Camillus Glynn (Fianna Fail)

Tá fáilte roimh an Aire Stáit go dtí an Teach. Senator Browne asked why the Mental Health Commission was established. I believe it is important this was done. I thank Senator Henry for calling for the debate, on which I was pleased to support her. The Mental Health Commission has pulled all the strands together and produced a very conclusive and informative report. Not alone has it set out the objectives of what psychiatric care should be, but it has also established what has been achieved since the publication in 1984 of Planning for the Future. I remember that document very well. Mr. Liam Flanagan, who was the Secretary of the Department at the time, had a very important role to play in it. This report outlines what has happened in the interim and what we should do in the future. It gives an overview of the service as it is, as it was and as we would all like it to be.

During the last Seanad, I asked that the title of Inspector of Mental Hospitals be abolished and be replaced by an inspector of hospitals. While I did not get my way the present Inspector of Mental Health Services goes some way towards my objective. As mentioned in the commission's report, most people would agree that the old established hospitals were off-putting. I worked in one for many years and was very pleased to do so. I was very proud of the service that was provided in that institution and others. I was proud to work with male and female colleagues in that institution as well as those in ancillary services.

I wish to refer to the composition of the commission. The finest people available are members of that commission. I refer to two of them, namely, Dr. John Owens, who was a consultant psychiatrist in St. Loman's Hospital at approximately the time I qualified, and Mr. Joe Casey who is well known as the former chief nursing officer in St. Senan's Hospital in Enniscorthy.

I spent many years in the psychiatric services. It used to be that the mental hospital was the be all and end all. Senator Browne is correct in pointing out that some inappropriate placings in psychiatric hospitals took place. While these were not as numerous as some might say, I could refer to a number of them. If one took place, it was one too many. Great strides have been made in the devolution from the hospital-based service to the community-based service. In his address to us this morning the Minister of State gave some very important figures on the numbers of patients now in psychiatric hospitals compared with a number of years ago.

Substantial progress has been made in recent years in ensuring that those in need of mental health services receive care and treatment in the appropriate settings. 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 inpatients with a corresponding increase in the provision of a range of care facilities based in the community to complement inpatient services. In December 1984, 12,484 patients were in psychiatric hospitals and units, compared with 3,701 at 31 December 2003. St. Loman's in Mullingar had more than 1,100 patients and I believe it has fewer than 300 patients now, which represents a huge step forward.

I am a former member of the Midland Health Board and was an officer of the board for many years. The purchase of community residences led to resistance from local people. I was somewhat annoyed that the same people would be quick to identify people they believed should have been in the care of the psychiatric services. They were happy to suggest that such people should go to hospitals and be treated for their condition for a period. However, when those patients wanted to come back into the community the same people showed hypocrisy in not wanting them back and wanted them to stay behind the closed doors and high walls.

I refer to what the Minister of State said about the implementation of the provisions of the Mental Health Act 2001. The rights of some, but not all, who were admitted to psychiatric hospitals, have been infringed and in some cases inappropriate placings were made. I refer to the past in the main; I am not aware of any such cases in recent times. It is imperative that they be entitled to due process. In some cases it was not because they had been diagnosed as having a psychiatric illness but that people were recommended for detention by a Garda superintendent or by a superintendent community welfare officer. It is doubtful that people in such positions had any notion as to what psychiatric illness was about. However, people were detained on the word of such people. I am sure those people were fine people in their own right. However, that was what happened under the Mental Treatment Act 1945 and it was wrong.

The detailed programme of the commission is a matter for the commission to determine in accordance with its statutory functions under the Mental Health Act. However, the commission has indicated that one of its priorities in coming years will be to put in place the structures required for the operation of the mental health tribunals. The mental health tribunals, acting under the aegis of the Mental Health Commission, will conduct a review of each decision by a consultant psychiatrist to detain a patient on an involuntary basis or to extend the duration of such detention. The review will be independent and automatic, and must be completed within 21 days of the detention or extension order being signed. 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 and the commission will also operate a scheme to provide legal aid to patients whose detention is being reviewed by a tribunal. This process is expected to commence in 2005. From a human rights point of view this is imperative. While it should have been done years ago, as the old saying goes, it is never too late to do the right thing.

The commission report also refers to nurse training. While the psychiatric services have some 5,000 nursing professionals, the age profile is unsatisfactory. Back in the 1980s many if not all the training schools were closed. One was closed in St. Fintan's in Portlaoise, in my health board area, and another was closed in St. Loman's in Mullingar. Based on its results, St. Loman's had the unique distinction of producing the finest students in the country.

When the nursing schools were closed, they were not replaced. I fought a battle for 14 years before a college of nursing was established in the former Midland Health Board area. The former Minister for Health and Children, Deputy Cowen, established such a college, with links to Athlone Institute of Technology. The training of psychiatric nurses has recommenced, thankfully, although it has happened somewhat late in the day. The report states that the age profile of the psychiatric nursing profession is unsatisfactory. I understand that the average age of a psychiatric nurse is 45, which is not acceptable in such a profession.

Reference has been made to funding. Everyone accepts that the community-based service is by far the best one. As someone who has always been passionate about this area, I certainly accept that view. The Mental Health Commission report points out that such a service ensures that people are treated with the minimum of disruption to their lives. I do not doubt that the placement of former patients of psychiatric hospitals in high-support, medium-support or low-support community residences is by far the best way to treat psychiatric illness. Indeed, such people are sometimes discharged into the community. People who are committed to psychiatric hospitals on an involuntary basis need special care. I ask the Minister of State to consider the provision of three or four special care units for such people. As the behaviour of such people is so challenging, the units should have a small number of residents and a high level of staffing, possibly on a one-to-one basis. The people in question are a potential danger to themselves and other members of society.

I will not speak for much longer because the Minister of State summed up this matter well in his speech, but I wish to refer to the need for new acute psychiatric units at general hospitals. I have argued that there is a need for longer-stay units. Successive Ministers have agreed with professionals in this area who have said that the best approach is to locate an acute unit in a multidisciplinary setting on the campus of a general hospital. They are right to advocate such an approach. The Minister of State referred to the number of new units which have opened.

I assure Senator Henry that phase 2B of the project in the Midland General Hospital at Mullingar is ongoing. I am pleased that a new psychiatric unit will be developed there. Provision will be made for additional child and adolescent psychiatry services which are being provided at Mullingar at present, although not to the extent we would like. I note the Mental Health Commission's important comments about services for people in their late teens. My experience has taught me that people in that age group can encounter serious difficulties. The necessary facilities to cater for such people have not been in place. There is a psychiatry of later life unit at St. Loman's Hospital in Mullingar. I will not mention the name of the excellent consultant who works there, as he is not a Member of the House. I do not doubt that the unit has had great success as a consequence of the work of that consultant.

I wish to conclude by talking about suicide. One of my first experiences when I was a trainee psychiatric nurse was to be given what was known at the time as a "red card". That meant I had to ensure that a patient in my care did not commit suicide. It was outrageous to give a young nurse such a responsibility. The patient in question was approximately 6 ft. 3 in. whereas I was approximately 5 ft. 7.5 in. and approximately ten stone. One can imagine what would have happened if he had wanted to do something. I would have had little chance of preventing him from doing so. My colleagues and I succeeded in ensuring that he did not commit suicide, thank God, and nothing happened.

The study of suicide has not progressed as a science. As I have said on previous occasions in the House, few families or homes have not been touched by the cold fingers of suicide. Young males are primarily the victims of suicide. We can all help to combat this social problem. There is a significant demand among young people for moral support. It is true that the young people of today are better educated than previous generations, but that does not mean they do not need to be supported. Every member of society has a role to play in preventing suicide. A certain individual with whom I was very familiar committed suicide in the not too distant past. It happened out of the blue — there were no signs, symptoms, utterances or other signals such as body language. I am as wise today about what caused it as I was at that time. I do not know what caused it and neither does anybody else.

The report of the Mental Health Commission is timely and extremely important. The Minister of State and I have discussed the psychiatric sector, in which he has an abiding interest, on a number of occasions. It needs to be given greater funding. When a problem is diagnosed and a prescription is written, the prescription needs to be funded. I ask that the many great proposals in the commission's report be implemented. Everybody should co-operate in their implementation.