Joan Freeman (Independent) | Oireachtas source

I move:

That Seanad Éireann recognising the shortfalls in 24 hour access to mental health services, resolves to ensure that resources in the mental health budget are allocated to ensure that there is comprehensive 24 hour access to mental health services, including weekend and out-of-hours services across Ireland.

I wish to extend my sincere thanks to the Minister of State at the Department of Health for personally attending the House to discuss this important motion. Once again, I really appreciate his support in all we are trying to do for mental health in this country.

When we talk about the provision of 24-7 crisis intervention, we need to consider the following question. Who are the people we are trying to serve? By considering this question and what is presently in practice, we will give this House a clear indication of how appalling mental health services are in this country. In some cases, the services are so appalling that they take one's breath away. There are some good news stories scattered around this nation but the overall picture is bleak.

Let us start with what adults need. There are men and women who need crisis intervention due to several factors. I am referring to people who have threatened or attempted suicide and those who have engaged in self-harm. In general, around 11,000 people present themselves to hospitals across the country each year. There is a known fact that approximately six times that number, or almost 70,000 people, attempt suicide every year in this country but those who are outside of the hospital catchment usually try to get better by themselves.

The people who need crisis intervention also include those in a psychotic state and people who are going through a dangerous breakdown where they and their families are in danger of their out-of-control state. These are the people that we need to serve. These traumatic incidents do not usually take place during working hours. Indeed, research shows that most presentations to hospitals take place at night and at weekends. In fact, Sunday night is the peak time for people who are in crisis.

The adults and their families who experience this terrible trauma soon realise that because of the absence of community-based supports, their only port of call is the emergency room in their local hospital. This busy, noisy and often chaotic environment that was created for physical health emergencies is now the only place a person in crisis can go. It is a place where these men, women and their families often encounter indifference, impatience and stigma from overworked staff. The unkind environment and uncompassionate approach is also coupled with the fact that the professionals who work in the emergency department have not undergone specialised training that would allow them to appropriately respond to someone in emotional distress.

The anxiety and deep distress experienced by our most vulnerable people is re-enforced by the lengthy waiting times that can last up to 12 hours. It is because of this that many people will not and cannot wait as the lack of care only adds to their crisis. Even if people are eventually seen, the lack of follow-on care when they leave can sometimes develop into a tragic death.

Eleven years after the publication of the policy document called A Vision for Change, mental health services for adults still do not provide the very basic model of care that includes 24-7 crisis intervention. Truly, and without being simplistic, there is a very simple, effective and economical solution to this problem, namely, extend the hours of the existing general adult mental health services and completely remove the service from the emergency department.

I shall now give an example of a communication that I received today from Wexford General Hospital. The hospital has 210 beds but it does not have a psychiatric unit or ward and yet, in the first eight months of this year, 606 emergency presentations involving a mental health issue were seen in Wexford General Hospital. Due to the fact that the hospital has no facilities, the adults are held pending a transfer to the acute unit at University Hospital Waterford. Let us consider that situation for a moment. A person is in a chronic state yet he or she must wait until he or she is ferried to another hospital that is located an hour and a half away. That is just one example of what one hospital is experiencing. I would like to talk about the second group of people who need crisis intervention, namely, vulnerable children, the most vulnerable of whom have mental health issues. The boys and girls of Ireland are treated as second class citizens and the Government needs to see this. The reason they are treated as second class citizens is because of the Government's relentless avoidance of improving children’s mental health services and ignoring the fact that these services are dying on their feet. If services are not improved in Wexford, the CAMHS in the area will probably close down completely within the next 12 to 18 months because of the lack of consultant child psychiatrists.

The only way I can ask the Minister and the Senators in the House to experience this, and to realise what it is like out there, is to paint a picture of what our children and their parents have to go through. I shall tell the House about a few lived experiences. Take the case of Sam - this is not his real name - who is 14 years old. Sam attempted suicide. He was brought by gardaí to the local hospital but because there was no child and adolescent service available for him he was taken to another hospital one and a half hours away. The nearest child and adolescent unit was two and a half hours away so he had to be brought to this general hospital. Sam was placed in the adult psychiatric unit in the part of the general hospital locally known as the dungeon. Sam was left in this unit for 41 days. He thought he was being punished for attempting suicide.

Consider the case of a young 17 year old who, in a suicidal state, spent the whole night in an emergency room until the following morning at 8 a.m. when he was admitted into the adult psychiatric unit. He was told that he could not leave the room as he would be in danger from other patients there. Imagine that a child who was in very acute distress was told, "You cannot leave this room because you will be in danger." His parent was told to leave so that the staff could calm him down, and when the father returned an hour later he found the child all alone. The laces from his shoes had been removed and his belt had been removed but he was left in an acutely distressed state all on his own. There was no available staff so the hospital eventually had to take on an agency nurse to look after him 24-7.

Finally, take the case of the 16 year old girl who had taken an overdose and was admitted to a chair in the Kilkenny adult mental health unit. After she received carbon, a substance given to those who have taken an overdose of paracetamol, she was given a bucket to vomit into while her mother stood helplessly next to her in a very busy corridor.

I could tell horror story after horror story and none of what I tell will remotely describe the traumatic lifelong effects that these experiences will have on our children. The ISPCC has been calling for comprehensive 24-hour supports for more than a decade. The ISPCC child line receives more than 1,000 calls from children needing help every single day. Some 70% of these calls are out-of-hours. The UN committee on the rights of the child has also called on the Government to put in place a 24-hour service. UNICEF Ireland’s latest report card on child well-being shows that Ireland has the fourth highest teen suicide rate in the EU. While suicide in Ireland has decreased, thanks be to God, it has increased among children in the 15 to 19 age group. These are the children who have nowhere to go.

Finally, in February of this year, the Minister of State's predecessor, Deputy Helen McEntee, declared that work was under way on a roadmap for developing out-of-hours access to mental health services. The HSE mental health division has not even completed a costing model for a 24-7 mental health service. We do not need a roadmap, we need action. We do not need another task force and we certainly do not need another report or a review of a report. We need a practical and easily implemented plan that can be rolled out over the coming months.