Fidelma Healy Eames (Fine Gael)
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I welcome the Minister of State, Deputy Shortall. I raise this matter to request the Minister for Health to fund residential treatment in the United Kingdom for a young woman with a severe borderline personality disorder who has been certified as being at imminent risk of suicide and who has already attempted suicide on 14 occasions. This is a severe and pressing case. It is the first time I have raised a matter of this nature in the Seanad and I do not do so easily. It is a case worth listening to carefully.

I have been contacted by the parents of a beautiful 22 year old woman. For the purposes of this debate, I will call her Danielle which is her first name, but that is as far as I will go in identifying her. She has been unwell for over six years and has been diagnosed with a borderline personality disorder. She started to self-harm at the age of 15 or 16 years and has had many admissions to hospital since. She has required surgery on many occasions. Her problem was discovered during her first term in UCD. Prior to that, she was a bright and energetic teenager with a promising future. She was involved in swimming, dancing and various other activities; she did a lot of voluntary work both in Ireland and abroad and was a very good student. She has spent 20 months of the last three years as an inpatient in various psychiatric wards in both Dublin and Galway and has attempted to take her own life on 14 occasions. The last attempt was on Friday, 2 September while she was an inpatient at a psychiatric facility.

Danielle's parents were advised earlier this year by a number of health care professionals to look for treatment in the United Kingdom or elsewhere abroad. They spoke to the consultant psychiatrist at McLean Hospital in Massachusetts in the United States who specialises in this condition. He advised that the cost of treatment there would be prohibitive and that they should investigate possibilities in the United Kingdom. They feel very fortunate that they have identified the best demonstrated and documented treatment for borderline personality disorder, intensive dialectic behavioural therapy, DBT. With a number of health care professionals, they researched several locations in the United Kingdom and found an institution which treats females with borderline personality disorder, which mostly affects females. Some 95% of the referrals to the centre are from the National Health Service in the United Kingdom.

The outcomes from intensive DBT programmes are excellent. Following this degree of intensive treatment, many need fewer admissions to acute psychiatric institutions. However, intensive DBT programmes are not available in this country. That is the key point to be made.

Danielle had a four hour assessment in the centre in the United Kingdom. Her parents were very impressed by that assessment and the professionalism of those who carried it out. It is a residential centre which offers a range of therapies on a daily basis as part of a lengthy programme of between eight months and one year. They were advised one week after her visit that their daughter had secured a place.

The first application for treatment abroad through the E112 process was made to the HSE on 24 July, but it was refused on the grounds that it did not meet the criteria laid down. The parents appealed this decision and asked the HSE to reconsider the application. They submitted all of the documentation required, as well as the letter documenting the excellent assessment that had been made in the United Kingdom, but, once again, they were refused on the grounds that the family did not satisfy the criteria. Instead, the HSE has offered a limited dialectic therapy service for one hour a week to their daughter.

DBT comprises four elements, but the therapist employed by the HSE can offer just one element of the four. The treatment being offered is less than what Danielle has been receiving in the past two years and that treatment has not worked. The process of applying for treatment abroad is not easy; it is slow and arduous. It takes time, even before an application is submitted, and is highly traumatic and distressing for patients and their families. The family in question have told me their daughter found the process so distressing that she became acutely suicidal and had to be admitted for observation. As a consequence, she is again an inpatient in an acute bed. The more she is refused, the worse it is for her because her coping skills are absolutely gone. The family have informed me that since the appeal was refused, their daughter has lost all hope and the will to live and, for the most part, is deeply agitated. They note she is extremely disappointed she has been refused the treatment and therapy she desperately needs to survive. Moreover, they have told me it was heartbreaking for them to watch her deteriorate before their very eyes in the knowledge she was being prevented from availing of the treatment she urgently needed. They find it hard to keep up her spirits each day, as she cannot understand the reason she is being denied treatment that could give her hope to live and have a life.

This is a willing participant who is not fighting against having such treatment. I am sure many families are going through similar traumas as living with mental illness is not easy. There is still a stigma attached to it in Ireland. There is a dearth of essential therapies, counsellors and psychologists to provide therapeutic care for those with a mental illness. The parents in this case have told me they are both professional public servants who have given more than 30 years of service to their country. They always have paid their taxes and tried unsuccessfully to sell their family home. It is important to note they are prepared to do whatever it takes and have tried to sell their home to raise money for their daughter's treatment because they are desperate to give her hope and a chance to live. They claim the only viable prospect for their daughter's recovery and long-term well-being now depends on her securing some HSE funding to help to pay for this treatment abroad. I understand it costs approximately €150,000. The parents insist they are not applying for full funding and are endeavouring to sell the family home. In essence, they are trying to save their daughter's life. As she has attempted suicide 14 times, each day constitutes a struggle to ensure she lives.

I acknowledge this is not a normal application to bring before the House in these straitened times. For that reason, I was careful before so doing. I look forward to the Minister of State's response.

Róisín Shortall (Dublin North West, Labour)
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I thank the Senator for raising this matter on the Adjournment. The Government has prioritised the development of the mental health service in line with A Vision for Change. In that context, it is committed to reforming our model of health care delivery in order that more and better quality care is delivered in the community. It is its intention that over time access to modern mental health services in the community will be significantly improved. It is proposed to ring-fence €35 million annually from within the health budget specifically to develop community mental health teams and services to ensure early access to more appropriate services for both adults and children. I am working with officials in the Department of Health and the HSE to deliver immediate and effective progress in this area.

Preventing and reducing the rate of suicide is an urgent public health issue that is at the centre of the Government's efforts and policies to build healthy and productive communities. Our policy strategy on suicide prevention, Reach Out, outlines the actions that must be taken to prevent suicide and deliberate self-harm and to increase awareness of the importance of good mental health. While much progress has been made in implementing these measures, one can never say one has done enough. It is essential that the Government continues to work and even redoubles its efforts. Members will be aware that an additional €1 million was provided this year to ensure the National Office for Suicide Prevention could build on initiatives to date. This special funding has enabled the office to target priority areas, which will make a real difference.

This year the focus will be on the further development of skills-based training and awareness programmes in suicide prevention, improving the response to those who deliberately self-harm, developing the capacity of primary care to help those presenting with suicidal behaviours, improving inter-agency co-ordination and the provision of a 24 hour emotional support helpline. I am sure Members also will be aware of the huge effort and commitment put into this area by my ministerial colleague, Deputy Kathleen Lynch, who, among other things, has special responsibility for mental health and disability services. I know she is working hard to regain the momentum in implementing the excellent strategy on mental health, A Vision for Change, and I am confident she will be successful in bringing about the improvements everyone wishes to see in this critical area for vulnerable groups.

On the case referred to by the Senator, I understand that on 25 July an application was received on behalf of the person in question in the offices of HSE West for treatment under the E112 treatment abroad scheme. A report has been obtained from the HSE on the application for funding and the subsequent appeal of the initial decision. Unfortunately, the decision of the executive which the appeals officer has upheld is that the application does not meet the conditions of the scheme and funding cannot, therefore, be provided. I understand the application was not approved owing to the fact that a treatment plan was available locally in Galway and the view of the treating consultant psychiatrist is this treatment plan should be availed of in the first instance.

I have been informed the person in question was admitted to the psychiatric unit in her area on 26 August following self-presentation and is now under the care of a consultant psychiatrist. It is the latter's view that while the person in question could benefit from admission to the therapeutic service in the United Kingdom, there are treatment services available here from which the patient would benefit and these should be used in the first instance. The consultant psychiatrist will continue to consider the request for treatment abroad while the person in question is under the care of the psychiatrist's team. I hope the person in question will avail of the treatment options being made available and that the treatment will be successful for her.

I again thank the Senator for raising the matter.

Fidelma Healy Eames (Fine Gael)
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I have a supplementary question. I imagine the family's reaction will be one of grave disappointment because my understanding is they are already availing of this treatment. Am I to understand from the Minister of State's response that the conditions attached to the scheme for travelling to the United Kingdom were not met because of the views of the treating consultant psychiatrist? I hope the consultant psychiatrist in question is not taking on too much responsibility that could place a life at risk. The Minister of State should clarify whether the conditions attached to the aforementioned scheme were not met because of the views of the treating consulting psychiatrist.

Róisín Shortall (Dublin North West, Labour)
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To clarify, in this case the clinical decision was taken by the clinical psychiatrist. It is the view of that psychiatrist that a treatment plan is available locally in Galway and that it should be availed of in the first instance. This is not something in which a Minister has a role. A clinical decision was taken by the young woman's treating clinical psychiatrist.

Fidelma Healy Eames (Fine Gael)
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We can always come back to it. I thank the Minister of State.