Keith Swanick (Fianna Fail) | Oireachtas source

I congratulate the Minister of State, Deputy Jim Daly, on his appointment and welcome him to the House. I thank Senator Freeman for introducing this important legislation, which Fianna Fáil is happy to support. This Bill, which proposes to end the practice of admitting children to adult psychiatric units, legislates for what is already the stated policy of the HSE and the Department of Health.

The admission of a child to an adult ward can make the inpatient experience far more distressing for the child. It does not place the child in an environment that supports his or her recovery. The inappropriate admission of children and adolescents to adult inpatient units is undoubtedly a matter of significant concern. Resources must be brought to bear as a matter of urgency to provide for the community-based service and the age-appropriate acute care that would reduce such admissions.

My party colleague, Deputy Browne, also has a mental health (amendment) Bill in process. Thankfully, it has been allowed to skip pre-legislative scrutiny and go to Committee Stage straightaway. This is in part as a result of a commitment to give mental health a level of priority which has usually been reserved for physical health. That mental health issues are featuring on the legislative agenda of both Houses with such support is a demonstration of increased awareness of mental health issues on all sides of the House.

Senator Freeman's Bill is to be highly commended. I say that as a doctor who has worked in the mental health service in Dublin, St. Ita's Hospital and the NHS system in Wales. If this Bill is passed, it will create a statutory basis for ensuring the practice of admitting children to adult psychiatric units can no longer occur. Generally speaking, admissions are covered by section 14 of the Mental Health Act 2001. The Bill before the House intends to amend the 2001 Act by inserting new provisions to the effect that, "No admission order shall be made in respect of a child under the age of eighteen to an adult inpatient unit save in exceptional circumstances where it is in his or her best interests to do so", and that, "Where a child is admitted to an adult inpatient unit he or she shall be accommodated in an area separate from adults in an age-appropriate environment with age-appropriate facilities." That is very important.

Mental health advocacy groups have expressed concern that this Bill, as drafted, could have unintended consequences. We would like these matters to be addressed as the legislation proceeds. There is a risk that the simple provision of a legislative lever that prohibits child admissions could have the effect of overbalancing resources towards the provision of more inpatient beds in a reactive manner. The provision of a better-resourced, community-based mental health service, in conjunction with some preventive measures, could be expected to have the effect of reducing the need for inpatient beds overall. It is expected that improvements in community-based services, including a seven-day service and a 24-7 community-based crisis intervention service, would lead to a significant reduction in the number of inappropriate child admissions to adult units.

It is critical to build the capacity of the primary care sector to provide comprehensive mental health services, with a particular emphasis on providing crisis out-of-hours mental health supports in every community. Similarly, we must develop local alternatives to inpatient services, such as assertive outreach, early intervention in psychosis and other community-based incentive supports, in addition to family-centred supports. It is vital that we increase accessibility to specialist child and adolescent mental health services, including both inpatient and outpatient services where necessary, to avoid inappropriate child admissions to adult units. There is also a concern that the effect of the establishment of a law that allows child admissions to adult units in exceptional circumstances, as set out in the Bill, could be the opposite of the intended aim. This could happen if a legal basis for inappropriate admissions that does not exist currently is created. We will tease this out at later Stages.

I am aware that many Members of this House want their local child and adolescent mental health services to receive better funding and resources. There is a need for a considerable increase in recruitment to community mental health teams. The HSE has admitted that it has just over half the staff it needs to operate such teams if it is to comply with A Vision for Change. One in four of the population of Ireland is under the age of 18. According to the HSE, there were 648 staff in the child and adolescent community teams at the end of 2016. This represents just over 54% of the staffing level of 1,195 that was recommended in the A Vision for Change policy document on the basis of 2016 population levels. Such insufficient staffing levels in our mental health services must be addressed with urgency. The inadequacy of current provision has the potential to pose serious knock-on effects.

While I understand that there are some problems with recruitment, I am sick and tired of hearing that the Government is doing everything possible in this respect, as I believe this is simply not true. According to the 2015 annual report of the Mental Health Commission, "there is still a most unsatisfactory situation whereby children are being admitted to adult units, there were 95 such admissions in 2015." It should be noted that the Mental Health Commission's code of practice, which has been accepted by the HSE, states that inappropriate admissions of children to adult units should not take place. Obviously, this has not translated into practice. There is a clear need for legislation to prevent such admissions. That is why I am supporting the Bill before the House.