Camillus Glynn (Fianna Fail)

Ba mhaith liom fáilte a chur roimh an Aire Stáit agus tréaslú leis as ucht na sár-oibre atá déanta aige dóibh siúd atá faoi mhíchumais intleachta. É sin ráite, tá níos mó le déanamh fós. Mar a deir an seanfhocal, "Tús maith leath na hoibre". Since assuming his present role, the Minister of State has been a hands-on Minister and has achieved a great deal but even he must acknowledge there is much more to be done and we all recognise that. I welcome this timely report which affords us an opportunity to review what has been achieved and assess what more needs to be done. I cannot agree with Senator Feighan's statement that progress has been painfully slow. It has not. I am a former psychiatric nurse and in the 1970s a colleague and I carried out an assessment using case notes to establish how many people with an intellectual disability had been admitted to a hospital in the midlands. Arising from that, the Lough Sheever centre was established and at least three wards were occupied by people with an intellectual disability. They received all the services that pertained at the time to their requirements. A similar development occurred at St. Fintan's hospital in Portlaoise when Alvernia House was set up.

Hearing the statistics read by the Minister of State, we all accept that 438 people in psychiatric hospitals as of May 2003 is 438 too many. However that number is down from 571 in 2001 and 970 in 1996. Can anyone imagine the numbers in the mid-1970s? Great strides have been made since then. Nevertheless, we need to do more. Only six beds are provided in Stewart's Hospital for the specialised treatment of people suffering a psychiatric illness and an intellectual disability. That is the only control which the Inspector of Mental Hospitals holds over those people. During the reigns of successive Governments the inspector has made adverse comments about the psychiatric services with many of which I agree. Much of the publicity around these comments is unfair because the local media give the impression that the medical, nursing and other staff are to blame for the conditions which they are not. We want to place that on the record.

I had a very pleasant experience yesterday. I was served in a shop in my local hospital by a girl with an intellectual disability. I was so pleased, because she went to school with my daughter. I placed my order, the girl charged me the appropriate amount and I got my correct change. There is no big deal about that as it is what I expected. This girl is not the only intellectually disabled person employed by the Midland Health Board or indeed by other boards.

While accepting that we have achieved much, there is more to be done. Page 64 of the report refers to "community area mental health/intellectual disability teams". I strongly favour the model proposed by the Irish College of Psychiatrists and I feel sure the Minister of State favours it too. In supplying mental health services to people with intellectual disability, the proposal is that the team should ideally comprise two consultant psychiatrists, four psychologists, four psychiatric nurses, four social workers, four registrars, two occupational therapists, one speech and language therapist and four administrative officers. The registered disability nurses for the intellectually disabled should be incorporated in that team, because we are speaking of an appropriate nursing discipline which should be used.

Reference has also been made in the report to secure units in the community, and this report is valuable because it highlights what is positive and negative about them. The report notes how skilled the staff have become in dealing with people in residential care in these units. That is fine, but it is clinically proven that there can be a downside for the clients.

To ensure progress, we must devolve additional resources and provide appropriately trained people. I served on a health board for many years and had the honour of being chairman for two years, up to last July. We currently have 943 adults and 470 children on the Midland Health Board's intellectual disability database. Like any community member, people with intellectual disabilities require intervention of the mental health services on an episodic and sometimes continuous basis. The mental health needs of many of these people can be appropriately met by the generic adult and child adolescent mental health services. However, some may require more specialised intervention. In this regard, the Midland Health Board has in recent years appointed a consultant child and adolescent psychiatrist with a special interest in learning disability, including autism, and a consultant general adult psychiatrist with similar interests, along with some support staff. The board will continue to augment and develop these services as resources permit. We must put in more resources because the report has identified the appropriate areas and recommendations have been put forward which must be acted on as far as possible. Like all recommendations, they are mainly resource-driven.

The report notes that the board's residential services for adults with intellectual disability were formally de-designated from the mental health services approximately 15 years ago. In recent years the board has invested significant capital and revenue funding to relocate people from large residential centres to more home-based community settings. The report says that completion of this process will be continue to be a key priority.

The resources devolved to community places have brought a significant improvement for those with intellectual disabilities or psychiatric illness and for their parents. During my health board service, I have seen the great benefit of that, but we must do more to provide appropriate trained nursing and medical staff, along with back-up personnel. Regarding secure or special needs units, recommendations have been made with the support of the Eastern Regional Health Authority, the statistics have been given and the cost analysis has been done. Many of the recommendations are well thought out. So far in his portfolio the Minister of State has made very good use of his time, and I know he will consider the positive and well-researched suggestions in the report.