Seanad debates

Tuesday, 21 April 2015

Commencement Matters

Mental Health Services Provision

2:30 pm

Photo of John KellyJohn Kelly (Labour)
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I welcome the Minister of State at the Department of Transport, Tourism and Sport, Deputy Michael Ring. While I have great respect for the Minister of State, there is something fundamentally wrong when we table a Commencement debate directed at the Minister for Health only for it to be taken by a different Minister who may not be familiar with the issues involved. We should change the way in which Commencement matters are selected to allow Senators to defer a Commencement matter if the relevant Minister is not available.

There are serious concerns about the future and direction of mental health service in County Roscommon. Morale among psychiatric nurses in the county is at an all-time low. One of the causes for concern is staffing at Knockroe House, which is a high support unit for patients with challenging psychiatric behavioural issues. At present the unit is only staffed by one nurse and one care worker during the day or at night, whereas previously it was operated by four specialist psychiatric nurses. Two serious incidents occurred in the unit in recent times, both of which were of a sexual nature. The first incident involved two patients and the second involved a patient and a member of staff. These incidents were not reported to the Garda but they were investigated by the HSE. I do not agree with the practice of the HSE investigating itself. The Mental Health Commission is now investigating the incidents, which I welcome.

The main reason I tabled this Commencement matter is to discuss a plan by the HSE to close the Rosalie unit in Castlerea, County Roscommon, which houses 25 long-stay psychiatric patients. In the 1980s, mental health service policy was based on a document called Planning for the Future. Under the policy, we established day care centres for psychiatric patients, supervised hostels and unsupervised hostels. As these options were not suitable for certain categories of patients, we also established a long stay unit to provide for their needs. The Rosalie unit fits the criteria under A Vision for Change to would allow it to remain in operation because it contributes to the 50 long stay beds available to a population of 300,000 between counties Roscommon and Galway. However, the HSE has vetted the 25 patients at the unit with a view to discharging them to private nursing homes. If they were wrongfully placed in the unit in the first place, can they now sue the HSE 25 years after their admission? I recently observed a patient with dementia who was staying in a private nursing home. She was uncontrollable and was attacking staff in the unit. I do not believe that a private nursing home is the appropriate place for these patients.

Staff in County Roscommon are highlighting areas of concern. They are like whistle blowers but the HSE is not listening to them. The same thing happened in Aras Attracta after a patient died but it was only when the HSE finally investigated the issues arising that the staff members who raised the issue were vindicated. A further 34 staff have since been appointed to Aras Attracta but HIQA have indicated this increased staffing level is not sufficient in itself.

It would be wrong to close the Rosalie unit in Castlerea. It has been a family home for between 20 and 25 patients for the last 25 years. All of the patients are elderly. I will not allow these patients to be discommoded because that would be grossly unfair.Will the Minister of State convey my concerns in the strongest possible terms to the Minister of State, Deputy Kathleen Lynch? This is an issue of grave concern for me and many others in County Roscommon.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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I thank the Senator for raising this issue for discussion. I am taking it on behalf of the Minister of State at the Department of Health, Deputy Kathleen Lynch, who is in Latvia on Government business today. She has asked me to convey her apologies to the Senator and the House.

Recent years have seen the Health Service Executive's mental health services nationally tackle the challenges of reorientating from a hospital and bed-based focus to developing the structures and processes required for enhanced community-based provision in line with national policy under A Vision for Change which recommends that integrated care be provided for service users in their local community and delivered primarily through community mental health teams, each of which would typically cater for a population of approximately 50,000 to be effective.

Galway-Roscommon mental health services are committed to full implementation of A Vision for Change. As such, their guiding principles are patient centeredness, equality, access to quality care that is focused on recovery, and integration with other mental health and mainstream health services. Recognising the need to reconfigure services in line with A Vision for Change, the HSE in Galway-Roscommon appointed an expert group to review local community mental health services. The report of the expert group was published in June 2014, with a focus on residential care settings and resources across both counties. The key goal of the report was to make recommendations that would ensure service users maximised their full potential and saw improvements in the quality of their lives.

The HSE in Galway-Roscommon provides an inpatient and community mental health service for a population of 314,000. It is at an advanced stage in the implementation of A Vision for Change and has moved into population sectors of 50,000, appointed team co­ordinators and developed an overarching clinical governance model. There are six general adult team sectors which are clinically led by two consultant psychiatrists and a multidisciplinary team, as highlighted in A Vision for Change. Each sector has its own unique service needs, based on identified population, age groups, culture, etc. There are 12 consultant general adult psychiatrists across the two counties which, again, is in line with A Vision for Change. Recent initiatives include the development of a psychiatry of later life team, the provision of an intensive home treatment team for the Roscommon area, the opening of an adolescent day hospital and the provision of a 20-bed child and adolescent inpatient unit with a 24-hours admissions policy.

In addition, Galway-Roscommon mental health services were successful in securing 58 additional new staff posts through development funding since 2012, of which 45 are in place. The remaining 13 posts are at various stages of recruitment. The make-up of these posts includes additional consultants in the areas of general adult community mental health teams, psychiatry of later life teams and rehabilitation and recovery teams, as well as occupational therapists, community mental health nurses, social workers and psychologists.

In the light of the above and consistent with the approach of reconfiguring services across all areas, it is not proposed to undertake the type of review suggested by the Senator. However, if he has any specific issue he wishes to pursue, he should contact either Galway-Roscommon mental health services or the office of the Minister of State, Deputy Kathleen Lynch.

Photo of John KellyJohn Kelly (Labour)
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The word "reconfigure" has been bandied about by the HSE for some years. It was bandied about during the term of the last Government and we are still hearing it. Of course, the reality of reconfiguration in County Roscommon was that we lost an emergency department.

The Minister of State has referred to investment made in mental health services and the additional staff appointed in County Roscommon. It is my understanding there has been no investment in community mental health teams in the county.

The Minister of State also referred to the quality of life of patients. The people about whom I am talking do not want to be moved into the private nursing home sector. That is the quality of life preference they are indicating. In that context, I reiterate my call for an independent assessment of the running of the mental health service in County Roscommon.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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In respect of the figures, 45 positions new positions were created. To be fair, much is happening in the mental health services and there have been many changes. The Minister of State, Deputy Kathleen Lynch, has worked hard at Government level to get the funding needed for these services. I will convey the Senator's very strong feelings on the issue to the Minister of State. I note he would wish she was present to debate the issue. However, she has made an offer that the Senator may contact her office or the service itself which I am sure he will take up. I will ask her officials to bring the debate to her attention to ensure she responds. If the Senator has anything further to add, he made do so through the Minister of State, Deputy Lynch, or the officials in the HSE.