Paul Coghlan (Fine Gael)
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The Minister of State, Deputy Finian McGrath, is very welcome as ever.

Jennifer Murnane O'Connor (Fianna Fail)
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I wish the Minister of State a good afternoon. I am disappointed that the Minister for Health, Deputy Harris, is not here today as I am raising a very serious issue, namely, the psychiatric unit in St. Luke's General Hospital in Kilkenny.

Paul Coghlan (Fine Gael)
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Deputy Finian McGrath is a very serious man.

Jennifer Murnane O'Connor (Fianna Fail)
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Absolutely. Both of them are.I welcome the Minister of State. I know he will relay my concerns to the Minister.

Last week, conditions at the department of psychiatry in St. Luke's Hospital came to public attention following a case which the Mental Health Commission took against the HSE under the Mental Health Act, the first such case to be taken. Staff, parents, patients and loved ones have detailed many of the issues that were found during an unannounced inspection of the unit which took place between 6 November and 9 November. I am deeply concerned that the voices of those using and working in the facility are not being heard and that it takes an unannounced inspection and a court decision for anything to be done. I have highlighted the unacceptable overcrowding at this facility a number of times, both here and in meetings of the mental health committee. I am appalled that it was used as an excuse for not having cleanliness as a standard in the facility. I have been on record to highlight patients being left on corridors, on floors in the TV rooms and on couches but the conditions in this case are staggering in the levels of deprivation on display.

How have we arrived at this point? Is there a culture in hospitals whereby patients seek mental healthcare in which everything is operated without adhering to standards until somebody is caught? I am concerned that these conditions are standard and I would like to be assured that they are not. I would like to be assured that these conditions will never happen again and I would like to be assured that there will be some accountability here.

For far too long, mental health issues have been ignored, stigmatised and demonised. We have buried our mentally ill in basements and back rooms under the veil of shuttered windows and barred doors. We need to clean up our attitudes and adopt modern attitudes in our facilities. We need to shed light on any kind of activity that demonises people who are in need of mental health. I am getting sick and tired of controversies over how we treat each other in this country. The patients in these facilities are the most vulnerable people and they matter, but it was disturbing, to say the least, to listen to my constituents tell me stories of being in the facility and leaving their beds to use the bathroom, only to return to find someone else in their bed, sometimes without clothing on, and to hear their harrowing tales of filth, dirt and unsanitary conditions.

What is the level of supervision of patients across the service? Why was this type of story repeated to me from several different perspectives? I heard from staff in the units who were exasperated with the workload, overwhelmed with actual care and unable to rectify maintenance issues. These staff need help to do their jobs and that is where the HSE comes in. We cannot have a situation where patients using mental healthcare facilities have nowhere to spend recreational time. They see blatant drug use and go to their bed at night in fear of opening their eyes and what they might see upon doing so. These patients are looking for help and what they are receiving is the stuff of torment and nightmares. It is too late when whistleblowers come forward and when unannounced inspections have to be relied upon to catch these things. What sort of a culture exists in the service? The public deserves to know that there is a standard of care across the board. These are most vulnerable patients. They cannot rely on themselves or other patients to look after them. We cannot, again and again, force hard-pressed people into the private system.

This Government does not care about the people who, through no fault of their own, are in financial distress but have to access the public health system for mental care. It is unacceptable to have a facility where there is dirt on the floor and walls and the bedding is of an extremely hazardous material. There has to be a standard from the outset and not in response to a judge. People die, disappear and lose themselves in our system and the Minister has to find a way to ensure these things do not happen. There seems to be money everywhere except where it needs to be put and I am asking the Minister to reassure me and the people of this country that not only will there be accountability, there will be root and branch investigations of all our facilities so that we create a culture of operating at the highest standard, and not just when an inspector arrives.

Finian McGrath (Dublin Bay North, Independent)
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I am taking this on behalf of the Minister of State at the Department of Health, Deputy Jim Daly. I assure the Senator and the House that mental health is, and will continue to be, a priority concern for the Government. I have heard the genuine concerns of the Senator on this matter. I agree that the public needs to know and that standards have to improve.

I wish to reassure the Senator on the point about money.The recent budget, which saw the mental health allocation increase to nearly €1 billion, is a clear indication of the importance placed on the mental health of the nation by the Government. We have increased the HSE’s mental health budget by more than €245 million since 2012. This has helped to fund a number of initiatives aimed at reducing demand on the mental health services. It has provided, for example, an extra 130 psychiatric nurse undergraduates places each year to come onstream in 2020 to 2021. In addition, 40 postgraduate places have been funded. Together with the recent appointment by the HSE of around 114 assistant psychologists and 20 psychologists into primary care and ten advanced nurse practitioners directly into the child and adolescent mental health services, CAMHS, it is anticipated these posts will help to deal with the increased demand for CAMHS.

Budget 2019 allocated an additional €55 million for the development of mental health services. The additional funding allocated to mental health services since 2012 has provided for the recruitment of nearly 1,700 new development posts in mental health. In the last year, the number of staff across the mental health service has increased by 163. The number of consultants has increased by 14 while the number of nurses has increased by 41. There are widely acknowledged difficulties in recruiting and retaining specialist mental health staff, particularly consultant psychiatrists. We accept there is a problem in that respect.

Every possible option is being pursued in order to recruit while acknowledging the critical impact medical vacancies have on service provision. To tackle this a dedicated medical manpower officer has been appointed. In addition, local management is working with 11 national and international agencies to source suitably qualified candidates. All options are being explored, including the provision of out-of-hours or weekend clinics by a consultant working elsewhere.

The Minister of State, Deputy Jim Daly, will be overseeing the roll-out a tele-counselling pilot project in 2019. This will ascertain the merits of delivering care from a distance using technology and video-conferencing. Tele-counselling can provide a range of services, including psychiatric evaluations, individual, group and family therapy, education and patient management. The Minister of State expects the introduction of tele-health services will expand over time to create additional capacity in psychiatry. Tele-health initiatives may offer flexible opportunities for consultants to work from their chosen location or in supported tele-hubs located in more convenient areas. This should increase the overall attractiveness of the advertised posts resulting in a higher success rate of filling the vacant positions.

The Minister of State, Deputy Jim Daly, has also met the HSE's executive clinical directors to discuss the recruitment and retention issues. He has written to them to request further suggestions on how recruitment might be improved.

The Mental Health Commission has an important part to play in ensuring that our psychiatric units are of a sufficiently high standard. The commission has responsibility for the establishment and maintenance of high standards and good practices in the delivery of mental health services and to take all reasonable steps to protect the interests of persons detained in approved centres.

Jennifer Murnane O'Connor (Fianna Fail)
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I thank the Minister of State for his response. I understand what he has said and that we need to recruit more psychiatrists and nurses and that would be welcome, However, the department of psychiatry in St. Luke's Hospital came to public attention last week on foot of a case, the first of its kind, brought by the Mental Health Commission against the HSE under the Mental Health Act. This is a massive issue. Many people have telephoned my constituency office about it. It is unacceptable. The Minister of State, Deputy Finian McGrath, the Minister, Deputy Harris, and the other Ministers of State in the Department need to step in to address this issue. What happened in this case cannot be allowed to happen again. These people were neglected. This was the first case of it kind. We need to make sure what happened in this in unit does not happen in any other psychiatric unit. The Minister of State's reply did not fully answer the issue I raised. I ask him to bring this issue to the attention of the Department and the Minister and to ensure it is addressed. This is very serious. I will raise this issue again in the next few days to get more clarification on it and a better answer, but I thank the Minister of State for coming into the House to respond to it today.

Finian McGrath (Dublin Bay North, Independent)
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I take very seriously what Senator Murnane O'Connor stated in respect of St. Luke's Hospital. As far as I am concerned, neglect is unacceptable. We accept that. I will bring the matter to the attention of the Minister of State, Deputy Jim Daly, and the Department. I reassure the Senator that the Minister of State and the Department are working closely with the HSE to address recruitment and retention issues across the mental health service. In conjunction with the Mental Health Commission, the Department is also monitoring efforts by the HSE to improve the standards and conditions for all patients in line with rules and regulations, as directed by the Mental Health Act 2001.

I will bring the Senator's major concerns to the Minister of State, Deputy Jim Daly, and the Minister, Deputy Harris, because such issues must be addressed. We must take a more hands-on approach. The bottom line is that we have to look after the interests and rights of patients and also be more supportive of families.