James Browne (Wexford, Fianna Fail)
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I raise the issue of the Mental Health Commission approved centre inspection reports that were published on 26 May 2016, in which 11 units across the country were assessed. As the Minister of State will know, every approved centre registered by the Mental Health Commission must, under law, be inspected at least once a year and during each inspection, the approved centre is assessed against all regulations, rules and codes of practice and section 4 of the Mental Health Act 2001.

These reports have highlighted a number of high-risk practices taking place in a number of psychiatric units throughout the country. For example, the acute psychiatric unit in Cavan General Hospital was found to have been non-compliant in its maintenance of records and had practised the use of physical restraint on high-risk patients. In St. Stephen's Hospital, risk management procedures were found to be at high risk while in the Aislinn Centre, staffing issues were found to be at high risk. In Letterkenny General Hospital, individual care plans and therapeutic services were again found to be high-risk issues while at Le Brun House-Whitethorn House in Clonskeagh, the premises and safety issues were found to be at high risk.

I want to focus, in particular, on the department of psychiatry in St. Luke's Hospital in Kilkenny. The premises was found to be of high risk and, extremely disconcertingly, the admission of children and the relevant code of practice was found to be a high-risk factor. The report states that "the approved centre was deemed non-compliant as there was no evidence of required Children First training or any other relevant training [of] staff [in this area]". The approved centre "was not suitable for the admission of children". The admission of children to adult psychiatric units is an ongoing issue. It is a wholly unacceptable practice and I ask the Minister of State what her proposals are in this regard and when it will stop. The previous Government promised to end this during its lifetime and that pledge was made in 2011 when it had come to power. It can only contribute to the mental health problems of these children by putting them into adult psychiatric units. While the staff will do their best, they cannot be given the full supports these children need, in particular early intervention supports, and many of these children are simply put on suicide watch.

The parents gave their consent to the children being admitted on most occasions to these units out of simple desperation and under a sense of duress as they feel they have no other options for their children who need psychiatric care. This is, of course, also a breach of the UN Convention on the Rights of the Child. There are many issues surrounding mental health - 24/7 care, in particular, is a key issue - but I ask the Minister of State to make this issue the No. 1 priority during her tenure to bring an end to this practice of putting children into wholly unsuitable and unsafe places, namely, adult psychiatric units.

Helen McEntee (Meath East, Fine Gael)
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I thank Deputy Browne for his question. The Mental Health Commission is charged with visiting and inspecting every approved mental health centre at least once a year. The commission, as the Deputy has rightly pointed out, has now published its report on St. Luke's Hospital in Kilkenny, Cavan General Hospital, Naas General Hospital and Clonskeagh hospital.

While each premises received excellent and good rankings for elements of their performance, there were concerns about the upkeep of the premises, other issues and the admission of children to the St. Luke's Hospital adult psychiatric ward. A maintenance programme is in place in each of the relevant hospitals to ensure all issues identified in the report on the premises upkeep are addressed. The Government is strongly committed to improving all aspects of our mental health services and, as Minister of State, I am committed to this also. Funding for mental health will increase from the 2015 outturn of €785 million to a projected budget of €826 million in 2016, an increase of €41 million, or 5.2%, which includes €35 million ring-fenced for mental health for new developments.

The admittance of children to adult units is sometimes permitted for reasons of geographic location, the expected length of stay, which is usually short term, and the age of the young persons involved, which is usually between 16 and 18 years. It is seldom a person younger than that is admitted, however it happens. Nobody agrees with this policy, and we all want to ensure it does not happen.

The HSE National Service Plan 2016 aims to improve the placement of children in age-appropriate mental health settings. We have set a target of 95% appropriate placement, and this is indicated in the plan, to allow for some operational flexibility surrounding emergency placements in adult units. I will take on board the Deputy's point that this must be a top priority. While it remains challenging, progress has been significant, despite increased demands on the CAMHS service. In 2008, there were 247 such inappropriate admissions to adult units, whereas in 2015 there were 95. While that was 95 too many, we are moving in the right direction and must continue to do so. It is a priority for the HSE to keep such admissions to a minimum, and this must be kept under constant review. It is not appropriate that anyone under the age of 18 be in a situation in which they feel scared or threatened and we want to ensure it does not happen.

I will continue to prioritise development of all aspects of CAMHS, including timely access to appropriate services, early intervention and an integrated service approach, again bringing it back to the community. A comprehensive approach, sometimes involving services outside of CAMHS or the HSE, is required to further reduce such placements. The admission of a child or adolescent to an acute adult inpatient unit is made following a clinical assessment of the needs of the individual. Sometimes, even if beds are available, they may be at a distance, and other factors must be taken into account.

The HSE is actively managing the issue of the admission of children to adult units. Specific measures adopted include a dedicated notification system to inform the mental health division whenever a child is admitted to an adult unit so it is constantly monitored. This information permits direct engagement with the local management team to develop a timely clinical management response to ensure a child or young person in this position is assessed and, if required, sent to an appropriate CAMHS as soon as possible. The timeframes are generally small. Many of the 95 admissions are, unfortunately, accounted for by a child who has come back a second or third time.

Bearing in mind all the circumstances, the hospitals concerned are making progress on the issues raised, while taking account of the wishes of each young person, his or her parents or guardians, and the complexities of each case. The Department will continue to closely monitor the issues raised in the report, particularly regarding the admission of children to places where they should not be.