09 February 2006
Minister of State at the Department of Health and Children (Mr. T. O'Malley): I am delighted to be able to speak to Senators on the Government's policy document A Vision for Change . . . In general I welcome this report.
Senator Henry: I welcome the Minister of State to the House and I also welcome this very fine report. It is a privilege to speak after Senator Lydon and we are very fortunate in this House to have someone of his professional experience comment on the report.
In view of the fact that the chairperson of the expert group was Professor Joyce O'Connor, who is a friend of mine, I was not in the least surprised at the thoroughness of the report and the enormous amount of work that obviously went into its preparation. All those who were involved in the preparation of the report, some of whom are in the House today, should be complimented on its breadth and on the amount of effort that went into its publication.
I can remember the launch of Planning for the Future over 20 years ago and while a considerable amount of that report's recommendations have been fulfilled, a great deal have not. We all know the reason for that, namely, a lack of resources. Insufficient resources were put into moving psychiatric services out of the old mental hospitals and into the community or the wards in the acute, major hospitals. I regret this very much because we could be much further on in terms of development had the resources been invested over the years. Nonetheless, I welcome the Minister of State's commitment to the area of mental health.
I discovered recently that more money was paid out for long-term disability payments to those with mental illness than was spent on the entire mental health service, including capital spending. That is a shocking statistic and indicates how serious the burden of mental illness can be, not just on the individual and his or her family, but on the economy also. Like Senator Lydon, I was very taken with the various statistics from the World Health Organisation about the burden, internationally, of mental health problems.
There is still a stigma attached to admitting to mental health problems and that is why there is far less pressure put on the health services to deal with mentally ill people and to resource the services better. The amount of funding for mental health services, as a proportion of the total health budget, has dropped from 11% ten years ago to approximately 7% now. This demonstrates the fact that the general population is not putting pressure on the health authorities to improve the situation for those with mental illness. We hear about problems in accident and emergency departments all of the time, but we rarely hear about the fact that people with acute mental illnesses are unable to gain admission to hospital.
It is important that, while moving as much of the service into the community as possible, we remember that people with mental illness of all ages will require acute admission occasionally. It is for the Minister of State and those involved in the area to decide whether such admissions are to one of the present-day large psychiatric hospitals, where bed numbers are greatly reduced, or to a ward in one of the acute general hospitals. However, I am repeatedly asked by psychiatrists to emphasise the fact that acute beds are still needed in the mental health service.
One of the best aspects of this report is the fact that patients, their families and carers were widely consulted as to their needs, rather than the top-down approach of those providing the service, working in the Department of Health and Children and the HSE deciding what was best for them. The emphasis on patients deciding what is best for them is very welcome.
A considerable amount of discussion has centred on the relative merits of the various therapies given to patients with mental illnesses, for example, drug therapy and the so-called talk therapies. For approximately 40 years, drug therapy was extremely popular and made a very significant contribution to dealing with those who had serious mental illnesses such as psychoses, schizophrenia, bipolar disorder and so forth. Such people, whom I saw as a student in the major psychiatric hospitals here and in the United Kingdom, would have had no hope of being discharged and returning to the community without drug therapy. In that context, we must remember that drug therapy has made a very important contribution to the treatment of mental illness over the past three or four decades.
The Minister of State is correct when he says that today people are more interested in psychological services but frequently these are not available. It appears to me that there are large numbers of people training in psychotherapy, psychological assessment and so forth. Is it the case that the necessary posts are not being created? Is it that qualified people are available but the posts have not been created to enable them to treat those who would prefer to try talk therapies before becoming involved with drug therapy?
There is an excellent series running on RTE Radio 1 at the moment called "The Other Side of Childhood" about children with behavioural disorders and mental illnesses. Last night the programme dealt with attention deficit disorder. The presenter, Ms Mimi Tatlow, and a panel of experts discussed the drug Ritalin and attention deficit hyperactivity disorder. I come from that part of medicine which is very anxious about medicalising behavioural disorders but these are areas that must be examined. We must also ensure that we are paying enough attention to child and adolescent psychology.
Senator Lydon pointed out the shortage of beds for serious cases but the psychological services for schools are also deficient. We must pick children up who have been put down as having behavioural disorders. It totally disrupts their educational career without doing anything for them.
Most of the research into mental illness is done with drug therapy because the pharmaceutical companies pay for it. Now we must pay up ourselves for the research into talk therapy. It will be worthwhile and resources should be invested in it. Senator Lydon was right to mention the lack of chaplaincy because that could also fall under talk therapy and is not to be underestimated. I could not find anything in the report about the genetics of mental illness. We must look at this area with care; it is sensitive, but we must not neglect it.
The Minister of State is right that it is difficult for patients to be allowed to recover from mental illness. I have written in the medical press that I am disgusted at the objections made to small houses in certain areas where three or four people with mental illness could go after they had been discharged from hospital. What sort of attitude is that? Communities must become more supportive. People can develop mental illness at any time of their lives. The fact people in a house on one side are recovering does not mean that the people on the other side will not develop mental illness in the near future so it is ridiculous not to support those who are doing their utmost to recover. Flexible employment is also important as is the maintenance of people in education. The universities have become much better about this when people have had to drop out for a while and then come back.
Team work is very important. Multidisciplinary teams are needed all the time but I had a bad experience in this area lately. A psychiatrist was appointed to work with the homeless in north Dublin but when she insisted on the appointment of a team to support her in her work, her post was cancelled. I do not know if anything has been done about it but there was talk about it in the psychiatric community and it does not encourage people when such things happen.
The day hospitals have not been successful because many of them are in the old psychiatric units and it would be better if they were associated with larger primary health care centres, such as the one in Ballymun.
I am glad the Health Service Executive and the psychiatrists have settled their differences about the mental health tribunals. I was involved in the legislation on the Mental Health Act and I felt that these tribunals were incredibly important. Approximately 3,000 people are still admitted involuntarily every year, a much higher incidence than in most European countries. We must examine this and get the tribunals going. I hope my psychiatric colleagues feel they can come forward now.
I approach legislation involving medical practitioners from the viewpoint of how those on the ground will work it. This is why I asked for retired psychiatrists and people who have worked in Northern Ireland to serve on the tribunals to encompass as many people as possible. Otherwise it will not be easy to get the personnel to do this.
I am concerned that not enough consideration has been given to the workings of the Criminal Law (Insanity) Bill. When the Minister for Justice, Equality and Law Reform was in the House, I tried to get him to bring it into line with the Mental Health Act. Frequently the same people will work both. Unfortunately he did not agree with me because, he said, different people are being dealt with. I am not sure he is right. Senator Lydon pointed out that many mentally ill people who are convicted of a crime are convicted of minor offences such as stealing a pint of milk from a supermarket, breaking a window or running up and down in the traffic and being a danger to themselves and to others. I would be grateful if the Minister of State could ascertain if the Minister might be more amenable to my views.
It is disappointing that local services will not accept people who may have a criminal convictions for minor crimes. The prison population has a far higher than average level of mental illness. The psychiatric care situation has improved but it is not yet good enough.
I was interested to hear the Minister of State say that it would be better if the Central Mental Hospital was not on a site associated with a prison but there is not much we can do about that, the main reason being the site in Dundrum is so valuable. It is unfortunate that this is the main reason for transferring a hospital into a prison setting. The Minister for Justice, Equality and Law Reform, on Committee Stage of the Criminal Law (Insanity) Bill referred to Hannibal Lecter but there are not too many such people around. I hate to see us making our plans based on the most extreme cases.
We are all living longer so old age psychiatry must expand, as must psychiatry for those with intellectual disabilities, who are also living longer. These are addressed in the report and are important issues.
The Minister of State should get hold of the Minister for Finance; he can decide if this will succeed or fail because huge resources are required. The will exists in the Department and the Health Service Executive but great plans have been brought forward in the past that have perished because of a lack of resources.
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