Seanad Éireann díospóireacht -
Wednesday, 19 Oct 1983

Vol. 102 No. 2

Adjournment Matter. - Care of Mentally Handicapped.

Mrs. Honan

I thank the Minister for coming in at this late hour. After such an exciting day he can see what a packed Chamber we have.

I hope when I leave public life that if I have done nothing else I will have left my mark not only on the services of the mentally handicapped in Clare but also in some way at national level. I remember 19 years ago, when I was the back-up to another person then serving in public life, I saw this dreadful gap in this nation when there was no service whatsoever for the mentally handicapped. It was in that way that I became involved. This is a little unusual for somebody who has nobody in the family who is mentally handicapped. People at conferences and with the national association with which I am affiliated are usually parents or relatives of mentally handicapped children. I have a lot to be thankful for to God and this is a field in which I will continue to serve.

We have an extraordinary set up in dealing with the mentally handicapped. The Department of Health, the Department of Social Welfare, the Department of Education, the OPW and the Department of Finance are all involved. If ever there was a case for one Minister for one section in our community it is certainly in the field of the mentally handicapped. If it is not done by this Government it might be done by the next Government. It is something that I will talk about again. If such an appointment were ever made I would hope we would not have the confusion we have in the Department catering for youth at the moment where the junior Minister does not know what the senior Minister is doing. We have all the schools, workshops, aids and grants, and trying to deal with them is really impossible.

I will certainly give credit to the Minister because the services which exist for the mentally handicapped are probably the best in the world. Unfortunately we have not yet reached out to give all the essential facilities that should be available to all mentally handicapped people. Parts of the country have no services at all; that is quite common and the Minister is aware of it. Normally where there is a good service it is where there is a very good back-up organisation at local level. The Acting Chairman who is from my own constituency is well aware of what I am talking about. If you get the people to support you, eventually the politicians see commonsense and then you get the service.

Some mentally handicapped people have to live in special residential care centres where care and development services will be available to them. It is estimated that 1,500 extra places are needed and the majority of those have not yet been provided. The working party report also draws attention to the fact that some 2,500 mentally handicapped people are in psychiatric and geriatric institutions. I have got into trouble locally and at conferences because I feel so strongly that no mentally handicapped child or adult should be in a mental hospital. I have the greatest regard for the people serving in the field of mental illness but in 1983 we should not have mentally handicapped children in wards in our mental hospitals. I am not putting the blame on the Minister here tonight. I am blaming successive Ministers. Because I have gone on record in making that statement I have not been popular in certain areas with certain professional people. Popularity does not worry me once I have the popularity in the right circle to enable me to make a case here for mentally handicapped people. I am not worried about my popularity with certain professional people.

I referred earlier to residential units. I have reservations about these big impersonal institutions like Swinford and Loughlinstown. I have seen the smaller unit work. I have bought houses and put the children into them and I have seen them going to school and going into a workshop situation. I am sure the Minister knows that I am right in this. Nobody will sell me the big institution again for mentally handicapped children and for the young adult.

What worries me is the embargo on the recruitment of staff for the services of the mentally handicapped, together with the compulsory reduction of numbers of staff in the service. In March 1983 we had a cut of 2 per cent and I understand a further 3 per cent cut is being mentioned. That is too great a cut-back in a service where there is still much to be done. I am not being dramatic or unreasonable.

No Minister for Health in recent years has shown as much concern so quickly as the Minister here tonight. He has singled out the service of the mentally handicapped. For that I am grateful. The National Association for the Mentally Handicapped are grateful to the Minister. We may be able to help him at the Cabinet table to leave the service and take another look at the staffing. I would worry about the reaction of staff coming in and serving in the field who would not be as committed as old staff were. If we keep cutting back and asking them to do more with less staff there probably will be a deterioration in services, something which I would not like to see. It is a most satisfying field to serve in and people are very grateful.

The stigma that has attached to having a mentally handicapped person in a family is gone. There is no such thing as a mentally handicapped boy or girl or teenager being down in the lower bedroom of a farm house. Years ago if you were not in the right party they hardly produced the child at all. They are coming to one now almost with a joy and pride and it is because the service has been laid on.

I understand that the Government may be considering a reduction of expenditure in some areas. I know how rough it is going to be to leave the money and to try to give the service that we need. With the cutting back of staff it is a field where we may not have such committed people coming in and serving. If we had any hassle it could spread very quickly and I would worry greatly about it.

In Ireland it is possible for anyone who is ill to have access to a full range of medical services. For the mentally handicapped that is not possible and it is an indictment of society to have to say that. I appeal to the Minister to try to provide more and not fewer resources for this marvellous and valuable section of our people. We call on him and the Coalition Government to adopt reasonable and clear-cut policies for the development of a comprehensive and caring system which will provide the disabled people of Ireland with a lifestyle to which they are entitled. We hear about constitutional rights but I am not going to go into rights. I thank the Minister for coming in here tonight. It again shows the concern there is, although the Chamber is almost empty. I appreciate that it is late but 10.30 p.m. is not too late for a debate on this subject, to which people pay such lip service when it suits them.

I sincerely thank the Leader of the House, Senator Dooge, for remaining for my few words, and also Senator Fitzsimons. It is a pity that people who pay lip service to this matter thought 10.30 was too late to take this motion. I ask the Minister not to cut the money, and if there is anything the voluntary bodies who are serving in this field, and the National Association for Mentally Handicapped, can do to strengthen the Minister's hand at the Cabinet table, he can call on me and I will see what we can do. I again sincerely thank the Minister for coming here.

Minister for Health (Mr. B. Desmond)

I thank Senator Treas Honan for her concern on this question. The involvement and commitment of the Senator have been readily acknowledged in the past by, for example, her nomination for Seanad Éireann by the National Association for the Mentally Handicapped of Ireland. That of itself is sufficient tribute.

I want to deal in specific terms with some of the points raised by Senator Honan. We are very fortunate in having built up in a relatively short space of time, a wide range of specialised services for our mentally handicapped people. The quality of the services now in existence, particularly over the past six or seven years, is recognised internationally. It has been in no small measure due to the fact that we have in the area of the mentally handicapped a wide range of various lay voluntary organisations doing quite remarkable work. They, together with the dedication of the numerous religious orders who are involved in the area, have produced an outstanding service. Admittedly the number of religious orders has diminished over the years and a number of voluntary organisations have found increasing difficulty in finding resources. Nevertheless, the work has been quite splendid and admirable. A great deal of the credit for the improvement in recent years must go to these organisations.

We have at the moment 8,600 mentally handicapped people in receipt of residential and community services under the general auspices of the Department of Health. I share the concern of Senator Honan that no person who is mentally handicapped should be either residing or receiving treatment in a psychiatric hospital. Unfortunately, a small number still are, and it is our ambition, mutually shared, that specific services should be produced from within our resources to bring an end to that situation. I am acutely aware of the need for more rapid change in Senator Honan's health board area in that regard. Our country and successive Governments have been spending a great deal more money in the past five or six years. I will just give three figures. In 1978 we were spending £35 million. In 1980 we were spending £58 million. This year, on current account, we are spending £100 million. In a very short space of time the increase in allocation has been quite remarkable. The capital allocation for the mental handicap services was £4.6 million last year. In 1978 it was only £2 million. It has increased considerably over recent years. Over a thousand new posts were approved in the mental handicap services in the late seventies. These basic statistics demonstrate that the Irish people, rather belatedly admittedly, have in the past five or six years spent more resources in giving priority to the treatment of our fellow citizens who are mentally handicapped, and particularly supporting their families. I do not cavil with Senator Honan in this regard. It was for this reason that the services for the mentally handicapped were exempted from the restrictions imposed on revenue allocations in the other areas of the health services in July 1982 and early in 1983. In the cutbacks in the health services in the middle of last year, services for the mentally handicapped were wholly exempted. Again in early 1983, when I discussed the revised Estimates, the Government again confirmed their decision to exempt the services from any cutback.

I was pleased earlier this year to confirm that policy of the outgoing Government to exempt certain new priority projects of the mental handicap services from the effects of the embargo on the recruitment of staff. That allowed 150 new jobs to be allocated to the mental handicap services so that these units which had been lying vacant could be opened. I am acutely aware of the shortfall of the services because with modern medicine, rehabilitation and modern methods of support, young people who are mentally handicapped, as Senator Tras Honan will readily confirm and as Senator Dooge as Leader of the House well knows from our own constituency, either Dunmore House or any one of the other areas here, have a much longer life. A large number of young people are coming out of the special schools and of course require continuing residential care. This is imposing a great deal of strain both on parents, many of whom are quite elderly, and on the services provided by the health board.

We recently had a census. Arising out of these trends there has been a substantial increase in the number of mentally handicapped persons in the moderate, severe and profound categories, much higher than the general increase in population because of longer life. There is a great need for extensive new projects to meet these particular needs. I invite Senator Honan to come down with me to Swinford, because there are still only the drawing board plans for Loughlinstown. In terms of Swinford, Cheeverstown or Loughlinstown, I assure Senator Honan that there will not be enclosed ghetto type housing for those who either require residential care or day care support. There is a concept of village integrated, tigín type, family-oriented support, where three or four mentally handicapped persons would live together with a house mother or father and learn to do their shopping together in a shopping centre in that area. That is why we are spending £11 million in Swinford. We have already spend £6 million in Cheeverstown. We hope to spend £6 million or £7 million in Loughlinstown and to have 500 or 600 persons between all three, especially those whose parents have died.

Many women in Ireland have mentally handicapped children because they married very late in life and they had children in their mid-forties. There is a much higher incidence in Mayo, Galway and Roscommon of mental handicap for a variety of reasons that are well known.

I conclude on the basis that I have made on special effort in which Senator Tras Honan might be interested and might have some consultations with the CEO in her own health board area and with the programme manager. In the past couple of weeks I have had discussions with the Department of Finance and the Department of Labour about using the youth employment schemes in the services for the mentally handicapped. I have had many difficulties in these discussions, but I am happy to report for the first time in public that voluntary agencies have been informed that they are eligible to avail of the grant scheme for youth employment. The scheme will enable the voluntary agencies in the field of mental handicap to recruit young people to facilitate the release of existing staff wishing to pursue training courses and also to assist in the introduction of new programmes and developments which were approved in recent years. I am glad to say that in the past three weeks more than half of the agencies eligible have already applied for approval to recruit young people for these activities. I find that among young people who are fortunate enough to have the best of health, there is enormous commitment and dedication to assisting those who are mentally handicapped. I commend that scheme to the Senator, particularly in her own health board area.

I have approved a number of minor capital grant schemes totalling £600,000 to enable the residential and day centres to expand their maintenance programmes, thus creating a higher standard of accommodation and services. That sum has been allocated in recent weeks to a wide range of services. The nearest to the Senator's area is St. Vincent's in Limerick. They got additional moneys for maintenance. I regret that in the Clare area we did not have particular applications, but that is not my responsibility.

There are at the moment very severe financial constraints. I am determined to continue to give the services for the mentally handicapped the highest possible priority and to ensure that the present standards for their care are fully maintained. I look forward to continuing this work with the support of Members of the Houses of the Oireachtas and, in association with the many voluntary agencies, I have no doubt that we can expand these services even in times of the most severe financial constraints facing the Exchequer.

I should like to thank the Cathaoirleach for allowing this matter to be raised. It is the first issue raised in our new session and I cannot think of a more appropriate one to be discussed on the Adjournment.

Mrs. Honan

I should like to thank the Minister, and when I was thanking Senator Dooge and Senator Fitzsimons I forgot to thank the Acting Chairman for staying on.

The Seanad adjourned at 10.45 p.m. until 2.30 p.m. on Wednesday, 2 November 1983.