Vol. 451 No. 7
5 Dr. Moffatt asked the Minister for Health the proposals, if any, he has in view of the recent comments by a number of psychiatrists in the Eastern Health Board area regarding the acute beds shortage, the consequences of early discharge from psychiatric hospitals and the lack of high support hostels, thereby resulting in a poor quality service to the public. [7149/95]
(Limerick East): I am aware of the recent comments made by a number of psychiatrists in the Eastern Health Board concerning acute bed requirements in the area. The Irish Division of the Royal College of Psychiatrists has recently made a submission to my Department with regard to the matter. In order to ascertain the nature and extent of the problems they outlined, they suggested that a prospective study be undertaken.
My Department has confirmed that, subject to approval from the Eastern Health Board which is responsible for the provision of psychiatric service in its area, it will support the proposal for a six month study on acute bed requirements in the Dublin area to be undertaken by the Health Research Board. Further information concerning the projected costs and other aspects of the proposed study has been requested.
Will the Minister agree that the community psychiatric service is inadequate, that we are discharging people out to an inadequate community service and we do not have high support hostels? The policy a number of years ago was to have fewer beds and to discharge patients out into the community. That suggestion was made ten years ago and our community services are still not up to par.
(Limerick East): That is rather like the previous question in which the Deputy's colleague was trying to establish a differentiation between the health boards. In this case also, practice differs from health board to health board. The level of community support available in some health boards is significantly higher than in others. It is time to have an audit of what is happening. Later in the year I hope to produce a White Paper on mental health. This will give us an opportunity to examine the overall picture. It will also give us an opportunity in the House to debate it and see what further initiatives we can take. In general policy terms, There has been a movement away from the huge psychiatric hospitals, which were a feature of our youth. The movement towards the community is welcome and will continue.
Does the Minister think that the problem is related to the fact that we are still operating under the 1945 legislation?
(Limerick East): Any study of mental health will look at the statutory base. Many good things can happen under old law and many bad things can happen under new law.
I welcome the Minister's statement that research will be carried out in this area. Does he accept the clear link between premature and unplanned discharges from psychiatric hospitals with homelessness, which causes more problems for his Minister of State, and the high rate of suicide? Will he request the people carrying out the research to take that aspect of the problem into consideration?
(Limerick East): Subject to the agreement of the Eastern Health Board, the Department of Health will support the proposal for a six month study of acute psychiatric bed requirements in the Dublin area. There are many anecdotes about people moving from enclosed psychiatric hospitals into the community where they end up homeless or commit suicide. However, hard evidence shows that hundreds of people are starting new and fulfilling lives in the hostel and residential accommodation provided by health boards. This policy has been extremely successful and has brought enormous benefits. Like all major changes, it has its growing pains and difficulties but one should not give the impression that it has been a failure when the opposite is the case.
Will the Minister agree that recent publicly quoted comments by a consultant psychiatrist in the mid-west about the physical abuse of patients by staff in psychiatric hospitals were at best unhelpful and at worst dangerous?
The Deputy is entering another area.
(Limerick East): I must not be going home often enough as I am not aware of the comments quoted by the Deputy.
They were made by a Member of this House.
(Limerick East): I am aware of the comments to which the Deputy is referring. The matter was dealt with previously. I always think of Dr. Bhamjee as Deputy Bhamjee.
Does the Minister agree that we have overshot the problem by not retaining sufficient beds for in-patients? Ten years ago the emphasis was on releasing patients into the community and we may have gone too far by failing to retain sufficient beds for in-patients.
(Limerick East): This is not correct in respect of psychiatric hospitals but it may be correct in respect of patients who move from psychiatric hospitals and who at times may need better access to beds. This is a matter for debate and the White Paper on Mental Health will give Deputies an opportunity to engage in this and enable us to refocus policy. We are talking on an anecdotal basis and one will hear different anecdotes in various areas.
Will the research cover hostel accommodation or projects such as the one in Ballymun which contacts discharged patients and informs them about day centres and other facilities?
(Limerick East): The study will deal more with acute bed needs than anything else. A total of 1,473 in-patient places are provided in public psychiatric units in hospitals in the Eastern Health Board area and approximately one-third of these are acute. With regard to community residential places, 83 residences provide 762 places for a catchment population of 1,283,516, which represents a rate of 59.32 per 1,000 of the population, the norm laid down in Planning for the Future refers to a rate of 60 per 1,000 of the population.
