Dáil Éireann díospóireacht -
Tuesday, 4 Nov 2003

Vol. 573 No. 3

Report of Inspector of Mental Hospitals.

Mr. Neville

I welcome the opportunity to raise this important issue with regard to the findings of the inspector of mental hospitals for the year ending 31 December 2002. The inspector has been particularly disappointed at the failure of three psychiatric general hospitals to open as planned in 2002.

I ask the Minister of State to outline the reason an attempt was made to requisition the unit at St. Luke's Hospital, Kilkenny, designed and funded for acute in-patient psychiatric services for short-term usage for medical beds. The inspector has stated that he does not fully understand the reason this has not been opened and I ask the Minister of State to outline the position.

Will the Minister of State also outline why, on completion of a unit in Portlaoise General Hospital for psychiatric patients mid-way through last year, it was taken over for other purposes for what was termed "a limited period" but which has run into 2003? Although ready and handed over, the unit in Castlebar Regional Hospital was likewise not opened in 2002. These are issues of serious neglect in the promised commitment to improve facilities for psychiatric patients.

The inspector again raised inequalities in the delivery of mental health services. The report outlines that psychiatric resources, rather than being concentrated in areas of greatest need, have been developed in areas of greatest affluence. The absence of an up-to-date national mental health strategy for services development is one of the main causes of the current inequalities in resource distribution.

There is no national strategy, which has led to a situation where there is very limited availability of specialist services. There is an urgent need for forward planning of mental health services to avoid ad hoc and inequitable resource distribution, as highlighted by the inspector of mental hospitals.

The health service's neglect of long-stay psychiatric patients, in ensuring their rights and treatment, must be addressed as a matter of urgency. Why, for example, do long-stay patients not participate in the BreastCheck programme in areas where these services have already become available to the general public? Why do some medical consultants refuse to admit patients to beds unless a psychiatric nurse accompanies them from their parent hospital, even though, as the inspector has stated, this is completely unnecessary clinically?

It is not acceptable that the intellectually disabled and others from mental institutions who have difficulties in feeding themselves, and who have been transferred to a general hospital, are subject to the food being delivered through the stomach wall by a tube because general hospital staff consider they do not have time to spoon feed such dependent and disabled patients. Some of these have returned to their psychiatric locations with the tube mechanism still in place. These examples of neglect of the psychiatric health services are an affront to the personal dignity of psychiatric patients and should not be tolerated in our society.

One of the central difficulties facing the mentally ill and those tasked with providing for them is the fact that many have become homeless. Homelessness leads to a rupture of contact with services, to petty criminality, contact with law enforcement agencies and, apart from damage to the patients themselves, it gives community care a bad name. With the increase of mobility of young persons and greater co-morbidity of major mental illness with substance abuse, the numbers of mentally ill people who are homeless has increased. It is of vital importance that this problem is tackled on two main fronts by providing housing and by outreach services from psychiatry working in concert and other relevant agencies.

Reports of the inspector of mental hospitals over the years have highlighted the total unacceptability of placing intellectually disabled persons in psychiatric hospitals. It is a disgrace that this practice is still continuing. The practice of continued care of intellectually disabled patients in long-stay psychiatric facilities is inappropriate and the inspector's reports over the years have recommended their transfer to appropriate services to enable them to obtain the skilled and specialised care not generally available in psychiatric hospitals. It is still extremely disappointing that the most recent report continued to express concern about this situation.

The inspectorate remains deeply unhappy with the general level of documentary recording in our mental health institutions. Case record structures are extremely poor. Records are disorganised and fundamental information is often missing. It is often impossible to ascertain the date of a patient's admission to or discharge from in-patient care or to determine from the case notes the patient's legal status.

There were 13 suicides or suspected suicides during 2002, of which nine were in hospital grounds. Three were by patients who were on unauthorised leave and one by a person on patient leave. There is extreme concern about this issue in our area. One of those suicides was by hanging and it happened in September last year. It requires immediate investigation. A young man died by hanging in the same unit on 25 October this year.

Mr. T. O'Malley

I thank Deputy Neville for raising this matter on the Adjournment. I welcome the publication of the 2002 report of the inspector of mental hospitals and acknowledge the important role the inspector plays in providing an accurate and detailed account of services in the mental health sector throughout the country. The inspector has had a remarkable influence on improving the standards of care in our mental health services.

In his report the inspector is complimentary of the developments in mental health care in all health boards and highlights the many improve ments which have taken place in the care of the mentally ill in recent years. At the same time the inspector provides an indication of the nature of the problems still to be overcome. I met the inspector recently to discuss his report and to elicit his views about the areas of the mental health services that require improvement. The inspector informed me that steady progress is being made across the country in the move towards an integrated, community-based mental health service, but that much remains to be done.

In his report the inspector refers to the ongoing replacement of old institutional mental hospitals with acute psychiatric units attached to general hospitals. He expresses disappointment at the failure of the newly constructed psychiatric units at Portlaoise General Hospital and Castlebar Regional Hospital to open as planned in 2002. However, I am pleased to inform the House that both of these units will open shortly. I also inform Deputy Neville that the unit in Kilkenny has already been opened this year. The construction of the new acute psychiatric units at James Connolly Memorial Hospital, Blanchardstown and at St. Vincent's Hospital is also nearing completion.

I remind Deputy Neville that industrial relations problems play an important part in terms of opening such units. Industrial relations issues have also delayed the movement of patients from the old institutions into the community, as recommended by the inspector. Given that the Deputy is aware of such issues, I ask him to support the Department in trying to expedite the process.

Mr. Neville

Industrial relations are the responsibility of human resources management.

Mr. T. O'Malley

Perhaps Deputy Neville is not aware that the two unions involved in the negotiations in the Mid-Western Health Board area recommended the proposals to their members, but they rejected them.

Mr. Neville

Staff management is the responsibility of management.

Mr. T. O'Malley

The health board was willing to accept the recommendations. Consequently, 37 patients in St. Joseph's Hospital in Limerick have been unable to move out into the community for the past two or three years.

The inspector also welcomed the considerable reinforcement of various sub-specialties within psychiatry with the appointment of additional consultants in later life psychiatry, child and adolescent psychiatry, forensic psychiatry, rehabilitation psychiatry and liaison psychiatry in general hospitals. It is my intention to facilitate the service providers in bringing about the improvements and developments identified by the inspector as quickly as possible. Additional revenue funding of €7.6 million was provided this year for ongoing developments in mental health services.

The inspector welcomed the establishment of the Mental Health Commission in April 2002. The commission will be the main vehicle for the implementation of the provisions of the new Mental Health Act 2001. It is an independent statutory body whose primary functions are to promote, foster and encourage the establishment and maintenance of high standards and good practices in the delivery of mental health services and to protect the interests of people who are detained for psychiatric care and treatment. The commission will arrange for an independent review by a mental health tribunal of all decisions to detain a patient on an involuntary basis and each decision to extend the duration of such detentions. The commission's independent status will be crucial in driving the agenda for change and modernisation in the mental health services in the coming years.

In his 2002 report the inspector of mental hospitals notes the continuing decline in the number of patients in psychiatric in-patient facilities from 4,256 at the end of 2001 to 3,966 at the end of 2002. Approximately 11% of all admissions to psychiatric hospitals and units in 2002 were involuntary admissions. Ireland has a significantly higher rate of involuntary admission than other European countries. However, it is anticipated that the full implementation of the Mental Health Act 2001, with its more stringent procedures for involuntary detention, will significantly reduce the number of involuntary admissions, bringing practice in this country more into line with the rest of Europe.

I assure the Deputy that while I am pleased with the scale of the progress being made in many of the services, I concur with the inspector's view that much remains to be done in providing a service which will enhance the quality of care of those suffering from mental illness. I am fully committed to endeavouring that the recommendations made in the inspector's report for 2002 are followed up as soon as possible.