Tim O'Malley (Limerick East, Progressive Democrats)

I thank all the Senators for contributing to a very good discussion on the Government's policy document, A Vision for Change. The contributions were very well informed. While I cannot comment on everything I have heard I will try to comment on some of it. One of the differences between this report and the last one, Planning for the Future, is that this report specifies an implementation body and a monitoring body, both of which are required to report on an annual basis, which will help.

It is not true to say the 1984 document was not implemented; much of it was. While it was not all implemented, much progress was made and much credit is due to the psychiatrists working in the sector. This area is complex and difficult and the psychiatrists should be thanked for the progress made. We are now moving forward and setting new goals. I take the point various speakers made about implementing and monitoring. The plan merely contains words; the implementation is what is important.

Many of the speakers referred to the community multidisciplinary teams. While in some areas the teams have been working very well, unfortunately in some other areas, owing to human nature, etc., the teams have not worked well. The structures did not exist and the group preparing the report placed a significant emphasis on team effort and people working together. This is one area that will be monitored. It is not beyond the competence of professional people to work together.

I believe Senator Lydon said that occupational therapists do much good work. The Mid-Western Regional Hospital in Limerick has very few occupational therapists. It is not a question of resources; it is as a result of decisions made by some vested interests. While I will not comment further that is the case. The same thing has happened in other areas around the country. People have asked about the lack of therapists, etc. I am not sure about the resolve of people to employ these therapists in the past. The Government has made decisions and many of these therapists are now being educated.

Speech and language therapists, occupational therapists and physiotherapists will not be coming forward for a few years but we are aware that there are many such professionals in other countries who could be brought here for a few years until we grow our own therapists, so to speak.

I agree with Senator Browne. When we talk about closing down the large hospitals, we are not suggesting that there will not be a small number of people who will need to be treated securely in a caring manner but it is a question of putting them into proper care. We realise we are talking about a small number of people who would be unable to live in the community. I share the Senator's concern, which is also real for many people, but I wish to allay it. I do not want the message to go out that people will take advantage of the vulnerability of a small number of people for other agendas. No speaker suggested that here this morning, nor am I suggesting it, but there will always be a need for small units for people who cannot be housed in the community.

On the funding issue, every speaker said we need more resources, something with which I agree. The report stated that there were adequate resources in some of the areas examined but the outcomes were not good. As well as having the resources, we must measure outcomes in future. That is stated in the report.

I agree with those Senators who spoke specifically about young adolescents and the lack of proper early interventions for them. That is something on which I intend to spend a good deal of time because I am aware, as were all the speakers in the debate, that if we intervene early with young people suffering from emotional problems — I prefer to use the term "emotional" rather than "psychiatric", and Senator Ryan covered that adequately — many problems that can occur later can be prevented. Much more needs to be done in that area.

I am glad Senator Ryan referred to the question of the sale of hospitals. The Government has given a commitment and the Cabinet has made a decision on funding but I have visited many hospitals and was very unhappy to see huge amounts of land surrounding some of them while at the same time the services being provided were appalling. People with mental health problems were living in appalling deprivation. What I am doing, and what the report recommends, is transferring those land assets to mental health assets. There is a commitment on the part of the Government to do that, and we will do it slowly. There is an assurance in this report that there is no question of dumping people into the community. I agree some incidents of that happened in the past. We will not revisit that but the people will be cared for properly before any institution is closed down.

Senator Ryan is right to concentrate on the homeless. I am looking at a particular model and have spoken to a few people in that regard. I would ask some of the Senators to think about this. I am not just selling land to the highest bidder. We have made mistakes in the past in that regard. If we are selling State assets and we need them for specific purposes, like the mental health area, we should consider inserting certain conditions. If 100 or 200 people have to be housed following the sale of a large institution, it should not be beyond our competence to devise a system whereby they can be housed in residential units in the area, with the rest of the land to be sold off. Some people have told me that is being done in other countries.

If we are selling the land we should control the end product, not developers. If it is sold to the highest bidder, the developer or speculator will do what he or she wants with the land and while we might get what people believe is a good price, we then have to buy other land to house the people concerned. I ask Senators to think about that and if they have any ideas to come back to me. It has not been done in this State yet but it is about time we did it, especially in this area because we are talking about social housing for many of these people with mental problems. Senator Ryan is right in that regard.

Many contributors to the debate raised the question of psychotherapy and counselling, an area in which I am interested. I agree that much important therapeutic work can be done in that area but we must tread carefully because there are charlatans operating who call themselves counsellors and psychotherapists but who are not qualified. There are also some great counsellors and psychotherapists. I have met many of these groups and they have now got together because they agree we must have proper standards. I met some of them again recently and they are making progress but we must tread carefully in this area. I mentioned the commitment on the part of the Department of Education and Science to ensure a sufficient number of such therapists are trained in the future.

I have dealt with the issue of the discharge of patients into the community. Proper places in residences in the community must be available before people can be discharged. The question of difficult to manage behaviour is dealt with in the report. It is an extremely difficult problem for the families, carers and loved ones of a young person exhibiting such behaviour but I hope we will get to grips with it.

Much progress can be made in the area of neuropsychiatry. Senator Lydon referred to chaplaincy. That is not mentioned in the report but there is no need to mention pastoral care. We are talking about counsellors and psychotherapists. Pastoral care comes under that heading and it would be wrong to mention it in the context of pastoral care as opposed to counselling. I have met many religious from all denominations who are doing great work in this area.

Senator Minihan raised a point about pharmacists. Speaking as a former practising pharmacist, I am somewhat critical of the profession for not being more of an independent voice monitoring the advent of hugely complex therapeutic new drugs. For years, Dermot Walsh, Inspector of Mental Hospitals, has commented on what is called polypharmacy. Many new drugs have come on the scene in the past several years but when people with mental or emotional problems are put on new treatments, they are reluctant to come off the drugs they are on, yet several others can be added to the patient's regime. We should examine that.

Forensic psychiatry is an area very close to my heart. It has been sadly neglected in the past. I would like to correct Senator Henry on one point. Her understanding was that the decision to close Dundrum was based on the fact that it was an extremely valuable site. I reiterate that a committee of all the users and providers of services in Dundrum was set up several years ago to examine all the options concerning Dundrum, including whether to remain on the site, move part of the site or move to a greenfield site. Its decision was to move to a greenfield site, although it did not specify a location. The Government has adopted that decision and we will move forward with a new central mental hospital.

I understand people's scepticism about this report. Even objective people and the voluntary agencies have been very supportive of it. However, the scepticism is understandable because in the past many reports were left to gather dust and not implemented. Like all the Senators that have spoken in the House today, I have an interest in this area. I will continue to raise the bar in this area. Not alone is this right, but it is something we have to do for the sake of society. It is not right that people with mental illness should be treated any differently from those with physical illness. The report is compiled by 18 individuals who do not represent associations or professions. I understand there were very robust discussions, but once the working group was set up I never got involved. There were disagreements, but at least they signed off on the report.

Implementation will be challenging, not just in terms of the Government coming up with the resources. It will also be challenging for many of the professions involved to change their ways. The changing of attitudes and how they do things can often be a bigger challenge for people. We have the report, it is Government policy and it is up to us to implement it. I thank the Members for their contributions. General acceptance of the report has been very positive. However, there will be small groups of people who will pursue their own vested interests. I am aware of one incident already in County Cork about people moving out into the community as well as other developments where efforts are being made to put people into proper residential care. People will come up with reasons these things cannot be done.

We, as elected representatives, must ensure this Government policy is implemented.