Pauline Tully (Cavan-Monaghan, Sinn Fein)
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Apologies have been received from the Chairperson, Deputy Michael Moynihan, who cannot be here today. Apologies have also been received from Senator Seery Kearney and Deputy John Paul Phelan.

The purpose of today's meeting is a discussion about the decongregation of mental health settings. The Mental Health Commission, MHC, has advised that it cannot discuss the specifics of Owenacurra for legal reasons. However, this does not constrain members from citing examples of lived experience in previous situations of decongregation.

On behalf of the committee, I extend a warm welcome to Mr. John Farrelly, chief executive, Dr. Susan Finnerty, Inspector of Mental Health Services, and Mr. Gary Kiernan, director of regulating standards and quality assurance.

On housekeeping matters, those present in the committee room are asked to exercise personal responsibility to protect themselves and others from the risk of contracting Covid-19. In the context of privilege, all witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against a person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if witnesses statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks, and it is imperative that they comply with any such a direction.

Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official, either by name or in such a way as to make him or her identifiable. I remind members of the constitutional requirement that members must be physically present within the confines of the Leinster House complex to participate in public meetings. In this regard, I ask members joining remotely, prior to making their contribution to the meeting, to confirm that they are within the grounds of the Leinster House campus.

I call Mr. Farrelly to make his opening statement.

Mr. John Farrelly:

On behalf of the commission, I thank the Vice Chairman for the opportunity to address the committee. I am joined by Dr. Finnerty and Mr. Kiernan. We really admire the work of the committee because it is rare that we get to look at something through, and very focused on, the UN lens. We are happy to help and, hopefully, it will be useful.

The MHC is an independent statutory body established under the provisions of the Mental Health Act 2001. Our principal functions are to promote, encourage and foster the establishment and maintenance of high standards and good practices in mental healthcare services. Our remit was extended under the Assisted Decision-Making (Capacity) Act 2015, which provided for the establishment of the Decision Support Service, DSS.

We have identified a number of key issues that we think are relevant to the brief of the committee. The first is, effective implementation of Sharing the Vision. As the committee will be aware, Sharing the Vision is Ireland's national mental health policy to enhance the provision of mental health services and supports across a continuum, and it is due to deliver this over the period 2020 to 2030. The Department of Health, the HSE and the national implementation and monitoring committee, NIMC, are collectively responsible for overseeing this, which, we hope, will reform the mental health services. It is a significant opportunity for change and reform in accordance with the principles set out in the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD.

Reform of the Mental Health Acts 2001 to 2018 will reinforce and improve existing protections for all people who use mental health services. The MHC has recommended already measures such as: extension of the regulatory remit to all community residential centres and services, but also the enhancement of the regulatory remit because the regulations are quite old and we do not have the powers that other regulators may have; comprehensive amendments to Part 4 of the 2001 Act in respect of consent to treatment making sure that people with a mental illness and people with a physical illness have parity in terms of treatment; and a new part because in the Act as it stands, it comes across as though restrictive practices are therapeutic. We say that they should not be in the section around therapeutics because they are a last resort practice and they are not therapeutic.

We have a fairly robust system in Ireland to support people who are involuntarily detained. In fact, it is one of the most robust systems in Europe. More can be done, however. We made a number of recommendations to the Department of Health. The Minister of State at the Department of Health, Deputy Butler, has led on driving the reform and confirmed to this committee that priority is to be given to drafting the Bill. We would urge this committee to support this in ensuring that priority is given to drafting this Bill and, thereafter, that resources are allocated to ensure that the proposed provisions can be implemented.

In terms of congregated settings, the right to community-based mental health services, expressly recognised in Article 19 of the UNCRPD, has significant implications for the organisation of mental health services in Ireland. Since 1984, the process of deinstitutionalisation in Ireland has led to developing supported accommodation services to enable people live in the community instead of large psychiatric hospitals. A range of provisions were developed, including residential facilities that are staffed 24 hours a day. It was anticipated that once the housing needs of the cohort who were brought out of these institutions had been catered for, the requirement for this level of 24-hour high-support accommodation would decrease. Unfortunately, this has not been the case.

In 2018, my colleague, the Inspector of Mental Health Services, carried out a review of these 24-hour supervised residences, which, incidentally, we have no power to register or regulate. We were pushing the boundaries there but it was worth it. Dr. Finnerty found that little progress had been made in addressing the rights of people with mental illness who lived there. A significant proportion of the residences had ten or more beds and multi-occupancy rooms with no privacy between the beds. The number of people residing in these residences was 12,000 people nationally. National policy at the time stated that these residences should have a maximum of ten places so that it was non-institutional. However, this is now outdated thinking and it is no longer appropriate practice. The HSE's report Time to Move on from Congregated Settings states that community houses for people with disabilities should have no more than four residents and they should have their own rooms. When we were in HIQA, we saw that being driven through. It is possible to do.

I want to talk about rehabilitation and recovery because this is supposed to be happening in the community so that people get the services they need. Recovery is about people experiencing and living with mental health challenges in their lives and the personal goals they want to achieve regardless of the presence of those mental health issues. This recognises their right to create a good life, make a home, engage in meaningful work or learning, and build good relationships.

The inspector met with people who provide rehabilitation services on the ground. She was impressed by the dedication, creativity, inter-agency collaboration and hard work, but they were under-resourced services throughout the country and they were working in difficult circumstances. The inspector also spoke with people with enduring mental illness who were frustrated and angry with their lack of progression to more independent living. Essentially, they were stuck in a system that was not meeting their needs.

Other people also live at home with their families, often with ageing parents, who can struggle to provide the support and care needed. A small but significant number of people remain in inappropriate acute inpatient care in the registered centres, unable to move to community living due to the lack of provision.

I want to brief talk about statutory safeguarding. The Chair should interrupt me, if I am going on too long. I have no problem with that.

The MHC strongly supports a rights-based approach to safeguarding and recognises that people requiring care and treatment can be vulnerable to abuse and to not having choice and autonomy. The MHC is currently calling for urgent reform of the safeguarding structures and mechanisms that are in place. At the practice level, it is unacceptable that people who use disability and older persons’ services can receive a service from the HSE adult safeguarding service, yet those who are in mental health services cannot access this. We have a safeguarding structure in place with social workers to help people with intellectual disabilities and physical disabilities and the elderly, but somehow people with a mental illness cannot access this. We find that hard to understand.

At a legislative level, in contrast to the established statutory arrangements in place for children, there is a stark lack of legal protection for adults who may be at risk of abuse, including institutional abuse. We are calling for a framework for safeguarding based on the principles of the UNCRPD.

A significant number of approved centres for inpatients are unsuitable as mental health facilities in that they contain multi-occupancy rooms, lack of personal and private spaces, and cramped bedrooms and living areas. In fairness, the HSE has responded with some new builds in the last three-to-four years. In the areas where new builds happened, people have better lives. There are single en-suite rooms and they are more spacious. They are located close to the communities.

However, there are areas where this is not the case. We need a targeted national capital investment plan to solve this. It is not that much money. Some 17 or 18 centres could be replaced - even over a ten-year period. All stakeholders with whom we spoke, including the Department of Health and the HSE, recognise this. We are optimistic that a clear costed and funded national plan can be agreed. We really hope the committee can support this.

Mr. John Farrelly:

Does Dr. Finnerty want to pick up on some of the questions?

Dr. Susan Finnerty:

I can talk about the diversion from Garda stations where people are brought in. We looked at the year before last in great detail. The HSE is trying to set up a diversion service in the Limerick area. I believe that has been held up by funding. It was not in operation when we finished the report. I am not sure what the recommendation of the task force is in respect of this. Looking at other jurisdictions, it works extremely well. There are different models of this, such as street triage, and various ways you can divert people into the appropriate services for them rather than bringing them to the Garda station, charging them with an offence, going through all that and the person ending up in prison. The HSE is thinking about it. Hopefully, the pilot in Limerick should start shortly.

I can talk about the lack of community support for people living in independent and semi-independent accommodation. Going back in history, when the institutions closed, whole wards were moved out into the community into large settings so it was literally a case of close a ward and put them into a suitable building like a convent or an old place like that. What happened and what is still happening is that there is very little accommodation for people to move on from those congregated settings. These were large settings. There was very little rehabilitation for people to prepare to move on to the medium and low support areas. That is still the problem today. The lack of accommodation and the lack of rehabilitation services are the main reasons why we still have congregated settings. You go further along that line to people in semi-independent and independent living. They should be supported by a rehabilitation and recovery team. There are not enough of such teams, however. When I looked at rehabilitation in 2019, we had 48% of the recommended number of rehabilitation teams according to A Vision for Change. Those teams only had an average of 35% staffing. You can see why the people who do get to semi-independent and independent living do not have the support they need. The risk of that is that their mental health then deteriorates and they end up in acute hospitals.

Mr. John Farrelly:

In terms of involuntary admission, depriving someone of his or her liberty is very serious and it must be done in accordance with the law. Let us make the law as good as it can be. The 21-day period is potentially too long so we are looking for a reduction in that. We recognise that people need treatment but at the same time, we must balance that with the deprivation of liberty. That was quite important. Regarding consideration of different types of renewal orders, this is aimed at ensuring people are not deprived of their liberty more than they need to be. Nobody has done anything wrong here. This is somebody with a mental illness, so we must layer that on. We need to get out of the habit of confinement and accidentally medicalising it. Confinement or forcing people to do things are not medical things. It is what society thinks is the only way a person can get treatment and it should be at the absolute minimum amount.

Deputy Ellis mentioned primary care. In fairness, primary care centres are being rolled out around the country. Some of them are lovely. The problem is ensuring there is an equality of roll-out. Even if you prioritised for communities with the most need, mental health should be given parity and included so that it is not some side door or side alley. Mental illness is a real illness like any other illness. Were there any other points?

Mr. Gary Kiernan:

I can address the point about Garda stations. When people become acutely unwell, their first point of contact should not be in a Garda station. There is a system through the HSE of authorised officers who are trained psychiatric nurses and ideally they are the best placed people to support people when they become acutely unwell in the community so somebody is not brought into a Garda station and their distress increased. Our submission called for that process to become much more widespread and for those authorised officers to fully trained and resourced so that people's first experience of care is not in a Garda station where it can exacerbate problems for people.

Mr. John Farrelly:

I might add to that, if I may, on the idea of an authorised officer. In, say, Cavan or Monaghan, authorised officers have been working in the community for a long time. My brother is a community nurse in Cavan-Monaghan. When someone becomes unwell there, he or she will have already had a relationship with the authorised officers, who go out to them. They know them as a person, what their strengths and weaknesses are and how they go if they are unwell, and that makes life a lot easier. The families trust the authorised officer and understand the needs because the carer is working in the community.

We do not have that yet. The compliance levels have increased greatly in the approved centres because we are regulating them but we do not regulate the community and we have not really invested in our community services in the way we should. We have kind of normalised the fact our community services are just okay, but they should be expanded greatly. We are a good bit behind.

Mr. John Farrelly:

My kids, like most people's kids, do not stay at home. They move, say, from the north side to the south side of Dublin city. I agree. One issue we come across relates to the different systems. GPs have a better system to know who people are than our health service for vulnerable groups. A lot of information is missing.

One point I try to make, which is a difficult one to make, is that I really want us to ensure we have money for mental illness. A load of money is put out for different projects and that is fine, whether to prevent mental illness or to keep people feeling well and happy, but the money should be going to where the most vulnerable people are. We cannot track where the money goes in the HSE. We are not sure what is happening there with that but, from our work to date, it is definitely not being put in the correct way to the people who need it most.

Neasa Hourigan (Dublin Central, Green Party)
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I thank our guests. Will they outline their views on the use by the HSE of the MHC's inspection report to justify the closure of the Owenacurra centre?

Mr. John Farrelly:

I am not going to speak about the Owenacurra centre-----

Neasa Hourigan (Dublin Central, Green Party)
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On what basis?

Mr. John Farrelly:

I understand and appreciate that this is a time of significant change for residents in Owenacurra. We understand that-----

Neasa Hourigan (Dublin Central, Green Party)
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I apologise, but if there is a legal reason Mr. Farrelly cannot talk about Owenacurra, will he state it?

Mr. John Farrelly:

Am I allowed to answer?

Neasa Hourigan (Dublin Central, Green Party)
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Yes, but I want to be clear about what my question is-----

Mr. John Farrelly:

I know what the question is.

Neasa Hourigan (Dublin Central, Green Party)
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There is no need to be so conflict based with me. I am just asking Mr. Farrelly to let me know whether there is a reason we cannot talk about Owenacurra. It is standard on all the committees on which I sit to use examples.

Mr. John Farrelly:

Under our regulatory process, the Inspector of Mental Health Services inspects providers against the regulations. We do not want to be drawn into comment, conjecture or discussion on any individual centre because that could prejudice any regulatory action we may need to take.

Neasa Hourigan (Dublin Central, Green Party)
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Is the commission in the process of a legal procedure on Owenacurra?

Mr. John Farrelly:

I used the term "regulatory action".

Neasa Hourigan (Dublin Central, Green Party)
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Owenacurra has a statutory footing. Is the commission in the process of some kind of a regulatory implementation?

Mr. John Farrelly:

Yes.

Neasa Hourigan (Dublin Central, Green Party)
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When did that commence?

Mr. Gary Kiernan:

We regulate in accordance with the Mental Health Act and the regulations made thereunder. As part of the escalation and enforcement processes prescribed in law and as part of the due process to be fair to the providers of that service, we have to comply with the law and we do not comment on centres individually-----

Neasa Hourigan (Dublin Central, Green Party)
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On 18 November, representatives of the commission commented to a national newspaper regarding Owenacurra. They stated that there had been a recent inspection and mentioned the fact there were six residents, as opposed to the 19 residents who lived there. They commented on the closure order, the HSE services, the residents' rights and the appropriate safeguards that had been installed. Again, has there been some legal change-----

Mr. John Farrelly:

Which newspaper was that?

Neasa Hourigan (Dublin Central, Green Party)
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The Irish Examiner. Has there been some kind of legal change relating to the commencement of some kind of enforcement between 18 November, when the commission saw fit to comment Owenacurra to a national newspaper, and today?

Mr. Gary Kiernan:

It is an evolving process that involves close engagement with the service and implementing the regulations under the 2001 Act and the registration requirements associated with that. Two processes are associated with that, namely, providers have a right to reply and we have-----

Neasa Hourigan (Dublin Central, Green Party)
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Mr. Kiernan has made that point and I fully accept it. My question is whether, between 18 November and 8 December, something changed whereby the commission can speak to a media outlet but not to a Oireachtas committee under privilege?

Mr. John Farrelly:

I might answer that. To be clear, the Deputy is quoting an article from-----

Neasa Hourigan (Dublin Central, Green Party)
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I apologise but my question was for Mr. Kiernan. I will bring in Mr. Farrelly afterwards, if that is okay.

Mr. Gary Kiernan:

I do not want to say any more than that we cannot undermine the process that is under way.

Neasa Hourigan (Dublin Central, Green Party)
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It is fine to say there is a process but will Mr. Kiernan speak to the dates 18 November to 8 December? Is there a significant difference in the commission's position?

Mr. Gary Kiernan:

Yes.

Neasa Hourigan (Dublin Central, Green Party)
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On what date did that change happen?

Mr. John Farrelly:

I am not getting into the regulatory process with an individual entity-----

Neasa Hourigan (Dublin Central, Green Party)
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We are here to discuss that.

Mr. John Farrelly:

The Deputy might let me speak.

Neasa Hourigan (Dublin Central, Green Party)
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There is no need to take that tone with me. I am just trying to get to the bottom of this.

Mr. John Farrelly:

The Deputy is taking a particular tone. To be clear, some of the articles in the Irish Examinerdo not necessarily reflect what we are saying or said. An awful lot of information is being put out in that newspaper. We get loads of questions from various people in the Irish Examiner and we have tried to avoid answering them-----

Neasa Hourigan (Dublin Central, Green Party)
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We are talking about a particular article. Is Mr. Farrelly saying nobody from the Mental Health Commission gave information suggesting it was confident the HSE services are in place to uphold the residents' rights and ensure appropriate safeguards?

Mr. John Farrelly:

We are not saying that. We are saying the obligation is on the HSE to have those things in place for all residents. What a journalist takes and puts into an article does not necessarily reflect what we have said-----

Neasa Hourigan (Dublin Central, Green Party)
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Somebody did speak to the newspaper, however.

Mr. John Farrelly:

That is the point. All residents are required to-----

Neasa Hourigan (Dublin Central, Green Party)
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Will Mr. Farrelly take my point?

Mr. John Farrelly:

May I answer? I am not going to prejudice our capability to ensure the residents and staff of Owenacurra will get the best possible from us. We have to act within the-----

Neasa Hourigan (Dublin Central, Green Party)
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I do not know whether it was Mr. Farrelly who gave the quotation, but Owenacurra was referred to by a representative of the commission and I am trying to get to the bottom of this. I have many-----

Mr. John Farrelly:

We are not here to discuss that.

Neasa Hourigan (Dublin Central, Green Party)
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May I finish my sentence? I have many questions about Owenacurra, but Mr. Farrelly started this process by saying he would not talk about Owenacurra. I am trying to get to the bottom of why that is the case. The normal practice at a committee is such that if a witness can flag if he or she does not want to talk about something. It is completely normal for committee members to cite examples from their life about how something is working. From Mr. Farrelly's point of view, the standard practice is for a witness to notify the committee that there is some legal reason a question cannot be asked and to outline that reason for that committee, but that is not the case here. A witness cannot appear before a committee and say something regulatory is going on and that, therefore, we cannot talk about it. Committees do not work that way. Witnesses do not get to say they will not talk about something. They have to give reasons.

Mr. John Farrelly:

I thank the Deputy for her comments. We understand and appreciate this is a time of significant change for residents and staff in Owenacurra-----

Neasa Hourigan (Dublin Central, Green Party)
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Mr. Farrelly has said that.

Mr. John Farrelly:

This committee has a terms of reference under which we have come in to help it-----

Neasa Hourigan (Dublin Central, Green Party)
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They are about decongregated settings, which is what is happening at Owenacurra, so this is within the terms of reference. I do not want Mr. Farrelly to imply to the committee that it is not within the terms of reference because it absolutely is.

Mr. John Farrelly:

We do not want to be drawn into comment, conjecture or discussion on any individual centre because it could prejudice any regulatory and enforcement action that may be taken.

Neasa Hourigan (Dublin Central, Green Party)
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I ask Mr. Farrelly to outline what the regulatory enforcement is.

Mr. John Farrelly:

We are not going to be drawn into commenting-----

Neasa Hourigan (Dublin Central, Green Party)
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Mr. Farrelly cannot provide any evidence that there is any actual regulatory enforcement. I believe Mr. Kiernan when he says that is occurring but witnesses cannot come to a committee and say that with no evidence. They have to provide us with some evidence.

Mr. John Farrelly:

This is not a court of law. Where does the Deputy think she is? Hold on. Do we have to come along-----

Neasa Hourigan (Dublin Central, Green Party)
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I am at an Oireachtas committee that has a statutory footing and the witnesses have privilege when they attend. It is very serious and what is happening to those people is serious. Mr. Farrelly can be flippant if he wants but it is serious.

Mr. John Farrelly:

I am not being flippant.

Neasa Hourigan (Dublin Central, Green Party)
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If Mr. Farrelly is going to come in and say he is not going to talk about it, he should at least do us the courtesy of explaining why. That is all.

Mr. John Farrelly:

We have talked about it.

Neasa Hourigan (Dublin Central, Green Party)
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My time is up. I will hand back to the Chair.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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We are in an Oireachtas committee. It is implied that we are discussing a serious issue. I call Senator Clonan.

Tom Clonan (Independent)
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I thank the witnesses for coming in. I worked for the Mental Health Commission for nine years, on the tribunals, as a layperson. It was a really great experience for me to see the work of the commission. I commend the commission on the advocacy work it does. I will ask the witnesses my questions and they can then take it in turns to respond to them. I ask them to answer all the questions.

I am not talking about Owenacurra specifically, but when representatives of HIQA recently attended the committee, they said it was time to move on policy and people moving from congregated settings. I was told that HIQA did not map or know where those people went. I know from my experience as a parent and a carer, and the community of parents and carers of which I am a member, that many end up being returned to elderly parents and they go into crisis. In the context of the housing and homelessness crisis that we have, I have a question about the process of decongregation. Ideologically and philosophically, I understand it is the right direction to take, but in the absence of suitable, acceptable placements to the individuals involved and their families, is there a case to be made to pause decongregation until we have a proper, viable alternative? In principle, would the Mental Health Commission consider pausing it?

In Ireland, persons placed in long-term placements with complex needs are often looked after by private organisations, such as Nua Healthcare Services. Does the commission or HIQA have any oversight of those settings?

In light of the Maskey report, does the commission have a view on the Kerry child and adolescent mental health services, CAMHS, being provided by video link with a doctor in Abu Dhabi? Is that acceptable?

About 50% of my constituents, approximately 35,000 people, live in south County Dublin, and I am asked a recurring question. If one seeks psychiatric services in south County Dublin as opposed to in Galway or Cork, will the services be medication only or is there access to accredited, trained cognitive behavioural therapists, occupational therapists or family therapists?

As a result of the crisis in recruitment and retention of hospital consultants, a problem has been identified in other disciplines where people are being appointed to hospital consultant posts who have no higher specialist training. It is as if I got on an Aer Lingus flight to London and the pilot told me that he has flown a Cessna but is not sure about flying the plane we are in. I do not want to be treated by somebody who has not done the senior registrar higher training scheme. In the case of psychiatrists being appointed to consultant posts, we saw what happened in Kerry CAMHS and other services when people with no higher specialist training were appointed. Does the Mental Health Commission have a view on that?

Does the commission feel that the College of Psychiatrists of Ireland is vocal enough in advocating for psychiatry? I thank the witnesses for their patience and listening to all those questions.

Mr. John Farrelly:

Dr. Finnerty might want to answer a question. We entirely agree on the issue of consultants. We would only employ people who are on that higher scheme and who are registered. For our independent tribunals, we absolutely agree that the consultant should be from the higher training scheme, as the Senator mentioned. That is the commission's position.

Tom Clonan (Independent)
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What about in the services?

Mr. John Farrelly:

That applies to the services, too. Absolutely.

Tom Clonan (Independent)
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Would Mr. Farrelly agree that that should not be the case?

Mr. John Farrelly:

Yes.

Dr. Susan Finnerty:

The Senator is correct that a number of consultants around the country do not have specialist training. As Mr. Farrelly said, we do not agree with that at all. Our view is that it should not happen. On the Maskey report, I am doing a CAMHS review across the country. We are about two thirds of the way through that. The Senator asked whether it is acceptable for the south Kerry team to have somebody from Doha doing clinical sessions and so on. It is not ideal. I know that south Kerry has had tremendous problems trying to get a consultant psychiatrist. The post has been empty since 2016. The service tells us this is the best it can do because it cannot fill the post. If it does not do this, it will not be able to offer any service in south Kerry. I saw the set-up the service has. It is not ideal but it is the best it can be in that situation. That is not the only service that does remote clinical sessions.

Tom Clonan (Independent)
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Dr. Finnerty feels it is acceptable.

Dr. Susan Finnerty:

No, I do not feel it is acceptable, but it is the best that south Kerry CAMHS is able to do.

Tom Clonan (Independent)
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It is not the best the service can do. It needs to appoint a properly trained person with higher specialist training. There must be a reason the HSE cannot recruit and retain consultant psychiatrists. The answer to that is that there is a toxic management culture, bullying and inappropriate oversight by non-clinicians who do not have clinical responsibility and make decisions that endanger patient safety. The commission's advocacy on decongregation is admirable and I agree with it but I wonder about advocacy in these key areas. There is a situation where children are lactating because of inappropriate prescription of medicine. One cannot treat somebody who has a mental health problem by video link. It is impossible. I would not say it is less than ideal but that it is a scandal. It is completely and utterly unacceptable.

Dr. Susan Finnerty:

Regarding recruitment difficulties, I would expand on the Senator's point by saying that the job is not attractive. There is very little ongoing training. Now that the Maskey report has come out, the HSE is saying that it is even more difficult to get interest from people. That is where it is at the moment.

Tom Clonan (Independent)
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I find this extraordinary. This is Dr. Finnerty's discipline as a psychiatrist. Would a surgeon or cardiologist accept the treatment of patients in Kerry by video link to somebody in Abu Dhabi? It is beyond the realms of fiction.

Dr. Susan Finnerty:

It is.

Tom Clonan (Independent)
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It is an extraordinary situation.

I am just surprised that the royal college is so passive and quiet about this. I am concerned about its advocacy. If we can move on to the questions-----

Mr. John Farrelly:

Just to be clear, we are not the royal college-----

Tom Clonan (Independent)
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No, I am just saying I am surprised at how passive those with an advocacy role, such as the royal college or the Mental Health Commission, are. One of the questions I asked was if the commission believes they are proactive and vocal enough in highlighting these issues.

Mr. John Farrelly:

We want to be regulators of the community services, including CAMHS, which we are not. Under the current Act, we do not have those powers. We only regulate the inpatient approved centres. Notwithstanding different issues, we have managed to get compliance up to around 85% nationally. We do not regulate community CAMHS. In fact, we have absolutely no powers whatsoever with regard to the inspections. We want the Mental Health Act changed to give us powers in order that we will be able to set standards, codes and rules that people would have to adhere to. We genuinely do not have them. We are also doing a review. We stepped in to say we wanted to do that independent review, which Dr. Finnerty is doing. We will publish that report and there are significant issues. We do not have the capability to change it. We need the laws to be in place to make people stick to the laws.

Tom Clonan (Independent)
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I am conscious of time. On the question about services in south County Dublin, is it medication only or are cognitive behavioural therapists, occupational therapists and family therapists also available? I remind the witnesses that we are all on the record here.

Mr. John Farrelly:

We do not regulate the community services in south County Dublin, so we do not get a chance to look and tell what is there. With the inpatient centres, we can tell the staff and tell against all of the regulations. Generally speaking, from looking at things, we have a medical model in Ireland. Generally speaking, from doing the different reports and rehabilitation and from going out into the community, we see a medically focused model. We do not see it expanded in the way the Senator describes. In the private services, one sees much more cognitive behavioural therapy and so forth, which one does not see in the public services.

Tom Clonan (Independent)
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I appreciate that the Mental Health Commission does not regulate this area but what I understand from the response is that there is no access through the public services to those other care pathways, and that it is medication only.

I move on to the absence of suitable and acceptable placements. Some 27% of people who are homeless have disabilities and mental health issues. They are sleeping in doorways and on streets. When they are taken out of congregated settings, they move in with elderly parents, experience a crisis and then end up in Garda stations, accident and emergency departments or on the streets. Given that we are in the middle of a crisis and that people with disabilities and mental health issues are disproportionately impacted by homelessness, is there an argument to be made to stop decongregation? I am not talking about Owenacurra here. Is there is an argument to be made for suspending decongregation until we have the proper supports, services and settings in place for these people? In my view, this is a failure in our duty of care. It is barbaric to decongregate people into settings they do not want to go to or in which they are likely to go into crisis. We are doing harm when we to do that. What is Mr. Farrelly's view?

Mr. John Farrelly:

I will also ask Dr. Finnerty and Mr. Kiernan to speak to this. It is very important that we have a system where people get the service they need. We all know that for the most vulnerable people, including those the Senator has mentioned, the services really are not there for them. Decongregation is not really a concept within mental health. It started in 1984. We have these approved centres and residential centres out in the community with ten or 11 people, but we have not built the facilities the Senator is talking about. There is not, therefore, anything to pause. We need to build the places for all of these people.

Tom Clonan (Independent)
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In the absence of those places-----

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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The Senator's time has concluded. We must move on.

Tom Clonan (Independent)
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I thank the witnesses for their time and patience.

Eileen Flynn (Independent)
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When I was nominated to the Seanad, it was for the people. The questions I have are from the residents of the Owenacurra Centre. My colleague, Senator Frances Black, visited the centre with Deputy Hourigan. The witnesses do not have to answer these questions but I would like them to set out a reason, not for me personally but for the residents who have been failed for the past year and half. The Owenacurra Centre was closed in June 2021. The residents fought very hard to get mental health supports when the centre was closed down. They were moved to Cork, which is far from home. People with disabilities have the right to live an independent life. The focus of this committee is the UN Convention on the Rights of Persons with Disabilities, UNCRPD, as well as the right of people to live in their own communities. Given everything that has happened over the past year and a half and how people have been failed in the centre, how can the Mental Health Commission stand by that? When the commission met seven residents of the centre in August they did not feel they were listened to. Again, this is not my view but the view of the people concerned. The commission is answerable to the people. I ask the witnesses to put me out of the picture.

When the commission told the Irish Examinertwo weeks ago that it was satisfied there were safeguards in place for the centre to uphold the rights of residents, some of the affected families wrote to the this committee and the Joint Committee on Health stating they were shocked by the commission's comments. They said the commission had passed on their concerns to the HSE. How will the commission support the remaining six residents in the centre? That question has been asked on behalf of the residents. I ask the witnesses not to answer for me but for the residents.

In other countries there is evidence that people's gender and ethnicity play a big role in determining whether they are more at risk of ending up in a mental institution or in a mental health service. Does the Mental Health Commission collect and publish data on members of the Traveller community, refugees, women and homeless persons? If not, does it plan to use ethnicity identifiers? As a colleague has said, homeless persons and people with mental health issues are over-represented in the prison system. Does the Mental Health Commission record such data?

With regard to mental health, I know of many young Traveller men who feel failed by the mental health services. This is not directed in any way personal to the three witnesses but relates to the system. I see young men with addiction issues who have very poor mental health. I spoke to a woman on Monday whose son is in a mental health service in Dublin. We were trying to support the young man to get mental health supports. In many cases involving these young people, they are deemed to be just Travellers who are sick again. That is how people feel. How can we make it easier for people from ethnic minority groups to get the supports they need?

I remember going to the accident and emergency department of the Mater hospital about ten years ago. I am a chronic pain sufferer and sometimes I can seem a bit crazy over that. I remember I was meant to see a psychiatric doctor because I was in chronic pain. They found out that two screws in my foot were tipping off the skin and making it very hard me to walk. I was put in a corner. How people were treated in our accident and emergency department services was absolutely appalling. How does the commission plan for better practice?

What do we need to meet the needs of the people? As we know, the mental health crisis in society has got worse, not only for the Traveller community but for people from all walks of life.

Mr. John Farrelly:

I just want to be clear that we are not responsible for providing mental health services. We do not provide or run any approved centre in Ireland. It is the provider-----

Eileen Flynn (Independent)
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But you are the Mental Health Commission.

Mr. John Farrelly:

Yes. It is the provider, for example, the HSE on behalf of the State, that is charged with the care and welfare of people in centres. I am sorry. I am not trying to get away from the question but that is it. We do not have any power to stop someone closing an approved centre. We have no power. If someone wants to close an approved centre, they can do so quite genuinely. What we try to do as much as possible, using the powers we have, is to make as much happen to protect the care and welfare of people. We do not have many powers. I do not want to get into a row or read the boring stuff but I can read out the powers we have. They are very minimal. This is why we are asking for the Act and the regulations to be changed. I can read it out if the Senator wants and she can stop me if she thinks I am bluffing. I am not. I just want to show the actual powers we have, which are very minimal.

The law requires that the proprietor of the approved centre informs us within three months that it will close. That is all the law requires. It requires that the proprietor shall arrange, prior to closure, for the transfer to an alternative location of each voluntary resident who continues to require treatment and that it is in accordance with his or her care plan. When a resident is transferred from another location, the new provider must have received the information on that resident. The provider shall continue to provide care and treatment for mental illness or mental disorder for a period of three months from the date of serving notice of intention to cease. That is all the law says. There is nothing else. It does not give us the power to intervene in any way. We are watching. We speak to people, including residents, but we have no powers. The HSE has the power, the board of the HSE has the power and the funding Departments have the power. We do not have it. I am genuinely not trying to shift anything on this or undermine anything we hope to do.

Dr. Susan Finnerty:

I share the Senator's concern about accident and emergency departments, particularly for people who are seriously mentally ill. It is no place for them. We do not regulate accident and emergency departments. I have visited a number of them.

Eileen Flynn (Independent)
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If we were to look at reviewing and changing the Act, what should we do? I do not mean to be smart in saying this but we have questions from residents and communities and the Mental Health Commission has few or no powers. It is good we know this. What should change to the Act look like? Perhaps that might be a more relevant question for the Mental Health Commission.

Mr. John Farrelly:

There should be some sort of a compulsion. For example, the units in the general Cork area are behind the rest of the country but we do not have the power to stop this from happening. We are in a very tricky situation because people need the beds, even if they are of low quality, because there is nothing else. There should be some compulsion in law to ensure the assets of the State are kept up to a normal acceptable standard in the community and that, slowly over time, investment in them does not stop. People are struggling today and I appreciate that people are advocating. We were there recently. I appreciate where people are coming from because I would be the same. We must understand we have to invest in the services and there has to be a compulsion in law to do so. We cannot just neglect something over time. It is just not fair. However, that is not in the law.

Mr. Gary Kiernan:

Senator Flynn asked about what the change should look like. As my colleague said, we do not have powers. This is why we really need a new mental health Act. The 2001 Act comes from a very different time with a very different approach. We want a mental health Act that is informed by all of the principles of the UNCRPD. We also need those regulations that fit under it to be much more specific about residents' rights in situations such as those described by Senator Flynn. As another layer, we need a statutory safeguarding framework. This is not in place at present for people in mental health services. It would vastly improve their rights in situations such as those described by Senator Flynn. We have examples from throughout the country of very good decongregation in other health and social care sectors. I have worked in disability services where we have very good examples of people moving from outdated institutions into appropriate community settings. They are advocating for these and choosing them. They are asking to be part of them. The regulatory framework and structure is much different from what we have. This is what we are calling for.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I apologise for not being here the whole time. I was at another meeting. I thank the witnesses. I do not know whether my questions have already been asked, and if they have, I apologise. The Mental Health Commission writes inspection reports on individual cases. When these cases do not meet the correct standard, what is the commission's role in providing a service plan for residents in that case? How is the will and preference of residents incorporated into the plan? With regard to individual reports on cases, how does the consultation process work for residents and their families, especially their advocates? Will the representatives discuss further the lack of community supports for people with mental health issues living independently or semi-independently in the community? This is a very big issue for me because we need to do much more. There are not enough services within the community. This needs to be addressed. At present, out of all of the community mental health services, only 24-hour residencies are inspected by the Mental Health Commission on a three-year rolling cycle. Is there a plan for the Mental Health Commission to inspect other community mental health services? This is something I have been asked about recently.

Mr. John Farrelly:

I will answer the Deputy's last question first. We do not have the powers to regulate any of these services.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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Yes, I know this.

Mr. John Farrelly:

We use our own resources to do this, which is Dr. Finnerty. In law we are not required to do this. It is a strategy we introduced so that we could gain information. In the new Act we want the powers to regulate. It would not solve anything but at least it would create transparency so that people would begin to see how things are.

Dr. Susan Finnerty:

We are very hampered by the fact we do not have regulatory powers for community settings. We are very much looking forward to it being in the new Act. Community services will change when they are regulated and have to perform to regulations and are assessed. This will be a huge breakthrough in mental health services in the community. We are looking forward to this.

Deputy Murnane O'Connor spoke about the lack of community services for people who are independently living or semi-independently living. I covered this in response to an earlier question but I am very happy to do so again. The history is that when the institutions closed, whole wards were moved out into the community. We had very large groups of sometimes up to 20 or 30 people in the community but not of the community, if the Deputy gets my drift. What happened over time was that, while smaller units were being built and used throughout the country, the people in those units got stuck. There are several reasons for this.

There are two main reasons. One is that there are very few rehabilitation services. As I said to the other Deputy, there is only 48% of what should be in teams and there is only 35% of staffing that should be there. It is very difficult to move people on from those congregated settings into medium or low secure settings. People who manage to move on to independent or semi-independent settings may still need some support and may need rehabilitation services. Where there is a rehabilitation team, they would be covered by that team. With only 50% of the required level in teams, I have no doubt some people are not supported in their independent or semi-independent setting.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I know we promote people living independently. How do the services work? The local authority and all the different agencies need to work together. That is another issue. We do not have enough housing at the moment and there are other issues in the sector. How does Ms Finnerty envisage that progressing? Anyone who wants to live independently should be able to and that is what we are all encouraging. In my area of Carlow, we need more houses but we just do not have the supply. How does that issue affect this area?

Dr. Susan Finnerty:

Rehabilitation and recovery are not just about medication and therapies. We need to take into account education, jobs, housing and socialisation into the community. The rehabilitation teams now in place are beginning to do that. There are housing placement specialists who have good connections with the rehabilitation team. They have peer support workers who help with the socialisation. It is vital to get those rehabilitation teams up and running and where they should be, because otherwise the people the Deputy is referring to tend to get lost, leading them back into the cycle of being admitted into an acute unit. I cannot overemphasise the importance of proper rehabilitation services.

Mr. John Farrelly:

The Deputy mentioned service plans but I think she means individualised care plans.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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Yes, care plans.

Mr. John Farrelly:

That is an issue in Ireland. I trained in England 30 years ago, and individualised patient or resident care is the first thing people are trained in. Ireland is still stuck regarding everyone as a group. We have not yet resourced around the individual. Mr. Kiernan may have the statistics on the care planning.

Mr. Gary Kiernan:

Every year, compliance with care planning is quite low. This is repeatedly mentioned in the inspector's reports. It requires that residents be consulted about that care plan and that they be part of the process. They inform how it is developed and the outcomes in that. This area also needs to be addressed through better and more specific regulation in how it is done, how frequently it is done, who is responsible for carrying it out and what appropriate care planning looks like in mental health services.

Holly Cairns (Cork South West, Social Democrats)
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When the witnesses say they have no power, I think we all understand what they mean. The Mental Health Commission has a power in that its words carry some weight. That in itself is a powerful thing the commission has. When we are asking about the stance and other things, the weight of the witnesses' words really does matter. The Mental Health Commission has a legal obligation to enforce that each resident has a place that meets their needs. Each person has the right to live independently or live in a setting that is suitable for their needs.

I know that mental health services that are designated continuing care provide for people with the highest level of need and have the highest staff to client ratio. Needless to say, as a Deputy from County Cork, I have significant concerns. West Cork has two community residences for people with enduring mental health illness, Perrott House and Saol Nua, both in Skibbereen. However, they are designated as high-support hostels. The only continuing care facilities in Cork are St. Stephen's Hospital in Glanmire, St. Catherine's ward near Cork city and the Owenacurra centre in Midleton. There is an older adult continuing care facility in north Cork in Mount Alvernia. I am not that familiar with the north Cork area. That means that, in west Cork, people with the highest level of need have no local community-based option. I know people from west Cork have been placed in St. Stephen's Hospital over the years. This requires major uprooting and detachment from their community. Of course, this committee is tasked with overseeing the UN Convention on the Rights of Persons with Disabilities. One of those rights is the right to live within one's own community.

Will Mr. Farrelly comment on the spread of 24-hour-staffed mental health services in Cork for people with enduring mental health illness? With the closure of the Owenacurra centre in Midleton, does this not mean people with the highest level of need in east Cork will now need to be referred to St. Stephen's Hospital or Saint Catherine's ward near the city, whereas until 2021 they were able to receive intensive support and live in the community?

Mr. John Farrelly:

There is no doubt the facilities in Cork, west and east, are behind the rest of the country. None of the options for people are great. We have had more enforcement actions in Cork than in the rest of the country. A capital plan is needed nationally, but a specific plan is needed for Cork. As the Senator said, we need a plan for Cork that ensures the services in Cork are aligned to the needs of Cork. The money needs to be allocated for that.

Holly Cairns (Cork South West, Social Democrats)
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Crucially, that means people in their communities.

Mr. John Farrelly:

Yes.

Holly Cairns (Cork South West, Social Democrats)
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From my experience in Cork South-West, I am well aware how willing the Mental Health Commission can be to take action against the HSE, as was the case with room sharing in the acute ward in the mental health part of the hospital in Bantry. I see it also took a strong line recently over the admission of an acute patient to St. Stephen's Hospital in Glanmire over a breach of directions from the Mental Health Commission. We have been very concerned over how silent and not inclined to take action the Mental Health Commission has been in the context of the closure of the Owenacurra centre. The Mental Health Commission claims it wants to keep people in the community. It comes out strongly against a breach of people's rights in other settings but there was nothing on this one. For example, the commission has not taken action or spoken publicly about the transfer of Owenacurra residents to shared rooms and ward-based institutional settings where they could potentially be spending the rest of their lives.

That includes unit 3 in St. Stephen's Hospital, which the commission has basically slated repeatedly. In reports it has raised major concerns about the staff culture, the condition of the premises, the poor rehabilitation focus, and fire safety. It has stated unit 3 is reminiscent of the kind of institution that might have been provided decades ago. These developments have been playing out in the public for everyone to see, and families have had to resort to sharing their stories to get anywhere at what is obviously huge emotional cost to families. These vulnerable residents have been moved from single rooms in a town centre location in their community to these wards far from home under the pretence that they deserve better. They deserve a better service to the high standard of care the Mental Health Commission wants. Under the Mental Health Act, the Mental Health Commission has a responsibility to ensure the HSE is meeting the needs of residents. Without just zooming out and saying we will just look at Cork for the moment, will Mr. Farrelly explain the inconsistency in the commission's enforcement action in that regard?

Mr. John Farrelly:

I do not think we have been inconsistent because we are required to enforce based on the law. We have not been inconsistent. Depending on what is in the media or what is not, it may be perceived that it is inconsistent, but it has not been inconsistent. We have been consistent where we have found significant breaches of, for example, conditions. St. Stephen's Hospital is now out of court so that is concluded. We applied the condition of not admitting people to St. Stephen's Hospital because it was just not good enough for people. The therapeutics were not there. That is why that one ended up in court.

We had stated the condition was that people could only be admitted from the Carraig Mór forensic unit so that-----

Holly Cairns (Cork South West, Social Democrats)
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My time is nearly up. Mr. Farrelly is not really answering my question. I hope I will be able to come back in later in the meeting. The commission has stood over the transfer of Owenacurra residents to inferior ward-based settings, cutting them off from the community, but it has taken a different stance on other situations. Has that called into question the oversight of these things by the commission? For example, we know that the remaining residents and their families were left distraught by Mr. Farrelly's comments in the Irish Examinera few weeks ago, when he stated that appropriate safeguards were in place to uphold their rights. What the families describe is a prolonged ordeal of being offered placements that do not meet their relatives' needs, not being consulted and so on. We had the whole issue in respect of failure to consult with communities. Dr. Finnerty wrote to a family member last October and stated that she could not arrange a meeting with the families due to legal constraints. A few weeks prior to that, however, Mr. Farrelly appeared, alongside a family member, on "Drivetime" on RTÉ radio for an extended interview on the closure. Now we have the witnesses coming before the committee and stating they will not discuss Owenacurra specifically, yet Mr. Farrelly just mentioned St. Stephen's hospital. They have not explained to the committee why they will not address the situation. The way Mr. Farrelly spoke to Deputy Hourigan is another issue. Will all this call into question the Mental Health Commission? Will it have an impact on people's views in respect of an extension of its remit into community adult and children mental health teams?

Mr. John Farrelly:

The Deputy has her views. I do not agree with them. How regulations work is how regulations work. It is active. It is happening all the time. We act as well as we can within the powers we have.

Holly Cairns (Cork South West, Social Democrats)
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Does Mr. Farrelly accept that, from the perspective of the general public, this might call into question whether the Mental Health Commission is the right body to go ahead and extend its remit into community and adult and child mental health teams?

Mr. John Farrelly:

The Deputy obviously has her view.

Holly Cairns (Cork South West, Social Democrats)
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I am not asking Mr. Farrelly about my view. I am asking for his view on that question.

Mr. John Farrelly:

The Deputy seems to have a very set view. That is her view.

Holly Cairns (Cork South West, Social Democrats)
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Does Mr. Farrelly think it is acceptable to appear before the committee and say what he will or will not talk about without explaining the reason for that? Does he think other bodies do that?

Mr. John Farrelly:

We explained to the committee why we cannot speak about it. We have a potential regulatory enforcement action going on and we do not want to prejudice it. We have an Act that we have to apply. The Act needs to be improved. We cannot speak about the issue and prejudice it. The Deputy is giving the impression that somehow we say it in one arena but not in others. There are different things happening at different times, however.

Holly Cairns (Cork South West, Social Democrats)
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Mr. Farrelly went on "Drivetime" with a family member and spoke at length about the issue, and Dr. Finnerty refused to meet a family member a week later. The situation had not changed much in a week. Now we have a situation where Mr. Farrelly spoke to theIrish Examinerbut he will not speak to the committee.

Mr. John Farrelly:

We are not speaking to the Irish Examiner.

Holly Cairns (Cork South West, Social Democrats)
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I can only presume that he did not quite understand when Deputy Hourigan tried to explain to him in respect of what normally happens at committees. Is that the case?

Mr. John Farrelly:

I understand what is required. The Deputy has her views and way of putting things and that is fine.

Holly Cairns (Cork South West, Social Democrats)
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If Mr. Farrelly understands what is required, perhaps he or Mr. Kiernan will explain when this legal action went into place or when the situation in respect of what the Mental Health Commission can or cannot speak about publicly and under privilege changed.

Mr. John Farrelly:

To be clear, we were not invited here to speak about Owenacurra. I am sorry.

Holly Cairns (Cork South West, Social Democrats)
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To be clear-----

Mr. John Farrelly:

We got a letter from the committee that set out why we were being asked to appear and we prepared our statement.

Holly Cairns (Cork South West, Social Democrats)
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To be clear, the committee is charged with the implementation of the UN Convention on the Rights of Persons with Disabilities. Under that convention, people with disabilities have the right to live in their community and independently. This clearly falls very much under the remit of the committee.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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The witnesses were invited in to speak about congregated settings. It is common practice for members of the committee to use examples from their area or wherever. It is not that Owenacurra was mentioned specifically. No specific centres were mentioned. However, it was not precluded from discussion either. It is relevant to the topic under discussion.

Mr. John Farrelly:

I would love to be able to speak about everything but I cannot do so. To be honest, it is not that we have gone to the Irish Examiner and spoken to it. What we are trying to do is to give a minimal amount of information without jeopardising matters. That is what we are trying to do but it does not always work out like that in the media. I am sorry.

Holly Cairns (Cork South West, Social Democrats)
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Now that we have the understanding that Mr. Farrelly can speak about it and he has spoken about other specific situations, why did the commission take such a strong stance in respect of other issues that have similarities but not in respect of this one? It says it wants to keep people in their community but not that is not the case in east Cork. Why has the Mental Health Commission taken such a different stance in respect of this issue compared with other issues, on which it has taken a very hardline and strong stance?

Mr. John Farrelly:

We do not have any power to stop the closure of Owenacurra. We have no power-----

Holly Cairns (Cork South West, Social Democrats)
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I did not state that the Mental Health Commission has the power to do that. I asked why it did not take a stance against the closure when it has done so very strongly in comparable scenarios.

Mr. John Farrelly:

We are doing everything we can within the remit of the Act to vindicate the rights of people in Owenacurra. I know the Deputy perceives-----

Holly Cairns (Cork South West, Social Democrats)
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Does Mr. Farrelly believe those residents should be able to stay in their community in Owenacurra?

Mr. John Farrelly:

I do not want to get into the specifics of that because it may jeopardise-----

Holly Cairns (Cork South West, Social Democrats)
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We have just been through that.

Mr. John Farrelly:

The whole idea is to be able to provide care to people in the way they want care and where they want it. There are issues in respect of the centre in Cork, such as the fact that the premises have not been well looked after, but we do not have the power to stop the HSE. In fairness, if the-----

Holly Cairns (Cork South West, Social Democrats)
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Once again, we have spoken about this already. We realise what powers the Mental Health Commission does or does not have but there is weight in its words. We have seen it coming out strongly against other situations relating to accommodation. How does Mr. Farrelly stand over taking a back seat and not saying anything in respect of people being moved from Owenacurra into ward-based settings out of their community?

Mr. John Farrelly:

Those are the Deputy's words. I am not taking a back seat. My job is to make sure that we do our job well. To be clear------

Holly Cairns (Cork South West, Social Democrats)
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Why does the Mental Health Commission not have a stance on that when it does on the other situations that I raised?

Mr. John Farrelly:

When we are taking a potential enforcement action, we do not say anything. When we are finished, we publish the report. When we are able to speak, we are able to speak. That is just how it is.

Holly Cairns (Cork South West, Social Democrats)
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Yet Mr. Farrelly is able to speak to the Irish Examiner.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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We need to move on. I call Deputy Canney.

Seán Canney (Galway East, Independent)
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My apologies for being absent; I had to go to the Dáil to speak on agricultural matters. I welcome the witnesses to the meeting. I was listening to the proceedings in my office before coming down to the committee room. A few matters came to mind while I was listening to the contributions of the witnesses. They are saying there is a lack of legislation for the Mental Health Commission to become more of a regulatory authority in terms of the community and CAMHS and all that goes with that. Who is regulating it at the moment?

Mr. John Farrelly:

Nobody.

Seán Canney (Galway East, Independent)
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Has the commission been pushing for legislation to give it that authority? How long has that been going on? What can the committee do to assist in that regard?

Mr. John Farrelly:

The heads of the Mental Health (Amendment) Bill have gone through the Oireachtas Joint Sub-Committee on Mental Health. The Minister stated its amendment would be prioritised, and we believe it should. If the committee can encourage the Minister and the Government to ensure it is prioritised, that would be helpful.

Seán Canney (Galway East, Independent)
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Is the legislation - the heads of Bill and all that - competent or coherent enough to give the Mental Health Commission the authority to regulate?

Mr. John Farrelly:

The Bill will be, but the regulations under the Bill need to be strong. There need to be regulations in respect of State upkeep of premises, as well as individualised patient care plans and whether there is a compulsory aspect to that. The Bill needs to come through but the regulations under the Bill also need to be stronger.

Seán Canney (Galway East, Independent)
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As regards the congregation of services, Senator Clonan mentioned that there seems to be a knee-jerk reaction, in that centres are being closed down without having a plan B in place and facilities available in the community. I see that in my neck of the woods, in Galway, where decisions are made to close a facility and then there is a flurry of activity to get people out into community places. Sometimes it is done on an ad hoc basis, which can be scary for the people involved and their families. Does the commission believe we should put on the brakes until there are proper alternatives in place to deal with the shift from congregated settings?

Mr. John Farrelly:

We have approved centres. How many units do we regard as congregated?

In general, how many beds or people would be in the long-stay units?

Dr. Susan Finnerty:

Approximately 800.

Mr. John Farrelly:

It is approximately 800 and, therefore, the idea is to plan nationally to make sure people get a place that would be suitable for them for their lives. People are older. National capital investment in that is a reasonable thing to do. However, we cannot stop the HSE or anyone closing approved centres. I definitely think if there was a capital plan, there are some very good people out there such as the Housing Association for Integrated Living, HAIL. There are different things. We really need to think about where people are going before they are discharged and we are looking to put them somewhere. That is a reasonable point.

Dr. Susan Finnerty:

There are approximately 800 people in long-stay approved centres or continuing care. There are also roughly 2,100 in 24-hour supervised residences. As I said earlier, there is a real block at the moment because, first, there is no stock of housing to move people on even if they want to and are able to move on. That causes a backlog in the congregated settings. People in that figure of 800 who are in approved centres may be able to move on to high-support hostels as part of their care pathway. They cannot, however, because the hostels and residences are full because the people in them cannot move on and, therefore, not having adequate housing is a real block.

Second, I mentioned this many times but because there is no rehabilitation team, or if there is, it may be poorly staffed, it is difficult then to move people on where there is maybe some medium support or low support. People do not have the skills to move on. They are skills that could be learned and encouraged, however. Again, it is twofold. It is a lack of housing stock for people to move on and also lack of proper effective rehabilitation.

Seán Canney (Galway East, Independent)
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In effect, we are saying that we do not have the houses or the rehabilitation teams. Should we be taking stock of what we are doing at the moment? Should the Mental Health Commission as an organisation set out a clear pathway by which decongregation happens in terms of what needs to be done to make it proper? We must bear in mind that everybody is an individual and there are different needs for different people. One size does not fit all. It is complex but at the end of the day, we are talking about people who need help. If they have a setting they can go into but do not have the rehabilitation support to allow them to develop as best they can, are we not failing them?

The last issues I will raise goes back to the question that was raised earlier about Owenacurra Centre. I am not awfully familiar with it but I have received correspondence in respect of the issue. I ask the commission to engage with the members who have serious issues about this. The witnesses are protected within the committee but there are questions. They cannot talk about it yet. They have been on public radio and in newspapers talking about it and they cannot talk to parents or families. Something needs to be done in that regard rather than having further aggravation for the residents, as was expressed here by members. I ask the witnesses to perhaps reflect on that and come back with more answers rather than just saying they cannot talk about things. I ask that in good faith. It is important because at the end of the day, it is not about us as members or the commission. The families who are affected by this need to get a bit more confidence about how we treat the person at the centre of all this. I will leave it at that. There are many questions I could ask the witnesses and they may not be able to go there.

I will mention one final issue regarding a review the commission is carrying out at the moment. When might that be complete? Does the commission just publish it? Does the Minister have to go through it before it is published? What is the process with that?

Dr. Susan Finnerty:

As I said earlier, we have completed two thirds of our field work at the moment. We hope to publish in April. I am sorry; I forgot the other question the Deputy asked.

Seán Canney (Galway East, Independent)
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When the report is published, is the publication conditional on the Minister seeing it or anything like that?

Dr. Susan Finnerty:

No. We are completely independent and we will publish the report. It will go to the Minister, obviously, but the commission makes the decision to publish.

Seán Canney (Galway East, Independent)
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Does Dr. Finnerty have any comment on the other issue regarding Owenacurra?

Dr. Susan Finnerty:

When we go to our inspections there, we speak to the residents who are there. We spoke to the families on the previous two occasions we were there.

Seán Canney (Galway East, Independent)
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Is the commission happy about it?

Mr. John Farrelly:

We are not happy that we are not able to vindicate people's rights in the way we want to. We are not happy that we are not able to account the way we want to account. We have to tactically figure out the best way to vindicate people's rights. It is very hard.

To be honest with the Deputy, we have been very quiet on this deliberately, but what members said about making sure the premises are in place for people before all individuals are moved is a credible thing to put forward. I do not want to jeopardise something if we go in and end up in a court room in County Cork on foot of something that happens. It can happen that someone turns around to us and says we are prejudiced and we already wanted to act. It is very tricky. Whatever impression we are giving, we are not intending to give that impression.

Seán Canney (Galway East, Independent)
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I say this to Mr. Farrelly in good faith. It is incredible that the commission would fear litigation or being challenged or whatever. It is more important to get services right for the service users. Litigation will or will not happen. As Mr. Farrelly said, he is being cautious and trying to do things right but at the end of the day, there is also an onus on us all to make sure things are right for the people involved.

Mr. John Farrelly:

We do not fear litigation; it is just that if we did go to do something, it could be tricky. We have tried to do a few things in County Cork and they have been challenged by the HSE. That stalls things again and things can happen. It is just tactically hard with a particular act.

Pat Buckley (Cork East, Sinn Fein)
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I thank the representatives of the commission for coming in. Sometimes there is an advantage to being last. I will cut straight to the chase because this has been a bugbear of mine since the Minister rang me regarding the closure. I will specifically use the example of Owenacurra because I am from Midleton and that is the local centre.

This is my first question and I will be blunt. I have feeling about this, but has the commission come under pressure from other entities for exposing the failures of the HSE? Mr. Farrelly mentioned Cork. He did not mention a scale but I will ask him on to answer on a scale. How bad are the services in the whole of Cork on a scale of one to ten, ten being the best and one being the worst?

I met recently with the residents. I will quote the following question:

I know that the Owenacurra families and others have written to you and asked you to address the HSE's misuse of your reports to justify the closure and the commission refused to do so. Why did you not correct the record and why did the commission allow the HSE to give an impression that they had your independent backing for this closure?

The reason I ask the question is that I have had numerous conversations with the HSE. The HSE is the proprietor. It is the landlord with responsibility for the upkeep. The Mental Health Commission's job is like the foreman or snagger who comes in to make sure everything is done right.

The commission's job is like that of the foreman, which is to make sure everything is done right. I have copies of records. There are more than 600 signatures from families. The HSE never spent money there. The problem is families are now being put into the old lunatic asylum in Sarsfield's Court, which is not an integrated setting. Why can the HSE use the commission's reports as a reason for closing the centre when the reports are supposed to make recommendations to bring the buildings up to standard? There seems to be a massive gap and there seems to be no oversight. I approached the HSE about this matter and could not get results. I must say the HSE is an absolute disgrace. I am not referring to the front-line care workers. The senior management are an absolute disgrace. I eventually had to go to the European Ombudsman about it. It responded and told me that the matter is not within its remit and recommended that I contact HIQA. I went to HIQA and was told it has nothing to do with mental health, and to approach the Mental Health Commission. I used a few choice words when I was told that. There is zero oversight around this.

We are dealing with services and real people. I meet these people every Saturday. I do not meet as many of them now because I think there are only six left. There was a fully integrated system that worked. The Garda station is beside the centre, the dentist is across the road, the doctor is on the other side, the community hospital, the market and the SuperValu centre is there and it is about 50 yd from the town. People will be taken out of the accommodation and put into Sarsfield's Court or above in Cork. They are going to be locked out for the day and wandering around the city. What is being done here is a cruelty to the most vulnerable human beings.

I have two more questions. Does the Mental Health Commission have an oversight role in this? On the commission's recommendations, it is true the building is crap, but that is not the commission's fault or that of the residents. It is the HSE's fault. Does the commission have the power to say its remit is to ensure the best possible services are provided for the most vulnerable in this country? Can it tell the HSE it has failed in its responsibility to maintain this premises and others? Does it have the power to say it is not acceptable? According to HSE spin, the Mental Health Commission is responsible for the Owenacurra centre's closure because it said it was not fit for purpose. Why has the commission not come back to say that, while it said the centre was not fit for purpose, it made recommendations in 2016, 2017, 2018, 2019 and three times in 2021 that the problems needed to be fixed but the HSE did not do it? Why does the commission not have the gumption to take the HSE to court? I know what the witnesses have said about restrictions and whatever. If the Mental Health Commission is an oversight body - and we do not have oversight within the HSE - why can we not set an example? The Owenacurra centre is personal to me. It should have been a pilot project that should have been replicated throughout the country. It was a fully integrated service and the residents were happy there. Now, I am listening to family members who are crying. I could go on and on. Is the Mental Health Commission being put under pressure for exposing the HSE? How bad is the situation? Why will the Mental Health Commission not correct the HSE's misinformation - I would like to use another word - that the Owenacurra centre has to be closed because the building is not fit for purpose? The commission did not recommend that the centre be closed; it said it was not fit for purpose. How can those records be corrected? I know there is a lot in what I have said.

Mr. John Farrelly:

We have powers to deregister a centre if we have significant concerns about it. To be clear, we have not deregistered any centre. If we were that worried about residents, we would be in court deregistering that centre immediately. That said, we have no control over whether the providers decide to close a centre. We have not deregistered any centre. It goes back to the dilemma of what happens to the people, even if they are in accommodation, and how things will be organised.

In terms of the report, we believe the issuing of reports is a very transparent thing. The reports show people the reality and they can look at them. With the publication of reports, 89% of approved centres are now 80% compliant or more. It has worked and there is transparency about what is going on. However, there is no doubt the capital investment by the State and the HSE has not matched what has been published in strategies, going back to A Vision for Change. That is the overarching issue. Perhaps Dr. Finnerty would like to comment on some of the Deputy's points.

Dr. Susan Finnerty:

I agree with Mr. Farrelly. We issue reports and we publish every report of every inspection we do, apart from those that are on a particular individual who could be identified. They are the only reports we do not publish. Anybody can look at them, have an opinion about them or use them in any way. We do not have any control over how the reports are used. As Mr. Farrelly said, we never said we were going to deregister the Owenacurra centre. On inspection, we found issues that needed to be addressed. Mr. Kiernan and his team look after the enforcement actions and so on. We did not say Owenacurra should close.

Pat Buckley (Cork East, Sinn Fein)
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Dr. Finnerty said that the commission cannot change people's opinions of the reports. I am going to ask the witnesses straight. Will the commission correct the record and get the HSE to take back its claim that it is the Mental Health Commission's fault that it has been forced to close the centre? The witnesses said that the HSE's decision was based on its opinion. Will the commission correct the record? The HSE is taking the power off the commission and it is also using the commission's reports as an excuse to close these centres. The Owenacurra centre is not the only centre that is being closed. The HSE is covering its backside because it has failed to uphold its part of the deal and the commission is the scapegoat. Will the commission ask the HSE to take back the claim that the commission recommended the closure of some centres, the Owenacurra centre in particular, and see what it comes back with? I have tried and it has been like trying to empty the Red Sea with a bucket with no arse in it. It is that hard to deal with the HSE.

Mr. John Farrelly:

I think the chief officer in Cork has put it on the record that he has taken the decision to close Owenacurra.

Pat Buckley (Cork East, Sinn Fein)
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He is using the commission's report as an excuse. The report stated the building at the centre was not fit for purpose. Michael Fitzgerald, the Cork Kerry Community Healthcare chief officer, is using the commission as an excuse. Is it possible for the commission to approach the HSE and say it is misinformation and an untruth? It is taking the information from the report out of context and is giving the commission a bad name for the good work it does. There are patients and families who are suffering.

Mr. John Farrelly:

I would have to think about that one. I do not think I would be automatically inclined to do so. We have a lot of correspondence with the HSE, much of which is of a regulatory nature with a view to improving services for patients in Cork. We try to concentrate on doing our job done within the scheme of the Act.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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Do any members want to ask an additional question on issues that have not been covered?

Neasa Hourigan (Dublin Central, Green Party)
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Just to stay on that point, has the commission had any communications with the HSE on its use of the commission's report?

The HSE has appeared before the Joint Committee on Health in statutory session - and it is now on the record of the Dáil - and has said that the reason for the closure is the commission's reports. Has the commission had any correspondence about the HSE's use of the reports? I want to be clear.

Mr. John Farrelly:

No.

Neasa Hourigan (Dublin Central, Green Party)
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The commission has never contacted the HSE about its use of the commission's reports. Is that correct?

Mr. John Farrelly:

I would have to check but I do not think so.

Neasa Hourigan (Dublin Central, Green Party)
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I presume that means that the commission has no concerns.

Mr. John Farrelly:

We publish the reports to create a transparency but we cannot control how the providers use them because then we would be getting into communications wars. We are-----

Neasa Hourigan (Dublin Central, Green Party)
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I have a couple of other questions and I do not want to get into a big back and forth on this but that does seem a remarkable position for a body that is tasked with protecting people in this regard.

I want clarity on the issue of enforcement. In his responses to other Deputies, Mr. Farrelly said "if we did do something in this area" and referred to "potential" regulatory enforcement action. I just want to get full clarity here. Is it a "potential" regulatory enforcement or is an enforcement in train or in process?

Mr. John Farrelly:

We are looking at the information all of the time-----

Neasa Hourigan (Dublin Central, Green Party)
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No, an enforcement is a legal process and there is a commencement date. If I run a restaurant and somebody enforces a health and safety regulation, I am notified. Is there a date about which the HSE has been notified? Is that in train or in place? Can the witnesses tell me that it is not potential but is in place?

Mr. Gary Kiernan:

It is an evolving situation whereby the HSE can challenge us at any time. There is something in place that it has a right to respond to.

Neasa Hourigan (Dublin Central, Green Party)
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Has the commission notified the HSE that there is an action in place against it?

Mr. Gary Kiernan:

Yes.

Neasa Hourigan (Dublin Central, Green Party)
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How many enforcement actions is the commission undertaking in respect of congregated settings?

Mr. Gary Kiernan:

I do not have the full number here. Our enforcement actions range from warning letters through immediate action notices right up to prosecution and the threat of de-registration-----

Neasa Hourigan (Dublin Central, Green Party)
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Will Mr. Kiernan undertake to give a note to committee on that? I would like to know how many enforcement actions there are in Cork in particular, but also more generally. I seek information on how many live enforcement notices are in place.

Mr. Gary Kiernan:

Yes, I can provide a note on that.

Neasa Hourigan (Dublin Central, Green Party)
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I want to return to Deputy Cairns's point on the consistency with reports. I do not want to harp on about the point about writing reports but not being responsible for what happens afterwards but I do want to examine the issues around consistency and the implications of report findings. The commission will be aware that the HSE has repeatedly made reference to concerns raised in the commission's inspection report on Owenacurra in 2021 regarding the size of some of the rooms. As an architect who worked in healthcare, this was of particular interest to me. This was one of the key reasons for closing the service and for saying that the building was not usable., yet when I looked into this further, through FOIs and parliamentary questions, it turned out that each of the rooms in a service in Skibbereen, known as Saol Nua, is smaller than each of the rooms in Owenacurra. The commission has not raised any concerns around room size in its latest available inspection report on Saol Nua. This is even more confusing because in an inspection report for Owenacurra, the commission stated in 2017 that residents had "ample" personal space. This was at a time some residents were sharing rooms. There were 24 residents there at that time and that was nowhere near the case in 2020 and 2021. I also note the many concerns, already discussed, that the commission has raised about wards in St. Stephen's Hospital but it tends not to mention the fact in those reports that residents share rooms, with the obvious privacy and dignity issues that go with that. We have Owenacurra residents being told, with reference to the commission's reports, that they would be better off moving from a single room in a town centre location to a shared dormitory in a remote, long-stay ward. I visited St. Stephen's Hospital in order that I could understand what we were talking about and I found it to be very remote. The concerns in the commission's reports seem remarkably inconsistent and it does not seem to be willing to engage with that issue. These concerns can be used and interpreted by the HSE in any way it chooses to justify closures or any other action it wants to take.

Mr. John Farrelly:

We prepare hundreds of reports every year on approved centres all over Ireland. They are consistent. There is a framework and a judgment and they are consistent. Can I just ask-----

Neasa Hourigan (Dublin Central, Green Party)
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I am pointing out inconsistencies to Mr. Farrelly.

Mr. John Farrelly:

The Deputy is saying there are inconsistencies-----

Neasa Hourigan (Dublin Central, Green Party)
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Is Mr. Farrelly saying that I am incorrect?

Mr. John Farrelly:

The Deputy is attributing commentary to the commission that we have never made.

Neasa Hourigan (Dublin Central, Green Party)
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No, this is not commentary; this is counting. A room is one size and it is not another size. It is not interpretative; it is counting.

Mr. John Farrelly:

Can I answer the question? Saol Nua-----

Dr. Susan Finnerty:

----- is a supervised residence.

Mr. John Farrelly:

We do not regulate Saol Nua.

Neasa Hourigan (Dublin Central, Green Party)
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There is an inspection report from the commission on Saol Nua.

Dr. Susan Finnerty:

Yes, that was part of our rolling three-year programme for inspections but we do not regulate Saol Nua.

Neasa Hourigan (Dublin Central, Green Party)
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How many other buildings, such as St. Stephen's Hospital, have the same room sizes that the commission described as being "unsatisfactory" in Owenacurra?

Dr. Susan Finnerty:

There are a number of others but I would not have-----

Neasa Hourigan (Dublin Central, Green Party)
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Almost all of them, by my reckoning.

Mr. John Farrelly:

I ask the Deputy to explain what she is saying.

Neasa Hourigan (Dublin Central, Green Party)
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Most of the rooms in St. Stephen's Hospital do not comply with the room sizes that the commission is implying are unfit for purpose in Owenacurra. There is no consistency. In its discussion of St. Stephen's Hospital, the commission rarely referred to the fact that residents are sharing rooms. We know that some of the residents from Owenacurra have been moved not just to other facilities, but also to nursing homes where they are sharing rooms. Does the commission take the point that there is inconsistency there?

Mr. John Farrelly:

We went to court and got undertakings from the HSE that it will replace St. Stephen's Hospital. I do not want anyone to get the impression that we are happy with St. Stephen's Hospital or that anyone is-----

Neasa Hourigan (Dublin Central, Green Party)
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The commission is not closing St. Stephen's Hospital, though, is it?

Mr. John Farrelly:

We are not closing Owenacurra.

Neasa Hourigan (Dublin Central, Green Party)
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But Owenacurra is closing.

Mr. John Farrelly:

We are not closing it.

Neasa Hourigan (Dublin Central, Green Party)
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We are being told, as Members of the Oireachtas, that the closure is based on the report from the Mental Health Commission.

Mr. John Farrelly:

We are not closing Owenacurra. As I have explained to the Deputy-----

Neasa Hourigan (Dublin Central, Green Party)
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The authority that is closing Owenacurra is using the commission's report. It is worrying that Mr. Farrelly said the commission writes hundreds of reports. Here is a report that is being used in a very specific way, and it is quite important that the commission takes ownership of the way its reports are being used if it is putting hundreds of them out into the world every year. We are being told at committee that a congregated setting is being closed, and the manner in which it is being closed is having a detrimental impact on the lives of people in a very real way, because of the commission's report. Is that not the case?

Mr. John Farrelly:

Just to be clear, the Deputy has been told lots of things by the HSE as to why it is closing Owenacurra. We have dramatically changed the lives of thousands of people in Ireland through our reports.

Neasa Hourigan (Dublin Central, Green Party)
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Mr. Farrelly-----

Mr. John Farrelly:

Can I finish please? Am I allowed to finish?

Neasa Hourigan (Dublin Central, Green Party)
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No, because I have to finish up and I have limited time.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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Please allow Mr. Farrelly finish.

Neasa Hourigan (Dublin Central, Green Party)
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Can the commission take responsibility for the use of its reports by the HSE?

Mr. John Farrelly:

I can take responsibility for the fact that the reports from the Mental Health Commission have generated new centres in Galway, Waterford, Cork and all over the country for people that were living in dilapidated settings. That is the work of the commission and its reports. I can bring the Deputy down to Waterford and show her people who are-----

Neasa Hourigan (Dublin Central, Green Party)
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Yes but its report has led to the closure of Owenacurra-----

Mr. John Farrelly:

Am I allowed finish?

Neasa Hourigan (Dublin Central, Green Party)
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No. I am out of time, unfortunately. I would like to go back to Saol Nua with Dr. Finnerty. I am under the impression that the commission did an inspection there. Is that correct?

Dr. Susan Finnerty:

Yes, we did.

Neasa Hourigan (Dublin Central, Green Party)
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Okay, I just wanted to be clear on that.

Mr. John Farrelly:

We do not regulate it.

Neasa Hourigan (Dublin Central, Green Party)
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Fine, but the commission did an inspection and wrote a report. Is that correct?

Dr. Susan Finnerty:

Yes.

Neasa Hourigan (Dublin Central, Green Party)
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If the commission does an inspection and writes a report but is not regulating the facility, then it is not taking responsibility for the impact of that report. The commission is publishing a report on Saol Nua but saying that it does not regulate it.

Dr. Susan Finnerty:

We do request-----

Neasa Hourigan (Dublin Central, Green Party)
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That is extraordinary.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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Please allow the witness to reply.

Dr. Susan Finnerty:

We request a quality improvement plan but that is as much as we can do for the 24-hour residences. We have called repeatedly, year after year, for regulation of those centres and now it looks like it is going to happen. We have been calling for it-----

Neasa Hourigan (Dublin Central, Green Party)
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I was very supportive of the idea at the pre-legislative scrutiny session of broadening the powers of the Mental Health Commission but not based on this session because I do not see that the commission is currently using its powers very well when it comes to that particular facility.

Mr. John Farrelly:

I am not sure the Deputy understand our powers fully.

Neasa Hourigan (Dublin Central, Green Party)
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That is an interesting line to take.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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Does anyone else want to ask an additional question before we bring the meeting to a close?

Pat Buckley (Cork East, Sinn Fein)
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Just to go back, I asked a question earlier about services in Cork overall and rating them on a scale of one to ten, with ten being best practice and one being crap. How would Mr Farrelly rate Cork?

Mr. John Farrelly:

We do not use that scale but Cork needs significant investment. If the Deputy has a look at the reports on Cork, he will see that. As I said earlier, we were in court recently regarding St. Stephen's Hospital and we got a commitment to replace that.

Many of the buildings in Cork need to be replaced.

Pat Buckley (Cork East, Sinn Fein)
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I will not touch on correcting the record. I will actually write and ask that it be done. As Deputy Hourigan said, the HSE uses these reports as excuses. The first question I asked was whether the Mental Health Commission has come under pressure from any external entities to tone down any of its services.

Mr. John Farrelly:

No.

Pat Buckley (Cork East, Sinn Fein)
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That is okay. I thank the Chair.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I thank Mr. Farrelly, Dr. Finnerty and Mr. Kiernan from the Mental Health Commission for attending and for their insightful contributions today.