Liam Quaide (Cork East, Social Democrats) | Oireachtas source

I congratulate the Minister of State on her reappointment as Minister of State with responsibility for mental health. We hear so many stories about what is going wrong with our mental health services and as public representatives advocating for our constituents it is difficult not to fall into a position of perpetual complaint and outrage at times because there is so much unmet need out there and sometimes decisions are made that are not in the interests of people attending our services. It is important to acknowledge there are also very fine examples of services from which we can draw inspiration and learning. I visited one of these last Friday in Midleton. It was the launch of the Coolmine east Cork hub. The hub is a joint venture between the HSE’s social inclusion team and Coolmine itself and provides community-based support for people with addiction. We heard from a woman attending the service whose life has been transformed by the support and connection she experiences there.

A focus for me over this Dáil term will be services for people with severe and enduring mental health difficulties, who are among the most vulnerable attending our services. They have often suffered greatly throughout their lives and may require ongoing intensive multidisciplinary support and sometimes residential placement in order to attain stability and a decent quality of life.

When I joined the north Cork mental health services as a psychologist in 2013 the rehabilitation and recovery team in that location was helping many long stay patients of St. Stephen’s hospital in Glanmire to reintegrate back into their communities. It was painstaking, complex and ultimately transformative work. That north Cork team and its three 24 hour-staffed community residences in Kanturk, Mallow and Fermoy remain an exemplar for the direction we need to take towards community integration for people with the highest level of mental health need. Unfortunately, the HSE’s current proposal to invest €64 million to develop a 50-bed residential mental health service on the grounds of St. Stephen’s is entirely at odds with that progressive trend and national mental health policy. It will lock vast amounts of public money into a centralised, isolated service when it should be spent on community-integrated settings in towns such as Cobh and Clonakilty where none currently exist. The HSE has responded to concerns I have raised about this proposal by emphasising the buildings, which will be five bungalows, will not be institutional in design. However, a home is about much more than a building; it is about the broader community in which a person is embedded. When residents of the Owenacurra Centre in Midleton were being uprooted in 2021 they were not concerned about the size of their bedrooms but devastated at the loss of community connections formed over years or in some cases decades. This relationship with their community was a core part of their identity, as it is for all of us. The land around St. Stephen’s is zoned for agricultural use and the land directly across from it for light industry, namely, an online warehouse. The nearest shop of any description to St. Stephen’s is a service station a 1.7 km walk from the hospital’s entrance. The first kilometre of that route has no footpath and Cork City Council has no plans to develop one. The nearest grocery shop is in Riverstown, which is 3 km walk from the hospital and again there is no footpath for the first kilometre. There are no community amenities within walking distance of St. Stephen’s and no plans to develop any. These residents typically do not drive, some have mobility issues and the distances cited above may be considerably longer depending on the exact location of the proposed residences within the large hospital campus.

This proposal, therefore, does not remotely reflect the kind of community integration espoused by A Vision for Change, Sharing the Vision or the HSE’s policy for people with severe and enduring mental illness and complex needs. It is also at odds with the UN Convention on the Rights of People with Disabilities, which enshrines the right of people with disabilities to live in their community. St. Stephen’s is a fine location for an elective hospital but it is not a suitable place for people to live over a period of years and in some cases for the rest of their lives. Centralising these residential placements in St. Stephen’s will necessarily disconnect people from their communities because a service of that size will take people in from a broad catchment area. Let us not go back in time with this proposal and misdirect lots of money in the process.

I also appeal to the Minister of State to engage intensively with front-line staff in mental health services that are in serious difficulty. Consulting senior management is obviously necessary in the Minister of State’s role, but senior managers are one group amid several key stakeholders. They often have their own pressures and are usually operating at a significant remove from the day-to-day running of services. Engaging with front-line staff in a confidential format would be invaluable to understanding where we are going wrong with service provision in some areas. I make the same suggestion to the Minister of State, Deputy Moynihan. The crises in primary care, psychology and child disability network teams are interrelated and staff on the ground will quickly inform the Minister of State of what needs to be done.

For the most part the answers relate to recruitment. Installing another layer of management to implement the retrograde pay and numbers strategy by redeploying existing staff will not solve the out-of-control waiting lists in primary care, psychology and CDNTs. It will lead to a plummeting of morale and drive clinicians out of the health service. There is no HSE service with an excess of psychologists. Some are doing relatively well with their waiting times, but this is something we should be striving to emulate rather than undermining it through a race-to-the-bottom redeployment strategy. In primary care psychology the problems with recruitment are primarily to do with insufficient efforts to recruit qualified staff on secure contracts and this is further hampered by the pay and numbers strategy. There is an overreliance on assistant psychologists who are not fully qualified and therefore are very limited in what they can provide clients.

I wish the Minister of State well in her post. Though we are on different sides of the House I hope to work in partnership with her, the HSE and other agencies for the betterment of services over the coming years.

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