Paudge Connolly (Cavan-Monaghan, Independent)
Link to this: Individually | In context

I thank the Ceann Comhairle for selecting this matter for debate. Obviously I would have concerns about the proposed closure of St. Davnet's Hospital in Monaghan.

I have to acknowledge that the need for vast psychiatric institutions does not exist because over the years numbers have fallen dramatically in such institutions, nationally and in St. Davnet's Hospital, Monaghan. The profile of patients within the hospital has changed as well. Effectively, there is an ageing psycho-geriatric population and an admission unit, although the admission unit comprises more first-time admissions.

Service delivery has changed to community-based service, as proposed by the report, Planning for the Future, quite a number of years ago. That community-based service is in existence. It is a fact of life and it is working well.

Recently another report, A Vision for Change, was published. Most of what was contained in Planning for the Future has been reprinted in A Vision for Change. While it envisages community-based services, there are a couple of issues in A Vision for Change about which I have major concerns. One of them is the proposal to close psychiatric admission units. The proposal is for one 50-bed admission unit per 300,000 of the population. This will have serious implications for the health service. It is a crazy proposal, a retrograde step. It puts us back in time, into an institutional form of care and admission units. It is not personal. It is not a good form of service. It baffles me how anyone could recommend what would obviously be an overcrowded 50-bed admission unit to treat acutely ill patients. It is difficult to understand how anybody could recommend more than 18 to 20 persons in an admission unit. They should look at that again.

We all know that the ethos of psychiatric treatment is to treat the person in the home initially, the community next, the day centre then and an admission unit thereafter, which is preferably close to home. Planning for the Future was all about bringing services to the people, not taking services away from them, which is what this involves. We will not even have an admission unit in Cavan/Monaghan if these proposals go ahead. This is occurring at a time when there is an increasing need for such services. Suicide rates are increasing and there is pressure on society generally. It is not the correct move to make. It is not a well thought through move.

While there is a proposal to sell St. Davnet's Hospital, we are proud that the World Health Organisation has adopted the Cavan/Monaghan model of care as best practice, one to be followed and copied internationally. We should take a closer look at that.

The St. Davnet's complex is like a village or campus. It contains quite a number of services other than the psychiatric hospital. It is a thriving community. It includes two community hostels, three private houses, a local health unit, the headquarters of the health care services for County Monaghan, a day centre training unit for the intellectually disabled, a residential intellectual disability unit, Enable Ireland which the Minister of State, Deputy Tim O'Malley, opened a short time ago, a third level education centre, an occupation unit, a sheltered industrial therapy unit, a 40-bed nursing home, day centres, day hospitals, laundries, admission units and psycho-geriatric units. A large volume of day patients are using this service. The service there is operating effectively and we should not ignore that it has been adopted as a model of care by the World Health Organisation.

One could sell these hostels and there would be a short-term gain, but we should look again at this policy of selling off the family silver such as excellent sites in the centre of towns. There is an undesirable practice within the health service of renting premises. Many Departments throughout the public service rent, rather than purchase, premises. This is a fantastic site, located in the centre of a town, which could possibly be sold off. We should be getting back to the Departments and asking whether they have need of a greenfield site, whether there is a need for an Irish school in Monaghan, for a theatre or for a third level college which could be built on the complex. It would offer a fantastic greenfield site for decentralisation. Selling should not be top of the agenda.

We should take another look. If there is a better location for a psychiatric unit they should consider it. In the case of St. Davnet's, however, such a better option does not exist. It is a fantastic site, a lovely leafy place with lawns, a private and dignified place for somebody who is ill and a good environment to facilitate recovery. If the Minister of State can get a better location in a general hospital, he may opt for it but I do not believe one exists.

Tim O'Malley (Limerick East, Progressive Democrats)
Link to this: Individually | In context

I thank Deputy Connolly for raising this matter.

I welcome the publication of A Vision for Change which outlines an exciting vision of the future for mental health services in Ireland and sets out a famework for action to achieve it over the next seven to ten years. This report is the first comprehensive review of mental health policy since Planning for the Future was published in 1984 and has been accepted by Government as the basis for the future development of mental health policy.

A Vision for Change recommends that specialist expertise should be provided by community mental health teams, CMHTs, expanded multidisciplinary teams of clinicians who work together to serve the needs of service users across their lifespan. Community mental health teams should serve defined populations and age groups and operate from community-based mental health centres in specific sectors throughout re-configured mental health catchment areas. Some of these CMHTs should be established on a regional or national basis to address the complex mental health needs of specific categories of people who are few in number but who require particular expertise.

Recent years have seen dramatic changes in both the concept and innovative practice of mental health care delivery in the Cavan/Monagahan mental health service. These changes have been very much in line with the model of service provision now recommended by the expert group.

The focus of mental health service provision in Cavan/Monaghan is to work towards a community-based model of care, supporting, caring for, and treating people with mental illness who are living in their own communities. This is being achieved through a range of services, which include out-patient clinics, day hospitals, home visits, community residences and supported accommodation as well as working in collaboration with voluntary organisations. This approach to care delivery has resulted in a sharp decline in the number of acute inpatient admissions to the admission unit at St. Davnet's Hospital. A Vision for Change envisions an active, flexible and community-based mental health service where the need for hospital admission will be greatly reduced. This has already taken place to a great extent in Cavan-Monaghan, as I have outlined. The expert group stated in the report:

Mental hospitals have been the mainstay of mental health services in Ireland for many years. However, the type of person-centred, recovery-oriented care recommended cannot be provided in institutions of this size or environment in the future.

On that basis, the group has recommended that steps be taken to bring about the closure of all the remaining psychiatric hospitals which are a legacy of a bygone age and to re-invest the resources released by these closures in the mental health services.

The closure of the large mental hospitals and the move to modern units attached to general hospitals, together with the expansion of community services, has been Government policy since the publication of Planning for the Future in 1984. Several large psychiatric hospitals around the country have already been closed, including Our Lady's in Cork, St. Patrick's in CastIerea, St. Columba's in Sligo, St. Mary's in Castlebar and Our Lady's in Ennis. The reorganisation of services which these closures entailed has resulted in the expansion of community facilities, new acute psychiatric units in some cases and most importantly an overall improvement in the delivery of services for the service users, their families and carers.

Most of the remaining stand-alone psychiatric hospitals cater in the main for long-stay patients, many of whom are over 65 years of age. This is also the case at St. Davnet's Hospital, Monaghan, where the majority of patients are cared for in elderly care wards.

The report recommends that a plan be drawn up for the phased closure of each of the hospitals. It is recommended that this plan consist of a four-stage process: identify measures required to enable admissions to cease and put these measures in place; cease admissions to the hospital and draw up plans for relocation of existing patients; implement plans for the relocation of existing patients; and final closure of the hospital. This process should take place on a phased basis with wards closing sequentially and will require funding for training and upskilling of staff who will then be redeployed to work within the mental health services provided in the community.

The Health Service Executive has welcomed the publication of this report and stated that the national mental heaIth directorate within the HSE will immediately establish an implementation group to ensure the recommendations are realised in a timely and co-ordinated manner. The HSE has also emphasised that hospitals can close only when the clinical needs of the remaining patients have been addressed in more appropriate settings.

The Government is fully committed to the implementation of this report, which has been accepted as the basis for the future development of mental health services. This is Government policy and has been accepted widely by service users and carers in the service. I hope the level of debate in future will enhance the services for people with mental illnesses and that no one will try to exploit the vulnerability of mental health patients.