Vol. 512 No. 7
10 Ms McManus asked the Minister for Health and Children the steps, if any, he is taking to address the serious criticism of the psychiatric hospital services outlined in the report of the Inspector of Mental Hospitals for 1998; and if he will make a statement on the matter. [27055/99]
I share the concerns of the Deputy in relation to the issues raised in the report of the Inspector of Mental Hospitals for 1998. I acknowledge the crucial role the inspector plays in providing an independent and detailed analysis of our mental health services. Many of the points raised by the inspector relate to clinical and administrative issues associated with the provision of care, and I would expect them to be addressed by the relevant professional and management staff in the health boards and hospitals concerned. In so far as the inspector has identified the need for improvements in facilities and staffing levels, it is my intention to make additional resources available to the health boards and hospitals. I have allocated an additional £12.2 million for improvements in mental health services for the coming year, which is an increase of more than 100% on the additional funding provided in 1999, and much of this will be devoted to tackling the deficiencies identified by the inspector.
The lack of multidisciplinary teams in many areas of the mental health services has been highlighted by the inspector in his report. A total of £2.9 million has been allocated for next year towards the further development of community based mental health services, including the improvement of psychology and social work services. I acknowledge that much still needs to be done in the provision of comprehensive facilities and services. It is my intention to assist health boards to provide community-based services, as an alternative to care in large institutions, in line with the widely accepted policy for the mental health services outlined in Planning for the Future through the provision of development funding, both capital and revenue, next year and in future years.
In his report, the Inspector of Mental Hospitals referred to the fact that some patients in psychiatric hospitals have been in institutional care for many years and recommended the establishment of dedicated teams to develop rehabilitation programmes to facilitate their transfer to more appropriate care in the community. I have allocated £250,000 to the Western Health Board to fund such a specialist-led team which will commence a rehabilitation programme for long-stay patients in St. Brigid's Hospital, Ballinasloe. If this pilot project is successful, a similar approach will be considered for other hospitals.
An additional £1.1 million is being allocated to further developments in child and adolescent psychiatry services. This funding will provide for the appointment of additional consultants in child and adolescent psychiatry and for the development of multidisciplinary teams to focus on specific areas.
The increase in the number of people living to advanced old age requires the development of specialist mental health services to meet their specific needs. Old age psychiatry services have been expanding in recent years and an additional £1 million is being allocated in 2000 to further this development.
The provision of acute psychiatric units attached to, or associated with, general hospitals to replace services previously provided in psychiatric hospitals is continuing throughout the country and 17 acute psychiatric units are now linked to general hospitals. A number of units are currently at various stages of development including the Mercy Hospital, Cork; Beaumont Hospital, Dublin; James Connolly Memorial Hospital, Dublin; St. Vincent's Hospital, Elm Park; Portiuncula Hospital, Ballinasloe; Castlebar General Hospital; Ennis General Hospital; St Luke's Hospital, Kilkenny; Nenagh General Hospital; Portlaoise General Hospital; and Sligo General Hospital. A further four acute psychiatric units are under consideration as part of the national development plan.
In addition, £1.35 million is being provided to facilitate substantial improvements in the forensic psychiatry services in Dublin, Cork and Limerick. These funds will enable the appointment of four additional consultant forensic psychiatrists and associated support staff, with two teams to be based in Dublin and one each in Cork and Limerick. These teams will liaise with the Director of Prison Medical Services and the Department of Justice, Equality and Law Reform regarding the provision of appropriate psychiatric services in our prisons.
In addition, £1 million has been allocated towards suicide prevention programmes and £2.5 million has been provided towards the costs associated with the implementation of new Mental Health Bill which I circulated yesterday. These initiatives clearly demonstrate my commitment to bringing about real improvements in the mental health services and in tackling service shortcomings identified by the inspector.
I thank the Minister for his lengthy response and for publishing the Mental Health Bill, but does he not appreciate that there is disappointment at the narrowness of his approach to dealing with serious deficiencies in our psychiatric services as outlined by the Inspector of Mental Hospitals? What is his view of the need to have in place a strategy to deal with the requirements of the inspector's report? Will he comment on the request from the Royal College of Psychiatrists to be given the task of drawing up such a strategy with the inspector? In relation to clinical practice, the Minister cannot leave it to the professional bodies to deal with the very serious criticisms of negligence and malpractice from health professionals in the psychiatric services. Does he accept he has a responsibility to ensure that the good practice in dealing with the psychiatrically ill that exists in many places is extended to all institutions, so that patients' rights are truly protected?
I reject the assertion that there is a narrowness of approach on the part of this Administration. It compares very favourably with my predecessor. During 1998 the inspectorate published guidelines on good practice and quality assurance in the mental health services which stress the areas of performance felt to be important for patient care and which, in some cases, needed improvement. The importance of patients' rights across a broad range of issues was stressed and the responsibility of mental health services in such matters was highlighted. The document was circulated to all mental health service providers.
In relation to the matter of good practice, I am providing in the Mental Health Bill for a Mental Health Commission and a central part of its remit will be to ensure good practice across the service. Again, to negate the assertion of narrowness of approach, I am proposing that the inspector will not be an inspector of mental hospitals in the future but an inspector of mental health services, which will incorporate community services. That means a far broader remit will be given under the new Mental Health Bill than has been the case until now.
While the guidelines on quality assurance were published and distributed to hospitals, what follow-up did his Department carry out to ensure hospitals apply the guidelines? It is clear from the current inspector's report that there have been many instances of the guidelines not being applied. It is one thing to issue guidelines but, while another structure is being created, which inevitably takes time, the Department of Health and Children must monitor the guidelines it has published and ensure they are being applied by the hospitals and services under the Department's aegis.
I contend that the monitoring and provision of service plans as well as the confirmation of indicators on performance targets being met on such plans provide far greater transparency than was the case in the past. It ensures that what health service providers, management and health boards set out to achieve occurs. That has been greatly assisted by the service planning that is now a central feature of the accountability system that exists as a result of the change in the health funding arrangements since 1996.
The inspector's role is an important one, but I acknowledge there is a need for improvements in this area. I have set out in detail the considerable additional resources being provided in the coming year in response to the 1998 report and I have asked for the 1999 report to be provided as quickly as possible. I am indicating that there is a policy response that is far greater than was the case with any previous report. Not only were there delays in providing such reports, but they were never debated. I look forward to going into far more detail on the specific aspects of the report this afternoon in the Seanad.
I am not referring to administrative problems. I refer to the professionalism or otherwise of clinicians.
The inspector recognises the professionalism of our clinicians in this area. That is not to say there are no problems in this area, just as there are problems in a range of areas. It is not being suggested that it should be left to the clinicians themselves to decide good practice. The Mental Health Commission will not simply be made up of psychiatrists but of people who have front line practice of best practice in this area. I hope it will be an important stimulus to ensuring that best practice is widespread and available throughout the service, as the inspector wishes to see.
