Limerick East): I thank Senator Henry for raising this topic. I would like to avail of this opportunity to reassure this House of my commitment to the introduction of new mental health legislation. Current procedures for detaining persons with a mental disorder for treatment and care are set out in the Mental Treatment Act, 1945, and subsequent amending Acts. While the Act contains provisions designed to safeguard persons against improper detention, they fall short of those required under this country's obligations as a signatory of the European Convention on the Protection of Human Rights and Fundamental Freedoms.
The new legislation, in addition to bringing Irish legislation into conformity with the European convention, will provide a modern framework for the care and treatment of the small number of persons with a mental disorder who refuse or who are incapable of seeking treatment or protection in their own interest or in the interest of others.
The Government has recently approved the draft heads and general scheme of a new Bill and the detailed drafting of the Bill is now a priority. I hope the new legislation will be enacted in 1997.
With regard to the recommendations for improvements in services made by the inspector in his report on the services for 1994, the inspector has had a remarkable influence on improving the standards of care in our mental health services and this influence is manifested in his report for 1994 which I regard as one of the most encouraging to date. The inspector is complimentary of the developments in mental health care in all health boards and his report highlights the many improvements which have taken place in the care of the mentally ill. At the same time it outlines the nature of the problems still to be overcome. I am pleased with the scale of the progress being made in the services while concurring with the inspector's views that much remains to be done in providing a service which will enhance the quality of care of those suffering from mental illness.
The inspector carried out a total of 37 inspections of services in 1994 and made recommendations, where appropriate, for improvements in those services. Details of the recommendations which have been implemented are set out in appendix 1 which, with your permission, a Chathaoirligh, follows my response. I have laid out the information for all of the health boards and Senators will see very quickly that significant progress is being made in their own localities and throughout the country.
In summary, I can inform the House that the majority of the inspector's recommendations for improvements in all services, as outlined in his report for 1994, have been implemented while the remainder are in the course of being implemented. It is worth pointing out that the inspector reviews progress in relation to the implementation of his recommendations on his yearly visits to psychiatric facilities and units. This progress will be reported on in detail in his report for 1995 which will be published before the end of the year.
I take the opportunity to compliment the inspector on the manner in which he reports. When I became Minister for Health the reports were significantly behind but those familiar with the reports will know that we had the 1993 and 1994 reports very quickly and he is well on the way to publishing the 1995 report before the end of the year. In future the report on mental services will be published in the calendar year immediately after the year being reported on. The target date is June. We can expect the 1996 report next summer. Then we will have a modern system.
It should be noted that the last few years have seen significant investment in the development and improvement of the services. Since 1994, additional capital and revenue funding has been provided for this purpose. These funds have been allocated to each health board with particular emphasis being placed on the improvement of psychiatric hospital facilities and units and the provision of enhanced day and residential care facilities.
Appendix 1
The North-Western Health Board has implemented in full all the recommendations regarding service practice and organisation while those recommendations which require capital resources are currently being planned.
As regards the North-Eastern Health Board — Louth/Meath mental health service — a mental health centre has been established in Drogheda. Rehabilitation and community resettlement programmes continue with appropriate in-patients at St Brigid's Hospital, Ardee. The transfer of patients with a mental handicap to community residences at Ardee and Drumcondrath has been completed.
Social work and psychology services are now available to the mental health services in County Meath sectors. Psychology services are available to County Louth sectors. The consent form for ECT has been updated.
As regards the Cavan/Monaghan mental health service, plans are at present in place to upgrade the decor and physical conditions of the admissions unit. A new health centre is planned for Virginia and accommodation will be allocated to the mental health services to operate a day hospital and outpatient facilities. In the same sector a new mental health centre has been opened in Bailieboro. The mental health services have been allocated accommodation for day hospital and outpatient services in the new health centre in Monaghan town. In Castle-blaney outpatients are now seen at a clinic at St. Mary's Hospital. Two psycho-geriatric wards are in the process of being de-designated.
As regards the South-Eastern Health Board — Tipperary mental health service — two community residences have been acquired in Clonmel and the movement of former patients to these houses will enable the hospital to develop a house on campus to accommodate a number of mentally handicapped persons currently resident in St. Luke's Hospital. The management team in St. Luke's Hospital meet on a regular basis to plan for the future direction of the services and to implement decisions to achieve these. A five year development plan covering the period 1991-95 was drawn up for the Tipperary psychiatric service and this has been updated. There is an admission policy in place. Progress is being made on the rationalisation of in-patient accommodation at St. Luke's Hospital, Clonmel, to ensure appropriate classification and grouping of patients so that elderly patients and those with mental handicap are separately accommodated. The sectors are being revised for Cashel, Clonmel and Tipperary, with full sector headquarters being proposed for each.
As regards the Waterford mental health service, the extension of Brook House, Sector Headquarters, has now been completed and the alcohol treatment services are now accommodated there. The out-patient clinic which had been held in St. Patrick's Hospital, Waterford, has been transferred to Waterford Regional Hospital since late 1995/early 1996. The project team for the 45 bed acute unit for Waterford Regional Hospital submitted a brief for this project to my Department. My Department has approved this brief and all subsequent planning stages for the project. There is a draft information document drawn up for patients and visitors which will shortly be finished.
The board has acquired the convent on the grounds of St. Joseph's Hospital, Dungarvan, to further develop services. A contractor has been appointed for this development and the work is due to commence shortly. A draft policy on services and guidelines for psychiatric nurses has been drawn up. Documentation has been circulated in relation to complaints procedures. Staff in the Department of Psychiatry in Waterford Regional Hospital wear identification badges. There is an information document for patients on ECT. There is also a staff policy document on the giving of ECT treatment. The seclusion room is no longer in St. Enda's and has now been relocated on the ground floor. There is a written policy on seclusion which is being upgraded.
As regards the Wexford mental health service, my Department has granted approval to the establishment of a project team for the purposes of drawing up a planning brief for the proposed acute psychiatric unit, Wexford General Hospital. As an interim measure, until the acute psychiatric unit for Wexford General Hospital is developed, the board proposes to refurbish the acute admission unit at St. Senan's Hospital, Enniscorthy. One hundred thousand pounds to enable this work to commence on a phased basis has been sanctioned. The matter is being treated as urgent by the board and the management of the hospital.
An 11 place community home for mentally handicapped persons in St. Senan's Hospital, Enniscorthy, was established through Respond Housing Agency, Wexford Mental Health Association and the South-Eastern Health Board at Westlands in Wexford town.
As regards the Midland Health Board — Laois/Offaly mental health service — approval has been granted for the new acute psychiatric unit at Portlaoise General Hospital. Stage III documentation for the project is nearing completion. The day hospital, day centre, sheltered workshop and sector headquarters in Portlaoise was opened 23 June 1995 and is operated on a similar basis as the Tullamore model as recommended by the inspector. There is a policy for the transfer of patients with a mental handicap from St. Fintan's Hospital to the mental handicap unit — Alvernia.
As regards the Longford-Westmeath mental health service, the de-designation of St. Brigid's Block, which includes St. Brigid's, St. Clare's and St. Maria Goretti wards, is currently being examined by the hospital management team with a view to bringing it into being as soon as possible.
A premises suitable for use as a sector headquarters/day hospital facility has been identified. Sector headquarters have been developing as the focus of clinical activity in their areas and this development will continue.
The seclusion policy at St. Loman's Hospital has been reviewed and an appropriate policy is now in operation
As regards the Mid-Western Health Board — Limerick mental health service — a multi-disciplinary Core Policy Review Committee has been established.
Four nursing officers and three deputy nursing officers have been assigned to unit 5B, Limerick Regional Hospital.
As regards the Clare mental health service, a building suitable for a high support hostel in the Ennis area has been identified.
A total of ten patients with mental handicap have now taken up residential accommodation in Kilrush. The board has acquired a property at Árd Na Gréine, Ennis, for the transfer of ten additional persons.
St. Patrick's Ward was closed during 1995 and the patients have been transferred to refurbished accommodation in a different part of the building.
As regards the Southern Health Board — north Lee catchment area — the board's four year action plan for the service is being implemented.
As regards the south Lee catchment area, the board has made significant progress in filling consultant posts on a permanent basis.
The recommendation relating to the establishment of community based facilities in each of the sectors is fully provided for in the board's action plan which also provides for the existing facility in St. Finbarr's to be designated as a community based facility.
As regards the north Cork catchment area, the board's four year action plan for the service confirms that the service in north Cork is sectorised but the requirement as outlined in the plan is that community based facilities be established in each of the sectors in order that the service can be managed and delivered at sector level. The facilities and professional personnel required are fully outlined in the action plan.
As regards the Kerry mental health service, a review of the sector boundaries in the Kerry catchment area is under way. The board has recommended the appointment of an additional consultant which will also require a significant review of sector areas. The remaining recommendations relate to the establishment of facilities in each of the sectors and considerable progress has been achieved in this regard in the Kerry area. Much more remains to be done and the details are included in the four year action plan.
As regards the Western Health Board — east Galway mental health service — steps are well under way to ensure that the west Galway service becomes completely autonomous without relying on any of the facilitates provided by the east Galway services and there has been a significant drop in the number of referrals.
The accommodation requirements associated with the provision of an acute psychiatric unit at Portiuncula Hospital, Ballinasloe, have been identified. High support accommodation has been provided in Ballinasloe. Significant progress has been made in the reduction of the number of patients with a mental handicap in St. Brigid's Hospital, Ballinasloe, and plans are at an advanced stage for the placement of the remaining patients in settings appropriate to their ongoing care and rehabilitation. A 20 bed dementia unit was completed recently and will be occupied by the end of 1996.
As regards the Roscommon mental health service, following the full closure of St. Patrick's Hospital which has since been handed over to the Department of Justice for use as a high secure prison, all of the remaining patients were transferred to appropriate accommodation.
Sector headquarters have been established at Boyle, Castlerea and Roscommon.
As regards the Mayo mental health service, the provision of an acute psychiatric unit has been included in the brief for the phase II development at Mayo General Hospital, Castlebar. In-patient occupational and recreational facilities have been significantly developed. The hospital laundry has been closed. A high support community residence in Ballina has been opened. A new low support community residence has been provided in Ballina. A community residence in Kiltimagh is being upgraded.
As regards the west Galway mental health service, I have already mentioned the considerable progress that has been made to ensure that the west Galway service becomes completely autonomous.
The residents in Unit 9A — continuing care unit — are receiving an active rehabilitation programme in advance of a number of transfers to the proposed new community based residences in Clifden and Carraroe. The Clifden project is at an advanced planning stage and will be in place during 1997. The Carraroe Hostel will also be available in late 1997.
As regards the Eastern Health Board — Psychiatric Unit, Vergemount Clinic — discussions are ongoing with St. Vincent's Hospital regarding the siting of the new psychiatric unit at the hospital and accommodation requirements associated with this development have been identified. Catchment and sector boundaries have been redrawn and have been communicated to relevant personnel. The facilities at Vergemount Clinic have been maintained and decorated pending the provision of a modern admission facility. Additional parking facilities have been provided adjacent to Vergemount Clinic.
The Eastern Health Board and St. Vincent's Hospital have set out their requirements for a modern acute admission unit for area 2 to be sited at St. Vincent's Hospital.
At the Cluain Mhuire Family Centre, day centre facilities are being developed in the Boylan Centre, Dún Laoghaire. As regards St. James's Hospital, a new high support hostel has opened at Greenmount Road. Administrative policies are currently being drawn up. A policy on the locking of external ward doors is in place.
At Newcastle Hospital, County Wicklow, a high support community residence was opened in Bray in December 1994/January 1995. A system to monitor the maintenance requisitions on a monthly basis has been introduced.
The hospital management committee is made aware of money allocated for maintenance work and has an input into the setting of priorities in relation to this work. A local launderette service was established for personal clothing in the hospital in 1995 and this service, combined with a rental arrangement for sheets and pillowcases, is working satisfactorily.
At St. Ita's Hospital, Portrane, a personal clothing service is being introduced throughout the hospital. All patients admitted to the hospital prior to 1945 have now been reclassified pursuant to the provision of the Mental Treatment Act, 1945. A medical audit system has been introduced to review medical notes taken in respect of seclusion. The inspector clarified that reference to an audit of notes relating to episodes of seclusion referred only to medical notes.
Considerable work has been carried out on the upgrading of long stay wards — psychiatric and mental handicap — during 1995 from additional money provided by the Department. A major window replacement programme in the admissions/assessment unit commenced in 1995. The hospital management committee review all maintenance work and a monitoring group has been established to prioritise outstanding work.
As regards St. Joseph's mental handicap service, St. Ita's Hospital, unit K is targeted for immediate closure on the opening of the Pink House and community house purchased at the Naul. Unit G has been closed. Substantial progress is being made in upgrading patient care areas within the hospital complex, particularly those areas which will be required in the medium to long-term.
Rushbrook House has been designated under the Mental Treatment Act, 1945. A small committee comprising representatives of management, nursing and maintenance staff has been established to monitor an outturn of maintenance requisitions to ensure that requests for maintenance work of a minor and non urgent nature are responded to within a reasonable timeframe.
Three community residential facilities have been acquired in the north county Dublin area — one of these residences The Pink House on the St. Ita's Hospital campus is now ready for occupation and the two remaining houses are currently being upgraded and made ready for occupation. In addition, Hawthorne Grove — formerly Madonna House — has been acquired by the Eastern Health Board and when commissioned will facilitate the transfer of residents from St. Ita's Hospital to a community setting.
As regards the Kildare Psychiatric Service, the provision of day support service in Athy and the relocation of the sector headquarters in Castledermot headquarters will take place when the new health centre in Athy is built. The sector boundaries for mid-Kildare have been redrawn. There are now two sector teams in mid-Kildare serving mid-east Kildare and mid-west Kildare. Space utilisation in the Lakeview Unit has been reviewed and is being used to maximum effect. A premises has been purchased in Kilcock to provide residential accommodation for new long stay patients in the Lakeview unit. The service administrative policies are being produced in an indexed booklet format available to all staff for information and reference and will be reviewed periodically.
At the James Connolly Memorial Hospital, unit 9 has been totally refurbished which involved the unit being fully painted, a new ceiling on the corridor, new lighting in the entire ward and gas central heating installed. An automatic fire detector system is also now in place.
The acquisition of an appropriate premises is being actively pursued for a high support community residence in the Blanchardstown sector. Plans have been drawn up to create additional toilets in unit 9 to facilitate more privacy, especially for the female patients. The kitchen was painted as part of the overall refurbishing of the unit.
At St. Loman's Hospital, the hospital management plan for two acute admission units with a sub-acute rehabilitation unit is being proceeded with and is being negotiated with staff organisations. Personal identification badges are now being worn by all staff at St. Loman's. Information on patients' rights is displayed prominently in all patient care areas. The seclusion room has not been used for seclusion for many years and it is not intended that it should.
At St. Brendan's Hospital a personal clothing policy has been introduced into all the wards in the hospital, with the exception of Units 1A, 2A and 10B. Units 1A and 2A are in the process of being closed. Bed screens are now in use in all the wards. In addition, as part of the upgrading of Units 8A and 8B, dormitories have been compartmentalised. All of the wards, with the exception of three, have been decorated over the last two years. Of these three wards, two are due for closure, that is, 1A and 2A; major renovations are due to commence in the third unit, that is, 1 OB.
Nursing care plans have been introduced in all wards. A standard of nursing procedure book has been introduced. Only two wards remain open in the long stay block, that is, Units 1A and 2A. The plan is to close Unit 1A by the end of October, 1996 and to close Unit 2A early in 1997. Arrangements are currently being made to issue identity badges to all staff. The administrative policy document has been finalised and made available in all clinical areas for staff reference and information. There has been a significant improvement in the hospital industrial relations system and as a result appropriate dispute procedures are now adhered to.
At St. Vincent's Hospital the additional newly-built community facility — Bradog — is now fully commissioned.
Work has commenced on upgrading the community residence at Grace Park.
Authorisation of seclusion by NCHDs has been reviewed and recommendations for seclusion are now endorsed by the consultant psychiatrist prior to the patient being put into seclusion and recorded in the seclusion book.
At the Central Mental Hospital, new seclusion policies were introduced in August 1996. The former governor's house was opened as a community residence in March 1996. Continued education for care officers is ongoing. Unit 1 has been redecorated. Unit 2 was closed and the patients transferred to Unit 5 which has been redecorated. Unit A was opened as a new admission unit in April 1996.
