Fidelma Healy Eames (Fine Gael)

I welcome the Minister of State, Deputy Shortall. I raise this matter to request the Minister for Health to fund residential treatment in the United Kingdom for a young woman with a severe borderline personality disorder who has been certified as being at imminent risk of suicide and who has already attempted suicide on 14 occasions. This is a severe and pressing case. It is the first time I have raised a matter of this nature in the Seanad and I do not do so easily. It is a case worth listening to carefully.

I have been contacted by the parents of a beautiful 22 year old woman. For the purposes of this debate, I will call her Danielle which is her first name, but that is as far as I will go in identifying her. She has been unwell for over six years and has been diagnosed with a borderline personality disorder. She started to self-harm at the age of 15 or 16 years and has had many admissions to hospital since. She has required surgery on many occasions. Her problem was discovered during her first term in UCD. Prior to that, she was a bright and energetic teenager with a promising future. She was involved in swimming, dancing and various other activities; she did a lot of voluntary work both in Ireland and abroad and was a very good student. She has spent 20 months of the last three years as an inpatient in various psychiatric wards in both Dublin and Galway and has attempted to take her own life on 14 occasions. The last attempt was on Friday, 2 September while she was an inpatient at a psychiatric facility.

Danielle's parents were advised earlier this year by a number of health care professionals to look for treatment in the United Kingdom or elsewhere abroad. They spoke to the consultant psychiatrist at McLean Hospital in Massachusetts in the United States who specialises in this condition. He advised that the cost of treatment there would be prohibitive and that they should investigate possibilities in the United Kingdom. They feel very fortunate that they have identified the best demonstrated and documented treatment for borderline personality disorder, intensive dialectic behavioural therapy, DBT. With a number of health care professionals, they researched several locations in the United Kingdom and found an institution which treats females with borderline personality disorder, which mostly affects females. Some 95% of the referrals to the centre are from the National Health Service in the United Kingdom.

The outcomes from intensive DBT programmes are excellent. Following this degree of intensive treatment, many need fewer admissions to acute psychiatric institutions. However, intensive DBT programmes are not available in this country. That is the key point to be made.

Danielle had a four hour assessment in the centre in the United Kingdom. Her parents were very impressed by that assessment and the professionalism of those who carried it out. It is a residential centre which offers a range of therapies on a daily basis as part of a lengthy programme of between eight months and one year. They were advised one week after her visit that their daughter had secured a place.

The first application for treatment abroad through the E112 process was made to the HSE on 24 July, but it was refused on the grounds that it did not meet the criteria laid down. The parents appealed this decision and asked the HSE to reconsider the application. They submitted all of the documentation required, as well as the letter documenting the excellent assessment that had been made in the United Kingdom, but, once again, they were refused on the grounds that the family did not satisfy the criteria. Instead, the HSE has offered a limited dialectic therapy service for one hour a week to their daughter.

DBT comprises four elements, but the therapist employed by the HSE can offer just one element of the four. The treatment being offered is less than what Danielle has been receiving in the past two years and that treatment has not worked. The process of applying for treatment abroad is not easy; it is slow and arduous. It takes time, even before an application is submitted, and is highly traumatic and distressing for patients and their families. The family in question have told me their daughter found the process so distressing that she became acutely suicidal and had to be admitted for observation. As a consequence, she is again an inpatient in an acute bed. The more she is refused, the worse it is for her because her coping skills are absolutely gone. The family have informed me that since the appeal was refused, their daughter has lost all hope and the will to live and, for the most part, is deeply agitated. They note she is extremely disappointed she has been refused the treatment and therapy she desperately needs to survive. Moreover, they have told me it was heartbreaking for them to watch her deteriorate before their very eyes in the knowledge she was being prevented from availing of the treatment she urgently needed. They find it hard to keep up her spirits each day, as she cannot understand the reason she is being denied treatment that could give her hope to live and have a life.

This is a willing participant who is not fighting against having such treatment. I am sure many families are going through similar traumas as living with mental illness is not easy. There is still a stigma attached to it in Ireland. There is a dearth of essential therapies, counsellors and psychologists to provide therapeutic care for those with a mental illness. The parents in this case have told me they are both professional public servants who have given more than 30 years of service to their country. They always have paid their taxes and tried unsuccessfully to sell their family home. It is important to note they are prepared to do whatever it takes and have tried to sell their home to raise money for their daughter's treatment because they are desperate to give her hope and a chance to live. They claim the only viable prospect for their daughter's recovery and long-term well-being now depends on her securing some HSE funding to help to pay for this treatment abroad. I understand it costs approximately €150,000. The parents insist they are not applying for full funding and are endeavouring to sell the family home. In essence, they are trying to save their daughter's life. As she has attempted suicide 14 times, each day constitutes a struggle to ensure she lives.

I acknowledge this is not a normal application to bring before the House in these straitened times. For that reason, I was careful before so doing. I look forward to the Minister of State's response.