Seanad debates

Thursday, 17 February 2005

Mental Health Commission Annual Report 2003: Statements.

 

1:00 pm

Photo of Ulick BurkeUlick Burke (Fine Gael)

I welcome the Minister of State, Deputy Tim O'Malley, to the House and am grateful for the opportunity to discuss this important report. I acknowledge the persistent demands of Senator Henry to the Leader over a long period to have this report brought here for discussion and I thank her for her endeavours.

I also acknowledge the stated commitment of the Minister of State to improving the state of mental health facilities and to introducing what he calls community-based facilities. Nobody in the House would disagree that improvements have been made over the years. In 1984 there were 12,900 bed occupancies in mental health institutions and in 2003 or 2004 that had decreased to approximately 2,800. That is welcome because patients who were lucky enough to get out of the institutions left behind a very dark and sad episode of their lives, perhaps a decade of institutional misery, given that the conditions in many of the institutions were of a deplorably low standard. That they have moved into community-based centres is welcome. Essentially what it means in my health board area is that we have placed patients in rented housing accommodation. They are domestic houses and by and large they are rented or leased by the health board. Over a period more patients were taken out of the institution. That is fine but it has a serious shortcoming in so far as there is a lack of therapeutic services available to them in those situations. They are in a house and are comfortable and some type of domestic life has been re-established but they do not have the services they require for rehabilitation.

While the Minister of State has given a commitment I am not speaking about the availability of funding alone but the whole area of rehabilitation. Senator Lydon mentioned that where it works, it works well. As a person directly involved he would understand the shortcomings.

In addition to the scattering of small groups of patients into communities, it is appropriate to acknowledge the wider community for its acceptance of these community centres. In a sense it is therapeutic for the community at large to realise these are people who have suffered for many years in institutions and now they are out in the ordinary community. They are welcomed into most communities but much more is needed and I do not know how it can be structured. Given that 70% of admissions are re-admissions, it is only then the penny drops that there is an inadequacy in the whole area of therapeutic support and rehabilitation. It is clear from the report of the inspectorate that is an area that is in serious need of assistance and it should be addressed urgently.

There are within some of our psychiatric institutions, particularly in the Western Health Board area, patients who are inappropriately placed. I refer to people with special needs and some disability and they have been in those institutions for decades. While great efforts have been made to relocate them in new centres it is a damning indictment of neglect by the Department and Ministers over the years that no other accommodation was available for those with special needs and a disability of some kind, other than mental disability. They were in those institutions because of absolute need and the inability of parents or family to retain them in their homes. I hope that within two or three years nobody will be able to identify a person misplaced in the psychiatric service when the problem is not psychiatric and that they will be placed in appropriate institutions.

We have been informed there is a clear commitment to those with disability and special needs under the Education for Persons with Special Educational Needs Act and the Disability Billwhich is before the other House and that they can be provided with the funding and facilities needed to give them their proper recognition in society.

Another issue highlighted in the report is that mental illness is treated largely in isolation and co-operation with primary care appears to be non-existent. This is clear from the fact that the number of referrals through general practitioners is small relative to other countries. That speaks volumes. I refer to a tragic incident which took place near where I live. It involved a patient who had been re-admitted on several occasions for treatment in a psychiatric hospital in the west of Ireland. He presented himself on a Friday morning to a general practitioner for help and assistance. He was crying out for help and assistance. The general practitioner contacted a particular hospital and was told the relevant consultant would not be on duty until the following Tuesday and he would see him by appointment on that day. Tragically that person was buried by then, having committed suicide. That is a classic example of where our services have stonewalled the needy. This person was crying out for help but that cry was rejected, resulting in a tragedy for a family. There are many similar cases. That incident occurred in 2004 and I would hope it would never recur in any part of Ireland. This case is a carbon copy of the inadequacies of the follow-up in existing services.

Senator Lydon said there was a necessity for a team approach and that many in the caring professions must be involved. They are not involved and are removing themselves from it for reasons best known to themselves. That has to change if we are to have a full and comprehensive response to the needs of those with mental illness.

St. Brigid's Hospital in Ballinasloe is slowly but surely losing its patients through the community service. The numbers have fallen from 1,200 a few years ago to a small number today. I do not fault the existing community service but it is inadequate in respect of its therapeutic and rehabilitation services. Even though patients are placed in the community, which is an improvement on the conditions from which they have come, they are isolated as they are cut off from the services they need.

Can the Minister of State give me an assurance that the resources that will accrue to the Health Service Executive from the sale of property and lands at St. Brigid's Hospital, Ballinasloe, will be ring-fenced for the development of mental health services on the site made available by the Western Health Board at Portiuncula Hospital, and the other services, if needed, in the east Galway mental health service area? It is important to have clarity on that issue. Many people who are in a state of uncertainty say the Department will take it back and use it for the overall national health service. That cannot happen if we are talking about the delivery of a first-class service which we traditionally had at St. Brigid's Hospital, Ballinasloe. We want a new modern comprehensive mental health unit with all the necessary rehabilitation and therapeutic units required for St. Brigid's Hospital in Ballinasloe. Are statistics available to the Minister of State to show the reason for such a high level of re-admissions to mental hospitals? This is not peculiar to any one area and there must be some reason for it. Is it an inadequacy in the treatment process? Are patients being discharged too early? Have they been properly assessed? A problem exists which must be resolved. Tragically some patients are never re-admitted because of situations that occur.

I find it difficult to comprehend the situation regarding the 2003 annual report. The other report is to be published separately at a later date. Is the current inspectorate not confident about what happened in the past and could not relate to it or is this a case of a new broom sweeping clean and the inspectorate wishes to maintain its independence?

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