Fergal Browne (Fine Gael)

I welcome the Minister of State and his officials to the House. I will not repeat what was stated by Senators Henry and Ryan and other speakers. I will summarise the issues raised by the Mental Health Commission report.

I had the privilege of sitting on the sub-committee of the Joint Committee on Health and Children which examined suicide. The report states suicide is responsible for three in ten deaths in the 15 to 24 year age group and is the highest cause of death in that age group. That is shocking. The report also states only four child and adolescent mental health teams are in place in the HSE south-eastern region although the population requires a minimum of eight teams.

Over a ten year period, the budget has been reduced from 11% to 7%, although I appreciate more money is being spent on health services. However, as we move away from large mental health institutions, pressure to match funding in other areas exists. We should not be tempted to cut funding. We should ring-fence a certain percentage of the budget every year to spend on mental health. We should not allow the matter to slip down the pecking order.

The report discusses the absence of lockable storage facilities and instances of theft taking place. It also states some wards have no locks on toilet or bathroom doors. The report also mentions inadequate sanitary conditions, leaking ceilings, damp, peeling paint and holes in walls. In terms of communication problems, the report states service users complain they do not receive adequate information on diagnosis, a lack of user involvement in drawing up care plans exists and insufficient information on patient rights and complaint procedures is provided.

The inspector's report makes reference to the fact that long-stay patients are cut off from society, friends, family and peer services. It also states the majority of 24-hour supervised units for people with mental illnesses are too large and a significant number of institutions are located in remote areas cut off from the community. The report also highlights a lack of suitable follow-up accommodation for people who have used 24-hour supervised units.

The report mentions a lack of places in the central mental hospital, which is the only high-security psychiatric hospital in Ireland. My colleague, Deputy Neville, who is a former Member of this House, continuously raises this issue. On 10 October, which is world mental health day, he raised the important aspect of human rights of patients with mental illness. The Government should not forget that area and it is vital we do all in our power to ensure people who require long-term and short-term mental health services are treated with the dignity they deserve.

Deputy Neville has also discussed the need for the national treatment purchase fund to be used to reduce the 12-month waiting list to receive psychiatric care. That seems to be a sensible suggestion. Will the Minister of State indicate whether the Government is in a position to take up that proposal? It is crazy to think someone needing help is expected to wait 12 months or longer.

I am frustrated by the fact that often we are restricted on what we can state on health because of a lack of knowledge through not receiving answers to the questions we ask. A counsellor who appeared before the sub-committee examining suicide raised the issue of the waiting list for adolescents. Afterwards, I asked the Minister for Health and Children about it but she was unable to give me the figures. We know a major problem exists, but we do not know how bad it is. We must work on that to enable us to do our jobs properly.

I was disturbed to read in last week's Sunday Independent that 15 mentally disturbed prisoners were awaiting treatment in the country's only high-security psychiatric hospital. They remain in various prisons while they wait to be admitted. The lack of prompt access to appropriate psychiatric services leads to more severe mental illnesses among prisoners. Executive director of the Irish Penal Reform Trust, Rick Lines, stated our prisons are becoming warehouses for people with mental illnesses. Waiting lists for admissions to the Central Mental Hospital have become the norm. Conditions at the Central Mental Hospital have been described as antiquated and three quarters of the patients treated there have gone through the courts system.

In his speech, the Minister of State made reference to the new complex due to be completed in 2010. What will we do during the next three and a half years? It might take longer to complete. Do we expect patients to put up with the same long waiting lists and the antiquated conditions?

A report in today's Irish Independent states 25,000 people are admitted to mental health hospitals every year, 8,000 of whom suffer from depression, and 70% are re-admissions. The Wellbeing Foundation makes the point that people suffering from depression need counselling and psychotherapy and not necessarily the services being offered. We must make the treatment relative to the needs of the patients and acknowledge depression is a major reason people are admitted to mental health institutions.

The report refers to individual hospitals and services. In one hospital in the HSE south area, the male admission ward is a locked ward and at the time of inspection had seven patients on temporary status. No policy on locking the door exists. Occasionally, children under 16 years of age are admitted as are people with moderate intellectual disability. There are frequent admissions for alcohol and drug detoxification and at the time of inspection six patients were undergoing detoxification. It is totally inappropriate that young people are mixed with not only adults but people with severe drug and alcohol problems.

Another paragraph reports that there are no therapeutic activities in the ward. Some patients go to the activation ward and there are frequent transfers of patients to other wards because of bed shortages. Patients complained of boredom and said the ward was too small. One patient complained about the lack of confidentiality due to the cramped nature of the ward. Another said that the nurses' office was centrally located and the walls of the office were open at the top so all conversations in the office could be heard in the dormitory.

In another case in the Dublin mid-Leinster region, the female admission ward is a locked 25 bed ward located on the first floor of the main psychiatric hospital. Eight patients awaiting alternative accommodation could be discharged if this was available. Access to a psychologist, occupational therapist or social work is by referral letter only, even within the multidisciplinary team. There are weekly multidisciplinary team meetings. Access to addiction counsellors is usually on discharge. The consultant psychiatrist and NCHD attend the ward daily and there is access to radiology and laboratory services. For medical and surgical assessments, patients must wait with staff, often for extended periods, in accident and emergency services in the general hospital. This can cause difficulties if the patient is disturbed and causes staff shortages on the ward.

I spoke to the Minister of State before about a particular case in Carlow and I acknowledge his help on that occasion. Recently, however, a mother came to me pleading about her 18 year old daughter, who was hitting her even while she was driving and has severe behavioural problems. That girl is unfortunately in Mountjoy Prison for six months but the mother is terrified of when she will be released. It became so bad the mother slept fully clothed holding her mobile phone and her car keys in case she was attacked by her daughter during the night. There is a huge gap in services for those in this situation. If one phoned for advice on where she could go, it was like pass the parcel in that no one knew but they always knew to refer her to someone else. No one took responsibility so I welcome the new policy formulated by Fine Gael and the Labour Party in this area.

I was amazed to find out that up to 11,000 people presented at accident and emergency wards following instances of self harm in 2003, with estimates that the figure could be as high as 60,000 incidents per year. We must talk about self harm and suicide in the same vein.