John Moloney (Laois-Offaly, Fianna Fail)

I thank Deputy Breen for raising this matter as it provides me with an opportunity to outline the plans for further development of mental health services in County Clare. To put the issue into context I should recall that A Vision for Change, the report of the expert group on mental health policy has been accepted by Government as the basis for the future development of our mental health services. While much has happened and much has changed economically in the three years since the report was launched, it remains a progressive document and our roadmap, charting the way forward for our mental health services. A Vision for Change proposes a new model of service delivery which is patient-centred, flexible and community based. The report proposes a holistic view of mental illness and recommends an integrated multi-disciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems. Extensive consultation with service users, their families and service providers informed this policy.

The most pressing priority voiced during the consultation process was the need for an accessible and user-friendly mental health service where service users can be respected as active partners in their own recovery and where they can avail of interventions to enable them remain meaningfully involved in their own communities.

Of course mental health services are provided in many settings, including acute in-patient facilities, day hospitals, day care centres, low support and high support community accommodation. While A Vision for Change recognises that acute hospitalisation will be always required to serve a minority who need intervention in safe, therapeutic settings, it also acknowledges the desire among service users, their families and carers to see an expansion of mental health service options established in local communities so that comprehensive care can be provided.

To turn to Orchard Lodge, in line with best practice, the HSE is currently engaged in a review of mental health services in County Clare with a view to ensuring that the most appropriate services are provided for service users, in the context of their changing needs. The HSE has consulted and engaged with carers, families and clinical and nursing staff and provided opportunities for them to put forward their views and to have a constructive input in the review process. At present there are 16 residents in Orchard Lodge and following individual clinical assessments it has been concluded that 11 of the residents, given their changing needs, would be more appropriately cared for in an older persons setting. It is therefore proposed to refer these residents to the older persons placement panel for consideration as to the most appropriate care setting for each individual. The remaining five residents who at this point require ongoing mental health care, will be accommodated in appropriate rehabilitation facilities.

While it is proposed to discontinue the residential facility at Orchard Lodge, I should clarify that there are no plans at present to change other services provided on this site, including the day service and the west Clare catering service. I should also explain that the closure of the residential facility will release mental health nursing staff and allow for their re-deployment to other areas where nursing staff are required and thus ensure best use of our valuable resources.

While I accept that the prospect of change can be daunting for service users and staff alike, we need to look at the bigger picture and recognise that the change which is proposed by the HSE is for the better. If we want to implement our national mental health policy, A Vision for Change, we need to be able to move forward and embrace change. Our major driver must be to meet the changing needs of individual service users and improve the quality of their care.

The residents of Orchard Grove have been clinically assessed and it has been determined that their needs would be better served in a different therapeutic setting. The HSE, to their credit, are proactively responding to the changing needs of these clients and are trying to provide the best possible care to them in the most appropriate setting. I am confident that the HSE will continue to engage actively with stakeholders and that notwithstanding the considerable challenges it faces, a satisfactory solution will be devised to the ultimate benefit of all concerned.

I fully appreciate Deputy Breen's concern regarding the stigma attached to mental illness. I intend putting forward a national programme to deal with that issue in January. I also intend to take an overview of the Vision for Change. With six years remaining for the programme, it is timely that we review its successes and acknowledge that the original reform has not been what we hoped it would be

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