Seanad debates

Thursday, 8 October 2015

Commencement Matters

Mental Health Services

10:30 am

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

The Senator may think this is patronising but I do not mean it to be but the reason I like taking Commencement matters in the Seanad – although I would prefer if I did not have to do them so often – is that there is always that extra bit of time to flesh out the question posed. When anyone dies by suicide, it is a tragedy. I can only imagine the distress the family feels, especially when they thought their loved one was somewhere but then discovered he was not. Equally, someone admitted to an acute unit in the psychiatric services is very distressed and these things will happen. It is very unfortunate and I can only imagine the distress of families and the chaos that suicide leaves behind and that is why I am very committed to the new strategy. It is an awful thing for any family to have to experience. I pray that none of us experiences it but that is not the reality as it does happen.

The reorganisation of the service in Galway-Roscommon is a priority of mine. If anything I read out here, because I asked for a detailed response, is in conflict with the facts, I would very much appreciate if the Senator would tell me that at some stage. I hope the answer will be satisfactory. It is a service in transition and it needs time to bed down but people’s safety should be paramount in that process.

It is widely recognised that this Government has prioritised development of all aspects of mental health policy. The explanation for that is the psychiatric service is different from the mental health services, which cover community-based and attitudinal problems. Despite severe financial pressures overall, we have provided significant additional funding of €125 million since 2012 to enable the HSE implement the long overdue modernisation of our mental health services, in line with A Vision for Change. Key to modernising services in line with current and future demand, and best international practice, is reorientation from a hospital and bed-based focus to developing structures and processes required for enhanced community-based provision. In line with the national approach, Galway-Roscommon mental health services are committed to full implementation of A Vision for Change. The HSE appointed an expert group to review community mental health services in the region, Galway-Roscommon, which reported in June 2014. The group recommended a broad reconfiguration across the area, with a focus on enhanced community care through residential and other community settings and a reallocation of resources across both counties. The HSE in the Galway-Roscommon administrative area provides an inpatient and community mental health service for a population of 314,000. It is well advanced in implementing A Vision for Change, including adopting the recommended population sectors of 50,000, appointing team co-ordinators, and developing an overarching clinical governance model. The number of acute beds is well within the recommendations of A Vision for Change, which indicates 50 beds per 300,000 people. Galway and Roscommon has 67 beds in total, 45 in Galway and 22 in Roscommon, for a population of 314,000. This will increase by a further five beds in Galway with the opening of the new acute unit there in early 2017.

When we started to realise that there was a difficulty there, we put a particular focus on that area. The HSE has secured significant additional new staff posts for Galway-Roscommon since 2012, including additional consultants in the areas of general adult community mental health teams, psychiatry of later life teams and rehabilitation and recovery teams. Allied staff include occupational therapists, community mental health nurses, social workers and psychologists. The service in Galway-Roscommon has a nursing complement of over 400 whole-time equivalents. It had funding of €62.3 million in 2013, €63.4 million in 2014 and an allocation of €65 million this year before receiving its share of the 2015 development funding, which was the ring-fenced funding for development posts. It should be noted that the service has mental health spending of approximately €190 per head of population which, when adjusted for deprivation indices, compares very favourably to the national average of €161. Therefore, funding is not a core problem for mental health services, either in HSE west or nationally. This is one of the few areas that had an increase in funding. There are, however, acknowledged staff recruitment and retention difficulties generally, symptomatic of the wider health system which are being addressed in this context. The problems we are experiencing now will not help that. Recruitment is becoming easier but it is still difficult. Notwithstanding such difficulties, an additional 16 staff are being recruited for the community home-based intensive treatment team, as an alternative to admission to Galway University Hospital. The Roscommon area has developed a home-based intensive treatment team, since February this year. The acute unit in Galway continues to recruit additional nursing staff. Based on a Labour Relations Commission agreement in early June 2015, this includes two clinical nurse managers, five registered psychiatric nurses, one suicide crisis assessment nurse and progressing registration for 12 post-graduate nurses. In addition, six clinical nurse managers and ten staff nurses are in the process of recruitment.

I understand that local HSE management has recently met with the Health and Safety Authority, HSA, and staff representatives, and that all concerns highlighted regarding health and safety are being addressed as constructively as possible. These things sometimes take time and they are not as straightforward as we like to think they are. Any indication that Galway mental health service is an unsafe service is unfounded and any patient or staff member requiring assistance from the service is encouraged to ask for it. I particularly mention from time to time that staff need support in this type of service, which is demanding and challenging. We always hear about the acute hospitals and yet the most challenging of all is the service delivered by our extremely qualified staff in the acute mental health units.


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