26 January 2005
An Leas-Chathaoirleach: I have also received notice from Senator Henry of the following matter:
The need for the Minister for Health and Children to outline the reasons for the inadequate funding and staffing of the Jonathan Swift centre for psychiatric patients attached to St. James's Hospital, Dublin 8.
Dr. Henry: Will the Leader arrange a debate on the Mental Health Commission report for 2003, published before Christmas? Could she also find out about an extraordinary omission from the legislative programme which the Chief Whip, Deputy Tom Kitt, sent to Senators? There is an EU directive on the safety of blood from the transmission of disease to donors and recipients. This directive was issued three years ago and should be enshrined in domestic law by 8 February next. It is not mentioned even under the heads of legislation in the legislative programme and all I can find out from the Department of Health and Children is that it is awaiting reports. In view of all the trouble we have had with blood in this country, the lack of urgency in this area shows a serious deficiency in the Department. I would like the Leader to find out why this situation has arisen.
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Dr. Henry: I welcome the Minister of State, Deputy Tim O’Malley, of whose interest in the area of mental health I am aware.
The Minister for Health and Children has made a resolution of the chaotic situation in accident and emergency departments a major objective of her term of office. However, this problem is caused by a lack of staff, beds and funding in other areas. Too frequently we focus on physical rather than mental problems. I applaud the Minister’s action in respect of the Ballymun health centre. This centre was to be a pilot scheme in respect of primary care but it remained unopened for between two to two and a half years because of a turf war between the local authorities and the Department of Health and Children. I am delighted the Minister applied common sense to the situation and I have written to her to indicate my pleasure with the initiative she has shown.
There are other areas outside of primary health care which are causing problems in the context of accident and emergency services. Bed shortages in acute hospitals are an important factor but we must also address the issue of people with mental illness and the way in which they are being seriously short-changed. Some of these individuals end up in accident and emergency departments which worsens a chaotic situation.
I wish to refer to the example of the Jonathan Swift clinic of the department of psychiatry in Trinity College which is based at St. James’s Hospital and which deals with a catchment area covering the south inner city. This is an area with many socio-economic problems. As the Minister of State is aware, poor mental health is frequently associated with socio-economic conditions. The catchment area to which I refer is discriminated against in respect of certain basic psychiatric services.
Other parts of the country have far more facilities available to them, particularly those relating to rehabilitation, assertive outreach, community services, family therapy, long-stay accommodation, etc. Without these facilities, patients are at increased risk of relapse with, as the Minister of State is aware, attendant risks such as attempted suicide, which lead to further admissions to accident and emergency departments, increased use of alcohol and other drugs and a diminished quality of life. Patients with these problems who attend the accident and emergency department at St. James’s Hospital are referred to the Jonathan Swift clinic. This means there is a chaotic cycle of inadequate support and funding.
Funding for this community service runs at approximately 50% of the national level per patient. As everyone is aware, funding for mental health has decreased in the past ten years from 9% to less than 7%. In the United Kingdom, funding for mental health services amounts to between 12% to 14% of the health service budget.
Mental illness is very common. Depression causes more days lost from work than any other illness. The cost to the Department of Social and Family Affairs of paying long-term benefit for those out of work due to mental illness is less than the funding provided for mental illness services by the Department of Health and Children, including the provision for the upkeep of buildings. Immigrants suffer high levels of mental ill health and many immigrants live in the south inner city. The service is severely stretched. Homeless people and those with psychiatric conditions who come to the accident and emergency department in St. James’s Hospital consume much in the way of resources before general patients are dealt with. A total of 30% of acute psychiatric inpatient beds are blocked by long-stay patients in St. James’s Hospital because there are neither staff nor financial resources in the community to enable them to be discharged.
Mental health services in Cavan-Monaghan are rightly given much praise. There is one non-consultant hospital doctor in psychiatry per 11,500 of the population in this region. In the St. James’s Hospital catchment area the figure is one per 22,167, representing nearly half as many doctors to patients. The figure for Tallaght, which also has problems, is one per 16,667. Those working in community psychiatry in St. James’s Hospital leave because it is impossible for them to do their job. People are frequently urged to obtain psychiatric help in the early stages but what happens if it is not available?
Funding for the clinic was reduced by 5% in 2003. There is a low level of nursing staff. For example, Kerry employs 250 nurses for a population of 125,000 while the Jonathan Swift clinic has 65 nurses for a population of 133,000. St. James’s Hospital has the lowest provision of consultants and NCHDs for psychiatric patients.
Is it fair to treat such vulnerable people so badly? Are they not as valued as those who live in more affluent areas? The situation does not just demand equity, it demands that the service be given greater than average resources. Will the Minister of State explain why this has not yet happened?
Minister of State at the Department of Health and Children (Mr. T. O'Malley): I thank Senator Henry for giving me the opportunity to outline the position in respect of this issue.
Responsibility for the provision of mental health services at St. James's Hospital is a matter for the HSE eastern region and the HSE south-western area. According to figures supplied to my Department, the cost of the St. James's Hospital area 3 mental health service will be in excess of €9 million this year.
In area 3, the public mental health service is provided in partnership with St. Patrick's Hospital and St. James's Hospital on behalf of the HSE south-western area. The Dublin south city service caters for a population of 130,000 across two sectors, Camac, which serves the south inner city, and Owendoher, which serves the outer sector as far as Rathfarnham. This catchment includes significant areas of social deprivation.
Community mental health services are provided by St. Patrick's Hospital. Inpatient care is provided at the Jonathan Swift clinic at St. James's Hospital, which has 50 beds, including nine specialist beds for psychiatry of old age. This is in line with the bed ratio as recommended in the policy document, Planning for the Future. The Jonathan Swift clinic is a professorial unit and has well-developed academic links with Trinity College, Dublin. Many mental health services have had the benefit of a legacy budget associated with a large institutional base. This service, unfortunately, has not had this advantage and, as a result, all resources require additional allocation from the Exchequer.
A new community mental health centre was opened at St. Martha's on the South Circular Road in October 2002 and this facility provides a sector headquarters and day hospital for the Camac sector. This service has a number of high, medium and low support hostels for patients with continuing care needs and has been working closely with Dublin City Council to develop and acquire additional accommodation for rehabilitation clients. It is intended to create a day hospital and sector headquarters for the Owendoher sector and a site has been identified by the South-Western Area Health Board for this purpose. The service has four consultant-led teams and works in close collaboration with the specialist service of psychiatry of old age and liaison service - two consultant-led teams employed directly by St. James's Hospital. A new consultant-led team has been allocated to this service to cater for the needs of clients in the Drimnagh area.
I refer to capital funding. The Health Service Executive eastern region will invest proceeds from the sale of the lands at St. Loman's Hospital into the development of mental health services on the St. Loman's site and in other locations in the HSE south-western area. I assure the Deputy that the needs of mental health services in the south-western area have been communicated to the HSE in the annual service planning process and will be taken into consideration in the context of the future development of services in this area.
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