Vol. 252 No. 10
I move:
That a supplementary sum not exceeding £43,700 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1971, for the expenses of the maintenance, etc., of patients in the Central Mental Hospital.
There seems to be a disquieting rumour abroad that some people are being sent from prison to Dundrum who are not fit cases to go there. Is the Minister prepared to make a statement to clear the air in that regard?
Many people certainly seem to be concerned about the use or abuse of this institution at present. I do not say it is true but some people have suggested that Dundrum is a dumping ground for criminals or people the State want to put away quietly. It is suggested that people are sent there as a matter of convenience and, like Deputy Barry, I should welcome a statement from the Minister on the matter.
I happened to see the "Seven Days" programme. I do not want to criticise those in charge of the institution but to me the people in charge seemed to be past their best years of service. In this institution which deals with many different types of people I think younger, efficient doctors and people in charge are required, people who would use more efficient and up-to-date methods. As a member of the health authority in Westmeath, I find a great difference in the methods of doctors. In an example we had last week we found one old doctor over retiring age had 550 patients, medical card-holders, and his bill was £225. In an adjoining area a doctor who had 70 more patients had a bill for £2,400. The younger doctor makes better and more efficient use of the newer drugs on the market.
Many people are very concerned about the number of escapes recently from Dundrum and many old people, especially women living close to the institution, are in fear of their lives. There have been two escapes in the last two months, I think. After the first escape "This Week" published a photograph four days after the escape showing the rope ladder by which the patients escaped still dangling from the wall. There is something wrong there. The Minister explained the last escape very fully to the House and it was due to some builders leaving a ladder against a wall.
A few moments ago the Minister dealt with inflation. We are faced in this Estimate with the same problem and in all other Estimates. The ratepayers and taxpayers have limited resources. Many are at their wit's end. All these increases, as the Minister knows, are affecting the growth of the economy. The ratepayers and taxpayers are punch drunk. They are grievously affected by increasing taxation.
Can this matter be raised on this minor Vote for the Central Mental Hospital?
Minor or senior, the Votes are all the same.
I am seeking the Leas-Cheann Comhairle's direction on this. We shall make a farce of all Estimates if on a minor Estimate for £43,000 a Deputy can make a major speech on inflation when I have already dealt with the question in general.
I am not making a major speech on inflation but I am not going to let the Minister get away with the remarks he made in concluding on the Health Estimate. We have here money for wages and we are entitled to give our opinion. I think those at the top of the ladder should stay where they are for the present and allow those at the bottom to get a greater share of the national cake. I think I am entitled to say that the percentage increases given to certain officials are completely wrong in my opinion. If you give a 10 per cent increase to a man with £4,000 he gets £400 a year, bringing his wages up to £4,400 and if you give the same increase to a man with £1,000 a year he gets only £100 bringing his wages up to £1,100.
The Deputy may not make this type of argument.
If the Minister was in order in stating that we are copying England in this regard I am entitled to say that the Minister should accept his own responsibility.
The Deputy could use that argument on every Estimate. The Chair does not want the Deputy to elaborate on this particular point.
The Minister replied at length and neither you nor the official in front of you said he was out of order. If he was in order in blaming England I think it is our own Government who are to blame and it is up to them to give a lead here in our own country.
The Minister has the right to make the final reply on any Estimate and it is not the position that some other Deputy on the opposite side of the House can resume the argument. The Minister listens to criticisms, abuse and observations for a long period and he has the right to make the final reply.
If the Minister has the right to say what he said on the last Estimate I have an equal right to refer to the same matters in this Estimate because in this Estimate the increase is for wages and salaries.
The Deputy is making a laughing-stock of the House.
The Deputy will appreciate that salaries and wages form part of every Estimate before the House.
I am entitled to point out that it is up to the Government to give the lead. It is their responsibility and neither the Minister nor any other member of the Government should stand idly by throwing their responsibility on to their employees or the workers of this country. It is up to the Government to give the lead by example but they are not doing this. Due to the fact that they are not giving this example taxation and rates are increasing year in year out in this country.
This institution has been in existence for a hundred years. Comments were made about it in the Report of the Commission on Mental Illness in 1966. The comments were universally unfavourable. This hospital should serve a remedial or rehabilitation function for people who are there. I believe the Department of Health, who are directly responsible for this institution with the Department of Justice, have been particularly neglectful and completely complacent in their failure to implement the recommendations of the commission in regard to this hospital.
The Minister and his predecessors have frequently dismissed the need to make any change in this hospital on the plea that when the joint authority took over it would then be a matter for the Dublin Health Authority, and the regional board. That shows an extraordinary lack of responsibility by the Department of Health because the recommendations were the recommendations of a very authoritative body of distinguished psychiatrists from this country and abroad. I gather from reading the commission's report that there was a very definite sense of urgency in regard to the need for changing the conditions in the Dundrum Central Mental Hospital but no significant changes have taken place. I want to emphasise in relation to the therapeutic standards in the hospital that I do not suppose they are any worse or any better than those in any of the other prisons or custodial institutions in the State. I am not inferring any criticism whatever of the three psychiatrists who are in charge of the hospital. I simply say that they have not been provided with a team of specialists, trained psychiatrists in forensic psychiatry, psychologists, psychiatric social workers and nurses with special forensic nursing training.
I cannot understand why these remedial changes have not taken place since 1966. The Minister has repeatedly said that people would not take the posts advertised. He seemed to feel that because it is taken over by the Dublin Health Authority in some remarkable way this will all be changed and people will go to work there. I should like to know his reasons for this assumption because he knows the very great difficulty about recruiting psychiatric service personnel at the present time. The institution is staffed to a dangerously high level with temporary psychiatrists who move around frequently, who certainly have no sense of continuity in their work and that is particularly important in this sphere.
The reasons for this are well known to the Minister. There is dissatisfaction with the conditions of service generally. The Minister must also know that matters are coming to a head between the medical union and himself and between the association and himself. Both bodies are very disturbed at the continuing deterioration in the quality of service in the mental hospitals generally. It is very difficult to get people to work in this kind of hospital. The work is of a type which will not appeal to many people for obvious reasons and, therefore, the Minister will probably have to make a special case for the Dundrum Central Mental Hospital.
Why is it that the Minister was unable to take the same action in regard to anticipating the take-over by the regional board which he took in regard to the setting up of the drug centre at Dundrum? He went to some trouble to have staff recruited for this drug centre so that there would be no delay once the take-over and the amalgamation took place.
The Minister and his Department appear to display apathy or indifference to the conditions for people in this hospital. It is because of the absence of remedial therapeutic facilities there—and I emphasise the word "remedial"—that I have protested here on a number of occasions about a young man, and the Minister knows to whom I am referring, who is in this hospital on charges of incendiarism, and if he is to stay in Dundrum, in fairness to him and his unfortunate family, he should have access to whatever services might help him to recover from the illness from which he is suffering and allow him, when he does leave the place, to be normal in every way.
The Minister knows that if he is to go through the long and difficult machinery of the Local Appointments Commission to make appointments, it will be a long time before he will have a staff in this hospital. Has the Minister any specific plan or have any recommendations been put to him which would give us some hope for these unfortunate people in this hospital? I take the view that they are all people who are ill—I do not accept the concept of criminality at all—and need medical help. The longer this is delayed the more difficult it will be to help them.
I would like the Minister to say a little bit more as to precisely what kind of person will be kept in this hospital. For instance, I am rather doubtful about the idea of drug addicts being sent to Dundrum. The whole project seems rather vague. Apparently they will go there and even though they may be admitted as voluntary patients they may be kept there. I am not quite clear about the conditions under which they may be kept there.
The Minister must know enough about drug addicts to know that if they do not want to stay, unless they are on a temporary form of committal, they simply cannot be kept there. What proposals does the Minister have for seeing that a drug addict who is considered to require this kind of custodial care, but does not opt for it himself, receives it? If the Minister decides to make a person who comes in voluntarily a temporary patient in the hospital, which means the person would not have the right to leave if he wished to do so, the Minister is interfering with the very important principle of voluntary admission to a mental hospital. It is very important to maintain the certainty that a person who voluntarily goes into a hospital may leave if he wishes to do so unless he is either homicidal or suicidal and must be kept for that reason. It is essential to maintain a patient's right to leave, even with this legally debatable right to hold him for an additional 72 hours after he has given notice that he wishes to leave. The Minister must understand that what are involved here are the two approaches to the question of drug abuse in society, whether one tries to encourage people to come for treatment by making conditions of treatment so attractive, which is very difficult, because drug addicts usually do not care so long as they get their drugs, but certainly conditions should not be unattractive so that they will continue to undergo whatever care or treatment is required to make them well again. A number of States in the United States tend to isolate the drug addict in his own interests and the interests of the community.
The difference between these two approaches is that in the second the illness is driven underground. The youngster makes certain he is not caught and consequently the problem becomes a particularly difficult one. In relation to the people who try to encourage drug addicts to come for voluntary care the hope is that they will not be frightened underground and that the relationship between the psychiatrist treating the drug addict and the addict is a trusting relationship rather than the psychiatrist acting as a kind of jailer.
This brings up the question of registration and whether one accepts that the addict——
I want to point out to the Deputy that the drug addiction unit in Dundrum hospital does not come under the Central Mental Hospital Vote and I am not briefed today to deal with it. The Deputy can ask a question after the Recess on what exactly the treatment will be. I am not briefed to deal with the drug addiction unit in the Governor's house at Dundrum. I am only dealing with the Central Mental Hospital for persons who have been committed either by the Minister for Justice or by myself under the relevant parts of the Act. I would not like not to be able to give the Deputy a very accurate description.
I am astonished that the Minister would come into the House without knowing about this very important departure in the use of the Central Mental Hospital and his general plan for the use of it. I would like to know that he is clear in his mind about the risks he may start if he goes ahead with this idea. I was hoping he would be able to tell us much more about the question of the drug addiction centre because there are serious dangers: the question of one of the youngsters deciding something and word getting around misrepresenting the reality; the fact that the Minister has a number of voluntary centres where he is going to treat drug addicts, and word might get around that a drug addict will be sent to Dundrum for six months if he goes to Jervis Street or Uusher's Quay for treatment.
The Chair wants to point out to the Deputy that this Vote is concerned with services ending tomorrow, 31st March.
And starting tomorrow too.
The money provided in the Vote is for services already being provided in the financial year ending tomorrow.
And they are starting tomorrow as well, Sir. However, if the Minister is not able to answer me, and I really feel it is an extraordinary state of affairs, it is probably useless my pursuing the matter. For his own information I wish he would inquire into the likelihood of his doing damage to the attempts he is making to deal with the drug problem here in Ireland. He must make up his mind whether he is going to adopt either the cumulative approach or register drug addicts and give them their drugs, maintenance doses and so on, as adopted in Great Britain. The Minister, I think, owes us some explanation or some indication of what he has in mind for the hospital. Now that its status is going to be altered will it take in the same kind of patient under the same kind of conditions or will the Minister change the status of the patient in line with the change in the status of the hospital? Heaven knows, he has had long enough to make up his mind. The recommendations were made in 1966.
