Thursday, 7 November 2019
Topical Issue Debate
Mental Health Services
I am disappointed that the Minister of State with responsibility for mental health is not here. While I appreciate that he may have other places to be, it is too regular an occurrence that a relevant Minister or Minister of State is not here to answer these questions. I wish to raise the very important issue of overcrowding and neglect in the department of psychiatry in University Hospital Waterford, which serves patients from Waterford and Wexford. My colleague, Deputy Butler, also called for this special debate but she sends her apologies as she is in hospital for a minor procedure and could not be here. She has been very strong on this issue.
We recently heard very harrowing accounts from patients and families of those who have attended the department of psychiatry there, Shauna Aylward on WLR FM and Ray Shannon on South East Radio and many on 'Liveline' on RTE. We have heard accounts of overcrowding, people being over-medicated and over-stretched staff that are totally unacceptable. There are stories of 24 patients in a 14-bed ward, patients on chairs and on floors. I have raised this issue several times in the past. I have asked the HSE how many patients are being kept on chairs and on floors and I have been informed that it does not keep an account of that, which is also unacceptable. A hospital should be a place of comfort, care and recovery. Instead, the patients are in a state of fear and neglect, and staff are overstretched.
I want to humanise this issue because we are all well aware of what is happening in University Hospital Waterford. Shauna Aylward describes hell on Earth. She spent three months in the unit earlier this year. She stated:
I had no idea of what I would expect, I had no idea it would be like that. I thought this would be somewhere I could get help, somewhere I would feel safe and could get better. Unfortunately what I witnessed was a disgrace.
She said she saw a patient being dragged naked down a corridor to be put in the seclusion room and stated: "I was too scared to go to the dining area to eat ... I was starving and I began to feel institutionalised." She said conditions at the unit were sometimes so bad that "you could go out of the ward and come back and your bed was occupied by a new patient". She added, "I didn't need to be pumped full of meds, I just needed somebody to talk to me."
A spokesman for the HSE said it does not comment on individual cases. This is not an individual case, as there are so many patients affected by this. It is an absolute and utter disgrace. I wish we could have some clear indication of who is responsible for the appalling treatment of these people.
I too think it is terrible that the Minister of State with responsibility for mental health is not here. I have raised this issue in the House on several occasions. A few weeks ago, on foot of the most recent report from the Mental Health Commission, I raised it during Questions on Promised Legislation. There were clear warnings, not just in the most recent report but in a series of reports from the commission, that there are serious problems in the psychiatric unit at University Hospital Waterford. It found that residents’ general health needs were not monitored and assessed in line with their appropriate and specific needs, that physical examinations were inadequate, that residents did not have access to a supply of appropriate emergency personnel and that the unit was not clean, hygienic and free from offensive odours. We have since found out that there are people sleeping on floors, there is overcrowding and patients are given a blanket or a chair. That is completely unacceptable.
The nurses are organising a protest on Friday outside the hospital. There is a real urgency to this issue yet the Minister with responsibility is not here. People are scandalised that this is happening time and again at that unit in the hospital. Patients are telling their stories and the Minister of State with responsibility does not see fit to show up to the Dáil to take this matter. I did not get any indication why he is not here. There may be good reason but given the seriousness of this issue, with psychiatric patients sleeping on floors, it is appalling.
I will be taking this matter on behalf of the Minister of State with responsibility for mental health, Deputy Daly, and I will bring to his attention the Deputies' disappointment that he could not be here. I do not know where he is.
I thank each of the Deputies for raising this very important issue. The Department of Health is aware of the issue and officials in the mental health unit have been in constant communication with the HSE to monitor the situation. The 44-bed department of psychiatry is the designated approved centre for acute inpatient services for the counties of Waterford and Wexford, serving a catchment area of 265,000. It is acknowledged that the acute bed numbers in Waterford are below the national average and there can, at times, be issues of over-capacity. Over the October bank holiday weekend, unprecedented demand on the service put significant pressures on the department of psychiatry in Waterford. This included ten involuntary referrals. By comparison, there were 21 in the entire previous quarter.
The department of psychiatry in Waterford too immediate steps to address the over-capacity issue, including using acute beds in alternative HSE areas, private placements and specialist rehabilitation beds in long-stay centres. There are currently 43 patients in the department of psychiatry at University Hospital Waterford and considerable efforts are ongoing to manage the demand on the service and where appropriate, discharge planning to community mental health teams and facilities.
Regarding the allegations made by an employee in the media, I assure all the Deputies that the Department takes patient safety and health care very seriously. In that context, the mental health unit has asked the HSE to investigate these allegations and report back. The HSE has assured the Department that the situation is being constantly monitored by both local and national mental health service management and the new clinical director for the department of psychiatry, who started this week, is expected to further assist in overall clinical management.
The HSE, in conjunction with University Hospital Waterford, is in the process of reviewing the existing department of psychiatry to assess long-term options to increase capacity. They will keep the Department of Health informed of any developments in this regard. The Minister of State, Deputy Daly, will also be meeting Deputy Browne next week to discuss this issue. A total of €39 million has been added to the mental health budget for 2020, increasing the annual allocation to €1.026 billion. This represents an increase of over €315 million since 2012. This funding will help in the continued improvement and development of mental health services. Funding alone is not enough. We also need to consider how we deliver services and how we can reduce demand for the specialist mental health services. In this regard, the HSE is introducing a number of digital mental health initiatives that are being driven by the Department of Health. These include telecounselling and telepsychiatry reports.
A pilot has been undertaken in the Wexford-Waterford region and will provide remote psychiatric consultations for the child and adolescent mental health service, CAMHS. Greater use of the technology available to us will help to deliver services at as early a stage as possible and will help to ensure that mild mental health issues are dealt with before they become more serious. These initiatives exemplify the serious intent of the Government to progress and improve mental health services not just in Waterford but throughout Ireland.
The fact the Minister of State with responsibility for mental health could not even give a reason as to why he is not here is totally unacceptable. It shows the Government’s level of contempt for this House.
There is nothing new in this case. The Mental Health Commission found that the Waterford department of psychiatry had a mere 57% compliance rate this year. The alternate unit nearby, St. Luke’s in Kilkenny, was prosecuted in the criminal courts for patient neglect. This shows the lack of care provided across the south east. There was nothing in the HSE’s capital plan this year for the provision of new units in the south east. There is a mention of a business case. Where is the healthcare or moral case? Why does one need a business case to ensure patients should not be left lying on floors or sitting in chairs?
People recover best when they are treated locally. The Minister of State’s response referred to remote psychiatric consultations. That is of no benefit to people who need inpatient care, however. We used to have one of the highest numbers of psychiatric beds in the world. Too many people were kept in inappropriate facilities. We now have the complete opposite with a complete shortage of inpatient psychiatric beds in which people can recover. The Minister needs to intervene and put a plan in place for the south east to ensure psychiatric patients can recover in a safe and appropriate environment.
In her response the Minister of State referred to Waterford general hospital. It is not a general hospital. It is a university and regional hospital. The Government might want it to become a general hospital. It is certainly doing its best to reduce it to that level. It is a university hospital and it should be given its correct title.
I am not taking this out on the Minister of State but people in the south east and across the State have been shocked by the images of psychiatric patients lying on floors in the unit in question due to overcrowding. It is beyond a scandal. It has been highlighted time and again by politicians in this Chamber and by people who work in the unit. They are not to blame. Nobody can blame the staff in the unit for what is happening. This is a capacity issue. St. Senan's hospital in Wexford was closed several years ago which was the start of this problem. Patients from Wexford are referred to Waterford but it does not have the capacity to deal with them. There are 44 beds, 14, acute and 30, sub-acute, in Waterford department of psychiatry. They are taken up every day and there is oversubscription.
I cannot understand why the Government is not dealing with this issue. What is the point of us raising this issue in the Chamber if the Minister of State with responsibility for mental health is not here? It is frustrating. People are angry that this is happening to patients in that unit in Waterford. The Government needs to do more.
I thank the Minister of State for her reply but I might as well have been looking at the blank side of the page. It was totally inadequate.
This scandal is happening all over the country, not just specifically in Waterford. The Minister of State with responsibility for mental health and the Minister for Health have copies of protected disclosures from personnel in mental health services. They have not been acted on, however, in the past six months. It is appalling and atrocious how patients are treated.
For Christ’s sake, will the Government do one thing right? Will it respect the people who tell the truth in this country? Will the Government respect the patients in the mental health services and the staff who are doing their best? Of all things, the Government cannot expect young people to sit 31 hours on a chair and 11 hours on a trolley only to be told there is nobody to see them.
Mental health services are shambolic. If the Government does not start investing in people and stop giving us fantasy figures, we will have more deaths on the books. It will be the Government’s fault. Will the Minister of State take this issue back to the Minister responsible? The time for talking is over. It is time for action because people are suffering. I will not be responsible for another death but the Government will be.
I acknowledge the frustration, anger and the horrific stories relayed here this afternoon. I am not in a position to comment on them, however. Nobody in any hospital should be subjected to some of the behaviour referred to in the allegations made earlier. I cannot comment on them but when people are sick they need the best care. Staff in all hospitals, mental health or otherwise, do their utmost to facilitate people and look after their health and well-being.
I do not know where the Minister of State is. However, there is an option that if a responsible Minister cannot be here, a Deputy can withdraw his or her Topical Issue matter. I do not know what happened today.
I just know he cannot be here this afternoon.
Everything is being done through private placements and special rehabilitation beds in long-term care centres to deal with the overcrowding in the area. As has been mentioned before, the Minister of State, Deputy Jim Daly, is confident the HSE will manage the situation effectively by taking immediate action and steps to address overcrowding. The HSE has assured the Department of Health that the situation is being constantly monitored and will be kept informed of developments in this regard. The HSE, in conjunction with Waterford general hospital, is in the process of reviewing existing units to assess long-term options to increase capacity.
I will bring Members’ concerns, as well as the serious allegations made, about the care of people in this hospital. There is an option for a Member to withdraw his or her Topical Issue matter if the Minister responsible is not available to take it. Unfortunately, I am not in a position to respond to some of the allegations made.