Dáil debates

Tuesday, 16 January 2018

Topical Issue Debate

Mental Health Services Provision

8:05 pm

Photo of John McGuinnessJohn McGuinness (Carlow-Kilkenny, Fianna Fail)
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I recently attended a protest outside the department of psychiatry, St. Luke's General Hospital, Kilkenny, with members of the Psychiatric Nurses Association. They were protesting about the quality of care that they are able to give to patients in that facility. I have visited patients at this facility for a long time but it has not been updated. It requires significant capital expenditure and investment in staff.

Staff are put to the pin of their collar. It is unfair to staff and to patients that the current situation would be allowed to continue. Yesterday, there were 51 patients in a 44-bed unit. Patients were being admitted to sit on chairs on which they were asked to stay and sleep while waiting for a psychiatric service, and that is not good enough. The staff attended that protest in their own time. They did not vacate the wards. They came in from their lunch breaks to highlight what they see as being an unfair system and very poor care for the patient.

Some of those there for the long term are in an inappropriate setting. They are waiting for placement elsewhere. People cannot get counselling services. Some patients are being told they will have to wait for three to six months before they are seen. If one is in a community setting outside the hospital, the same waiting list prevails. How can one tell someone who is in a crisis regarding mental health that he or she will have to wait for three to six months? There are volunteer organisations on the ground, such as Taxi Watch founded by Derek Devoy. It monitors those who may be on the verge of suicide and brings them to the attention of relevant services. What can the services do when they are underfunded, understaffed and under pressure in the department of psychiatry? I am not saying that for political purposes. Those central to delivering the care are saying it. The HSE is referring patients who are looking for counselling services to Teac Tom, a voluntary organisation in Kilkenny city. It provides immediate, on-the-spot counselling services but the HSE refuses to pay for the service because it believes it is referring the individual to a service that is run on a voluntary basis. How can that be? How can the Minister of State allow that to continue? I stood on that picket line with a friend of mine, a councillor, Joe Malone, who is associated with the care of those who need care for their mental health and well-being.

What will the Minister of State do to provide capital expenditure and the needed staffing requirements? What plans are there to extend the department of psychiatry? When will an extension or refurbishment of that centre be provided for? This has gone on for a long time and someone has to cry stop before we have another death by suicide. It is that critical. I invite the Minister of State to visit the service, to visit Teac Tom and to talk to Derek Devoy in the other service, and to see first-hand what is going on in the department of psychiatry. We also need investment in the management of that service. It is deplorable that the managers of a service cannot see the issues confronting their staff and that the management is not planning ahead for the numbers attending the service and the staffing levels required. I draw the Minister of State's attention to the fact that the same circumstances prevail with the Waterford services.

8:15 pm

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I thank Deputy McGuinness for raising this important question. I know from his work in Kilkenny that he cares passionately about mental health services. Carlow-Kilkenny mental health services focus on delivering a broad range of primary and community-based services as well as specialised services for children, adults and older people. These services are provided in a number of different settings, including the individual's own home, inpatient facilities, outpatient clinics, acute day services, day hospitals and day centres, and high, medium and low support community accommodation.

The 44-bed department of psychiatry based in St. Luke's General Hospital, Kilkenny, is the designated approved centre for acute inpatient services in the area of Carlow, Kilkenny and south Tipperary. This enables all acute inpatient admissions to be managed at a single site. Referrals to the department of psychiatry are through a consultant psychiatrist who makes the clinical decision to admit based on the level of acute presentation or need. I am pleased to say that I am informed by the HSE that there are no waiting lists for admission to the acute inpatient service. The HSE acknowledges that at times there can be issues of over-capacity at the department of psychiatry, which I take the Deputy's point about. When this occurs, all additional controls relating to risk management are applied. This includes ensuring that staffing levels are at an appropriate level. Regarding staffing, a number of posts are with the national recruitment service to be filled and are currently being filled in a temporary capacity.

In addition to the department of psychiatry, a dedicated psychiatric liaison team operates from the emergency department in St. Luke’s General Hospital. All service users presenting to the emergency department who require psychiatric assessment will receive that assessment within agreed timeframes in line with the relevant department of psychiatry or emergency department guidelines. Onward referral pathways are agreed with all service users upon completion of a psychiatric assessment in the emergency department. Pathways can include admission to an acute unit, referral to a relevant community mental health service team or referral back to a person's own general practitioner.

In line with A Vision for Change and Mental Health Commission recommendations, there have been significant developments in the area of community mental health services. The comprehensive development of community mental health teams has brought together key professionals to provide a wide range of mental health interventions on a multidisciplinary basis to service users in the community. This approach is based on assessment of a person's needs. The HSE has assured me that any waiting times for community mental health teams are in line with the national key performance indicator requirements. In addition, the development of the home-based services teams in Carlow and Kilkenny has ensured the delivery of a service that facilitates recovery in the service user's own home environment.

I am glad to have the opportunity to share with the Deputy the continuing steps being taken to improve mental health services in this area. The Carlow-Kilkenny mental health service is engaging in the reform programme to realign services to primary care networks in line with national policy. The aim is to facilitate integration of services and to seek to provide a seamless service to service users. In addition, there is a significant focus on the involvement of the service user in the management of his or her illness, through initiatives such as involvement centres and a recovery college. I hope this information has addressed the issues raised by the Deputy to his satisfaction. I will report back on the other issues he has raised with me to the Minister, Deputy Simon Harris.

Photo of John McGuinnessJohn McGuinness (Carlow-Kilkenny, Fianna Fail)
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That is not good enough. The Minister of State has not addressed any of the issues. As I said to him, there are 44 beds and 51 patients. How can the Minister of State tell me that is good health care, whether for mental health or otherwise? How can he say to a family waiting for a counsellor for three to six months that is satisfactory? I respect that the note the Minister of State read was probably given to him by the HSE. It is a load of nonsense. It is not true. The Psychiatric Nurses Association of Ireland went out on a picket line - its members went out on a protest march. They did not do that for fun. The reply the Minister of State has given does not answer the questions. It is very unfair to put that ráiméis on the record of this House without addressing the real trauma that affects the families of those who are patients in the department of psychiatry in St. Luke's General Hospital in Kilkenny. I ask the Minister of State to come and see it for himself. He should visit it and see the capital expenditure that is needed. It is obvious. Will he please explain to me why the HSE can outsource its counselling service to a voluntary organisation and not pay for it? It is reprehensible that our Government would stand by and watch what is going on in the south east and in the department of psychiatry in St. Luke's General Hospital and not do something about it. It is unacceptable that the management would not acknowledge the fact that it is not delivering the services, that there are inappropriately placed people in the department of psychiatry and that young people and others are asked to come in as patients and take their place on a chair and sleep there.

Mental health issues are not the same as a broken leg; they mean a broken life. We are putting people's lives at risk if we do not accept the fact that our services are falling down around us and we are not prepared to acknowledge it. It is not just that the Minster of State is not prepared to do so. The HSE and the Department are also not prepared to do so because they wrote the briefing note for him. They have, therefore, told a story that is absolutely misleading. The Minister of State should meet union representatives and talk to them about this. He should visit the hospital and at least acknowledge the fact that something has to be done. People who are suffering from mental health issues and poor well-being are in a situation where services cannot cope with what is happening. I ask for a better response and that the HSE be forced to acknowledge what is happening on the ground.

8:25 pm

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I said I would convey the issues raised by Deputy McGuinness to the Minister. The Deputy made critical points about the current situation being unfair to the staff and the patients. It is unacceptable for people to have to sit on chairs. He also mentioned the fundamental question of capital expenditure on the refurbishment of the centre. In Kilkenny, there is significant focus on meaningful involvement of the service users in the management of their illnesses with the development of recovery-focused services. Six actions are being undertaken: the development of involvement centres, which are peer-led support services located in Carlow and Kilkenny; the development of a recovery college that delivers programmes for people who have lived experience in mental health; the delivery of wellness recovery action planning, WRAP, which is a programme to help people to manage their mental health; a class programme that supports service users and their relatives; projects, which focus on recovery from mental ill-health; and service user forums, which facilitate service users to feed back on service delivery and development of service initiatives.

I take the Deputy's point about major problems emerging. It is important that Ministers see what is happening first hand and that they engage with psychiatric nurses. I am very much open to that. It is also important to acknowledge that, in budget 2018, an additional €35 million has been allocated to develop mental health services and that the Minister has also committed an additional €55 million in funding in 2019, delivering a total of €105 million in additional funding for the implementation of A Vision for Change over the three-year period 2017 to 2019. I want to see exactly where the money is going. I take the Deputy's point that if issues are raised in Kilkenny they have to be dealt with in a comprehensive way and I will bring that message back to the Minister.