James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I wish to discuss the implementation of regulation of community-based mental health care services. Last week the Mental Health Commission, MHC, published reports on 24-hour nurse supervised residences after inspecting 43 of these units. This is the first publication of inspection reports in this area. It is part of a three-year programme that will see the inspection of all 24-hour residences. The findings were both illuminating and disturbing. The Mental Health Commission found serious deficiencies in many of the residences. Residents were not free to leave in six residences, which had locked doors. There was no access to a kitchen to make tea, coffee or snacks in 19 residences. Residents were unable to lock their bedroom doors in 33 residences. More than half - 25 residences - had more than ten beds although ten is the maximum number of beds recommended in A Vision for Change. Only 19 of the 43 residences were in good physical condition. Eight required urgent maintenance and refurbishment. Only 25 residences offered all residents single-room accommodation. Furthermore, two residences had bedrooms which catered for four people. In residences with shared rooms, 58% had no privacy between beds or within the bedrooms. A rehabilitation team provided services for only 51% of these residences.

There is no reason to believe that the residences not yet inspected are any better. Dr. Susan Finnerty, inspector of mental health services, was clear in her unease at the findings, saying that it is concerning that some of our most vulnerable citizens, many of whom have spent decades in psychiatric hospitals, are now being accommodated in unregulated, poorly maintained residences that are too big, are institutionalised, restrictive and are not respectful of the privacy, dignity and autonomy of residents. The chairman of the Mental Health Commission, Mr. John Saunders, stated that ideally, there should be a care pathway where people move from hospital to highly supported accommodation, graduating to more independent settings as they gain skills and confidence. However, at present there is a serious lack of suitable accommodation options and rehabilitation and recovery staff to enable service users to move through the different stages of recovery and progress towards the goal of independent, community-based living. Many people have to remain in highly supported accommodation.

The Mental Health Commission justifiably used very strong language in its conclusion. It highlighted how a lack of regulation means people in 24-hour residences are at risk of abuse and substandard living conditions and treatment. Does the Minister of State agree with the findings of the report and its conclusions, and how does he intend on acting on the issues raised in the report?

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for raising this issue, which has come under the spotlight again recently. I appreciate the opportunity to address some of the concerns that were raised as a result of this issue being highlighted recently.

Under the Mental Health Act 2001, the Mental Health Commission has the power to inspect, regulate and enforce standards in all approved centres. Approved centres are hospitals or other inpatient facilities for the care and treatment of people experiencing a mental illness or mental disorder and which are registered with the Mental Health Commission. Such inspections are carried out annually. The commission also has the power to visit and inspect any other premises where mental health services are being delivered under the direction of a consultant psychiatrist. There is no requirement to carry out such inspections in a particular timeframe and currently, the commission does not by law have the power to enforce its recommendations.

Last week, as the Deputy noted, the Mental Health Commission published inspection reports into 43 of the country’s 24-hour nurse supervised residences for persons with mental illness. The commission highlighted some concerns it has regarding some of these residences. The commission has called on the Government to introduce legislation to provide the commission with the powers to regulate and inspect these residences. The Mental Health Commission fulfils a very important role in ensuring our mental health services are of a high standard. The Government agrees with the commission that all mental health residences should be subject to regulated inspection. The expert group review of the Mental Health Act 2001, which was published in 2015, recommends extending the existing regulation and inspection powers of the commission to such residences at regular periods.

My officials are working on a comprehensive set of amendments to the Mental Health Act 2001 at present and this important recommendation will be included in the heads of a Bill, which I expect to be significantly advanced by the end of the year. I accept the importance of advancing this work as quickly as possible. It is a comprehensive legislative undertaking, which must now also take account of the provisions of the Assisted Decision-Making (Capacity) Act 2015 which was enacted after completion of the expert group report. Once the draft general scheme of the Bill has been prepared, my officials will undertake consultations with the Mental Health Commission on refining the draft text. Once the general scheme is completed, it will be forwarded to Government for approval before publication. In the meantime, it is important to point out that while the commission cannot enforce the findings of the reports issued last week, service providers must take account of the concerns raised.

In conclusion, I can reaffirm to the Deputy that my Department is taking due account of the recommendations laid out in the report of the expert group review of the Mental Health Act 2001 and is progressing these amendments to the Act as quickly as possible. These and other changes, when included in revised mental health legislation, will further improve the protections available to vulnerable people who need care and treatment, ensuring that they can avail of mental health services in the most appropriate environment.

James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Mental Health Commission has consistently called for the regulation of 24-hour supervised residences to protect vulnerable people and has called on the Government to take action in this regard. The report of the expert group on the review of the Mental Health Act 2001 was published in 2015. It made 165 key recommendations to make mental health laws fit for purpose. It is now three years since it was published. We have had three Ministers with responsibility for mental health in that time and three years of broken promises from those Ministers to the effect that these recommendations would be implemented. Alarmingly, only one of these recommendations has been implemented. We do not even have a draft Bill addressing the other recommendations. Two of these recommendations, Nos. 124 and 125, specifically recommend giving the Mental Health Commission the powers it seeks in its report to empower it to take action to ensure people in 24-hour residences are at risk of abuse and substandard living conditions. Most people were shocked at the content of the report but were equally disturbed to learn that the Mental Health Commission does not have these basic powers to protect vulnerable people availing of mental health services.

I have raised this issue before but there seems to have been little progress since. When is the Government going to act on these specific recommendations to empower the Mental Health Commission to protect these vulnerable people under the care of mental health services? Is the Minister of State engaging at all stages of the implementation of these recommendations with the relevant stakeholders. In particular, is he fully engaged with the Mental Health Commission and keeping it aware and updated on any steps being taken? I listened to the comment about engaging with the Mental Health Commission on refining the draft text. It would be far more important and relevant to engage with the Mental Health Commission at this stage of the drafting of the text, rather than refining it later. Ultimately, if the recommendations are to be implemented and the powers given to the Mental Health Commission, it has to be engaged at the early stage of the drafting and not just come in at the end when the Bill has been drafted. At that stage it might be sent back to stage one again if it is not fit for purpose. The Mental Health Commission is the key stakeholder on this issue. It will be implementing the recommendations and must be involved from the very start of this process.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I share the Deputy's concerns. Politicians on all sides of the House are anxious to try and bring about a situation where the Mental Health Commission will have its powers enhanced. It is free to make inspections and we expect that recommendations made by the Mental Health Commission on foot of any visit to any facility with 24-hour care of some of our most vulnerable patients would be implemented and adhered to. That is a realistic expectation and I believe it will be delivered on.

One recommendation of the review of the Mental Health Act 2001 was that all high, medium and low-support hostels, crisis, respite houses and other residential services, such as day hospitals, day centres and other facilities, in which mental health services are provided would be registered, and to introduce inspection on a phased basis. It was also recommended that the standard should be made by way of regulation, and that regulation should be underpinned by way of primary legislation. The Deputy has commented on the slow pace of the process, but he will appreciate that it is a huge amount of work to enforce all 165 recommendations, most of which require legislative changes to the Mental Health Act 2001, which is a substantive body of work. The challenge is to do that all in one go rather than tampering with the Act on a bit-by-bit basis. The preference is that we would make the changes required in one item of legislation, and that is why it is taking a bit longer. Patience is required on this particular endeavour but I assure the Deputy that I will continue to monitor the progress of the officials in the Department and ensure that priority is afforded to publishing the heads of that Bill before the end of the year.