Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

Is the Minister of State, Deputy Catherine Byrne, taking this matter?

Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Yes.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

I am disappointed that the Minister for Health or the Minister of State-----

Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I can explain. The Minister of State, Deputy McEntee, was admitted to hospital suddenly last night and cannot be here today.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

That is a perfectly acceptable reason.

Last weekend, a letter from the Mental Health Commission to the Health Service Executive, HSE, came into my possession. It was quite shocking as we learned for the first time that it was the intention of the Mental Health Commission to de-register the psychiatric unit in University Hospital Waterford and completely close it down. It is the psychiatric acute unit for the counties of Wexford and Waterford. The new determination of the Mental Health Commission was to reduce the number of acute beds from 14 to six.

I will give some brief background. In 2010, following the closure of St. Senan's Hospital in Enniscorthy in accordance with A Vision for Change, the acute psychiatric services for County Wexford, except for its very north, were added to the acute psychiatric service for Waterford and provided in Waterford. The 14-bed unit had caused deep concerns over recent years as being inadequate.

The letter from the Mental Health Commission states that serious concerns remain as to the safety, health and well-being of residents in the approved centre and that it is quite clear that the current unit is not fit for purpose. While this may well be the case, the notion that there would be only six acute beds available for the counties of Waterford and Wexford is wholly unacceptable. In a letter received by me and, I presume, other Deputies yesterday, the Minister of State, Deputy Helen McEntee, to whom I wish a speedy recovery, indicated that an appeal would be lodged. However, the appeal must be determined by next Friday. If not, the unit will be reduced to six beds as and from next Wednesday. It is unacceptable.

Will the Minister of State, Deputy Catherine Byrne, indicate in very clear terms what provision will be made for acute patients beyond next Wednesday, assuming the ruling of the Mental Health Commission stands? The letter I received yesterday aggregated acute and sub-acute beds and referred to 36 beds. I am focusing exclusively on acute beds, which are to be reduced from 14 to six, which is wholly unacceptable and will cause consternation among all the population of Wexford and Waterford.

David Cullinane (Waterford, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I, too, have a copy of the Mental Health Commission's leaked report which considers a number of options, one of which is to deregister the entire unit at University Hospital Waterford, which would be inconceivable. Another is to reduce the acute beds in the psychiatric unit at Waterford from 14 to six. This would have profound implications for people who suffer from mental health issues, not just in Waterford but in Kilkenny, Carlow, Wexford, Tipperary and possibly further afield.

Today, I received correspondence from a constituent who suffers from mental health issues. She asked me to relate her story to the House. Her name is Antoinette Murphy. She runs an organisation called Candles in the Dark which campaigns for improved mental health services.

On Monday, 23 January I presented to the emergency department at University Hospital Waterford. I was suffering from chest pains and was having a severe panic attack. I was seen by a psychiatrist but I was informed that due to a shortage of beds I could not be admitted. I was turned away and I was left devastated. The staff informed me that I was the fourth person to be turned away that night. How is it allowed that people with suicidal ideation are turned away without adequate supports? I would have gladly sat on a glass floor rather than being sent home. I was left at home and suffered multiple panic attacks since. Do those in authority understand what it is like to suffer from mental health issues? Why do those in power allow a grossly inadequate system to remain in place?

It is hard to disagree with the questions she posed.

Will the Minister of State give assurances to the people of the south east that the acute bed capacity in the psychiatric unit at University Hospital Waterford will not be reduced? The current system is already under pressure and patients are being turned away from the hospital. I have received late night calls from people who have been asked to travel to Cork because the services were not available in Waterford. I have received responses to parliamentary questions to the Minister for Health informing me that key psychiatric posts in the hospital have not been filled. This is adding to the pressures.

Will the Minister of State confirm that the possibility of the unit being deregistered is not on the table? Will she also confirm that the number of beds will not be reduced? Will she outline when the vacant posts will be filled? This is not just for patients in Waterford but for those across the south east.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

It was with shock and horror that I learned over the weekend that the Mental Health Commission had recommended the closure of up to eight of the 14 acute mental health beds at University Hospital Waterford. Mental health services in Waterford and the south east are already greatly overstretched. Many people with mental health issues cannot access adequate treatment given that there are not enough acute beds in University Hospital Waterford. Now we have learned that we could lose up to eight beds. It is unacceptable and wrong.

The 14 acute beds in the psychiatric department covering Waterford, Wexford and part of the south east has a catchment area of approximately 300,000 people. The Mental Health Commission has recommended that up to eight of these beds close. The commission has taken the view given that it is concerned that the unit at University Hospital Waterford is overstretched and under-resourced. I am familiar with the unit. The staff are fantastic and work extremely hard under challenging circumstances. However, we cannot turn our backs on people who have mental health issues and who need acute care.

The Mental Health Commission said the unit was under-resourced and that additional resources were required. This must be remedied. The Minister of State must intervene and make funding available to help secure the 14 beds. It is unthinkable that there may be only six acute mental health beds to cover the population of 300,000 people in the entire south east. University Hospital Waterford is already desperately fighting for other services, such as 24-7 cardiac care. Waiting lists are at a record high. We cannot lose what we have. We cannot stand by and see these beds close.

This was a crisis waiting to happen and it is a direct result of the failure to fund and support mental health services properly. A number of outstanding issues with mental health services need to be resolved, such as the provision of a seven-day mental health support service in every catchment area throughout the country. The practice of admitting people suffering from mental health issues to emergency departments must end. Mental health spending is allocated year to year. It is obvious it is not working. We need a multiannual plan in order that our mental health services can be developed with certainty and we do not see a recurrence of this. The stress and trauma of people with mental health issues cannot be compounded by further bed closures. It is imperative that the message goes out loud and clear. We cannot lose even one bed in the psychiatric unit in Waterford, never mind eight.

Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

It is unfortunate the Minister of State, Deputy Helen McEntee, cannot be here but she was taken ill suddenly last night. She has been released from hospital and is at home.

The Government has been strongly committed to improving all aspects of mental health services since 2012.

4 o’clock

Approximately €140 million has been added to the HSE mental health budget, which now totals €851 million.

I will now turn to the provision of acute psychiatric care in counties Wexford and Waterford. The acute mental health unit at St. Senan's Hospital, Enniscorthy, County Wexford, was amalgamated with the Waterford mental health services in 2010. This now provides a 44-bed acute inpatient mental health unit at University Hospital Waterford. The department of psychiatry in University Hospital Waterford provides inpatient assessment, treatment and care to service users living in the Wexford area. Service users who live in north Wexford, who attend Tara House mental health services in Gorey and who require acute inpatient admission have access to Newcastle Hospital, Greystones, County Wicklow.

To ensure that each mental health facility is fit for purpose, the Mental Health Commission is charged with visiting and inspecting every approved mental health centre at least once a year. On 3 February 2017 the Mental Health Commission notified the HSE that following a number of inspections during 2016, it proposed that the department of psychiatry at University Hospital Waterford would be registered as an approved centre, with conditions. Primary among these conditions was that the number of beds be reduced. As Deputy Howlin stated, the HSE has until Friday, 24 February to make representations to the commission to either modify or remove those proposed conditions based on evidence that University Hospital Waterford is or will be compliant with the regulations to which the proposed conditions relate. The HSE intends to request that the commission does not, as a condition of registration, require it to reduce the number of beds in Waterford. Under section 64(6)(b)(iii) of the Mental Health Act 2001, the commission can specify the maximum number of residents in an approved centre or within an area of an approved centre. In this instance, that is proposed because in the view of the inspectors there is insufficient space for the total number of residents, there is a lack of dining, recreational and quiet spaces for residents and the previously proposed programme of works would not have addressed these issues. Taken together, these issues pose a risk to service user safety. The HSE will make representations to the commission before 24 February detailing how the HSE intends to address these issues, including a revised programme of works and associated timelines.

The HSE will outline how, on balance, a bed reduction is less safe for the service user population of the community health care organisation region CHO 5 than maintaining the current bed base, with the controls and improvement plans to be provided. Bearing in mind all the circumstances, I am confident that the HSE and University Hospital Waterford will resolve the issues raised by the commission. The Department will, however, continue to closely monitor the issues raised by the Mental Health Commission, in conjunction with the HSE, to ensure that the necessary corrective actions will be taken.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

I regret to say that the Minster of State has not given factual information to the House. She stated, "This now provides a 44-bed acute inpatient mental health unit at University Hospital Waterford." That is not true.

David Cullinane (Waterford, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Hear, hear.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

The Mental Health Commission, as the licensing authority, has conditions, the first of which states that the maximum number of residents that may be accommodated within the acute unit of the approved centre is six patients. There is also a sub-acute unit of an additional 30 patients. People with acute psychotic conditions need acute beds in acute units. There are now 14 beds. From next Wednesday, there will only be six. There are no provisional plans to deal with that eventuality. The HSE met the Mental Health Commission on 27 January and it failed, at that stage, to convince the commission not to reduce the number of beds. If it fails again between now and Friday, what contingency plans are being put in place by the Minister and the Department to provide acute psychiatric services provision for the people of Wexford and Waterford?

David Cullinane (Waterford, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

What is happening here is absolutely outrageous. As the Minister of State said, the service in Wexford was amalgamated into the Waterford service. The Mental Health Commission's report states very clearly that there is a lack of capacity regarding space, therapists and staff and that, essentially, the unit in Waterford was starved of resources and capacity. Bizarrely, the commission's recommendation is to close the unit or dramatically reduce the numbers there, with no consideration given to people who have mental health issues and who need the services of that unit right across the region. Rather than looking at closing or reducing the services, the Minister and the Government should be focusing on increasing the capacity, which the Mental Health Commission has said is not there. Where are the therapists? When are the vacant psychiatric posts going to be filled? How is the Minister going to increase the physical space for recreation areas and quiet rooms? The commission spoke of these things but what is the plan? If there is no plan and if the Government does not put the resources in place, then we could be faced with losing beds and that would be on the heads of those in this Government. Shame on the Government if we see beds close in a psychiatric unit it will have a deep impact on people who suffer from mental health issues.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I reiterate the absolute necessity of retaining these 14 acute beds that serve the catchment area of Waterford and Wexford. We must put in place the necessary supports for the patients and staff. As already stated, we cannot afford to lose even one of these beds, for which there is a waiting list. Unfortunately, we all know someone who has needed one of these beds at some time. What worries me most is that if this document had not been leaked at the weekend, four Deputies would not be here debating the issue and trying to get an answer in respect of it. The timeline from 3 February to 24 February is very short. I commend whoever got his or her hands on this document - I believe it was Deputy Howlin - because if we had not had sight of it, we would not be discussing this matter and the fact that eight beds at University Hospital Waterford will be closed on Friday next. People who most need those services will be left without them.

Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Unfortunately, I will not be able to answer some of the specific questions that have been asked. I was just asked to take the Topical Issue. I know this is not helpful to all the Deputies here. I do, however, want to make a few points.

I have not spoken with the Minister of State, Deputy McEntee, or the HSE on this matter but I will ensure that if the service has to close, everything possible will be done by the HSE and the Minister of State to ensure that those people have a place to go to. I am very much aware of the whole situation around mental health and services, especially for families who are caught up in a service that may not be around after next Friday. The Deputies have raised an urgent concern. The Minister of State has made it very clear that she will do everything possible to ensure that people are facilitated if the closure goes ahead. We must wait and see because there is no point in jumping the gun. We must afford an opportunity to the HSE to respond. Deputy Howlin explained that the HSE had already met the commission in January. I assure the Deputy that I had not known this while coming in to the House, so I thank him for that information.

I agree with the Deputies that is a very serious matter. The situation needs to be corrected - as anybody who has someone suffering from mental health issues will understand - particularly in the context of people with serious mental health issues being turned away from accident and emergency departments due to lack of beds. I am very sorry that I cannot give more specific answers.

I will relay the messages back to the Department, the Minister and the HSE.

David Cullinane (Waterford, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I ask that the Minister with responsibility would forward a written response to us.

Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I will request that. Unfortunately, the circumstances that arose last night were not foreseen.

Pat Gallagher (Donegal, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

We must move to the next matter in the name of Deputy Michael D'Arcy.

Michael D'Arcy (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Before I begin, I ask that the Minister's response be sent to all of the Oireachtas Members in Waterford and Wexford. I want to support my colleagues from Wexford. The prospect of this happening is deplorable.

Pat Gallagher (Donegal, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

We must move to the next matter.