Vol. 525 No. 2
105 Mr. Neville asked the Minister for Health and Children if he will respond to the criticisms and recommendations of the Inspector of Mental Hospitals in his report for 1999; if he has plans to introduce the necessary reforms; the timescale for such a plan; and if he will make a statement on the matter. [24519/00]
The most recent report of the Inspector of Mental Hospitals, for the year ending 31 December 1999, was published in July this year. While the inspector acknowledged the progress that has been made in the provision of acute units in general hospitals, community mental health centres, day hospitals and community residential facilities, he stated that the rate of progress needs to accelerate. It is my intention to facilitate the health boards in as far as possible bringing about the improvements and developments identified by the inspector. In particular, I intend to facilitate further significant development of the mental health services under the national development plan.
Approximately £150 million capital is being provided over the lifetime of the national development plan for the development of the mental health services. A significant part of this funding will go towards general hospitals for a replacement of services previously provided in psychiatric hospitals. At the end of the period of the national development plan, it is the intention to have the programme of acute psychiatric units completed which will mean that acute admissions to the old psychiatric hospitals will no longer occur. The plan will also provide for more community facilities such as mental health centres and community residences which will further accelerate the phasing out of the old institutions.
Concern was expressed in the inspector's report about difficulties in recruiting qualified psychiatric nursing personnel, which were particularly acute in the eastern region. However, more than £1 million has been provided for local and national marketing campaigns undertaken by the Nursing Careers Centre and the schools of nursing around the country. The success of these campaigns is evident from the fact that the schools of nursing have since succeeded in filling a record 254 training places in psychiatric nursing in 1999 and this record figure was exceeded this year, rising to 300. Increasing the annual intake of student psychiatric nurses is a key element in the Government's strategy for addressing the current shortage of nurses.
In his report, the inspector also referred to the lack of multi-disciplinary teams in many mental health services, particularly in the area of psychology and social work services. Additional resources of £1.4 million were provided to health boards in 2000 for improvements in these services. The inspector also highlighted a number of other service and quality of care issues which were raised with individual service providers. These issues will continue to be pursued with a view to bringing about the improvements required.
Does the Minister agree that, over past decades, mental health services have been among the most neglected areas of the health services? The people in need of these services deserve the same level of care, albeit inadequate, as people in the general health services. Does the Minister agree that the widespread prescription of poly-pharmacy drugs is totally unacceptable and that the lack of any planned approach to reviewing the drug intake of long-stay patients is disgraceful? Does the Minister have plans to ensure that this practice will cease and that the prescription of drugs in all mental institutions will be frequently reviewed on a mandatory basis?
I agree that mental health services did not receive the same priority as other health services over the decades, nor were they accorded the priority they deserved. However, there has been a significant improvement in this area in recent years in terms of the development of acute psychiatric units within hospitals and the development of community facilities and residences throughout the country. The position of people with intellectual disability has also been significantly improved in that institutionalisation is being phased out and there is a move towards improved community facilities.
I share the Deputy's concern about the widespread administration of medication to a number of psychiatric patients. I am not a clinician and while clinical autonomy should prevail in regard to the overall treatment protocol of individual patients, the development of increasing numbers of multi-disciplinary teams will lead to an improved holistic approach to patients' treatment. The proposals contained in the mental health Bill will go some way towards improving the position in regard to the administration of medication to patients. In particular, the establishment of the mental health commission will ensure a review of the operation of mental hospitals throughout the country and will result in more proactive action being taken on behalf of patients.
The Minister referred to the improved position of people with intellectual disabilities. Will he comment on the inspector's view that it is totally inappropriate that 300 such people are receiving in-patient care in psychiatric hospitals? Does he agree it is inappropriate that these patients should have to share accommodation with patients suffering from functional psychotic illnesses? The inspector takes a very serious view of the derogation of the duty to deliver appropriate care to both of the above groups. The problems experienced by some elderly people are more of a geriatric than psychiatric nature and they should be catered for in geriatric facilities. There are three groups of people who are not receiving proper treatment, namely, those with intellectual disabilities and psychotic illnesses and elderly people who are inappropriately placed in psychiatric homes. Does the Department have plans to overcome these difficulties?
It certainly does. Approximately 300 patients with intellectual disabilities, excluding those in St. Joseph's special unit in St. Ita's Hospital, Portrane, currently reside in public psychiatric facilities. Initiatives are well advanced throughout the country, particularly in Limerick, Killarney and Kilkenny, to provide these patients with alternative accommodation. Similar initiatives are being pursued in Wexford and Tipperary. The national development plan provides us with the wherewithal to carry out these developments which will result in the appropriate placement of people with intellectual disabilities. I accept the Deputy's point about elderly people requiring geriatric care.
