Dan Neville (Limerick, Fine Gael) | Oireachtas source

I thank Mr. O'Brien and Mr. Lynch for their attendance and contributions. I would like to deal first with the area of data protection. This issue arose earlier and, for the information of the HSE, the then Ombudsman made it quite clear that in respect of any representations made by a public representative, there was an implication that the constituent had given permission by way of contacting the public representative. At earlier stages in the operation of the HSE, letters were sought from everybody we would represent giving permission, but the Ombudsman, in writing and at a meeting of the Committee on Procedure and Privileges, made it quite clear that a representation made to a public representative indicated that there was implied permission for full disclosure of any information. There is a letter to that effect from the previous Ombudsman.

The issue of a culture of complaints has been dealt with, but the word "complaint" may be the wrong one in this context, as it conveys the message that the complainant is a bit of a nuisance and that he or she is trying to find something about which to complain. However, that is way it is and that is the word that is used. "Concern" might be a better word if we could change the approach to this. A culture of complaints implies that a complainant is one of those people who always complains about everything, although, in fact, people are very slow to complain within the health services because of the delicacy of what is involved. It is only in extreme cases that complaints are made. As was mentioned, there is a fear of retribution. How many of us have found that a person, on calling to see us to make a complaint, has suddenly pulled back from doing so when we say that we will deal with it? They say they do not want to proceed and that they will leave it. It is very frustrating for a public representative who knows that there is something wrong, because the first thing one will be asked on making a complaint is the case concerned and the name of the person involved, which is fair enough. We do not want people walking in off the road saying that they want to make a complaint if they have an issue, although I am not saying that is wrong. That is very frustrating for us and I do not know how we can get over it, but we should be conscious that people are very reluctant to complain. That also inhibits the HSE from being informed of difficulties on the ground. In the previous discussion I dealt with the issue of mental health, the mental health services and the culture of secrecy around communicating with the patient. In one case involving an inpatient, the medics almost spoke over the patient suffering from a mental health difficulty, as if they were not cognisant of or did not understand what was happening.

Another issue I raised earlier was that of communication with carers in the context of aftercare for people who are discharged from a mental heath inpatient facility. I refer to instances in which a psychiatrist says that a matter concerning a patient is confidential and they cannot discuss it. They will not even ask the patient for permission to discuss it; they just close down. This does not relate to all psychiatrists; if I were to put a figure on it I would say it is applies to around 60% of them, because we have some very good psychiatrists, and I know many of them. It is very difficult and frightening for many people who are not engaged in the mental health services or with the illness that is mental illness. It is because of a tradition going back 20 years before my mother became a psychiatric nurse, when mental health facilities were known as lunatic asylums. We are coming from that era and that attitude. We know about the stigma attached to mental illness and we also know what HSE is doing through the See Change campaign. I will not go into that discussion, but there is that issue. There is an issue around communication with carers in terms of aftercare and how they are informed.

The Irish Advocacy Network, which is a peer advocacy group for mental health services, has not appeared before the committee. If the representatives have any comment to make on their experience of that network, I would welcome hearing it.

With respect to the appointment of Leigh Gath, I must declare an interest because I know her very well. Anyone who wants to study a person who had a serious disability but overcame it very well should read her biography. Hers was an inspired appointment. She is dealing with residential facilities. Do the representatives have any plans in the future to build up that service outside of the residential area? That would be a channel through which we could have the nucleus of a broader advocacy area, which, while semi-independent-----