Dáil Éireann Debate, Wednesday - 18 April 2012
1326 Deputy Billy Kelleher asked the Minister for Health the level of Health Service Executive supports available for persons with mental health difficulties in the community; and if he will make a statement on the matter. [18768/12]
View answer1364 Deputy Billy Kelleher asked the Minister for Health the way the Health Service Executive proposes to follow on psychiatric care in order that the person can be fully integrated back into society; and if he will make a statement on the matter. [19024/12]
View answerI propose to take Questions Nos. 1326 and 1364 together.
This Governmentstrongly supports the implementation of the 2006 Report of the Expert Group on Mental Health Policy —A Vision for Change. The intention is to continue with the closure of the old psychiatric hospitals and move from the traditional institutional based model of care to a patient-centred, flexible and community based mental health service, where the need for hospital admission is greatly reduced, while still providing in-patient care when appropriate.
The core unit of mental health service delivery is now the Community Mental Health Team of which there are 124 Adult Teams and 61 Child and Adolescent Teams in place nationally. These Teams provide care to individuals living in their own home or in supported accommodation within their own community. In some areas specialist Rehabilitation and Recovery Teams also provide support to those with severe and enduring mental illness to move towards recovery. Mental health services are provided in various settings in the community including community residences, day hospitals, day centres and respite houses all of which offer community based services as an alternative to in-patient admission. GPs, Primary Care Teams and the voluntary sector, in partnership with local mental health services also play a critical role in the support of individuals with mental health needs.
In addition, a special allocation of €35 million for mental health was announced in Budget 2012 in line with our Programme for Government commitments. Funding from this special allocation will be used primarily to strengthen Community Mental Health Teams in both Adult and Children's mental health services. It is intended that the additional resources will be rolled out in conjunction with a scheme of appropriate clinical care programmes based on an early intervention and recovery approach. Some of the funding will also be used to advance activities in the area of suicide prevention and response to self-harm presentations and to initiate the provision of psychological and counselling services in primary care specifically for people with mental health problems. Some of these funds will also be used to advance the re-location of mental health service users from institutional care to more independent living arrangements in their communities, in line with A Vision for Change.
1327 Deputy Billy Kelleher asked the Minister for Health the number of patients admitted to psychiatric hospitals as voluntary patients who have had their status changed to involuntary patients for the years 2001 to 2011; and if he will make a statement on the matter. [18769/12]
View answer1328 Deputy Billy Kelleher asked the Minister for Health the patients admitted to psychiatric as involuntary patients who have had their status changed to voluntary patients for the years 2001 to 2011; and if he will make a statement on the matter. [18770/12]
View answer1332 Deputy Billy Kelleher asked the Minister for Health if a voluntary patient is free to leave a psychiatric ward at any time; if there is a process for leaving; and if he will make a statement on the matter. [18774/12]
View answerI propose to take Questions Nos. 1327, 1328 and 1332 together.
A voluntary patient is not subject to an admission order and is therefore free to leave an approved centre at any time. However Section 23 of the Mental Health Act 2001 provides that where a voluntary patient indicates that they wish to leave an approved centre, and a consultant psychiatrist, registered medical practitioner or registered nurse on the staff of the centre is of the opinion that the person has a mental disorder, they may detain the person for a maximum period of 24 hours. Where a person is detained in this manner, the person must be examined by a consultant psychiatrist who must either discharge the person or arrange for an independent examination to be undertaken by another consultant psychiatrist within the 24 hour period. If the second consultant psychiatrist is satisfied that the person is suffering from a mental disorder, an admission order for reception, detention and treatment is made, whereupon the person becomes an involuntary patient. The rights, provisions and procedures applying to persons admitted involuntarily are afforded to the patient, and the admission order admitting the patient involuntarily is subject to review by an independent Mental Health Tribunal within 21 days.
The Mental Health Act 2001 commenced in full, in November 2006 so statistics relating to the operation of Part 2 of the Act are only available from that date.
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Form 13: Regrade of Voluntary Patient to Involuntary |
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Nov and Dec 2006 |
105 |
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2007 |
623 |
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2008 |
584 |
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2009 |
590 |
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2010 |
546 |
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2011 |
586 |
In relation to the reclassification of patients from involuntary to voluntary, the position is that this data is not routinely collected. While Section 28 of the Mental Health Act 2001 obliges a consultant psychiatrist to revoke an admission/renewal order where the person is no longer believed to be suffering from a mental disorder, in some cases the person will leave the centre while others may opt to remain as a voluntary patient. The consultant psychiatrist must notify the Mental Health Commission of all such revocations, but is not required to specify whether the patient has been discharged from the approved centre or remains as a voluntary patient.
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Form 14: Revocations |
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Nov and Dec 2006 |
249 |
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2007 |
1,444 |
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2008 |
1,290 |
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2009 |
1,376 |
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2010 |
1,347 |
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2011 |
1,397 |
1329 Deputy Billy Kelleher asked the Minister for Health the reason it takes three weeks for an involuntary patient in a psychiatric hospital to have their case reviewed by a mental health tribunal; and if he will make a statement on the matter. [18771/12]
View answerThe Mental Health Act 2001 provides that where an admission or renewal order has been referred to a Mental Health Tribunal, the Tribunal is required to make a decision to affirm or revoke the order as soon as may be, but not later than 21 days after the making of the order.
While I fully accept that a patient should be detained for no longer than is necessary, I believe it is also important to be realistic about the logistical and administrative implications of holding tribunals within a shorter timeframe. The present 21 day timeframe takes account of the fact that the Mental Health Commission is also required to appoint an independent Consultant Psychiatrist to examine and interview the patient with a view to forming a judgement as to whether the patient is suffering from a mental disorder and making a report available to the Tribunal within 14 days.
As the Deputy will be aware however, the Mental Health Act 2001 is currently under review and the feasibility of reducing this timeframe will be examined in that context.
1330 Deputy Billy Kelleher asked the Minister for Health the measures he is taking to ensure that the Mental Health Act 2001 and the Mental Capacity Bill address the need to review the mental health care of psychiatric patients in order to ensure that voluntary patients receive the same standard of care as involuntary patients and that every patient whether voluntary or involuntary receives a personal care plan; and if he will make a statement on the matter. [18772/12]
View answer1334 Deputy Billy Kelleher asked the Minister for Health the levels of legal safeguards in place to protect the rights of voluntary patients who enter psychiatric hospitals; and if he will make a statement on the matter. [18777/12]
View answer1335 Deputy Billy Kelleher asked the Minister for Health if a psychiatric patient has any input into their mental health care plan; and if he will make a statement on the matter. [18778/12]
View answerI propose to take Questions Nos. 1330, 1334 and 1335 together.
Regulation 15 of the Mental Health Act 2001 (Approved Centres) Regulations 2006 requires that the registered proprietor in each approved centre must ensure that each resident, whether voluntary or involuntary, has an individual care plan. In addition, the Mental Health Commission, which has a statutory role to promote, encourage and foster high standards in the delivery of mental health services, has published a Quality Framework for Mental Health Services in Ireland. This framework provides a mechanism to continuously improve the quality of services and promotes an empowering approach to service delivery, where services facilitate an individual's personal journey towards recovery. The framework, which incorporates the Mental Health Act 2001 (Approved Centres) Regulations 2006, requires that each service user has an individual care and treatment plan that describes the levels of support and treatment required in line with his/her needs. The preparation of these individual care and treatment plans is co-ordinated by a designated member of the multi-disciplinary team, and is developed with input from the service user, the multi-disciplinary team and the service user's family/chosen advocate, where appropriate.
Issues relating to the detention of, and protections provided for, involuntary patients are dealt with in the Mental Health Act 2001. A number of protections in the Act also apply to voluntary patients e.g., rules governing the use of seclusion and mechanical means of bodily restraint. As the Deputy will be aware, the Mental Health Act 2001 is currently under review and in that context, the need to extend the scope of the Act to voluntary patients will be examined.
1331 Deputy Billy Kelleher asked the Minister for Health the ratio of community mental health nurses to psychiatric outpatients and the way this compares to the recommended levels; his views on whether community mental health nurses are currently overstretched; and if he will make a statement on the matter. [18773/12]
View answerAs this is a service matter the question has been referred to the HSE for direct reply.
Question No. 1332 answered with Question No. 1327.
1333 Deputy Billy Kelleher asked the Minister for Health if the Health Service Executive has any plans to introduce more counselling services for persons with mental health issues; and if he will make a statement on the matter. [18776/12]
View answerA special allocation of €35 million for mental health was provided in Budget 2012 in line with the Programme for Government commitments. Some of this funding will be used to initiate the provision of psychological and counselling services in primary care specifically for people with mental health problems.
