Camillus Glynn (Fianna Fail)

I welcome the Minister of State and the opportunity to speak on the annual report of the Mental Health Commission and the report of the Inspector of Mental Health Services. It has been a significant year for mental health in many ways. The Minister of State touched on this in the course of his contribution.

I welcome, in particular, the additional resources devolved to the psychiatric services, despite the fact that the sector was coming from a low base. I compliment the Minister of State because since his appointment, with special responsibility for mental health services, he has thrown himself body and soul into the job. The provision of these additional resources is in no small way due to the efforts he has made.

I listened attentively to the Minister of State's speech and to Senator Henry — I agree with much of what she said. The Minister of State spoke about the large number of old style psychiatric hospitals that remain. He said the inspector's view is that the continued admittance of patients to long-stay wards is unacceptable. I am not disagreeing with the inspector other than to say that in some cases where people were regularly admitted to a psychiatric institution, they would be admitted straight to a long-stay ward and not an acute one. Even were they to be admitted to an acute ward, they would soon be referred to a long-stay one. This could happen for a number of reasons, not least pressure on beds.

The report did not make reference to inappropriate bed occupancy. The House has debated this issue on a number of occasions. I recall that Senators Norris and Quinn tabled a motion on inappropriate bed occupancy in the last Seanad. I understand that this is still a feature and I would like to see it discontinued. We must bear in mind that psychiatric hospitals are not hostels. If there is a lack of facilities for homeless people, I do not see psychiatric beds as filling in for them. This is not an option and it should be discontinued forthwith.

The inspectorate said that even in wards where conditions were poor, nursing staff were making enormous efforts to care for patients and provide appropriate activities. That is most welcome. I would have liked the inspectorate's report to contain a few paragraphs dealing with the issue of visitation, especially for long-stay patients. I have previously made this point on another issue and I have not changed my mind. With the advantage of many years of experience, I have seen people who stopped getting visitors after a period of time. The isolation of people in long-stay institutions, psychiatric or otherwise, contributes to institutionalisation. When contact with the outside world discontinues, the patients will make themselves at home in their institutional surroundings. This is not a good thing by any standard.

As the Minister of State has said, a great deal of progress has been achieved since the publication of Planning for the Future in 1984. If memory serves, this was introduced by Mr. Liam Flanagan. I was pleased to hear the Minister of State say that greater resources will be provided for securing community-based facilities. Large psychiatric hospitals have served their purpose and every one of them should be closed. However, when one door is closed another one to a better facility must be opened. When established psychiatric institutions are closed, it must be borne in mind that in each of them a ward or unit was specially provided for people with challenging behaviour. Units are also needed for people who would not normally be resident in an acute ward — their behaviour may not be so challenging but they may have other illnesses.

The number of acute psychiatric units in general hospitals has increased from eight in 1984 to 24 today. It is time that we fast-tracked the completion of psychiatric units in all general hospitals. My local hospital in Mullingar is an example; it will get a psychiatric unit in the second part of phase 2B. Senator Henry was correct in stressing the importance of providing child and adolescent psychiatry units in all hospitals, even in ones that do not currently have a psychiatric unit.

The idea behind providing acute units to general hospitals is to demonstrate that psychiatric illness is an illness, and that psychiatric nursing and medicine are disciplines in their own rights. Why should there be a separate facility for psychiatric illness? This was one of the main contributors to the stigma surrounding psychiatric illness. However, were the truth to be told — and it is not often told when referring to the incidence of psychiatric illness in families — many people would be revealed as having psychiatric illness. I state this only as an established fact and not to glory in it.

In his contribution, the Minister of State said, "During my term of office as Minister of State with special responsibility for mental health, I am endeavouring 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 throughout the country". This important statement is one of the central themes of this debate. It has long been acknowledged that community-based services are better. However, they are more expensive. I remember the time when community-services ceased at 5 p.m. on Friday evenings and did not resume until 9 a.m. on Monday mornings. Thankfully, we have seen the last of those days. Why were they closed? They were closed because the service was resource driven. Of course, one could say that the service was not driven because of the lack of resources.

The Minister of State also said that eight additional consultant-led child and adolescent psychiatric teams per year will be established nationally for the next four years to enhance community and in-patient services. The provision of child and adolescent psychiatry services is an imperative. When considering the vexed issue of suicide — especially among young males for whom the incidence of suicide is seven times that of young females — it is clear that this is an area on which we must focus.

I echo Senator Henry's comments on moving the Central Mental Hospital to a new site. From what I hear, it will be a flagship development and it is so important that words cannot describe it. I welcome it.

When we speak of health, psychiatric or otherwise, it is important to remember that we all have responsibility for our own health. Psychiatric health is equally important as any other part of our well-being and should be looked after. There is a difficulty with psychiatric illness because, in many cases, there is a lack of insight into one's condition. This can be a problem not alone for the carers, but also for the person in receipt of care. The 2001 Act is coming on stream, which is important. Many people have been critical of it, which is fair, but if it is constructive criticism we have to welcome it.

Regarding involuntary admissions, I welcome the tribunals, which are necessary. The loss of freedom for any reason, however, is a traumatic experience for any individual. That does not exclude people who have a psychiatric illness but there are people who, because of the nature of their illnesses, will need to be involuntarily admitted. Regardless of whether we believe that, it is the case.

I made a comment on the Order of Business regarding the visiting committees. As somebody who served in the psychiatric profession for many years, was a member and a chairman of a health board for many years and was on numerous visiting committees, I believe it is vital we consider the re-establishment of the visiting committees. The reason for that is simple. They have a therapeutic value, especially for the residents, because they recognise, say, the Minister in his capacity as a local authority member, myself, Senator Browne or any other public representative and there is interaction. It is a contact with somebody they know, a friendly face. That is very important to them. I have always held that view and nothing in the interim has changed my mind.

We are having a strong debate in a sub-committee of the Oireachtas Joint Committee on Health and Children on the use of pharmaceuticals. I agree with the necessity to have that debate. Questions arise regarding the use of certain pharmaceuticals, especially in the psychiatric services, and there is an urgent need to provide care and alternative treatment vis-À-vis psychotherapy, psychoanalysis, occupational therapy, which service has been in place for some time, and the other services that pertain to treatment that have a non-medical basis.

Regarding the Mental Health Commission's report for 2005, which includes the report of the Inspector of Mental Hospitals, since the Mental Health Commission was established in 2002 it has made an important contribution to the continued improvement of services for people with mental illness. The report highlights a number of areas that are of continued concern in mental health services, namely, the standard of long-stay accommodation for people with severe and enduring illness and the need for multi-disciplinary teams to support the people in the community. That aspect has been addressed but I ask the Minister of State, who appears to be good at getting his hands on additional resources — it seems to be a particular talent of his — to expedite that in whatever way he can to ensure the facilities for long-stay residents of our psychiatric institutions are improved and the fast-tracking of the acute units in the general hospitals. That is imperative.

I am delighted to hear the multi-disciplinary teams are being brought on-stream and will be increased in the next four years at the rate stated in the Minister of State's contribution. Tá mé fíorbhuíoch den Leas-Chathaoirleach agus den Aire. Comhghairdeachas aríst.