John Crown (Independent) | Oireachtas source

Cuirim fáilte roimh an Aire Stáit. I was just doing the sad little mental arithmetic on this and, without putting too much effort into it, I can think of 12 people I knew who died as a result of self-harm as a consequence of mental illness over the years. A couple of them were cancer patients. Three or four of them were health workers who worked in the cancer area as doctors or nurses. Others were people I knew socially, including family members. This is a serious problem and I am delighted that so much attention is being focused on trying to reform the way we deal with it.

There is a transition phase when a modernisation process occurs, when we move from what is clearly and demonstrably the wrong way of doing things - as in the past with the incarceration and isolation model, which was a sort of leper colony approach to mental health care - to a more modern community-based approach. The danger is that as that transition is taking place, for all the deficiencies that existed in the old service as it is withdrawn, and before fully funded and adequate services are put in to replace it with a more modern community-type of approach, a huge hiatus can develop where there is no service.

I sometimes think that the Ballinasloe-Ahascragh triangle must be the epicentre of all public discourse in this country. I worked in Ballinasloe for six months and we provided the medical service in Portiuncula, a fine general hospital, for the patients from St. Brigid's psychiatric facility if they became unwell. I have two points to make about that. If psychiatric patients need to be in hospital, it makes sense that the hospital should also be part of a general hospital campus. We have had much discussion recently about co-location, bi-location and tri-location, but the idea used to be that psychiatric illnesses were treated in an entirely different kind of hospital. Talk therapy and support therapy are great, but some people need medical care for what happens when they are psychiatrically unwell. It tended to deprofessionalise the context of what was happening to these patients and somehow put them on a different plane from patients with more physical illnesses. In truth, however, most illnesses - psychiatric or otherwise - ultimately have some physical basis. I urge that great care be taken in the transition. We should be as enthusiastic in building up the new services as we are in closing the old ones, and there should be a match.

Getting back to the Ballinasloe model, I always remember one elderly gentleman who had grown up somewhere in Connemara. At an early age, as was the sad custom in those days, he emigrated to England where he worked in the canning factories near Bristol together with a group of other lads who had emigrated from his town. Over the years they never came back.

They may have returned once. Interestingly, 40 or 50 years later at the time of retirement they were still speaking Irish to one another. They had formed a little micro-society and were more or less looking after one another. When this particular gentleman, who was elderly, retired and needed to return home he could not do so because the family home was gone and his family were scattered. For a variety of medical and psychiatric reasons, he probably did not have a great capacity for self-management in a non-sheltered world different to the one in which we had previously lived and ended up, even though he was not that terribly mentally ill, in St. Brigid's Hospital in Ballinasloe where he became a long-term resident. There was no place for him to go but the hospital, which for him was a nurturing environment where he received fine and compassionate care. The point I am making is that there will be a complex set of needs unmasked as we wind down the care of people in long-term psychiatric facilities. We will need to ensure that we have places available for people in the community services.

There are other less glamorous components of psychiatric care that urgently need attention. One that springs to mind is that of liaison psychiatry. There is a huge need for psychiatric support for patients who may be in hospital with a primary diagnosis that is not psychiatric. A number of years ago by Dr. Rachel Cullivan, a brilliant young psychiatrist from the unit to which I am attached who is now a consultant in Ireland, and I both undertook research which showed that approximately one quarter to one third of all of our patients admitted with a cancer diagnosis met every criteria for a diagnosis of depression and-or anxiety. The truth is that we do not have good provision in place for these patients. There are spin-off and knock-on effects of inadequate provision in respect of the psychiatric-mental requirements of these patients, which translates into a greater demand on inappropriate use of other aspects of the physical health services.

I ask that the Minister of State, when formatting the plans, examine the need for the development of what I believe is a humane system in good quality hospital-based supportive psychiatry and, most important, one that makes sense in terms of resource utilisation. I commend the Minister of State on her reform efforts and urge that she continue her good work.