Denis Naughten (Roscommon-South Leitrim, Independent)
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I echo the comments of the Acting Chairman, Deputy Thomas P. Broughan. I raised this issue three weeks ago as a parliamentary question and I am still awaiting a reply. I have requested a Topical Issues debate on five occasions in the interim. However, none of the three Ministers believed it was worthwhile to come here to address the crisis in the acute psychiatric unit in Roscommon County Hospital. It requires urgent and immediate action by the Department of Health.

The crisis has its origin in a decision made last August. At the time I expressed my serious concerns to senior management. I expressed my reservations again in April. On both occasions I was assured that there were adequate provisions in place to cater for all patients and ensure the safety of patients, staff and the community at large. Despite these assurances, two families have gone public in the past two weeks with a different perspective. The family of a 38 year old mother who died following a tragic incident in the acute psychiatric unit has called for a public inquiry into the circumstances surrounding her death. The family of a second patient has raised another matter. The patient was seriously assaulted by an outpatient who was subsequently allowed to be in close proximity to the innocent victim owing to the unavailability of appropriate alternative accommodation. During the same period two female nursing staff were seriously assaulted. To compound this, in recent months An Garda Síochána has been called on a number of occasions to support staff at the unit.

I am deeply concerned by the range of reports I have received on the capacity of the facility to cater for existing demand and the ongoing needs of the community it serves. There is no doubt that, from senior management down, the current staffing level in the psychiatric service in County Roscommon is grossly inadequate to deal with the existing caseload of the acute unit. As a direct result, management has redeployed staff from the community and day services to try to assist with the operation of the unit. This is leaving service users without day services and vital community supports, thereby putting even further pressure on the acute psychiatric services locally.

Two steps are required urgently. First, additional staff must be allocated to the psychiatric service in County Roscommon in the light of the fact that there has been a disproportionate loss of staff as a result of retirements. Second, long-term involuntary patients should not be accommodated in an acute psychiatric unit. Steps must be taken to transfer such patients to more appropriate facilities as a matter of urgency.

Luke Flanagan (Roscommon-South Leitrim, Independent)
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For years it has been correctly said Governments do not give a damn about people with a mental illness. Eighteen or 19 months ago the Technical Group tabled a Private Members’ motion on the subject in which it outlined its concerns and what it would like to see done. We did not push the matter to a vote because we did not want to turn it into a political football. It is way too serious for that. We said we would trust the Minister of State to do her job.

Yesterday, at a meeting of the Joint Committee on Public Service Oversight and Petitions, the Minister of State, Deputy Kathleen Lynch, was present to talk about suicide awareness and what we could do about having a suicide prevention strategy.

She said "[I]t is essential that when people reach out for that help, it is available to them." She also said that the environment should be enabling and not disabling, and that all we can do is to ensure people will know what they need to do if they get in trouble.

What was going on was outlined to the Minister of State yesterday. I imagine she is well aware of it. I was told I would get some answers. This week I tabled Topical Issues on Tuesday and Wednesday, which were refused. Obviously it is not important enough that our psychiatric hospital is in dire trouble. Today the matter was selected. One of the Ministers who should care has not even bothered to turn up. What has happened today is sick and twisted.

There is a public meeting in Roscommon today to discuss what we will do. The message Deputy Naughten and I will have to bring back is that no one seems to give a damn. We hear rubbish to the effect that if someone had a broken leg he or she would be taken care of. I agree. A mental health problem should be treated as equally important. It is quite clear that is not happening. It is not good enough - with respect to the Minister of State, Deputy Hayes, who is an expert on other issues but knows nothing about this - that he has been brought in here. It is an insult.

Brian Hayes (Dublin South West, Fine Gael)
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I apologise for the fact that the Minister of State, Deputy Lynch, is not able to be here today. She is in Brussels. As Deputies Flanagan and Naughten, know the selection of Topical Issues is exclusively a matter for the Office of the Ceann Comhairle. The Minister of State regrets that she is not here because she would have been more than happy to respond to this debate.

Luke Flanagan (Roscommon-South Leitrim, Independent)
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She was here yesterday and on Tuesday.

Brian Hayes (Dublin South West, Fine Gael)
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She does not select Topical Issues, and the Deputy knows that. In fairness to her, she is not in the country today. She is representing the Government in Brussels. On her behalf I thank both Deputies for raising this issue. I understand the sensitivity of this matter in County Roscommon.

Addressing the generally accepted historical deficiencies in capital and non-capital aspects of our mental health services remains a priority for, I hope, every Government. This has been reflected in our programme for Government commitments, with some €70 million provided this year and last year for a range of new posts and other specific initiatives relating to mental health and suicide prevention. Notwithstanding progress on addressing the overall financial pressures still facing the country, and the demands being placed on all areas of our care system, the mental health budget increased this year from €711 million in 2012 to €733 million this year. The HSE service plan indicates that Galway-Roscommon local health office will receive in the region of €69 million for mental health services in 2013.

The Deputies will appreciate that the HSE has statutory and operational responsibility for the planning and delivery of services at local level, including in County Roscommon. Community and inpatient services are provided in Roscommon and are deemed to be a single entity in the context of the Galway-Roscommon local health office area. Services include outpatient clinics in various towns in County Roscommon, augmented by community mental health nurses who visit clients in their homes. Notwithstanding the challenges presented by the need to reform our health services overall, including mental health services, the objectives of change will be undertaken while maintaining safety and quality throughout all of our health services.

With regard to the acute psychiatric unit in Roscommon, the HSE has indicated that it has regular high activity levels due to the needs of clients and the nature and complexities of their illnesses. Unfortunately, there have been recent incidents at the inpatient unit, but these were not due to staffing shortages. At weekends the full complement of nursing staff and senior managers are on duty and a consultant psychiatrist and medical staff are available on call throughout the weekend. Patients who require treatment are assessed and evaluated by the nursing and medical team. This is normal practice. Over recent times there have been staff requirements and resignations, as mentioned by Deputy Naughten, and not all of the staff who left can be replaced owing to the moratorium on recruitment. As a result, staffing levels are reviewed on a daily basis and members of staff can be relocated according to the needs of the service. There have also been occasions on which staff are required urgently elsewhere and redeployment occurs.

In the context of the issue raised, the HSE is seeking to redeploy nurse management in Galway-Roscommon to provide enhanced management and leadership as required in mental health provision. The House can be assured that the Government is very focused on developing mental health services, not only in Counties Galway and Roscommon but nationwide, in line with A Vision for Change. The Department of Health will continue to liaise closely with the HSE on the specific issues raised.

Denis Naughten (Roscommon-South Leitrim, Independent)
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I am extremely disappointed with the response I have received from the Minister of State. I accept the Minister of State, Deputy Lynch, is away, but there are two other Ministers in the Department. This is a serious issue. The redeployment of management is not the issue. We need nursing staff in the acute psychiatric unit now. That message is coming from everyone who is dealing with the service. We need to ensure that long-term involuntary patients in the acute unit are put into more appropriate settings. What is happening in the acute unit in Roscommon is akin to a situation in which an older person who requires a nursing home bed is taking up an intensive care bed in a tertiary treatment hospital. It is unacceptable and cannot continue. We need immediate action from one of the three Ministers and Ministers of State on this issue today.

Luke Flanagan (Roscommon-South Leitrim, Independent)
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I heard A Vision for Change mentioned. I love the idea that people can be treated in the community and are not stuck unnecessarily in large units. However, that is not happening, and there is no point in trying to cod people into thinking it is. In fact, the opposite is happening. In order to deal with the shortage of staff in the hospital services, staff are being taken from community care, which does not make a lot of sense. People who could have dealt with their issues in the community no longer have services available to them and are less likely to use them. As a result, they are more likely to become increasingly mentally ill and to need the unit in Roscommon.

The Government can say what it wants but it does not change reality. It is not implementing A Vision for Change or being fair to people in the psychiatric hospital. They are people who are at their most vulnerable. Families have contacted me and told me they are terrified to send mentally ill members of their families in that direction because they feel they would be safer at home, unsafe as that is.

Instead of turning up at runs in aid of Pieta House at 4 a.m., as many Government Deputies did as well as Deputy Naughten and me, we need to get more serious about this. The Government can cry about it when it is too late, but it should do something before it is too late. It is not on. We are going back to the equivalent of Bedlam and lunatic asylums with the policies of the Government. I thought we had moved on but we have not.

Brian Hayes (Dublin South West, Fine Gael)
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A number of serious issues have been raised in this debate, especially in the remarks of Deputy Naughten. One is the question of the staffing component in the psychiatric unit in Roscommon. I will direct the HSE to respond to him and Deputy Flanagan on that issue. The official position is that the complement is there, despite the fact, as he rightly points out, that there has been a significant increase in the number of people who have left the service. There is an attempt to relocate people who have some knowledge and expertise in this area. I will ask the HSE to reply to the Deputies directly on the appropriateness of having long-term patients within the setting.

That is a problem right across the system, as the Deputy knows. I will ask HSE management to reply to him on that issue also. The question of appropriate settings, particularly in the case of psychiatric units, is very important. We are seeking to minimise the difficulty for people and to have an environment in which patients and their families can have confidence.

Despite the budgetary difficulties faced by every Department, the information available to me indicates that 21 new posts are currently advertised. These additional staff will have expertise in the psychiatry of later life, suicide prevention, community mental health, self-harm and liaison psychiatry. These are the types of professional we need as part and parcel of the service. The additional personnel are being recruited as a result of the additional funding the Minister of State, Deputy Kathleen Lynch, has succeeded in securing in the past 12 months. In circumstances where budgets are being cut across the board, this is one of the few areas where funding has been extended. By allocating these additional moneys, doing things differently, relocating personnel and managing the service in a more effective way, I hope we can get to a better position in a timely and transparent way. I accept that there are issues which must be addressed and will instruct the Health Service Executive to reply directly to the Deputies in that regard.