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Dáil Éireann díospóireacht -
Tuesday, 23 Apr 1985

Vol. 357 No. 7

Ceisteanna — Questions. Oral Answers. - Deaths in Mental Institutions.

12.

asked the Minister for Health if, in view of the disclosures on the "Today Tonight" programme of Thursday, 21 February, he will inform the House of the number of deaths from causes other than natural causes among patients in mental institutions for each of the past ten years.

The number of deaths from causes other than natural causes among such patients in the past ten years was as follows:

1974

14

1975

8

1976

14

1977

13

1978

12

1979

18

1980

13

1981

23

1982

23

1983

21

1984

19

On average, therefore, there were about 16 deaths per year from causes other than natural causes. This number should be seen in the context of some 40,000 patients treated annually in our district psychiatric hospitals.

An examination in detail of deaths in the last two years shows that the majority of the patients involved were voluntary patients. In accordance with modern concepts of treatment they had freedom to leave the hospital to visit their homes or do shopping, etc. Three out of four deaths occurred outside the hospital grounds among patients who had regularly enjoyed considerable freedom of movement in this way. About half of the deaths which occurred in the hospitals resulted from accidents, such as falls by elderly people.

Following each death the circumstances are examined by the hospital authorities and over the years the more obvious risk factors have been eliminated as far as possible. Nevertheless some non-natural deaths occur. It would be difficult, if not impossible, to eliminate all risk situations, especially in a modern liberal therapeutic approach which has contributed greatly to the discharge of so many patients in recent years.

If my sums are correct, 178 people died from other than natural causes in mental institutions in the past ten years. The Minister stated that three out of every four of these deaths happened outside hospital. This means that 44 deaths occurred within the hospitals. Is the Minister happy that deaths from non-natural causes among such people are properly accounted for and that the parents, next-of-kin and the Minister for Health are given an account each time there is a death from non-natural causes?

I might explain it best in this way. The up-to-date information relates to the past two years, in which there were 40 deaths, 26 male and 14 female. Eleven of the patients were between the ages of 65 and 74 and three were over 75. Of the 40 deaths, ten occurred within the hospital structure, one occurred in the hospital grounds and 29 occurred outside the hospital grounds. The most common cause of death was drowning and this accounted for 26 of the deaths. There were four persons hanged; three died from chocking and suffocation; two were hit by a car; one arose from the taking of poison; one from an overdose; one as a result of a fall. Another death also involved a fall and in one case there was a combination of causes, including pneumonia. That is a detailed analysis.

It must be pointed out that 70 per cent of the deaths during 1983 and 1984 were as a result of drowning and many of these deaths occurred while patients absconded from hospitals. Some of them occurred when patients were on weekend leave and day passes. In most hospitals patients are now encouraged to leave the hospital grounds and it reflects the general trend during the past ten or 20 years of allowing patients much more freedom and placing far less emphasis on locked wards. In most of the reports received on those deaths the staff state that there were no indications that any of the patients were contemplating suicide. That is the broad profile over the past two years.

I would stress that this data must be taken in the framework of 11,500 residential patients and 40,000 patients who are treated annually in our psychiatric hospitals. It must also be considered in the framework of the settled community where a large number of non-natural deaths also occur — suicides and so on — among those who are not in a psychiatric setting.

Are there any indications of the reasons for the fairly significant increase in the rate of non-natural deaths during the past three years or so? On the figures given it appears that the average was between 12 and 14 up to three or four years ago; then the figure rose to 19 or 22 per year. Are there any indications as to the reason?

It is basically because we have been practising as a matter of deliberate treatment procedure the opening up of psychiatric hospitals and encouraging patients to go and live with their families if at all possible, to live in hostels, to go outside the psychiatric hospitals and work in training workshops or in conventional employment. We are generally giving a great deal of freedom. The parallel implication of that policy is a growth in the prospect of accident or the prospect of suicide occurring in the case of patients who have suicidal tendencies. That is inevitably a development which we must take on board if we want to have a different regime in operation.

The Minister indicated that following the death of a person who is a patient in a psychiatric hospital the circumstances of the death are examined by the hospital authorities. In the particular circumstances of the death due to non-natural causes of a patient confined to a psychiatric hospital, would the Minister not agree that it would be more appropriate that the circumstances surrounding such a death should be examined by an authority outside the hospital authorities rather than by the hospital authority themselves? I would ask him to bear in mind when replying that much concern has been expressed recently in the media that following the deaths of a number of persons who were patients in psychiatric hospitals the next-of-kin and relatives were unable to get information which they required in order to satisfy themselves as to the cause of the death.

In all such cases where non-natural deaths occur the coroner in the area is notified and the chief executive officers of the health boards are obliged to act in a meticulous way in dealing with such reports. The coroners have entirely separate statutory powers and in all non-natural——

With respect, the only evidence is from members of the hospital staff.

The Minister should not be interrupted in the middle of an answer.

In all such non-natural deaths a report must be made not only to the coroner but to the inspector of mental hospitals. So far as the Department are concerned, there is no question of patients not being cared for fully in that setting and neither is there any question of relatives being kept in the dark about precisely what happened to patients. I would not accept any other procedure in any hospital.

The Minister has not answered my question. He has not said whether he is satisfied that the parents concerned are given due account in those cases. In the past ten years 178 patients died in these hospitals and in three out of every four cases the incident happened outside of the hospitals. Therefore, one in every four, or approximately 45, occurred within the hospitals. That represents about five per year but there has been a significant increase in the trend in the recent past with the numbers increasing from 14 in 1974 to 23 in each of the years 1981 and 1982. The figure in respect of 1983 was 21, while for 1984 the number of incidents was 19. In other words, there is an increase of about six patients per year dying from non-natural causes in mental hospitals.

The Deputy is giving information he has received.

Having regard to the fact that certain matters were disclosed on a "Today Tonight" programme, can the Minister assure the House he is satisfied that there is adequate machinery for dealing with investigations into such deaths?

If the Deputy has some incidents in mind, he should specify them directly instead of relying on allegations made on a television programme.

I have raised one case with the Minister.

We must be very specific in these matters. An alternative to the recent trend would be to keep everyone in a rigid residential and total custodial framework but that is not possible. I assure any parent in any part of the country that any complaint about the treatment of a patient in a mental hospital will be investigated rigorously. That is what has been happening. Any such complaint should be referred either to the Department or to the acting inspector of mental hospitals. Then, any action considered necessary will be taken in a most emphatic way. Allegations in such matters should be accompanied by detailed information.

The bashing of a young girl's head should be ample information that investigation is necessary. The Minister should be answering questions and not asking them.

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