Mr. Peter Tyndall:

The default position over the years in dealing with people with requirements which are not met in the community has been to go to institutional care. Thankfully, over the decades we have seen many institutions closed. Institutions have been a theme of my time as Ombudsman.

The first instinct of any State should be to support people to continue to live at home and, if they cannot live at home, to find alternatives in the community to support them. Our first instinct too often has been to support people in institutional settings. Many older people in nursing homes could have been supported in their homes and would have been happier. That is not a criticism of nursing homes, but people are in them because they cannot be supported to stay where they want to be, which is in their homes where supports and adaptations could be made. We are moving in the right direction and need to continue to do so.

There are a particular set of issues affecting people with mental health problems. Closing the old large mental hospitals was obviously desirable, but alternative means of access to support must be provided for people with mental illness who otherwise would not thrive in the community. Facilities need to be provided to support them so they can live decent lives and so that clinical interventions are available to them in clinical settings when required. Closing the institution is not the end of it. I have tried persistently and consistently to say we have to provide proper support for people, not just to enable them to live a bare existence in the community but to be engaged in the community and to have work, social lives and relationships so they can live proper, fulfilled lives.

I do not know the facts and do not want to comment but I will say we cannot provide all services for people with mental illness purely in a community setting without some kind of inpatient services for people in crisis at times when they cannot manage. That does not and should not mean permanently being absent from the community, but it should mean they can be supported when they need help in appropriate settings.