David Norris (Independent)

I welcome the Minister of State, but I doubt I will welcome what she has to say in her prepared speech. This issue concerns once again the continued asset stripping of community resources, particularly from rural areas. I have raised a number of these issues in the past with various Governments, including the issue of the Bethany homes in Carlow - also the location of the issue I am raising now - Abbeyleix in my home county of Laois and Valentia hospital. Many of the cutbacks are mean-minded, hamfisted and inefficient because, in the long term, they lead to greater Exchequer expense.

I have visited St. Dympna's in Carlow the resource that is the subject of this matter and have been immensely impressed. St. Dympna's deals with people with intellectual difficulties of one kind or another and emotional problems and is very much a community-based service. I was very impressed by the environment, the staff and by one of the patients who remembered me. It took me some time to recall him, but I had a long conversation with him and he was extremely flattering about the impact the services have had on him personally. I believe he is a person who will suffer if the services are cut back or abolished. It would be wrong to do that.

It has been suggested that staff levels at St. Dympna's, and on the STEER system in particular, are above the average. This fails to take into account that many of the staff complement work in a remarkable intellectual disability unit in the grounds of the hospital. If this was taken into account, the situation would be clearer. This is matter that is not just parochial and of importance to Carlow. It is symptomatic and for that reason it is being taken up actively by the Psychiatric Nurses Association. Mr. Des Kavanagh, the general secretary of the PNA made the point that people in the Carlow region are extremely annoyed to see model services that have been built up in this area over a long period being slowly dismantled. He said that clients have had services cut, outreach services have been halved and in the case of a very effective service, the supported training education employment referral, STEER project, it was being dismantled completely. He went on to say that the result of this scale of cutbacks on services would be to outwardly put more demands and costs on other areas of psychiatric services in the long run. All of those concerned in the mental health services are united in demanding these cuts are reversed. In the long run, these cuts are not cost savings.

The assertive outreach service, which provided much needed support to service users will be effectively halved. This move, as well as being unfair to service users and staff, is short-sighted and will cause an even greater spend in the long run. These clients now face even greater risk of relapse. STEER supported and reassured patients and gave them opportunities that ensured they were integrated in society and given possibilities that made them less likely to relapse. It also improved their quality of life and gave them access to choices and helped them return to education. Its work was very impressive. It may seem to those who might be intellectual snobs, with university degrees and so on, that the level of attainment is quite small - FETAC and so on - but that level is a huge achievement for somebody with an emotional or intellectual disability, difficulty in adjusting and who has never had the benefit of systematic or proper education. For them to achieve this is remarkable.

There is also a service entitled Clann Nua a name that tells us it provides a "new family". Clann Nua provides a familial environment for vulnerable people. It is a day service for clients living in hostels and sheltered accommodation. The service users in question whom I know personally are completely dismayed at the possibility of the loss of this service as it is vital to them. They find assistance from it with everything, from managing their budgets to medication management. It is significant for them to get this assistance from people they have come to know and trust. The alternative management centre is a considerable distance away and puts unbearable difficulty on them.

The STEER approach is to move clients away from the industrial unit sheltered workshop base back to mainstream work or education, rather than keep people within the mental health services area. I am sure the Minister of State will agree this is important. This system motivates patients. The figures are impressive. In one year, there were 176 job referrals. The results of the intervention are that people are happier as noted in the shifts of mood recorded - STEER keeps detailed records on this - even after just the third session. For people who experience this kind of difficulty, it is important this service should be there. There is significant contact with groups that can provide jobs, such as FÁS, FETAC and so on. These organisations maintain personal contact with the management and tutors and like to get referrals from STEER because of its reputation. Prior to the STEER programme, people would have remained unemployed for years.

The impact of the proposed reconfiguration will be that the assertive outreach programme will be damaged. It provides a service for 26 active clients who are among the most vulnerable users. Crisis intervention will also be inhibited. With a single nurse on duty, it will not be possible to have crisis intervention and this will hamper the capacity for relapse prevention and early detection. The day services will also be affected.

I remind the Minister of State that this is a situation where there are vulnerable people and where it is possible there will be cutbacks to the services. I have raised the matter of cutbacks in other areas where it has been shown that there was mean-minded application of HIQA criteria, like closing a facility because of peeling paint. Does the Minister of State seriously believe that bothers people? Perfectly adequate facilities are being closed down, with a destructive impact on the community and an ultimate cost on the Exchequer although it may appear there is an immediate saving. I appeal to the Minister of State to look again at this situation.