Tim O'Malley (Limerick East, Progressive Democrats)

I thank Senators for inviting me to speak on the National Disability Authority's recently published report, Review of Access to Mental Health Services for People with Intellectual Disabilities. I am pleased to have the opportunity to outline what the Government is doing to meet these and other needs which have been identified for people with intellectual disability.

Ireland in recent years has enjoyed increased investment in its health and social care economy, helping it to modernise services, raise standards and extend provision to more citizens in need. Additional funding amounting to €643 million has been invested in health funded support services for people with disabilities since 1997. This includes an additional €25 million in current expenditure which was made available by the Minister for Finance in the 2004 budget for services for people with disabilities.

Additional revenue and capital funding of €370 million has been provided for intellectual disability and autism services since 1997. This has provided approximately 1,700 additional residential places which are mainly based in the community. This figure also includes new residential respite places developed in 1997 and 1998. Between 1999 and 2002, approximately 465 extra dedicated respite places have been provided. In addition, 2,950 new day places were developed.

We have also funded alternative placements and an enhanced level of services for persons with an intellectual disability or autism who were resident in psychiatric hospitals or other inappropriate placements. The number of persons accommodated in psychiatric hospitals in May 2003 was 438. This is down from 571 in 2001 and from 970 in 1996. Huge progress has been made in this area and there has already been a large reduction since 2003. The new accommodation provided has included community based homes and a number of residential and day complexes.

Since 1998, approximately €16 million has been put into the system to enhance early intervention, pre-school and multi-disciplinary support services for children with an intellectual disability and those with autism. Between 1999 and 2002, the Department provided additional funding of €11.43 million to enable health boards to put in place a range of support services for persons with an intellectual disability or autism who present with major behavioural problems and therefore require a more intensive level of support.

Key developments noted in the 2002 report of the national intellectual disability database reflect this investment. There has been a 37% growth in the number of people with intellectual disability living in full-time residential placements within local communities and a 165% increase in the provision of intensive placements designed to meet the needs of individuals with challenging behaviours. This includes individuals whose behaviour may arise as a result of a dual diagnosis of intellectual disability and mental illness. There has been a 47% reduction in the number of people accommodated in psychiatric hospitals and a continued expansion in the availability of residential support services, in particular, service-based respite services, which have grown by 255%, with an additional 443 people reported as being in receipt of these services between 2001 and 2002. There has also been increased provision in almost all areas of adult day services and in the level of other support services delivered as part of a package of day services to both children and adults.

In the period 1999-2003, additional revenue funding of €78.3 million was provided for ongoing developments in mental health services, to develop and expand community mental health services, to increase child and adolescent services, to expand the old age psychiatry services, to provide liaison psychiatry services in general hospitals and to enhance the support provided to voluntary agencies. Approximately €190 million in capital is being provided over the lifetime of the national development plan to fund the development of acute psychiatric units linked to general hospitals, as a replacement for services previously provided in psychiatric hospitals. Substantial progress has already been made and 21 general hospital psychiatric units are now operational. It is expected that a further unit will become available to the mental health services in the near future.

Substantial progress has been made in recent years in ensuring that those in need of mental health services receive care and treatment in the most appropriate setting. Health boards have developed, and are continuing to develop, a modern comprehensive community-based mental health service. This has resulted in a continuing decline in the number of in-patients, with a corresponding increase in the provision of a range of care facilities based in the community to complement in-patient services. It is intended to continue to accelerate the growth in alternatives to hospitalisation with the further development of community based services throughout the country. There are approximately 400 community psychiatric residences in the country, providing more than 3,000 places. This compares to 111 residences, providing less than 1,000 places, in 1984. Approximately 200 day hospitals-day centres provide more than 3,500 places. This compares with 39 such centres, providing approximately 1,200 places, in 1984.

The new Mental Health Commission, established in April 2002 under the provisions of the Mental Health Act 2001, has an important role to play in improving the quality of our mental health services. The primary functions of the commission are to promote and foster high standards and good practices in the delivery of mental health services and to ensure that the interests of detained persons are protected. The Mental Health Commission is now working, along with officials from my Department, to put in place the structures required for its new role. The commission has appointed an inspector of mental health services and the inspector will be required to visit and inspect all approved centres at least once a year. The inspector's annual report and review of the mental health services will be published and laid before the Houses of the Oireachtas along with the commission's annual report.

There are, however, a significant number of people whose needs intersect both services, those with a dual diagnosis of intellectual disability and psychiatric illness and-or challenging behaviour. The NDA report states that published evidence suggests that approximately 8,000 people with an intellectual disability in the State also have a psychiatric condition. Some 4,500 of these may require some type of specialist assessment and treatment.

The NDA report states that persons registered with a generic intellectual disability service provider find it difficult to gain access to appropriate mental health services for assessment, treatment or continuing care. In some areas, local informal arrangements exist to provide emergency assessments and treatment, but a defined service appropriate to the needs of the dual diagnosis group does not exist nationally at present. The report of the review group on mental handicap services, Needs and Abilities, which was published in 1991, recommended that people with a mild intellectual disability should not be referred to the specialist intellectual disability services, but should access generic services, including generic mental health services. The NDA report has also outlined some of the reasons this approach is not working for people with a mild intellectual disability as regards accessing mental health services.

My Department has been concerned about this issue and has endeavoured over a number of years to encourage and assist health boards to put in place arrangements to improve access to services for this group. Two specific initiatives now present my Department with an opportunity to progress this matter. The first is the national policy framework for mental health services. The health strategy, Quality and Fairness — A Health System for You, includes a commitment to prepare a new national policy framework for the further modernisation of mental health services, updating the 1984 policy document, Planning for the Future, and taking account of significant initiatives and policy developments which have occurred in the interim. An expert group on mental health policy was established in 2003 to prepare this national policy framework. It is envisaged that the expert group will examine, among other issues, access to psychiatric care. Last year the group requested submissions from interested organisations, individuals and the public on the issues concerned and more than 140 submissions have been received. Each submission received will be carefully read and considered by members of the expert group and will feed into the group's deliberations over the next few months. It is expected that the expert group will complete its work in 18 months.

In accordance with a commitment in Sustaining Progress, the social partnership agreement for 2003 to 2005, my Department is required to carry out a strategic review of existing service provision, in consultation with relevant interests, with a view to enhancing health and personal social services to meet the needs of people with intellectual, physical and sensory disabilities and autism. This review is particularly timely for the following reasons: the period of time which has elapsed since the publication of the relevant policy documents in this area; Government policy in relation to mainstreaming services for people with disabilities; the level of additional funding invested in the services in recent years; the publication in 2000 of the health strategy, Quality and Fairness — A Health System for You, and the primary health care strategy; the health services reform programme approved by Government and published in June 2003 and the new legislative measures being introduced in the area of disability.

This review will examine a number of specific areas of service provision, including access to mental health services for people with intellectual disability and those with autism. The strategic review has a similar timeframe to the expert group on mental health services and both groups will take into account the recommendations contained in the report published by the National Disability Authority in terms of their respective services.

Substantial progress has been made in recent years in ensuring that those in need of mental health or disability support services receive care and treatment in the most appropriate setting. However, much remains to be done. I am committed to the provision of quality care in both areas and I will continue to endeavour to secure additional funding for these sectors in the coming years. The active participation of all involved will assist in progressing what is ultimately most important, namely, the delivery of quality and cost effective services to people with a dual diagnosis.

I congratulate the National Disability Authority on the publication of a timely and informative report. This is one of a number of reports published recently by the NDA. The other two cover the areas of service provision for people with disabilities and further education, training and employment services. I assure those who gave of their time and expertise to enable these reports to be published that they will be of great assistance to the service reviews which are currently underway. I also encourage them to take any opportunities which may arise over the coming months to make further contributions to this process. The active participation of all involved will assist in progressing what is ultimately most important, namely, the delivery of quality and cost effective services to people with a dual diagnosis. It will also guide the planning, development and delivery of mental health and disability support services over the coming years.