Frank Feighan (Fine Gael)

I welcome the Minister of State to the House. I also welcome the opportunity to debate this important report on a neglected area of our health and disability services. Like the Minister, I congratulate the National Disability Authority on taking the initiative in this area and on the production of a report which makes depressing reading for those of us in public life who have a role to play in the development of public policy and services.

The availability and appropriateness of mental health services has long been a neglected area. One must read the many hard hitting reports of the inspector of mental hospitals in recent years and the appeals made by mental health patient advocacy groups to understand the severe gaps in services throughout the country. This report highlights the enormity of the problem facing a group of people, namely, those with an intellectual disability, who may have experienced inadequate and inappropriate services for many years. According to the national intellectual disability database, 515 people with intellectual disabilities are resident in psychiatric hospitals. Many of those people are inappropriately placed in full-time psychiatric care. However, there are shortfalls in the services for people who may genuinely require psychiatric and mental health services. Almost 34% of people with an intellectual disability also have a psychiatric condition and more than half of them may require assessment and treatment.

The report was published during the European Year of People with Disabilities when Ireland had the honour of hosting the Special Olympics. On the eve of the publication of the long promised and eagerly awaited Disability Bill, any feel good factor which was generated during the Special Olympics last summer has been diminished by this report. As a society, we are moving away from the paternalistic model of disability and are moving slowly towards a recognition of the human rights of individuals with a disability. The parents, families and advocates of people with intellectual disabilities have driven much of this progress. The approach lays increasing emphasis on the participation of persons with a disability and their representatives in the formulation and implementation of plans and policies affecting them. The current mental health service provision is grossly inadequate. The review underlines the very stark and unpalatable fact that there is incoherence in the strategy of the Department of Health and Children. Meanwhile, in my area, a group of parents of children with disabilities have for many years sought reasonable dental care for their children, to no avail. Several of my Oireachtas colleagues have asked about this in the Dáil. I raised it on the Adjournment here last year and the Minister of State responded, as did the Minister, Deputy Martin, when it was raised with him. The response of each Minister is to pass the responsibility on to the CEO of the Western Health Board yielding no improvement.

When will people take responsibility? As the group finds it nigh impossible to resolve this issue, which requires limited resources, what hope is there for initiation of the broad framework service envisaged in this report? These difficulties should be resolved here but once again they are passed down through the bureaucracy. There has been no intervention in this area and I ask the Minister of State to intervene as soon as possible.

People with intellectual disabilities do not enjoy the same right to a range of mental health services as the general population, and community services are virtually non-existent. There is no clear route to support during acute psychiatric episodes for people with intellectual disabilities. While many reports have been published and many policies espoused, there has been little progress due to the lack of leadership at a political and policy implementation level. There are in the State only six psychiatric hospital beds dedicated to the in-patient care of people with intellectual disability who suffer from a mental illness and who are under the remit of the Inspector of Mental Hospitals. Far too few psychiatrists specialise in intellectual disability for adults and children. We cannot in conscience allow this to continue.

I agree with the NDA conclusion that we must act now to protect and promote the rights of all citizens with mental health problems, in particular, a comprehensive mental health service for people with intellectual disabilities must be provided urgently. To allow the current inappropriate and inadequate situation to continue is a denial of human rights. There is a pressing need for provision of primary services and the development of new services with a legislative base and a right to access and standard service must apply. At a departmental level, political and policy leadership is required to promote a national policy statement and service framework for mental health services for the dual diagnosis group. There must be consistency of services throughout the country. Geography must never be used as a barrier to service access as unfortunately is happening in my area. The realignment of the health services promised under the health strategy and the other recent major health reports must take account of these needs. Where possible, services should be provided in the community which will facilitate intervention by multidisciplinary teams during every stage of assessment, diagnosis and treatment.

There are 50 recommendations in this report covering all action areas. They must be examined, prioritised, funded and acted upon because this report is a wake-up call. There can be no further delay. The provision of appropriate services to people with a disability has been inadequate for too long. Despite investment over the past decade, progress is painfully slow. Like the Minister of State, I look forward to the publication and enactment of a comprehensive rights-based disabilities Bill as promised by the Government for this month. Some progress has been made but much remains to be done.

We celebrated wholeheartedly the Special Olympics as a showcase of excellence, ability and extraordinary talent, and I pay tribute to many of the organisers and those involved over the years, particularly last year. It was refreshing and reassuring to see that spirit of giving. Now that the games are over, we must all work together to build a truly inclusive and equal society where everyone, including and especially those with disabilities, is empowered and enabled to contribute to her or his full potential. It is a difficult area and I wish the Minister of State well. I will support him in any initiative that will help ease these problems.