Mary Henry (Independent)

I welcome the Minister of State to the House and recognise his commitment to the mental health services in the country. I was pleased to hear Senator Glynn speak before me, as his comments as someone who has experience working in the psychiatric services are very useful. I welcome the establishment of the National Office for Suicide Prevention, but how much more do we need to find out before action is taken on the issue? What worries me about the report and the discussion on it today is that there has been little concentration on the resources that are required to implement the recommendations within the report.

We have seen report after report. Senator Browne mentioned the problem with alcohol and he is correct. There was an excellent report on deaths in Cavan, Monaghan and Louth in 2001 and 2002. There were other reports, such as the 2004 report from the National Suicide Research Foundation; the 1998 report from the national task force on suicide; the 2002 report from the strategic task force on alcohol, as Senator Browne pointed out; the 1991 report of the advisory group on prison deaths; and a 2001 report entitled Suicide in Ireland — A National Study. I could go on quoting even the home-grown reports. However, minimal action has been taken in areas outlined by Senator Glynn, for example.

Despite the publication of these reports, nothing has been done. Although we see the direction that should be taken no progress is made. I am pleased Senator Glynn highlighted the important issue of pre-existing mental illness in people who commit suicide or those who attempt suicide. We are on shaky ground by stating that much has been done over the past ten or 15 years to improve mental health treatment in the country.

The policy document Planning for the Future was published over 20 years ago. The report made the transition from large mental hospitals, which would hold about 30,000 people in custodial institutions, to care in the community. Senator Glynn is correct to say that care in the community is more expensive. This is the issue on which we are failing. Having brought people out into the community, we have not put in place teams which are now recognised as necessary to treat the people. Although the acute phase of an illness might be treated, a person might be left too much to his or her own devices with inadequate support and care.

The report being discussed today makes for very interesting reading but it is profoundly depressing. With regard to the section on unemployed people committing suicide, we know that a third of those who commit suicide are unemployed at the time. We also know that a problem of homelessness exists in this city and the country as a whole. Even if a person gets into a hostel, it can be difficult for people to happily integrate into them because a considerable number of homeless people have mental illness that could be out of control.

How are we dealing with the problem? A psychiatrist to treat homeless people in the north Dublin area was appointed approximately six months ago.

She said she required a backup team. Members have heard Senator Glynn discuss the importance of teamwork in psychiatry nowadays whereby one needs psychiatric social workers, psychiatric nurses and communities in which patients are accepted. Unfortunately, some communities completely reject people who have had any psychiatric illness. While the psychiatrist asked for backup staff, she did not get them and the post was subsumed. What message does that send out about our commitment to people who are among the most vulnerable to committing suicide in this city? It sends an appalling message.

Some 14 beds in the Mater Hospital were to be allocated to deal with such patients when they became acutely ill. What happened? The beds were not put in place, apparently because the space pressures on the Mater Hospital are too great. We have a terrible problem regarding acute beds for mentally ill patients. While we try to treat them in general hospitals rather than mental hospitals these days, we have had much trouble in setting up such wards in the general hospitals.

We also have a shortage of psychiatrists. I believe that approximately ten extra posts were created last year and the Minister has stated that a further 13 will be put in place next year, in the hope that my colleagues, the consultant psychiatrists, will become involved in the Mental Health Commission. It will be essential to start the mental health tribunals in operation. However, if those consultant psychiatrists who have been already put in place do not receive back-up support, we will have much trouble in persuading them that future promises will be any better than past events. I have received constant complaints from people installed in posts around the country that they have not received such support. For example, a psychiatrist was installed in Navan, where she eventually received an office. It was then discovered that the office did not have planning permission enabling her to consult with patients there, thus obliging her to see people in their homes. What productivity levels does that suggest? We must have some adequate planning and team structures. This is the most important way to go forward.

On page 34 of the report, it is pointed out that in a recent review paper, it was reported that 97.3% of those who died by suicide had diagnosable mental illness. This refers to Arsenault and Lapierre's study of 2004. The authors note that caution should be exercised in interpreting such results, as many of the studies included in the review did not use a control sample. They examined more than 3,000 cases and reported on them. However in the report, Suicide in Ireland: A National Study, 47% of those who committed suicide could have been identified by a GP as having mental health problems. Senator Glynn has pointed out the importance of major depression in these circumstances. Senator Browne noted the effects of substance abuse. Personality disorders and psychotic disorders such as schizophrenia are also significant. These are all recognisable conditions with which we should make an attempt to deal.

We also have a serious problem regarding the lack of child and adolescent psychiatrists and facilities in which to treat such people. I believe there are six beds in Dublin and 14 in the west. While others have been promised, I do not know when they will come into effect. Frequently with mental illness, it is important to begin treatment as soon as possible. The situation regarding prisons is also appalling and it is reckoned that 30% of inmates have a psychiatric problem. While there has been an improvement in the number of psychiatrists working within the prison system, it is in no way adequate. We have an enormous responsibility to care for those whom we involuntarily detain within our prisons in the best possible manner. If such people commit suicide, Members, as legislators, will be held partially responsible for the inadequacy of care.

The situation regarding accident and emergency departments is also extremely important. Such departments are where one encounters parasuicides and such people should be referred immediately to psychiatric help. Can the Minister state that this happens? I do not believe so. Many such patients are referred from accident and emergency departments without adequate referral to psychiatric help. Sometimes, I have received complaints from general practitioners that they did not even know that their patients had in fact attended an accident and emergency department in such serious circumstances.

To a great extent, we are obliged to rely on drug treatment for psychiatric illness. This is an international problem, rather than simply being an Irish problem. I visited the United States last week and listened to Dr. Tim Murphy, who is a Republican Party member of Congress and a psychologist, speak about the fact that 75% of anti-depressants in the United States are prescribed by non-psychiatrists. While I do not claim that one must be a psychiatrist to prescribe such drugs, they are extremely potent. It is important to remember — it is far more common in the United States than here — that the psychotropic drugs prescribed for children are never tested on them and a considerable number of such drugs are not recommended by their manufacturers for children.

How are general practitioners supposed to deal with such children if they cannot get help for them from specialists in child and adolescent psychiatry or if they cannot procure verbal therapy, such as the services of psychologists or psychotherapists for them either? These two professions are also in short supply. This has led to concerns on the part of members of the public whose closest relatives have been prescribed drugs, particularly selective serotonin reuptake inhibitors, that these were the cause of the patient committing suicide.

When Dr. Murphy spoke in Congress, he made a good point, namely, that when people were put on such treatment, their initial improvement might have led us to believe they were doing better than was the case. Subsequently, those who were not experts in the area let their guards down, so that sufficient supports of other kinds were not given to such patients. Hence, they committed suicide due to lack of support rather than due to the effects of the drug itself. There have been many claims made in the United States and the United Kingdom about these drugs but no proof has been forthcoming that they were the cause of suicide. We must be cautious about damning drugs which have been useful in some cases. Nevertheless, I have practised medicine for long enough to have seen many drugs prescribed, particularly in psychiatry, which were considered to be entirely unsuitable ten years later. This is an area on which I hope the Irish Medicines Board is keeping a close eye.

As I have stated, the lack of specific resources is what really troubles me about this issue. Sometimes, my breath is taken away by the manner in which legislation is introduced in these Houses with a lack of concern for the resources. When the Mental Health Act passed through this House, I raised the issue of resources and they were considered to be important by the Minister at the time. However, considering the current dispute with the consultant psychiatrists, in some cases they have a choice of leaving their patients to attend the tribunals in situations where no locum is available to deal with the patients in their absence. If they do not attend the tribunal and adhere to the law, they may be very heavily fined or imprisoned. They will be in a difficult situation unless more resources are invested in the area to ensure that neither the patients they have nor the patients who should be before the tribunals are neglected.

It is wrong that such a high proportion of patients are held involuntarily in this country, a higher proportion than most countries in Europe, and that we have not managed to establish the tribunals. I do not know whether it was helpful for the Tánaiste and Minister for Health and Children to start telling the consultants they will not get their 1.6% benchmarking increase unless they co-operate; half of that 1.6% will vanish in tax. It was not a tactful comment by the Tánaiste.