I thank the Chairman for the welcome he has given me on my return to this committee. I have had the opportunity to read the transcripts from the last meeting and the prepared script has been circulated. I propose to read through the prepared script and address the issues later.
I am delighted to be here to discuss the redevelopment of the Central Mental Hospital, CMH. Accompanying me are representatives of the office for disability and mental health, Ms Dora Hennessey and Ms Joan Regan.
I acknowledge that most of this information is on the record already, thanks to Ms Bairbre Nic Aonghusa, but I have been invited here and so must go through some of the statements that have already been read into the record. If people are bored by hearing this for a second time, I must still proceed.
By way of background to the Government decision to replace the hospital I should explain that the CMH was first opened in 1850 and, although there has been some innovation and refurbishments of parts of the facility, it is clear that the hospital is no longer an appropriate place in which to treat and care for persons with mental illness. Many elements of the existing facility reflect the Victorian era and are increasingly unsuitable for the provision of best psychiatric care. In recent years we have been subjected to much criticism regarding the physical infrastructure of the Central Mental Hospital and the outdated facilities are simply not suited to their current purpose. They do not facilitate best practice care; for example, the design, structure and fittings of both the old and new buildings are unsafe and insecure. The bedrooms are too small and the walls are too thick to allow refurbishment incorporating something as basic as modern, en suite plumbing. Facilities in the wards for treatment groups, assessment and rehabilitation activities are extremely limited.
The 2007 report of the Inspector of Mental Health Services found that the building on the current site is unsuitable for the provision of inpatient services and cited examples such as the women's admission unit being too small, cramped and inappropriate for its purpose. The 2006 report also found that the Central Mental Hospital was an unsuitable location for delivering forensic services.
The European Committee on the Prevention of Torture and Inhuman or Degrading Treatment or Punishment has repeatedly criticised facilities at Dundrum, specifically its unsatisfactory physical environment and sanitary conditions. A recent report of the committee supports the move to redevelop the hospital.
While increased investment in the hospital over the years has, undoubtedly, led to the improvement in patients' living conditions and care through renovations and the provision of increased multidisciplinary staffing, the fact remains that the hospital is no longer an appropriate place for treating and caring for persons with mental illness. Unquestionably, the existing hospital facility must be replaced.
In 2003 the Minister for Health and Children established a project team chaired by the East Coast Area Health Board to progress the redevelopment of the Central Mental Hospital. A broad range of stakeholder interests were represented including the Department of Health and Children, the Central Mental Hospital, the National Development Finance Agency, the Irish Prison Service and representatives from the health boards.
The project team examined various options for the provision of an appropriate facility for the operation of the National Forensic Psychiatric Service. The options appraised included new building versus refurbishment of the existing facilities at Dundrum, building on the existing or a new site and a combination of building options. It is worth noting that the project team met on ten occasions in addition to meetings held by subgroups set up to examine specific tasks within the remit of the team. The project team recommended that the most appropriate option for the optimum delivery of patient care was for a new hospital to be built on a greenfield site with ready access to the M50 motorway to ensure accessibility for the population served. A site of 20 acres was required to provide capacity for 300 admissions per year.
In 2006, in keeping with the recommendations of the project team and having regard to the lack of appropriate alternative sites in the greater Dublin area, the Government approved the development of a new national forensic mental health facility at Thornton Hall in County Dublin. This decision is consistent with the recommendations in A Vision for Change, the report of the expert group on the mental health policy. While the decision was taken before my time in office, it represented the best option available to the Government at the time. I am satisfied that it was taken in good faith and with appropriate consultation.
One of my predecessors, former Deputy Tim O'Malley, met Professor Kennedy, the CMH clinical director, and later walked part of the Thornton Hall site with him. As I understand it, Professor Kennedy's view at the time was that while the location of the hospital adjacent to a prison complex was not ideal, the key priority was that a new hospital be provided as soon as possible. He was optimistic that the difficulties posed by having the hospital adjacent to the prison could be overcome by ensuring there was a clear boundary between the two facilities, that they would be managed separately and that the hospital would have a separate entrance and a separate address from the prison. He also suggested new governance arrangements be put in place to strengthen the independent identity of the hospital. A press statement which issued at the time, responding to concerns regarding the proposed location at Thornton Hall, made it clear that the concerns expressed by Professor Kennedy and the safeguards he had requested had been fully taken on board by former Deputy Tim O'Malley and the Department of Health and Children.
The decision to redevelop the CMH is undoubtedly a major step forward in the provision of quality care for persons with a mental illness. The new hospital facility will provide a therapeutic, forensic psychiatric service to the highest international standards. By building a new hospital on a greenfield site we will open up a range of opportunities for the provision of modern treatment and care. A purpose built, modern hospital, with all the necessary recreational facilities, coupled with the required specialist multidisciplinary staff, will offer the best possible treatment to those requiring forensic mental health services and significantly improve the physical living and treatment environments for patients. The new hospital will also provide much needed additional admission capacity.
The cost of developing the new enlarged 120 bed hospital at Thornton Hall will be met from the proceeds of the sale of the existing site in Dundrum and the balance of the funds realised will be ring-fenced for further investment in the mental health service. There are serious deficits in terms of the necessary physical infrastructure; therefore, the sale of the Dundrum lands will provide a very welcome financial boost and help us realise our vision for the mental health service, as outlined in A Vision for Change.
I am aware that concerns have been expressed that the proximity of the prison will lead to the criminalisation of the hospital and its client population and the stigmatisation of the mentally ill. However, there are already hospitals around the country which are adjacent to prisons, for example, the Mater Hospital beside Mountjoy Prison, Portlaoise and Limerick and I have never heard any suggestion this has led to the stigmatisation of the patients in these hospitals. I admit that as the majority of admissions to the hospital come from within the prison service, the location of the hospital adjacent to a prison will have operational benefits. However, that being acknowledged, the new hospital will constitute a separate capital project, completely independent of the prison complex. Furthermore, the new hospital will retain its identity as a separate, therapeutic health facility and there will be clear boundaries between the hospital and the prison.
There is also, I understand, a perception that the decision to locate the CMH beside the prison is the first step towards subsuming the hospital into the Department of Justice, Equality and Law Reform structures. Nothing could be further from the truth. The first principle of the United Nations principles for the protection of persons with a mental illness and the improvement of mental health care clearly states all persons have the right to the best available mental health care which shall be part of the health and social care system. The forensic mental health service is properly placed within the health service and I do not and would not support the transfer of responsibility for the CMH to the Department of Justice, Equality and Law Reform. I can, therefore, assure the committee that the hospital will continue to be managed and directed by the Health Service Executive, as a therapeutic, health care facility with a governance structure which will remain distinct from that of the prison.
There has been criticism that the location in Thornton Hall is too isolated and that there will be problems for patients who are in the rehabilitation phase of their treatment. I am pretty certain Dundrum was an isolated location in 1850. I am confident that in time, just as in Dundrum, a vibrant community will build up around the new hospital in Thornton Hall. In the meantime I am sure Professor Kennedy and his staff will be innovative and consider ways and means of addressing this community access issue.
This joint committee has met many groups regarding the redevelopment of the CMH. It is clear that despite our differing opinions on the merits of the Thornton Hall site, we want the same thing — we want the best possible care for the patients in the CMH. However, while we engage in talk, the urgent needs of the patients for improved living conditions somehow gets lost. We also forget that there are persons in our prisons who are urgently in need of admission and treatment. We need a new hospital, we need a larger hospital and we need one sooner rather than later. I fear that unless somehow we can resolve concerns regarding the location of the new hospital, the development of a modern, much needed, national forensic mental health facility will be unnecessarily delayed. I am also conscious of the changing economic climate; unless the issue of the location of the hospital is resolved in the short term, the opportunity to develop a new hospital could be lost. In the circumstances, the priority at this time must be to minimise delays, so that we can build a new hospital as soon as possible.
I will be happy to answer questions.
