Adjournment Debate.

Mental Health Services.

Mr. Neville

I intend to discuss the recommendations of the report of the expert group on mental health policy, A Vision for Change. I thank the Ceann Comhairle for allowing me the opportunity to debate this important report and welcome the participation of my colleague, the Minister of State at the Department of Health and Children, Deputy Tim O'Malley.

A comparison between these latest recommendations and the 1984 report on psychiatric services, Planning for the Future, reveals little progress and raises questions about our attitudes towards improving the treatment of mentally ill people. It is depressing that a report dating from more than 20 years ago contains so many of the recommendations made by the most recent expert group. While this does not undermine the validity of those recommendations, it reveals how little progress we have made in terms of the way we treat the mentally ill. All this time, we have been promising to care for this most vulnerable group in their communities but progress has been painfully slow. How many other sectors in these modern and fast-paced times measure milestones in decades rather than years?

The Government proposes that its new plan will be effected incrementally over ten years, with funding from the sale of 15 mental hospitals to provide the necessary structures at community level. Why should the desperate need of the mental health sector depend on its ability to raise its own finances? Other areas of need are not treated in that way. By all means, let the Government raise money where possible from the sale of institutions but why should vital recommendations wait until this is complete before they are implemented when the money could be made available immediately?

It is a poor reflection on our society that our economy is in rude health, yet we still fail to act on behalf of the mentally ill. The disappointing proposal to increase the percentage of the health spend for mental health services from 6.98% to 8.24%, which the Minister of State has endorsed, compares unfavourably with other countries. For example, the comparable spend in England is 12% and is 18% in Scotland. For that matter, the recommendation falls far short of Ireland's mental health spend in 1997, which was 11% of total health expenditure.

There are inescapable doubts about the ability and commitment of the Government to deliver on the changes that the mental health sector so desperately needs. After knowing for 20 years the essential requirements of the mental health service, I have little confidence that the recommendations of this report will be implemented by this Government. I want to know how many sales have been completed since last March, when the Minister of State announced the sale of mental health service property to facilitate expenditure on psychiatric care.

It is unacceptable that there is a serious dearth of suitable community-based facilities for the delivery of high quality care. This not only applies to community mental health centres but also to day and hospital accommodation and community residences. Specialised mental health services are lacking and the neglect of young and old people with difficulties and of those with intellectual disabilities reflects badly on the Government.

Outpatient services for those suffering from mental or emotional illnesses are not being determined by need but by available resources. An integrated model of care should be introduced to address the broad needs of service users, including biological, psychological and social aspects of presenting disorders. Emotional aspects of mental disorder have been neglected, as has the disruption this can cause to sufferers' social and occupational functions. We did not need this report to inform us that there is a major scarcity of psychological therapists dealing with mental illness and the re-establishment of healthy supportive relationships. Some 22 years after the publication of the report, Planning for the Future, there are serious shortcomings in existing services for people with severe and enduring mental illness. At present, there are only five specialist rehabilitation teams in the country, none of which has the full range and number of staff required. Only two rehabilitation community mental health therapy centres have sufficient staffing.

For many years, I have witnessed the exclusion by the psychiatric service of families involved in the recovery and care for loved ones. The family of people with severe mental illnesses carry significant burdens of care but this goes unrecognised. There is a need to provide families and carers with support, information and, when needed, accessible help. The instant response by specialists to more than 90% of queries on the conditions of loved ones is that the matter is confidential and cannot be discussed with families. This contrasts with other areas, where the involvement of families and loved ones is welcomed by specialists.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

I thank Deputy Neville for raising this matter.

I welcome the publication of A Vision for Change, which outlines an exciting vision of the future for mental health services and sets out a framework for action to achieve it over the next seven to ten years. The report has been accepted by Government as the basis for the future development of mental health policy.

I established the expert group on mental health policy in August 2003 in recognition of the need to review long-standing policy in this area and to formulate a blueprint for a modern, comprehensive, world class service to meet the mental health challenges facing our society.

The group's report is the first comprehensive review of mental health policy since Planning for the Future was published in 1984. The expert group was chaired by Professor Joyce O'Connor, President of the National College of Ireland, and consisted of 18 widely experienced people drawn from a range of backgrounds within the mental health services.

Wide-ranging consultation took place throughout the country in the development of this policy, drawing on the experience, perspectives and ideas of key stakeholders, interested agencies and concerned individuals. The findings from the consultation process provide a very clear indication of service users' views on the current state of the mental health services and how they should be developed in the future.

The report proposes a holistic view of mental illness and recommends an integrated multidisciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems. It proposes a person-centred treatment approach which addresses each of these elements through an integrated care plan, reflecting best practice, and agreed with service users and their carers. Special emphasis is given to the need to involve service users, their families and carers at every level of service provision. Interventions should be aimed at maximising recovery from mental illness and building on the resources of service users themselves and within their immediate social networks to allow them to achieve meaningful integration and participation in community life. A Vision for Change recommends that specialist expertise should be provided by community mental health teams — expanded multidisciplinary teams of clinicians who work together to serve the needs of service users across their lifespan. The community mental health teams should serve defined populations and age groups and operate from community-based mental health centres in specific sectors throughout reconfigured mental health catchments areas. These teams should assume responsibility for self-governance and be accountable to all their stakeholders, especially service users, their families and carers. Some of these community mental health teams should be established on a regional or national basis to address the complex mental health needs of specific categories of people who are few in number but who require particular expertise.

A Vision for Change envisions an active, flexible and community-based mental health service where the need for hospital admission will be greatly reduced. This policy will require substantial funding and it is recommended in the report that steps be taken to bring about the closure of all psychiatric hospitals and to re-invest the resources released by these closures in the mental health service.

The closure of large mental hospitals and the move to modern units attached to general hospitals, together with the expansion of community services, has been Government policy since the publication of Planning for the Future in 1984. A number of large psychiatric hospitals around the country have already been closed, including Our Lady's in Cork, St. Patrick's in Castlerea, St. Columba's in Sligo, St. Mary's in Castlebar and Our Lady's in Ennis. The re-organisation of services following these closures resulted in more community facilities, new acute psychiatric units in some cases and an overall improvement for service users, their families and carers. The remaining stand-alone psychiatric hospitals cater in the main for long-stay patients, many of whom are over 65 years of age.

The report recommends that a programme of capital and non-capital investment in mental health services adjusted in line with inflation should be implemented in a phased way over the next seven to ten years, in parallel with the proposed reorganisation of mental health services. The proposed new workforce will comprise more than 11,000 staff throughout the service. Allowing for the assimilation of all existing posts, the expert group has estimated that a total of 1,803 new posts across the service, together with a total non-capital investment of €151 million per annum in addition to existing funding are required.

Due to the current non-availability of certain health professionals, investment will be required on an incremental basis, resulting in a proposed non-capital investment of an additional €21.6 million each year for the next seven years. An additional €25 million has been allocated to the HSE for mental health services in 2006 and it is hoped to continue this level of investment in the coming years.

Significant capital investment is also required to provide and equip the proposed new mental health infrastructure. The report estimates that €796 million will be required. There are, however, substantial capital assets in the existing psychiatric hospital buildings and lands which could be released to fund the capital investment required.

Rape Crisis Centres.

Ms B. Moynihan-Cronin

I thank the Ceann Comhairle for giving me the opportunity to raise this important issue.

Violence against women is extensive, pervasive and ongoing. Frontline services including rape crisis centres, refuges and support services are operating at a funding level, capped since 2002, which can only be described as severely inadequate to meet current needs. Such services were operating on a resource deficit in 2003 and the subsequent cap in funding occurred alongside increased demands for service delivery and new research which highlighted populations of victims who are not seeking help from dedicated support agencies. Various NGOs have recommended that current investment on dedicated, frontline responses to violence against women be increased by €7 million. This allocation should be ring-fenced for frontline service responses and their national bodies. Funding arrangements must also improve to alleviate the worst effects of the current inefficiencies.

Currently there are 40 locally based responses to domestic violence and 16 rape crisis centres. In June 2004, members of national networks were surveyed on direct State funding in 2003 and a total of 51 frontline services responded. Three quarters of all frontline service providers indicated there was no change to the level of funding they received from statutory sources in 2003 compared with 2002 and there has been no increase since then. Service providers described their inability to meet existing demand and pointed out that being overstretched automatically prevented them developing their services, particularly with regard to inaccessibility for certain populations. Service providers have not been able to deal with staff pay increases, the absence of pension provision, training of new volunteers and even applications from prospective volunteers. Service providers described cutting back key service areas, such as help line cover, which automatically reduces the accessibility of the service for existing and new clients.

Investment is urgently needed in this vital service. An article in the Irish Examiner today states that more than 1,000 women reported rape by a partner in 2004, a figure which clearly indicates the urgency with which this issue must be dealt. At this point, I wish to compliment all those involved in frontline services in rape crisis centres and refuges. The job is difficult and such people are doing magnificent work with very limited resources.

The failure of the Government to provide for a sexual assault treatment unit in Kerry is a very serious matter. Currently, there is only one such unit in the Munster area, in Cork. The need for a unit in Kerry was identified to ensure that victims of rape could be examined in Kerry General Hospital. A dedicated working group was set up, comprising medical staff, gardaí and the staff of the Kerry Rape and Sexual Abuse Centre. A pilot scheme was undertaken in April 2002 and the service operated very successfully, despite having no resources allocated to it by the Government. A total of 60 clients were seen at the unit and supported. A decision was made in September 2004 to contact GPs in the Kerry region, with a view to having trained doctors on an on-call rota to undertake forensic medical examinations. Ten GPs expressed their interest in undertaking the training and being available. The Department of Justice, Equality and Law Reform refunds the costs incurred in forensic examinations but, unfortunately, due to the lack of resources to fund a nursing post and on-call nurses, this initiative did not take place.

The genesis of a service is available but it is functioning at a low level entirely as a result of the lack of funding. Even with the existence of a sexual assault treatment unit in County Kerry, victims in remote parts of the county will have to travel for at least an hour. Victims are now reporting that they may have to travel to Cork for the examination, a six hour round trip. This is an unacceptable burden on those people who have been subjected to the most traumatic experience of rape. They are also required, at their own expense, to return to Cork for any follow-up treatment, which may involve four visits.

Funding was promised to the rape crisis centres but none has been made available for the sexual assault unit in Kerry. This is another broken promise from the Government and once again the most vulnerable are left to suffer.

Mr. T. O’Malley

I will be taking the adjournment on behalf of my colleague, the Tánaiste and Minister for Health and Children. I thank the Deputy for raising this matter.

The national steering committee on violence against women was established following the report of the task force on violence against women in 1997. It is chaired by Deputy Fahey, Minister of State at the Department of Justice, Equality and Law Reform. The Department of Health and Children is represented on the national steering committee, as is the Health Service Executive.

The purpose of the national steering committee is to provide a multi-disciplinary, multi-agency and cohesive response to the problem of violence against women and in so doing to progress the recommendations of the task force. It is representative of a wide range of interests concerned with violence against women and has a number of objectives which include ensuring that regional and local structures are established, developing public awareness campaigns, co-ordinating and advising on the distribution of resources among the health regions and co-ordinating and advising on ongoing development of policies, including those concerning perpetrators, criminal justice intervention, services and supports.

The Government is committed to working with all interested parties, including service providers, and has undertaken a range of measures to reduce the incidence of domestic violence, to respond to the needs of victims and perpetrators and to raise awareness among the public about the dynamics of this crime. These measures can be seen across a wide range of Government policy and include legislative measures, Garda response, health services, national research and treatment programmes for perpetrators.

Funding for service provision is a key indicator of Government commitment to the issue. Funding for service provision for victims is channelled primarily through the Health Service Executive Vote. In addition, other Departments such as Justice, Equality and Law Reform, Education and Science, Social and Family Affairs, Community, Rural and Gaeltacht Affairs and the Environment, Heritage and Local Government contribute to responding to the issue.

Funding in the health sector has risen from approximately €3.8 million in 1997 to approximately €12 million in 2005. This shows the commitment of Government and of the Department to addressing this important issue. The allocation of this funding, including to individual rape crisis centres, is now a matter for the Health Service Executive. The former health boards, now the HSE, worked closely for many years with a range of NGOs, including the rape crisis centres.

The Department of Health and Children will continue to monitor the level of investment in services for victims of sexual offences, including rape. The Tánaiste has asked the Department, together with the Health Service Executive, to undertake an analysis of the current level of service provision in this area with a view to planning future service needs. The Tánaiste has recently received this report and my Department will meet the HSE in this regard.

Recently the Tánaiste received a delegation of the relevant violence against women organisations operating dedicated frontline service responses to violence against women. The Tánaiste is considering the report presented to her at that meeting.

In keeping with the recommendations of the task force on violence against women, the HSE works through the regional planning committees to determine the needs of their localities and to co-ordinate statutory and voluntary approaches to these needs. The Health Service Executive is exploring the possibility of co-ordinating funding streams and the development of a more unified structure for violence against women services.

Hospital Services.

Mr. M. Smith

I wish to share time with Deputy Hoctor.

Since 1997 there have been significant developments in the county hospital in Nenagh, including the appointment of a range of consultants, nursing and other staff, the refurbishment and extension of the hospital and the building of a one-stop shop to incorporate a range of administrative and other services.

We are now on the cusp of a major extension that will include the accident and emergency department, laboratory and x-ray facilities. We are asking that the x-ray facility, housing the CT scanner so essential for the development of services in the hospital, be included in the overall contract. As the project was planned, the x-ray facility was an integral part of the facilities and we urge the Minister of State to respond in a positive way to the final stage of a significant development for the hospital.

Ms Hoctor

I endorse the comments of my colleague, Deputy Michael Smith. In September 2004, the then Minister for Health and Children, Deputy Martin, approved €2.2 million for the extension to the accident and emergency department, laboratory and radiology department at Nenagh hospital. This was to address the deficits and build on the strengths identified in the Hanly report for the future of the hospital, which was one of the pilot project hospitals in the report of the task force. Planning and tender were approved.

For some reason, however, we have learned the development is to go ahead without the extension to the x-ray department. We are here this evening to make it known to the Minister and the Department that we will not accept this. The accident and emergency, pathology and radiology departments are interdependent. Radiology is in need of expansion, no more than the accident and emergency department and the laboratory.

A CT scanner is also needed. The Minister of State knows of the logjam at the regional hospital in Limerick. If we secure a CT scanner as part of the radiology extension, we will be able to perform x-rays that would normally be sent to Limerick with accompanying medical and nursing staff. If our package goes ahead as originally approved by the Minister for Health and Children in 2004 we will be able to conduct those services under the one roof at Nenagh hospital.

If radiology is discommoded, the extensions to the accident and emergency department and to the laboratory will be less productive. Savings in costs from not sending patients to Limerick will be to the financial benefit of the hospital and to those who avail of the services.

I call on the Minister to address the urgent need for the approval of all parts of the extension for Nenagh hospital. It is essential approval is granted when we consider the growing population of north Tipperary, with people from as far as Littleton, Upperchurch, Redwood and Lorrha availing of the services at the hospital.

If we are to see reform in the health service, it is only right that Nenagh hospital should be a pilot project. Management had the courage to undertake the project following the Hanly report and should now get its just reward. We are not looking for anything extra, simply for what was agreed last year, the extensions to the accident and emergency department, the laboratory and radiology department.

Mr. T. O’Malley

I will take this matter on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. I thank Deputies Michael Smith and Hoctor for raising this matter as it provides me with an opportunity to outline to the House the Government's commitment to the continued development of services at Nenagh General Hospital and continued provision of high quality, safe acute hospital services to the people of north Tipperary.

In recent years, funding of €2 million has been provided to facilitate the extension of existing buildings and significant refurbishment of existing facilities. A sum of €750,000 has been spent on the refurbishment and upgrading of mechanical and electrical services and additional ultrasound equipment has been purchased at a cost of €200,000. In addition, space has been protected on the Nenagh campus for the proposed future provision of a geriatric assessment-rehabilitation unit and approval has been given to the development of a health centre-community care headquarters.

The next capital development project at Nenagh hospital comprises an extension to the laboratory, radiology and accident and emergency departments and provision of a CT scanner. The estimated capital cost of this project is in excess of €2 million and the project has been progressed through planning stages. I understand tenders for the work have been sought and I have been informed by the Health Service Executive that approval has been given to proceed with the extension to the accident and emergency department and laboratory. However, the extension of the radiology department and provision of CT scanning will require the provision of additional revenue funding and staffing. It will not be possible to proceed with this aspect of the project until the required additional revenue and staffing can be identified.

In summary, the planning process has commenced for the further development of facilities at Nenagh General Hospital. The national hospitals office will continue to work with the HSE mid-western region to identify the revenue required for the radiology department and CT aspects of this project.

The Government is committed to the continued development of services at Nenagh General Hospital. We have provided for developments at the hospital in the past and are committed to continuing the investment in services at Nenagh. Nenagh General Hospital will continue to play its part in providing services for the people of north Tipperary.

Job Creation.

Mr. Hayes

I thank the Minister for Enterprise, Trade and Employment, Deputy Martin, for coming before the House to listen to Deputy Healy, and I making a case for Carrick-on-Suir. As the Minister will be aware, it was announced today that 42 jobs will be lost in SRAM Ireland, which is located in the town, with a further 11 jobs set to be transferred elsewhere in the region. This is a major blow to the constituency of Tipperary South, specifically Carrick-on-Suir.

In this time of unprecedented prosperity we expect to gain rather than lose jobs. I am concerned about the 42 people who will be left with no work, some of them in as soon as three months' time. I am also disappointed that only 11 jobs will be transferred to SRAM Ireland's new facility in the south east. The company cited competition from the Far East as the reason for the job losses. The Government must step in to protect workers. Towns such as Carrick-on-Suir can be devastated by a closure of a factory, however small. The Government must take a proactive role in protecting jobs in factories when there is a danger of job losses occurring due to competition from countries with lower production costs. In these circumstances, it must actively source alternative employment for workers, particularly in heavily dependent towns such as Carrick-on-Suir. I urge the Minister to take serious measures on behalf of the people of the town and its surrounding areas which have received a devastating blow today.

Mr. Healy

Carrick-on-Suir has been felled by the news that 53 jobs will be lost to the town as a result of the closure of SRAM Ireland. This is a bad blow, particularly as the town already has an unemployment rate of more than 20%, with 890 people on the live register. Carrick-on-Suir is one of six blackspots in the south east identified by the South East Regional Authority. The town's circumstances have been brought to the attention of the Minister and his predecessors. Oireachtas Members and local elected members and officials met the Minister on 19 July last to discuss the issue and I raised the matter with him on 28 September 2005. In view of the job losses announced today, I repeat the request I made at the July meeting that job creation and investment be prioritised for Carrick-on-Suir and a dedicated task force established for the town.

Last September, the Minister indicated that the Department would not fulfil this request and referred to similar circumstances prevailing in other towns. The situation in Carrick-on-Suir is extremely serious and not comparable to that of other towns. As a result of today's developments, the town will have an unemployment rate in excess of 25%, which is almost unique. Carrick-on-Suir must be prioritised for job creation and the only way to do so is to create a task force specifically for the purpose of targeting jobs for the town.

In September 2005 the Minister stated: "I am confident the policies and strategies pursued by the development agencies, together with the ongoing commitment and support from Government, will bear fruit in terms of sustainable additional investment for all the towns in south Tipperary." This has patently not been the case. We need specific strategies for Carrick-on-Suir. We cannot continue to allow more than 20% of the workforce of the town to remain on the live register. It is not good enough that unemployment rates in Carrick-on-Suir have not improved one iota since 1997. I urge the Minister to establish a task force for the town immediately.

Minister for Enterprise, Trade and Employment (Mr. Martin)

I thank the Deputies for raising these matters. As they noted, SRAM Corporation announced to its staff that it would cease operations in Carrick-on-Suir with the loss of 53 permanent and temporary jobs. Some 11 permanent staff will be retained in distribution support activities and finance. This is devastating news for the workers in question and their families and our thoughts are with them.

The company attributed the redundancies to ongoing cost pressures and falling sales. It informed IDA Ireland of its decision earlier in the day. SRAM Corporation intends to end manufacturing production and distribution activities at the Carrick-on-Suir site and transfer the remaining employees, who are involved in support activities, to new offices in Waterford city.

The role of FÁS, the State training agency, will be particularly important in assisting those who are to lose their jobs. The agency will, as a matter of urgency, make contact with the management and staff of the company to outline the support services FÁS can provide, particularly advice and training opportunities for the workforce. Finding alternative employment for the workers affected will be a priority for the State development agencies.

I assure Deputies that IDA Ireland, Enterprise Ireland and FÁS will play their part in developing a way forward. Deputy Healy is correct that there is little point setting up more groups and task forces when there is a uniform response across the country, and in areas where there is significant unemployment in given localities or where redundancies take place, the State agencies which are in place respond in a proactive manner to the issues.

Mr. Healy

Nothing has happened since the Minister met a deputation from Carrick-on-Suir last year.

Mr. Martin

The present IDA Ireland strategy for south Tipperary is to concentrate future economic development in Clonmel by developing the town as a first-class location for overseas investment. This strategy has been agreed with the South Tipperary County Development Board. At a meeting of Carrick-on-Suir Town Council last year the agency's plans for south Tipperary and Waterford city were outlined to the council and the need for Carrick-on-Suir to find a way to link into the economic growth centres of Clonmel and Waterford underlined. This is a key issue. I have stated across the country that people must view their position in a regional context to determine how they can maximise investment in the region.

Mr. Healy

Nearly everyone from Carrick-on-Suir with a job is employed outside the town. We need employment in the town.

Mr. Martin

I want to stress however, that Carrick-on-Suir is not being neglected. I met a delegation from the town council last year and then met with FÁS. The town council specifically brought the FÁS service to my attention and asked us to expand and improve it. Following a meeting with the council the agency agreed to increase its level of engagement with the long-term unemployed in the town. This process, which commenced last October, will continue throughout 2006. While the main focus from the IDA's perspective is on Waterford and Clonmel, there are knock-on benefits in sectors such as supply, distribution and transport thus creating further investment and employment opportunities for people in surrounding areas including Carrick-on-Suir. Carrick-on-Suir can benefit from its close proximity to both Waterford and Clonmel. The largest single IDA job creation project in 2004 was Guidant with a 1,000 job expansion project in Clonmel, which must have a ripple effect across the area.

Mr. Healy

Carrick-on-Suir has the same number of unemployed today as it had 12 months ago. It had no effect.

Mr. Martin

The company will seek to recruit approximately 200 staff per year, both graduates and non-graduates, for the next five years. The development of community based enterprise centres is a crucial part of the drive to create new regional enterprise. Enterprise Ireland provided support of €54,852 in 1998 for the setting up of the enterprise centre in Carrick-on-Suir. This centre has been sold to a private developer and the proceeds of that sale have been invested in a new community resource centre for the town. The community enterprise centre is now incorporated into a state-of the-art resource centre. A high quality training facility is now at the heart of the community enterprise centre and should bring long-term benefits to the town. The unemployment rate for the south east, according to the latest quarterly national household survey, is 6.7%. The latest CSO live register analysis shows that those claiming unemployment benefit in south Tipperary fell to 3,238 in December 2005——

Mr. Healy

What about Carrick-on-Suir?

Mr. Martin

Would the Deputy please listen? That was a fall from 3,411 in December 2004.

Mr. Healy

Is it true that the same number of people are unemployed in Carrick-on-Suir today as 12 months ago?

An Ceann Comhairle

The Minister without interruption.

Mr. Healy

It is a pity he will not tell us the truth.

Mr. Martin

The focus of my Department and its agencies is firmly concentrated on managing this transition of our economy through the use of the best possible blend of policies to strengthen both national and firm-level competitiveness. An integral element of the Government's policies is to encourage enterprises to undertake increased levels of investment and research, to use more technology in product development and to encourage more innovation across all sectors of the economy. This will help firms produce improved value-added products and services. In the longer term this will provide longer lasting and higher quality jobs. I assure the Deputies——

Mr. Healy

That he will do nothing for Carrick-on-Suir. It is the same reply I received four months ago.

Mr. Martin

——that the State development agencies, under the auspices of my Department, will continue to work closely together and with the County Development Board, as well as participating in the special working groups set up in October 2004 by the county manager of Tipperary south to deal with job creation issues in the towns of Carrick-on-Suir and Tipperary. The working group is already established. Should any further co-ordination be required, I consider——

Dáil Éireann díospóireacht - Wednesday, 1 Feb 2006