Dáil Éireann Debate, Thursday - 9 July 2015
9. Deputy Terence Flanagan asked the Minister for Health if he will ensure that an out-of-hours assessment service is provided at the Ashlin Centre in Beaumont Hospital in Dublin 9; and if he will make a statement on the matter. [27373/15]
View answerMy question is on the provision of a 24-7 service for psychiatric patients at the Ashlin Centre at Beaumont Hospital. Unfortunately, there have been reports of in the media in recent weeks of clashes and potential problems. Can the Minister advise the House as to when 24-7 care will be provided in the Ashlin Centre?
It has been the experience of north Dublin mental health service clinicians that most of the cases presenting to the emergency department at Beaumont Hospital out of hours and referred to the on-call psychiatry team are complex and multifaceted and often require the input of other hospital services. Persons presenting, for example, with intoxication, overdose, confusion or self-harm require assistance with these issues and, while there may be an allied psychiatric condition, other aspects of their care will fall to the emergency department to deal with first. Acute mental-health units, such as the Ashlin unit, are not designed or staffed to deal with these issues. Direct admission to a psychiatric bed without a thorough medical assessment would constitute a significant risk for patients. As there are no plans to include an out-of-hours assessment centre at the unit, persons presenting with complex issues are first assessed in the emergency department.
North Dublin mental health services work in partnership with Beaumont Hospital liaison psychiatry and the emergency department so that the needs of individuals requiring mental health services are co-ordinated to ensure optimised patient care. Two nurses assigned to the self-harm programme of the mental health service work in the emergency department. An additional self-harm nurse at clinical nurse specialist level is also being recruited. It is acknowledged that north Dublin mental health services have recently experienced some difficulties in terms of bed capacity. However, the HSE is working proactively to address these issues, with the number of available acute beds being kept under review and the recent approval of funding to facilitate onward discharges to community placement. The Ashlin Centre currently has 38 psychiatric adult beds, of which 37 are occupied. Approval is being sought for a further ten beds for 2016 as part of the ongoing development of north Dublin mental health services.
While I thank the Minister for his response, the situation in Beaumont is terrifying. The accident and emergency department is already overstretched, but when one has psychiatric patients as well as ordinary patients attending, there can be problems. Unfortunately, there have been some negative incidents. Staff are trying to work and do their jobs, but unfortunately one staff member was stabbed. It is horrific. It does not feel like a safe environment if something like that could happen. There is an absence of 24-7 assessment for mental health patients. They should be getting the help and care they need. Can the Minister address that?
It is important to say that all major emergency departments have security on site. It is not just mental health patients who can attack staff or other patients. It is a very sad feature of our health service that sometimes patients attack staff. It can be true for ambulance crew and even reception staff. It is an unfortunate reality that we have to face all the time. When psychiatric patients present in emergency departments, they generally do so with other problems also. A patient may have had an overdose, which is a medical toxicological issue that must be dealt with first. A patient may have injured himself, cut his wrists, tried to hang himself, even tried to shoot himself or done some other form of harm to himself. A patient can also present with very severe medical problems because he has not been looking after himself due to his psychiatric illness. For example, he may have a very bad infection. All of those things must be dealt with first. It is not the case that someone with a mental illness can be shipped straight to the psych ward. It should never have been done that way. When a patient has medical, surgical or other problems, it is important that those are dealt with first and the patient is medically cleared before he goes to the psych ward.
Have there been incidents in other hospitals in which violence has been directed towards HSE staff that have not been reported in the media? A Vision for Change stated that 24-7 assessment would be provided for mental health patients. When will that happen? There is a commitment there. When will the necessary resources be put in place, particularly at the Ashlin unit?
I support my colleague, Deputy Flanagan. We are receiving incredible complaints about the situation. Other mental health hospital facilities have accident and emergency functions. Can there not be a separate function even within the existing accident and emergency department in Beaumont Hospital?
I do not have the figures, but it is certainly the case that assaults on staff occur at other hospitals. It is a particular feature of psychiatric hospitals and care homes and it can also be a feature in emergency departments. It is not particular to the health service; it happens to gardaí, prison officers and teachers also. It is never acceptable for public servants to be assaulted by their clients, but it is a reality of the environment in which dedicated public servants have to work.
In terms of the 24-7 service, I am advised that the service currently has two nurses assigned to the self-harm programme working in the emergency department. One is a qualified clinical nurse specialist, CNS, and the other is working in an acting capacity. One of the nurses works a seven-day fortnight roster, which is a 12-hour shift, and the other staff member works a 5-7 roster, which is 9 a.m. to 5 p.m. A further appointment of a self-harm nurse at clinical nurse specialist level is being progressed via the national recruitment service, NRS, panel and it will be filled in the near future.
I do not know if it is the case for Beaumont but it would be the norm for a large hospital like that to have a psychiatry doctor on-call at all times but that doctor may not be called until the patient's medical issues are dealt with first.
The Minister is happy with the situation in Beaumont.
No, I am not, but that is beside the point.
The Deputy who tabled Question No. 10 is not present. I call Deputy Fleming on Question No. 11.
