Michael McNamara (Clare, Independent) | Oireachtas source

Like Deputy Ward, I wish to raise the cases that were brought to light by the Committee for the Prevention of Torture. It is embarrassing, at the very least, for the State that people should be treated in this way in our country. It is especially embarrassing that such treatment should only come to light through the visit of a delegation from an international body. It is unacceptable that, in this century, people would be treated in the ways that were identified, including, in one case, being found lying in their own excrement. This harks back to previous times. In fact, such treatment was deemed unacceptable by the Victorians, to whom the Minister of State referred in her introduction.

I welcome the proposal to move the Central Mental Hospital, finally, from the facility in Dundrum, which was built long before the State was founded, to a new purpose-built facility in Portrane. That is very much to be welcomed. However, what we need more than a change in bricks and mortar is a change in attitudes to mental health, particularly in prisons. I am talking about the attitudes from on high, which may include people in this House and certainly includes the Minister of State's Department and the Department of Justice. The Committee for the Prevention of Torture noted in its report:

The CPT's delegation received hardly any allegations of ill-treatment of patients by staff in the establishments visited. On the contrary, patients mainly spoke highly of staff and the delegation observed their commitment to provide care and treatment to patients, often in difficult circumstances.

It is important, when the ill treatment of patients and prisoners has been highlighted to the extent that it has and when we are discussing the issue, that we acknowledge that it is not the fault of the staff in the institutions. It is also important to note that what the situation highlights is a lack of attention to mental health within the Departments of Justice and Health.

There has been much talk about data on mental health and the lack thereof. I was glad to receive a communication from the HSE, based on the issues I raised yesterday in the Dáil and which I also posted on social media, apologising for not responding before now and saying that it would welcome any interaction with me. If it had welcomed interaction with me, I would not have raised the matter in the Dáil. Every single question I have asked, and I have asked many since being elected to the Dáil, has been met with an exercise in obfuscation by the Departments of Health and Justice. I am sorry to say that but I invite the Minister of State to look at the correspondence for the evidence of it. I do not think any reasonable person would conclude otherwise. When one asks specific questions, one gets general answers. If one asks more specific questions, one gets no answer. It is simply not good enough. There was an attitude to many areas of health in the past - I daresay we still have it in some quarters - that doctors know best and they cannot be questioned. I accept that doctors know best but I do not accept that they cannot be questioned. Whether it is the National Public Health Emergency Team, the Central Mental Hospital or the College of Psychiatrists of Ireland, they are all funded by means of taxpayers' money. It is the duty and role of this House to question what is being done with taxpayers' money and whether the public is receiving a service. It clearly will not be receiving a proper service until such time as we have adequate data.

I would like to know more about the man, identified by his initials only, who was found lying in his own excrement. I understand he had been there for days and was there for weeks afterwards before the situation was dealt with by the High Court - not the executive, the High Court. On the broader issue of mental health provision generally, I had the opportunity, not under the current President of the High Court but the previous one, to visit the wards list. I am mindful of the need to observe the separation of powers but as the individual in question is no longer President of the court, I think I can say that it was very much to his credit how he dealt with the wards list. It should not necessarily come to the very difficult decisions that have to be made at times in regard to that list. I have digressed in talking about it. Going back to the particular prisoner to whom I referred, where was he registered? How is the State recording such incidents or is it recording them at all? I do not know the answers to those questions. I would really like a collaborative response rather than the usual exercise in hiding information. We all accept that unless we get information out there and unless we know what the problems are, they will not be dealt with.

I had the misfortune to say that I did not think that mental health data were being considered by public health doctors during the Covid crisis. I received a barrage of criticism from doctors for daring to suggest that. Of course that information was being considered, I was told. In fact, it was not being considered, because it was not being collated at the time. There are two State agencies the role of which is to collate the data. One of them, the National Self-Harm Registry Ireland in Cork, could not do so because its staff were not considered essential workers during the first lockdown. They have since resumed collating the data, both retrospectively and prospectively. The other agency is jointly run by the HSE and the College of Psychiatrists of Ireland and we were told that it was collecting fantastic data. However, when I looked for the information, it was not there. Maybe it is there and perhaps my inability to access it is a consequence of obfuscation by the HSE or the Department of Health or their refusal to provide the data. If the data are not there, why not just admit that is the case? Why does the State not admit that it is pretending to run a modern psychiatric service in this country based on empirical data when, in fact, what it is doing is relying on findings and research from other countries because it could not be bothered - that would be the polite word to use - to collect the data itself or it does not have the resources to do so? If we do not have the resources, then that needs to be highlighted.

This House, empty it is this evening, decides how resources are allocated in this State. There has been a sea change in attitudes to mental health, by the general public if not by the people who occupy Larry Goodman's fine edifice on Baggot Street Lower in Dublin. I say that because the mental health budget has repeatedly been plundered. I supported a Government for five years that was very proud to say it was the first to ring-fence money for a mental health budget. In fact, when one drilled down into it, there was an amount allocated for the first time, just as there is an amount allocated in the recent budget, but that was not spent on mental health and neither is the new allocation being spent on mental health. Even this year's budget was an exercise in obfuscation. There was a large amount of money allocated for additional services but only 50% of what it costs to provide the existing level of services was allocated. One does not have to be a mathematician or accountant to figure out that if existing services cost twice as much as is allocated for them, they are going to eat into the additional budget for new services.

Having said that, I welcome the allocation for additional services. I would welcome even more an assurance that those funds will, in fact, be spent on mental health and that when we look back this time next year, we will be able to see how they were allocated. Looking into the HSE's budget and how it spends its money can be a little like trying to find data from NPHET or data on mental health. There is a lot of obfuscation and one gets led around in a lot of circles and, at the end of it all, one goes from being told that there are fantastic data from all over the country to finding out that there is a representative sample, which I understand is what we have up the end of August. That is what I was provided with when I asked for all of the data, namely, a representative sample of 12 emergency departments out of the 36 which, in normal times, would be recording presentations of self-harm.

My time is almost up. I will conclude by saying that there is a great deal of talk about an increase in suicides, but we do not know whether there has been such an increase.

Even if there has been an increase, I fully accept that not every suicide is a result of mental health problems. Some certainly are but others are not. There are people without any mental health problems who make what could be considered a fully rational decision to end their own lives. That is tragic but it is even more tragic and more damning of this State if recurring mental health problems are not treated, leading to someone ending his or her own life.

I welcome this Bill. I welcome the fact that we are moving this service from Dundrum to Portrane. However, we have to change attitudes as well as the physical locations of certain facilities. We need much greater data collection and greater clarity in the provision of that data. We also need data to be provided in a timely manner, not after two years.

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