Tim O'Malley (Limerick East, Progressive Democrats)

I welcome the publication of the Annual Report of the Mental Health Commission 2005, which includes the report of the Inspector of Mental Health Services. The report relates to the year 2005. I acknowledge the important role the Mental Health Commission and the inspectorate play in providing an accurate and detailed account of services in the mental health sector.

The Mental Health Commission was established in April 2002 under the provisions of the Mental Health Act 2001. The Act is a most significant item of legislation and its purpose is twofold. First, it provides a modern framework within which people who are mentally disordered and who need treatment or protection — either in their own interest or in the interest of others — can be cared for and treated. In this regard, the Act brings our legislation in respect of the detention of mentally disordered patients into conformity with the European Convention on the Protection of Human Rights and Fundamental Freedoms. The second purpose of the Act is to put in place mechanisms by which the standards of care and treatment in our mental health services can be monitored, inspected and regulated.

The Mental Health Commission is the main vehicle for the implementation of the provisions of the Mental Health Act 2001. The commission has 13 members, including a practising barrister, three registered medical practitioners, of which two are consultant psychiatrists, two representatives of the nursing profession, a social worker, a psychologist, a representative of the general public and three representatives of voluntary bodies promoting the interest of people suffering from mental illness, of whom two have suffered mental illness in the past.

During 2005, the Mental Health Commission completed an extensive programme of work related to the commencement of Parts 2, 4, 5 and 6 of the Mental Health Act 2001. Part 2 deals with the procedures related to involuntary admissions, Part 4 covers treatment issues such as consent to treatment, rules for treatment, etc., Part 5 related to regulations and registration of approved centres and Part 6 deals with rules related to seclusion, bodily restraint and transitional arrangements. I am happy to inform the House that all remaining provisions of the Mental Health Act 2001 will be commenced on 1 November 2006. This includes the establishment of the mental health tribunals and provides for the commission to be the registration authority for all hospitals and in-patient facilities providing psychiatric care and treatment. One of the principal responsibilities of the Mental Health Commission is to promote and foster high standards and good practice in the delivery of mental health services.

The Mental Health Act 2001 requires the Inspector of Mental Health Services to visit and inspect every approved centre each year and, as he or she thinks appropriate, any other premises where mental health services are provided. This includes community residences, day centres and acute inpatient facilities. The inspector is then required to carry out a review of mental health services in the State and to furnish a report in writing to the Mental Health Commission.

The inspector's review of the services, including reports of inspections carried out, is published with the Mental Health Commission's annual report and is laid before both Houses of the Oireachtas. The inspector's annual report informs the commission, the Minister for Health and Children and all interested parties on the current state of affairs within the mental health services. In carrying out their inspections, the inspectorate paid special attention to care planning, how multidisciplinary teams were resourced, how they functioned, the therapies available, activities provided for service users, the physical environment and the management of such units.

The inspectorate believes, in common with good practice, that individual care plans are the basis for care and treatment provided that service users are actively involved, each service user has a key worker and the care plans reflect multidisciplinary assessment and treatment inputs. This is in line with the principles outlined in the new national policy framework for the mental health services, A Vision for Change, which was published on 24 January 2006.

A Vision for Change was developed by the expert group on mental health policy and has been accepted by the Government as the basis for the future development of mental health policy. The report outlines a vision of the future for mental health services and sets out a framework for action to achieve it in the next seven to ten years. The core principle underlying this policy is that people suffering from any form of ill health should be enabled to live as independently as possible. The inspectorate was concerned about the physical environment in some hospitals, the lack of proper care planning and the lack of therapeutic activities for inpatients.

The inspectorate was especially interested in the service provided to people who are resident in long-stay wards in large psychiatric hospitals. A total of 95 such wards, accommodating approximately 1,800 people, still remain in large psychiatric hospitals nationwide, all of which were inspected in 2005. The inspector's view is that it is unacceptable that patients continue to be admitted to long-stay wards. However, the inspectorate stressed that even in those wards in which conditions were poor, nursing staff were making enormous efforts to care for patients and provide appropriate activities.

The report of the expert group on mental health policy, A Vision for Change, recommends that plans should be drawn up for the closure of all mental hospitals. The expert group's report noted:

Mental hospitals have been the mainstay of mental health services in Ireland for many years. However, the type of person-centred, recovery-oriented care recommended ... cannot be provided in institutions of this size or environment.

The closure of large mental hospitals and the move to modern units attached to general hospitals, together with the expansion of community services, has been Government policy since the publication of the policy document, Planning for the Future, in 1984. A great deal of progress has been achieved since and the number of acute psychiatric units in general hospitals has increased from eight in 1984 to 24 at present.

A Vision for Change emphasises that this process should take place on a phased basis with the sequential closing of wards. It emphasises that hospitals can only close when the clinical needs of the remaining patients have been addressed in more appropriate settings. A Vision for Change proposes a holistic view of mental illness and recommends an integrated multidisciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems. It recommends a person-centred treatment approach that addresses each element through an integrated care plan that reflects best practice and, most importantly, has evolved with the agreement of both service users and their carers.

One of the fundamental principles of the report is that of recovery, in the sense that people with mental illness can and should be facilitated in reclaiming their lives and becoming involved in society. To achieve this objective, people need both supportive mental health services and communities in which actions are taken to address basic needs such as housing, employment and education.

I am committed to the provision of quality care in the area of mental health, to upholding the civil and human rights of those who suffer from mental illness and to encouraging measures aimed at combating the stigma that is often associated with such illness. During my term of office as Minister of State with special responsibility for mental health, I have endeavoured to continue to accelerate the growth in more appropriate care facilities for people with a mental illness through the further development of community-based facilities nationwide.

The inspector refers to the continuing need to develop specialist psychiatric services. The need for such services has been recognised for some time and substantial progress has been made to establish them. As for child and adolescent psychiatric services, it is accepted that with the increasing pressures on young people, there is a need to improve responses to their mental health needs.

As I stated previously, the full provisions of the Mental Health Act 2001 will come into force from 1 November 2006. The Act defines a child to be anyone under 18, which brings mental health law in line with other Irish legislation. While very small numbers of children require involuntary admission due to mental illness, we have an obligation to provide the highest standards of care and treatment to this vulnerable group. It is accepted that additional beds for the treatment of children are needed and work is continuing towards ensuring that appropriate child and adolescent psychiatric inpatient services will be put in place without delay.

The Health Service Executive, HSE, established a working group on child and adolescent mental health services. The group consisted of representatives from the Irish College of Psychiatrists, the Irish Hospital Consultants Association, the Irish Medical Organisation, senior HSE managers and practitioners. The group explored options capable of creating immediate additional capacity for the regional provision of inpatient facilities for those children and adolescents who require involuntary admission under section 25 of the Mental Health Act 2001. The group's report has been adopted by the HSE.

The report proposes how services can be best delivered in an integrated and holistic manner and has identified additional inpatient bed capacity for children and adolescents. Each of the four HSE regions will identify three to four beds in adult units for the treatment of children and adolescents on an interim basis, pending the provision of dedicated units. Each unit will be supported by a consultant-led child and adolescent multidisciplinary team. Staff in such units will receive additional training and appropriate clearance.

Eight additional consultant-led child and adolescent psychiatric teams per year will be established nationally for the next four years to enhance community and inpatient services. This year, the HSE has allocated an additional €3.25 million for this purpose and recruitment is under way. This constitutes a significant commitment to child and adolescent services. The House will agree that the full implementation of the Mental Health Act from 1 November 2006 is to be welcomed as this will provide much needed protection to all adults and children who are involuntarily detained without further delay.

Recently, there has been increased recognition of the need to address mental health as an integral part of improving overall health and well-being. Mental health is now accepted as being as important as physical health as poor mental health has a significant impact on people's quality of life and their contribution to society.

The promotion of positive mental health is a broad concept that emphasises the improvement of the psychological health and well-being of individuals, families and communities. Rather than pertaining to mental health problems, it focuses on the promotion of positive mental health for all. It is important to note that responsibility for the promotion of positive mental health does not rest solely with the health services. It also should be part of daily life in schools, at work and in the wider community. Most health promotion initiatives, such as the encouragement of physical activity, also include an element of mental health promotion.

A Vision for Change also recognises the importance of promoting positive mental health and calls for the availability of mental health promotion initiatives for all age groups to enhance the protective factors and decrease risk factors for developing mental health problems. More specific recommendations identified particular age groups, treatment and community settings for the increased promotion of positive mental health.

In a previous report, the inspectorate recommended that the plans to relocate the Central Mental Hospital to a new, purpose-designed building should progress as quickly as possibly. I am happy to inform the House that the Government gave approval on 16 May for the development of a new Central Mental Hospital to be built on the site set aside for that purpose at Thornton Hall, County Dublin. The new hospital is to be built on its own campus, adjacent to the planned Mountjoy Prison replacement complex. It will retain its identity as a separate, therapeutic health facility owned and managed by the Health Service Executive.

The Central Mental Hospital is a national tertiary service and is the only centre in the State providing psychiatric treatment in conditions of maximum and medium security. The hospital provides acute psychiatric in-patient care to mentally disordered offenders including both sentenced and remand prisoners.

The Government has agreed that a new governance structure will be put in place for the Central Mental Hospital in advance of its move to the new site. It is proposed that a board of directors for the hospital be appointed following consultation with the Health Service Executive and other relevant stakeholders. The Government has also agreed that the development will be funded from the sale of the existing hospital site at Dundrum. Any balance of funds remaining after the completion of the new hospital will be available for re-investment in the health services, in particular for capital developments in the mental health services.

I wish to acknowledge the commitment of the commission members, the management and administrative staff and the inspectorate team. I thank the House for affording me the time to speak on the 2005 Annual Report of the Mental Health Commission, including the report of the Inspector of Mental Health Services.