Tommy Broughan (Dublin North East, Labour)

Let me first commend Deputy Kathleen Lynch in her new role as Minister of State with for mental health and on her efforts to progress services and facilities for citizens with mental health needs. I am glad to have the opportunity to bring the critical issue of mental health services in the north Dublin area to the Minister's attention. Under the direction of the Mental Health Commission, the male and female acute units in St. Ita's Hospital, Portrane, are set to close on 31 August when the hospital's licence is being withdrawn. These critical services are supposed to be replaced by a new acute unit at Beaumont Hospital. Of course, I accept the bona fides of the Mental Health Commission's decision that the acute facilities at St. Ita's are massively sub-standard and hugely outdated. There has been a long campaign to phase out the hospital. There are, however, profound concerns about what will happen to citizens with acute psychiatric hospital needs when the St. Ita's acute units close at the end of August.

While generally aware of the closure, I was shocked to see a couple of weeks ago in Dublin City Council's planning list for week 25 the planning application for the Beaumont unit only being granted now. Many people thought that this unit was close to completion or had been already built. Development is proposed for two sites on the Beaumont grounds, immediately to the east of the existing multi-storey car park and to the north of the Irish Kidney Association building. The site near the multi-storey car park is to consist of a new two storey structure with a number of internal courtyards housing an acute psychiatric residential facility and old age psychiatric residential facility. According to the Minister for Health, the contract has been awarded for the new acute admissions unit at Beaumont and construction on the unit will not start at the end of 2011.

In a reply to a question submitted by Deputy Ó Caoláin on 14 July, the Minister for Health reported that there was an interim plan to refurbish part of the existing buildings at St. Ita's until the new Beaumont unit was ready. Incredibly, however, the Minister also reported on the same date just last week that: "Refurbishment work has not yet been undertaken and I understand that the HSE is in discussions with the Commission with a view to agreeing alternative arrangements for patients."

I hope the Minister present will be able to comprehensively report on the outcome of those discussions. It is shockingly close to the closure deadline and many patients and their families are very worried because they are completely in the dark about what will happen after 31 August. For example, it is rumoured in Fingal that Fingal patients will have to be accommodated at locations like Ardee, County Louth.

There is also a serious crisis in the provision of mental health services for adolescents in the north Dublin region, and a number of staff working in the area are regularly in touch with me on this matter. Since the recommendation by the Mental Health Commission of a ban on the admission of adolescents into adult wards, there has been an ongoing crisis in the provision of appropriate assessments or inpatient admissions when necessary for 16 and 17 year olds. There are just six beds in the adolescent unit in St. Vincent's Hospital, Fairview for the huge catchment area of the northside of Dublin and they are always full. Local clinicians report that this is an excellent unit that tries to free up beds as quickly as possible. But with only six beds available it is very difficult to find a bed if a young person is in extreme crisis in an accident and emergency room or a GP's surgery. Private hospitals such as St. John of God's or St. Patrick's do not accept emergency admissions over the weekend so an adolescent must spend the whole weekend in an accident and emergency department waiting for admission if a crisis occurs at the weekend.

Incredibly, staff have reported that they have been directed to seek adolescent beds in Cork or Galway if the Fairview unit is full. Understandably, local clinicians believe the proposed transfer of an adolescent in a crisis or suicidal situation to a bed hundreds of miles across the country in Cork or Galway is not an appropriate or practical response. I understand that staff also believe that HSE management have not been properly engaged on this matter and there have been ongoing issues about getting senior HSE managers to attend critical meetings with local clinicians and mental health service providers.

Why can 16 and 17 year olds who need access to mental health services not be seen by child and young adolescent services rather than adult psychiatry services? In the Mater Hospital and Temple Street hospital there are 24-hour on-call services for children and adolescents up to the age of 15 for emergency assessments which 16 and 17 year olds cannot access. Incidentally, why is there not a similar 24-hour service available at Beaumont? In the longer term, local clinicians have suggested the creation of youth mental health teams which could be manned by both child and adult psychiatrists and psychologists and nurses. These teams could deal with young people between 15 and 25.

On St. Ita's and youth mental health service provision, the key problem is that the Mental Health Commission has rightly made decisions on the unsuitability of current mental health facilities or practices. Inadequate interim measures and resources have simply not been put in place and are causing extreme distress for citizens who need to access mental health services. What reassurances can the Minister now provide to patients and staff across the north Dublin region that the profound deficit in mental health services in our region will be urgently addressed?

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