Tim O'Malley (Limerick East, Progressive Democrats)

I welcome this opportunity to make a statement in the House concerning the second annual report of the Mental Health Commission. This report relates to the year 2003. The Mental Health Commission was established in April 2002 under the provisions of the Mental Health Act 2001. The Act is a most significant piece of legislation and its purpose is twofold. First, it provides a modern framework within which people who are mentally disordered and who need treatment or protection, either in their own interest or in the interest of others, can be cared for and treated. In this regard, the Act brings our legislation in respect of the detention of mentally disordered patients into conformity with the European Convention on the Protection of Human Rights and Fundamental Freedoms.

The second purpose of the Act is to put in place mechanisms by which the standards of care and treatment in our mental health services can be monitored, inspected and regulated. The Mental Health Commission is the main vehicle for the implementation of the provisions of the Mental Health Act 2001. The commission has 13 members, including a practising barrister, two registered medical practitioners, two consultant psychiatrists, two representatives of the nursing profession, a social worker, a psychologist, a representative of the general public and three representatives of voluntary bodies promoting the interest of people suffering from mental illness, of whom two have themselves suffered mental illness in the past.

The commission is chaired by Dr. John Owens, former clinical director of mental health services in Cavan-Monaghan. The commission appointed Ms Bríd Clarke to the position of chief executive officer in 2002 and a full complement of 23 staff has been recruited and appointed since then. Directors have been appointed to head the two main divisions, one dealing with standards and quality and the other with tribunals. Under the provisions of the Mental Health Act 2001, the previous office of the Inspector of Mental Hospitals has been replaced with the office of the Inspector of Mental Health Services. Dr. Teresa Carey has been appointed to the position of Inspector of Mental Health Services and together with her team of assistant inspectors has commenced a programme of inspections of mental health services. The commission has also acquired and refurbished suitable premises and now operates from St. Martin's House, Waterloo Road. As I have indicated, one of the principal responsibilities of the Mental Health Commission is to promote and foster high standards and good practice in the delivery of mental health services.

The Mental Health Act 2001 requires the Inspector of Mental Health Services to visit and inspect every approved centre each year and to visit and inspect any other premises where mental health services are being provided, as the inspector believes appropriate. This includes community residences and day centres as well as acute inpatient facilities. The inspector is then required to carry out a review of mental health services in the State and furnish a report in writing to the Mental Health Commission. The inspector's review of the services, including reports of inspections carried out, is published along with the Mental Health Commission's annual report and is laid before both Houses of the Oireachtas. The inspector's annual report, which is before us today, informs the commission, the Minister for Health and Children and all interested parties on the current state of affairs within the mental health services.

The annual report of the Mental Health Commission for 2003 includes for the first time the report of the new inspector. This report, unlike future reports from the Inspector of Mental Health Services, does not incorporate reports on mental health services inspected in 2003. These inspections were completed by the former Inspector of Mental Hospitals and were published separately.

The aim of Dr. Carey's more limited report for 2003, her first year in office, is to inform the commission on the role of the inspectorate and how it plans to carry out its duties. Dr. Carey indicates she will prioritise inspection of service delivery rather than inspection of structures, as the availability of resources and the way in which resources are used have a major impact on service quality. To this end, the inspector intends meeting service managers and providers to discuss and jointly evaluate local services. The inspector will obtain the perspective of general practitioners, local gardaí and other referring agents. She also indicates her intention to develop ways of ensuring that the views of service users and providers are sought and recognised.

In her report Dr. Carey sets out her intention of working closely with the Mental Health Commission to ensure the commission's priorities and policies are reflected in the inspection process. This will allow the commission to be fully informed about issues of quality in service delivery and will facilitate the commission in its statutory obligation to promote high standards and good practice in the delivery of mental health care.

Dr. Carey's first report highlights current issues within the mental health service, trends in mental health service delivery and the inspectorate's views on priority areas which need to be addressed in modernising mental health services. She refers to the 1984 document, Planning for the Future, which recommended the establishment of a comprehensive, community-orientated mental health service as an alternative to institutional care for persons with mental illness. A shift from a predominantly hospital-based service to a service delivered to patients with the least disruption to their daily lives in the community has taken place in recent years with significant improvements in standards of patient care.

In recent years there have been dramatic changes in both the concept and practice of mental health care delivery. Major strides have been and continue to be made in developing a comprehensive, community-based service which is integrated with other health services. I am fully committed to furthering the process of providing community-based facilities. Under the national development plan significant capital funding has been made available to the mental health services. A major part of this funding has gone towards the development of acute psychiatric units linked to general hospitals as a replacement of services previously provided in psychiatric hospitals. In addition to the 22 acute units in place, a number of units are at various stages of development. In 2003 new acute psychiatric units opened in Kilkenny and Castlebar. In 2004 a new unit opened in Portlaoise and two more such units at Connolly Hospital, Blanchardstown, and St. Vincent's Hospital, Elm Park, are expected to open in the near future.

The plan also provides for more community facilities. Services have been developed towards creating a modern, comprehensive community-based mental health service. This has resulted in a continuing decline in the number of inpatients with a corresponding increase in the provision of a range of care facilities based in the community to complement inpatient services. Approximately 418 community psychiatric residences provide more than 3,210 places. This compares with 391 residences providing 2,878 places in 1997. These developments have resulted in a continuing decline in the number of inpatients. In December 1984, there were 12,484 patients in psychiatric hospitals and units, compared to 3,701 at 31 December 2003.

However, I accept that, as Dr. Carey points out in her report, much remains to be done. I am committed to providing quality care in the area of mental health, upholding the civil and human rights of those who suffer from mental illness and encouraging measures aimed at combating the stigma often associated with such illness. During my term of office as Minister of State with special responsibility for mental health, I am endeavouring to continue to accelerate the growth in more appropriate care facilities for people with a mental illness through the further development of community-based facilities throughout the country.

The annual revenue expenditure on our mental health services reached €725 million in the 2005 Estimate. This has allowed for the development and enhancement of multidisciplinary teams in the areas of child and adolescent psychiatry, psychiatry of later life, liaison psychiatry, rehabilitation psychiatry and suicide prevention programmes and support for the voluntary sector. An additional €15 million revenue funding has been made available for the further development of mental health services in 2005.

The inspector refers to the continuing need to develop specialist psychiatric services. The need for these services has been recognised for some time and substantial progress has been made in putting these services in place. With regard to child and adolescent psychiatric services it was accepted that, with the increasing pressures on young people, there was a need to improve responses to their mental health needs. A working group was established by the Minister for Health and Children in June 2000 to examine the state of child and adolescent psychiatric services, carry out a needs analysis of the population aged under 18 years for such services, identify shortcomings in meeting such needs and make recommendations on how child and adolescent psychiatric services should be developed in the short, medium and long term to meet identified needs.

The development of child and adolescent psychiatric services has been a priority in recent years. Since 1997 additional funding of almost €19 million has been provided to allow for the appointment of additional consultants in child and adolescent psychiatry for the enhancement of existing consultant-led multidisciplinary teams and towards the establishment of further teams. This has resulted in the funding of a further 19 child and adolescent consultant psychiatrists. Nationally, there are now 52 such psychiatrists employed.

The first report of the working group on child and adolescent psychiatry published in March 2001 recommended the enhancement and expansion of the overall child and adolescent psychiatric service as the most effective means of providing the required services. The working group found that internationally acknowledged best practice for the provision of child and adolescent psychiatric services is through the multidisciplinary team. It noted that many of the child and adolescent psychiatric teams currently in place throughout the country do not have the full complement of team members required and recommended that priority should be given, in the first instance, to the recruitment of the required expertise for the completion of existing teams.

The first report also recommended that a total of seven child and adolescent inpatient psychiatric units for children ranging from six to 16 years should be developed throughout the country. At present, inpatient services for children and adolescents under 16 years are provided in two locations, Warrenstown House, Dublin, and St. Anne's in Galway. Project teams have been established for four such units in Cork, Limerick, Galway and one in the Eastern Regional Health Authority area at St. Vincent's Hospital,Fairview. Approval was recently given to tender for design teams for the projects in Cork, Limerick and Galway.

The second report of the working group on child and adolescent psychiatry was presented to me at the Department of Health and Children on 10 June 2003. This report contains proposals for the development of psychiatric services for 16 to 18 year olds. It recommends that, in the further development of the child and adolescent psychiatric service, priority should be given to the recruitment in each health board area of a consultant child and adolescent psychiatrist with a special interest in the psychiatric disorders of later adolescence.

The working group's report further recommends that arrangements should be made with the relevant adult psychiatric services for the admission to acute psychiatric units of persons aged 16 to 18, under the care of the consultant child and adolescent psychiatrist with a special interest in the psychiatric disorders of later adolescence, where such a consultant is available. The report emphasises the importance of co-operation and close liaison between child and adolescent psychiatry and adult mental health services and suggests that the current arrangements, whereby the adult services serve the population of their catchment are, including the 16 to 18 age cohort, should continue on an interim basis.

There is widespread concern at the rise in suicide rates in Ireland. Undoubtedly, suicide is a serious social problem in this country. There were 444 deaths from suicide in 2003. The high incidence of suicide is not confined to Ireland but is a growing global problem. Apart from the increase in the overall rate of suicide in Ireland, a disturbing feature is the significant rise in the male suicide rate, in particular that of young men. These worrying trends require further research so that better strategies are developed to help people who are particularly at risk.

Since the publication of the report of the national task force on suicide in 1998, there has been a positive and committed response among both the statutory and voluntary sectors towards finding ways of tackling this tragic problem. A suicide research group has been established by the chief executive officers of the health boards. Resource officers were appointed in all health boards with specific responsibility for implementing the task force's recommendations.

The level of funding being provided for suicide prevention is now more than 20 times greater than in 1999. A cumulative total of more than €17.5 million has been provided towards suicide prevention and research. The health strategy, Quality and Fairness — A Health System for You, includes a commitment to intensify the existing suicide prevention programmes in future. Work on the preparation of a national action oriented strategy for suicide prevention is now well under way. The proposed strategy, which will involve the Health Service Executive, the national suicide review group and the Department of Health and Children will be action based from the outset and will build on existing policy. All measures aimed at reducing the number of deaths by suicide will be considered in the preparation of the strategy, which will be completed later this year.

The Mental Health Commission and the Inspector of Mental Health Services operate independently of the Minister for Health and Children and the Department. The inspector, as an independent office holder, has a crucial role to play in providing an accurate and detailed account of services in the mental health sector throughout the country. This independent status is crucial to the advancement of the agenda for change and modernisation in the mental health services in the coming years.

The inspector has indicated in her 2003 report that the work of the Mental Health Commission is closely linked to her own, particularly in the areas of standards and quality. The Mental Health Commission will maintain a register of approved centres in which each hospital or inpatient facility providing psychiatric care and treatment must be entered. The Minister will make regulations specifying the standards to be maintained in all approved centres, including requirements pertaining to food and accommodation, care and welfare of patients, suitability of staff and the keeping of records. The Mental Health Commission will be responsible for the execution and enforcement of these regulations through the work of the new Inspector of Mental Health Services.

As well as working to ensure high standards and good practices within the mental health services, the Mental Health Commission has a second significant function. One of the key provisions of the Mental Health Act 2001 is that each decision by a consultant psychiatrist to detain a person involuntarily for psychiatric care and treatment will be reviewed. This review will be carried out under the aegis of the Mental Health Commission. The review will be independent, automatic and must be completed, except in certain circumstances, within 21 days of a person's detention. The process will begin immediately on a person's admission. All patients will have a right to review, even if they are discharged before 21 days have elapsed and the Act provides that they must be so informed when they are discharged. Reviews will be carried out by one or more mental health tribunals, consisting of a consultant psychiatrist, a lawyer and a lay person operating under the aegis of the Mental Health Commission. As part of the review process, the mental health tribunal will arrange, on behalf of the detained person, for an independent assessment by a consultant psychiatrist. The commission will also provide free legal representation to each person whose detention is being reviewed. The review of detention will be substantive and will focus on whether the person concerned is mentally disordered and whether the correct procedures were carried out in his or her detention. A tribunal will be empowered to order the release of a patient if it considers involuntary detention to be unnecessary.

The Mental Health Commission's strategic plan 2004-05 indicates that one of the commission's priorities for the coming year is to create the structures required for the operation of the tribunals. The commission's officials are working with the Health Service Executive, my Department and all stakeholders to ensure these structures are in place as soon as possible.

This House might be aware that I established an expert group on mental health policy in 2003 to prepare a national policy framework for the further modernisation of the mental health services, updating the 1984 policy document, Planning for the Future. The terms of reference for the group are to prepare a comprehensive mental health policy framework for the next ten years, to recommend how the services might best be organised and delivered and to indicate the potential cost of the recommendations.

The expert group will address many of the issues highlighted by Dr. Carey's report. The group consists of 18 widely experienced people who are serving in their personal capacity. The membership encompasses a wide range of knowledge and a balance of views on many issues affecting the performance and delivery of care in our mental health services. Dr. John Owens, chairperson of the Mental Health Commission is a member of the expert group and Dr. Carey herself works as a member of one of its subgroups.

The expert group has consulted widely in its work. Submissions were invited from interested organisations, individuals and the public in October 2003 and 150 submissions were received. These submissions are now being considered by the group and further consultative initiatives with various stakeholders have been undertaken. The views of many service users were obtained from a questionnaire issued through the service providers.

The consultation process consisted of written submissions, questionnaires, two public consultation days and one-to-one consultations with service users in the adult mental health services. On Thursday, 9 December 2004, I launched two reports which resulted from the process, Speaking Your Mind, prepared by Carr Communications, and What We Heard, prepared by the Irish Advocacy Network. The reports reflect the wide ranging knowledge and expertise that exists among professionals and service providers with regard to mental health issues. They also give a clear indication of service users' views of the present state of the mental health services and how they should be developed in the future. I believe these reports will facilitate further discussion on the role of advocacy services in the development of services for people with mental illness. They will also have a significant impact on the work of the expert group and on the future direction of mental health policy, in which the Mental Health Commission will play a key role. I thank the House for affording me the time to speak on this important issue.