11 October 2006
Dr. Henry: I welcome the Minister of State at the Department of Health and Children, Deputy Seán Power, to the House. I am glad to see that the UN Committee on the Rights of the Child recognised that progress has been made in Ireland. However, that progress has been far too slow in some areas.
With regard to health and health care services, while the committee welcomes the commitments undertaken by the State in a number of policy documents, it remains concerned about the lack of a comprehensive legal framework and the absence of statutory guidelines to safeguard the quality of and access to health care services, as stipulated in Article 24 of the convention, in particular for children in vulnerable situations.
In view of this country's current wealth, I find it difficult to understand why medical cards are not provided to all children. We could start with children under the age of 12 because, fortunately, teenagers are not frequent users of medical services. Proposals in this regard have been made by the medical profession on a number of occasions. The increased cost of seeing a doctor or buying medicine could be an important factor in decisions by families to delay seeking medical care for their children.
We have not yet addressed the possibility of preventing disability in children before they are born. Promises have been made with regard to fortifying flour with folic acid but I have been raising this issue since I was first elected to the Seanad 14 years ago. Ireland has the highest incidence of neurotube defects in the world, so, more than most, we need to take action on this issue. The United States, Canada and the United Kingdom now fortify their flour with folic acid, so it is no longer valid to make the excuse that Ireland's confectionary trade with the United Kingdom would be affected if our flour was fortified. Several hundred disabilities could be prevented each year through the addition of folic acid, therefore, I hope the Department of Health and Children will address this issue as rapidly as possible.
We still do not have neonatal hearing tests, which are relatively cheap to administer. That is serious because we know that the earlier hearing defects are recognised in a child, the better it is for his or her total development. That is another area in which we can begin to prevent disability. We have a national disability strategy from 2004 and the committee welcomed it. However, the more disabilities we can prevent, the better. It is bad enough for someone to acquire a disability during his or her life, but it is even worse if the disability need not occur at all. We really should try to do much more about this.
Senator Glynn mentioned road accidents and the fact school buses now have seat belts. The issue of children killed or injured in road accidents is discussed. I read a report recently but, unfortunately, I cannot remember the timeframe over which the figures were accumulated. However, 57 children who were killed in road accidents over the period had not been placed in any type of restraining device in the car. That is illegal and we must try to enforce the law. One cannot expect three year olds to ensure they are placed in seat belts. This is an offence for which not only a couple of penalty points should be given to whoever is driving the child but for which far more points should be given.
I believe the 57 children were killed over a three-year period. That is an horrific number of children being killed and left unrestrained in cars. The Minister of State and, I am sure, other Members know that children are left unrestrained in cars and that children who look younger than 12 years of age sit in the front seats of cars. There is this crazy notion that SUVs are safer for children but they are not because they are more likely to roll over. There is also the question of airbags which might provide safety for adults but which are more of a problem for children if they are hit by them.
Obesity was not mentioned in the report. I suggest we deal with it in tandem with the play policies being put forward because we can make an effort to ensure children have a healthier lifestyle. It is very important children have better access to safe play areas because years ago, we all used to run around a lot. Advertising directed at children is mentioned in the report. The advertising of unhealthy food is also an issue.
We need to examine vaccination levels. Unfortunately, levels are lower among lower socioeconomic populations than among people who live in better off areas. If special campaigns are necessary in such areas, so be it.
A serious situation arises in the area of the mental health of children and adolescents. On 1 November, Part 2 of the Mental Health Act 2001 comes into force. The situation regarding facilities for children and adolescents with mental health problems are no better than they were when I became a Member of this House. The committee reiterates its previous recommendation and recommends the State party make full use of the findings and implement recommendations of the expert group on mental health policy appointed by the Minister of State at the Health and Children in 2003. Three years later, we have moved from 16 beds for children and adolescents who need inpatient treatment to 20 beds.
At the end of the month it will be a legal requirement for those running whatever institution to which the child is admitted and its clinical director to have him or her placed in properly segregated facilities for children and adolescents with suitably trained staff. However, this will not be possible. It has been suggested that 120 beds are needed for the country and that in some parts, parts of adult facilities will have four or five beds for children which is really not what is needed.
The Minister of State may have seen a headline in one of today's newspapers where Dr. Margo Wrigley, mental health spokesperson for the Irish Hospital Consultants Association, pointed out that recently a seriously ill child spent over 24 hours on a trolley in an accident and emergency department in one of the Dublin hospitals. That simply will not do. I told the House previously about a child psychiatrist who telephoned me one night to tell me she could not get a 12 year old girl admitted to hospital and that she was afraid the child would seriously damage herself or some member of her family. It is not right that a psychiatrist must telephone a public representative late at night to try to find accommodation for such an ill child. I do not believe the situation has improved much.
It has been suggested that we need a specialist team and not only a psychiatrist per 100,000 of population. These teams need to be resourced when put in place. There is a terrible shortage of psychologists. One extra child psychiatrist has been appointed since 2003 which simply will not do. We also need services on a 24 hour basis. We witnessed that terrible tragedy in Wexford last year where a woman with a serious mental illness drowned herself and her children. She sought help, could not get it and this is what happened. We need to catch up as a matter of urgency.
There are children who are intellectually disabled and who are not in a suitable accommodation. They should be placed in proper accommodation in which there are specialised staff to care for them. This is a huge problem and we have approximately 20 days remaining to solve it properly. Otherwise, those running the institutions and their clinical directors, who will be medical people, will be brought before the courts and given a hefty fine or put in prison. However, what are they supposed to do if the facilities in which these children can be dealt with are not in place?
Bullying was also mentioned in the report. This is an area in which we seem to have let matters go off the boil. Professor Mona O'Moore of Trinity College Dublin has done a considerable amount of work on bullying in schools which was very much supported by the Department of Education and Science. Approximately four or five years ago, a pilot scheme was set up in County Donegal on bullying in schools which was a huge success. Everyone said there was a significant reduction in bullying in the schools. Why has that pilot not been extended throughout the country since it was a success and in view of another issue addressed in the report, namely, suicide?
The committee urged the State party to implement the new ten-year national strategy for action on suicide prevention and the recommendation from the second report of the strategic task force on alcohol. We bring forward reports and task force recommendations but we do not follow on. Bullying among children and adolescents is very important in the context of suicide. Some children and adolescents turn to alcohol and drugs because of bullying before they commit suicide.
I mention another issue which perhaps the Minister of State's Department might address. Dr. John Connolly, who has a great deal of expertise in the areas of bullying and suicide, is chair of the Institute of Suicidology. He said that the Internet sites which talk about depression and feeling like killing one's self are seriously unchallenged. I cannot tell the Minister of State how much he can do but there is a committee which observes the Internet in regard to problems that can arise in respect of children. Apparently these suicide sites do not urge people to look for help but tell them how they can commit suicide. We all know how clever children and adolescents are with the Internet and I would like to know if the Department has addressed this issue. I was most alarmed when I heard Dr. Connolly talk about it because I, not being an Internet aficionado, do not know about these sites. However, it is horrific to think they exist and that this type of information is being given out to children.
We have been told we are not addressing the issue of alcohol urgently enough as well as reproductive and sexual health information and that we should not rely on schools to bring forward the information all the time. The Crisis Pregnancy Agency has done terrific work. It appears we have quite a low rate of teenage pregnancies and no one should think it is because these girls are going to England for abortions or something like that. That is not so. That rate is also low and declining. This is an area where we are doing quite well. As the committee suggested, perhaps a more enthusiastic effort in that regard would put us in an even better situation. I did not realise until recently that 30 years ago Holland had the highest incidence of teenage pregnancy in Europe. It took them 30 years to get to the stage of having the lowest incidence. We are making progress and we should continue with it. We know teenage pregnancy has not just a serious effect on the child but also on the young mother.
Criminal law issues have come up in the course of the debate. I was most disappointed when the Children Act 2001 was modified by the Minister for Justice, Equality and Law Reform in the Criminal Justice Act 2006. The effect of that was to reduce to ten years the age of responsibility for serious crimes. I was particularly disappointed when the Minister asked during the debate on that Bill what would be the media response if a child of ten committed a murder. The media will say what it likes. We have to introduce the best possible legislation.
I do not believe the committee can have known that under that legislation, responsibility for places of detention for children has been moved from the Department of Education and Science to the Department of Justice, Equality and Law Reform. That is also a retrograde step. The committee expressed its concerns about anti-social behaviour orders and how carefully they need to be monitored. I agree with that.
I also agree with what has been said about St. Patrick's Institution but what is the point in saying anything about it. In the Whittaker report, Mr. Ken Whittaker said nearly 30 years ago that it should be closed. It has no educational facilities although children aged from 16 upwards are in the institution. Neither are there any training facilities. This is ridiculous. Detention should be a last resort with children. It should really be for only violent and serious crimes. We will have to get better at trying to deal with them in the outside world.
The longitudinal study is very welcome as these data are needed. Professor Sheila Greene was going to head it up. It will be an excellent study. While 18,000 children sounds a large number, it is not that many. I hope it will include the ethnic and minority groups to which the committee referred. We need to get an overall picture.
I accept the Ministers of State, Deputies Brian Lenihan and Seán Power, are both most enthusiastic about trying to bring forward these issues but we should not be overly enthusiastic about congratulating ourselves because we have a great deal more to do in many areas. I would like to see the area of mental health brought forward for debate as a matter of urgency before some of my colleagues will be put in jail by the end of November.
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