Dáil debates
Wednesday, 12 February 2014
Topical Issue Debate
Mental Health Services Provision
1:30 pm
Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source
I acknowledge the presence in the Chamber of the Acting Chairman, Deputy Feighan, and of the Minister of State, Deputy Cannon. I am calling for a stay to be put on the reconfiguration of mental health services in the Galway-Roscommon area, pending a review of the services available in the wider catchment area, which comprises the west and midlands regions. The initial evaluation of the acute units in the region was flawed. On the question of whether the location is adjacent to a major or regional hospital, Roscommon hospital was deemed to be an excellent level 2 hospital, which is a hospital that does not have an accident and emergency department and where minor surgery is the only form of surgery that is available. Portiuncula Hospital in Ballinasloe scored below average even though it is a level 3 hospital, which is a hospital with a 24-hour, seven-day accident and emergency unit and where complex surgery is available 24 hours a day, seven days a week. It is alleged that the reason for Portiuncula Hospital's score is that the €3.1 million St. Luke's acute psychiatric unit is 3 km away.
The HSE is currently spending €5 million upgrading a similar acute unit in St. Loman's Hospital in Mullingar, which is 3 km from the level-3 regional hospital in Mullingar. The minutes of a meeting in January 2011 refer to one of the authors of that evaluation, Mr. John Meehan, stating that St. Brigid's Hospital was to close. Clearly the report was to endorse the decision and not the other way around.
This is not about Roscommon versus Ballinasloe because the same meeting in 2011 outlined that the long-term plan for the Galway, Roscommon and Mayo mental health catchment area was for 50 acute psychiatric beds. Coincidentally that is what is planned in a new €13 million unit in Galway University Hospital. This would leave psychiatric patients, who are neighbours of the Acting Chairman, Deputy Feighan, 120 km away from their local acute psychiatric unit.
Patients are not at the centre of the plan for reconfiguration. For example, eight months ago when a woman lost her life in Roscommon psychiatric unit, I was told that there was no six-bed high-dependency observation unit vacant in Galway University Hospital. However, when management at Galway University Hospital realised last September what was being planned with the closure of St. Luke's unit in Ballinasloe, miraculously this six-bed unit was found and is now being opened. Beds are being found to deliver on the downgrading plans but not to protect patients. I urge the Minister of State to carry out an independent review of the services across the region.
1:40 pm
Colm Keaveney (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
This topic arises as a consequence of a report in last week's edition of The Connacht Tribune, which suggested that mental health patients from the east Galway mental health services who would previously have been directed to St. Brigid's Hospital were left on trolleys in an emergency unit in the middle of last week. From information the HSE gave the local media, it appears that the patients concerned may have been involved in a self-harm situation.
However, that does not change the fundamental principle that it is completely inappropriate for patients reporting with mental health difficulties to be left in an emergency department for any length of time beyond that required for their immediate treatment. It is particularly inappropriate in the case of those attending owing to self-harm because the emergency department is not a ligature-free unit, unlike the inpatient unit in St. Brigid's that was only recently upgraded at a cost of €3.1 million to provide a ligature-free environment.
From my discussions with the front-line staff - an exercise in which the Minister of State should involve herself - I have discovered that in the incident at Galway University Hospital, no psychiatric nurses were available to support critically ill people. I have also discovered that private security personnel were there to support general nurses with respect to their admission. Issues such as this will continue to arise and the decision to close a recently refurbished state-of-the-art unit in Ballinasloe is flawed. The Galway University Hospital psychiatric unit is simply not capable of undertaking the workload to be adopted from the east Galway services. The unit in Galway University Hospital has been subject to significant criticism from the mental health inspectorate. I call on the Minister of State to commit to carrying out a review of the decision to close St. Brigid's Hospital.
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
We are not closing St. Brigid's Hospital, we are changing what goes on there. We all need to be very careful with the language we use when discussing mental health and people who find themselves in need of an acute service. I think some people are being reckless in that regard.
I thank the Deputies for raising this issue for discussion today. The HSE has, on several occasions recently, indicated the clear need to modernise mental health services across the HSE west region, including in the Galway and Roscommon area. A key factor in this regard is that the current overall stock of 79 beds in Galway and Roscommon is too high, as set out in A Vision for Change, allied to a corresponding underdevelopment of community-based mental health services.
In this context, an implementation plan to reconfigure mental health services across the Galway-Roscommon administrative area was recently put in place. Phase 1 of this was implemented on 20 January with the transfer of five acute beds from Ballinasloe to the existing acute unit in Galway University Hospital. The initiative now under way is a rebalancing in a more focused way of available resources and skills towards community-based services. It has not resulted in reduced service levels overall for Galway and Roscommon mental health services.
The existing Galway University Hospital acute psychiatric unit is currently registered to operate at a higher bed number, so no issues arise with regard to capacity or managing increased bed numbers. The Deputies will also be aware that a purpose-built 50-bed acute mental health unit will come on stream at Galway University Hospital next year to replace the existing smaller unit. This new facility will consist of 35 general adult mental health beds, with the remaining 15 beds dedicated for psychiatry of later life, eating disorders, and mental health and intellectual disability purposes. The acute unit in Roscommon will continue to provide 22 general adult mental health beds.
Regarding the two cases of patient care raised, the HSE has indicated that, on occasion, patients may present with co-existing medical emergencies. In such cases, they are managed initially through an emergency department, in line with best practice, to ensure their medical needs are addressed as a priority. The majority of patients admitted to the psychiatric units in Galway or Roscommon are referred via community-based mental health teams or directly through consultant psychiatrists. Very few patients come directly to psychiatric services through an emergency department.
Mental health services in the Galway and Roscommon area have been enhanced recently by the introduction of a suicide crisis assessment nurse, SCAN, service. This service will help address gaps and provide supports to general practitioners in the area, and patients who present to them with thoughts of suicide. Access to the SCAN service is via a single mobile telephone number which gives the GP direct access to the service, allowing for speedy referral and immediate discussion of an individual's case.
The HSE is not aware of any recent increase in the incidence of self-harm in the catchment area. However, when such cases occur, a community mental health team is available to deal with such incidents, and where necessary, patients can be admitted to Galway University Hospital, or the department of psychiatry in Roscommon. The executive also points to a welcome and increasing awareness generally of issues surrounding depression and self-harm, which include specific measures adopted by local mental health services.
I am satisfied that the decision taken by the HSE, based on expert recommendations, to enhance future mental health provision across Galway and Roscommon is the best option, taking account of overall service needs and competing resource priorities. The approach and objectives to bring about change in this case is no different from that undertaken, or planned elsewhere to implement a widely agreed policy on improving mental health services. Therefore, all concerned should work together to improve future service provision in this area.
Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source
In her response, I had hoped the Minister of State could address some of the questions I have raised. She made the point that very few patients come directly to the psychiatric services via an emergency department. I can tell her that is not the case in Portiuncula Hospital where a substantial number of people have come through the emergency department, as the Minister of State, Deputy Cannon, will be aware.
I will put to the Minister of State a hypothetical situation, which highlights the flaws in what is happening not just in our catchment area but across the country. A woman from Baylough on the Connacht side of Athlone might give birth to a baby in the local maternity hospital up the road, which is Portiuncula Hospital. If that baby has serious complications he or she could not go home with the mother and because of that separation the mother might suffer post-natal depression, which is not uncommon. However, instead of that woman being treated beside her baby in Ballinasloe, she would need to travel 70 miles to St. Loman's Hospital in Mullingar.
If I were to cut my finger here today I could go to St. James's Hospital and have it sutured but if I were harmful to myself or someone else in this House I would have to be transported to the acute psychiatric unit in Roscommon town because that is my designated unit.
Why is mental illness not being treated the same as physical illness? St. Luke's unit in Ballinasloe, which is the most modern in the country, cannot provide a service to patients within its own local catchment area - so much for treating the patient as close as possible to his or her home. Would it not make far more sense to put mental health on an equal footing with physical health and allow catchments in respect of acute psychiatric units to be similar to those for accident and emergency departments in respect of general hospitals?
1:50 pm
Colm Keaveney (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I observed with great interest the Minister of State's caution around language when it comes to the issue of mental health. I also noticed the absence of a wholesome response to the substantive questions that have been raised here.
To focus again on the evaluation that facilitated the political decision to accelerate this type of reform, could the Minister of State share with the House if she is prepared to stand over the objectivity of the professional input? Will she also share with the House the timelines applying to that criteria in terms of the evaluation? I am of the firm belief that this evaluation took place significantly earlier than the justification to apply the matrix that was used by the consultants associated with it.
I wish to deal with the issue of staffing in the Minister of State's response. Under A Vision for Change, there is provision for 97 staff to be provided for the facilitation of this change across the region. To date, there are only 37 staff in situ. The Minister of State is accelerating this reform and change, which, we would argue, is based on flawed criteria. I would be grateful if she would comment on that. The staff are not on the ground to facilitate this organisational change. We both want to support the implementation of A Vision for Change but the ethos underpinning that change, that the composition of the community-based teams would be in place before the scale of this change happened, is simply not there.
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
I advise Deputy Naughten that there will not be a separation of mothers and babies in any new unit that will be built. In the case of any woman who suffers from postnatal depression, the plan is that there will be a bed available for both the mother and the baby. All modern thinking informs us that there should be no separation.
Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source
They are living in County Weatmeath - that is the problem.
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
That is what will happen. I wish to reply to the Deputy's point about what has happened about treating the patient as close to home as possible. What we are doing is ensuring that they will be treated at home - not as close as possible to home but at home. The community mental health teams will call every morning, afternoon and evening and they do so in my area. That is how I know about it, and that is what is going to happen.
Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source
For the acute phase.
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
It is during the acute phase that this happens. That is what happens in Cork North-Central, in Tipperary and in other areas where this has been rolled out. This is not something that has been done without history and practice to back it up.
I do not understand why the Deputy thinks that only 10% of the teams are in place. Off the 44 teams, 32 are in place. On Deputy Keaveney's point regarding the additional staff that are necessary to implement this, 64 was number made in the business case and 64 is the number that is being allocated. Almost all of them are in place and the rest are being recruited. That is the business case that was made to us and that is what we are doing. I do not have the information with me but I have gone over this numerous times in regard to Ballinasloe and I do not mind doing so because I went through it in terms of Clonmel and I will go through it in terms of a certain part of Cork. The same argument will made, namely, how was the assessment done, what was the analysis and what was the outcome. I stand over the conclusion of the expert group because I have spoken to the members of it time and again. I spoke to one of the members about it in Stewarts Hospital three weeks ago and I again went over all of this. I stand over this.
Colm Keaveney (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Does Deputy Naughten's observations - that one of the consultants was minuted - not concern the Minister of State?
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
No, they do not concern me because I know the consultant and I have asked him face-to-face about these matters. He is a man whom I consider to be of the highest possible integrity who desperately wants to give the best possible service to people in the community. I understand the politics of this but I do not understand how anyone could possibly justify keeping people in an institution when there is a better way to ensure they have a better life.
Frank Feighan (Roscommon-South Leitrim, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Thank you, Minister of State.
Colm Keaveney (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
They were sent to another institution that the Mental Health Commission has said is inappropriate.
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
May I address that point?
Colm Keaveney (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
The Mental Health Commission had not-----
Frank Feighan (Roscommon-South Leitrim, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Allow the Minister of State to conclude.
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
The most recent report from the Mental Health Commission is an excellent one.
Colm Keaveney (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
The one I have clearly states that Galway University Hospital is inappropriate
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
The one the Deputy has is clearly the one to which he is going to cling like a life-raft.
Colm Keaveney (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
It is the one I received last week.
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
The one I have-----
Colm Keaveney (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
The Minister of State is talking about the one she did not get. She is rolling away on this on the basis of information she does not have.
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
It is a scandal-----
Colm Keaveney (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
It is a scandal. What happened is a scandal-----
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
-----that any elected representative would use vulnerable people to enhance their own reputation.
Colm Keaveney (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
-----that two vulnerable people were left abandoned in Galway University Hospital last week by her plan to roll ahead with this based on sand. Scandal is right.
Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source
It is a scandal.