I welcome the opportunity to raise this issue on the Adjournment. The report of the inspector of mental hospitals for the year ending 31 December 2003 highlights the Government's lack of attention and interest in the psychiatric services. The report is distressing reading and is a catalogue of failure on the part of the Minister for Health and Children to deal with issues raised over the years by the inspectorate.
The inspector expressed his concerns over the contrasting conditions between private and public accommodation. He pointed to the sharp contrast between private hospitals and, for example, the Victorian realities of ward one at St. Brigid's Hospital, Ballinasloe. He stated that the contrast between the new admission ward at St. Patrick's Hospital and the acute admission ward in St. Brendan's Hospital a few yards across the River Liffey could hardly have been more striking and highlighted current inequalities in the provisions for different social groups. The inspector highlighted the reduction in non-capital funding for psychiatric services from 13% in 1988 to under 7% in 2003. He also contrasted this with 1960-61 when 21.8% of the total health budget was allocated to the psychiatric services.
This outlines the failure of the health service to apply the moneys which were made available from the reduction of numbers in psychiatric hospitals to community psychiatric services and the absorption of budgets previously applied to the health services into the Government coffers for other uses. This is one of the biggest scandals with regard to the apportioning of moneys over the years. I would be grateful if the Minister were to address the inspector's views regarding the unacceptable care and treatment of patients because of unsatisfactory conditions in the following hospitals: most of the Central Mental Hospital, St. Brendan's Hospital, the old buildings at St. Brigid's Hospital, Ballinasloe, long stay wards in St. Finnan's Hospital, Killarney, St. Enda's and the current female admission ward in St. Loman's, Mullingar, the admission wards of St. Ita's Hospital, Portrane, the female admission ward to St. Senan's Hospital, Enniscorthy, Vergemount Clinic, Dublin, consulting care wards in St. Luke's Hospital, Clonmel, and wards in St. Joseph's Hospital, Limerick. The failure to provide safe observation facilities at St. James's Hospital, Dublin, and Limerick Regional Hospital was recently raised. An independent study recently found that this was linked to the death of a student by suicide in 2002.
The inspector raised the stopgap arrangements put in place in St. Loman's Hospital, Mullingar, with the refurbishment at considerable cost of the admission unit when the appropriate response would have been to provide the admission unit in Mullingar General Hospital. The inspectorate was struck by how little rehabilitation took place in community residence and how management was orientated towards continuing rather than decreasing dependency.
Each year the issue of the intellectually disabled in psychiatric hospitals arises. The inspector pointed out that intellectually disabled persons still remain in St. Senan's Hospital, Enniscorthy, St. Luke's Hospital, Clonmel, and St. Brigid's Hospital, Ballinasloe. In some cases such persons were mixed indiscriminately with functionally psychotic patients, some newly admitted. The virtual absence of inpatient residential places for children and adolescents is a serious national shortcoming. The consequences are serious not alone for the services, but they also impinge on adult services as in the case of the acute general adult unit in Limerick Regional Hospital.
In 2003, 19 sudden or unexplained deaths of inpatients occurred in hospital premises or while on leave. All were reported to the coroner and were the subject of post mortems. Of the 19 deaths, 15 were deemed on clinical grounds to be suicide or suspected suicide, eight were males on leave, four without permission and one on accompanied leave visiting an external hospital. Three inpatients died from causes that may have been drug related. One of these was associated with gastrointestinal effects from one of the newly atypical anti-psychotic drugs and the remaining two from sudden cardiac deaths, deemed by the pathologist to have been from cardiac arrhythmia, possibly related to current medication.
The inspectorate was of the view that the use of closed circuit television to monitor patients was a serious invasion of personal privacy and dignity. Will the Minister reflect on this issue as it highlights the difference in approach to those in hospital from general medical conditions and those in hospital from a psychiatric condition? On a number of the inspector's visits patients were observed sitting in lounges or in dormitory areas with little activity. When interviewed they often complained of being bored, especially at weekends when there was nothing to do except smoke and watch television. This should not be allowed to happen in 2004.
