I welcome the opportunity to make a statement to the Seanad on the Inspector of Mental Hospitals Report, 1999.
Under the provisions of sections 247 and 248 of the Mental Treatment Act, 1945, the inspector issues an annual report on psychiatric hospitals and services and the care of patients therein. The report serves to highlight areas within the service which require particular and sometimes urgent attention from service providers.
In the first chapter of the 1999 report, the inspector details some general matters affecting the psychiatric services at the time of inspection and highlights the main developments envisaged in the psychiatric services in each health board. The report then proceeds to deal with each individual service. Each health board is allocated a separate chapter, with a chapter also being devoted to registered psychiatric hospitals. Finally, there is a presentation of the latest statistical information on the psychiatric services.
I am pleased to inform the House that substantial progress has been made in addressing the matters raised by the inspector in the 1999 report. One of the recurring themes in the annual reports of the inspector has been the standard of accommodation provided for users in the old style mental hospitals. The Psychiatric Services – Planning for the Future, published in 1984, recognised that old institutional hospitals are unsuitable for the delivery of a modern mental health service and developed the concept of a comprehensive psychiatric service located in the community close to where people live and work. This policy is still valid today.
The shift to a community oriented mental health service as an alternative to institutional care for persons with mental illness is progressing significantly. New mental health centres, day hospitals and other facilities have been set up and, at the same time, additional community-based residential accommodation has been made available. The number of community residences established in 1984 stood at 121, providing 900 places, increasing to 392 in 1999, providing 2,875 places. In the same period the number of day hospitals and day centres increased from 32 to 270. However, it is recognised that further improvements in providing alternative facilities are needed and, while there continues to be a steady decline in the number of patients in psychiatric hospitals, the rate of progress in developing alternatives to this institutional service needs to be accelerated.
In response to the inspector's concern at the delays in this area, substantial capital funding under the national development plan has been allocated to the development of mental health facilities. Almost £150 million capital will be provided for mental health services over the lifetime of the national development plan. A significant part of this funding will go towards the development of acute psychiatric units linked to general hospitals as a replacement of services previously provided in psychiatric hospitals. In addition to the 18 acute units already in place, a number of units are currently at various stages of development, including Beaumont Hospital, Dublin, St. Vincent's Hospital, Elm Park, James Connolly Memorial Hospital, Ennis General Hospital, St. Luke's Hospital, Kilkenny, Portiuncula Hospital, Ballinasloe, and Nenagh, Portlaoise, Castlebar and Sligo general hospitals. A further four acute psychiatric units are planned, as part of the national development plan, in Dundalk, Wexford, Mallow and Mullingar. The aim of this programme is to provide people with accessible treatment facilities which are of a high standard and to phase out admissions to the older larger-scale psychiatric hospitals.
A sum of £18.64 million has been made available to the mental health services for 2001 to address specific areas, including those highlighted by the Inspector of Mental Hospitals as requiring special attention. These include the development of community mental health services; the expansion of child and adolescent services; the provision of liaison psychiatry services in general hospitals; and, most importantly, the development of old age psychiatry. This funding, which represents a major increase on the funding made available in previous years, will be used as follows: £8.2 million is being allocated in 2001 directly towards the further development of community-based mental health services, including the improvement of psychology and social work services. The lack of multidisciplinary teams in many areas of the mental health services has been highlighted by the Inspector of Mental Hospitals in his report. This funding will provide for the establishment of additional multidisciplinary teams and the recruitment of additional staff to strengthen existing services.
Priority is being given to the development of mental health services for both older people and child and adolescent psychiatric services. Additional resources are being made available by the Department to enable improvements to be carried out in these services. An additional £3.2 million was allocated to further developments in child and adolescent psychiatry services in 2001. This will provide for the appointment of additional consultants in child and adolescent psychiatry and for the development of multidisciplinary teams to focus on specific areas, such as attention deficit-hyperactivity disorder – ADHD. A working group has been established by my Department to review child and adolescent psychiatry and to finalise a plan for the further development of this service. The group has been meeting since June last year and presented its first report last week.
The report emphasises that the treatment of ADHD-HKD is an integral component of the provision of a comprehensive child and adolescent psychiatric service. It recommends the enhancement and expansion of the overall child and adolescent psychiatric service throughout the country as the most effective means of providing the required services for this group. It also recommends that priority should be given, in the first instance, to the recruitment of the required expertise for the completion of existing consultant-led multidisciplinary teams. The report also calls for closer liaison and interaction with the education system and other areas of the community health services.
The report recommends that a total of seven child and adolescent in-patient psychiatric units for children ranging from six to 16 years should be developed throughout the country. It is envisaged that the focus of the centres will be the assessment and treatment of psychiatric, emotional or family disorders, including major adjustment disorders, anxiety disorders, mood disorders, eating disorders and schizophrenia, using a combination of family systemic, individual psycho-dynamic and medical model perspectives. Five in-patient units for children and adolescents are to be developed and funded under the National Development Plan, 2000-2006. At present, three of the units are at the planning stage and project teams have been appointed to oversee their implementation. These are the units to be based at Bessborough House, Cork, for the Southern Health Board region, Limerick Regional Hospital complex, Limerick, for the Mid-Western Health Board region and Merlin Park Hospital complex, Galway, for the Western Health Board region. It is proposed to develop two child and adolescent in-patient units for the ERHA and the location of these units will be decided by the authority.
The increase in the number of people living to advanced old age requires the development of specialist mental health services to meet their specific needs. Old age psychiatry services have been expanded in recent years and £1.87 million is being provided in 2001 towards the provision of additional consultants in old age psychiatry. The Inspector of Mental Hospitals recommends this development in his 1999 report.
There is a small number of individuals who for shorter or longer periods require special facilities because of the extent of their disturbed behaviour consequent on severe illness. The appropriate interventions and skills required for these patients are not ordinarily available in acute units. My Department is committed to providing dedicated facilities for disturbed mentally ill patients. These facilities will cater for approximately ten to 15 patients and will be staffed by specially skilled professionals in each health board. Discussions with health boards on this matter are ongoing and capital funding has been provided under the national development plan.
Concern was expressed in the report at difficulties in recruiting qualified psychiatric nursing personnel, which were particularly acute in the eastern region. However, over £1 million has been provided for local and national marketing campaigns undertaken by the Nursing Careers Centre and the schools of nursing around the country. The success of these campaigns is evident from the fact that the schools of nursing have since succeeded in filling a record 254 training places in psychiatric nursing in 1999. This was exceeded last year, rising to 300. Increasing the annual intake of student psychiatric nurses is a key element in the Government's strategy for addressing the current shortage of nurses.
The provision of psychiatric services to those in the criminal justice system is essential and the inspector has rightly expressed concern regarding the current forensic psychiatry services. Resources were provided last year to enable the establishment of four additional consultant forensic psychiatrists and associated support staff. There has been a delay in progressing these posts due to inexperience on the part of the health boards and their staff in the area of forensic psychiatry. However, discussions are now under way with both the Mid-Western Health Board and the Southern Health Board regarding the structure of the consultant posts and the service implications of establishing this service.
At national level priority is being given to education awareness and promoting a better understanding among the public towards mental health, thereby facilitating a greater and more positive acceptance of the transfer of mental health services from institutional to community-based settings. I am sure the House shares our concern about recent developments where communities have opposed the location of such needed facilities in community settings. It is important to develop far more positive approaches by community groups. Links with the voluntary sector continue to be strengthened, both at national and local level, and an additional £730,000 has been made available in 2001 to strengthen these links and services. There is ongoing co-operation between the boards and several voluntary organisations such as AWARE, GROW, Schizophrenia Ireland, the Samaritans and local branches of the Mental Health Association of Ireland.
In response to some of the ongoing concerns expressed by the inspector over many years, legislative change is now under way. The Mental Health Bill, 1999, published in December 1999, is expected to be enacted later this year. The purpose of the Bill is twofold. First, it will provide a modern framework within which people who are mentally disordered and who need treatment or protection, either in their own interest or in the interest of others, can be cared for and treated. In this regard, the Bill will bring legislation on the detention of mentally disordered patients into conformity with the European Convention on the Protection of Human Rights and Fundamental Freedoms.
The second purpose of the Bill is to put in place mechanisms by which the standards of care and treatment in our mental health services can be monitored, inspected and regulated. The vehicle for achieving this will be the mental health commission, to be established under the legislation. The commission will have responsibility for promoting and fostering high standards and good practices in the delivery of mental health services; improving and modernising the criteria and mechanisms for the involuntary detention of persons for psychiatric care and treatment; estab lishing a system of automatic and independent review of all detentions, including the provision of legal aid to all those who are detained; the establishment and administration of a legal aid scheme for detained persons; the maintenance of a register of approved centres, in which hospitals or residential facilities providing psychiatric care and treatment must be registered; and the appointment of the Inspector of Mental Health Services. This important Bill is on Report Stage in the Dáil at present and I hope to bring it to this House before the summer recess.
In response to the specific proposals and recommendations set out in the 1999 inspector's reports for individual health boards, plans for implementing those changes have been prepared by each board. Progress is steady and health boards keep my Department informed of developments. I am satisfied that the inspector's concerns and recommendations are being addressed both at national and local level. I understand my officials have made available additional information regarding details on implementation to Members of the House. If not, we will make available a summary of each health board's response to the issues raised in the report. I have a copy before me which might be of use to Members in terms of their health board areas.
The 1999 report was published earlier than in previous years and I am informed by the Inspector of Mental Hospitals that the inspection of facilities for 2000 have been completed and the process of preparing the 2000 report for publication is well under way. As an independent office holder, the inspector plays a crucial role in providing an accurate and detailed account of services in the mental health sector throughout the country. It is generally accepted that his reports have acted as a catalyst for improving the services and highlighting the inefficiencies in them. I thank him and his office for their constructive input into the development of services for the mentally ill. It is my intention to facilitate the health boards in as far as possible to bring about the improvements and developments identified by the inspector. We look forward to an ongoing and constructive relationship with him.