Dáil debates

Wednesday, 13 March 2019

Ceisteanna - Questions - Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Mental Health Services

10:30 am

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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1. To ask the Minister for Health his plans to regulate community residences which are providing care to a large cohort of vulnerable persons with long-term mental illness; and if he will make a statement on the matter. [12661/19]

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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I ask the Minister for Health what his plans are to regulate community residences which are providing care to a large cohort of vulnerable persons with long-term mental illness; and if he will make a statement on the matter.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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The Mental Health Commission was established under the Mental Health Act 2001. The commission’s main functions are to promote, encourage and foster high standards and good practices in the delivery of mental health services and to protect the interests of patients who are involuntarily admitted. Accordingly, the Mental Health Act 2001 states that the Inspector of Mental Health Services shall visit and inspect every approved centre at least once in each year, and visit and inspect any other premises where mental health services are being provided as he or she thinks appropriate.

The expert group review of this Act was published in 2015 and work is under way on preparing the general scheme of a Bill to reflect the group's recommendations in revised mental health legislation. A number of proposed changes to the legislation will affect the operation of the commission. Included in these is the recommendation to remove the requirement to inspect each approved centre annually. Instead, there would be a requirement to inspect each approved centre at least once in every three-year period and more often according to targeted risk. This would allow, on a phased basis, the registration and inspection of all community mental health teams and other mental health facilities such as support hostels, crisis or respite houses, other residential services, day hospitals, day centres and other facilities in which mental health services are provided at the discretion of the Mental Health Commission.

Significant progress has been made in recent months with the aim of finalising the draft heads of the Bill in the coming weeks. The initial draft will then be passed on to the Mental Health Commission for its views. Notwithstanding other legislative pressures on the Oireachtas at the moment, it is anticipated that the mental health (amendment) Bill will then commence its progress through the Oireachtas later this year.

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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I thank the Minister of State. There continues to be great concern about 24-hour staffed community residences which are not regulated but provide care to a large cohort of vulnerable people with long-term mental illnesses. The Mental Health Commission has stated that it takes the view that these residences accommodate too many service users, are often of poor physical infrastructure, and are institutional in nature and lack individual care plans. Regulation of these residences should be prioritised. I am glad to hear it may be dealt with in the coming legislation but, nonetheless, it should have happened before now. As I understand it, the heads of this Bill have been promised every year for the last three years and we still have not seen them.

Over 1,300 vulnerable adults with mental illness were accommodated in community residences that are unregulated, mostly in institutionalised settings. We regularly hear the mantra of the Minister about decongregation but it would appear people will be decongregated from regulated settings into unregulated settings in the community. Rather than decongregation being a situation of empowerment for people with mental illness, it would appear they are being abandoned to these unregulated centres. We saw the scandal at Leas Cross in the past and I am very concerned that similar situations could be allowed to arise in these unregulated mental health services.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I share the Deputy’s concerns. I am anxious to see the Mental Health Commission roll this out as soon as possible. Obviously, we have to get the legislative piece of work done. Regarding the Deputy’s comments on the year-on-year promise of the legislation, I have committed that it will be sent to the commission within the next few weeks, and the officials in the Department are very close to finalising it. I do not know how long the commission will have but I would expect the legislative journey will begin later this year and I am very optimistic about that. I am very anxious, as is the Deputy, to ensure every single centre is regulated, is visited and comes under the auspices of the commission.

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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I understand the proposal in the legislation will be to reduce the inspection rate for currently regulated centres from every year to every three years. In Kilkenny recently, there was the first ever prosecution of a mental health service. A report from Mental Health Reform came out this morning which stated that patients using the services of the HSE are seeing a failure to treat patients with dignity, frequent changes of staff and a high focus on medication. I am not sure reducing the levels of inspection for current facilities is the answer to servicing the unregulated facilities. I would rather that this is done in addition and that the necessary resources are put in so that all services are regularly inspected.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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The idea is that every service would be regulated. This is a debate we can have during the passage of the legislation, which will come before these Houses. At the moment, the suggestion is it would be better to have every single premises inspected at least once every three years as opposed to a select number being inspected once a year and others never being inspected. The best option is to have every premises and centre inspected every three years but that is a debate I am sure we will have as the legislation comes before the House.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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Question No. 2 is in the name of Deputy O'Reilly and permission has been given to Deputy Quinlivan to take it.