Dáil Éireann Debate, Wednesday - 26 May 2004
31 Ms O. Mitchell asked the Minister for Health and Children the reason the increase in funding in 2004 for psychiatry is the lowest of all medical specialties; and the further reason for a drop in mental health services funding from 11% of the health budget in 1997 to 6% in 2004. [15735/04]
Amharc ar fhreagraIn recent years, significant additional resources have been committed to developing comprehensive, community based mental health services. This has resulted in a continuing decline in the number of in-patients from 5,192 in 1997 to 3,966 in 2002 with a corresponding increase in the provision of a range of care facilities based in the community to complement in-patient services. There are now 411 community psychiatric residences providing 3,146 places compared to 391 residences providing 2,878 places in 1997.
Since 1997, approximately €90 million additional revenue funding has been invested in the mental health services. This funding has been used to provide medical and health professional staff for expanding community mental health services, to increase child and adolescent services, to expand the old age psychiatric services, to provide liaison psychiatry services in general hospitals and to enhance the support provided to voluntary agencies.
Recent years have seen a considerable expansion in the number of professionals in the mental health sector. For example, in 1997 there were 207 consultant psychiatrist posts and by 2004 this had increased by 74 to a total of 281. This includes an extra 19 psychiatrists dealing with children and adolescents, eight dealing with learning disability, three with forensics, 28 with adults and an extra 16 dealing with geriatric patients.
Since 1997, five new acute psychiatric units have opened in general hospitals. These units are in the Mercy Hospital, Cork, as well as Tallaght and Ennis general hospitals and two units opened in 2003 in Kilkenny and Castlebar. There are now 21 acute psychiatric units attached to general hospitals. A new unit at the Midlands Regional Hospital, Portlaoise is due to open to clients next month. Other units are currently at various stages of planning.
The injection of capital funding in recent years has accelerated the shift from a predominantly institutional based mental health service to a more community directed service as set out in the 1984 report on the psychiatric services, Planning for the Future. A new capital development framework for the period 2004-08 is being prepared and will include further significant developments for the mental health services.
Additional information not given on the floor of the House.
The estimate for the mental health expenditure in 2004 is €661.35 million or 6.69% of the total health budget. It should, however, be considered that in the financial year 1956-57 the percentage spent on mental health services was 19.5% and rose by 2.3% to 21.8% in 1960-61. At that time there were almost 20,000 public in-patients, and this figure has since fallen to around 3,200 in 2003. In this regard, it must be noted that in-patient care has always been the most expensive element of the mental health service and with the consistent reduction in psychiatric hospital bed numbers and the ongoing transfer of intellectually disabled and elderly patients to other settings, it is to be expected that expenditure relative to other services would fall.
Recent years have seen a significant transfer of intellectually disabled and elderly patients from psychiatric hospitals to other, more appropriate settings. In this regard it is noteworthy that the percentage of health expenditure allocated to services for the intellectually disabled has increased substantially since 1997 and expenditure on services for older people has also increased in the same period.
Substantial progress has been made in recent years in ensuring that those in need of mental health services receive care and treatment in the most appropriate setting. However, much remains to be done. I am committed to the provision of quality care in the area of mental health and I will endeavour to secure additional funding for this sector in the coming years. The further development of our mental health services will be considered in the context of the Estimates process for 2005 and subsequent years.
I do not wish to be rude to the Minister of State, but one has to be deluded to believe there is a comprehensive community psychiatric service. There simply is not. He says there is a move from institutional beds to the community. The "community" does not exist. What exists is people living in doorways out there in Molesworth Street and elsewhere. This is often an acute service. Virtually no acute beds are ever available in this city or throughout the country. Some 45% of acute beds are blocked at any time. Does the Minister of State realise that if this was happening in the ordinary health service, and not in area of mental health, there would be revolution? Almost 50% of the beds are blocked.
Is there a plan or strategy of any sort to develop multi-disciplinary teams, as recommended by the Irish College of Psychiatrists. The Minister of State rightly says additional psychiatrists have been appointed. However, on their own they can do nothing except administer drugs. That is all they can do if they do not have multi-disciplinary teams to back up the service. Is the Minister of State aware of the major hardship being placed on families by the absence of any follow-up comprehensive treatment other than the fact that people can be doled out drugs week in week out?
As regards the 11%, anyone can play around with percentages. The funding for mental health services in 1997 was £326.8 million. Eight years later that funding had doubled. In 2004 it was €661.352 million. At the same time, on account of the large increase in expenditure in the whole area of health, the percentage has fallen from 8.96% to 6.69%.
I understand the points made by the Deputy, but it is not true to say there are not plans. Significant plans exist at the moment for all the health services. Even as regards the other disciplines, apart from the psychiatrists I mentioned in my reply, there has been a large increase in the number of psychologists, occupational and speech therapists. I agree the number in the services is not sufficient, but we have put in place a comprehensive range of new courses in several of the institutional colleges around the country, to educate more clinical psychologists. These will come on-stream in a few year's time.
I will also tell the Deputy about further plans for a comprehensive roll-out in a seamless fashion. She is right in so far as there is much debate about the mental services and how the money is being used. I have set up an expert group. It is diligently reviewing the entire area of mental health. It has had more than 140 submissions and I have attended two days of consultations in this regard, where the group has engaged with clients who use the mental health services, as well as providers. There is broad-ranging discussion as to the way forward and the need to change some of the current methods. In many cases there may not be a need for general practitioners to refer some of the patients in the mental health area directly to consultant psychiatrists. There should be a seamless way of doing it, through psychologists, counsellors and so on, and that is one of the topics which the expert group is examining. I met recently with the IMO which is also acutely aware of the problems in the education of doctors in the mental health area and it is trying to resolve those problems.
Will the Minister of State guarantee that he will not wait until this report is published at least to deal with child and adolescent psychiatry? That is a service that is acutely needed. When an adolescent presents with a psychiatric problem it is most acute and families are distraught to have a child in that condition, with no service. The only treatment available is pharmacological, which is totally unacceptable nowadays. Will the Minister of State guarantee that he will at least look at that area as a matter of priority?
I am looking at that area but it can be too easy and glib to say that medication is the only resource available. Often there are other reasons but I do not want to go into this in detail.
I understand that but it does not excuse the absence of all the other services needed.
