Dan Neville (Limerick, Fine Gael)
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This relates to the provision of a child and adolescent bed unit in Limerick, as recommended in A Vision for Change, the report of the expert group on mental health, in 2006. Recommendation 10.9 of the report states, "Urgent attention should be given to the completion of the planned four 20-bed units in Cork, Limerick, Galway and Dublin, and multidisciplinary teams should be provided for these units". Since then, the HSE, in its wisdom, has decided that no such unit should be built in Limerick. Why is this the situation? A Vision for Change was very meticulous and detailed in its investigation of all the needs of the mental health services and it made this suggestion.

There is an urgent need in the city. Psychiatrists, psychotherapists and general mental health services staff have expressed concern about the unsuitability of minors sharing inpatient psychiatric care with adults. It is seen as potentially detrimental to the recovery of children and adolescents. All mental health professionals regard having children, some under ten years of age, in the same ward as adults as being very unsuitable and detrimental to their recovery. Children are very vulnerable when they go into a hospital unit and this is especially true if they are suffering from a severe mental health difficulty, which is the case for children being admitted to inpatient mental health services. Adult mental health patients of all ages have certain difficulties and may be incapacitated in many ways, and while their behaviour can be upsetting for adults, it can be frightening for children.

Children in Limerick and the mid-west who are in need of inpatient psychiatric treatment must move to Cork, Galway or Dublin. One of the key issues in the recovery of children from any condition, especially mental health conditions, is the presence of their parents. They need their parents to visit them, to feel the support of their parents and to feel comfortable with their parents. If a child from the mid-west is placed in Dublin, Cork or Galway, it is extremely difficult for the families. Some families can afford to visit their children only occasionally, which is very detrimental to the children. Why has the recommended provision of inpatient mental health services been withdrawn? The HSE has failed to meet the code of practice on the admission of children drawn up by the Mental Health Commission under the Mental Health Act 2001.

The code of practice specified that from July 2009, no child under the age of 16 years should be admitted to an adult inpatient unit, that the same should apply from December 2010 to any child under 17 years and from 2011 to any child under the age of 18 years. However, last year, 89 children were admitted to adult psychiatric services, in contravention of the code of practice.

A Vision for Change recommended that the agreed proposal to supply additional 20-bed units in the major hospital centres I have mentioned, including Limerick, should be completed as a matter of urgency. This provision would result in 100 inpatient beds for children and adolescents nationally. The provision should be evaluated after five years to assess how it is meeting the needs of the population. Inpatient facilities should provide large, spacious rooms for activities and possibly even classroom facilities in order that children can continue their school curriculum work during their stays. Only 58 inpatient beds have been provided. There was to be a review after five years, in 2011. Was there a review? If so, what was the outcome? If not, why was there no review?

6 o’clock

As I have just stated, unfortunately the HSE is not meeting the targets outlined in A Vision for Change. There are reports of admissions of minors, including children under the age of ten, to adult institutions. These children are in serious need of inpatient care. Of course we do not want children and adolescents to go to inpatient units, but some of them need the treatment offered at such facilities. The current situation is totally unsatisfactory. Why is the mid-west being discriminated against? This is not something we are demanding as a proposal. Experts from many areas of the psychiatric services have deemed it to be an absolute necessity and said that urgent attention should be paid to the completion of the planned four-bed units, including the units in Limerick that we are now informed will not be finished. Why will they not be completed? Can the Minister of State guarantee that the implementation of the carefully thought-out proposal in relation to Limerick and the mid-west will be reconsidered?

Aodhán Ó Ríordáin (Dublin North Central, Labour)
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I thank the Deputy for raising this important issue for discussion today. Nationally, inpatient child and adolescent bed capacity has increased from 12 beds in 2007 to 58 beds at present, with 26 beds in Dublin, 12 beds in Cork and 20 beds in Galway. This represents an almost fivefold increase over eight years. I am pleased to announce that a new purpose-built 22-bed child and adolescent inpatient unit located on the grounds of Cherry Orchard Hospital has been completed and will be opened next week by my colleague, the Minister of State, Deputy Kathleen Lynch. The existing 14 beds in the current temporary facility will transfer across to the new facility. This means that there will be an additional eight child and adolescent mental health beds in the country and that the total number of beds will increase to 66. Those who provide child and adolescent mental health services in the mid-west region, which covers Limerick, Clare and north Tipperary, have access as required to a modern state-of-the-art inpatient child and adolescent mental health facility in Galway. Requests for admissions to this facility are made by the local child and adolescent mental health teams in the mid-west to their counterparts in Galway. All applications are appropriately considered and prioritised.

The HSE is committed to the appropriate provision of child and adolescent mental health service inpatient beds for children. From time to time, a young person may have a very short admission to an adult facility pending the availability of a bed in a child and adolescent unit. These placements are generally for very short periods. Progress in this area is underscored by the fact that such admissions have declined from 247 in 2008 to 89 last year. It is important to stress that the HSE's intention is to aim for appropriate placements and to reduce to the greatest extent possible the need for and dependency on inpatient beds. Modern-day multidisciplinary interventions for children are much more appropriate to non-inpatient admissions and to supporting children in their own family settings.

In the mid-west region, a consultant-led child and adolescent mental health service is provided by multidisciplinary teams across Limerick, Clare and north Tipperary. This service operates an emergency service for critical cases of same-day referral. In addition, an out-of-hours on-call service is provided through the emergency department of the University Hospital Limerick. This is not replicated in all parts of the country. The child and adolescent mental health service based in Limerick is scheduled to move to a new outpatient and clinical premises shortly, subject to the completion of some final details in respect of the property involved. Plans are being advanced to explore the possibility of providing the equivalent of a day hospital-type service. This will further enhance the capacity of the services within the region. The Deputy will appreciate the priority shown by this Government to modernise mental health policy and services in line with A Vision for Change. He will also be aware that significant new resources have been allocated for mental health since 2012.

Dan Neville (Limerick, Fine Gael)
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The case I made for the provision of inpatient psychiatric beds for children and adolescents has not been answered. I clearly asked why the recommendation in A Vision for Change that 20-bed units should be provided by 2011 has not been adopted. It was stated in A Vision for Change that the number of psychiatric beds urgently needed to be increased to 100 by 2011. That has not happened. As the Minister of State said, we now have 58 such beds. That falls far short of the 100 beds that should have been provided by 2011 in line with the recommendation in A Vision for Change. Maybe the Minister of State will inquire for me whether a national review of psychiatric inpatient beds took place in 2011, as firmly recommended in A Vision for Change. If such a review took place, what was the result of it? I remind the House that it was recommended in A Vision for Change that by 2011, no child or adolescent should be admitted to an inpatient bed. The Minister of State is correct when he says there has been a considerable improvement. It is a shame to have to say, four years after the recommendation that no child anywhere in the country should be admitted to an adult inpatient bed should have been implemented, that there were 89 such admissions last year. I appreciate that there have been improvements in outpatient services and in other areas, but they are not the subject of this Topical Issue debate. I am asking about the provision of a 20-bed inpatient psychiatric unit for children and adolescents in Limerick to serve the mid-west region. That is the point I am making in this debate. I have not yet received a reply. Why did the development of such a unit not take place? Why was it scrapped?

Aodhán Ó Ríordáin (Dublin North Central, Labour)
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The Deputy makes a solid case. He has acknowledged the movements and the improvements that have been made in this area, as borne out by the statistics I provided to him in my initial reply. I do not have an answer at the moment to the very direct question he has asked. I will ensure the Department makes direct contact with him and supplies him in writing with the information he has sought in the question he has asked this evening.

Dan Neville (Limerick, Fine Gael)
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I thank the Minister of State for his commitment.