I move:
That Seanad Éireann notes with alarm the delay in the publication of the Inspector of Mental Hospitals Report for 1996; calls on the Minister for Health and Children to publish it immediately; and asks that the Leader of the House initiate a debate on the reports of the Inspector of Mental Hospitals now.
I welcome the Minister for Health and Children to the House. I am delighted this motion is being debated this evening as it has been on the Order Paper for some time.
Mental hospitals and the treatment of patients with mental illness are governed by the Mental Treatment Act, 1945. Since 1945 attitudes to psychiatric illness and its treatment have changed dramatically. In the Department of Health's four year action plan for 1994-7 the following was listed as a priority: "To introduce a new Mental Health Act to give greater protection to the civil rights of the small number of people with mental illness who have to be detained for treatment and to bring our legislation into conformity with the European Convention on Human Rights". We have signed the 1950 European Convention on Human Rights and Fundamental Freedoms but we have yet to bring forward the legislation necessary to implement those rights in our law. That we are in breach of the European Convention on Human Rights was acknowledged in the 1995 White Paper, "A New Mental Health Act".
The Agreement reached in the multi-party negotiations on Good Friday in Belfast states in the section on rights, safeguards and equality of opportunity, under subsection (9), that the Irish Government will take steps to further strengthen the protection of human rights in this jurisdiction. It also states that the Irish Government will establish a human rights commission with a mandate and remit equivalent to that within Northern Ireland. The Mental Health (Northern Ireland) Order, 1986, is fully in accordance with the European Convention on Human Rights. Our concern for the civil rights of psychiatric patients and the responsibilities of those who deal with them is 12 years behind Northern Ireland. As one of those who hopes for the safe passage of both referenda, I hope the Minister recognises the urgency of dealing with this legislation.
At present, under the 1945 legislation, mental hospitals are inspected by the Inspector of Mental Hospitals. He produces excellent reports which are part of the social history of our time. He visits all the mental institutions at least once every two years, but many more frequently. For a long time he has held the fort on behalf of psychiatric patients.
There are consistent delays in the publication of his yearly report which, under section 247(2) of the Mental Health Act, is required to be laid before the Houses of the Oireachtas and a copy sent to the President of the High Court. I have been unable to find any reference to a debate on his report in either House, so we are making history tonight. The 1996 report has still to be published so I had to use the 1995 report for this debate.
The inspector's report focuses on major problems but also gives praise. The decline in the number of patients in large institutions is welcomed but the fact that the number of community based residences and day care facilities are not being set up fast enough is noted. He points out that by virtue of the perceived increased level of violence in our society, the rise in the number of homeless, the increasing problem of marriage breakdown and the undoubted increase in suicide rates in recent years, it becomes extremely important that alternatives to in-patient care are quantitatively and qualitatively adequate so that patients do not become homeless and do not suffer social or economic deprivation and are adequately housed and fed. In report after report he highlights the difficulties and lack of staff and the fact that multi-disciplinary teams have not been formed.
It is interesting that purpose built units attached to general and private hospitals come in for far less criticism than the old mental hospitals, so we must be getting somewhere. The inspector recommends in the 1995 report one day place per 1,000 of population and 1.5 residential places. That was the first time he made specific recommendations on the number of places needed in both categories.
Child and old age psychiatry and suicide prevention are covered in the report. There is much comment on the management of the disturbed patient and the need for strict guidelines regarding the use of seclusion, the ultimate sanction on the disturbed patient, and the need to assess its effect on them. A special report on dealing with the disturbed or regressive patient was commissioned in 1995 and was to report in 1996 but I cannot find any evidence of it, although I may not have looked in the right places. I am glad the task force on suicide has reported. The number of adolescents in adult wards is noted. However, I do not see any comment on the lack of facilities for dealing with new mothers with post-natal depression and their babies, despite the fact that we know rapid treatment gives better results.
The inspector's reports are not all complaints. He frequently praises his staff for the work they do in difficult conditions, pointing out the difficulties of keeping old buildings clean and trying to function in acute units with inadequate facilities and staff. There has been little complaint in recent years about treatment, with the possible exceptions of seeking more explanations, privacy for patients undergoing electroconvulsive therapy and the need for strict guidelines on the use of seclusion.
I cannot expect the Minister to give me hope that the system will be improved but there are a few things he could do which would show that we are establishing patients' human rights as a priority. Section 247 of the Mental Health Act requires the inspector to furnish a general report each year to the Minister on the administration of the law and the care, welfare and treatment of persons of unsound mind. This is one area where there are complaints year after year and where, with better management, the civil and human rights of patients could be improved.
Ten years ago when I was on the board of the Eastern Health Board I was involved in inspecting the mental hospitals in its area. I thought huge improvements had been made in terms of a personal clothing policy for patients. However, I regret that policy is not universal. One of the greatest humiliations for long stay patients, that is, patients who have been in hospital continuously for over a year, is the lack of a personal clothing policy. The 1995 report states:
Newcastle Hospital:
Efforts were being made to rectify the unsatisfactory situation resulting from the closure of the laundry service in the previous year. A small laundry was under construction and when this became operational the personal clothing system would be fully restored.
St. Ita's Hospital:
Only some of the patients within St. Ita's Hospital had personal clothing and toilet requisites and greater efforts should be made to ensure that these were provided, especially for long stay patients.
When one considers the difficulty of preventing infection in mental hospitals it is dreadful to think of people sharing toilet requisites. The report mentions it again in relation to St. Brendan's Hospital. It states:
A personal clothing policy to be introduced in all wards of St. Brendan's Hospital. All patients should have personal clothing, night attire, toilet requisites and individual lockers.
The report continues:
The Central Mental Hospital:
Personal clothing and toilet requisites to be introduced for all patients.
St. Bridgid's Hospital, Ardee, County Louth:
Personal clothing should be introduced in all wards.
It is good that St. Patrick's Hospital in Castlerea has closed because the following was the situation in 1995:
The lavatories were dirty, underclothing and night clothing not personalised. The male geriatric sleeping areas were dirty and untidy. Full bottles of urine in a locker and on a window ledge were observed.
The following was the report's analysis of the situation in St. Mary's Hospital in Castlebar:
Concern over the unsatisfactory laundry facilities continued. Overall, the physical facilities of the hospital were most unsatisfactory. The quality of food provided for the evening meal in one ward was noted and was not impressive.
Many of the long stay patients in these hospitals are over 65 years of age and many have few visitors; in fact, approximately one third have no visitors at all. The only hope of their physical conditions being improved is if some attention is paid by the Minister to the inspector's reports.
Another simple recommendation which would help patients, family and friends is identification badges. Lack of these were noted in St. Loman's Hospital in Lucan, St. Ita's Hospital, St. Brendan's Hospital and St. Loman's Hospital in Mullingar, where facilities appear to be bad and staff are working with facilities which the inspector deems to be unacceptable and inadequate for the treatment of patients with acute psychiatric illness. Identification badges are not worn in some wards in Our Lady's Hospital in Ennis, Limerick Mental Hospital, St. Davnet's Hospital in Cavan, St. Senan's Hospital in Enniscorthy, St. Finian's Hospital in Killarney and St. Conal's Hospital in Letterkenny. Identification badges are worn in all hospitals where patients with physical illness are treated. Why does this not happen in mental hospitals? The strategic management initiative recommends that all civil servants should wear identification badges. I have to wear an identification badge when I go into a hospital.
Basic human rights allowing the patient some dignity are being ignored. Again regarding privacy, large wards are still in use in many hospitals and the inspector suggests a correlation between them and behavioural problems with patients. In some hospitals patients sleep, eat and live in the same wards day and night. There are no policies on smoking, meaning non-smokers have to sit and eat with patients who are smoking. This is not allowed in hospitals for physical disorders. Why in mental hospitals? Our European Commissioner, Pádraig Flynn, with his strong views on smoking, I know would support me.
Integration of male and female patients has not been initiated in many hospitals, another sign of the way mental patients are discriminated against.
Senators and members of the general public were very alarmed regarding reports of conditions in St. Ita's Psychiatric Hospital last February. Lack of information on what research was carried out in the hospital, and how and when the ethics committee functions also caused concern. While I can understand Senators wanting to visit there, a quick read of the Inspector's report on St. Ita's gives more than enough food for thought. I described the Minister's reply to my Adjournment debate on St. Ita's as a platitude. The patients in St. Ita's deserve better than that.
On page 211 of the report and on subsequent pages, Dr. Walsh has produced a check list for those who inspect mental hospitals. I wonder how many delegations from health boards use such a list?
Last year when I had Private Members' time I asked that we should debate the Mountjoy Visiting Committee's report. There has been so little action on that report that this year the visiting committee resubmitted it with comments because nothing had changed. One of their main worries is that at least 10 per cent of prisoners in Mountjoy have serious psychiatric illness. It was suggested that a barter system was in operation between Mountjoy and the Central Mental Hospital — when one prisoner goes up there one comes down.
Attempts to repatriate patients deemed suitable for return from the Central Mental Hospital to their present psychiatric services appear to be resisted, holding up places which could be used by prisoners. There is no supported residential accommodation so that suitable patients could be discharged back into the community. It was suggested that the governor's house was available in the grounds and could be made into a rehabilitation residence. If even a small number of places were "freed up" we could avoid episodes such as happened in Mountjoy recently when a seriously ill woman was kept in a padded cell for 25 days before accommodation was found for her in Dundrum.
Another small improvement would be if nurses were re-enabled to give patients their medication to take with them when they are going out for a day or two. Recently nurses have been informed that they must get doctors to write a prescription for dispensing in the pharmacy which can cause difficulties if patients are asked out at short notice.
We have not got a comprehensive mental health service nor is there one which is integrated with the rest of the health service. Hostels are not integrated into the community; who has responsibility for them? There is much to be done but if the Minister would see his way to help dignify the patients' lives I would be extremely happy.