James Browne (Wexford, Fianna Fail) | Oireachtas source

I move:

That Dáil Éireann:welcomes:

— the recent annual report of the Mental Health Commission and the report of the Inspector of Mental Health Services;

— the comprehensive nature of the reports and their contribution to building a culture of transparency in mental health services; and

— the recognition and reporting given to improvements, as well as deficits, within the services monitored;

notes:

— the findings and warnings from the Mental Health Commission which highlight significant governance and management deficit within mental health services;

— concerns about seclusion, physical restraint and services for young people;

— likely obstacles to the registration of some of the country’s in-patient mental health units without significant improvements in levels of compliance;

— a serious concern with hygiene and maintenance in a significant number of approved centres;

— mental health services where the degree of dirtiness and shabbiness is unacceptable and shows disrespect for patients’ dignity;

— that 70 per cent of approved centres (in-patient mental health services registered by the Mental Health Commission) remained dirty, malodorous and poorly maintained;

— that a number of centres remained unsuitable and not fit for purpose;

— that a significant number of approved centres have, on a consistent and sustained basis, failed to provide the most basic and fundamental aspects of a service;

— that more than 40 per cent of approved centres were non-compliant on the need for individual care plans; and

— that residents in long-term care are not being adequately monitored for serious physical illness and there was widespread lack of access to essential healthcare such as physiotherapy, speech and language therapy, dietetics and seating assessments;

further notes that:

— the Mental Health Commission annual report also highlighted ongoing concerns around child and adolescent mental health services;

— while the total number of admissions of people under the age of 18 to approved centres in 2018 was 408 (down from 439 in 2017), there were 84 admissions of children and adolescents to 18 adult units during the year;

— children and young people in crisis are left with the unacceptable ‘choice’ between an emergency department, general hospital, children’s hospital, or an adult in-patient unit;

— there are only Child and Adolescent Mental Health Services (CAMHS) units in three counties – Dublin, Cork and Galway – and they generally do not take out-of-hours admissions; and

— in April 2019 the number of CAMHS clinical staff nationwide stood at 57 per cent of the level recommended by A Vision for Change;

agrees that:

— while policy creates hope, the evidence gathered by the Mental Health Commission indicates that it is only well-governed, well-managed and well-resourced services that deliver for the public;

— the absence of regulation of State-provided mental health community residences leaves residents open to the risk of abuse;

— there is no justification for some of the low levels of compliance evidenced in the Inspector of Mental Health Services’ report;

— there are significant governance and management deficits within our mental health services;

— it is difficult to see how some of the lowest compliant centres could be registered in the future without significant improvement;

— hope and dignity are key elements of any mental health service and that not all approved centres are providing that, either through the service itself, or the physical buildings in which they operate;

— it is necessary to respect the wishes of service users and their families/carers in facilities such as the Rosalie community psychiatric unit in Castlerea, Co. Roscommon;

— a planned, costed and funded capital investment programme is required to bring a significant number of Health Service Executive (HSE) buildings up to date, make them fit for purpose and ensure that they are registrable;

— the placement of any child in any adult unit indicates a gap in service provision; and

— a child or adolescent’s first introduction to mental health care should not be through a service or building which is not specifically equipped to deal with their needs; and

calls for:

— a system of governance that drives best practice across the whole country;

— measures to ensure that the specialist in-patient approved centres are up to standard;

— the continued movement of the treatment and recovery model to specialist professional community care;

— the introduction of a system of regulation to protect the more than 1,200 people who live in State-provided mental health community residences;

— adult safeguarding regulation to be put on a primary legislative basis;

— a planned, costed and funded capital investment programme to bring a significant number of HSE buildings up to date, make them fit for purpose and ensure that they are registrable;

— an urgent implementation strategy to ensure that the CAMHS services provided match what is recommended under A Vision for Change;

— the recognition of the rights of 16 and 17 year olds to have the equivalent say over their mental health as they currently do over their physical health;

— the establishment of a national advocacy service on a statutory footing for adults and children under eighteen;

— the establishment of a statutory right for patients to information on their treatment;

— the updating of the Mental Health Act 2001 in line with the Report of the Expert Group on the Review of the Mental Health Act 2001 and to include guiding principles for children; and

— the right of involuntary patients to have any advance healthcare directives respected.

I am sharing time with my colleagues. It is unfortunate that I need to propose this motion in respect of the Mental Health Commission's annual report and the report of the Inspector of Mental Health Services with the intention of keeping mental health on the agenda. I hoped there would not be a need for it to be kept on the agenda but the reports indicate that there is such a need. They are comprehensive and highlight some serious areas of concern and failure within our mental health services. They point to a number of positives as well. However, in 2019, some 13 years into A Vision for Change, a lot of these issues are totally unacceptable and unnecessary. They make for stark reading.

One of the key issues to highlight is that of unregulated facilities. Similar facilities relating to disability care and physical health are regulated by the Health Information and Quality Authority, HIQA, but, in terms of mental health, they are unregulated. I am concerned about the potential for serious issues to arise in some of these facilities. There is no reason to fail to have them regulated and assessed. The reports refer to centres being unfit for purpose or unsuitable. We had the first ever prosecution under our mental health services in respect of St. Luke's in Kilkenny, which had to be prosecuted because of the lack of care for some of our most vulnerable people. There is no justification for many of these faults.

I want to focus also on child and adolescent mental health services, CAMHS. As the Ministers of State will know, this is where the 10% of the most acute circumstances arise that affect our young people's mental health services. These services again remain seriously understaffed 13 years into what was to be a ten-year plan, A Vision for Change. Only 57% of staff were found to be in situ. In two areas, CHO 5 and CHO 7, less than 50% of the necessary staff are in place. Similarly, only 7.6% of the necessary staff arein situin CAMHS for children with intellectual disabilities. There are no staff to care for such children in three areas - CHO 1, CHO 3 and CHO 6 - comprising almost a third of the country. This affects children who suffer from autism or Down's syndrome. Children with intellectual disabilities are four times more likely to suffer a mental health issue and are least able to cope. There continues to be a long waiting list for children, with 2,500 on it. The numbers of children admitted to adult units were 84 last year and 68 three years ago; the trajectory is unfortunately in the wrong direction. I was contacted by a parent whose child was admitted to the Waterford department of psychiatry, DOP, last night and had to be kept on a trolley. He had been on a hard chair all day because not only is there no place in a child unit but there seems to be no place even in an adult unit for him. We have the continued situation of no after-hours access. We have unqualified consultants and we have been waiting a number of years for the Mental Health Act 2001 to be updated; we do not even have the heads of a Bill yet.

On the consequences, in Temple Street Hospital and my local hospital, Wexford general hospital, the number of children being admitted to the emergency department has increased significantly. Suicide remains the greatest cause of death among young people aged between 15 and 24. Antidepressant prescription is increasing because general practitioners, GPs, are seeing no other options and there are no other pathways out there. I am not questioning the bona fidesof the Minister of State as I know he is doing his very best but I do not get a sense of urgency from the Government. I do not get the sense that it is prioritising mental health, putting the necessary funds in place or giving him the support he needs. In a country of 4.5 million people, there should not be a postcode lottery. We have a population approximately the size of greater Manchester and there should not be such large differences, even in Dublin, between what someone on one side of a street can access and what someone on the other side can.

A clear implementation strategy needs to be rolled out in order that everybody across the country has equal and fair access to services. The key issues I have highlighted need to be addressed.

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