Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

This unit will consist of 35 general adult mental health beds with the remaining 15 beds relating to psychiatry of later life, eating disorders, and mental health and intellectual disability. The acute unit in Roscommon will continue to provide 22 general adult mental health beds.

We must make rational decisions if we are to create and reinforce the community mental health teams around which A Vision for Change model is built. A Vision for Change recommends a catchment area of this size would have nine community residences for rehabilitation and continuing care. There are currently 58 such hostels in this catchment area, 11 of which cater for people with an intellectual disability. This level of support has absorbed a significant amount of resources and we need to see how we can best marshal our available resources to the best effect. We need to look to the future. Excellent models like Jigsaw in Galway city have been supported by reworking old resources. The funding for the brand new 20-bed child and adolescent unit at Merlin Park has been fashioned from the reinvestment of savings achieved through the decommissioning of older services

Why would we stop now? We must remember that St. Brigid’s Hospital opened in 1833 and accepted patients from all over Connacht. The hospital had a long and honourable tradition of care and support when hospitalisation was the only model of service available to distressed and mentally ill members of the community. Today, we have better options to offer, so we must modernise. At the end of 2013, there were 920 posts in the Galway-Roscommon mental health service. We now need to create a sustainable model of service. In 2013, this service spent over €61 million which is €194 per head of population, significantly above the national average of €168. Galway-Roscommon has a population of over 314,000 people, 6% of the national population, but currently spends 10% of the national mental health budget. This creates an equity issue as overspend in one area creates a corresponding underspend elsewhere. This imbalance also occurs within the catchment area with a significant imbalance of resources for the population living in sectors Galway-Roscommon 1, Galway-Roscommon and Galway-Roscommon. The overconcentration of resources in one area is at the expense of its neighbouring catchment. This cannot continue in a nationally managed mental health service.

National and local managers are working to address this imbalance to ensure all communities can avail of resources that are fairly and evenly distributed. We welcome the passion and commitment people have shown to protect their mental health services. I invite the people of Galway and Roscommon to work with us to reshape this resource into a more modern and dynamic service model. This service has a history of innovation and has adopted many of the recommendations of A Vision for Change and, indeed, 1984’s Planning for the Future. Now that we are about to take the final steps into the community, we should not pause on the progress made but continue what we have started.

A comprehensive review of services in this area has shown there are sufficient resources to deliver on all aspects of A Vision for Change, but we need to ensure it is properly configured to meet the modern needs of the population particularly young people, adults, older adults, people with very particular needs. Are we suggesting we halt the extraordinary progress made across the country where clinicians, managers, professional staff and service-users have worked to move away from this institutional model of care? Have we learned nothing from our past? We have recently dealt with residential homes, Magdalen laundries and old and remote psychiatric hospitals. I heard a Deputy in the other House earlier talking about allowing people wander the fields. Surely not. We continually encourage people at a time of distress to come forward, talk it through, seek help and treatment. The historical legacy of the asylum still lingers on in the public imagination, however. We are now towards the end of that journey. Are we to turn back and reverse the work of the past 30 years? Let us not forget the stigma which has been associated with these services in the past, the hopelessness and the sense of abandonment felt by service users. We cannot halt the progress of A Vision for Change and we can no longer disappoint vulnerable individuals in our communities who wish to re-gather their lives, have treatment and return to school, college, work, their families and their homes.

I acknowledge the professionals, staff, managers and various leaders who have done so much, in difficult circumstances, to modernise our mental health services and who have no desire to hold back the tide of progress and return to limiting, stifling and institutional ways. When we look back at the services in the past, we must admit they did it with the best intentions and to ensure the best care was provided. I hope when people look back on us, that they will be as kind to us. We do no better and we know there is a better way.