Paudge Connolly (Cavan-Monaghan, Independent)

I thank the Ceann Comhairle for selecting this matter for debate. Obviously I would have concerns about the proposed closure of St. Davnet's Hospital in Monaghan.

I have to acknowledge that the need for vast psychiatric institutions does not exist because over the years numbers have fallen dramatically in such institutions, nationally and in St. Davnet's Hospital, Monaghan. The profile of patients within the hospital has changed as well. Effectively, there is an ageing psycho-geriatric population and an admission unit, although the admission unit comprises more first-time admissions.

Service delivery has changed to community-based service, as proposed by the report, Planning for the Future, quite a number of years ago. That community-based service is in existence. It is a fact of life and it is working well.

Recently another report, A Vision for Change, was published. Most of what was contained in Planning for the Future has been reprinted in A Vision for Change. While it envisages community-based services, there are a couple of issues in A Vision for Change about which I have major concerns. One of them is the proposal to close psychiatric admission units. The proposal is for one 50-bed admission unit per 300,000 of the population. This will have serious implications for the health service. It is a crazy proposal, a retrograde step. It puts us back in time, into an institutional form of care and admission units. It is not personal. It is not a good form of service. It baffles me how anyone could recommend what would obviously be an overcrowded 50-bed admission unit to treat acutely ill patients. It is difficult to understand how anybody could recommend more than 18 to 20 persons in an admission unit. They should look at that again.

We all know that the ethos of psychiatric treatment is to treat the person in the home initially, the community next, the day centre then and an admission unit thereafter, which is preferably close to home. Planning for the Future was all about bringing services to the people, not taking services away from them, which is what this involves. We will not even have an admission unit in Cavan/Monaghan if these proposals go ahead. This is occurring at a time when there is an increasing need for such services. Suicide rates are increasing and there is pressure on society generally. It is not the correct move to make. It is not a well thought through move.

While there is a proposal to sell St. Davnet's Hospital, we are proud that the World Health Organisation has adopted the Cavan/Monaghan model of care as best practice, one to be followed and copied internationally. We should take a closer look at that.

The St. Davnet's complex is like a village or campus. It contains quite a number of services other than the psychiatric hospital. It is a thriving community. It includes two community hostels, three private houses, a local health unit, the headquarters of the health care services for County Monaghan, a day centre training unit for the intellectually disabled, a residential intellectual disability unit, Enable Ireland which the Minister of State, Deputy Tim O'Malley, opened a short time ago, a third level education centre, an occupation unit, a sheltered industrial therapy unit, a 40-bed nursing home, day centres, day hospitals, laundries, admission units and psycho-geriatric units. A large volume of day patients are using this service. The service there is operating effectively and we should not ignore that it has been adopted as a model of care by the World Health Organisation.

One could sell these hostels and there would be a short-term gain, but we should look again at this policy of selling off the family silver such as excellent sites in the centre of towns. There is an undesirable practice within the health service of renting premises. Many Departments throughout the public service rent, rather than purchase, premises. This is a fantastic site, located in the centre of a town, which could possibly be sold off. We should be getting back to the Departments and asking whether they have need of a greenfield site, whether there is a need for an Irish school in Monaghan, for a theatre or for a third level college which could be built on the complex. It would offer a fantastic greenfield site for decentralisation. Selling should not be top of the agenda.

We should take another look. If there is a better location for a psychiatric unit they should consider it. In the case of St. Davnet's, however, such a better option does not exist. It is a fantastic site, a lovely leafy place with lawns, a private and dignified place for somebody who is ill and a good environment to facilitate recovery. If the Minister of State can get a better location in a general hospital, he may opt for it but I do not believe one exists.

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