Seanad debates

Thursday, 17 February 2005

Mental Health Commission Annual Report 2003: Statements.

 

12:00 pm

Don Lydon (Fianna Fail)

Regarding Senator Feighan's comments about the Tánaiste, her statements have an adamantine veracity about them and her integrity is unassailable.

I welcome the Minister of State to the House. He is a caring man and will take some of the remarks made this morning in the spirit intended because they are aimed at helping a vulnerable sector of our population.

In 1984, the Planning for the Future document charted a course for a community care model of psychiatry which, for the most part, is very good. There are, however, deficiencies. The larger institutions were closed down. They were Victorian and out of date but many of the people who were discharged were incapable of functioning in a community care model. It was incorrectly assumed that some people with long-term illnesses, particularly schizophrenia, would be able to operate from group homes and do all the things people do without much support, or even with it. That is not what happened. Many of the people who had places in some of these hospitals ended up homeless.

It was right to close down the large hospitals but in the smaller psychiatric hospitals, people had a routine, support and their own lifestyle, with the hospital acting as a town or village in the community. Most of all, they felt safe and secure. They did not want to cope with some of the problems presented by life; they needed to be cared for. Although the community care model proposes that this be done within a group home setting, it is not the same and it is sometimes difficult for people. We must recognise that there are people who will always need care in a hospital not because they will do anything out of the blue, but simply because they are unable to cope with the vicissitudes of normal life. They are vulnerable and they need help. It behoves every Government, irrespective of party, to look after these people.

I feel for these people because I have seen some of them who were forced out of hospitals, who wandered around and came back in temporarily for respite care or as the result of an acute breakdown. It was expensive to house them permanently in hospital. Many would say it was demeaning but it was not. They had a routine in their lives, they knew where they were, and they were secure and safe.

The rest of the community care model is excellent because it involves everybody — general practitioners, psychiatrists, social workers, psychologists, community nurses and so on. Where it works, it works well but it is a very expensive model. It requires a huge support team, which is not always provided. For most illness types it works well. It works for people who can reside in group homes or in their own homes and for people who only need respite care from time to time.

Another issue to which I want to refer is adolescent psychiatry. I do not say child and adolescent psychiatry but adolescent psychiatry. Adolescents are a special group, especially those between the ages of 12 and 18, sometimes younger, sometimes older, depending on the maturity of the person. This is a special group of people who are not children and who are not yet adult. Sometimes they are adult in a physical and intellectual sense but certainly not in an emotional sense.

I am familiar with this cohort. I was the first psychologist ever to be awarded a Council of Europe medical fellowship to go abroad and study the residential treatment of disturbed adolescents. I later served on the then Department of Health consultative body on the residential treatment of disturbed adolescents. No matter how we tried nothing really happened. Dr. Tom Brennan, a wonderful psychiatrist and one of the most erudite and caring men I have ever met — I say erudite in the widest sense of the word — was a member of that group. We subsequently opened an adolescent unit at St. John of God Hospital but were eventually forced to close it.

There are two places in the country for adolescents, Warrenstown House and St. Anne's in Galway, but there is a need for many more. The reason these are not provided is that they prove so expensive to run. Such units must work not only with the adolescent but with his or her family. A family-based approach is essential because one cannot possibly alter a young person's behaviour in any way without dealing with the parental expectations and so on. Much work is required involving many people, including psychologists and psychiatrists. I am glad more child and adolescent psychiatrists have been appointed. However, they are mostly child and adolescent psychiatrists and are not specialists in the area. Dr. Tom Brennan was one of the first adolescent psychiatrists to be appointed here and Dr.Terence Larkin is also a wonderful adolescent psychiatrist.

A psychiatrist cannot run a unit like this on his or her own. It requires specialised nursing, not just psychiatric nurses but nurses who have some interest and training in adolescent psychiatry. Adolescent psychiatry is different from child psychiatry and is much different from adult psychiatry. Adolescents are a very vulnerable group. I am not criticising any Government in my comments. Even the Minister of State said here today that the working group noted that many of the child and adolescent psychiatric teams currently in place do not have the full complement of team members required and recommended and that priority should be given, in the first instance, to the recruitment of the required expertise for the completion of existing teams. I praise the Minister of State for that statement because it is an acknowledgement that a service does not exist and this must be a priority. I would like the Minister of State to put some effort into this area — I am not saying he will not — because adolescents are a group that can be helped.

I have seen adolescents change their behaviour again and again. I worked in adolescent psychiatry for approximately five years and had connections with it afterwards. There is a wonderful organisation called Citywise. It is run by a man called Mark Hamilton. He started a little place in Dublin and now has a large place in Jobstown. He enlisted the help of local builders and developers and is building a large facility. He has a place in Belfast, one in Limerick and another somewhere in the midlands. The adolescents he takes in have no hope. They are usually illiterate, wild, totally unruly and come from broken homes. Some of the parents are drug addicts, murderers and so on, yet he fills them with a sense of their own well-being, somehow motivates them and shows them there is hope in life. I commend people like that. He does not deal with psychiatric problems. Some of the people he deals with have psychiatric problems, but that is not his primary function.

Even the unit in St. John of God Hospital, which is quite a good hospital, had to close because it did not have the required staff. The staffing complement for such units is very high as adolescent services are very expensive to run. The State must ask itself whether it is worth investing in a young person. I can tell the House from experience that it is. Many of them can come out at the other end, have a meaningful adult life, get a job, get married or settle down. If there is sufficient input into their treatment, they can blossom. Some people will always have severe psychiatric illnesses in their adult life, but with medication or through other means will sometimes live a normal life. Although they may sometimes have a relapse, for the most part they can be helped.

I implore the Minister of State to focus on this area. If somebody leaves a child on one's doorstep one would need to be very heartless not to do anything about it. Somebody will care for the child. An adolescent in a family who has behavioural problems or psychiatric problems or an illness of some kind affects the whole family, not just himself or herself. There is a ripple effect; older and younger children are affected as are the parents who must devote so much time to this person. I am not referring to autistic children or people with neurological problems. I could range over many different areas of psychiatry, but this is one area I know about and about which I am concerned. I am glad the Minister of State made that acknowledgement in his speech. On behalf of these adolescents, so many of whom I have met, I ask the Minister of State to do his best to get the facilities for them. It would ultimately pay the State to help them, and this would ultimately benefit society as well as the children and their families.

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