I commend Senator O'Dowd and other speakers on their contribution. Did Senator O'Dowd's party show the same commitment in Government which it is now showing in Opposition? We need to improve the mental health services and the amendment acknowledges that. Under the national development plan we will provide the resources which were not provided by previous Administrations.
I have listened carefully to the contributions to this debate and I fully recognise the need to improve standards in our mental health service. The Inspector of Mental Hospitals plays a crucial role in providing an independent and detailed analysis of our mental health services. On the publication of the report for 1998 I was the first to acknowledge that much needs to be done to develop the quality of our services. I also stated that I intended to facilitate health boards in bringing about the improvements and developments identified by the inspector.
The Framework Document, The Psychiatric Services – Planning for the Future, which has been the cornerstone of the policy of successive Governments over the past 15 years, developed the concept of a comprehensive psychiatric service located in the community close to where people live and work. It was envisaged that this would replace the centralised and largely institutional services which were planned at a time when modern treatment methods were not available. The policy outlined in that document is still valid today. The problem lies in the rate of progress in providing the alternative facilities it recommended.
Notwithstanding the shortcomings identified in the inspector's report, there have been many improvements in mental health services, which have been outlined in successive annual reports of the inspector. These relate particularly to the increase in the number of acute psychiatric units associated with general hospitals. In 1983, prior to the publication of The Psychiatric Services – Planning for the Future, there were ten such units in place. This has now increased to 17. Approximately one third of all psychiatric admissions in 1998 went through these units. The number of community residences in 1983 was 111 with less than 1,000 places. In 1998 this had increased to 386 with almost 3,000 places. In the same period the number of in-patients has reduced from approximately 13,000 to 5,000.
The challenge now facing the health services is to provide all our in-patients with an alternative to care in large psychiatric institutions. Unfortunately, the rate of progress in providing this alternative service has fallen behind. It must be acknowledged that the mental health services have frequently lost out to other services which have been given priority in the allocation of development funding.
It is time to make a concerted effort to tackle in a determined and comprehensive manner the problems in our mental health services which have been so clearly highlighted in the inspector's reports and in this evening's debate. As a first step, I have allocated an additional £12.2 million revenue funding to the mental health service for next year. This represents an increase of over 100 per cent on the additional funding provided in 1999.
The lack of multidisciplinary teams in many areas of the mental health services has been highlighted by the Inspector of Mental Hospitals in his report. Some £2.9 million has been allocated towards the further development of community based mental health services, including the improvement of psychology and social work services. Extra funding is being allocated to the health boards in 2000 for the recruitment of additional paramedical staff to address this issue. The precise numbers of additional staff will be worked out in discussions with the health boards early in the new year.
An additional £1.1 million has been allocated to further developments in child and adolescent psychiatry services. This funding will provide for the appointment of additional consultants in child and adolescent psychiatry and for the development of multidisciplinary teams to focus on specific areas, such as attention deficit hyperactivity disorder.
The increase in the number of people living to advanced old age requires the development of specialist mental health services to meet their specific needs. Old age psychiatry services have been expanding in recent years and an additional £1 million is being allocated in 2000 to further this development. The details will be discussed further with the health boards early in the new year.
In his report for 1998 the Inspector of Mental Hospitals referred to the fact that some patients in psychiatric hospitals have been in institutional care for many years and recommended the establishment of dedicated teams to plan their reintegration into the community. Some £0.25 million is being allocated to the Western Health Board to fund such a specialist-led team which will commence a rehabilitation programme for long-stay patients in St. Brigid's Hospital, Ballinasloe. If this pilot project is successful, a similar approach will be considered for other hospitals.
Some £1.35 million is being provided to facilitate substantial improvements in the forensic psychiatry services in Dublin, Cork and Limerick. These teams will liaise with the Director of Prison Medical Services and the Department of Justice, Equality and Law Reform regarding the provision of appropriate psychiatric services in our prisons. They will also assist in the management of disturbed behaviour within the health board mental health services. An additional £1 million has been allocated towards suicide prevention programmes and £2.5 million has been provided towards the implementation of the new Mental Health Bill which I circulated yesterday.
The provision of capital funding is essential if the mental health services are to be transformed in the way we would wish. I have ensured that substantial capital funding under the national development plan will go towards the development of mental health facilities. Over £140 million capital will be provided over the lifetime of the plan for the service. A significant part of this funding will go towards the development of acute psychiatric units linked to general hospitals as a replacement of services previously provided in psychiatric hospitals.
In addition to the 17 acute units already in place, a number of units are currently at various stages of development including the Mercy Hospital, Cork; Beaumont Hospital, Dublin, which I intend to announce in the next few days; St. Vincent's Hospital, Elm Park; James Connolly Memorial Hospital; Ennis General Hospital; St. Luke's Hospital, Kilkenny; Portiuncula Hospital, Ballinasloe and at Nenagh, Portlaoise, Castlebar and Sligo General Hospitals. A further four acute psychiatric units are under consideration as part of the national development plan at Dundalk, Wexford, Mallow and Mullingar. At the end of the period of the national development plan, it is the intention to have the programme of acute psychiatric units completed, which will mean there will be no further acute admissions to the old psychiatric hospitals. The plan will also provide for more community facilities, such as mental health centres and community residences, which will accelerate the phasing out of the old institutions.
It is worth noting that many of the points raised in the inspector's report relate to clinical and administrative issues associated with the provision of care. I expect them to be addressed by the relevant professional and management staff in the health boards and hospitals concerned. To assist service providers in attaining excellence in care delivery, the inspectorate prepared guidelines on good clinical practice and quality assurance in mental health services. The guidelines are based on a checklist used on inspections embracing the main issues relating to the satisfactory clinical and administrative practice. The document sets down a series of desirable and achievable standards of care both in relation to the physical structure in which care is delivered and the clinical and other issues connected with the provision of care.
The guidelines are seen by the inspectorate as an educational endeavour to increase awareness of the main quality issues in service delivery and their monitoring, refinement and improvement. I arranged to have the guidelines published and circulated to mental health professionals and service providers in the country. The Inspector of Mental Hospitals is currently paying particular attention, when carrying out inspections, to the extent to which the procedures recommended in the guidelines are followed.
In September of this year I made a commitment to publish new mental health legislation before the end of the current session. Yesterday I fulfilled that promise with the publication of the Mental Health Bill, 1999. This Bill will significantly reform existing legislation concerning the involuntary detention of persons for psychiatric care and treatment.
In many respects the Bill I have published goes further than the proposals originally envisaged in the White Paper on mental health legislation. This is particularly the case in so far as the rights of detained patients are concerned. I noticed that Senator Henry regards it as a small Bill. It contains 73 sections and deals with protection of patients' rights, something I regard as a priority in the context of a legislative response to transform and modernise mental health services. Provision is made in the Bill for an automatic, independent review of each decision to detain a person for psychiatric care and treatment within 28 days of their detention. Reviews will be carried out by mental health tribunals consisting of a consultant psychiatrist and a legal assessor and operating under the aegis of the mental health commission. The review will focus on two issues, whether the person concerned is mentally disordered and whether the correct procedures were carried out in detaining them. A tribunal will be empowered to order the release of a patient if it considers that he or she does not require to be detained involuntarily.
Some commentators have referred to the fact that the White Paper proposed a review of detention after seven days and have suggested that what is contained in the Bill published yesterday offers less protection to involuntary patients than was promised in 1995. That is incorrect. The White Paper proposed that a procedural review of the legality of a person's detention would take place within seven days of involuntary detention. The type of review envisaged then would have been a paper exercise which simply checked that all the correct procedures had been carried out. It would not have touched at all on the crucial question which must arise in all cases of involuntary detention – whether the person is mentally disordered to the extent that it warrants a restriction on his or her liberty. The White Paper did not consider that the type of fundamental, clinical review which I am proposing was necessary until a person had been detained continuously for over a year. Therefore, my proposals represent a major advance on those put forward in the 1995 White Paper. I hope the columnists take note.
The new Mental Health Bill will also have major implications for the role of the inspector. Under its provisions, the existing office of the Inspector of Mental Hospitals will be replaced with the office of the inspector of mental health services. The inspector will be employed by the mental health commission, also established under the terms of the Bill, and will thus have complete independence from the Minister and from his or her Department. This represents a major improvement, in my view, on the proposal in the White Paper that the office of the inspector be associated with the Department of Health and Children.
In addition to the annual inspections of in-patient facilities which are carried out at present, the new Bill will require the inspector to carry out an annual review of all mental health services. The inspector's review of the services, including reports of inspections carried out, will be published along with the mental health commission's annual report.
Another important new role for the inspector will be the regulation of standards in the mental health services. A register of approved centres, in which each hospital or in-patient facility providing psychiatric care and treatment must be registered, will be maintained by the mental health commission. Regulations will be made specifying the standards to be maintained in all approved centres, including requirements in relation to food and accommodation, care and welfare of patients, suitability of staff and the keeping of records. The execution and enforcement of these regulations will be the responsibility of the inspector of mental health services.
I thank Senators for providing the opportunity to debate the content of the reports of the Inspector of Mental Hospitals and the mental health services generally. The initiatives which I have outlined will, I hope, reassure Senators that mental health services are not being neglected by this Government and that the service shortcomings identified by the inspector are being addressed.