I thank the Cathaoirleach, Deputies and Senators for the opportunity to describe the loss of the Owenacurra Centre and its far-reaching impact on people in east Cork with severe and enduring mental health needs.
The Owenacurra Centre, Midleton, was established in 1988 to allow residents of the old institution of Our Lady’s Hospital, Cork, which was one of the county asylums, to live in their community. It is ideally located in the town, close to shops, the farmers’ market, the library and a range of amenities and services.
In the letters pages of the Irish Examiner in 2021, Monica Doyle, a former clinical nurse manager of the centre, recalled the momentous transition of those first residents from Our Lady’s Hospital and the new lives they found in Midleton. Some went on to require 24-hour staffed residential placement but greatly increased their levels of purpose, meaning and connection within that framework of support. Others, Ms Doyle noted, discovered the joys of independent living with the help of the local mental health team. This was a time, she wrote, when the aim of the Southern Health Board was “to promote integration and prevent institutionalisation”.
There were 20 residents when the bombshell news came in June 2021 that the service was to close. There are now just six remaining. Three of those six will be accommodated in a house the HSE recently purchased in Midleton. This is a fraction of the service provision needed in east Cork, and even that would not have come without the sustained pressure of the local campaign to save the service. The closure announcement was met with shock and dismay by residents, family members, local mental health clinicians and the whole community. The centre has been described by one family member of a resident as life-saving for her relative. It has been greatly valued in east Cork over the past 35 years.
The closure rationale was based on a contention by the HSE that the premises were not fit for purpose; in particular, that some of the centre's single bedrooms were of insufficient size. The HSE also repeatedly made reference to concerns raised by the Mental Health Commission in its briefings on the closure. Neither rationale has stood up to scrutiny. Some residents were offered shared dorms in long-stay wards outside east Cork, which would involve a much greater restriction on dignity and privacy than a small single room in Owenacurra. Also, the Mental Health Commission compliance rating for Owenacurra has been impressively high in recent years and stood at 90% in the latest inspection report in 2022, while the commission has repeatedly and severely criticised some of the alternative facilities offered to residents. Its rating for St. Stephen’s Hospital, Glanmire, was 70% and for St. Catherine’s Ward in St. Finbarr’s Hospital, Cork, it was 74%.
In March 2022, following a site visit to the centre and to St. Stephen’s Hospital, the Joint Oireachtas Committee on Health wrote to the Minister of State, Deputy Butler, calling on her to reverse the closure. The committee stated that “evidence presented by the HSE [for][...] the closure has been unconvincing” and expressed concerns about the ad hoc nature of the decision-making in relation to capital infrastructure of mental health facilities. The committee repeated the call to reverse the closure in later letters to the Minister of State, appealing to her to visit us in Midleton, to Mr. Paul Reid, then of the HSE, and, later still, to the HSE board. In one such letter from May 2022, the committee stated "the loss of the Owenacurra Centre, including its town centre location, would involve far-reaching adverse consequences for one of the most vulnerable groups of people attending the east Cork mental health services and would constitute a regression in their care and rehabilitation”.
The HSE’s original plan, as discovered through a freedom of information, FOI, request, was to move many of the residents to St. Stephen’s Hospital, Glanmire, an institutional and isolated setting, as Our Lady’s Hospital was. It is 45 km from Youghal, which is at the eastern side of our east Cork catchment area.
In December 2021, the HSE said repeatedly in a health committee meeting that it would not be replacing the 24-hour staffed residential placements in east Cork. Under sustained pressure from the campaign, the HSE announced in May 2022 it would construct a new ten-bed service in Midleton to replace the Owenacurra Centre. While this appeared a promising development, 14 months later no site has been identified for this building, no capital funding has been secured and no development team appointed.
In recent weeks, local management have given very optimistic timelines for this project in responses to parliamentary questions from Deputy Hourigan, claiming the HSE will begin building the service in the first quarter of 2024 and that construction would be complete in the first quarter of 2025. We are concerned this is creating false expectations, given that the usual minimum completion time for a new build project of this scale is at least four to five years. Dismantling the Owenacurra Centre in the meantime and replacing 20 single-room placements with a possible new house containing only three bedrooms will not remotely meet the needs of this vulnerable client group in east Cork, who require continuity of care and community integration, which is the most important part of this centre being in the centre of our town. Just as the construction of premises is a lengthy and complicated process, so too is the recreation of a service which would involve recruitment or redeployment of staff.
The client group served by the centre is broadly referred to as experiencing severe and enduring mental illness. People with this level of difficulty typically struggle with the most debilitating levels of distress of any client group attending our mental health services, which can take the form of entrenched depressive or psychotic conditions. Some people with severe and enduring illness can live independently or with family support. Others will require intensive multidisciplinary therapies, residential placement and sometimes life-long residential placement. They can have great difficulty pursuing goals or sustaining involvement in training or employment. They are prone to being destabilised by transitions such as changes in accommodation or the ending of therapeutic relationships.
Those who require long-term or respite placement who do not have a community-based residence available to them typically experience one or a combination of the following outcomes, which outcomes have been pointed out by the Mental Health Commission itself. Some people with severe needs live with ageing parents who are unable to cope. Some, according to Dr. Susan Finnerty, chief inspector of the commission, are "trapped" in psychiatric wards indefinitely and are detached from their communities, as outlined in the commission's paper Rehabilitation and Recovery – Mental Health Services in Ireland 2018/2019. Others end up in very precarious situations in the community, at risk of homelessness, addiction and suicide. We have one of the highest rates of suicide in the country, as I am sure members know. Those at risk can be caught in a cycle of acute psychiatric ward admissions. When people with this level of need move to services such as the Owenacurra Centre, it can take many months or even years of painstaking therapeutic work, usually with several clinicians, to achieve stabilisation, develop good quality of life and integrate into the local community.
In the absence of interim provision in east Cork while a new service is being constructed, the closure of the centre will result in people from east Cork with the highest level of mental health need being placed in St. Stephen's and St. Finbarr's hospitals.
Our campaign acknowledges the positive and open engagement in recent weeks of HSE CEO Bernard Gloster with our representatives. Before Mr. Fitzgerald retired, he had agreed to meet me as well. We are very grateful to Mr. Gloster but ask him to commission an independent investigation into the standards of some of the alternative placements offered to the residents. Residents moved outside east Cork on the basis that they deserved a better-quality service should be offered the opportunity to return to Midleton and their families. The HSE has an obligation to ensure continuity of care for people who require respite or rehabilitation placement in east Cork. That requires local interim service provision while new premises are being constructed or acquired over the protracted period that this will take. We ask Mr. Gloster to commit to the provision of services across Cork for people with severe and enduring mental health difficulties in accordance with A Vision for Change and the UN Convention on the Rights of People with Disabilities.
The north Cork HSE catchment provides a model of the service provision that should be replicated in each area with a population of 100,000. According to A Vision for Change, this includes a specialist, multidisciplinary rehabilitation mental health team and three community residences, each with ten placements for the 100,000. This is the service provision that is required for the combined HSE catchments of Midleton–Youghal and Cobh–Glenville. In north Cork, which has the same population as the two east Cork mental health team areas combined, there are three community residences, one in each of the towns of Mallow, Fermoy and Kanturk, and each with 14 placements with single-room, en suite facilities. There are 42 in total. Ours are going to be removed for the whole of east Cork. We will not have any residential placements in any of our communities of 100,000.
The HSE plans to invest heavily in a 50-bed continuing-care rehabilitation service in St. Stephen's hospital, Glanmire, that would replace long-stay wards on campus. The funding should be redirected to community residences for the client group in question in major towns such as Cobh and Youghal and our town, Midleton. St. Stephen's is an isolated hospital campus disconnected from any urban centre and is not a suitable location for long-term living.
Our Lady's Psychiatric Hospital is the typical asylum or psychiatric hospital that we talked about. Having opened in 1882, it finally closed in 1992, thank goodness. However, St. Stephen's is the replacement psychiatric hospital. It was built as a tuberculosis hospital in 1954 and it is now being suggested that residents be transferred there. Our centre is right in the heart of our town. As a society, we have a responsibility to look after those who were born with or developed certain mental challenges. We must keep them in our community and not isolate them, or, as Dr. Finnerty said, send those regarded as not fit for purpose in society to an isolation area.
St. Stephen's was previously a TB hospital. It is going to be a combined site for the general hospitals – Cork University Hospital and Mercy University Hospital. They are going to rebuild some of their wards there. Our Lady's Psychiatric Hospital was closed only in 1992. Actually, it is rather poor. The Owenacurra Centre is right in the heart of the town, beside our farmers' market, the banks and the library.
