Mick Wallace (Wexford, Independent)

I will start on a positive note by commending the Government on going ahead with funding for accident and emergency and maternity units in Wexford, which were much needed. For some strange reason, Wexford has been poorly treated for a long time. It has one of the highest literacy rates in the country yet it is one of the few counties without a third level education institution. At present, Wexford has one of the highest rates of unemployment, with more than 20,000 people unemployed. Even in the good days in 2007, 50% of the Wexford people who were working worked outside the county. It is welcome that Wexford is getting the much-needed hospital unit.

What is less positive is that in Wexford yesterday, 24 beds were closed and 15 patients were on trolleys due to the manager having the sole job of meeting a certain budget It is hard to blame her because her job seems to be to cut patient care in order to meet the budget.. Given the amazing statistic that the population of Wexford increased by 10% in the past five years, going from 131,000 to 145,000, one can imagine the extra pressure on the hospital. This is most noticeable in the maternity unit. At present, there are 14 wholetime midwives working 37.5 hours per week. The moratorium on recruitment and the fact that the maternity unit is part of the general hospital means the hospital cannot hire midwives, irrespective of demand. This year, the hospital has seven fewer midwives because of the moratorium and it is about to lose another three before Christmas. One wonders how they make this work and, from what I understand, it happens because of the goodwill of the midwives, which involves working through lunchtime, working late hours and receiving no overtime rate for this work. I am not sure how long this will last and, given that the situation will become worse if the moratorium is left in place, I fear for what will happen.

It is accepted that there is a direct correlation between financial problems and mental health. The Minister of State, Deputy Lynch, was present at the launch of a recent report by the Mental Health Commission entitled The Human Cost. This provides an overview of the evidence on economic adversity and mental health, as well as recommendations for action. Speaking at the launch of the report, the Chairman of the Mental Health Commission, Dr. Edmond O'Dea, said that the recession affects everyone, that for those with pre-existing mental health problems, issues such as debt and unemployment are likely to make things worse and that "in addition to the effect on people with pre-existing mental health problems, people with no previous history of mental health difficulties can be affected." Some of these individuals may have little previous experience of coping with hardship or financial insecurity.

From 2008 to 2009, there was a 24% increase in suicide. Suicide is a major problem in Wexford and today in my village, a man a few years younger than me took his life. The Minister of State is aware that the mental health institution in Wexford, St. Senan's, was closed earlier in the year. Some 75% of the patients go to Waterford and 25% go to Newcastle, County Wicklow. The facility in Newcastle, used by those in the north of County Wexford, is an excellent, state-of-the-art facility. However, the facility at Waterford is not fit for purpose. The 2010 report of the Inspector of Mental Health Services included the following observation: "The department of psychiatry was situated in the lower ground floor of Waterford Regional Hospital. It was divided into acute and subacute areas. The former was locked on the day of inspection. There were two involuntarily detained patients. While there was a garden area, residents did not have access to this. This impinged particularly on the residents in the acute area who were not free to leave the unit. A smell of cigarette smoke pervaded the building which was particularly noticeable in the acute area. A porch to this area served as a smoking room. Staff informed the Inspectorate that extractor fans were unable to clear the air adequately."

The Minister informed me in this House in May that a new crisis house would be opened in Wexford to replace St. Senan's Hospital which would ensure we would not be too dependent on services in Waterford. The new unit which is about to open at St. John's Hospital in Enniscorthy is being sold as an acute admissions service, but it is essentially a rehabilitation facility for patients coming from Waterford and Newcastle. That is not good enough.

Last week there were reports that mental health services in Wexford were likely to face further cuts in the near future. Following the closure of St. Senan's Hospital, community services in Gorey, Wexford and Enniscorthy were upgraded to be available seven days a week to cope with demand. However, we are now told there is a possibility this service will be reduced to five days owing to cutbacks. The Mental Health Commission has highlighted the connection between primary care services and mental health services and that the majority of common mental health problems are treated at primary care level. Further reductions in primary care provision will make the job of front-line workers extremely difficult.

A 2011 report by the World Health Organization on the impact of economic crises on mental health observed: "It is well known that mental health problems are related to deprivation, poverty, inequality and other social and economic determinants of health. Economic crises are therefore times of high risk to the mental well-being of the population and of the people affected and their families."

The economic crisis that began in 2007 has led to significant declines in economic activity, a rise in unemployment, a depressed housing market and an increasing number living in poverty. It continues to pose major challenges in health service delivery in the south-east region.

See this speech in context