Tommy Broughan (Dublin North East, Labour)
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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female acute units in St. Ita's Hospital, Portrane, are set to close on 31 August when the hospital's licence is being withdrawn.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of the Mental Health Commission's decision that the acute facilities at St. Ita's are massively sub-standard and hugely outdated.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?

Phil Hogan (Carlow-Kilkenny, Fine Gael)
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I will be taking this matter on behalf of my colleague the Minister for Health and I thank Deputy Broughan for raising it as it provides me with an opportunity to update the House on the current position in the development of mental health services in north Dublin.

The Mental Health Commission has attached a condition to the registration of St. Ita's Hospital which requires the closure of the existing male and female acute units by 31 August. Officials and clinicians from north Dublin mental health services had meetings with the commission regarding requirements to address this condition, and a plan involving the refurbishment of part of an existing building at the hospital was developed as an interim solution pending the completion of the proposed new acute psychiatric unit at Beaumont Hospital. The refurbishment work has not yet been undertaken and I understand the HSE is in discussions with the commission with a view to agreeing alternative arrangements for patients. The HSE has, however, assured the Minister that access to appropriate acute mental health services will continue to be provided for the people of north Dublin beyond 31 August 2011.

With regard to the new acute psychiatric unit at Beaumont Hospital, the position is that the contract has been awarded and an application for planning permission has been submitted. The Minister is hopeful that construction will commence in the last quarter of 2011.

Traditionally adult mental health services were responsible for the 16 to 17 year old age group and admissions to approved centres in that age group were to adult facilities. However, the Mental Health Act 2001 amended the definition of a child to include 16 and 17 year olds, and A Vision for Change subsequently recommended that the child and adolescent mental health service should provide services to all children up to the age of 18 years. Thus, in the context of the implementation of A Vision for Change, the HSE is required to reconfigure resources and to remodel psychiatric services to ensure 16 and 17 year olds are treated by the child and adolescent service. Currently, transitional arrangements apply for services for children in this age group, as resources are redirected from the adult service to the child and adolescent service.

At present, the community adult mental health services in HSE North Dublin provide out-patient services to 16 and 17 year olds, while the Mater child and adolescent mental health services provide the service for young persons up to 16. This arrangement will continue until the services provided by the Mater are developed in line with A Vision for Change.

There are currently 61 child and adolescent mental health teams nationally, of which 56 are community based. Further teams will be developed in line with the recommendations of A Vision for Change and in this regard I would like to draw the attention of the House to the commitment in the programme for Government to ringfence €35 million annually from within the health budget to develop community mental health teams and services to ensure early access to more appropriate services both for adults and children.

In-patient psychiatric services for adolescents in north Dublin are provided at St. Vincent's Hospital, Fairview and at Warrenstown for children up to 16 years. I am pleased to say that work is due to commence later this year on the second phase of the child and adolescent unit at Fairview, which will increase capacity from six to 12 beds. It is also proposed to provide an eight-bed interim facility in St. Loman's, Palmerstown, pending the proposed development of a purpose built 22-bed child and adolescent unit in Cherry Orchard.

I again thank Deputy Broughan for raising this matter and giving me the opportunity to allay any concerns regarding the provision of mental health services in north Dublin. The House can be assured of the ongoing commitment of this Government to the development of mental health services in line with A Vision for Change.