I wish to share time with Deputies Grealish, Callely, O'Connor and Brendan Smith.
Private Members' Business. - Mental Health: Motion (Resumed).
The following motion was moved by Deputy Neville on Tuesday, 10 June 2003:
That Dáil Éireann:
– noting the recent critical reports on the treatment of people with mental illness by Amnesty International, the Irish Psychiatric Association and the Inspector of Mental Hospitals;
– concerned that Irish mental health policy and service provision remain out of step with international best practice and that the institutionalisation of the mental health services in Ireland has failed to live up to World Health Organisation standards;
– believing that the high admission and re-admission rates to psychiatric hospitals are due in large measure to the lack of community based facilities;
– concerned at the lack of dedicated psychiatric facilities for adolescents, the lengthy waiting lists for treatment and the lack of consistency in the provision of mental health services throughout the country; and
– deploring the fact that people with intellectual disability continue to be inappropriately accommodated in psychiatric facilities in violation of human rights law;
condemns the Government for its neglect of the mental health sector and failure to vindicate the human rights of people with mental illness and for the reduction in the percentage of the health budget spent on mental health and calls on the Government to immediately bring forward a comprehensive package of measures, including appropriate finances, to provide:
– a comprehensive, needs-based, service-user-led review of the mental health care services, promptly and fully implemented, ensuring that they meet international human rights standards and best practice in line with the World Health Organisation 2001 annual report, with an emphasis on community-based care;
– regular quality research in all areas of mental health care needs and service provision, an essential prerequisite for the development of a quality service;
– full financial provision for all areas of mental health care;
– all necessary resources and assistance for the Mental Health Commission in its securing adequate care and conditions for people with mental illness;
– effective action on all relevant recommendations made in the reports of international treaty-based committees, annual reports of the Inspector of Mental Hospitals, and Government reviews and reports;
– a comprehensive system of personal advocacy and an effective complaints procedure to ensure that people with mental illness are assisted in exercising the full range of their rights;
– specialised mental health care for all who need it, including children, the homeless, prisoners, people with other forms of disability, Travellers, asylum seekers and refugees, and other minority or vulnerable groups;
– a public education and awareness campaign to counter the stigma of mental illness, emphasising the rights of people with mental illness; and
– rights-based disability and mental health legislation to give full effect to its international human rights obligations, with due regard to its obligation to enable persons with disabilities to exercise their rights on an equal basis with other citizens.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and to substitute the following:
– welcomes the Government's commitment to prepare a national policy framework for the further modernisation of mental health services which will take account of recent legislative reform, developments in the care and treatment of mental illness and current best practice;
– commends the action taken by the Government and the former Government since 1997 in improving mental health services, in particular, the further development of community-based services and the development of new acute psychiatric units in general hospitals; and
– acknowledges the need for the further development of services to people with a mental illness over the coming years.
–(Minister of State at the Department
of Health and Children, Mr. T. O'Malley).
Agreed. The Deputy may share his 30 minutes.
Issues around mental health services usually generate little debate and arouse relatively little public attention. That is one reason that we from time to time come across reports which are critical of services. Unfortunately, our attitude to those with a mental illness historically has been negative and ill-informed and has contributed in no small way to the poor quality of service provision until recently.
Having said that, it is fair to acknowledge that, over the last quarter of a century, considerable progress has been made and over the last seven to ten years that has been dramatic. There are some outstanding professionals working in the area, and even in the days when the approach was less enlightened, there were wonderful professionals working with people with mental illness, as well as very dedicated campaigners, all of whom made a very positive contribution. Unfortunately, the service delivered was quite uneven across the country.
One of the improvements seen in recent years is that the standard has been raised all round, and the service has become more uniform across the country. It is one of the areas where expenditure under the health budget has made a positive contribution. In that regard, I welcome the commitment of the Ministers, Deputies Martin and O'Malley, who were here last night, to address outstanding problems and issues and continue to give this area of health the priority it needs.
The move from ancient, forbidding, Dickensian buildings to modern acute facilities and community-based services has been a tremendous success. I have experienced it in my own area of County Clare, where the huge old mental institution at Our Lady's Hospital has thankfully been closed and replaced by an acute unit in the grounds of Ennis General Hospital. There are also many excellent community facilities. One occasionally hears suggestions that the level of support or manpower around some community facilities might be greater for those who have been de-institutionalised. That area is among those currently being addressed.
The Mid-Western Health Board frequently comes in for criticism, but this is one area where considerable credit is due to it and its chief executive officer, who vigorously pursued the modernisation process in mental health. This was successful in my own county. The fact that the acute unit is now on the campus of the general hospital has helped mainstream mental illness as an ordinary ailment. It is realised that a full recovery is likely for the vast majority, and people are much readier to seek professional and medical advice at a stage at which they would not previously have countenanced it. One of the scandals has been that many people with intellectual disabilities and acquired brain injuries have been forced to live in unsuitable mental institutions. Our growing problem in the area of acquired brain injury is putting a massive strain on resources. We have nowhere near a sufficient level of service, and that must urgently be addressed.
There has also been considerable public debate on the issue of suicide and the need to address the causes and develop strategies to recognise those at risk. We should acknowledge the positive role of the Inspector of Mental Hospitals over the years and also the Amnesty International report, Mental Illness – The Neglected Quarter, which in some sense begot this debate. Some would say that the report is 20 or 50 years too late, but it is better late than never, and it is high time that some of the issues raised were addressed. I refer in particular to homelessness which is difficult to deal with at a health or national level. The input of the voluntary sector has been positive, and we should support it strongly.
It is also fair to say that it is easy to debate mental illness and prescribe all kinds of remedies. However, society generally, and probably even we in the House, should acknowledge that we have not been good at maintaining contact with those who are mentally ill and have been consigned to institutions – or those who now live in the community. That is one of the great failures of Irish society and must urgently be addressed. Perhaps the most significant progress made in recent times has been the Mental Health Act 2001 and the setting up of the Mental Health Commission, which will ensure that our service reaches the highest international standards.
I am pleased to have the opportunity to contribute to this debate and say there are many good things happening in health. I acknowledge that there are gaps in certain services. As Minister of State with special responsibility for older people, I have a particular concern about services for the elderly mentally ill, and I wish to focus in particular on developments in the psychiatry of later life.
As Deputies may be aware, there are now more than 60 million people in the European Union aged 65 or over. One in five of the population of the EU is an older citizen, and the ratio is set to rise to one in four quite rapidly. In Ireland, estimates suggest that, by the year 2011, our population aged 65 and over will have grown by 25%. Each year our over 65 population increases by approximately 6,000, and the number of people aged 80 and over goes up by 1,500. Inevitably, that will give rise to an increase in the number of older people suffering from mental illness and will present a major challenge to our mental health services in coming years.
In his most recent report, the Inspector of Mental Hospitals noted that 40% of in-patients in psychiatric units and hospitals are over 65, and in some instances, particularly among long-stay patients, that figure exceeds 50%. According to the inspector, many of them show little sign of behavioural disturbance related to psychiatric disorder and, among the more elderly in particular – something that I believe reflected society's thinking at the time of their admittance – their needs and disabilities relate instead to their age. The inspector has stressed the need to transfer their care either to community residences, where possible, or to suitable in-patient continuing care facilities for older persons.
I assure the House that the provision of appropriate care for older people is a key priority, both for me as Minister of State and for this Government. The increase in the number of people living to an advanced age requires the development, as a priority, of specialist mental health services to meet their specific needs. The psychiatric needs of older people include specialist services for those with functional mental illness and those with dementia and associated behavioural problems.
In 1996 the National Council on Ageing and Older People published the results of a study on mental disorder in older people in Ireland undertaken by the Health Research Board.
The report focused on the mental health of older people and examined the treatments available to those with mental disorder. In line with the results of that study, psychiatric services for older people have been expanded in recent years and the integration of community and hospital-based psychiatric services with geriatric medicine is progressing. Over €7 million additional revenue funding has been committed since 1999 to enable a start to be made on the establishment of specialist services for the elderly mentally ill in health boards where no such service had heretofore existed. A total of 17 consultant-led teams specialising in psychiatry of later life are now in place around the country and a further four consultants have been approved by the Department of Health and Children.
In relation to health services for older people in general, additional revenue funding for the development of these services has increased significantly from €12.7 million in 1997 to an additional €87.807 million in 2002.
In excess of €270 million additional funding has been provided for services for older people from 1997 to date. This has resulted in more than 1,000 additional staff being recruited. Between 1998 and 2001 in excess of 550 additional beds were provided in new community nursing units and more than 1,250 day places per week have been provided in new day care centres.
In 2003, a total of €23.6 million in additional revenue funding was allocated to services to older people. This funding is being used for a variety of services including home help service; nursing home subvention; support to carers; opening new community nursing units; development of dementia services; funding of day care centres and development of consultant-led services. The continued development of these services for older people is a key priority for the Government and we will continue to work with the health boards to ensure the provision of a comprehensive service.
A very significant development in addressing the mental health needs of older persons was the establishment of the dementia services information and development centre in St. James's Hospital, by the Department of Health and Children in 1998. This centre serves as a resource for professionals and service planners. Through its education, research, consultancy and information services, its remit is to promote excellence in all aspects of dementia care. I am aware that since its establishment the centre has facilitated a wide range of education workshops nationally, for care staff working in a large variety of settings. I recognise we have a lot of work to do in providing services to people suffering from dementia and Alzheimer's, although I am pleased the Alzheimer's Society of Ireland received a 25% increase in its core grant from my Department this year. That shows the importance I attach to this area.
Throughout the country other service initiatives are also being explored, such as the development of "in home" respite care, a service which we know is particularly welcomed by family carers because it means that their relatives are offered respite in a familiar environment. As the population of older people here in Ireland increases, we should not forget that our elders have been instrumental in building the Irish State to the prosperous level we enjoy today. Their full measured contribution to the economy is widely acknowledged and this Government is fully committed to improving all aspects of their lives by focusing on issues that affect their well-being.
I thank my Fianna Fáil colleagues for sharing their time.
We will never see the day when we can say we have done all we can for people with disabilities. There will always be more to be done, as every public representative and person caring for family members with disabilities knows. If we are to be fair, we will ask ourselves if we are making progress with providing services for those with disabilities and we will recognise progress when it is made.
We have been making progress in this area in recent years, particularly in services for people with intellectual disabilities, and yesterday the Minister of State, Deputy O'Malley, set out that progress. No-one could deny it. In the past five years, an additional 1,700 community residential places have been provided and almost 3,000 new day care places have been added. Families have also benefited from 465 new respite residential places in the past three years.
No-one is saying this is all that needs to be done but it is certainly progress. I do not expect the Opposition to stop opposing the Government for a minute but I expect it to have the decency and self-respect not to claim it is the only who cares about people with disabilities. The Opposition should not ignore the progress we have made. It does no service to people with disabilities and their families to whip up an antagonistic, confrontational and bitter atmosphere surrounding disability services. Yet that is the behaviour of the Opposition and certain non-elected people associated with it.
I agree with the warning to politicians not to use the Special Olympics for photo opportunities or publicity; my party and the Government have no intention of using the Special Olympics for political publicity. We should leave politics out of sport and the Special Olympics in particular. This view is clearly not shared by the chef de cabinet of the Labour Party who uses his weekly media bully pulpit to put the Special Olympics into the same frame as his predictable criticisms of the Government.
Last Tuesday he urged the Taoiseach and the Government to seize the moment of the Special Olympics to provide an extra €50 million for disability services. This sounds like advising the Government to use the Special Olympics for the purposes of political propaganda. If a Minister were to take this free advice and make announcements on the back of the Special Olympics the same Labour Party would be the quickest to condemn him or her in its highest moral tones. Does the Labour Party approve of the politicisation of the Special Olympics or will it undertake not to politicise the games like the rest of us? Who is the real spokesperson on health and disability issues in the Labour Party?
The Labour Party chef de cabinet had the opportunity over many years to be tetchy for the Tánaiste of the rainbow coalition. It is a pity he was not more tetchy about disability funding then, when he could have prodded Labour, Fine Gael and Democratic Left into providing better funding for disability services. The total budget for disability health services was under €400 million when that coalition left office. There was a Labour Minister for Finance and a Fine Gael Minister for Health, with a brooding Tánaiste's office checking everything out. Now the budget is three times bigger, with €1.1 billion being spent on disability – an increase of €160 million on last year's figures.
It is also pretty low politics to complain now about the number of people who need intellectual disability services. When the rainbow coalition left office it had no idea how many people needed such services; it did not know who or where they were or what they needed. There was no national intellectual disability database such as exists now, with almost 90% of those on the database receiving services. That does not solve everything but it is progress no-one can deny. The situation is much better than when Fine Gael and Labour had their chance.
The way in which Labour and Fine Gael are criticising the Government on disability issues does not make for constructive Opposition. It is not policy-based and it is not principled, caring or moral. It does no good for people with disabilities and offers no solutions. That is why I support the Government amendment to the motion.
It is unfair to refer to a non-elected member of the Labour Party, an adviser with a genuine interest in disability.
I intend to support the Special Olympics. There will be pitch and putt in Glenville in Tallaght and basketball in the National Basketball Arena. I intend to attend – to pay my way through the turnstiles and support my neighbours.
I congratulate Deputy Neville on his work, particularly on suicide prevention. I attended a youth conference exhibition in the Mansion House where I picked up a copy of an information booklet on suicide prevention for young people published by the National Youth Federation – I am a former press officer for that organisation. The booklet outlines the work being done in this area and I support Deputy Neville in this regard.
I use my experiences in my constituency in my contributions and I often speak about Tallaght. It was my privilege to be a member of the Eastern Regional Health Authority until recently and I was also a member of the Eastern Health Board from 1994. In 1999, the Eastern Health Board produced a report, We Have No Beds, and the Minister of State, Deputy Callely, was the board chairman who launched the report. The report stated there were sufficient acute beds in the region but that many were taken up by people who did not need acute care. The term "bed blocker" is often used in regard to such people. However, I take the view that they are not bed blockers but rather continue to provide an example to all in this House of what urgently needs to be done, namely, a range of community based services which would intervene in a positive way at an early stage to prevent acute illness and which can equally be available after acute illness must be put in place. We must do this by continuing to invest and by developing the partnership with the voluntary sector. I have no doubt that the Government will do just that. I have been greatly impressed by the work of the Minister of State, Deputy Tim O'Malley, in this regard. I greeted him in Tallaght recently at a function organised by Enable Ireland and I applaud his work in that regard.
For quite some time I have been supportive of the mental health services in Tallaght, which is the third largest population centre in the country. As some Members will know, we have two 25 bed acute in-patient units at Tallaght Hospital. A mental health day care centre and hospital was opened in 1988 and these facilities on the Belgard Road are being upgraded and will be ready in August of this year. There is also an out-patients' clinic at Mary Mercer Centre, Jobstown, and Tallaght is greatly served by consultants on those teams.
A high support hostel, Beaufort House, was opened in 2000. New Horizons, a vocational training workshop, is operated by EVE Holdings at Broomhills industrial estate in Tallaght. Clients from Tallaght also attend the recently opened club house project – Phoenix Club House – in nearby Clondalkin which was opened last year.
There are challenges and needs in Tallaght, as there are elsewhere. Recognising the population expansion and the social needs of Tallaght, the mental health services have told me they require two multi-disciplinary home care teams to provide an assertive, outreach model of care in the client's home. They also need additional rehabilitation accommodation options to improve patient flow through the acute units, which is important. We need an out-patients' clinic to serve east Tallaght and a second club house in Tallaght, which would be especially helpful. We also need additional staffing for the six bed Aspen psychiatry unit for old age at Tallaght Hospital. I was particularly pleased to hear the Minister of State, Deputy Callely, expressing his support in that regard.
Tallaght also needs a mental health liaison team to work at the hospital, particularly in the accident and emergency department responding to needs of acute presentation and para-suicidal patients. Specialist services required include psychotherapy, eating disorder, obsessive compulsive disorders and personality disorder programmes. An extended alcohol service programme to include a staff training facility is also needed. I understand from my local contacts that an academic post to develop the research and training aspects of the service is required.
It is important we support those in our community who need our help and for whom we should care. It behoves all of us to continue to express our support for these services to Government. The Minister and the Ministers of State are listening and I have confidence that they will deliver the services because it is important to do so. It is important that we take action to correct the perception which exists among some of the groups. I support these groups and it is important we understand what they are saying, the challenges faced by the services and that we do what we can in difficult economic times to continue to serve those in our community who need us.
I am glad to have the opportunity to make a short contribution on this important matter. Like Deputy O'Connor, I congratulate Deputy Neville on tabling this motion. The issue under discussion is one which affects a group of people who would not have had a voice in the past. It behoves all of us to raise at every opportunity the need to improve services for people with a mental disability. I read the Minister of State, Deputy Tim O'Malley's, speech, which was very strong. I know of his personal commitment to improving the level of services needed throughout the country. The Minister of State stated at the outset of his contribution last night that nobody is saying the services are adequate. We need more services and facilities. I am sure that in the coming years, the Minister of State, Deputy Tim O'Malley, with his strong and caring leadership will ensure that the necessary funding is provided and that the additional facilities and services are provided throughout the State.
Deputy Killeen mentioned the problem of homelessness. I suppose it is an issue for which we could all accept blame in not addressing it adequately over the years. Were it not for organisations such as St. Vincent de Paul and other voluntary groups, the plight and the number of homeless would be much more severe. Great credit is due to the many voluntary organisations. Often in a parish or town, a handful of people ensure a place to stay and basic comforts are provided for people who have fallen on difficult times. All of us know of individual cases and the people concerned. Unfortunately, there is a recurring theme of these people falling out of favour with society, often as a result of the abuse of alcohol. Unfortunately, it is an issue which is brought to our attention because at times, there is not adequate provision for the treatment of people suffering from alcohol abuse. Better services need to be provided at our general hospital or elsewhere.
Last year the Minister, Deputy Martin, appointed Dr. John Owens, the consultant psychiatrist and former clinical director of the Cavan-Monaghan Mental Health Service, as chairperson of the new commission established as a result of the Mental Health Act 2001. All of us, particularly those of us from the Cavan-Monaghan region and those who have taken an interest in the delivery of health services throughout the country, will be aware of the pioneering work and models and systems put in place by Dr. Owens. We hope that his leadership and the style of care and delivery of service he has provided in the Cavan-Monaghan area can be improved and replicated throughout the country.
The Minister of State, Deputy Callely, stated that mental incapacity can often be associated with people growing old and that there is a higher dependence among the elderly. An issue which has been brought to the attention of those of us who represent rural constituencies, in particular, is the plight of many of our emigrants living in Britain or in the United States, and Deputy Cowley has been active in this regard. I come from an area which was totally devastated by depopulation over the years and in which parishes were practically wiped out. Those of us who maintain contact with our county associations throughout Britain and the United States know that a particular age group of emigrants face hardship. Some local authorities and many voluntary agencies have done Trojan work in ensuring that housing is provided in these people's native area in order to allow them to come home. Thankfully, emigration has been much reduced, if not eliminated, in recent years. That means the age profile of our emigrants, whether in Birmingham, London, Coventry, elsewhere in Britain or in New York or Boston, in particular, is very high. Those people left this country when there was no living to be made and many of them reared families back home by sending home dollars or sterling. Those people have been left vulnerable and isolated. I hope the Minister will ensure better co-ordination among local authorities in providing housing for people who wish to come home to their native area – people who are vulnerable, isolated and living in lonely circumstances in many of the cities to which Irish people travelled in the past.
As the Minister of State, Deputy Callely, said, those people and those who remained at home worked in very difficult times and, in many instances, barely eked out a living. With a well developed economy and a standard of living to which that generation thought we could never aspire, there should be an obligation on us to try to improve the housing circumstances of those who wish to return home. I know from speaking to representatives of many of our emigrant associations that mental difficulties are a recurring theme among many of the elderly people living in bedsits or small flats throughout Britain and the United States. I hope the Minister's Department is in a position to drive a housing scheme for emigrants involving all local authorities, particularly in the counties that suffered from huge depopulation over the years.
I wish to share my time with Deputies Ó Caoláin, Cowley and Connolly.
An Leas-Cheann Comhairle
Is that agreed? Agreed.
The issue of mental health is best looked at from the perspective of human rights. Responsibility for compliance with international human rights law lies firmly with the Government. It does not lie with the health boards, civil servants, service providers or individual Departments. The buck stops with the Minister and he must make the decisions.
Recent reports by Amnesty International have shown that in-patient and community based services are inadequate in many respects, inconsistent in their application throughout the country and severely under-resourced in terms of staff and funding. The most compelling statistic is the massive drop in overall funding devoted to mental health services. Total expenditure over the past 15 years has dropped from 12% of the overall health budget to 7.2%. Obviously, there has been a significant increase in the overall health budget, but to see the provision for mental health services drop so dramatically – by approximately 40% – is disturbing. The problem needs to be addressed by central Government.
The UN Principles for the Protection of Persons with Mental Illness were adopted in 1991. Although they are not legally binding, they mirror the basic rights and freedoms outlined in the international covenant on economic, social and cultural rights. The Mental Health Act 2001 was passed to amend the scenario whereby people with mental illness can be detained involuntarily in psychiatric facilities by procedures that fail to protect against arbitrary detention. Under the current regulations, a person can be detained for up to 21 days. This period, which is far too long, should be shortened and the Green Party wants to see this happen.
It was interesting to be present some weeks ago at the launch of Amnesty International's report on mental illness and homelessness. Moreover, it was interesting to hear Dr. Fernandez, director of the homelessness programme at St. Brendan's Psychiatric Hospital in Dublin, make a very passionate plea for an increase in funding and for a change of heart and dedication to the cause of addressing the lack of services in this area. He made the very interesting point that a distinction must be drawn between mental health problems induced by homelessness and mental illness which may be a factor in one's becoming or remaining homeless. These are two separate issues, yet we do not have the resources needed to provide the correct services in this regard. I am interested to hear the views of the Minister of State on how this can be addressed.
The Standard Minimum Rules for the Treatment of Prisoners state that sick prisoners who require specialist treatment shall be transferred to specialised institutions or to civic hospitals. The problem is that those facilities do not exist. We have the Central Mental Hospital in Dundrum but it is not enough to cope with the variety of patients. Prisoners are often discharged into a state of homelessness and receive little or no after-care. This should be addressed by the Minister.
We are concerned at the failure to provide the mental health policy update, promised for mid-2003 under the national health strategy of 2001. We are worried that we will simply see an updating of the 1984 document. It is crucial that the Minister holds the meeting with Amnesty International, postponed because of the SARS outbreak, to discuss the relevant issues.
Recent publicity on health has failed to refer to mental health, nor has mental health been included in the initiatives in the health strategy. We want to see an improvement in this area. There has been no commitment to providing extra Revenue funding, which we would like to see.
The Minister for Health and Children has been heading a very high profile media defence of the health system and his activities to date in the Department, yet he has not mentioned the long-standing crisis in mental health services. We are concerned at the kind of signal this sends to the public about the importance of this sector.
There are four things we want: a meeting between the Minister and the various organisations; a public education and awareness campaign to combat the stigma of mental illness; rights based disability and mental health legislation to give full effect to international human rights obligations; and adequate funding for all areas of mental health.
Ar son Teachtaí Sinn Féin, ba mhaith liom tacú go hiomlán leis an rún seo ar shláinte intinne. Molaim freisin an Teachta Neville ach go háirithe as é a chur os ár gcomhair. On behalf of the Sinn Féin Deputies, I fully support the motion and commend Deputy Neville in particular for bringing it before the Dáil. The Deputy has repeatedly highlighted the issue of mental health over the past six years and I am glad to see that its scandalous neglect is now being exposed to a wider audience and that, at last, we are having a full-scale debate. Let us hope that real and concerted Government action will follow because that is the purpose of the motion.
The Amnesty International report on mental health care, which has already been referred to, is a real wake-up call. It is so important because it places the rights of people suffering mental illness at the top of the agenda. I was present at a recent meeting in the Mansion House when the representative of Amnesty International spoke in very particular terms on this issue. I commend that contribution, and the work of the organisation in this area is very welcome.
For too long, the mentally ill have been without rights and without a voice. The Amnesty International report reveals how mental health has been treated as the Cinderella of the health services. Current policy is based on an outdated review going back to 1984. This is an indictment of successive Governments but it is also a call to action and an opportunity for the Government to begin to get it right.
People with mental health problems are stigmatised by society and denied the full range of effective treatments because of under-resourcing, a lack of proper training and inadequate strategies to deal with mental health in our health services. Our rate of involuntary admissions to psychiatric facilities is higher than the European average. The rights of people as citizens and as service users are not being protected.
Following criticism of Irish mental health provisions by the United Nations last year, Amnesty International's report identified how far short of international standards this State falls, especially given our recent level of economic prosperity. During our economic boom, I believe our standards and performance were particularly poor and very regrettable.
I join in the tributes to Dr. John Owens and Dr. Teresa Carey, who has succeeded him at the helm of St. Davnet's Hospital in Monaghan. They have pioneered community based treatment. The failure to take on board the merits of this approach in other parts of the jurisdiction has resulted in the totally inappropriate use of prisons as unofficial mental hospitals. According to the Irish Penal Reform Trust, approximately 40% of all prisoners suffer from mental illness.
The vast majority of these are serving time for minor, non-violent offences, often connected with their illness. Frequently, these people come into conflict with the law only after years of going without proper clinical treatment.
Such people need and have the right to adequate clinical care. Instead, they find themselves imprisoned and often subjected to solitary confinement in lieu of treatment or proper care. They inevitably deteriorate further in prison. The cycle of deterioration often includes homelessness on release, and we have many examples of that in this city, which in itself becomes an exacerbating factor. Cycles of recidivism are virtually guaranteed in such cases. The Government must end the policy of incarcerating people suffering from mental illness. This policy has resulted in a de facto criminalisation of the mentally ill, and is a violation of their human rights.
In conclusion, I acknowledge the role of the Psychiatric Nurses Association in highlighting the disgraceful neglect of the mentally ill. It points to the decline in spending on mental health as a percentage of gross Government expenditure on health, from 13.5% in 1976 to a paltry 7.2% in 2001. That is a damning statistic and revealing fact. The PNA points also to the need to ensure adequate staffing levels are maintained and that the appalling conditions patients are forced to endure in some of our institutions are addressed and redressed. I commend and support Deputy Neville's motion.
I am glad to support this important motion and I thank Deputy Neville for proposing it. I was interested to hear the Minister say that in his most recent report the Inspector of Mental Hospitals noted that 40% of inpatients in psychiatric units were over 65 years of age and that in some instances, particularly among long-stay patients, the figure exceeds 50%. The inspector has stressed the need to transfer their care either to community residences, where possible, or to suitable inpatient continuing care facilities for older persons.
Many years ago the Green Paper on psychiatric services said the same thing. It said that the majority of long-stay people in institutions are over 65 years of age. Long-stay means people are there for a year or over. Those people should be at home in their own community but they are not because there is not sufficient provision for them in their community. Deputy Neville's motion spells out for us that because of the lack of facilities in the community people are in psychiatric hospitals who should not be there. That is the bottom line no matter how it is dressed up.
In my own area I became involved in what we call St. Brendan's Village which is about supporting people in their own community. It is about providing a community alternative to incarceration in institutions. People who killed people end up in jail for four to eight years but people are incarcerated for life in mental hospitals. These people are not murderers or anything like that but they have an illness. They deserve a chance.
The answer is St. Brendan's Village type developments. Such developments are in the community and cost a third of the cost of a State institution to build and only half the cost to run. Even if they cost twice or ten times as much they would be better because people want to be in their own community. However, the icing on the cake is that they do not cost more but are cost effective. There should be a St. Brendan's Village in every town and village in Ireland.
When I came to Mulrany as a general practitioner I discovered people needed to see me more as a person than as a doctor. There is a lot of loneliness and depression in our country. As the Minister pointed out, in eight years time the population over 65 years of age will have increased by 25%. That is a lot of people. What will we do with them? They should be supported in their own community because that is the right thing to do. It is also cost effective to do so. Money is the god but it can be done. In St. Brendan's Village, not alone have we stopped the sad side of migration of older people to institutions but we have reversed it and brought people back into the community. We went into institutions and found the people from our area and brought them back into the community. These were people who could not otherwise have left the institution because there was no place for them to go.
The inspector is right in saying that the vast majority of these people should be at home in their own community. If there was a St. Brendan's Village there would be a place for them. It is said that doing something that is right brings a spin-off. St. Brendan's Village is the biggest employer in our village, employing 65 people, 25 of whom are on community employment. It is a powerful economic regenerator and should be supported. We get some support through the health board from the Department of Health and Children. However, we are red circled or ring-fenced in that there is no defined revenue funding scheme. This is something that should be brought to Cabinet. There should be a defined revenue funding scheme.
Supporting people in their own community makes a lot more sense and is a lot more cost effective than putting people up in profit driven non-community nursing homes. It is a win-win situation. If the Government continues to support disability as it should, children too will not have to be incarcerated in institutions but can be supported in their community. It makes sense to support people in their community and to give them the supports they need. The real winners will be the people. We are an ageing population and are getting older. Our day will come too. I would much prefer to stay in my own community than to live in an institution where people lose heart and die before their time.
Amnesty recently issued a report, Mental Illness – The Neglected Quarter. My first reaction was one of shock when I heard Amnesty was becoming involved in mental health affairs. I was surprised because I thought Amnesty was a body involved in international issues such as human rights of prisoners, oppressed people, international racism and wars etc. and that one helped the organisation by buying a candle at Christmas. I was unaware of the rules change within the past two years.
I welcome the involvement of Amnesty. In a short time it has managed to do some things on which it must be complimented. It has attracted major media attention to mental health issues and has brought these issues to the forefront in Ireland. It has also issued seven recommendations to the Government. We hope Amnesty will continue to monitor these recommendations over the coming years.
In the past we had an Inspector of Mental Hospitals who was meant to be the champion of patients' rights and was meant to safeguard them. His role meant he should call unannounced to each hospital at least once a year. However, his visit was always well signposted, as I know from experience of working in those hospitals for several years, and it was natural that staff always made sure to put their best foot forward. This may have harmed the situation, and the inspector should have conducted his visits as they were meant to be conducted. Inevitably, after each visit the inspector produced a policy for each hospital. This meant there were 29 or 30 different policies across the country. This did not make sense at all because under his nose in Cavan-Monaghan we had the template for a successful community home-based treatment team that is the envy of countries across Europe. I could never understand why the inspector did not put this template forward as a policy to which each of the hospitals could aspire. Much good work has been done. Our template should be pushed forward. I hope the new inspector of health services will take on board such things and have one policy for the country. It is well known that early detection is the key to successful psychiatric treatment. The only way to ensure that is to invest resources in the community. Research has shown that early treatment means less treatment is required and this, in turn, leads to greater success. If we know that early treatment is the best way, it is strange that it has not been implemented. Financial resources are required.
Mention has been made of the halving of health service budgets over the years. This is coupled with the fact this issue should be a part of the school curriculum. For transition year, students should learn about and become involved with mental health projects. Adolescents must be targeted and no student should leave secondary school without knowing about the mental health services and how to access them. They should leave school with the knowledge that if they are ever troubled with suicidal thoughts, their lives are worth one telephone call or a plea for help. This should be driven home at school level.
Having worked in the service for 29 years, there is much more that I would like to say but I am restricted by the five minutes speaking time I have been offered. However, I am delighted to support Deputy Neville's motion.
I wish to share my time with Deputies Kehoe, Coveney and Seán Ryan.
An Leas-Cheann Comhairle
Is that agreed? Agreed.
I congratulate Deputy Neville on the significant amount of work he has put into this issue. No-one in this House, including the Minister, can speak with more credibility on this issue, into which the Deputy has put a great amount of time, much of it without thanks. We are here to debate for the first time on a Private Members' motion the state of mental health services. It is a reflection on all of us that over the years we have allowed this issue to slide. There are no votes in it and it has been neglected.
For this debate, I dug out the last strategic statement on this issue made almost 20 years ago in 1984. There has been nothing but disappointment in the intervening years, if we are honest with ourselves. The high hopes raised in that document of a rapid move to a modern mental health service have not materialised – that is the blunt truth. We have certainly reduced the number of people in in-patient, long-stay psychiatric hospitals – the number has come down from about 12,000 in 1983 to 3,500 to 4,000 at present – but the matching services to balance that reduction in long-stay services have not been developed.
I can illustrate that point by reference to my own patch, that of the Northern Area Health Board on the north side of Dublin. If the criteria set out in the 1984 report had materialised there would be the following: 270 beds in acute hospitals, including Beaumont and the Mater – there are 37; 400 day centre places for people with mental health problems – there are 135, or less than a third; and as many residential places in the community as long-stay beds – we are 370 short of that equality.
A vivid illustration in this regard is the psychiatric unit in Beaumont hospital. In the 1984 document, the psychiatric unit in Beaumont was described as "built". Some 20 years later, it is described as being at the design stage. We have not developed a psychiatric unit in the intervening years. The consequences of this are plain. There are people in inappropriate settings, families struggling to pick up the pieces and vulnerable people falling outside all services and ending up either homeless or in prison – we know from Amnesty International's reports that 40% of homeless people and prisoners have mental health problems, complicating their other needs.
On behalf of the Northern Area Health Board, I today read the report of the Inspector of Mental Hospitals which shows the grim picture that is the reality on Dublin's north side. The Mater Hospital's unit – just 15 beds – is said by the report to be too small to be capable of delivering anything like the service in line with national policy, and it is probably the biggest hospital in the country. Beaumont Hospital, also one of the biggest in the country, has no unit. The report expresses alarm at the lack of clinical psychologists, social workers, occupational therapists and physiotherapists linked to any of the services available in the northern area. This means that the opportunity for rehabilitative services is severely curtailed. It deplores the lack of community services which it describes as severely limited and in bad need of refurbishment where they are in place.
The overall picture is one of well-intentioned staff struggling to cope in a service that is not properly integrated. Admission units are badly designed, units are trying to play conflicting roles, Alzheimer's patients are admitted to psychiatric units, those with intellectual disabilities are still in units designated as psychiatric and seclusion is used in that health board area 4.5 times more than the national average because of the lack of development.
The inspector's report goes further and points up two crucial gaps on the north side of Dublin. First, there is no integrated programme for older people in an area with a severe shortage of nursing homes, psychiatric units and even of ordinary geriatric units to deal with the needs of older people who often end up misplaced in psychiatric units. Second, there is no coherent strategy for dealing with intellectual disability and the report highlights this fact.
Unless we move to a rights-based system – this goes to the core of Deputy Neville's motion – change will never happen. There is no other group of people less able to articulate their needs than those with mental health problems. We must take this on the chin, notwithstanding the reservations of the Department of Finance. We must move to a rights-based system and we should also have a permanent sub-committee of this House which will work with the Inspector of Mental Hospitals to continually and politically highlight these issues. They have been neglected and swept aside and it is time to make a stand. It is a pity the Minister of State, Deputy Tim O'Malley, is not accompanied by his ministerial colleagues who will make the final decisions. This is an important issue raised by a Deputy who is clearly committed to the cause. I hope we will get a decent response from the Government.
I compliment Deputy Neville for his hard work on this issue, which he continuously highlights on behalf of mental health patients across the country. Listening to some of the Fianna Fáil Deputies in this debate, especially the watchdog, Deputy Grealish, one would swear that plenty of money had been provided for the mental health services. However, when I make a representation on behalf of anyone with a mental health disability, I might as well be beating my head off a brick wall. I hope the Minister takes in what Members on this side of the House have said.
The Government has totally neglected the mental health services. Fianna Fáil has been in Government for perhaps 15 of the past 20 years but what has it done in regard to mental health? Can the Minister list the measures taken? Deputy Richard Bruton referred to a 1984 report in respect of which no action has been taken. The Government has chosen to ignore the stress, pain and suffering caused by the scandalous lack of resources put into the mental health services. I hope that all Members, across the House, support Deputy Neville and the Fine Gael motion.
The Amnesty International report on mental health makes for grim reading. It refers to the case of a 22 year old Dublin woman who had to go to the Mater Hospital after trying to commit suicide. She came from a broken family and was defined as homeless, and a home could not be found for her. Despite this, no bed could be found for her in the Mater Hospital or another hospital, a situation which illustrates what is happening to ordinary people.
I compliment the great work of voluntary organisations such as the Simon Community and similar organisations. A psychiatric hospital, St. Senan's, is located in my home town of Enniscorthy. Some great work has been carried out there but it is an 18th century building without proper facilities. People over the age of 65 are left there without hope for the future. County Wexford has some fine community houses and this provides an opportunity for some of the psychiatric patients to be brought from the psychiatric hospital into the local community. Patients go to the day care centre during the day and are brought back to the community houses in the evenings. This gives them a chance to mix with ordinary people and get involved in a community, whether by getting involved with a voluntary organisation or going to the local shop or pub. However, this is not happening for many people. There are people in St. Senan's Psychiatric Hospital in Enniscorthy who are over 50 years old and have not seen the outside world, because the Government has totally neglected the care of such people by failing to put community houses in place. Some of the Deputies on this side of the House have already referred to the great community houses in their own constituencies, but a great deal more needs to be done. The Government slogan was "A lot done, more to do", but in this situation nothing has been done and there is a great deal to do. I hope the Minister takes on board everything that has been said tonight.
In the past, people in mental institutions called them madhouses. I am not ashamed to say that members of my family had to spend time in these institutions, although they are now back to full health. Years ago, one was afraid to say one had a friend or relative in one of these hospitals, but now it has changed and everything is out in the open. One in four people will be affected by mental illness in his or her lifetime. According to the Simon Community and the Amnesty International report, our mental health care is way behind any other country. I hope the Minister takes on board everything that has been said.
Suicide is an issue which causes a great deal of sensitivity among families and is something that no one wants to see visiting their door. Suicide levels in Enniscorthy town and County Wexford have gone out of control. Since October 2002, some ten people have committed suicide by hanging and drowning in Enniscorthy, and yet the Government has cut the budget for suicide prevention by 40% to €655,000. When the Minister of State sums up, will he explain why his Department has cut suicide prevention funding? It is terrible to see the effects of suicide on any family. I would like to see a comprehensive review of mental health care services in order that people get the care they deserve. We should make sure that all our psychiatric hospitals and units are brought up to standard and that we encourage community housing across the country.
I wish to share time with Deputy Seán Ryan.
Is that agreed? Agreed.
Like other Deputies, I congratulate Deputy Neville on the tireless work he has been doing in the area of mental health and, in particular, suicidal behaviour, since I entered the House four or five years ago, and I am delighted to have the opportunity to speak on this debate.
Consecutive Governments have had a poor record in regard to mental health. The reports which have been referred to by other speakers, including those by Amnesty International, the IPA and the Inspector of Mental Hospitals, indicate that the treatment facilities are, in many cases, in poor condition for people who are suffering from mental health problems.
I am on the psychiatric services committee of the Southern Health Board and have been exposed to many experiences regarding mental health over the past three to four years. There is a clear policy, with which all Members will agree, of a move away from institutional care towards a community care model. The first half of that objective is well on the way to being achieved, in that we are reducing the number of people in institutional care. The problem is, however, that we are not following through on the second half of that commitment, to fill the vacuum which is produced when people leave institutional care by providing support systems in the community.
The reality is that our community care services for people suffering from mental health problems are unco-ordinated and provided on a piecemeal basis. If we are to make the serious decision to attempt to move people out of institutional care, many of whom have been institutionalised over a long period of time, the Government must ensure that the necessary supports are available within the community and from families.
There are a number of target areas in which we could make significant improvements. It is totally unacceptable that children are queuing for child psychiatry services. Not only are they waiting but, in many cases, they are suffering and their condition is deteriorating while they are on a waiting list. It is one thing waiting for a physical operation, it is quite another to have to wait if one has a mental health condition or requires psychiatric treatment or assessment. This is something the Government needs to target specifically.
Many Deputies have mentioned suicide and para-suicide. It is an issue about which there is huge concern in the Southern Health Board region, in particular. An unusually high percentage of the population of Cork and Kerry is affected by suicidal behaviour. Indeed, Kerry has the highest such level in the country. The Government needs to specifically target this area because it has not done so to date.
Members of Young Fine Gael are outside the gates of Leinster House this evening trying to highlight the fact that about 50% of homeless people living on the streets, in shelters or in hostels are suffering from mental illness. We need to get more psychiatrists and psychologists into hostels and on to the streets, to help those people to recover from their mental illness problems. That is the only way to get them off the streets.
I am pleased to have the opportunity to contribute to Fine Gael's Private Members' motion on mental health. I congratulate Deputy Neville for providing us with the opportunity to discuss this important issue.
The mental health service has attracted severe informed and deserved criticism in recent year. To their credit, family members and friends of people with disabilities have become more assertive and critical. It is evident that the political establishment has failed to grasp the nettle of the problems of mental health. Why is that? The answer is that, over the years, the issue was perceived to attract few votes. Expenditure on mental health as a percentage of gross expenditure on the health services has continued to decrease from 13.5% in 1996 to 7.2% in 2001.
Other than meeting the requirements of the Mental Treatment Act 1944, to produce an annual report, what have been the benefits of the reports of the Inspector of Mental Hospitals? It seems to me that it is just another report to be filed away to gather dust. I make this allegation because it seems that, year after year, the same issues are highlighted and recommendations for actions are made, but little progress occurs.
The practice of continued care of patients with intellectual disabilities in long-stay psychiatric facilities is totally inappropriate and, over the years, the inspector has recommended that they be transferred to appropriate accommodation. While acknowledging that some progress has been made, St. Joseph's Association for the Mentally Handicapped in Portrane has been campaigning for years for the provision of two purpose built complexes on the campus. They were first mooted in the mid 1990s and year after year since promises have been made but today not a sod has been turned. Is it any wonder the association found it necessary to bring its case to the European Court?
The inspector, in his report, stated that the admissions unit in St. Ita's Hospital is unsuitable for modern acute psychiatric care even though it has been upgraded considerably in recent years. This highlights the delay in constructing the promised acute unit in Beaumont Hospital – more promises, promises, promises. The report referred to serious deficiencies in the provision of appropriate clinical care for patients, the total absence of social workers, psychologists and occupational therapists and stated that physiotherapy was particularly disappointing. The inspector continued that it was inconceivable that a service for almost 300 people with intellectual disabilities in Portrane would not have a psychologist for clinical assessment purposes and no social worker. Today there is no GP either.
The role of the staff has been acknowledged in a positive way in the report but, as one who lives in Portrane and who has seen the service provided over the years, if it was not for the commitment and dedication of the staff, the lives of the residents would have no meaning. I hope the Minister takes this on board.
I welcome the fact that Fine Gael tabled this motion because it raises important issues about the provision of services to persons with mental illness.
As Minister of State at the Department of Health and Children with special responsibility for children, I would like to focus in particular on the provision of psychiatric services for children and adolescents.
There is a growing awareness and concern throughout the country about mental health matters and the National Health Promotion Strategy, 2000-2005, in conjunction with the health strategy, Quality and Fairness – A Health System for You, sees mental health as being equally as important as physical health.
The promotion of positive mental health can contribute significantly to combating the ignorance and stigma which often surrounds mental illness. Better understanding of mental illness encourages people to access professional help sooner rather than later and this facilitates early recovery. Eventually, with time and education, the stigma associated with mental illness may fade further away, allowing sufferers and their families to participate fully in society in every way.
The development of a comprehensive child and adolescent psychiatric service has been identified as a priority by my Department. I acknowledge that services for this group still require substantial development. However, we have already come a long way since 1997 when there were few child and adolescent psychiatry services available outside the major cities. Now each health board has a minimum of two consultant-led, multi-disciplinary teams. Additional revenue funding of more than €15 million has been provided by my Department since 1997 for child and adolescent psychiatric services. In 2003, additional funding of €1.64 million will be provided to fund the ongoing expansion of child and adolescent psychiatric services.
A working group was established by my Department in June 2000 to review child and adolescent psychiatry provision and to finalise a plan for the further development of this service. The group published its first report in March 2001. The report made a number of recommendations on the expansion of the overall child and adolescent psychiatric service throughout the country. It also recommended that priority should be given to the recruitment of expertise for the completion of existing consultant-led multi-disciplinary teams.
In its first report, the working group also examined the issue of in-patient psychiatric services. It recommended that a total of seven child and adolescent in-patient psychiatric units for children ranging from six to 16 years should be developed throughout the country. At present, four of these child and adolescent psychiatric in-patient units are at the planning stage and project teams have been appointed to oversee their development. These units will be built in Dublin, Cork, Galway and Limerick.
The health strategy includes a commitment to the implementation of the recommendations of the working group's report and the development and expansion of appropriate mental health services for persons aged between 16 and 18 years. In this regard, the working group has just completed its consideration of the provision of psychiatric services for 16 to 18 year olds. Its report on this important issue was formally presented to the Minister of State, Deputy Tim O'Malley, yesterday by the group's chairperson, Dr. Paul McCarthy. I join with the Minister of State in welcoming the findings of this latest report, which recommends that priority should be given to the recruitment in each health board area of a consultant child and adolescent psychiatrist with a special interest in the psychiatric disorders of later adolescence.
The working group is now examining the needs of persons suffering from eating disorders and how appropriate services can be developed in the short, medium and long-term. The group has invited submissions from interested parties on how this problem can be tackled.
As Minister of State with special responsibility for children, it is my intention to ensure that psychiatric services for children and adolescents, both in-patient and community based, will continue to be prioritised in the coming years.
I thank all the Deputies who contributed to this important debate and I stress once again this Government's commitment to the ongoing development of services for those suffering from mental illness.
I would like to deal with one aspect of this issue – suicide. Deputy Neville comprehensively covered mental health issues last night and it is with some trepidation that I stand beside the president of the Irish Society of Suicidology, someone who has devoted a great deal of time to raising this matter, as I speak.
As Deputy Neville stated last night, in the first half of the 1960s, an average of 64 people died per year by suicide. In the last five years, an average of 456 died each year; last year 451 took their own lives and around 10,000 people attempted to do so. The situation is catastrophic. We in politics must offer hope in society. That hope will only come about if we talk about responsibilities as well as rights. Those of us who can should take responsibility because none of us knows the hour or the day one of our families will need the assistance of which I am speaking.
The decline in religious practice and spiritual leadership has made a contribution to this state of affairs. I would like to see the churches being kept open. If the new Archbishop of Dublin should do anything, he should set about making sure the churches are kept open because they are places of solace for many people. The church should not be one of fear but of hope, and not just the Catholic Church but churches generally. By promoting hope through religious belief, many people might overcome their despair.
In my constituency, a close friend lost two of his sons to suicide. I know a family where three sons committed suicide and the fourth is suicidal. It is a complicated issue but it is real nonetheless. In raising this issue, I will quote from Patricia Redlich in the Sunday Independent on 8 June:
Suicide is an act of despair. We do understand that desperation fuels the self destruction. . . . The circumstances of every suicide are always personal, different, unique to the person involved, and very often heartbroken parents, family and friends search in vain for reasons. . . . Boys are uniquely isolated growing up. It is an almost in-built part of being a teenage male in our society. Kissing and hugging stops at around ten, or 12 if they are terribly lucky – not because parents are careless but because the boys retreat. And thus they are condemned to be without hugs throughout the frightening process of growing up. Nor are there many words for boys are truly terrified of seeming soft or silly to their friends. So they worry and struggle alone.
Our modern talky-feely society doesn't sit easily with boys either. They are simply less skilled verbally than girls, biologically programmed for action rather than words to put it somewhat provocatively. If they don't feel quite like aliens, they certainly feel seriously one-down, in our world where women seem so at ease. And, no, this is not a nasty side-swipe at feminism. A man's role is now more difficult to define and consists of skills not easily learned while growing up.
I suggest to the Minister and the Minister of State at the Department of Health and Children that they read that article and take on board the whole teaching process in relationships and sexuality where there is a serious problem. So far as the article refers, the issue has to do with young men, not so much young women although it affects them as well. This is a serious issue and Patricia Redlich has touched on a matter about which we as legislators could do something if we set about it. Perhaps the Minister and the Minister of State with responsibility for children would meet Patricia Redlich and try to see how our system of education could take on board the concerns she has raised.
The great dawn for improved psychiatric services for persons with mental illness, which I recall was heralded in over 30 years ago in Planning for the Future, was an imaginative step at that time. Unfortunately what was proposed did not materialise to the degree planned. There is no point in saying nothing has happened, as great progress has been made in some areas. I pay tribute to my colleague, Deputy Neville, for the time and effort he has put into this subject both inside and outside the House. In an assembly such as this we are lucky to have somebody who takes such a great interest in the subject.
On a night like this we have to evaluate some of the tried and tested programmes which operated in every town and village in Ireland, including my own place in Mountbellew where there are three community houses. We live within the shadow of St. Bridget's Hospital in Ballinasloe. I remember a time when there were 1,200 patients in that hospital but I understand the number is now about 200. We were able to prove that dignity and self-respect could be restored to those who were locked behind high walls for half a generation. I see them walking around in the towns and villages of rural Ireland. They are able to take their place on some of the FÁS schemes and do their shopping with the help of a house parent who looks after what they cannot do themselves.
The most wonderful part of this is that they are totally accepted by the local community. There is no barrier. There have been objections to refugee groups, etc., but never in my 25 years in politics have I witnessed objections to persons with mental handicap. Given that much progress has been made why is it that many of the 4,000 who are still in prison and are well able to look after themselves have not had their dignity and self-respect restored to them? That is the major question for the Minister and the Government.
Like my colleagues I receive hundreds of representations from persons, parents and carers of mentally-handicapped children every day. They are highly motivated groups who want rights-based legislation and want to ensure their sons and daughters have the same access to education and medical services as the rest of us. That is what they want and are entitled to. It is also what the people of Ireland want for them. However, it is difficult to know where the Government stands on the issue. It sidesteps the issue every time it is raised here.
There are two sides to this issue. We were able to prove that community-based activities work. Therefore, one is not inventing the wheel in that area. We believe it is a question of resources. For those who cannot be accommodated, and there are many, including the seriously disturbed, surely in this day and age they cannot be in the old mental hospital style atmosphere. Over the past 25 years, every Inspector of Mental Hospitals has said animals should not be put into most of them. Were it not for the consideration of consultants, psychiatric nurses and administrative staff in many of those hospitals the system would have broken down years ago. If we believe in the dignity of human life we know what to do. What is stopping us is that the Minister is not allocating Exchequer funding to the sector.
I thank all those who contributed to what was a positive and constructive debate. I should not single out Deputy Grealish but I was disappointed and he was the exception to the tone of the debate.
I pay tribute to the leader of Fine Gael and the Fine Gael Front Bench for taking on board this issue when I submitted it to them and for the encouragement they gave me. Mental health has been described as the Cinderella of the health service and there is no doubt about that. The Minister would accept that. The Minister of State present is not responsible for all that has happened as it has happened over decades. The Minister responsible in this Government has a duty to do something about it.
Over 15 years the Exchequer contribution to mental health services has fallen from 12% to 7.2% of the health budget. That is a halving of the health budget which mental health services had 15 years ago. One may speak about advocates but nobody here is parading about mental health because of the stigma surrounding it and people do not want to speak about it. In some ways they are afraid to visit the subject. We must realise that of the 4 million people in the State, 1 million will suffer from a psychiatric condition at some stage in their lives, needing intervention. Sometimes they do not obtain the intervention for some of the reasons mentioned and sometimes they do not recognise the need for intervention.
In many of the cases to which Deputy Gay Mitchell referred, young people do not recognise that they suffer from depression. They feel it is despair, they are under pressure but they do not recognise it is depression, needing treatment. The Minister spoke about advocacy and I welcome that. It is important because I know of a real situation in the psychiatric unit of a general hospital where if a patient asks for a second opinion he or she is transferred out of that service to the long-stay hospital where there are no psychological or counselling services. He or she is almost punished. The reason given is that the patient was difficult, displayed unmanageable conduct and was unreasonable because of the request for a second opinion. The advocacy issue is very important. Amnesty International has raised eight issues, each one of which deserves a Private Members' debate.
In the area of psychiatry there are brilliant psychiatrists but there are also bad psychiatrists. The whole area of how the psychiatric service is delivered must be examined. Everybody is afraid to question a psychiatrist. They feel they have knowledge that is incomprehensible to most of us. There is a problem with the delivery of psychiatry in Ireland that should be examined. I have a great deal of contact with brilliant psychiatrists through my role as president of the Irish Association of Suicidology. They are on my board. Our chairman, our secretary and our outgoing chairman were, respectively, two professors of psychiatry and a consultant psychiatrist. They are excellent people as is Professor Malone, who also sits on our board. People who do not sit on our board such as Professor Patricia Casey and Dr. Anthony Clare are also brilliant people. There is a problem and it should be examined.
It is worth quoting Dr. Anthony Clare's point that the mentally ill are now the most systematically stigmatised group in our society. They are the true lepers of today. That point reflects fully the state of affairs. The stigma attached to mental illness must be addressed and it is the responsibility of the Government to play a large part in that. We must get people to understand, involve themselves, avail of and demand full and proper psychiatric services of the Government. Unfortunately, until the people demand it, the Government will not react.
The Minister referred to the suicide research group. To correct the record, I do not think there is such a group as there is a lack of research carried out in this country. There is a suicide review group which simply reviews what is happening. Perhaps we will discuss that in the future. The review group is a cover for the Government doing nothing.
Amendment put.
Tá
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Ahern, Michael.Ahern, Noel.Ardagh, Seán.Aylward, Liam.Blaney, Niall.Brady, Johnny.Brady, Martin.Brennan, Seamus.Browne, John.Callanan, Joe.Callely, Ivor.Carty, John.Cassidy, Donie.Collins, Michael.Cooper-Flynn, Beverley.Coughlan, Mary.Cowen, Brian.Cregan, John.Curran, John.Davern, Noel.de Valera, Síle.Dempsey, Tony.Dennehy, John.Devins, Jimmy.Ellis, John.Finneran, Michael.Fitzpatrick, Dermot.Fleming, Seán.Gallagher, Pat The Cope.Glennon, Jim.Grealish, Noel.Hanafin, Mary.Haughey, Seán.Hoctor, Máire.Jacob, Joe. |
Keaveney, Cecilia.Kelleher, Billy.Kelly, Peter.Killeen, Tony.Kirk, Seamus.Kitt, Tom.Lenihan, Brian.Lenihan, Conor.McDaid, James.McDowell, Michael.McGuinness, John.Martin, Micheál.Moloney, John.Moynihan, Donal.Mulcahy, Michael.Nolan, M.J.Ó Cuív, Éamon.Ó Fearghaíl, Seán.O'Connor, Charlie.O'Dea, Willie.O'Donnell, Liz.O'Donovan, Denis.O'Flynn, Noel.O'Keeffe, Ned.O'Malley, Fiona.O'Malley, Tim.Power, Peter.Power, Seán.Sexton, Mae.Smith, Brendan.Smith, Michael.Wallace, Dan.Wallace, Mary.Wilkinson, Ollie.Woods, Michael. |
Níl
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Allen, Bernard.Breen, Pat.Broughan, Thomas P.Bruton, Richard. |
Burton, Joan.Connaughton, Paul.Connolly, Paudge. Costello, Joe. |
Níl–continued
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Coveney, Simon.Cowley, Jerry.Crowe, Seán.Cuffe, Ciarán.Deasy, John.English, Damien.Enright, Olwyn.Gilmore, Eamon.Gogarty, Paul.Gregory, Tony.Harkin, Marian.Higgins, Joe.Higgins, Michael D.Hogan, Phil.Howlin, Brendan.Kehoe, Paul.Kenny, Enda.Lynch, Kathleen.McCormack, Padraic.McHugh, Paddy.McManus, Liz.Mitchell, Gay. |
Mitchell, Olivia.Morgan, Arthur.Moynihan-Cronin, Breeda.Murphy, Gerard.Neville, Dan.Ó Caoláin, Caoimhghín.Ó Snodaigh, Aengus.O'Keeffe, Jim.O'Shea, Brian.O'Sullivan, Jan.Pattison, Seamus.Penrose, Willie.Perry, John.Rabbitte, Pat.Ring, Michael.Ryan, Eamon.Ryan, Seán.Sargent, Trevor.Sherlock, Joe.Stagg, Emmet.Upton, Mary.Wall, Jack. |
Tellers: Tá: Deputies Hanafin and Kelleher; Níl: Deputies Kehoe and Stagg.
Amendment declared carried.
Motion, as amended, put and declared carried.