Wednesday, 29 May 2019
Saincheisteanna Tráthúla - Topical Issue Debate
Mental Health Services Provision
I thank the Ceann Comhairle’s office for giving me the opportunity to raise this issue.
Mental health services in Tipperary were devastated in 2012 following the closure by the then Minister of State, Kathleen Lynch, of St. Michael's inpatient unit at South Tipperary General Hospital in Clonmel. That decision left north and south Tipperary with a mental health service which was not fit for purpose. It is important to note that all stakeholders at the time, namely, staff, patients, GPs and the public, were opposed to that closure. It meant that south Tipperary patients had to travel to Kilkenny for inpatient treatment while north Tipperary patients had to travel to Ennis. These units themselves were not fit for purpose. For confirmation, one only needs to look at various HIQA reports and a prosecution and conviction for failures in the Kilkenny unit. The units are overcrowded, leading to late admissions for Tipperary patients as well as early discharges. It is leading to serious transport difficulties for families and friends supporting patients. Outpatient services and community-based teams are understaffed and underfunded. They did not and still do not comply with A Vision for Change standards and staffing levels.
The Minister of State, Deputy Jim Daly, has accepted the closure of St. Michael's unit was wrong and should not have happened. I acknowledge the work done by the Minister of State, representatives of the Save of Our Acute Hospital Services committee and Members from Tipperary to reinstate inpatient beds in the county. I hope that work will come to fruition soon.
A specific promise made at the time of the closure was that there would be the construction of a purpose-built mental health crisis house in Clonmel. Seven years later, the public, patients and staff have seen little or no progress on this.
Will the Minister of State clarify the position regarding the construction of this unit? I have a number of questions for him which might help us ascertain exactly where this project is at. Will he indicate the timescale for the construction this crisis house project? Will he confirm that funding for it has been approved and is in place? Will he confirm also that the project and funding of it will not be affected by the overrun on the national children's hospital? Has formal approval for the project to go to tender been confirmed and, if so, when is it envisaged that will happen? When is it envisaged that construction will commence? Is there a targeted date for the completion of the construction of this unit?
The construction of a purpose built crisis house is urgently required. I ask the Minister of State to confirm today that it will be dealt with as a matter of urgency and that progress will be made in the tendering of the project and the commencement of construction of the unit.
Gabhaim buíochas leis an Leas-Cheann Comhairle as ucht an t-ábhar seo a roghnú inniu. I thank him for selecting this Topical Issue matter. I thank the Deputy for raising it. I have said here previously that one of the most admirable characteristics of any Deputy, or Senator for that matter, is consistency. I acknowledge Deputy Healy's consistency and thank him for his continuing interest in all areas related to mental health in the area he represents in Tipperary. He has continuously raised this issue and challenged us on it and I acknowledge the good work he has done on behalf of the mental health sector in promoting awareness of the issue in his local area.
Specifically on the issue of the construction of a crisis house in Clonmel, as the Deputy will be aware, I am quite familiar with the project. I have met him and his colleagues on a number of occasions and have visited the area and met them there also to view the services that are available and to see how we can progress this project. I am anxious to see the crisis house project in Clonmel developed as soon as possible. As the Deputy will be aware from our meetings, new building regulations have been introduced since the project was designed which, as the Deputy said, dates back seven years. New building regulations have had to be taken into account and that has been done. A detailed redesign has taken place accommodating the new building regulations, therefore we had to recost the project, which is being done. I am anxious to see this project included in the capital development plan, which will be launched shortly by my colleague, the Minister, Deputy Harris. There is nothing to stop it progressing from there.
As alluded to by the Deputy, I have been down in the area and have acknowledged there is an issue with accommodation and beds in the greater Tipperary area. I view this as an absolute priority on a national front and I do not say that lightly. People in every constituency are looking for something to be done in their area but I have no difficulty whatsoever in saying that I would like to see the crisis house project in Tipperary top of the list of projects coming under the mental health area and to see that need being addressed because there is an issue there.
The Deputy will also know that my philosophy is very much to build a level of infrastructure at a lower level, and I do not like using the word "lower" but a reduced or a lower level of infrastructure for mental health. Thankfully the Jigsaw service will be rolled out in Tipperary, which the Deputy has publicly welcomed previously. We need more investment in that level of infrastructure to prevent the need for people having to access psychiatric beds. When we reflect on our history and look back to the 1960s there were 20,000 psychiatric inpatient beds in the country and all of them were filled. Today, there are fewer than 1,000. We have come a long way in how we deal with the challenges presented by people with mental health issues.
In the two years I have been in this job I have tried very much to refocus and reorientate the system towards having more proactive, bottom up supports, earlier intervention to prevent people having episodes of psychosis and such like which result in they sometimes having to go into care. We have to deal also with the issue of people presenting with acute mental health issues. I accept the challenges that exist in terms of accommodation and people having to travel to Kilkenny.
I am anxious to see this project progress as soon as the recosting is done, with which I do not envisage there will be any delay. I do not see any problem with having the funding available for it. This has been a top priority nationally. Thanks to the good work of the Deputy and his colleagues, they have ensured that it remains so. The people in the HSE are aware of my concerns and those of the Deputy and his colleagues regarding this project and our anxiety to see it proceed as quickly as possible. I certainly will do everything I can for my part to ensure that the crisis house project is built in Clonmel without delay.
I welcome the Minister of State's reply and thank him for the detail of it. I particularly welcome the fact that he believes this project is a priority issue for mental health services in Tipperary. The existing crisis house is not fit for purpose. It is an old building. It is particularly not fit for purpose having regard to modern psychiatry and modern standards. The construction of a purpose built unit for the purposes of a crisis house is necessary and an urgent priority.
I take this opportunity to welcome the Jigsaw project which the Minister of State mentioned. It is one we have sought for quite some time in Tipperary. It has been welcomed widely across the county.
I want to acknowledge briefly the work of the staff in the mental health services across Tipperary. They work above and beyond the call of duty. It is also important to recognise the work of many voluntary organisations across Tipperary which are working in the field of mental health. I welcome the Minister of State's reply and hope we will see JCBs on the site in the not too distant future.
I have said what I had to say regarding the specifics of the project. I wholeheartedly endorse it as a priority nationally and not only one for County Tipperary. I have no difficulty whatsoever in standing over that. I am determined to see it being developed and delivered for the people of Tipperary. We will continue the work we are doing in the other areas of mental health in the county.
I thank the Deputy and his colleagues who have continued to keep a keen focus on the area of mental health in County Tipperary. Many of his continuing efforts have resulted in decisions such as the Jigsaw project opening up in the area. I look forward to the next phase in the development of mental health services there.
I concur with what the Deputy said about the staff who deliver the services. Often people can be very quick to run down the services in the mental health area and say they are non-existent, not in place or not available but staff are working very hard in the delivery of services. We all hear the hard, tough stories. We would prefer we did not ever have to witness them and that nobody would have to go through some of these extremely upsetting episodes but many children and adults are availing of mental health services across County Tipperary on a daily basis being delivered by exceptional staff in a very challenging area. I concur with the Deputy in acknowledging the work and thanking the good people of Tipperary who have been delivering mental health services across the country during the past number of months and years.