Dáil debates

Wednesday, 24 January 2018

Topical Issue Debate

Mental Health Services Provision

1:40 pm

Photo of Eugene MurphyEugene Murphy (Roscommon-Galway, Fianna Fail)
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I express my sincere thanks to the Minister of State with responsibility for mental health and older people, Deputy Jim Daly, for coming to the House to address this very serious matter relating to the Rosalie unit at Castlerea, County Roscommon. I commend the Minister of State on acting speedily to meet a deputation from County Roscommon this evening. I appreciate that. I also acknowledge a representation made to the Minister of State by his party colleague, Senator Maura Hopkins.

I call on the Minister of State to provide clarity and answers on the future of the Rosalie unit at Castlerea, County Roscommon. I thank him most sincerely for agreeing to meet a deputation this evening. Like many others, I am deeply concerned that the Health Service Executive, HSE, has reneged on a 2015 promise to keep the Rosalie unit in Castlerea open. Many people fear that closure by stealth is now taking place. This is a pretty new unit. It may be there 20 or 30 years but I am not sure. It is a fine unit, originally designed to cater for 33 people. Now, it is catering for 12 or 13. Many of the residents of the Rosalie unit suffer from Alzheimer's disease or dementia. An embargo on admissions to the unit was put in place in September 2016, despite assurances given the previous year. A former Minister of State at the Department, Ms Kathleen Lynch, told a deputation she met at the time that there were absolutely "no plans to close it and there will be no such plans". The HSE has stated that the intention is to provide care for the residents in the unit as long as this is in the interests of the individual residents. As the Minister of State knows, such language is very vague. Who decides what is in the interests of individual residents? I often wonder about such language. The Minister of State is very passionate about his brief and I know he is very sincere but when somebody in the HSE makes a statement about deciding what is in a person's interest, I do not accept it at all.

Many family members also fear their loved ones could be moved to Ballinasloe, which is a long way from Castlerea. Ballinasloe is in east Galway and Castlerea is in County Roscommon. Such a development would be horrendous for many of the patients currently in the unit and their families. It is sad because this affects some of the people in the unit now. It is of great concern that the Rosalie unit has been closed to new admissions since September 2016. Will the Minister of State clarify the position ? I want answers to my questions. Will the unit remain open and will the Minister of State provide a date as to when new residents will be accepted? There are 12 or 13 people in the unit, which has capacity for 33. Over the years, the number of people there has steadily reduced. This is a big issue, not alone in the environs of Castlerea but throughout County Roscommon. We saw large public meetings two years ago but we were satisfied at the time we had got assurances and everything was going to be okay. Now we are very concerned.

I am not saying that the unit will close but the Minister of State knows that when we see this happening, one would wonder how much longer it can remain open. I know a number of people who could not get into any unit over Christmas but who could have used this one for a couple of weeks.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I thank the Deputy for bringing this important matter to the attention of the Dáil. I also thank him for his generous comments and commend him on acknowledging my colleague, Senator Maura Hopkins. He and the Senator have been very committed to and focused on this matter, ensuring that it has come on my radar for as long as I have been in this job. The people they represent are fortunate to have representatives of their calibre and commitment to this issue and all matters pertaining to mental health. The Deputy is very passionate and genuine about it and has always acknowledged, in a generous fashion, the work of his colleagues, particularly Senator Hopkins.

A Vision for Change sets out a comprehensive policy framework for the development of mental health services. It recommends, broadly, a move from the traditional, institutional-based model of care to a more patient-centred, flexible and community-based service where the need for hospital admission is greatly reduced while still providing inpatient care, as appropriate. This Government has prioritised the reform and resourcing of our mental health services in line with A Vision for Change.

The Rosalie unit, part of Áras Naomh Chaolain, is located in Castlerea, County Roscommon. It is a continuing care facility for psychiatry of later life patients. There are currently 13 residents at the Rosalie unit and the intention of the HSE is to continue to provide care for these residents in line with their identified needs in their individual care plans. The Rosalie unit has been closed to new admissions since 27 September 2016. The HSE indicates that it is not proposed at present to reopen the unit to new admissions.

With respect to the particular query raised by the Deputy, the report of the expert review group on community mental health services in Galway and Roscommon was published in July 2014. The review focused on 59 residential care settings and resources, including the Rosalie centre at Castlerea. The report was based on the guiding principles of patient centredness, equality, access to quality care that is focused on recovery and integration with other mental health and mainstream health services.

The key goal of the report was to make recommendations to ensure service users maximise their full potential and to improve the quality of their lives overall. It advocates that each client is individually assessed and is provided with the most appropriate care relevant to their needs. The local mental health service and, in particular, the psychiatry of later life community mental health team work with clients and their families to develop plans that will improve their quality of life overall. The executive indicates also that capacity exists within the Creagh suite, in Ballinasloe, to accommodate psychiatry of later life patients who have complex continuing care needs. The Creagh suite is an approved centre under the Mental Health Act, which has recently been extensively renovated and modernised to the highest standards and has access to enclosed state-of-the-art gardens.

The HSE has assured me that in its management of the Rosalie unit it has taken due account of the principles laid out in A Vision for Change and the recommendations of the Roscommon report on mental health services. I, in conjunction with the HSE, will closely monitor the development of all community-based mental health services in the Galway-Roscommon area, including those provided at the Rosalie unit.

1:50 pm

Photo of Eugene MurphyEugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank the Minister of State for the detailed reply. However, I am deeply concerned about the last few sentences in his statement. Obviously, the HSE has given him this information. My interpretation of it is that it is the HSE's intention to consider moving people to Creagh in Ballinasloe, which is up to 40 miles from Castlerea. Many of the patients in the centre are unsettled because of this news. Their families live locally and can visit and spend time with them. There are great staff in the unit and the people are very happy there. The consultant geriatrician in Roscommon University Hospital, Dr. Gerard O'Mara, said that he believes the unit is being closed by stealth. There is a big demand for an Alzheimer unit in Roscommon, where approximately 2,000 people of all ages suffer from the disease. I believe that is probably the largest number of patients anywhere in the country. We must take account of what a senior medical practitioner says about this, which is that we cannot afford to let this unit close.

We talk about A Vision for Change. We all accept the policy and we all wanted to adopt it. However, we did not all agree completely with every detail in A Vision for Change. My focus is on people being made unhappy, such as Liam's mother, Anita's relation and others who have approached us about it. Their representatives will be here this evening to speak to the Minister of State. They are concerned because their relatives are very unhappy now. We were given commitments two years ago. I ask the Minister of State to do all in his power to stop the HSE making this change. It will cause much despair and upset for people. I acknowledge that the unit in Ballinasloe is great but it is too far away and it will cause upset for the patients.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I appreciate the sentiment and passion the Deputy brings to this matter and his concern on behalf of the residents. I would be distressed if the residents were unsure and unsettled because of uncertainty pertaining to their future. I certainly will address that. I will be meeting the Deputy, representatives of the HSE and Senator Hopkins later this evening on this issue. I will also get a sense of the issue from the other people who will be present. As the Deputy knows, I cannot give a commitment as to what will open or close in such situations. However, I agree with him that while A Vision for Change was a great document, it did not get everything right and we did not always make the right decisions. Deputy Mattie McGrath will be aware of what I mean because we have discussed it in his local area. There could have been haste in closing some institutions at the time without sufficient progress being made on building community services and supports for people afterwards and alternative avenues of care. I know a fair amount about Roscommon but not enough, so tonight's meeting will inform me further.

I can give the Deputy a sincere commitment that I will approach this with a fully open mind. I will assist and support the Deputy and his Oireachtas colleagues every step of the way in holding the HSE to open, transparent and full accountability and communication. We will do everything we can to provide assurances, first, to the residents in the Rosalie unit, as well as to the wider community who care so much about it.

Photo of Eugene MurphyEugene Murphy (Roscommon-Galway, Fianna Fail)
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I appreciate that.