Dan Neville (Limerick West, Fine Gael)

I welcome the chance to speak on this Bill. I am pleased the Minister is here as I will take the opportunity to raise an issue on which I sought a debate earlier today, namely mental health services. I offer my sincere sympathy to the family of Michael Hughes who was so tragically murdered. There are currently no dedicated beds available for severely disturbed and violent psychiatric patients. St. Brendan's Hospital deals with such matters for the State but the number of beds there has been reduced from 24 to 14 and those are occupied by long-stay patients. Therefore there are no beds for any disturbed person who becomes violent and is suffering from a psychiatric illness. It was reported today that a court decided a violent and disturbed person who was charged with a crime should go into a facility like St. Brendan's. However, because no such facility was available, that person got bail. The Minister knows the implications of that type of decision.

I will not comment on the death of Michael Hughes because I do not know the full circumstances. A psychiatrist cannot be expected to anticipate that a patient he is trying to assess would go out and kill somebody. However, the position regarding disturbed patients is very serious. Throughout the State, disturbed people are put into long-term psychiatric hospitals and isolated but the staff are not trained to deal with disturbed and violent patients. It is an affront to the patient that the services are not equipped to treat him or her. That is an indication of the dearth of resources provided and attention paid by many Governments to psychiatric patients.

On 12 December, I was informed by the HSE that 3,298 children are on a waiting list for psychiatric services. Many have been waiting for more than 12 months with some waiting for several years. This is serious because early intervention to treat psychiatric conditions is absolutely vital to achieve a long-term cure. I do not understand why the Minister and the Government are not addressing this issue because early intervention is cost effective. If the child is dealt with early, he or she will have a great chance to be cured and will not need long-term care. However, delay in the treatment of a child or an adolescent compounds his or her position and his or her condition usually becomes chronic resulting in him or her entering long-term psychiatric services. Even from an expenditure point of view, it is in the Minister's interest to deal with these children. Many reports have been published and suggestions made on what should be done.

I am extremely concerned that the former Minister of State at the Department of Health and Children, Tim O'Malley, stated €25 million would be invested in developing psychiatric services in 2007 and implementing the recommendations in the report, A Vision for Change. However, the Irish Mental Health Coalition states, "Most of this money is not being spent and much of it has been used to pay for budget deficits in the primary and continuing care sector". Surely this is not the case. Has the miserly contribution of €25 million to develop psychiatric services been siphoned off to deal with other problems? This beggars belief. I have been involved in the Irish Mental Health Coalition since its foundation and its chairman, John Saunders, who is also director of Schizophrenia Ireland, has demanded from the HSE a clear financial account of where the money has gone. If a person with the status of John Saunders is asking that question, that rings many alarm bells in my mind about investment in the development of mental health services.

I refer to the report on the management of mental health services. The appalling absence of proper management in this service is unbelievable. Twenty local health managers have replaced the former health boards and they are responsible for all health services, including mental health services. Each region has a local health manager with strategic responsibility for adult mental health and disability services and child and adolescent mental health services. Mental health services occupy only a small fraction of the attention of the manager, according to the report. In most areas, mental health services are not represented within the management team. Mental health services are managed at catchment level by senior management teams, which comprise in most cases a clinical director, a director of nursing and a hospital manager. The absence of full multidisciplinary psychiatric teams, which were recommended 23 years ago in the report, Planning for the Future, is a scandal.

More senior management teams in the mental health service contain no representation from disciplines such as occupational therapy, social work or psychology. While the vast majority of services have signed up to the multidisciplinary teams, this is not reflected at management level. There is no logical reason this is the case but the apparent resistance to the widening of the senior management base is surprising. In view of this, when will service users be represented at management level? This is light years away. There is a also serious failure of management in communications and in the context of decision making. Managers of mental health services are not part of decision making and the majority of senior management teams do not feel they are part of the decision making process. There is little evidence of effective catchment teams. Senior management teams are rarely integral participants in the planning of the mental health services. I look forward to the Minister's response.

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