12 October 2006
(On the Order of Business)
An Cathaoirleach: 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 facilities for children and adolescents who need to be detained under the Mental Health Act 2001 due to come into force on 1 November are not in place, particularly given that if such children are detained in a place deemed unsuitable, those responsible may be brought before the courts and subjected to a custodial sentence or a fine.
(On the Adjournment)
Mental Health Legislation.
Dr. Henry: I welcome the Minister of State to the House. Yesterday we discussed the latest appearance of Ireland before the committee monitoring the United Nations Convention on the Rights of the Child. While we agreed that progress had been made as regards the rights of children in this country, there were large gaps.
There are large gaps regarding the treatment of children in the area of mental health. For the first time, section 25 of the Mental Health Act 2001 allows for the involuntary detention of children. While the consent of the child's parents is considered to be very important, if consent is not given, a social worker or another official may apply to the courts, on an ex parte basis, to have a child admitted to an approved centre. The problem is that in some areas we have no approved centres for the detention of such children. Those who have to accept them from the courts into a centre could, in fact, be sued for taking them into an unsuitable place under sections 63 and 64 of the Act, which define approved centres.
Figures provided to me on in-patient places indicate that they vary from 20 to 35 in the whole country - some in Dublin and some in the west - for children who are so seriously mentally ill that they need to be admitted. We have no notion of the number of child patients who may need admission because mental illness is not included on in-patient waiting lists. We have a serious problem in that, from 1 July, professionals in this field could be before the courts because they do not have adequate facilities in which to treat these children. A considerable number of children who are admitted are older children. That is because psychosis and schizophrenia are more likely to occur in teenagers than in children under 12. Currently, 16 to 18 year old are de facto treated in adult services even though that is considered to be entirely unsuitable. For example, the Mental Health Commission is bringing forward regulations whereby staff working in these services for children who have to be admitted should be screened under the children first regulations. I do not know how that is going to happen, however. It is recommended that they should be seen by adolescent or child psychiatrists but these people may not be working in the centres to which the children are admitted.
Even if two, three or four beds are segregated within an adult unit, it is most unlikely that there will be proper play facilities for young children or educational facilities. Many of them will be admitted for serious reasons, particularly for attempted suicide or because they are considered to be suicide risks. These children are badly in need of treatment, yet as far as I can see we have made no effort in recent years to do anything about this issue, even though it was known that it was coming down the line. It is recommended they should be cared for in separate areas or, if not, in well segregated areas in psychiatric institutions because otherwise it is considered they will not be properly treated.
There is also a shortage of psychologists and other personnel in the service to deal with these children. Even if we have the facilities, the shortage of staff is woeful. It is reckoned that 120 places are needed. With early treatment being much more preferable in treating those suffering from mental illness, it is sad we have allowed this situation, to which we should have been alert, develop because it has been pointed out for a long time. I would be glad to hear from the Minister of State how it is proposed to deal with the issue in a timeframe of fewer than three weeks.
Mr. Fahey: I thank Senator Henry for raising this matter on the Adjournment. I assure the House that work continues towards ensuring that appropriate child and adolescent psychiatric inpatient services are put in place without delay. In addition, I assure the Senator that it is not anticipated that the Mental Health Act 2001 will lead to individuals being brought before the courts in the circumstances she outlined.
As the Senator said, the full provisions of the Mental Health Act 2001 will come into force from 1 November. This is significant legislation which replaces the outdated 1945 legislation that currently governs involuntary detentions of people suffering from mental disorders.
The Department of Health and Children, the Health Service Executive and the Mental Health Commission have been working together to ensure the successful implementation of the Act. It defines a child as anyone under the age of 18, bringing mental health law in line with other legislation. A very small number of children require involuntary admission due to mental illness. However, we have an obligation to provide the highest standards of care and treatment to this vulnerable group.
It is accepted that additional beds for the treatment of children are needed. This was outlined in a Vision for Change and these required facilities will be delivered within the capital programme of the HSE. In the meantime, children and adolescents requiring inpatient treatment, both voluntarily and involuntarily, will continue to be admitted to adult units when necessary. Recognising this interim situation, the Mental Health Commission has prepared a draft code of practice on the treatment of children in adult facilities.
The HSE established a working group on child and adolescent mental health services. The group consisted of representatives from the Irish College of Psychiatrists, the Irish Hospital Consultants Association, the Irish Medical Organisation, senior HSE managers and practitioners. The group explored options capable of creating immediate additional capacity for the regional provision of inpatient facilities for those children and adolescents who require involuntary admission under section 25 of the Mental Health Act 2001. The group's report has been adopted by the HSE.
The report proposes how services can best be delivered in an integrated and holistic way and has identified additional inpatient bed capacity for children and adolescents. Each HSE region will identify three or four beds in adult units for the treatment of children and adolescents on an interim basis pending the provision of dedicated units. Each unit will be supported by a consultant-led child and adolescent multidisciplinary team. Staff in these units will receive additional training and appropriate clearance.
Eight additional consultant-led child and adolescent psychiatric teams per year will be established nationally for the next four years to enhance community and inpatient services. This year the HSE has allocated an additional €3.25 million for this purpose and recruitment is under way.
As the Minister for Health and Children has previously stated, it is not acceptable for children and adolescents to be treated in adult units. However, the Mental Health Act 2001 does not prevent the treatment of children in approved adult facilities. Therefore, the question of somebody being brought before the courts and subjected to a custodial sentence or a fine does not arise.
I am sure the House will agree that the full implementation of the Act from 1 November next is to be welcomed as this will provide without any further delay much needed protection to all adults and children who are involuntarily detained. I take on board the points made by the Senator and I will convey them to the Minister for Health and Children.
Dr. Henry: I thank the Minister of State for his reply and additional remarks. I am afraid the position is as bad as I thought.
The Seanad adjourned at 4.45 p.m. until 2.30 p.m. on Wednesday, 18 October 2006.
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