I thank the Chairman and members for inviting the Mental Health Commission before the joint committee. A presentation has been circulated to members. I do not intend to go through it in full because time is of the essence but I will highlight some of the key points in it.
The Mental Health Commission was established in April 2002 when the Minister for Health and Children signed the commencement order relating to certain sections of the Mental Health Act 2001. Members of the committee are probably aware that all of the remaining sections of the Mental Health Act 2001 came into operation on 1 November 2006. Under paragraph 1.1.2, members of the committee will see the principle statutory functions of the Mental Health Commission. It is important to emphasise that these include the promotion and encouragement of the establishment and maintenance of high standards and good practices in the delivery of mental health services and taking all reasonable steps to protect the interests of persons detained in approved centres.
Our key functions are listed on the second page of the presentation and I will only highlight those that are of particular relevance to the issue under discussion today. The first relates to the appointment of an inspector of mental health services, a function the commission holds. We also license and register all approved centres, or inpatient facilities, like the Central Mental Hospital, and attach and revoke registrations. The commission protects the interests of persons detained in approved centres and runs the independent review system, including mental health tribunals.
The fundamental principle that underpins the Mental Health Act 2001 is the protection of the best interests of the patient and this is a welcome inclusion in the Act. I particularly draw attention to subsection (3), which points out that when the commission makes a decision, under the Act, concerning the care or treatment of a person due regard should be given to the need to respect the rights of the person to dignity, bodily integrity, privacy and autonomy. As the Mental Health Commission is the statutory body responsible for inspecting and registering inpatient facilities and for protecting the interests of people detained and as it also has responsibility to promote high standards and good practices we believe the provision of forensic mental health services is a key issue for the commission. We published a discussion paper in February 2006 on forensic mental health services and it is available on our website. We consulted stakeholders in mental health services and will publish a position paper on forensic mental health services in September.
On page 5 we give a definition of forensic mental health services. They are services that deal with mentally ill people whose presentation has been assessed as requiring a more focused level of expertise and-or increased levels of physical security. I will not go through the entire definition. Some patients are identified at the level of general psychiatry and some via the criminal justice system. In other words, within the Central Mental Hospital there are people who have come through the prison system and have a mental illness and there are also people who have been referred from local mental health services around the country. Comhairle na nOspidéal provides a definition of forensic mental health services but I will not go into it because it is an area with which committee members are familiar.
I emphasise the principles underpinning the provision of mental health services on page 6. I particularly draw attention to the United Nations' principles regarding the protection of persons with mental illness and the improvement of mental health care. A number of the UN principles are very important regarding the location of the Central Mental Hospital. The first is principle 1.1 states that all persons have the right to the best available mental health care, which shall be part of the health and social care system. Every person shall have the right to be treated and cared for, as far as possible, in the community in which he or she lives. Principle 9.1 states that every patient shall have the right to be treated in the least restrictive environment and with the least restrictive or intrusive treatment appropriate to the patient's health needs and the need to protect the physical safety of others. I draw attention to principle 13.2 which states that the environment and living conditions in mental health facilities shall be as close as possible to those of the normal life of persons of similar age.
I will move on to page 8 of the presentation and an area the committee may wish to further examine. In 1999 the Scottish Executive produced a report on forensic mental health services. Scotland is a country at which we look quite closely because its population, at 5 million, is a little larger than that of Ireland, and the demographic structure is quite similar. The report states that users of forensic mental health services should be cared for having regard to the quality of care and proper attention; in the community rather than institutional settings as far as possible; under conditions of not greater security than is justified by the danger they present to themselves or others; in such a way as to maximise rehabilitation and their chances of sustaining independent lives; and as near as possible to their own homes or families if they have them. In the report, considerable importance is assigned to the planning process for forensic mental health services. This is something the Mental Health Commission also wants to emphasise. We have attached at appendix A the Bamford Review of Mental Health and Learning Disability (Northern Ireland), which was published in 2006, in which forensic mental health services are also considered. This report came out a little after the Government report A Vision for Change.
Section 3 of this presentation is about the proposed location of the forensic high and medium-security facility at Thornton Hall. I would like to go through this in full because it is the core of what is being discussed. The Mental Health Commission fully supports the replacement of the current Central Mental Hospital with a purpose-designed modern facility which promotes patient safety and dignity. The commission is of the view that the proposal to site this facility at Thornton Hall, beside a new prison complex, is not in patients' best interests and is not conducive to promoting patient rehabilitation and recovery. The siting of two large institutional complexes in one location will promote isolation and exclusion of the population resident in these facilities. This will increase the stigma already experienced by people with a mental illness. The purposes and functions of both facilities, in the view of the commission, are distinctly separate. A prison has a strong focus on detention and security; however, the primary focus of a forensic mental health high security unit is the creation of a therapeutic environment which will promote patient rehabilitation and recovery.
The proposed location, which I gather the committee visited this morning, is not well served by public transport, thereby placing a considerable additional burden on families to maintain contact with their relatives. This is contrary to the principle of promoting community and family contacts as outlined in the United Nations principles. There will be few, if any, opportunities for local planned external activities such as work experience, which are all essential elements of a managed rehabilitation programme. The commission is of the view that building a new facility on the current site at Dundrum would eliminate all these serious problems. There is an excellent transport system, including the Luas; a wide range of community and social facilities in the locality; and, importantly, the facility is well established in the local community.
The commission wishes to emphasise the importance of planning and delivering an integrated, comprehensive and quality forensic mental health service in Ireland. To do that, the commission's view is that there should be a comprehensive assessment of need for forensic mental health services and this should be undertaken as a top priority. Forensic mental health services should be provided primarily on a regional basis rather than being centralised in Dublin as at present, although it is acknowledged that the medium and high security facility should be situated in Dublin. Forensic mental health services should encompass a wide range of services, including high security care, medium security care, low security care and community-based forensic mental health teams which can provide in-reach services to the local prison population and local mental health services. What we are proposing is in line with Government policy as issued in A Vision for Change in 2006.
It is the view of the commission that it is imperative that the development of a high-security facility is not undertaken in isolation. Our best estimate - although, as I said, we believe there should be an assessment of need - is that there is a need for four regional low security facilities around the country. This will ensure that people with a mental illness are not placed in settings with higher than required levels of security and will guarantee care in a setting as near as possible to the person's family and community. We also believe that regional forensic mental health teams should be working in the community. These would be multi-disciplinary teams providing community assessment and treatment services.
For the conclusion I will hand over to our chairman, Dr. O'Dea.