The shift to a community oriented mental health service as an alternative to institutional care for persons with mental illness is making steady progress. New mental health centres, day hospitals and other facilities have been set up and at the same time additional community based residential accommodation has also been made available. At present there are approximately 400 community residencies providing over 3,000 places. There are also approximately 200 day hospitals/day centres, providing over 3,500 places. However, it is recognised that further significant improvements in providing alternative facilities are needed as a matter of urgency.

While there continues to be a steady decline in the number of patients in psychiatric hospitals, the rate of progress in developing community based alternatives to this institutional service needs to be accelerated. Substantial capital funding under the national development plan has been allocated to the development of mental health facilities. Approximately €190 million is being provided over the lifetime of the plan, which will enable the further provision of acute psychiatric units attached to general hospitals and the provision of additional community based facilities.

The inspector refers to the ongoing relocation from of old institutional mental hospitals to acute psychiatric units attached to general hospitals. Since the publication of Planning for the Future in 1984, 18 new acute psychiatric units attached to general hospitals have opened. During 2001, further new acute psychiatric units were completed or nearing completion at St. Luke's Hospital, Kilkenny, Mayo General Hospital, Castlebar and at Portlaoise General Hospital. It is expected that each of these units will become available to the respective mental health services shortly. Construction of new acute psychiatric units is also well advanced at James Connolly Memorial Hospital, Blanchardstown, and at St. Vincent's Hospital, Elm Park. At the time of inspection in 2001, the few remaining patients at Our Lady's Psychiatric Hospital in Cork were due to transfer to a newly refurbished unit at the former St. Anne's Unit in Shanakiel in Cork city, facilitating the final closure of Our Lady's, and I am pleased to report that this process has now been completed.

Priority is being given to the development of mental health services for the psychiatry of later life and the child and adolescent psychiatric services. Additional resources have been made available by my Department to enable on-going developments in these services. The increase in the number of people living to advanced old age requires the development of specialist mental health services to meet their specific needs. Later life psychiatry services have been expanded in recent years and € l.831 million is being provided in 2002 towards the provision of additional consultants in later life psychiatry.

The Inspector of Mental Hospitals recommends this development in his 2001 report. An additional €6.061 million was allocated in 2002 to further develop the child and adolescent psychiatry services. This funding will provide for the appointment of additional consultant psychiatrists in child and adolescent psychiatry and for the development of multi-disciplinary teams to focus on specific areas, such as attention deficit/hyperactivity disorder – AD/HD.

A working group has been established by my Department to review child and adolescent psychiatry provision and to finalise a plan for the further development of this service. The group published its first report in March 2001. This first report of this group emphasises that the treatment of ADHD/HKD is an integral component of the provision of a comprehensive child and adolescent psychiatric service. It recommends the enhancement and expansion of the overall child and adolescent psychiatric service throughout the country as the most effective means of providing the required services for this group. It also recommends that priority should be given, in the first instance, to the recruitment of the required expertise for the completion of existing consultant led, multi-disciplinary teams. The report also calls for closer liaison and interaction with the education system and other areas of the community health services.

In its first report, the working group also examined the issue of in-patient psychiatric services. It recommends that a total of seven child and adolescent inpatient psychiatric units for children ranging from six to 16 years should be developed throughout the country. It is envisaged that the focus of the centres will be the assessment and treatment of psychiatric, emotional or family disorders including major adjustment, anxiety, mood and eating disorders and schizophrenia.

At present, four of these child and adolescent psychiatric inpatient units are at the planning stage and project teams have been appointed to oversee their development. The proposed units are to be based at Bessborough House in Cork, Limerick Regional Hospital, Merlin Park Hospital in Galway and St. Vincent's Hospital, Fairview, Dublin. In addition to these, the working group is considering the provision of services for 16 to 18 year olds and its report on this important issue is expected shortly.

The working group on child and adolescent psychiatry also proposes to examine the needs of persons suffering from eating disorders and how appropriate services can be developed in the short, medium and long term. The working group has invited submissions from interested parties on how the needs of persons suffering from an eating disorder can best be met.

Additional revenue funding of €24.447 million has been made available to the mental health services for 2002 to address specific areas, highlighted by the Inspector of Mental Hospitals in his report, as requiring special attention. These include the development of community mental health services, the expansion of child and adolescent services, the provision of liaison psychiatry services in general hospitals, the development of later life psychiatry and suicide and suicide prevention programmes.

This funding represents a 350% increase on the addition funding allocated in 1999 –€6.98 million – and will further enhance the significant improvements which have been made in recent years. Some €10.473 million was allocated in 2002 towards the further development of community-based mental health services primarily for the establishment of additional multi-disciplinary teams and the recruitment of additional staff to strengthen existing services.

The lack of multi-disciplinary teams in many areas of the mental health services has been highlighted by the Inspector of Mental Hospitals in this report. At national level, priority is being given to education awareness and to promoting a better understanding among the public towards mental health, thereby facilitating a greater and more positive acceptance of the transfer of mental health services from institutional to community-based settings. Links with the voluntary sector continue to be strengthened both at national and local level and an additional €1.529 million has been made available in 2002 to strengthen these links and services. There is ongoing co-operation between the boards and several voluntary organisations such as Mental Health Ireland, AWARE, GROW and Schizophrenia Ireland.

There are growing moves to provide advocacy services in Ireland. This, although still embryonic, is most advanced for people who experience mental distress. Within mental health services, an advocate can be someone who represents and defends the views, needs, wishes, worries and rights of individuals who do not feel able to do so themselves. Funding of €0.251 million was provided in 2002 for the first time for mental health advocacy services. The national health strategy, Quality and Fairness – A Health System for You, includes a commitment that mental health advocacy services will be encouraged and resourced.

Suicide is a serious social problem. There were 448 deaths from suicide in 2001. These figures are disappointing in that they indicate an increase of 35 on the 2000 figure. The figures highlight the need to intensify our efforts and to put additional resources in place for suicide research and suicide prevention programmes. The high incidence of suicide in the general population is not confined to Ireland but is a growing global problem.

Apart from the increase in the overall rate of suicide in Ireland, a disturbing feature is the significant rise in the male suicide rate. There has been a significant increase in the rate of suicide among young males. These are worrying trends which require further research so that better strategies can be developed to help people who are particularly at risk.

Since the publication of the report of the national task force on suicide in 1998, there has been a positive and committed response among both the statutory and voluntary sectors towards finding ways of tackling this tragic problem. A suicide research group has been established by the chief executive officers of the health boards. Resource officers have been appointed by all health boards with specific responsibility for implementing the task force's recommendations. Additional funding of €1.110 million was provided in 2002 towards suicide prevention programmes in the health boards and towards research aimed at improving our understanding of this issue. Nationally, since 1997 over €6 million has been provided by the Department of Health and Children for suicide prevention activities.

The Inspector of Mental Hospitals has recommended that the most appropriate way of addressing the needs of mentally ill persons before the courts and in custody is through the development of a high-quality forensic psychiatric service. There are now five consultant forensic psychiatrists in the Dublin region and steps are being taken to provide special interest consultant forensic inputs to Cork and Limerick prisons.

The national health strategy, Quality and Fairness – A Health System for You, contains a commitment that the Department of Health and Children and the health boards will work in close collaboration with the Irish Prisons Authority in improving the health of the prisoner population, within the framework of the recently published report of the expert group on the structures and organisation of prison health care systems.

The inspector welcomed the report of the forum on medical manpower and the establishment of a medical manpower committee. One of the primary recommendations of the forum is the commitment to provide, as far as possible, first line consultant services so that mental health services, like other medical and surgical services, come to be consultant delivered as well as consultant led. At the end of 2001, there were 261 permanent consultant posts in psychiatry in the public mental health service. Of these, 15 had been approved during the year 2001, bringing the total of new consultant psychiatrist posts approved in the five year period 1996 to 2001 to 57 new appointments.

While the inspector expressed concern about the inadequate skill mix and lack of flexibility within many mental health services, he welcomed the introduction of new measures aimed at attracting and retaining nursing staff and the development of higher level courses for nurses wishing to follow a clinical career path. November 2001 was a significant month in the history of nurse education and training. For the first time it was agreed that the registration programme in psychiatric and disability nursing would be at degree level. This new degree programme will replace the three year diploma programme.

In response to some of the ongoing concerns expressed by the inspector over many years, legislative change is now under way. The Mental Act, 2001, was signed into law in July 2001. The Act provides for the establishment of the Mental Health Commission, which was established with effect from 5 April 2002. The commission is an independent statutory body whose primary functions are to promote, foster and encourage the establishment and maintenance of high standards and good practices in the delivery of mental health services and to protect the interests of people detained for psychiatric care and treatment. While the detailed work programme of the commission is a matter for the commission itself to determine, I understand one of its priorities over the next year will be to put in place the structures required for the operation of mental health tribunals. It will also be recruiting an inspector of mental health services, as provided by the Act, and assisting him or her in putting a system of annual inspections and reports in place.

The Mental Health Commission and the new inspector of mental health services have the potential to play a pivotal role in the further modernisation of mental health services. The current Inspector of Mental Hospitals has already begun this process. I hope and expect that the new inspector, when appointed by the commission, will build on this work in the years to come.

The Mental Health Act, 2001, will require the new inspector of mental health services to carry out an annual review of all mental health services, including community residences and day centres as well as acute in-patient facilities. A registrar of approved centres, in which each hospital or in-patient facility providing psychiatric care and treatment must be registered, will be maintained by the Mental Health Commission. Regulations will be made specifying the standards to be maintained in all approved centres, including requirements in relation to food and accommodation, care and welfare of patients, suitability of staff and the keeping of records. The execution and enforcement of these regulations will be the responsibility of the commission, through the work of the new inspector of mental health services.

The new inspector's review of the services, including reports of inspections carried out, will be published with the Mental Health Commission's annual report and laid before both Houses of the Oireachtas. The current inspector, as an independent officeholder, plays a crucial role in providing an accurate and detailed account of services in the mental health sector. It is my intention to facilitate the health boards in as far as possible to bring about the improvements and developments identified by the inspector.

I thank the House for affording me the time to make my maiden speech on such an important issue as the report of the Inspector of Mental Hospitals.

The whole spectrum of mental health does not get the attention given to general health services. It is the Cinderella of the health service. This is also reflected in the allocation of resources. Mental health has long been regarded as the hidden illness, but, thankfully, the stigma attached to it is receding and there is now a new understanding and some enlightenment. It is now recognised for what it is – an illness with parallels to physical illness, in which it is often entwined.

Society will be judged by the way it looks after the most vulnerable, the old and those with a weaker voice such as persons with psychiatric problems. It can be gleaned from Dr. Walsh's report that progress is being made in this area, but the pace of that progress is not what we had hoped for.

The major innovative stride of the past decade is the shift away from institutionalised to community based care. This may not always be an option, but the rights of the people concerned are also pertinent. In that regard, I welcome the establishment of the Mental Health Commission.

The role of those who work in the area of mental health is to be commended as are the innovative initiatives in areas such as County Roscommon and County Monaghan. The professionals in this area drive the system, but in regard to these initiatives, Dr. Walsh refers to the inflexibility of the unions. It has to be remembered, however, that in these changing times, much flexibility is being shown by the workers in the unions concerned in adapting to the new demands in training. From talking to workers on the ground, I am aware that morale in this branch of the health service is excellent. That is unusual because when I set out to talk to many of the workers in this area of the health service, I expected morale to be low.

The role of the various organisations, such as the Mental Health Association of Ireland, GROW, AWARE and Schizophrenia Ireland, is very important, but they need a professional focus and guidance. This must be delivered. We are all too aware of the devastation caused by suicide, which presents a serious problem. The mental health of children and adolescents is of the utmost importance.

The text of the report is very medical in nature and could have included a broader representation from consumers, their representatives or members of the public. My only dissatisfaction with the report is that it should have had a broader vision.

We have to be careful not to emulate the mistakes made in the United Kingdom by returning persons ill-equipped to cope with life in the community. The necessary backup services must be in place. The Minister of State referred to day care facilities, more residential hostel accommodation and short-stay or halfway house units with the necessary professional support. All these facilities need funding. I hope in the developing financial climate we have experienced in the past five months, the area of mental health will not be seen as one for belt tightening or adjustments, to use the Government's term. I hope adjustments will not be inflicted on the mental health service.

Advances have been made with the development of strategies such as having acute psychiatric units attached to general hospitals and those in County Roscommon. The advantages of this innovative measure are cross-disciplinary consultation, assessment and treatment as required. It means also that services are much more accessible to those in need and will be availed of earlier with consequential benefits.

The demise of the large institutions, which have ominous and historic connotations in the Irish mindset, is to be welcomed. However, it appears they will still have a role in the short term due to the lack of adequate accommodation in homes for the elderly, where many residents of those institutions might be better placed. I appeal to the Minister of State to seek more funds and resources for the provision of such additional places for those people for whom community based care is vital.

I hope the national health strategy, Equality and Fairness – A Health System for You, will live up to its title for the benefit of those most vulnerable in our society and that the annual report on mental hospitals will continue to monitor the situation. When its remit is expanded to include the broader mental health services, under the provisions of the Mental Health Act, 2001, I expect it will provide an invaluable resource for all involved. I welcome Dr. Walsh's report, for which I thank him.

I wish to share time with Senator Bannon.

In his opening statement, the Minister of State referred to the standard of accommodation provided for patients in old style mental hospitals. The inspector's report was also very critical of some of the residential units established in recent years. He condemned the condition of a community residence for psychiatric patients in my home town, Longford, as "distressing and unsatisfactory" as patients were forced to live in neglected premises. Does the Minister of State consider this good enough for very vulnerable people in society? It is not good enough and this type of neglect should be eliminated once and for all.

The report highlighted the fact that a semi-detached house, which accommodated psychiatric patients, was in an unsatisfactory condition and needed immediate attention. The gardens were overgrown with weeds and several caravans were parked around the house. Fire alarms in the house were not in proper working order, there was no floor covering in one bedroom, the house was in a poor state of decorative repair, windows had not been painted for some time and glass was broken in doors and windows. One of the residents said the occupants of the house were constantly harassed and, although the Garda had been informed, the nuisance continued.

There is a clear message from that experience with regard to the location of community residential facilities. Before such premises are purchased, acceptance within the local community should be checked. At the last meeting of the Midland Health Board I expressed serious concerns with the report on this type of accommodation for psychiatric patients. I demanded that the board address the situation immediately and I await a report at its next meeting. That shameful situation must not be allowed to happen again in any part of Ireland.

The inspector also expressed criticism of the Longford community mental health centre and day hospital highlighting the fact that this combined use of the premises is unsatisfactory. He recommended the provision of a new day centre to allow the existing premises to function as a true day hospital and deal with more disturbed patients. This demonstrates the need for funding to provide this facility with additional space and better accommodation. The report commented on procedures and practices in each service, particularly with regard to privacy and dignity for patients, an issue which has been greatly neglected. It also stressed the need for follow-up care programmes for patients after discharge from hospital and commented on the number of homeless persons occupying acute in-patient beds due to the lack of alternative accommodation. The Government should take note of this when preparing its budgets for housing.

Service provision issues in the report include inadequate development of day centre and day hospitals in community settings, coupled with reluctance of some staff to be based in, and work from, community mental health centres. The report highlighted a requirement that elderly patients, whose needs are primarily physical, should be accommodated in more appropriate community care facilities for older persons. It also noted the inadequacy of physical health examinations of in-patients. Those issues must be addressed by the health boards and the Minister should ensure they do so.

The Minister of State referred to the incidence of suicide on a national basis. There were nine cases of suicide among psychiatric patients during 2001 and the inspector has requested all services to review all cases of suicide in their service with a view to scrutinising existing clinical management and risk assessment of patients for the possibility of self harm. The inspector recommended continuation of the practice of transferring of intellectually disabled people into more appropriate care facilities to enable them to receive skilled and specialised care not generally available in psychiatric hospitals. He emphasised the need for a local register to be established for investigation of complaints and outcomes to be audited. I hope action will be taken on those recommendations.

This report provides the Government and Minister for Health and Children with important information for use in preparing his budget for mental health services and a basis for capital investment plans. It is very important that the inspector's recommendations are acted upon and incorporated into each board's plan when making their submissions for funding.

The contributors to this debate seem to have consulted the index of the report to find out about their own health board area. The North Western Health Board, which covers counties Donegal, Sligo, Letrim and my adopted home town of Sligo, was the pioneer in this practice. Saint Columba's, a very large hospital, was one of the first major hospitals to be sold. There are now 217 patients in residential accommodation throughout the catchment area. Unlike Senator Bannon's experience in Longford, the inspector has been very complimentary about how we have accommodated those patients in Sligo. There are many of them in the small electoral ward in which I live and one could not ask for nicer neighbours. There have been times when local communities have objected to having patients living among them. This was very bad and no longer happens.

The Government has made very positive moves to develop policy which favours patients. The fact that there is such a fine report to debate is evidence of this. Senator Bannon suggested that there should be a report twice a year. So much work and resources go into one report that it would not be possible to have two.

The Government has paid close attention to delivering a patient-centred structure. The Minister of State referred to this in his speech when he mentioned facilities such as day hospitals. Anyone who is familiar with a day hospital in their community knows the extent of their good work. The Minister of State also alluded to the wonderful nursing staff. I particularly praise community psychiatric nurses who carry out Trojan work. The Minister of State rightly said that nursing moved into a new sphere one year ago. Nurses across the three disciplines are now entering four year degree courses. In some areas I fear that they may become mini-doctors, but it is good that education knows no boundaries. No matter what profession or walk of life you are in you cannot have enough education.

Senator Feighan rightly pointed out that people with a psychiatric illness are very vulnerable. I represent the public interest on the Medical Council and part of my remit is to visit training hospitals for non-EU doctors to check that facilities and training are adequate. The hospital inspection took me to Saint Loman's which is a flagship hospital. It is one of the psychiatric hospitals which have relocated to a general hospital and it is now in Tallaght. I was pleasantly surprised to see the lovely surroundings. It took a few moments to adjust to the fact that in such a secure unit the door locks behind you. We are not used to this but it is a necessary component of a secure unit. There were wonderful pictures on the walls inside the unit. It seemed like a hotel and this is proper and fitting. I was very impressed with the level of training which junior doctors receive and the commitment of senior consultant staff to give their time. The Department give protected time to junior house doctors for this training. We can be proud of this aspect of the health service.

I am not a member of a health board but I know that they have a remit to inspect hospitals. They do this on an ongoing basis. This provides a watchdog to ensure that everything is in order. It would be remiss not to recognise that there are problems in the whole psychiatric area, but the Minister cannot be blamed for all of them. Staff shortage is a major problem. Despite vigorous advertising in the national media and the medical press many of the posts remain unfilled. The staff of the psychiatric services should be commended for their dedication and commitment. This is true across the board, for nurses, doctors, social workers and psychologists.

We should recognise the variety of treatments available today. The Minister of State will recognise this because he was a pharmacist in his former life. He must have seen a change from what was recognised and criticised as a drug-based treatment to a more therapeutic base. There is family therapy, addiction therapy and behavioural therapy. Drugs are a necessary component of any illness and our lives would be terrible without them. However, there are alternatives which are used very effectively. I congratulate the Minister and the Department on the work which has gone into the psychiatric area.

With our kinds of lives and the world in which we live today, many of my friends and associates discuss stress. People are now susceptible to acute mental breakdown and I would hate to think that anyone would be treated in some of the old hospitals which still remain. There is such a unit in Sligo which dates back to the 1950s. I spoke to the chief executive officer of the health board this morning and he told me that there are plans for it. Perhaps the Minister of State would find out how advanced they are and move them along. We in the health board area would be delighted.

There are very good recommendations in the report. One of them, which has not been mentioned, is the repatriation of long-stay patients in hospitals. Sligo is the base for Donegal, Sligo and Leitrim. There are six or seven long stay patients from Donegal in Saint Columba's. It would be lovely if they could be repatriated to a facility in their own counties where their families could have easier access to them.

I welcome Professor Dermot Walsh's recommendations and hope that they are taken on board. I also welcome the wonderful facilities planned for adolescent and child psychiatry, as outlined by the Minister. Members are aware of social problems and the way our courts deal with them. We might have fewer social problems if the services in that area were to improve.

The Minister spoke about the lack of multi-disciplinary teams in the psychiatry service. I spoke in the House last week on the primary care strategy and about the wonderful initiatives that multi-disciplinary teams have in place for the community, especially in relation to general practice. GPs are for the first time becoming part of multi-disciplinary teams and this is something all medics and health professionals are embracing. That could be progressed and the importance of multi-disciplinary teams and psychiatric services recognised.

It was depressing to hear Senator Bannon talk about problems in getting patients into the community and objections being made about patients going to houses in certain areas. The Senator should not think that the problem is only in Longford. Where I live in Dublin 4, a house is to be bought for people being discharged from psychiatric hospitals. I was depressed to be contacted by a local institution to ascertain, as I live nearby, whether I would be supportive if there were problems raised about people going into this house. I am glad that there have not been problems there but this issue is being raised not just in rural areas but elsewhere also.

It is good that the general health of the population in these hospitals is looked after much better than in the past. For example, it is known that those with mental illness have a lower life expectancy than others but it is good to see that efforts are being made to ensure no-smoking areas are being made available for them and that work is no longer rewarded with cigarettes. That was a very bad idea, although not as much was known then about the damage that smoking can do.

Praise is due in many areas and it is most rewarding to see that the effort put in is now bearing fruit. However, I am concerned by one omission from the Minister's speech. There was no reference to the Central Mental Hospital which is the big black spot in the mental health services. I have said in the past that I believe there is a turf war ongoing between the Department of Health and Children and the Department of Justice, Equality and Law Reform to see which can do least for the mentally ill in the Central Mental Hospital and in the prisons.

I understand that Ireland is in trouble with the European Committee for the Prevention of Torture due to the fact that we have so many mentally ill people in padded cells in prisons. I thought there had been agreement recently at Cabinet level that an intensive forensic care unit was to be set up in the Central Mental Hospital where, I was told, 30 beds were needed. There will of course be a price tag on that because, even with the great increase in the number of forensic psychiatrists, there is a still a shortage in this area and in that of psychiatric nurses. Some 26 nurses are needed and this has led to the closure of many beds so that the hospital is only able to take 75 patients at the moment. I hope it is not heard in Strasbourg that the prisons are probably keeping more people in padded cells now. We must deal with this matter at once.

I constantly hear about the new Bill on the treatment of the mentally ill before the courts and in prison. However, in July 2001 when the last Mental Health Act went through, Members were told that the new Bill on the treatment of the mentally ill before the courts and in prison would be before the House that autumn. There is still no sign of it one autumn later. I was foolish not to have asked which autumn was referred to.

It is worrying that Ireland appears to have the highest incidence in Europe of mentally ill people in prisons. About 160 of the 11,500 admissions to prison last year were of people described as mentally ill. Efforts were made to transfer these people to the Central Mental Hospital but there was frequently no room. The 1999 report from the Department of Justice, Equality and Law Reform on the IQ levels of those in our prisons showed that some 28% had an IQ level of 70 or below. There is an odd situation in our prisons and, while I realise this is not the Minister of State's area, there is a dreadful gap between the Department of Justice, Equality and Law Reform and the Department of Health and Children about what is happening to the mentally ill and the intellectually disabled in prisons. The Minister of State should liaise with his colleague on that.

I am alarmed that there was no mention by the Minister of State of what the inspector sees as the serious misuse of section 208 of the Mental Health Act, 1945, the legislation we work under at present. I refer the Minister of State to pages 38 and 41 of the report where it states that section 208 allowed for the transfer to the Central Mental Hospital from local psychiatric services if the latter felt they did not have appropriate facilities to treat such patients. The transfers became possible under a Supreme Court judgment in 1994 and these patients were generally considered to be a danger to themselves and others because of their mental illness.

Following the judgment the inspectorate considered it wise to issue guidelines for the transfer of the patients from local psychiatric units to the Central Mental Hospital. The guidelines were intended to prevent the abuse of the transfer system. Unfortunately, as the inspector says, some disquieting features were noted in the case notes of these patients. About 20% of the patients in the Central Mental Hospital at the moment are there under section 208. The report states:

Firstly, the guidelines as issued by the inspectorate did not appear to have been used, or if they were used the appropriate transfer forms, as suggested by the inspectorate were not completed and hence not copied to the inspectorate as advised. Secondly, there appeared to have been little or no formal liaison between the referring hospital personnel and that of the Central Mental Hospital during the patients' stay. Such liaison should exist so that the patients could be discharged from the Central Mental Hospital at the earliest possible opportunity. Thirdly, and more significantly, a worrying practice appeared to have been developed whereby patients admitted to the Central Mental Hospital from the prison services, on reaching the end of their sentence and not having been deemed fit for discharge, were placed on a temporary detention form and sent to an appropriate mental hospital, usually St. Brendan's. Section 3 of the temporary forms were then completed and the patients were transferred back to the Central Mental Hospital under section 208 of the Mental Treatment Act, 1945.

The inspector goes on to highlight the fact that consultants frequently tried to get patients back to their own psychiatric hospitals and were refused and suggests that we must get some medium type secure units for these patients. Practice is at variance with the legislation and I ask the Minister to have a look at that.

The inspector also pointed out that people in the Central Mental Hospital were frequently put into seclusion by nursing staff and the form signed retrospectively by junior doctors. This he said was a bad idea. Old hospitals are emptying and the inspectorate points out that it might be a good idea, since some of the patients left in them are really only institutionalised elderly patients whose mental illness is no more, if parts of these institutions could be adapted to dealing with the elderly. He points in particular to St. Finan's in Killarney where 60% of the 200 patients are over 60.

Another interesting topic brought up was the situation in regard to alcoholism. The inspector says acute cases should not be treated in mental hospitals but in general ones. He queries the long occupancy of people with alcoholic problems in our mental hospitals. We should look at this carefully because these patients occupy many acute beds which are thus unavailable for people with serious mental illnesses.

We also need to keep working at the separation of the mentally ill and those with intellectual disability. Slow progress is being made in this area. Senator Feeney pointed out that we now have two separate degree courses for nurses in this area. The two patient groups do not require the same sort of care. This option may not be expensive and in these days of adjustments it may be possible for the Department to keep working at achieving this.

It is tremendous that we have got some acute wards going at last. I share Senator Feeney's enthusiasm for the one in Tallaght but ask what is happening in places like Beaumont. Beaumont must be nearly 20 years old yet we are still waiting for its acute ward to open. The inflexibility of staff, and others, sometimes leads to this sort of problem. In Tallaght the ward was empty for about three years while agreement was sought with psychiatric nurses. Nurses need to be more flexible.

We also need a mother and baby unit. The last tri-annual report in England of maternal mortality reported 15 suicides and said it thought this was a grave under-estimate. If women who get post-natal psychosis or depression attempt suicide it is usually something grim such as hanging. Two thirds of these women hang themselves. We have a small unit in St. Patrick's but we need more. It is often when the crisis is over that such persons commit suicide. I ask the Minister to look at this area.

I was delighted the Minister mentioned adolescents and children. We have about 49 teenagers in adult units all over the country. People have contacted me about the lack of facilities for children with psychiatric illness. It is not asking too much to seek such facilities. The Minister mentioned this and we must get working at it as soon as possible because the earlier illness is treated the better.

Suicides in mental hospitals were mentioned. Relatives of these patients frequently feel that they were not adequately informed about the situation. I have had complaints from two people. The daughter of one of them committed suicide on the private hospital's premises. In the other case the person's brother left the public hospital and committed suicide. Both relatives were dissatisfied. We also have the problem of sudden deaths of which we had nine, three of them drug reactions.

The Minister mentioned liaison psychiatry which is important. We must get it going, particularly in accident and emergency units, an area that seems to be forgotten. Seriously ill patients often come into accident and emergency units. It is difficult to deal with them there and to transfer them on to somewhere else without psychiatric help. Efforts are being made to deal with the homeless and another consultant psychiatrist has been appointed in the Dublin area to give help.

I ask that the Minister do as much as possible to help and support the carers and families of people with mental illness. The patients are frequently discharged back into the community as a result of shortages of psychiatric nurses. While the families and carers are willing to take people home they are often expected to take up the burden without adequate support.

The report being debated is important and current given that it covers the period up to the end of 2001. I know Dermot Walsh, the Inspector of Mental Hospitals, well because I met him on numerous occasions when I was a Minister of State in the Department. I congratulate him on his excellent work with Liam Hanniffy, the assistant inspector of mental hospitals. The report is always met with some fear and concern by health boards. I know chief executive officers are given a chance in advance of its completion to comment on specific situations.

It disappoints me that it takes time to bring about results. I know from having been a Minister of State in the former Department of Health the strides which have been made to ensure better mental health services. It is a complex area. The Mental Health Act, 2001, is a major step forward and I appeal to the Minister to implement all its parts as quickly as possible to bring it into full effect. There was a significant debate in the Dáil in the 1980s on a similar Bill which was passed by both Houses of the Oireachtas but never implemented.

One major change in the treatment of mental health is the number of patients who have been discharged into and live in the community. They have been treated and provided with excellent services.

In 1987 when I was Minister of State in the Department of Health, as it was known, a proposal was made for an acute psychiatric unit in the county hospital in Roscommon for more than 30 patients. There was little welcome for this. I was brought before a conclave of 40 priests who were deeply concerned that this policy was being implemented. I did not have the guidance of my officials but I went before this conclave and had to acquit myself. One statement I remember making was that that no one could say they would not be affected by mental illness at some stage. It is no worse than any other illness. It just happens to affect the brain. I persuaded the priests that they would not stop us in this regard. It was a major challenge to go before people of that calibre and ability.

I gave a stark warning then which has come to be realised: no one is excluded from mental illness. Everyone should realise that and accept that the modernisation of treatment brings challenges to everyone, especially in institutions where there was major resistance from the psychiatric services, the psychiatric nurses' association and unions because it affected a way of life. The institutions were horrible and were the next thing to prisons. I bid farewell to them. I compliment successive Ministers on having the courage to bring forward major change and I know the Minister of State will see that this continues.

Communities have accepted former patients. There was resistance in the beginning but that no longer exists because people realise former patients have been given excellent treatment. In some cases, house parents lend assistance. It is a significant change in the quality of life of a person who had a psychiatric illness to be cared for in the community with support services and treatment. The Minister of State has considerable relevant experience in the medical field and from his constituency. He has always supported the development of housing in Limerick city to assist former patients to recover.

A report was compiled on the distribution of drugs to patients in the Midland Health Board area and some consideration was given to it. I know there was a question mark over this and the issue of illicit drugs. It is my belief that there was a misunderstanding in the report and I have been informed on good authority that there was an inaccuracy. That said, the Garda was involved, the inspectors considered the matter and certain protocols have been put in place. Patients in acute services must be carefully monitored. There must also be maximum security to ensure they are not provided with any illicit substances, including alcohol, during their treatment. This is a problem which arises in certain hospitals.

I am a former chairman of the Western Health Board on which I served for a number of years. My period in office terminated at the end of June this year. I would have been delighted to serve for longer, but the opportunity did not arise. However, in this House I have an opportunity to bring forward issues. In relation to County Roscommon, I ask the Minister of State to provide funding for a day hospital for the services there. We have a greenfield site beside the swimming pool in Roscommon town and currently have temporary accommodation. Plans are well under way. We are also trying to incorporate a small community centre for the elderly.

I fully agree with self-advocacy, but there is also a need for a group to represent patients and former patients. There is a group representing those with an intellectual disability and I was very proud to attend their conference in the Hodson Bay Hotel on 4 and 5 November. I congratulate the Brothers of Charity and the self-advocacy group on their excellent work in that regard. Patients who have an intellectual disability should under no circumstances be in a long-stay psychiatric hospital. I ask the Minister of State, therefore, to provide funding and leadership by going to St. Brigid's Hospital, Ballinasloe to kick-start the move into the community. We have the site and the plans. What we need is the money to ensure those patients, some of whom are elderly, can live in dignified surroundings.

I thank the Minister of State for his attendance in the Seanad today. I congratulate him and wish him every success. I know he will do an exceptional job. He comes from a very distinguished family which has given and will continue to give sterling service to the State.

There are a couple of matters I would like to raise in relation to this report. The first is the reference to the Garda Síochána and mental health. This is a significant social element because, as the report points out, there are circumstances in which the Garda is among the first agents of the State to come into contact with a situation where there is clearly mental disturbance. What does it do about it? Historically the view taken of the situation was the same as that in relation to a family row. If there was a marital dispute, if there was wife beating, the Garda would encourage the couple to try to make things up, saying it could not get involved because it was a family matter. In addition, its members have no training.

There is a suggestion in this report that the capacity of the Garda to become involved should be explored as an additional resource for the State. The inspectorate, for example, expressed the view that training for gardaí in the elements of mental health care provision was necessary and further recommended that in each divisional area certain officers should be designated mental health specialists to deal with and advise on issues likely to confront them and their colleagues in their ordinary duties. This is a very positive development and should be encouraged. I am very pleased to note that during 2001, the period covered by the report, the Department, with representatives from the inspectorate of mental hospitals, went to Templemore and had discussions with the intention of establishing a proper training module for student gardaí. This is an excellent and positive development and I encourage the Minister to continue along this line.

In terms of legislation, there are matters at which perhaps this and the other House should look. Our attention is drawn specifically to them, in particular, section 208 of the Mental Health Act 1945, which allows for the transfer of people from mental hospitals to the Central Mental Hospital, Dundrum. In the old days that was a byword – it was just a sink into which people were dumped and then sedated. It is still worrying. There was apparently a challenge in the Supreme Court to the operation of this section, which was upheld. However, the intention was that people transferred from prisons or other mental hospitals directly to the Central Mental Hospital should there receive appropriate treatment in order that they should recover. It seems, however, that this is very much the equivalent of the "at her Majesty's pleasure" notion in England. I recall dealing with a case of a constituent, a graduate, who was virtually imprisoned in a British mental hospital as a result of behaviour which had been provoked by the fact that he had joined a religious sect, got entangled in various ways and then tried to break out of it and caused a limited amount of violence. He was literally imprisoned in a hospital in Liverpool for a decade and I had to move heaven and earth to get him out.

We need to be very sensitive in using such powers. We need to make sure that when section 208 is invoked, the end result is not that people are pushed out of sight and sedated, but that they actually do receive appropriate treatment. The report states the spirit of the section was that such transfers would be made to provide treatment for individuals in the Central Mental Hospital which was not available to them in their psychiatric hospital or unit of origin. The fact that some persons transferred under section 208 have been in the Central Mental Hospital for a prolonged period, several years in some instances, seems at odds with the intention of the section. This is worrying because it suggests a kind of mini-gulag into which people who are inconvenient are stuffed out of sight, and the report states some of them have been there for years. Are they being treated, and, if so, is the treatment not successful?

With regard to those persons engaged in the treatment I welcome, with the report, the fact that from November 2001 degrees are available in psychiatric nursing. That is excellent. However, even though I am an academic, degrees are not the only thing. In nursing generally there has been almost too much of a shift towards the academic discipline and not enough recognition of the humane element. We are enormously in the debt of people who have come from other countries to service our health service, both in the psychiatric and the general nursing profession and in particular – perhaps I am being racist in saying this – I cannot help noticing the contribution made by Filipino nurses. Perhaps as part of their culture, they are endlessly patient with people whom somebody like myself, who is on a short fuse much of the time, would probably strangle. It is wonderful that they are able to deal with such situations. We are very much in their debt.

May I have your indulgence? I know you said I had one minute, I think it is an expanding minute under Einstein's theory. I draw the Minister's attention to the list of eight recommendations on page 96.

Even though the report is critical of some of the health boards, I am sure the Western Health Board, of which I am a member even though I do not speak for it, would very much accept the criticisms made. At the end of 2002, it is somewhat unreal to discuss a report carried out in 2001 or earlier. Since the report was written, the inspectors have on two occasions visited St. Brigid's Hospital in Ballinasloe, to which Senators referred earlier. Many things can happen in a year or 18 months. One of the criticisms of St. Brigid's Hospital centred on wards 2 and 3. Since the report was published, ward 2 has been closed and the health board hopes that improvements will be made in ward 3. The inspector is concerned that learning disability is still being dealt with in the psychiatric hospital. While there are criticisms, it should be accepted that improvements must be made and I would like to see them take place as quickly as possible.

In the 1970s there were 1,500 patients in St. Brigid's Hospital and this is now down to 280. The average stay in the hospital is now 11 days. Given that massive reduction in hospital patient numbers, community services must be available. This has been the objective of the Western Health Board and by and large we have very good community services in the eastern part of County Galway. In west Galway, there has been more criticism in the report of the services in the city, in the University College Hospital Galway, and more particularly the lack of community services in the west of the county. The upshot of that is many patients come to the eastern region where there are better services.

A service that is particularly valuable in a psychiatric hospital is the alcoholism unit. The alcoholism unit in Ballinasloe is the only one in the health board region with residential facilities. That is very important where people need to be taken out of the environment in which they live. Not all issues can be dealt with in a day care centre or an out-patient centre; therefore we must have residential services. There have been many threats that the residential unit in Ballinasloe will be closed but it should be retained.

Another welcome development is the great liaison between the psychiatric hospitals and the long-term or geriatric hospitals. The consultants can now see patients in either hospital. In the past there was considerable transferring of patients, which was very upsetting for them and not very practical.

As the number of patients in psychiatric hospitals has reduced, it is interesting to see what use can be made of vacant buildings. The Government talked about decentralisation many years ago. St. Brigid's Hospital was the first to offer a building suitable for a Department office. The same hospital offered facilities to the local committee for the Special Olympics to be held next year. They were welcome developments, but it is somewhat ironic that St. Brigid's is a heritage site and it is always difficult to deal with the adaptation of such sites. Planning permission and a fire officer's report are required. It was not possible to install a ramp beside Ward 1 because of planning considerations. When trying to make changes to a building it is very frustrating to come up against heritage problems, fire officer's problems, etc., making further use of the building impossible. These are issues to be dealt with by the planning office and are not within the remit of the Minister.

It is very good that numbers are reducing and that we have very good community facilities in the regions. There can be objections to some of the community houses that are put in place. In the past people have objected to the use of two or three houses in an estate. The same objections arise when trying to deal with centres for the homeless or lone parents. There is a consultation and education process which Departments and health boards must go through to get suitable places in the community.

I agree with Senator Henry's comments on the high incidence of mental illness in prisons. There is also a high level of mental illness in residential care homes. Every health board has to address the issue of elderly people in psychiatric hospitals. The Minister of State referred to the ongoing relocation of patients from acute psychiatric hospitals to general hospitals. Eighteen such units have opened. I hope in the case of Ballinasloe that the unit in Portiuncula hospital is opened as soon as possible.

The Minister of State mentioned suicide. We had 448 such deaths in 2001, an increase on the 2000 figures. I welcome his comments regarding suicide research and prevention and I echo his concerns about male suicide. The Minister also mentioned depression, which should be researched as well. I have said here and in other fora that under age drinking is linked to depression, particularly the binge drinking which worries so many people. The Minister for Justice, Equality and Law Reform has referred to a superpub culture in the country. Longer opening hours have led to serious instances of excessive and binge drinking. When the Minister looks at the superpub issue I hope he also looks at the question of opening hours, which have caused serious social problems.

I welcomed the announcement in November 2001 of degree level training for disability and psychiatric nursing. This is very welcome, as are the diplomas and degrees for general nursing. I hope the mental health commission and the new inspector of mental hospitals are successful and that they modernise the mental health services. We have seen the drab buildings and poor conditions the inspector referred to and, while improvements have taken place, we have a long way to go to modernise the mental health services.

I wish the Minister of State every success in his post and I hope he can deal with the issues raised today.

There is no doubt that by contrast with the reports of 20 years ago, we have made considerable progress. Some of the material in reports published 20 years ago was among the most horrifying one could read and it was a reproach to us all that we allowed it. It was not just because the country was poor – it was as much a statement of the way we looked at psychiatric illness as a statement of fact about a society that would not spend money it was supposed to spend. It was not as simple as ignoring the matter. It was because none of us were able to handle it.

I remember a former Member of one of these Houses – I will be no more specific than that – telling me how, in his 50s, he discovered he had an uncle living in a long-stay psychiatric hospital for almost 30 years. The family had simply written him out of their family history. During a conversation at a funeral the former Member discovered a gap and when he inquired about the gap there was silence. After a while he visited his uncle, who had been in a psychiatric ward for 30 years. The tragedy was that the man was not so seriously ill that it necessitated continual institutional care. He was no threat either to himself or society.

We had a problem and while there is no doubt about that, we still have problems. Although there is a lot yet to be done with our psychiatric services, I am reluctant to beat too many political drums, as this issue goes deeper than politics. We can talk about cardiac services and if one calls a meeting in any town in Ireland one will have lists of people trying to get up on the platform claiming they needed cardiac surgery but could not get into hospital because there were no beds. One would find it very difficult to get one person to get up in a country town to say they suffered from serious depression and could not get into hospital because there were no beds. We still have not accepted that it is an illness and no more. It is not a genetic trait or something which reflects on a family, but it is because of that belief that we allowed so much of this neglect to happen.

It seems extraordinary that one needs a special Inspector of Mental Hospitals but if we did not have one the situation would be even worse. We have a long way to go yet and urgency was not indicated by the Minister of State. He said the national strategy document included a commitment to prepare a national policy framework for the further modernisation of the mental health services. He also said that planning and work on the development of this new national framework is due to commence in the coming months. It is a long time since 1984 when Planning for the Future was published and it is disappointing that we are still waiting to start work on a new strategy. That does not suggest the kind of urgency that many of the recommendations of the Inspector of Mental Hospitals deserve.

It is difficult to get human stories told about this issue compared to other areas of illness. I do not want to speak about funding on this occasion but when it comes to priority – organisational, managerial or administrative priority – this issue should not be pushed down the agenda either because people are uncomfortable or because it is not seen as politically juicy. The only aspects of psychiatric illness which will get newspaper headlines are either hair-raising stories from the Inspector of Mental Hospitals or huge human tragedies like suicide. The routine drudgery of dealing with depression or mid-level schizophrenia is what most people want to keep a distance from.

Whoever is in Government, it is up to the political leadership to keep those issues high on the political agenda, as the external demand will never be there. No matter who is in Government, they will never feel the same heat about poor psychiatric services that they will feel about cardiac units, radiotherapy or BreastCheck. That is why it is good to have a serious debate on this matter and because it is serious I have deliberately not become involved in the usual political battling over whose fault it is. The issue deserves more than that.

There are certain matters in the report that deserve to be dealt with. One issue that has long been close to my heart is psychiatric services for homeless people. The problem is that everybody has been talking about this but the voluntary organisations dealing with the homeless still tell me that there are huge gaps in comprehension as to how the service should be provided. There are good doctors but how does one provide services in the community for people who do not have a foothold in the community? How can services be provided in the community for people who are living in a night shelter where of necessity they have to spend whole day on the street?

Unless there is a seamless structure of communication and feedback between the institutional care and those who look after the homeless, there will be a situation where literally people who are nominally under community psychiatric care will be walking the streets, because the place they live in requires them to leave during the day. It is not the fault of the people providing the service such as the Simon Community. The service does not have either the physical or staff resources to keep people during the day. To talk about care in the community for people like that is a contradiction.

The policy framework within which psychiatric patients may be discharged from hospital is a matter of contention in my own home. There is a general directive that they cannot be discharged unless there is somewhere for them to go. Many people in the psychiatric service feel that they are being asked to provide a service which is way outside the brief of the psychiatric services. They feel they are being asked to provide a housing service. Part of care in the community is the care of the community, the care of the family. On the specific issue raised by the inspector about homelessness, I counsel this or any other Minister to go beyond the advice from the managers or the doctors and listen to the voluntary sector also. Those in the voluntary sector have a story to tell which is part of the proper integration of the service.

The second issue which arose is the unfortunate continuation of the inappropriateness of psychiatric hospitals as places of residence for people who suffer from various forms of intellectual disability. It is time that ended and that it was guaranteed that nobody was in a psychiatric hospital simply because there was nowhere else to put them. That is wrong for the individuals, they are not patients, and it is wrong for the service. The service will become frustrated and demoralised.

Other issues arise from the report that deserve to be mentioned. It is important to remember what the late Dr. Michael Kelleher, former consultant psychiatrist in Cork, wrote about suicide. Contrary to what had been thought, suicide among young men was as much if not more a consequence of rural isolation as it was of urban alienation. People regarded suicide as an unfortunate consequence of urbanisation and the breakdown of the family in urban areas and the collapse of religious beliefs. His evidence at the time, and it may have changed, was that suicide was proportionately more likely to occur in isolated, rural settings. It is an interesting commentary which should make us less romantic about the things used to be compared to the way things currently are.

I am pleased that Senator Kitt mentioned the subject of drinking. As somebody who is anything but a Pioneer I believe that there is indisputable evidence that excessive drinking is a contributory factor to the sense of pointlessness that has led to the frightening increase in young suicides. I do not believe that the opening hours of licensed premises are the cause rather they are a symptom of our problem. The longer opening hours do not explain the almost 50% increase per capita in the consumption of alcohol in the last five years. We should wonder about this vastly increased level of consumption of alcohol.

One of my children spent the summer in France and was in an area where the bars did not close until the early hours of the morning. She noticed that when she was in a bar with her French friends the speed at which they drank was the biggest difference between France and Ireland. The young French people sat in a bar and had a beer which would take about a half to three-quarters of an hour to finish while they talked.

As Senator Kitt said, the most frightening sign for us in Ireland is that in the surveys one quarter of people between 15 and 18 years of age get so drunk on a monthly basis that they cannot remember what they did. That is so far distant from the conviviality of having a drink with friends. There is a determination to obliterate themselves. There is a lack of values and a lack of alternatives and that should disturb us. That sense of being oblivious to anything worthwhile in life is obviously a place where suicide and violence against other people can become issues. A sense of hopelessness can lead to crime. As a society we have to wonder why a quarter of our young people would say that they go out on a regular basis as under 18s and get so drunk that they cannot even remember whether they enjoyed themselves.

I welcome the fact that our Victorian institutions are moving into history. I am glad to see we are prepared to talk about issues that were a source of embarrassment in the past. I urge the Government and without any political tone to keep this as a central priority in the development of the health services.

I refer to the inspector's report and the Minister of State's statement because they present a problem for me and the Mid-Western and South Eastern Health Boards. As the Minister of State knows, there are no acute mental health services for north Tipperary. The Government has proposed the building of an acute unit at Nenagh General Hospital which is going through the various stages. The Minister of State was present at the health board meeting earlier this year when management expressed disappointment that only somewhere in the region of €50,000 has been allocated to advance the programme further. The inspector recommended that services for north Tipperary be provided in Limerick and those for the remainder of the constituency be provided in Clonmel in the South Eastern Health Board area as at present. The difficulty that creates is that the South Eastern Health Board is short of accommodation as is the case in Limerick. I ask the Minister of State to look at that matter.

The inspector referred to the diet of patients in the mid-western and south eastern regions and I ask the Minister of State to look at that. Patients need to be properly looked after and to get a staple diet. I do not wish to rehash what other Senators have said but concur with much of what they said, in particular what Senator Ryan said about recognising that the mental health services have come some way. They have, however, a long way to go and I have no doubt the Minister of State will advance them. I pay tribute to St. Cronan's workshop in Roscrea which does marvellous work with mentally handicapped young people. It is amazing to see the talents they have. Units such as that which are backed by the local community and by people who give their time voluntarily to raise funds and so on do marvellous work. I ask the Minister of State to help people and communities such as that who provide a tremendous service.

I am probably stepping out of line by raising the following issue. The Minister of State fought hard for radiotherapy services for Limerick when on the health board. The health board has the facilities and all it needs is the capital and the go ahead to provide the services. I am putting the Minister of State on notice; I want those services for Limerick just as he does. The vibes I am getting are not good and I would like to the Minister of State to work on that.

On the mental health services, perhaps the Minister of State will let us know what is happening to the proposed unit at Nenagh General Hospital.

Care in the community is not a cheap option. It has to be accepted that it is actually much more expensive and labour-intensive. Anything I say is in the context of the enormous respect I have for those who work in the mental or psychiatric health services generally, whether in hospitals or the community. By and large, they overburdened and short of resources, and work with extremely difficult people in extremely difficult circumstances. I say this just to put in context some of the more critical remarks I might make.

I hope the inspector's reports in the future will be just a little more hard edged than this one. People tend to use slightly emollient language in dealing with these matters, they tend to take into consideration the feelings of those with whom they are dealing. There has been a move away from the inspectorial mode to one in which we are all professionals in this together, but this can go too far. I would like to see a little more of a crusading spirit in the inspector's reports. Where the inspector finds things going wrong, they should say this plainly.

One of the disappointing features that emerges from the report is the slowness of movement out of institutions and the build-up of services in the community. We have arrived at a sea change in approach. Recent decades have seen a movement out of large psychiatric hospitals and into the community. Community services used to be seen as outreach services from the hospital. That was right and proper at the time. Now, however, we should reach the point where we see hospital services and consultants based in the community, and the acute hospitals, the in-patient facilities, as providing backup for the community services, rather than the other way around.

More attention should be given to the development of child and adolescent services, an area in which we are very badly served. There is no mention of this matter in the report, but every large accident and emergency department should have psychiatric services and backup. There are several reasons for this. Many of those who present at accident and emergency departments at all hours of the night are more in need of psychiatric care than surgical or other interventions. They can be very difficult for staff to deal with. It should be almost a sine qua non for accident and emergency departments to have full psychiatric backup.

I was attracted by what Senator McHugh said. I, too, have seen the use of drama and various other art forms in therapy, and encourage the Minister of State to experiment with and support this. I also urge him to continue assisting those people supporting families and others in the community on a voluntary basis. I urge that more be done to deal with depression in particular and argue in favour of shifting the treatment service increasingly into a community base.

I cannot comment on every matter raised or I would be here all day. Senator Feighan referred to mental health always being the Cinderella of the health service. We all agree that fantastic changes have been made in recent years. As Senator Ryan rightly said, this has not been political, there has been an evolution of thought by all political leaders. I look forward to continuing this process of change. As change is always met by resistance, it is up to me and the political process generally to harness it for the good of all and ensure it continues.

One of the problems is that there is resistance to change. Unfortunately, this resistance, by a small minority, can cause huge problems in certain areas. Senator Henry, among other speakers, noted that if there was any suggestion of a place being provided in the community for people coming out of institutions, it was often the case that a small number of people would lead the charge against it. This happened in relation to Ferndale, a facility across the way from the regional hospital in Dooradoyle, but thankfully I was able to stop the opposition immediately. I have visited many other institutions around the country where this happens and it takes the guts of local leaders to stand up to the small number of people who object. If it is good for these people, it is good for the community. There have been no problems anywhere. We must say it is the right thing to do and that we should not fear it.

Senator Feighan spoke about the morale of workers being good, which I am delighted to hear because we seem only to hear bad news regarding disputes in the health sector. As someone who has been involved with the Mid-Western Health Board for many years, I am aware of the huge contribution of doctors, nurses and psychiatric nurses. I am thankful to the Senator for mentioning that. Psychiatric nurses must embrace change and have the courage to pioneer it.

Several speakers have mentioned advocacy groups. I have been in this job only a few months but I see the role and evolution of these groups as one of the best things that has happened in the mental health and psychiatric areas. One does not have to agree with them all the time – and I do not always – but they are well meaning advocates for people with mental illness and intellectual disabilities, people who in many cases cannot speak out for themselves. The Department of Health and Children gave money to this sector last year and I will insist more money is made available in future because of the value of the wisdom and understanding of advocates, many of whom have family members who suffer from mental illness. It behoves us all, irrespective of where we stand on the debate, to listen to these advocates.

At the Irish psychiatric meeting which I addressed in Galway recently, I challenged psychiatrists to listen to advocates because everybody involved in the debate must listen to what is being said. None of us is an expert. There was a time when people professed to be experts and no one else was entitled to an opinion, but the debate on mental health has moved on and many people have views which need to be listened too. I intend to do much more in that area

Senator Bannon referred to a situation in Longford which I understand to be an exception to the rule. There are many good institutions in Longford and much good work has been done in that health board area. I understand that the matter the Senator raised has been corrected by the health board.

I agree with Senator Feeney's observations on the change from the custodial approach to the therapeutic and counselling approach, as well as the changes in the management of people with mental health problems. Change will be resisted by some people but it behoves all of us to listen.

As a pharmacist, I have strong views on the model of psychiatry and treatment of psychiatry in the past. There may be a greater role for pharmacists who are drug experts to challenge the medical profession. I will be speaking to and listening to all the groups. We debated the drug Seroxat recently and much of what was said was unedifying and ill-informed. There are problems relating to drugs and how they are used which need to be examined. Nonetheless, there have been great advances in drug treatments for patients which have enabled them to be treated in the community.

The inspector referred in his report to polypharmacy – the mixing of drugs – and I will be talking to doctors and psychiatrists about that. We must have a more conservative approach to the prescribing of drugs.

Senator Feeney referred to the training of junior doctors and much good work is being done in the training of psychiatrists. I met a number of junior doctors yesterday. Staff shortages, particularly of psychologists, have been mentioned by several Senators and I will be doing all I can to address that. I am well aware there is an anomaly in the system which means we are not producing enough psychologists when they are needed now. Around 40 or 50 qualified last year but we are still not producing enough and that matter is being examined. Some Senators referred to the stressful lives we are all aware of. Perhaps those of us in leadership roles in society should speak out more about it.

I am delighted Senator Ryan and other speakers referred to alcohol. As someone who takes a drink, I assure the House that I am appalled by what I see in terms of the consumption of alcohol. Figures show that alcohol consumption per capita rose by 41% between 1989 and 1999 and that figure has now reached 45%. That cannot be right. It raises questions in terms of our educational system. There is no doubt there is a connection between alcohol abuse and mental illness. There is a challenge for all of us in political life to engage in policy-making which may be difficult but necessary for the good of our country and especially our youth.

Echoing Senator Henry's remarks, I spoke to a group representing North-South co-operation yesterday on positive health. We often speak about mental health problems, which afflict all families in some way, but we do not put enough stress on positive health.

There are many other things we take for granted and do not speak out about. For example, bullying in the workplace can be viewed as a form of mental health problem. The bully may be a boss and go unchallenged for years, causing major mental health problems. It behoves all of us to challenge this. This applies equally to alcohol abuse and it is encouraging that many more local politicians are taking a strong line on it, which I have observed as a member of the health board.

It is unbelievable that a small country like Ireland can have one of the greatest levels of consumption of illicit drugs in Europe, particularly when one considers that 30 years ago, none of us had any money, whereas now there is great affluence and there are godfathers in communities all over the country.

I do not want to dwell on the issue of the Central Mental Hospital. I am well aware of the problem the Senator and other speakers mentioned. It is a real problem and I will speak to the commission about it and see what I can do.

On the question of acute wards, Senator Daly mentioned what had been done in that regard in County Clare. The same has been done in several areas; I will not delay the House by mentioning them again, but they are shining examples of what can be done. We should strive to focus on the positive side of mental health and not dwell on the Dickensian aspects, although we had to learn about the appalling conditions people with mental health problems and their families had to put up with in the past, from which we have come a long way. I welcome the challenge Senator Ryan put down to me and the Government, but it is up to people like him—

On the problem of post-natal depression, one Senator mentioned the need for mother and baby units. It is a coincidence that I spoke on the subject of post-natal depression this morning at a seminar which opened today in the Rotunda Hospital. This is a major problem in our society as evidenced by the fact that at 9.30 a.m. 200 midwives were discussing it at the seminar in the Rotunda. This is a matter that psychiatrists, midwives and nurses are taking on board, with the Department of Health and Children. The health boards are also keenly interested in it. I am aware of the major problems post-natal depression can cause, which does not only affect new mothers. It can affect a woman having her second, third or fourth child and cause major problems for the whole family if it is not treated properly and quickly.

The point about communications with the bereaved is a valid one. As a society, we have been remiss in the way we have dealt with families who experienced a suicide. This issue has been taken on board by the health boards.

In her maiden speech, on which I congratulate her, Senator Kate Walsh spoke about support from communities. I agree that is imperative, but it is happening.

It would not be right for me to comment on Senator Leyden's remarks about the termination of chairmen.

My colleague, Senator Coonan, has thrown me a few hospital passes today as a former member of the Mid-Western Health Board. On the question of the psychiatric unit in Nenagh Hospital, on which the inspector has reported, the Senator, as a member of the Mid-Western Health Board, will be aware that it is the health board which makes the policy decisions. I am aware that it has made a decision.