Dáil Éireann díospóireacht -
Tuesday, 26 Jun 2007

Vol. 637 No. 2

Adjournment Debate.

Mental Health Services.

Deputy Dan Neville

I thank the Ceann Comhairle for selecting the issue of psychiatric services for debate. I feel honoured this is selected as the first matter for an Adjournment debate in the 30th Dáil.

I call on the Government and the Minister for Health and Children to reverse the decision to move the Central Mental Hospital to a site adjacent to the new prison at Thornton Hall in north Dublin. The Government must respect the human rights of people with mental illness. To locate a therapeutic facility for people with mental illness, many of whom have not committed a crime, beside a prison is stigmatising and discriminatory.

Not alone has this proposal been roundly rejected by the families and carers of Central Mental Hospital residents, voluntary organisations, the Mental Health Commission, the clinical director of the Central Mental Hospital and the Human Rights Commission, it also flies in the face of the core values and principles enshrined in the report on mental health services, A Vision for Change, which the Government proposed to accept as its policy.

Central to the treatment process for patients at the Central Mental Hospital is the aim to overcome the stigma arising from criminalisation which, in most cases, is an accidental effect of their mental illnesses. Other key objectives include the rehabilitation and reintegration of patients into mainstream mental health services when it is appropriate and safe to do so. None of these objectives would be helped by placing the Central Mental Hospital adjacent to a large, high-profile prison.

In his letter to the Taoiseach, the clinical director at the hospital stated, "the proposal is about as bad an idea as it is possible to imagine". The director, Dr. Kennedy, is strongly critical of the fact that he was not included in plans to move the Central Mental Hospital and that he only learned of the developments through the media. There is an urgent need for a new hospital to replace the Central Mental Hospital. This has been recognised for a number of years and should have been acted upon at a much earlier stage.

Dr. Kennedy is insistent that the new hospital should be located beside a general hospital. He stated 200 secure psychiatric beds are needed to end the situation in which prisons are used as psychiatric waiting rooms and are equivalent to accident and emergency department trolleys. The case for revisiting this decision made by the previous Government is compelling and I call on the Minister for Health and Children to do so immediately.

One of the key issues which must be dealt with in regard to mental illness is the challenge to de-stigmatise the one in four people who will suffer from such an illness during their lifetime. Those who suffer feel stigmatised by attitudes and views from a time when psychiatry was not as developed as it is today. Society must address its attitude to those who at some stage suffer a psychiatric illness. The siting of the Central Mental Hospital adjacent to the new prison complex reinforces the prejudices and misunderstandings that many people have about mental illness. The stereotyping of mentally ill patients will allow people to continue to discriminate against those who are suffering. We must rise above this approach. The Government must do so by reversing its decision on the siting of the Central Mental Hospital. It should give leadership in attempting to educate people who do not understand the pain of mental illness. Only then will people come forward and begin to admit the pain of their illness and seek solid mainstream help. Then and only then will we demand action from Government to acknowledge the scandal and neglect of the psychiatric services. Until there is a watershed in societal attitude many will hide their illness.

A recognition of the need to change the decision to locate the Central Mental Hospital would play a key role. Until it is acceptable to be mentally ill as it is to be physically ill we, as a society, will not begin to regard the reality of mental illness as part of our human existence. Until our everyday language becomes sensitised to the need to eliminate stigma we will not succeed in addressing the need of those who suffer a mental illness. Anyone can suffer a mental illness. Anyone can die by suicide.

Given the trenchant nature of objections raised by the clinical director of the Central Mental Hospital, Dr. Harry Kennedy, there is a compelling case for the new Government to revisit the decision to site the hospital at Thornton Hall. I urge the Minister and the Government to do so as a matter of urgency.

Minister of State at the Department of Health and Children (Deputy Brendan Smith)

I am replying to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney. I thank Deputy Neville for raising this matter and acknowledge with him the importance of working to prevent suicide and improve mental health. This debate allows an opportunity to outline to the House the plans for the redevelopment of the Central Mental Hospital.

In May 2006, the Government approved the development of a new national forensic mental health facility at Thornton Hall, County Dublin. This decision was consistent with a recommendation outlined in A Vision for Change, the report of the expert group on mental health policy which recommended that the Central Mental Hospital should be replaced or remodelled to allow it to provide care and treatment in a modern, up-to-date, humane setting and the capacity of the Central Mental Hospital should be maximised.

The new hospital will be a separate capital project, independent of the prison complex. It will be managed and directed by the Health Service Executive. The new hospital will be built on its own campus and will retain its identity as a separate, therapeutic health facility. It will have a separate entrance and a different address to the prison complex. The cost of developing the new hospital will be met from the proceeds of the sale of the existing site of the Central Mental Hospital in Dundrum.

The Health Service Executive has established a project team to progress the redevelopment of the Central Mental Hospital. The design of the new hospital will take into account new standards for secure mental health facilities emerging in the UK and Canada. A new governance structure for the hospital is being finalised at present.

The decision to redevelop the Central Mental Hospital is a major step forward in the provision of quality care to prisoners with mental illness. There has been little or no structural change to the main part of the existing hospital since it opened in 1850. With the exception of a small, single-storey block built some 20 years ago, it remains essentially unchanged since it was built. Many of the elements of the building are unsuited to the provision of a modern forensic mental health service. Like other, unsuitable, older psychiatric hospitals, the closure of the existing facility in Dundrum is the correct decision. The Central Mental Hospital is the only centre in the State that provides treatment for mental illness in conditions of medium and maximum security. The majority of admissions to the Central Mental Hospital are from within the Prison Service.

Conditions within the Central Mental Hospital have greatly improved in recent years with increased staffing and an end to the practice of slopping out. Important safeguards for patients have also been introduced by the Criminal Law (Insanity) Act 2006 and the Mental Health Act 2001. The Department of Health and Children and the Health Service Executive continue to strive to improve conditions at the existing facility.

However, the existing hospital facility must be replaced. The report of the Inspector of Mental Health Services stated that the building at the current site is unsuitable for providing an inpatient service. The Council of Europe Committee on the Prevention of Torture which visited the Central Mental Hospital in Dundrum earlier this year was also critical of the current facilities. Building a new hospital on a new site will open up a range of opportunities for the provision of modern treatment and recreational facilities. A purpose-built, modern facility, coupled with the required staffing, will offer the best treatment to people requiring forensic mental health services. I again thank the Deputy for raising this important issue.

Special Educational Needs.

Deputy Mary O’Rourke

I congratulate the Minister on her re-appointment to the Department of Education and Science and thank her for being here for this debate. I welcome the relatively slim paragraph in the programme for Government which mentions the applied behavioural analysis, ABA, method for dealing with autism in young children. I have a particular personal interest in this matter from my family history and have studied it. A very interesting conference was held in Trinity College last weekend the papers from which I received today. They are amazing and very thought-provoking.

The most heart-breaking aspect of autism is that the child has great intelligence potential which is very difficult to unlock and thus it is very difficult for the child to communicate either with other children or with his or her parents. The ABA method of dealing with autism supplies the key for unlocking that potential within the child. Since I opened the Sapling School in Mullingar two years ago I have seen the potential grow within those children. I have seen them flower both at home and at school. It is wrong that we have not given the full accolade to such a method of education. I know of 12 schools that operate on a pilot basis and the programme for Government commits to funding them fully in the long term. I would like the Minister to outline whether they will have permanent status, which will be important for their buildings. There are 12 other schools pending. Will those 12 schools get the funding needed?

We all know of the Ó Cuanacháin case, which is costing so much for everyone. I have met the family to talk about their lovely boy. The change in him is stupendous since he started availing of the ABA method. I hope that is not to be snatched from him. When there is potential, every effort and financial input should be made towards bringing out that potential.

I do not know whether the in-built resistance to the ABA method rests with the Department or the Minister. Knowing the Minister as I do, I do not believe it lies with her. Occasionally we hear reference to the eclectic method, which is a lovely word which can bamboozle if one did not know what it meant. However, I would prefer to see a policy that the ABA method would be facilitated if that is the parents' wish. Those children are precious to their parents and need this method of education to unlock their potential and to attain the status of balanced young adults.

Deputy Jan O’Sullivan

I welcome the opportunity to debate this issue and I am particularly pleased that such a distinguished Government Deputy has also seen fit to raise it. Deputy O'Rourke is a former Minister for Education and Leader of the Seanad. I am also grateful that the Minister is present. I congratulate Deputy O'Rourke on regaining her seat in the House and I also congratulate the Minister on retaining her portfolio.

Deputy Mary O’Rourke

I thank the Deputy and I also congratulate her on retaining her seat.

Deputy Jan O’Sullivan

This gives me hope that we may make progress because there is interest on both sides of the House in this issue. I share Deputy O'Rourke's concern that a blockage is preventing the approval and expansion of ABA schools and that needs to be unblocked. I am disappointed the programme for Government has not provided as much for education as I had hoped. The Minister would have invested as much in the sector without any new partner in Government. I expected more from the Green Party, given the emphasis it put on education in the election campaign and the Government negotiations. I am particularly disappointed the second tranche of 12 ABA schools has not been given any comfort in the programme for Government.

My motion acknowledges that the 12 schools in the current pilot scheme will gain full recognition in time and I hope that will be the case. Deputy O'Rourke has sought clarification on this, given that there are several caveats. I am concerned about the next 12 schools and other schools throughout the State that are experiencing a demand for the ABA method of teaching. Deputy O'Rourke is correct that parents are hugely committed to this method. I do not cast aspersions on the Minister but one has to see ABA in practice to believe it, as I did when I visited the Bluebell school in Limerick city. I accept other methods are available to teach autistic children and the ABA method does not work for all of them but it suits a percentage of children. Parents are willing to go to the ends of the earth to raise money to keep ABA schools going. The school in my constituency receives no Government funding apart from home tuition grants, which are given to most of the children. Their parents will do anything from shaving their heads to holding duck races to raise funds. A local philanthropist who is very kind has also donated money to the school. Parents will do anything for their children, particularly if they have a special need, and they deserve support.

In the long term, these ABA schools will save the State money because approximately 40% of the children who pass through them can enter mainstream schools after a few years of education through the ABA method. One child who attended the Bluebell school in Limerick will enter a mainstream school in September. The child will receive support for the first few months but will be then fully integrated into the school population. ABA is a scientifically based system that has proven its worth. As Deputy O'Rourke stated, it helps children to deal with the world around them because they cannot relate to the world in the way most other children do. They need to learn the behaviour that will allow them to sit in a normal classroom. I have seen children who were taken out of mainstream schools and put into an ABA school before returning to the mainstream school with their behaviour totally changed.

A wide variety of initiatives are in place in the education system and it is argued they are working effectively but they do not provide an adequate solution because we need to understand why parents are willing to fight so hard for ABA schools. This also raises an equality issue. If the 12 schools on the pilot scheme are recognised, why should children in other parts of the State not have the same opportunity and rights as the children attending these schools? I hope minds will be open to this. I am particularly concerned about schools that have been waiting for more than two years for recognition. Every year those involved must raise sufficient funds to keep the schools going. It is all very well if parents can afford to fund the schools but if they cannot, their children are denied their rights. ABA schools facilitate people who cannot afford the fees but, in the long term, affordability is an issue. Whatever about what was just debated regarding a two-tier health service, we cannot allow a two-tier education service to develop, particularly with autistic children, who are so vulnerable. I hope we will have a positive response from the Minister.

Minister for Education and Science (Deputy Mary Hanafin)

I thank Deputies Jan O'Sullivan and Mary O'Rourke for their good wishes on my election and re-appointment. I am very pleased to see both Deputies back, as it is always important to have people in the Chamber who have a genuine interest in and knowledge of education to be able to debate the issues of importance.

It is significant that two of the issues on the first Adjournment debate concern education. That shows the interest held by all sides of the House. The particular topic raised by the Deputies allows me the opportunity to clarify the Government's position on the education of children with autism and the role of applied behavioural analysis, ABA.

We are determined to ensure that all children get the support they need to reach their full potential. I am particularly conscious that the parents of children with special needs are under much pressure and give much dedicated time and commitment to their children. It is also true that the record of the State over decades in providing for children with special needs was very poor and that we are still playing catch-up. However, significant advances have been made in recent years, improving the lives of children with special needs and their families.

There are now in the region of 17,000 adults in our mainstream schools working solely with children with special needs, compared with just a fraction of that number a few years back. As well as providing for very significant increases in staff, we have also improved the procedures for accessing extra support with the establishment of the National Council for Special Education. Parents and teachers now have local special educational needs organisers on the ground to work with them and help them get the appropriate support for their children.

There are, of course, significant numbers of special schools throughout the country, which continue to play a very important role, and many of which will be developed as centres of excellence. They will support mainstream schools and their children. Over €820 million is being provided for special education in 2007, which is €180 million, or nearly 30%, more than was provided in the 2006 Estimates. Further improvements in services are on the way with the roll-out of the Education for Persons with Special Educational Needs Act 2004 and the implementation of other commitments in the new programme for Government.

With regard to specific provision for children with autism, the Government believes that as each child with autism is unique, such children should have access to a range of different approaches to meet their individual needs. Applied behavioural analysis, or ABA, is one of the methods used in special classes for children with autism. The issue of contention is whether ABA should be the only method used in some settings.

Advice received from international experts on autism, the National Educational Psychological Service and the inspectorate inform the Department of Education and Science's view that a range of approaches should be used, rather than just one. An analysis of research, including the report of the Irish task force on autism, also supports this approach, and autism societies in other countries also caution against relying on just one method. By enabling children in special classes to have access to a range of methods, including ABA, the Government is doing what we are advised is in the best interests of such children.

It should be noted that teachers in special schools were using ABA principles more than 25 years ago. ABA involves the systematic application, at any time during the child's day, of behavioural principles to modify behaviour. The effectiveness of behavioural interventions to improve the performance of children with autism and to ameliorate behavioural difficulties has been recognised for decades.

The use of ABA as part of the range of interventions is particularly useful for addressing behavioural issues. The Department of Education and Science therefore supports the use of ABA and training is provided for teachers in its use. However, the Department does not accept, based on research, advice and best practice, that it should be the only method used. Whereas ABA helps to improve behaviour, other methods, such as TEACCH and PECS, are just as important in developing children's communication and speech skills.

It is important that children have access to a range of methods so their broader needs can be met. Children in special classes have the benefit of fully-qualified teachers trained in educating and developing children generally and who have access to additional training in autism-specific approaches, including ABA. The level of such training available to teachers has improved dramatically in recent years and is a major priority for the Government. Children in special classes also have the option, where possible and appropriate, of full or partial integration into mainstream classes and of interaction with other pupils.

Approximately 200 autism-specific classes have now been approved around the country, while more are being set up all the time. There are a maximum of six children in each special class with a teacher and at least two special needs assistants. Extra assistants are provided where the children need them. An individual child can have his or her individual SNA if he or she needs one.

In regard to the programme for Government commitment raised by the Deputies, the position is that this relates only to the 12 pilot ABA centres that were established in the absence of this network of special classes in our schools.

The Government is committed to long-term funding for these 12 pilot centres, subject to agreement on standards that will enable the Department to support them as primary schools for children with autism. Areas in which standards need to be agreed include the professional qualifications of the staff and the educational programme available to the children.

I am pleased to advise the Deputies that, since the launch of the programme for Government, the officials from the Department of Education and Science met the advocacy group for the pilot centres concerned — I met the groups concerned many months prior to that — to progress the implementation of this commitment.

In terms of autism provision in other locations, we will continue to work to ensure that all children can have access to a broad programme, with provision for ABA as appropriate, in special classes. I hope this clarifies the position for the Deputies and I thank them again for raising the matter.

Road Network.

Deputy Fergus O’Dowd

The route of the M3 at Tara is very controversial. It is certainly true that the NRA did not recommend the most important route, which was the one that would least damage the archaeology of the area — I believe it was termed "the pink route". Nevertheless, because of due process and planning, legal and other issues that were examined at the time, Fine Gael believes the route must proceed and we support it.

However, the Green Party has a different view. The Minister, Deputy Ryan, said:

We are not willing to lose our archaeological past or give up our sense of ourselves and from whence we come. The current political mood questions where we are now and the way the Government wants to move forward. It is bent on building roads and servicing the building industry at whatever cost. That is its idea of progress. It is not progress, it is destruction, it is bad transport and social planning and ... it is destroying the essence of our heritage and our ability to understand it.

As late as 14 May 2007, Deputy Cuffe, on behalf of the Green Party, said: "The Green Party wants all work on this controversial motorway to come to an end, in particular the massive floodlit Blundelstown interchange." It is, however, still there and the Minister has not arranged for it to be removed. Deputy Cuffe continued: "Instead we are calling for the upgrading of the existing N3 Road." The reality is that the Green Party has betrayed its base. It has betrayed what its members said no later than 14 May 2007.

In its election manifesto, the Green Party was so bold as to say that where there is concern about potential damage to our heritage, it will investigate how this can be minimised within the scope of the contract or by renegotiation. However, the facts are that the Minister, Deputy Gormley, has been on planet Bertie for perhaps only a few weeks and the Minister's sacred site has been visited by the person who held office before him, the Minister of State, Deputy Roche, who is quoted as having said that the question of the M3 was discussed. He said there was nothing underhand about his decision. He believes it was discussed during negotiations with the Green Party.

I ask the Minister, Deputy Gormley, whether it was discussed. Where does he stand on this issue? In what position has the Government left him standing on this issue? Is it not a fact that he has been left to defend the indefensible from his party's point of view? When the Minister said that Fianna Fáil visits its sacred sites, he said it is in "the tent at the Galway races, where they pay homage to their gods and the gods bestow them with gifts for doing their bidding". The Minister of State, Deputy Roche, has done the Minister's bidding. He has visited the Minister's sacred site and from the Minister's perspective he has allowed to develop something to which the Minister's party is totally opposed. To paraphrase the words of the Minister, Deputy Gormley, "It is a strange place, Planet Bertie". It is certainly strange and alien to his party's sensibilities.

The facts are the Minister has failed at the first hurdle. His predecessor emasculated the Green Party by going against one of its core values, which was highlighted on 14 May when the Minister, Deputy Gormley, stated this controversial motorway must come to an end. I call on the Minister to defend himself if he can.

Minister for the Environment, Heritage and Local Government (Deputy John Gormley)

I thank the Deputy for raising this issue.

The statutory role of the Minister for the Environment, Heritage and Local Government in respect of an approved road development lies in the issuing of directions as to how works of an archaeological nature are to be carried out on an approved route. The recent determination of statutory directions by my predecessor, Deputy Roche, arose in circumstances where a national monument was discovered during the carrying out of archaeological works on the approved route of the M3. The discovery was made subsequent to the approval of the road development by An Bord Pleanála. Neither that approval nor the environmental impact statement prepared for the scheme dealt with what was then an unknown monument.

I first knew of Deputy Roche's directions when I received a text in this Chamber on the evening of Thursday, 14 June. Neither I nor any of my party colleagues had any prior contact with Deputy Roche on this issue. On 15 June 2007, following my appointment as Minister for the Environment, Heritage and Local Government, I examined my Department's file regarding the directions given to the National Roads Authority on the Lismullen national monument. In making the directions in question, the then Minister followed the procedures prescribed under the National Monuments (Amendment) Act 2004.

I have received unequivocal legal advice from the Attorney General that, without a change in the material circumstances relating to the newly discovered monument, it is not open to me to review or amend the directions given by my predecessor. I am aware of media reports in recent days of apparent new national monuments discovered near the site of the national monument at Lismullen. These were reported to the Department of the Environment, Heritage and Local Government in early May and I have been informed that they are not regarded as national monuments. I have asked the director of the National Museum for his advice in respect of these souterrains.

The House may be also aware of the recommendation of the director of the National Museum that a special committee should be quickly installed to ensure excavation of the national monument at Lismullen is carried out to the highest and most transparent standard. This recommendation has been accepted and is referred to in the directions. The national monuments service of my Department, Dr. Pat Wallace, director of the National Museum, the National Roads Authority and Professor Gabriel Cooney, head of the school of archaeology at UCD, are represented on the committee. At my request, Dr. Conor Newman of the department of archaeology at NUI Galway, recognised as an expert on Tara, has also agreed to join the committee. Last week I visited the Tara-Skryne valley with Dr. Conor Newman and Dr. Pat Wallace.

Deputy Fergus O’Dowd

Was the Minister on his bike?

Deputy John Gormley

The committee meets for the first time tomorrow to advise on the conduct of the archaeological investigations to be carried out under the directions. It will continue to meet as often as is necessary over the course of the excavation of the monument.

I assure the House that I am fully committed to preserving Ireland's internationally renowned archaeological heritage. It is my intention to consult in the coming weeks with a wide range of interests in the area to hear their views. That process started last week and I intend that it will be continued and intensified.

It is interesting that the Fine Gael Party has raised this issue this evening. I always had the impression — the Deputy has confirmed it — that Fine Gael was totally committed to the building of this road through the Tara-Skryne valley——

Deputy Fergus O’Dowd

The Minister was completely opposed to it.

Deputy John Gormley

——and that it would, had it been in government, have insisted on the current route being followed. Fine Gael is not in government and what we are hearing from it at present is sour grapes and nothing more.

To ensure the highest levels of transparency and accountability, I also intend to release the entire file on Lismullen to the media in the near future.

The Dáil adjourned at 10.25 p.m. until10.30 a.m. on Wednesday, 27 June 2007.