Mental Health Services Provision

Dáil Éireann Debate, Tuesday - 25 June 2013

Tuesday, 25 June 2013

Ceisteanna (73)

Luke 'Ming' Flanagan

Ceist:

73. Deputy Luke 'Ming' Flanagan asked the Minister for Health if he will confirm the location within County Roscommon of the units (details supplied) referred to in A Vision for Change for the care, treatment and rehabilitation of persons with difficult to manage behaviours; the date on which they will be operational; the location of the regional forensic mental health units; the location at which patients currently in need of this provision will be treated and detained; with regard to the Roscommon mental health service, if he will give details of the development plan for the roll out of A Vision for Change and the timescale envisaged; and if he will make a statement on the matter. [30653/13]

Freagraí ó Béal (5 píosaí cainte)

Minister of State at the Department of Health

Addressing the generally accepted historic deficiencies in both the capital and non-capital aspects of our mental health services remains a priority for the Government. This is reflected in the fact that we are following through on our programme for Government commitments, with some €70 million provided this year and last year for a range of new posts and other specific initiatives relating to mental health and suicide prevention.

Notwithstanding progress on addressing the overall financial pressures still facing the country and the demands being placed on all areas of the care system, the HSE mental health budget increased this year, from approximately €711 million in 2012 to €733 million in 2013. The HSE service plan for this year indicates that the Galway-Roscommon local health office will receive approximately €69 million for mental health services in 2013.

The Deputy will appreciate that the HSE has statutory and operational responsibility for the planning and delivery of services at local level, including for the Roscommon area. It should be noted that the per capita spend on mental health services across Galway-Roscommon is the second highest in HSE West, at €220 per head of population, and is significantly above the national average spend of €160 per head. In short, there are significant resources in Galway and Roscommon mental health services, but there is also a need to review the current configuration of services. Both community and inpatient services are provided in Roscommon and are deemed to be the one entity in the context of the Galway-Roscommon local health office area.

Replacing the Central Mental Hospital, CMH, with an appropriate modern facility is one of the priority health projects set out in Infrastructure and Capital Investment 2012-2016: Medium Term Exchequer Framework. The Minister for Health announced in November 2011 that the CMH would be located at St. Ita's, Portrane, County Dublin. This project includes replacement of the CMH and also development of associated new facilities. Four regional intensive care rehabilitation units, ICRUs, are also planned, one of which will be located at Portrane. The further three ICRUs will be located in Cork, Galway and Mullingar.

Additional information not given on the floor of the House

A steering group for this project is in place and members include representatives from the Department of Health, the HSE, the Central Mental Hospital, the National Development Finance Agency and representatives from appropriate non-statutory stakeholder groups. The design team appointed in July 2012 is advancing the design for the project and this work is progressing satisfactorily. The most up-to-date position on reconfiguration of the national forensic mental health service facilities is contained in the current HSE capital programme.

On the wider implications raised in the question, implementation of A Vision for Change, the report of the expert group on mental health policy in 2006, and the reform of mental health services are a priority for the Government. Although implementation of A Vision for Change has been somewhat slower than expected, a great deal of progress has been made with the accelerated closure of old psychiatric hospitals and their replacement with bespoke new facilities, better suited to modern mental health care. Progress also includes shorter episodes of inpatient care and the involvement of service users in all aspects of mental health policy, service planning and delivery. There has been a considerable decline in the number of patients resident in psychiatric facilities, with numbers falling from 10,621 in 1987, to 2,812 in March 2010, representing a reduction of 73%.

A modern mental health service is best delivered in the community and in this regard the Government has provided an additional €70 million and almost 900 additional posts in the past two budgets, primarily to further strengthen community mental health teams in both adult and children’s mental health services, to develop forensic services, to advance activities in the area of suicide prevention, to initiate the provision of psychological and counselling services in primary care specifically for people with mental health problems, and to facilitate the relocation of mental health service users from institutional care to more independent living arrangements in their communities, in line with A Vision for Change. It is expected that the appointment by the HSE of a new director for mental health in the near future will greatly accelerate the pace of implementation.

Deputy Luke 'Ming' Flanagan

I know the Minister of State is trying and is putting money into the service, but people are not happy with it. It is a very sensitive issue to discuss, but if people who have relations in the unit in Roscommon hospital are worried about it and telling me it is an appalling situation that must be addressed immediately, one must make a choice. One can either talk about it openly and potentially be accused of making people wary of using the services, or keep quiet about it, which lessens the chance that something will be done to solve the problems. There are problems, regardless of what people might admit is causing them, be it staff shortages or the requirement for a secure unit or whatever acronym one wishes to use for it. In fact, the lack of a secure unit is causing a major problem. It is causing a logjam which means that nurses and staff must be taken out of the community to deal with difficult situations in the unit. As a result, people who go to the local services in order that they can avoid going to the acute services end up having nowhere else to go but the acute services. Obviously something must be done.

Deputy Kathleen Lynch

I thank the Deputy for his question. The language used today is better. Ultimately, it is about language and we must be very careful not to discourage people from using the service when they need it. This is not a resources issue. There are 890 people working in the Galway-Roscommon service. They might not be in the right place, but they are in that area.

Those who work in this service have always dealt with very difficult people. It is the nature of the illness that people are unpredictable and do things unexpectedly. That is the reason we have professionals working in this area. We are working on this issue and must reconfigure the service. If we can have a service with the same number of staff relative to the same population base in other areas of the country that is an excellent, community-based service, clearly we must examine why that is not happening in Galway-Roscommon. I genuinely believe people must embrace change. I constantly hear calls for the roll-out of A Vision for Change and people saying it is not happening quickly enough, yet when one starts to do this, one tends to meet these bottlenecks. We really must begin to look at putting the service user at the centre of all of this.

I have no doubt that people are worried. Having listened to debate of the type heard on the radio over the past two weeks, I would also be worried if I had somebody requiring the service. However, there is no need to be worried as we have a service that can be excellent. It is a safe and secure service.

Deputy Luke 'Ming' Flanagan

The bottleneck is not created by staff being unwilling to do X, Y or Z; it exists because when a very difficult patient who requires a far higher level of care than others is put in an unsuitable unit without CCTV and one-to-one care, rather than a purpose-built unit to ensure both staff and patient are safe, it creates a pull from the very community services that the Minister of State is advocating people should use. The lack of a secure, purpose-built unit is one of the major problems, although I acknowledge it would not solve the problem entirely. This needs to be dealt with quickly.

I understand that Ms Catherine Cunningham from the PCCC service and others are to meet the Minister of State in the next week or so on this issue. Even if they receive the thumbs-up and the Minister of State has a cheque on the day, progress will take some time. In the meantime, there will be a backlog. Even today, two families have contacted me on this matter, and they are still expressing serious concern. I hate to have to say that because it worries those who need to use the service. If it is a fact, however, it is a fact. All of these people cannot be wrong and they have nothing to gain from taking their stance. All they are getting out of it is absolute worry about their nearest and dearest who are at their lowest possible ebb.

Deputy Kathleen Lynch

Worry is not a basis for not using the service. The types of language and debate we have heard on this issue are such that I am not surprised people are worried. People who present with very challenging behaviour have always been dealt with by the service. That is what the mental health service does. In the main, 95% of people can be dealt with in the community but there will always be those who will require the acute unit and those who present with challenging behaviour.

The Central Mental Hospital, under Professor Harry Kennedy, has now developed a very good outreach service to guide local services for people who present with challenging behaviour. Before any call was made, he was already working on this because that is what the service does. The staff, who are specialists, are good at this, and that is what they do.

I acknowledge that Deputy Luke 'Ming' Flanagan has an interest in this area; there is no doubt about it. I plead with people to allow us to get on with what we need to do with mental health services. Let us reassure families who need reassurance that when their loved ones seek to avail of a service, it will not only be available but will also be safe and secure. We need to reconfigure, however. We cannot have a community-based service if all our staff are in the acute unit.

With regard to the review of the Mental Health Act, whose outcome I cannot predict, I have asked that the Mental Health Commission, which licenses only the acute unit, thereby resulting in the unit's very specific numbers, to start to license community-based programmes also so there will not be a continuous draw from those programmes.