Denis Naughten (Roscommon-South Leitrim, Independent)
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I thank the Ceann Comhairle's office for this opportunity to raise this important matter. I welcome the positive news that this issue, as it applies to the Galway acute psychiatric unit, is to be referred to the LRC. However, I stand by my request this morning for an independent review of the staffing and operation of mental health services across Counties Galway and Roscommon.

Last year, when I made the point in this House that the Galway unit was an accident waiting to happen because of inadequate staffing and resources, I was accused of scaremongering. As in the case of the Galway unit, staffing and resources at the acute psychiatric unit at Roscommon County Hospital in respect of specials are inadequate. Specials are sick patients who are a danger to themselves and other people in the unit, be they staff or patients. This continues to be the case at both of the units in Galway and Roscommon. All of these issues need to be examined.

To compound those particular problems, the acute psychiatric unit at St. Luke's in Ballinasloe has been closed, adding to the pressures already on the units in Galway and Roscommon.

It is clear there is an issue in relation to resourcing. What makes it even more bizarre is that last year, the mental health services in Roscommon and Galway handed back €6 million and this year their budget has been cut by a further €3.5 million.

In the Ballinasloe catchment area, within the past three weeks, 14 patients have been referred to the acute unit in Roscommon, putting considerable pressure on the acute unit in Roscommon. On top of that, we are coming into the summer months where there is further demand on mental health services in Galway because of the dramatic increase in population in the Galway area during the summer. As an interim measure, I would urge the Minister to re-open the acute unit at St. Luke's in Ballinasloe to take pressure off both Galway and Roscommon acute psychiatric units.

It is not only the acute units that are causing problems. There is a very serious issue regarding staffing at the high support unit at Knockroe in Castlerea. Serious allegations of misconduct in relation to a male patient have been raised there and it has been claimed that matter has not been properly investigated by the mental health services or properly reported to the Garda. I want an assurance from the Minister that this issue will be independently investigated and that an independent report will be produced.

Colm Keaveney (Galway East, Fianna Fail)
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This morning's action is as a direct result of a political decision not to proceed with the opening of a facility in Ballinasloe - a €3.2 million spend on a brand-new unit and the only ligature-free unit in the HSE. It was never opened and the Minister of State, Deputy Kathleen Lynch, transferred services and centralised them around Galway University Hospital, GUH.

The unit has been described by the health and safety official on site as a creaking, leaking and subsiding unit. It is held up with RSJs and there is water coming down on walls. Staffing levels had been unacceptable. We have highlighted this consistently in this House for the past 14 months but we were accused of scaremongering. In fact, in the Irish Examineron 20 February 2014, the Minister of State, Deputy Kathleen Lynch, said the Opposition was "scaremongering". She stated the changes "would liberate the service users" with an environment of "calm". This is a unit in which 36 assaults on staff took place already this year. The Department underspent the budget by €6 million last year and it was lost in the black hole of overspends across the public health service.

I am glad the senior Minister is here. I do not know whether it due a lack of confidence in the Minister of State, Deputy Kathleen Lynch, but I can tell him that the front-line staff in GUH have no confidence in the Minister of State, Deputy Kathleen Lynch. According to a statement by the Department of Health on 22 May of last year, the "Minister of State with responsibility for Mental Health, Kathleen Lynch TD, today affirmed her view that acute mental health services at the University College Hospital Galway are being delivered safely and that the overall re-configuration of services in the Galway-Roscommon region is in the best interests of services users."

The reconfiguration of services across Roscommon, Mayo and Galway is a disaster. There is a brand-new facility sitting idle in GUH but the Minister would rather herd the most vulnerable people to an accident and emergency unit so that they can be triaged, if they are lucky, to get into a psychiatric unit, where water comes down on the walls and which has been described as a creaking unit.

This was a political decision. The front-line staff have not been listened to nor has the Opposition but the crusade continues. In the past two years, we have seen a €70 million underspend in mental health - the greatest public health crisis of our generation. Would the Minister explain that?

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I put it to the Minister that the evidence is mounting up that there is a quite a dangerous situation emerging in mental health services right across the country as a result of chronic staff shortages. The situation in Galway is merely the latest example of this where, with 36 assaults on staff, workers feel forced into a situation where they do not go into work because of staff shortages, but it is not an isolated example.

Two weeks ago, a psychiatric nurse in Cork was suspended for talking to the media about services being unsafe because of staff shortages. Deputy Denis Naughten mentioned the situation two years ago. We had exactly the same situation in Roscommon where nurses refused to go to work because of an unsafe situation. In my constituency this week, I presume for the same reasons, a man who attempted to commit suicide one week ago was released against the wishes of himself and his family and is now homeless on the streets of Dún Laoghaire.

The situation in child mental health services is even worse. I want to ask the Minister directly did the Minister of State, Deputy Kathleen Lynch, mislead the House when she stated that staffing levels in child mental health services were up to 80% and that protocols for those aged 16 and 17 had been agreed with the IMO when a statement came out last week from the IMO stating no protocols had been agreed and that staffing levels were 55% and are putting patients and staff in danger. Were we misled? In this situation where we are dealing with young people, we are aware of the scandal of young people being put into adult hospitals with mental health problems, but the IMO is in dispute with and is directly contradicting what the Minister of State said about the staffing levels and the agreed protocols when it comes to vulnerable young people with mental health problems.

Joan Collins (Dublin South Central, United Left)
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The reason I put this forward as a Topical Issue today was because I heard on radio this morning that staff had refused to go to work as they could not provide the care needed in a safe environment due to a lack of staff. I felt it was a cry for help from these workers who wanted to raise this issue. They would not have taken this action this morning unless there was a chronic problem within the services in Galway University Hospital. It seems there are other issues in relation to other services in Galway University Hospital. Is there a need for the Minister to make a statement about what is happening across the services in this hospital?

The PNA representative, Mr. Derek Cunningham, stated this morning that 36 staff had been assaulted since January and that this had been raised with the HSE. The HSE has condemned these workers for taking this action and for not working in unsafe conditions for the patients and workers. The Minister must respond to this and say to the Dáil, the patients in the hospital and the workers that he will do something about it because this has been going on too long.

As other Deputies have said, the matter has been raised over the past two years. A Vision for Changedoes not seem to be doing what it is supposed to do in terms of mental health services. The annual report of the Mental Health Commission is due in June. I would like to see that report to know whether there have been advances since last year when there was condemnation by the PNA and the workers in the HSE.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputies for raising this issue and for giving me an opportunity to update the House. I am taking this debate on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch, who is on Government business elsewhere.

Galway-Roscommon mental health services are committed to full implementation of A Vision for Change. The guiding principles involved under this widely agreed policy include patient centeredness, equality, access to quality care that is focused on recovery and integration with other mental health and mainstream health services.

The HSE in Galway-Roscommon provides an inpatient and community mental health service for a population of 314,000 and is at an advanced stage in the implementation of A Vision for Change. It has already moved in to local service provision with catchment areas of 50,000, as recommended in A Vision for Change, and appointed team co-ordinators and developed an overarching clinical governance model.

Staff working in the health service cope with significant service pressures and that this is also the case in mental health. However, the focus and priority must always be on provision of care for the patient.

Patients in this service can often display challenging behaviour and HSE staff are provided with a wide range of training and supports. Where a patient has assaulted a staff member, it is recorded and the rarer instances of serious assaults are investigated as part of health and safety management.

In line with revised safety incident management policy, staff are encouraged to report all incidents. The HSE in Galway reviews recorded assaults. According to the records, up to the end of March there were 29 recorded incidents in the acute unit in Galway. All such incidents are risk-rated. Of the 29 incidents of assault, 25 were classified as physical, two as attempted and two as verbal. Of the 25 physical assaults, one was rated high, ten were rated moderate and 14 as low-level. All incidents are discussed and reviewed locally, and any suggested actions are implemented. Trends are reviewed and analysed at clinical governance meetings in Galway. I understand several of the incidents were physical in nature, with staff being struck in the jaw and in the stomach. Clearly, none of us can condone this. However, it is not necessarily the case that additional staff would have prevented any of the assaults on staff members since they were predominately one-on-one assaults.

The whole-time equivalent number of staff working in the acute unit in Galway has risen from 47 in 2013 to approximately 60 in 2015 - a total increase of 13 staff on two years ago - as part of the ongoing reconfiguring of services in the area.

It is important to contextualise the situation in the acute unit. Some of the patient's clinical needs require that they be nursed by a male member of staff. HSE west management have indicated that the executive is finding it increasingly difficult to recruit male nurses. It has put a number of proposals to the Psychiatric Nurses' Association of Ireland to address the gender imbalance. However, I am informed that to date the PNA has rejected all options such as skills mix and a rotation of psychiatric nurses from a community setting into hospitals. The HSE is also progressing the high-dependency unit, which will help to alleviate the pressure on the acute unit. This proposal has gone to the PNA for a response and a response is still awaited.

I am most concerned at this morning's unannounced industrial action. Disruptions to the delivery of care cause unnecessary worry and anxiety. This is clearly not in the interests of patient safety and puts additional pressure on other staff, compromising their health and safety. I call on all concerned to work co-operatively to solve the current situation facing mental health services in Galway. I welcome the Labour Relations Commission intervention earlier today. This would have been possible without the events of this morning. Of course, the LRC is independent, and it is in a position to examine staffing levels and make appropriate recommendations, as it has done in other areas.

Denis Naughten (Roscommon-South Leitrim, Independent)
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I thank the Minister for his response. At the outset the Minister referred to the issue of patient-centredness. We are all keen to see that. At the moment there is a serious question mark over the Rosalie unit in Castlerea, which provides psychiatry of later life. This has been in the media for the past six to eight weeks. Yet there has been no contact or communication with the families of the individuals in that unit or the staff who operate that unit. Despite this, we are told that the HSE is working with the individuals in the unit and their families to develop care plans for them. That is the evident lack of patient-centredness as we speak in the Galway Roscommon service.

There have been assaults in Galway and in Roscommon. Moreover, there have been assaults not only of staff but of vulnerable patients in some of these units as well. I have raised a particular issue with the Minister. I want the matter independently investigated and I want answers to the questions that I have raised in the House. I also want clarity from the HSE on what exactly is happening at the unit in Áras Naomh Caolinn and in the Rosalie unit in particular. The patients and families deserve answers on the plans for these units, but the HSE is operating under a cloak of darkness and then shutting down the service unannounced overnight.

Colm Keaveney (Galway East, Fianna Fail)
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The Minister made reference to difficulties in recruitment in his response, and I thank him for the clarity on the matter. However, one of the biggest difficulties we have with recruitment is the political decision to time-delay it. The HSE's service plan refers to a preference to recruit in December, not in January. Therefore, in the small print somewhere else there is a reference to not recruiting staff and a commitment to recruiting them, only for the HSE to hold off recruiting them until December.

I am pleased that the Minister referred to a patient-centred approach. However, what about the 3,000 children waiting each year for an appointment at the first point of contact in our psychiatric services? In the past two years, the Department underspent to the amount of €70 million, or 10% of the entire budget, in mental health. Yet 3,000 children will wait 12 months for an appointment.

The HSE has threatened disciplinary action. What about the Minister's role in taking action to protect staff and services? It is similar to what has happened in Cork University Hospital. The Minister or someone suspended a front-line worker for speaking out. This morning the HSE threatened to discipline someone for not being part of the cover-up of the scandalous delivery of services in Galway. That is what is happening. Those involved are not going to be complicit with the cracks and the cover-up and so on.

In the context of A Vision for Change, it is an absolute no-no and a breach of human rights to ask people in a mentally distressed state to access a unit that is creaking, falling apart and understaffed and then ask them to admit themselves to an accident and emergency unit. That is unacceptable. The Minister should take responsibility rather than shifting the burden of blame onto the staff. The staff are carrying the service despite the ineptitude and lack of commitment of a Minister who is out of touch and who has lost the confidence of front-line staff throughout the west of Ireland.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Would the Minister, in all honesty, come into work day after day if he thought he might be punched in the jaw or the stomach, and if he thought there were not enough staff to prevent that from happening? For the Minister to suggest there is no direct connection between staffing levels and the chaotic and dangerous situation in our mental health services is preposterous. It is well established that a lack of staff or an over-reliance on agency staff jeopardises patient and worker safety.

I have asked the Minister directly, in respect of child mental health services, whether the Minister of State, Deputy Lynch, misled the House when she said that staffing levels in youth mental health services were up to 80% and that there was an agreement on protocols for 16 and 17 year olds. This week the Irish Medical Organisation said that what the Minister of State said last September was not true, that staffing levels are at 55% and that no agreement is in place on protocols for 16 or 17 year olds. Indeed, a review group was set up. At one of the meetings, the HSE did not turn up at all. Then, at the second meeting, the HSE walked out when the IMO raised the issue of whether staffing levels were sufficient to deal with 16 and 17 year olds. Was the House misled? Is the Minister going to take serious action to deal with this crisis?

Joan Collins (Dublin South Central, United Left)
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At the end of the Minister's reply he said he was most concerned at today's unannounced industrial action. The Minister is a member of one of the health care professions. Does he believe health care workers would refuse to work if they were not confident doing so? Those workers took a decision this morning not to continue work because they believed that the staffing levels were not high enough given what they were working with at the time. They were short four staff. They were threatened by the HSE with suspension. That should be withdrawn and there should be an apology to those workers for taking that action. This is not industrial action. This is a question of workers pointing out a health and safety issue and saying that they cannot work in those circumstances. The Minister for Health should stand over the decision the workers had to make this morning. They are seriously concerned about their patients. That is why they took action this morning. I hope the LRC can resolve this as quickly as possible. However, the Minister for Health is ultimately responsible, and he has to stand over what happened this morning in University Hospital Galway.

Leo Varadkar (Dublin West, Fine Gael)
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On a general point, I am informed that Galway-Roscommon mental health services have a per capita spend of €191, compared to a national average of €160. In addition, Galway-Roscommon mental health services have been successful in securing 58 additional new staff posts using development funding since 2012. Of these 58 new posts, a total of 45 are now in place and a further 13 posts are at various stages of recruitment. The make-up of these posts includes consultants in the areas of general adult psychiatry, psychiatry of later life, rehabilitation and recovery, as well as occupational therapists, community mental health nurses, social workers and psychologists. As Deputies can see, there has been a significant increase in staff, and there are more to come.

Deputy Boyd Barrett raised issues relating to child and adolescent mental health services in Dún Laoghaire. The Topical Issue matter Deputy Boyd Barrett submitted relates only to Galway and Roscommon services.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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That was not the case in my question.

Leo Varadkar (Dublin West, Fine Gael)
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Needless to say, I was not able to get a briefing on the issue that he raised with about three minutes notice. I think it is rather opportunistic to raise issues in that way.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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It is at the top of the Minister's own document.

Leo Varadkar (Dublin West, Fine Gael)
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It refers specifically to Galway.

With regard to what was mentioned by other Deputies, it is important to bear in mind that the staff who refused to work this morning left the night shift in situ, and they would have been on for 12 hours at that stage.

Joan Collins (Dublin South Central, United Left)
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They said they would stay on for cover.

Leo Varadkar (Dublin West, Fine Gael)
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That is something that needs to be borne in mind. That is not a course of action that I hope any of us here condone in that the shift already on were left in situ.

Joan Collins (Dublin South Central, United Left)
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They were replacing a shift that was not fully staffed.

Leo Varadkar (Dublin West, Fine Gael)
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For the information of other Deputies, I have worked in an emergency department. An emergency department is a place where one is at risk of assault and it is a place where staff do get assaulted by violent people and by drunks, and I turned up for work on every occasion that I worked in an emergency department. However, procedures are put in place to minimise risk and deal with assaults where they occur.

Again, I cannot comment on the Rosalie unit as it was not specifically mentioned in the request for this debate either.

Denis Naughten (Roscommon-South Leitrim, Independent)
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It was. It referred to Galway-Roscommon health services.

Leo Varadkar (Dublin West, Fine Gael)
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The Deputy cannot submit something with one or two hours notice and then go into detailed questions that were not even mentioned in the question.

Denis Naughten (Roscommon-South Leitrim, Independent)
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The Minister of State at the Department is well aware of the issue as I have raised it in the House on other occasions.

Alan Farrell (Dublin North, Fine Gael)
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Order, please.

Leo Varadkar (Dublin West, Fine Gael)
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It is a pity we have got to the stage in this Parliament that Members put down debates at short notice. Ministers are very happy to turn up and deal with debates at short notice but Members then raise issues that were not referred to specifically in their questions, and then try to shout down the Minister when the Minister tries to-----

Denis Naughten (Roscommon-South Leitrim, Independent)
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The Minister is misleading the House. I ask him to withdraw that comment.

Alan Farrell (Dublin North, Fine Gael)
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Deputy Naughten, please take your seat.

Denis Naughten (Roscommon-South Leitrim, Independent)
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I specifically asked about the health services in Galway and Roscommon. The Minister has received parliamentary questions from me, one after another, on the Rosalie unit and he refused to answer the questions.

Alan Farrell (Dublin North, Fine Gael)
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Deputy Naughten, please sit down. I will not ask again.

Denis Naughten (Roscommon-South Leitrim, Independent)
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It is the same in regard to the unit in Knockroe. It is a scandal what is going on.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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On a point of order, in the document the Minister gave out with his speech, which details our questions-----

Alan Farrell (Dublin North, Fine Gael)
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What is the Deputy's point of order?

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The document specifically mentions youth mental health services. Would he withdraw the suggestion that we were being opportunistic? It is specifically mentioned in his own speech.

Leo Varadkar (Dublin West, Fine Gael)
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I am happy to withdraw the term "opportunistic" if it offends the Deputy but what he specifically mentions is Galway and other major problems, particularly in the area of youth mental health. If we want to have a serious Parliament and we want to hold Ministers to account, we really need to raise issues-----

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I put it in 25 times and it was refused.

Leo Varadkar (Dublin West, Fine Gael)
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-----with adequate notice so that it is possible for us to give comprehensive responses to the questions. There is little point in putting down a question about services in Galway and then raising questions about Dún Laoghaire if the Deputy expects to get an answer.

Denis Naughten (Roscommon-South Leitrim, Independent)
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The issues I raised in Roscommon were all over the newspapers at the weekend.