Mick Wallace (Wexford, Independent)
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9. To ask the Minister for Health his plans to establish an acute mental health unit in Wexford General Hospital in view of the fact that the need for same has been long recognised; and if he will make a statement on the matter. [20549/15]

Mick Wallace (Wexford, Independent)
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I accept putting patients in acute mental health beds is not ideal or seen as best practice. When A Vision for Change, a good document, was published in 2006, it looked away from locking up people behind walls and drugging them to their eyeballs. The plan, however, was that the acute bed units would not be done away with until there was enough support and facilities in the community to replace them. This has not really happened and A Vision for Change has remained just that, a vision.

Kathleen Lynch (Cork North Central, Labour)
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The HSE Waterford-Wexford mental health service serves a population of nearly 280,000. The executive is continuing its approach to develop integrated mental health care across both counties.

The significant funding provided by this Government is enabling Waterford-Wexford mental health services to implement the recommendations of A Vision for Change, to move from a traditional hospital-based model to a more patient-centred and community-based care.

In 2010, the acute mental health unit in St. Senan's Hospital, Enniscorthy, County Wexford was amalgamated with Waterford mental health services to provide a 44-bed acute inpatient mental health unit in University Hospital, Waterford. In addition, arrangements are in place whereby service users who live in north Wexford, and who attend Tara House mental health services in Gorey and require acute inpatient admission, have access to Newcastle Hospital, County Wicklow. Overall, 49 acute inpatient beds are available in the area which meets the requirements set out in A Vision for Change. Development of community mental health services include day hospitals and associated services at Wexford, New Ross, Enniscorthy and Gorey.

In addition, mental health services covering Wexford include Tara House in Gorey, Carn House in Enniscorthy, Summerhill in Wexford, Maryville in New Ross and a suicide crisis assessment nurse service available in Wexford. The latter provides a skilled mental health nursing service for those in suicidal or self-harm situations. This is based at the emergency department in Wexford General Hospital where there is a liaison nurse-led, seven-day service. In July 2014, a new purpose built crisis respite unit opened in Enniscorthy, providing ten respite beds for service users referred through a community mental health team, for respite care.

The Deputy will be aware that the Health Service Executive has statutory responsibility for the planning and delivery of services at local level, and that any new service or capital development proposals can only be considered and prioritised in the context of the annual HSE national service plan, and the multi-annual health capital budget. I understand that the HSE has already supplied the Deputy with a more detailed response on 28 April 2015 to his recent parliamentary question on this matter.

Mick Wallace (Wexford, Independent)
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There are day hospital services in Wexford, as the Minister of State has listed, but they are closed after 5 o'clock in the evening. To gain access to those services people need a referral letter from their general practitioner. What is a family supposed to do if a family member is in acute crisis and suicidal? The person has to go to an accident and emergency department and sit in a corridor or on a trolley waiting to be accessed. As there is no consultant psychiatrist in Wexford General Hospital, the psychiatric liaison nurse will have to ring Waterford hospital to consult a psychiatrist there. If it is decided that the person in crisis needs to go to an acute bed in Waterford, they are sent off and will have to go through the accident and emergency department in that hospital also. Therefore, a Wexford patient will have to go through two accident and emergency departments. It has happened in the past that people sent to Waterford hospital from Wexford General Hospital were sent home, having travelling all the way there while in acute distress. It is all a bit mad. It is not a good service.

Back in 2009, Susan Lynch, the HSE manager of mental health and elderly services, said that an acute ward in Wexford General Hospital was more than a proposal, that it was in the HSE's south capital plan, but it never happened. It fell off the lorry. Why did it not happen?

Kathleen Lynch (Cork North Central, Labour)
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I am responsible for many things but I am not responsible for what happened back in 2009.

Mick Wallace (Wexford, Independent)
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I did not say that the Minister of State was responsible.

Kathleen Lynch (Cork North Central, Labour)
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I do not know what happened to that proposal. I speak not only to HSE people but to the people who deliver the service on the ground and I speak to one person in particular in Wexford on a regular basis. An investment of more than €18 million has been made in Wexford. A Vision for Change was published in 2006 and I believe it needs to be updated, but I have to say that if I listened to every request for an acute hospital I would reopen every psychiatric hospital in the country. On the other hand, I have a magnificent new unit in Cork in which people will not work, which is illogical in regard to psychiatric services. Wexford is well served with day hospitals, as the Deputy rightly said. There is a respite unit, crisis houses and an assessment nurse which many other places do not have. Also the ECD who runs the service in Waterford is an incredible man. When I ask him questions such as the one the Deputy has asked, and I will inquire about it with him, he tells me there has never been a case where somebody needed to be admitted who was not admitted. There may be instances where people need to be assessed and returned to their own community and I have no doubt that happens. I will make further inquiries on foot of the Deputy's parliamentary question.

Mick Wallace (Wexford, Independent)
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People have died because they were not admitted to hospital; people have committed suicide in Wexford. The Minister of State has said that Wexford and Waterford are well served, but, according to the HSE's mental health division plan for 2015, spending per capita in the mental health area in the region is €148. That compares to €223 in Carlow-Kilkenny, €198 in south Tipperary and €206 in Mayo. The average number of acute beds per thousand of population across the country is 0.21 and it is 0.16 in Waterford-Wexford. People in Wexford who have to go through two accident and emergency departments are at a disadvantage to people in Waterford who only have to go through one accident and emergency department. Also, people in Wexford have to travel to Waterford and Wexford is one of the poorest served areas. This area has a suicide rate of double the national average and an unemployment rate as of today of more than 23%. That is incredible.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Could the Deputy put his question, as his time is up?

Mick Wallace (Wexford, Independent)
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It has one of the highest levels of teenage pregnancy and one of the highest levels of illiteracy. The service is not good enough. I am serious about this.

Kathleen Lynch (Cork North Central, Labour)
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I am only responsible for the mental health end of it, as the Deputy will know, I am not responsible for the other pieces.

Mick Wallace (Wexford, Independent)
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That is the knock-on effect.

Kathleen Lynch (Cork North Central, Labour)
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When I got this job I had the same view as the Deputy in regard to how people in crisis access the services. I was of the opinion that a person should not go through an accident and emergency department but because of the difficulties in regard to self-harm and possible self-harming, the accident and emergency department is the appropriate place, and I am convinced of that now, but the service would also include the suicide assessment nurse-led team. People who have a difficulty with their mental health and are in crisis would be assessed both for their mental health and for their physical well-being. I will make further inquiries on foot of the Deputy's parliamentary question. I am setting up a new group to examine what is beyond A Vision for Change and if it reports back to me with a recommendation that we should have an acute unit in every single town, I will take a serious look at that but as of now I am not convinced of that.