Dan Neville (Limerick West, Fine Gael)

I appreciate that the Minister of State is not present; I am sure he is on his way. I appreciate the opportunity to discuss this frightening and important report. I congratulate those involved in drawing up the report, including Judge Harding Clark SC, and Patient Focus for its energy and persistence in ensuring that the issue, which was delicate and serious, was exposed. The culture this has exposed of power within the health services almost generating fear is as serious as the damage done to the people involved. It exposes a culture in the Health Service Executive of a lack of involvement by people operating the system.

We have known this for some time. A culture of fear, control and, to some extent, bullying by those on different levels of authority within hospitals is not new. Too often I have seen nurses who have decided to leave their work because of difficulties experienced or attitudes and approaches by those in authority, be they consultants, senior nursing staff or other senior personnel in hospitals. This culture and approach fostered over time this extraordinary and terrible scenario in Our Lady of Lourdes Hospital. Others have pointed out the desperate situation for those involved. I will not repeat that, other than to acknowledge that what happened in this hospital was traumatic beyond words for those who experienced it. Nothing we can say and no compensation the State can give will make up for such an experience, which cannot be rolled back. We must acknowledge that in this debate and try to alleviate the extreme physical, psychological, emotional and social damage that has been visited on people who trusted a health system to protect them and operate in the best interests of their future health. The system did not do that and I do not believe it was an isolated incident. It may not happen to the same extent or in the same field of practice but there is a hidden culture of unquestioning acceptance of authority in the health system which must be recognised and challenged. I have experience of such a culture in the psychiatric services, where there is silence on the treatment of psychiatric patients. There is a barrier to discussing any aspect of the delivery of services, either with patients or their families. Too often people come to me frightened because a family member with suicidal ideation has been discharged from a hospital. We know hospitals are overcrowded and another patient is waiting for every bed but the hospital will not even discuss the patient's aftercare with the family.

I welcome the fact that the report of the expert group on mental health policy, A Vision for Change, outlined and challenged that culture of silence, in its chapter 3. The report clearly stated that professionals needed to be willing to accept that patients had a right to be involved in their care and treatment and to be consulted accordingly, and that acceptance should be automatically built in to the operation of the system. It also recommended that imbalances of power between service users and professionals must be acknowledged and addressed. The imbalance of power, between patients and consultant in the case of Mr. Neary, and between nursing staff and consultants in a hospital, was one of the key problems that allowed this situation to develop. The message should be sent that this imbalance of power must be challenged. Those who are aware of wrongdoing or who even feel something should be investigated should be encouraged to ask questions as a positive advantage to the service in its entirety.

There is a culture among all but the most progressive psychiatrists which dictates that under no circumstances will a patient's condition or treatment be discussed with any family member or any future carer after they have been discharged, for reasons of professional confidentiality. That is not accepted best practice anywhere in the world. I have spoken with people who have delivered such services at a very senior level in the US and who said it was more important to save a life if there was a danger of suicide than to stand on one's professional confidentiality. If patients were consulted by their psychiatrists for their permission to speak to their families about their condition, especially with regard to care after discharge, at least 95% would fully welcome it but it does not happen because consultants do not want it to happen. They want the power their silence affords them and which creates an aura of mystery over their profession, making their decisions exclusive to them. As a result the patient, the family or the future carer does not become involved and that is wrong and should be changed.

There have been serious consequences arising from the denial of what happens within the psychiatric services. In June 2004 a report on deaths in the Mid West Regional Hospital in Limerick included an account of the suicide by hanging of a 21 year old girl, who had been in the hospital for less than 24 hours, because of absolute neglect on the part of the health services. That independent report was sent to the Minister in June 2004 but was never published. Why is it rightly acceptable that reports on the general health services are published but a strong, serious report on deficiencies in the psychiatric services is not? It is because the public and the press demand that the former are published. Due to the stigma and the historical and cultural burying of psychiatric illness the Minister gets away with not publishing a very serious report that would encourage a public discussion to shed light on a problem which I believe is rampant throughout the psychiatric services, because this is not the only case of which I know.

I ask the Minister again to ask his senior, the Tánaiste and Minister for Health and Children, who is responsible for psychiatric services, to publish the review of the care and treatment of Anne O'Rahilly, deceased, in the course of her admission to the acute psychiatric inpatient unit at the Mid West Regional Hospital in September 2002, which was produced in June 2004.

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