Wednesday, 19 July 2017
Mental Health Services Provision
I welcome the Minister of State, whom I have not met previously.
I refer to the Central Mental Hospital in Dundrum. The 2015 Mental Health Commission inspection report referred to various areas of compliance and excellent standards, with many good practices on display. It appears that the hospital and, in particular, its staff are working to a high level and providing an excellent service within the confines of the resources given to them. The hospital was described in the report as:
The approved centre was an inpatient service of the National Forensic Service. It was located in Dundrum Dublin and had 94 beds ... The main building was over 150 years old and was not suitable for the care and treatment of mental health patients. Plans for the new forensic hospital were progressing.
The plans will be now be realised on the site at Portrane. Will the Minister of State confirm that the opening date will be 2020?
I would like to discuss the facilities in place for violent, mentally ill people while we await the new hospital. The Irish Times reported on 21 June that Professor Harry Kennedy, the clinical director, had told the High Court that all 94 beds in the Central Mental Hospital were full and that there was a waiting list of 24. He said that while mental hospitals in Ireland had been closed down, the necessary services were not being provided to look after people who had been detained in them. This sentiment was echoed by my old colleague and the former general secretary of the Psychiatric Nurses Association, PNA, Mr. Des Kavanagh, in his report earlier this year.He stated, "the correlation between the closure of hospitals and the increase in the prison population of people with serious mental illness is inescapable." He continued by discussing regular cases of violence and, indeed, homicide involving those who are mentally ill. He urged the Government to review all such killings and assaults over the past ten years and come up with recommendations for a prevention strategy.
The Mental Health Commission's inspection report in 2015 found that:
There were eight units in the approved centre [at the Central Mental Hospital] and this allowed the male patients to progress from acute care with high security through medium to low security and rehabilitation. However, all ten female patients were accommodated in one unit, whatever their level of acuity, security requirements and rehabilitation needs.
Does the Minister for Health think that the opening of the extra beds in the period prior to the new hospital being opened would improve these conditions? The report also states:
Due to the waiting list of seven patients in other approved centres [never mind prisons] awaiting transfer ... plans were progressing to renovate and re-open a closed unit (Unit 5) to provide 10 beds for these patients. The completion date for this was the end of 2015.
The beds in question are ready, duvets have been placed on them and yet they lie empty. Mental health institutions have been closed down and nothing substantial has replaced them. As a result, the rare but real cases of people with mental illness who have violent inclinations have slipped through the gaps and caused real harm in our society and to themselves.
I have a few questions for the Minister. Has the Central Mental Hospital reopened the ten beds? If not, why? How does he intend to rectify the current crisis in the period prior to the facility in Portrane being opened?
I have spoken to various staff and learned that negotiations have been held up due the fact that decisions handed down by the Workplace Relations Commission in 2012 have not been implemented. I ask that the Minister intervene in order to get the negotiations going. I urge him to bring people to the table and to get these beds open.
I thank Senator Devine for raising this matter, which I am taking on behalf of the Minister for Health who, unfortunately, cannot be with us.
The Central Mental Hospital in Dundrum has a current bed complement of 93. All of these beds are operational. It is a priority under the HSE's service plan for 2017 to increase bed capacity at the hospital. An additional ten beds to accommodate patients awaiting admission under section 21(2) of the Mental Health Act 2001 are due to be commissioned shortly, which will increase capacity to 103 beds. The additional beds remain unopened pending agreement between the executive and the relevant unions on issues that have been through a process at the Workplace Relations Commission. I understand that these are likely to be referred to the Labour Relations Commission for adjudication. At this point, it is not possible to give a precise date for the additional beds to open. The executive is continuing efforts to open them in the autumn. I urge all involved with this process to work together to open these beds as quickly as possible.
It has been accepted generally for some time that there are serious bed capacity pressures at the Central Mental Hospital. It is on this basis that the HSE prioritised the opening of more beds. The management of those requiring admission is being prioritised on the basis of assessed clinical need. The provision of new facilities, or other non-capital initiatives, to enhance forensic mental health provision nationally is core to modernising mental health services in line with A Vision for Change. To date, significant ring-fenced funding has been provided to improve all aspects of mental health care, including prioritising the replacement of the Central Mental Hospital. This has resulted in a total funding of just over €850,000 to the HSE for mental health for this year.
Following the signing of a contract on 1 June, construction of a new 170-bed national forensic mental health complex at Portrane recently began. This facility will replace the Central Mental Hospital in Dundrum. It will also include dedicated components for mental health and intellectual disability, a forensic child and adolescent mental health service, CAMHS, and a new 30-bed intensive care rehabilitation unit. The new national facility will provide psychiatric care in a modern and high-quality setting that rivals the best available elsewhere.
A core approach is developing the concept of recovery, wherever possible, in delivering mental health services - whether in community or residential settings - into the future. The operation of the additional beds at the Central Mental Hospital in Dundrum will assist towards this objective. It will relieve the acknowledged pressures on the existing forensic mental health and judicial systems. It also paves the way to opening the new facilities in early 2020. The Senator may rest assured that I will keep this matter under close review with the HSE or that I will refer the issues to the Minister, Deputy Harris, in order that all of the parties involved in the current process reach agreement as quickly as possible in the interests of those that require this key service.
I thank the Minister of State for his reply. Unfortunately, no date has been given in terms of the negotiations at the Workplace Relations Commission. The stalemate has lasted a year and a half at this stage.
Does the Minister of State understand that there are people who cannot be managed in approved centres and people in prison who are waiting to avail of the new facility? A tragedy occurred in my area, which is located in the constituency of Dublin South-Central, last week. The person involved cannot be admitted to the Central Mental Hospital due to overcrowding. To free up space, the institution would have to pick somebody to return to the prison population but he or she would clearly be unfit to be moved. We are not fulfilling our duty of care and nurses in particular are concerned about this matter.
The HSE has agreed that the staff have made prudent demands. Rosters were also implemented without a by your leave. The days of draconian management are over. Consultations and negotiations are required, which is the nub of the issue, but the Workplace Relations Commission will probably not meet for some months. I urge the Minister of State to ask the Minister to hurry this matter along and get these much-needed beds opened.
Unfortunately, the Minister of State is not the line Minister. I am sure he will convey the Senator's concerns to the senior Minister. Does the Minister of State wish to add anything? No. I thank the Minister of State and Senator Devine.