Mary Henry (Independent)
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I welcome the Minister to the House. We repeatedly read in the newspapers of cases before the courts in which no places of safety or treatment can be found for some of the most vulnerable people in our society. Children, adolescents and adults with serious conditions must be treated outside the country. Adults with mental illness, intellectual disorders or autism spectrum disorders or acquired brain injuries can be kept in prison or other places of detention because there are no proper facilities for them here. This is especially true if there are behavioural problems involved. I am sure there are many people who do not come before the courts who also have to leave the country to have their problems treated.

Children and adolescents are constantly before the courts with mental illness, intellectual disability, autism spectrum disorder and acquired brain disease. The reason they are there in the first place is that, as judges in the children's court have complained for years, there are no places of safety to which these children can be sent. I am sure the Minister is aware of a case which has repeatedly come before the courts in the last few weeks and was reported by Carl O'Brien in The Irish Times. A boy of 17, who was brain damaged in a car crash and has a mental age of seven to eight, had to be kept in Cloverhill Prison for about six weeks. While it was recognised that the prison officers did everything they could to facilitate the boy, allowing him to telephone his aunts and so on, it was not a suitable place to have a child with a condition such as this.

It is extraordinary that there is such a terrible lack of facilities in Ireland even though we have been aware of this problem for several years. People in the Republic of Ireland — adults and children — must be referred to Northern Ireland or our neighbouring island, or further abroad, for places in which they can be kept in safety and receive treatment if possible. People from the few institutions in which adolescents can be kept have asked me whether I can do more to obtain teaching for these children. Some of them need to keep up with schoolwork as best they can for when they recover from their mental illnesses. This must be costing the taxpayer an enormous amount of money. Would it not be better to build suitable facilities here and staff them? The problem has not started with the current Administration; it has been there for a long time. It is socially unacceptable to place people in institutions so far away from their families; if they are to be rehabilitated it is essential that they are as near to their families as possible.

I have not been able to obtain up-to-date figures of the cost per day of the UK National Health Service medium-secure units, but in 1998 the cost per day was £300 sterling, which adds up to more than £2,000 per week — about €3,000 — and I am sure it costs a great deal more now. At the time, a low-security unit cost about two thirds of this. I cannot understand why we cannot build our own units and recruit staff who will look after these patients, because they would be far better off near their families.

Recently the board of the National Disability Authority said its members would visit the worst hospital in the State. This is how the Inspector of Mental Hospitals described the Central Mental Hospital in his last report. The cost per day there is a few hundred euro. It would be much cheaper to rehabilitate that hospital — to rebuild it, if possible — and create other institutions especially for children so they will not need to be sent to institutions abroad, which is not helping the Irish taxpayer and is certainly not helping the recovery and rehabilitation of these people.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I am replying on behalf of my colleague, the Minister for Health and Children, Deputy Martin, but I am not certain whether my reply addresses the concerns of the Senator. The Minister wishes to thank the Senator for raising this matter. The general policy of the Department on the development of services for persons with disabilities and those with mental illness has seen considerable change in recent years. The Department seeks to put in place a broad range of appropriate support services in consultation with the health boards, the other relevant service providers and persons with disabilities or mental illness and their carers. Best practice must be incorporated as a norm and the Department must take account of internationally recognised advances in treatment or approaches to meeting individual needs. It is only in particular circumstances that individuals would be placed in services outside this country and decisions on those placements are a matter for the relevant health board.

The Minister does not have the statistics available this evening but he has asked the health board to furnish them to him. He will then forward them to the Senator. Investment has been made in service development. Additional revenue in capital funding, amounting to €643 million, has been invested in health funded support services for persons with disabilities since 1997. This includes an additional €25 million in current expenditure which was made available by the Minister for Finance in the 2004 budget for services for persons with disabilities. Capital funding will also be allocated for these services from within the 2004 allocation.

Since 1997, an additional €80 million has been allocated to the mental health services and the total amount spent on mental health services on the current side is now over €600 million. This has allowed for developments in child and adolescent psychiatry, psychiatry of later life, liaison psychiatry, rehabilitation psychiatry, suicide prevention programmes and support for the voluntary sector. An expert group on mental health policy is preparing a national policy framework for the further development of the mental health services, updating the 1984 policy document, Planning for the Future. The expert group was established in 2003 and will examine a number of issues, including models of care, the respective roles of medication and complementary therapies, measures to reduce stigma and psychiatric services for specialised groups such as the homeless, prisoners and children or adolescents. Submissions were requested from interested organisations in October 2003 and more than 140 submissions were received. They are now being considered by the group.

The strategic review of disability services is taking place in accordance with a commitment in Sustaining Progress, the social partnership agreement which runs from 2003 to 2005. It has a similar timeframe to the expert group on mental health services. The outcome of both reviews will assist in ensuring that services are being delivered in an appropriate, effective and cost efficient manner and will identify targeted areas to be addressed in planning for the future.

The detailed information requested by the Senator about the numbers and costs associated with persons with disabilities or mental illness who have been placed in services outside this country over the past five years is not readily available in the Department. The Department has requested this information from the chief executive officers of the Eastern Regional Health Authority and the health boards. It will be forwarded to the Senator as soon as it becomes available and I look forward to discussing it with her on receipt of same. However, the number of cases in which persons with disabilities or mental illness are placed in services abroad will be small in the overall context of the numbers availing of these services.

The Senator referred to a recent matter which came before the courts. Indeed, I dealt with this matter in the course of an Adjournment debate in the Lower House. I share the concern of the Senator. It was unacceptable that a child of 17 and a half years was incarcerated in a prison when other treatment was clearly required. It should be borne in mind, however, that under our criminal law, a person over 17 years of age is of full age where penal treatment is concerned. That will change when the Children Act 2001 is fully implemented. The Department of Justice, Equality and Law Reform is required under the legislation to establish separate facilities for the penal detention of 16 and 17 year olds. Nevertheless, even those provisions permit the Department to establish those facilities within the confines of an existing prison or institution.

As a result of the concern I had about this matter, I sought a report from the South Western Area Health Board and a placement was arranged in Ballydowd, near Lucan. The assessment of the individual in question is extremely complex. In fairness to the health board, its legal representatives described the case as practically unique in their experience. The essential problem of diagnosis, as I understand it, was whether the cause of the condition and the signs the individual displayed was challenging behaviour and a predisposition to engage in challenging behaviour or if the brain injury, which was much referred to in public comment on the case, had an impact on the pattern of behaviour. Conflicting views on this issue were expressed by various parties and it was not possible for the health board to arrive at a definitive conclusion at any stage in the proceedings. That is the reason the option of having the child examined abroad has been raised in the course of the hearings.

However, it is an operational matter for the health board and I am glad it was able to meet its responsibilities. As has been made clear at all stages, it was not a question of resources or of the health board, as was wrongly suggested, seeking to wash its hands of responsibility in the matter when the individual reached the age of majority. The matter arose in criminal proceedings to which the health board was not a party and, as far as both criminal proceedings were concerned, the individual was subject to adult treatment. The case was heard in the Children's Court because that part of the Children Act has been commenced. All individuals under the age of 18 years of age are brought before the Children's Court.

I agree it is important to evaluate constantly the services we have provided in this area. In recent years, there has been substantial investment in new buildings for holding young children. I propose to commence this spring the provisions of the Children Act dealing with special care orders. That will give a proper legislative basis to the detention of persons under 18 years in these institutions. However, there has been well documented publicity about the difficulty of recruiting and retaining staff in them. Clearly, questions also arise about the restraint and other therapies that are available to help the children in these institutions.

These are pertinent issues but the State has made a substantial investment in this area. The current cost of staffing these institutions is also substantial. There is an onus on all involved, both on the professional and on the political side, to devise solutions that will improve the outcomes for these children.

Mary Henry (Independent)
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I thank the Minister for his extended reply. I am well aware of the difficulty in getting staff for these institutions. However, the Minister must grit his teeth and try to do something for these troubled young children. He will have the support of all Members of the House. I look forward to receiving the detailed information from the Department.