. Should the Minister ask us to examine other options, we would be pleased to do so. However, the priority at this time must be to minimise delays in order that a new hospital can be built as soon as possible. The alternative, which would result in patients continuing for several more decades to endure the conditions prevailing in Dundrum, is not acceptable.