Brendan Ryan (Labour)

Cuirim fáilte roimh an Aire. One should say at the outset that there is no disputing the enthusiasm and commitment the Minister of State has brought to the debate. I may have some negative comments to make about the outcomes of his enthusiasm and commitment but, as Senator Henry said some years ago, she believed he was the first Minister with responsibility for mental health who visited the Central Mental Hospital in Dundrum. I was never one to argue with Senator Henry's authority on these matters. That he is the first Minister to do so is to his credit and to the shame of all his predecessors of whatever political party, and I say that without attempting to defend any Minister. From time to time, people in the voluntary sector who were occasional visitors to that hospital had stories about the necessary conditions imposed on the staff there because of the unsatisfactory physical environment. That was in spite of the considerable commitment of people who work there.

Apart from controversies about how much was paid for the site and various other issues, while I can accept a certain logic to the juxtaposition of the Central Mental Hospital and the new prison, the convenience of the prison service ought not to impact on the design, layout or access to the hospital. For instance, there should be two separate entrances. Apart from the physical juxtaposition there should be no reason for anybody who has a family member or loved one in the Central Mental Hospital to have any sense that he or she is in an area of security, other than the security of their loved ones, or to have any sense of having to get special permissions to visit.

I know the Department of Justice, Equality and Law Reform too well not to believe that, shortly after this process starts, it will identify the Central Mental Hospital as a potential vulnerability in the security of the prison and introduce a system to check people in the interests of the security of the prison. It may come after, for instance, some security issue in the prison which may turn out to have a connection between the prison and the Central Mental Hospital. I do not have an argument in principle with that, although many do. People are of the view that this stigmatises people but that not need be the case. Geographical adjacency should not necessarily stigmatise, but I have a genuine concern that does not relate to the position of the Minster for Health and Children or the Health Service Executive. I have experience over many years of the all-embracing focus on absolute security of the Department of Justice, Equality and Law Reform, which has been transferred to the Prison Service, and which I believe is a danger to what the Minister wants to do.

I would argue that there should be a statutory basis for the independence of the Central Mental Hospital and the new prison. It should be written down and made clear that the Department of Justice, Equality and Law Reform cannot impose security conditions which would be different from those that would otherwise be required in a high security mental hospital. Otherwise, I can guarantee that — perhaps not in his time as Minister, which might not be very long, or even in my time as a Senator, which might not be much longer — if there are two adjacant buildings with a considerable and inevitable movement of people between them, the Department of Justice, Equality and Law Reform will try to take over the way the process is controlled. It is in its nature to do so and that will be the case, unless the law states unequivocally that it cannot do it. If any room for manoeuvre is left to the Department of Justice, Equality and Law Reform, we will have a security fence around the entire complex within 20 years. I guarantee that will happen. There are good reasons the two units should be close to each other, mainly to do with the well-being of individuals and the possibility of overlap of services etc. but I guarantee that unless it is written down in explicit terms, the Department of Justice, Equality and Law Reform will end up being the determinant of what is appropriate and a security fence will be put up that will have to be breached by every visitor visiting a family member in the Central Mental Hospital. That is not what the Government, the Department of Health and Children or anyone wants but it will happen. It is difficult to reconcile the excessively congratulatory and upbeat tone of the commission and the carefully worded, extraordinarily serious criticisms of the inspector.

I have an interest in this area because my wife is a consultant psychiatrist. I must choose my words carefully because I am answerable to a critic far more formidable than any Member of this House. The views I express are my own and should not be attributed to anyone else. In the past I have made comments about schools my children attended. Subsequently, I discovered that senior officials at the Department of Education and Science contacted the schools when they should not have done so. I do not want that to arise. I will quote only from what is in the public domain.

The situation of children remains far from satisfactory. They should not be in adult psychiatric wards. The Mental Health Act was passed in 2001. That a solution is now being found to a problem that existed for five years is not a good sign of the commitment and energy needed, which I believe the Minister of State has. This is far from satisfactory.

The situation of people with intellectual disability is described at length in the inspector's report. It states:

There is no HSE Region in the State with an acceptable level of service for people with intellectual disability and mental illness. There are insufficient consultant posts in all regions, and those posts that do exist have no multidisciplinary teams associated with them.

Does the Government accept that this is factual and that services need to be set up? The report states:

Persons with intellectual disability and mental illness may be receiving care in settings that are not approved. There is no statutory inspection process for either community-based or institutional-based services for persons with intellectual disability. There is no national record of the levels of use of particular practices, such as restraint, seclusion or the use of medication without informed consent or against resistance.

I do not wish to politicise an issue when no Government of the past 30 years emerges with much credit.

Throughout the crises in the health services of the 1980s and the early 1990s, the practice of health boards was to save money in mental health services irrespective of the intent of central Government. This occurred because the last person who can publicly complain about the lack of a bed in a hospital is a person suffering with mental illness. Therefore it is easiest area in which one can make cutbacks.

According to the Minister of State, the Mental Health Act will be in force from 1 November. Have all issues with regard to nursing escorts and their legal liability, insurance position and training requirements been resolved? A "Yes" or "No" answer is needed.

There is differing information on the number of acute units in psychiatric hospitals that are locked at night or during the day. Have investigations been carried by the commission that have concluded by suggesting that doors be locked in case patients might escape? Is the commission recommending a practice that the inspector is attempting to eliminate? We must be clear on the precise status of the inspector vis-À-vis the commission. If the inspector of mental hospitals thinks a certain practice is wrong, is the commission free to ignore that opinion? That would be a disturbing possibility.

There is a need for people with mental illness to have access to more than psychotropic drugs or pharmacological treatment. Are we encountering bottlenecks in respect of the caseloads of people other than consultant psychiatrists? Is there evidence of this and what will the Government do?

On page 56 the report addresses the uneven nature of funding. I will be provincial on this matter because the report states that Cork is underfunded by comparison with other regions of the country. That is the result of historical decisions of the health boards. If there is merit in the HSE it is that it provides a rational basis for funding. In that case, despite anomalies throughout the country, there cannot be a sixfold difference in per capita funding in different regions. The Minister and the HSE must address this problem and not in ten years' time. Funding can either be increased in some areas or reduced in others.

Why do involuntary admission rates vary by a factor of five or six around the country? It is not because there are more ill people in one region than another. It is a matter worthy of investigation. The area in which I have most family connections, south Lee, has one of the lowest rates of involuntary admission in the country.

I am concerned that hundreds of people are in psychiatric hospitals for more than five years. The long stay issue must be addressed. If one is in a hospital for more than five years it is acting as a hostel. It may have to be a high security hostel but it is a secure unit to protect the person or society and not a hospital. I am not sure our mental health services have improved. I thank the Acting Chairman for his indulgence and I thank the Minister of State for taking the time to listen. I am aware that he does listen, which is one of the reasons it is well worth participating in a debate such as this.