I thank the Senator for raising this matter which I am happy to address on behalf of my colleague, the Minister for Health and Children. I will begin by emphasising the Government's commitment to addressing the concerns of psychiatric nurses about their safety and security, and outlining the measures in place and the significant steps being taken in this regard. In 1998 the inspector of mental hospitals published guidelines on good practice and quality assurance in mental health services which were issued to service providers.
The guidelines recommend that: all staff should be trained in the techniques of management of violence and aggression through participation in a recognised training course; training courses should be organised on an ongoing basis in order that all staff have the opportunity to attend refresher courses periodically; all staff should be trained in the manual handling of loads and safe lifting techniques; all staff should be aware of their responsibility in relation to personal safety and the safety of patients and colleagues and in the reporting of identified hazards; if considered appropriate, staff should carry personal safety alarms which will enable a speedy response to be available to them in emergencies; locations, such as interviewing rooms or offices where staff may work in isolation, should have panic alarm systems installed.
In the course of his annual inspections of mental health facilities the inspector monitors the extent to which the guidelines are followed in each location and, should he deem it appropriate, comments on the matter in his annual report. One area of mental health nursing where particular concerns in relation to safety and security might arise is the provision of patient escorts. In response to the difficulties and concerns raised by psychiatric nurses, the Garda Síochána and service providers, a working group, which included representatives of the various interests involved, was established in October 2001 to review the practice of patient escorts in mental health services.
The terms of reference of the group were to review the practice of patient escorts in the context of the future development of mental health services and, in particular, the provisions of the Mental Health Bill – since enacted to become the Mental Health Act, 2001 – and to make recommendations in relation to future practice. Its report on patient escorts has been completed and circulated to members of the working group. Key recommendations and guidelines on the role of general practitioners, gardaí, nurses and other members of the multidisciplinary team are set down in the report. Training needs are identified in the areas of de-escalation techniques, risk assessment, breakaway and control and restraint.
In April 2002 my colleague, the Minister for Health and Children, Deputy Martin, established the task force on assaults on psychiatric nurses at work in response to a demand by nurses' unions for a comprehensive compensation scheme for nurses injured as a result of assault at work. The terms of reference of the task force are: to examine the incidence of assaults on nurses and the level of injury arising therefrom, to investigate the reasons for such assaults with a view to designing programmes aimed at prevention and to put forward proposals for an appropriate compensation scheme for nurses injured through assault at work with regard to the special position of psychiatric nurses. The task force is concluding its work and expected to report to the Minister in the near future. It is envisaged that it will, inter alia, make recommendations on risk assessment and preventive measures, including training and educational programmes for staff dealing with violence and aggression.
There are a small number of individuals who, for varying periods, require special facilities due to the extent of their disturbed behaviour consequent on severe mental illness. The appropriate intervention and skills required for these patients are not ordinarily available in acute units. The Department of Health and Children is committed to facilitating the development of dedicated facilities in each health board for such 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.
Approximately €190 million capital is being provided over the lifetime of the national development plan for mental health services. A significant part of this funding is going towards the development of acute psychiatric units linked to general hospitals, as a replacement of services previously provided in psychiatric hospitals. There are now 18 acute psychiatric units operating in general hospitals. By the end of the period of the national development plan, it is anticipated that new psychiatric units will be provided at St. Vincent's Hospital, Elm Park; James Connolly Memorial Hospital and Beaumont Hospital in Dublin and the general hospitals at Sligo, Kilkenny, Portlaoise, Castlebar, Nenagh and Wexford. When the programme of acute psychiatric units is completed, it is anticipated that there will be no further acute admissions to psychiatric hospitals.
The House will agree that serious efforts have been made by my Department to deal with this issue. I offer my assurances that these efforts will continue.
