James Browne (Wexford, Fianna Fail)
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3. To ask the Minister for Health his views on the Mental Health Commission’s call for it to be given powers to regulate community-based care services. [41052/17]

Jim Daly (Cork South West, Fine Gael)
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The Mental Health Commission is a statutory body whose functions are set out in the Mental Health Act 2001. Among its key responsibilities is the establishment and maintenance of a register of approved centres. The Act also provides that the inspector of mental health services visit, inspect and report on every approved centre at least once every year. Details of these inspection reports, including compliance issues, are available on the commission’s website. While the commission has the authority to visit and inspect any other premises where mental health services are provided, the enforcement powers of the commission only apply in the case of approved centres.

As regards the regulation of community-based services by the commission, the expert group review of the Mental Health Act 2001 examined this issue in detail in its 2015 report. The expert group recommended that a proportionate and risk-based system of inspection should be developed by the commission. This would include a phased introduction of registration and inspection of all community mental health teams. In addition, all high, medium and low support hostels, crisis-respite houses, other residential services, day hospitals and day centres would also be subject to inspection and enforcement by the commission.

The expert group also suggested that to enhance the standard of care provided in approved centres, the revised legislation should provide for the Mental Health Commission to make standards in respect of all mental health services and to inspect against those standards. The standards would be made by way of regulations and the regulations would be underpinned by way of primary legislation.

Amendments to the Mental Health Act 2001 based on the recommendations of the expert group review of the Act are being progressed. The Government approved plans to proceed with the general scheme of a Bill. Officials are working on the heads of the amending Bill that will legislate for the recommendations of the review, including those relating to the proposed registration and inspection of community mental health services.

My Department and I accept the importance of advancing this work as quickly as possible. We acknowledge it is taking longer than stakeholders in this area would like. That said, it is a comprehensive legislative undertaking, which must also now take account of the provisions of the Assisted Decision-Making (Capacity) Act 2015, enacted after completion of the expert group report. I expect the text of the general scheme of a Bill to be significantly advanced by the end of the year.

James Browne (Wexford, Fianna Fail)
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I understand only one out of the 168 recommendations from the expert review group has been implemented. The review group is now three years out of date. As the Minister stated himself, the Assisted Decision-Making (Capacity) Act is beginning to become obsolete, which is unacceptable.

Over 90% of all people receiving supports received them in non-approved centres. Only 10% of centres are actually approved and inspected. The next Leas Cross will happen in people’s homes because no inspections are being carried out and there is no risk that anyone will be caught.

The Mental Health Commission has reiterated its call on the Government to give it powers to regulate community-based services with the increasing number of patients accommodated in those. We had the policy of closing down the old Victorian hospitals, which was right, but adequate community supports are not being put in place. No one is inspecting those supports being put in place. There needs to be increased supports. The Mental Health Commission is seeking regulatory powers and should be given to it.

Jim Daly (Cork South West, Fine Gael)
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I share the Deputy's concerns. I would like us to get to a position on enforcement. The commission has the powers to inspect and visit those facilities if it wishes. I met the Mental Health Commission last week and discussed this issue at length with it. I am anxious to get this legislation in place. It is a comprehensive piece of work.

There is a great deal of legislation before the Houses, such as a couple of amendment Bills put forward by the Deputy and Senator Joan Freeman's Bill. There is much legislative work being undertaken and competing for time in the Department at present. However, I am as anxious as the Deputy to get to this stage because I wish to see it regulated, with the powers of enforcement in place, to ensure we can guarantee safety and quality in the services we are providing.

James Browne (Wexford, Fianna Fail)
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The Fianna Fáil Bill that attempts to amend part of the Mental Health Act will go through Second Stage in the Seanad in October. Effectively, that is an attempt to force the Government's hand to bring forward the comprehensive Bill that is required to reform the Mental Health Act in light of modern human rights changes in that area. Mr. John Saunders, chairman of the Mental Health Commission, said: "These community residences have become too large by accommodating too many people, creating a number of mini institutions... These residences are not regulated and yet they provide care to a large number of vulnerable people with mental illnesses." The Minister of State must be aware of the comments of the Mental Health Commission. These stem from the recent publication of a report on Roscommon mental health services. The external review found that mental health services in the county were marked by control, negativity and a culture of blame. The author of the report said that some senior staff normalised bad behaviour while others perpetuated it. The evidence is available. I have no doubt that what happened in Roscommon is happening in other parts of the country. This issue will become worse and will perpetuate itself unless proper investigations and assessments are made in these areas.

Jim Daly (Cork South West, Fine Gael)
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Again, I appreciate what the Deputy said. My reference to the Deputy's legislation is by way of information. There are a number of different, conflicting elements in trying to progress legislation as quickly as possible.

I am acutely aware of the Roscommon situation. I have discussed it with numerous people, including the Acting Chairman, Deputy Eugene Murphy, who has a keen interest in it, and other Members from the area. I will visit Roscommon next Monday to meet some of the people there, to hear about what is happening, to see what went wrong there and to ensure that the recommendations are fulfilled. I appreciate the concern that this could be replicated in other parts of the country. That concern is real and I share it.