19 October 2006
Dr. Henry: I thank Senator Browne for allowing me to speak first on this issue. The commission approached its new position in a most energetic manner and brought forward a strategic plan for 2004-05 which has six priorities. These are first, to establish the management, professional and organisational systems and infrastructure which will enable the commission to fulfil its statutory responsibilities. Second, to promote and implement best standards of care within the mental health services. Third, to promote and protect the rights and welfare of persons availing of mental health services as defined in the Mental Health Act 2001. Fourth, to promote and enhance knowledge and research on mental health services and treatment interventions. Fifth, to increase public awareness and interest in the mental health services and sixth, to provide an efficient, responsible, quality service for customers. The commission has tried to address this.
There is a great deal of information in this report, but there is still a considerable amount missing on the issue of mental health in this country. We have information on the huge decrease in beds; in 1963 there were 20,000 people in mental hospitals and this was reduced to just over 3,500 by November 2005. There are around 4,000 beds available, which is approximately 131 beds per 100,000 of the population over 16 years of age. In the Dublin region the figure falls to approximately 63 beds per 100,000 of the population over 16 years of age. I do not know if this is an adequate number of beds. It is more or less in line with the international average, however, in this country there is a propensity to admit patients and, naturally, they should be as near as possible to their families.
The Minister of State pointed out that there are now beds in 24 acute hospitals, as opposed to eight, which was the case in 1984 when Planning for the Future was introduced. This is a welcome change because it helps remove the stigma attached to separate mental hospitals and allows the patients in question be admitted to ordinary hospitals. The inspectorate interviewed service users in the report and they said they did not like being admitted through general accident and emergency units if they were already known to be users of facilities within a hospital. Dr. Margot Wrigley, in a press release on behalf of the Irish Hospital Consultants Association, complained of a teenager who spent over 24 hours on a trolley in an accident and emergency department despite the fact that he was acutely psychiatrically ill. We must watch the admissions procedure used in such cases because it is bad enough to sit in the accident and emergency department with a Colles fracture but it is far more difficult to sit there during an acute psychotic episode.
The Inspector of Mental Hospitals complains that some people admitted to general psychiatric hospitals are not admitted to admission wards but to long stay wards. This is unsuitable and must be very disturbing for some. Some 30% of those admitted to psychiatric hospitals have not previously been admitted to such a facility and many people recover and are not readmitted. Admission to a long stay ward is not suitable and I support the inspector's concerns on this issue.
The Minister of State raised the matter of children being admitted to adult psychiatric hospitals and I have spoken on this issue often in my time in the House. It is deplorable that facilities for in-patient admissions of children have improved so little; there are 20 or 30 such beds in the country. The admission of children is unusual but the admission of adolescents is more common. Serious mental illnesses can develop in adolescents and we must be in a position to deal with such cases. We must even be prepared to deal with serious cases of eating disorders.
Making three or four beds available in an adult psychiatric hospitals is not suitable, they need to be segregated. Even if children are not in separate hospitals they should be in separate units where they have facilities for play, education and so on. I spoke to a young woman who was treated in a mental hospital in the same ward as Fr. Brendan Smith, though she did not sleep there. He was subsequently charged with the sexual abuse of children.
I am anxious to discuss the 240 individuals who became long-term patients in 2005, which means each was in a mental health facility for over a year. Mental health treatment has made much progress and it is worrying to read this statistic. Half of those patients were in five of the major psychiatric hospitals and we must be careful not to develop a pool of long-term patients in the older psychiatric institutions. We have received complaints in the Joint Committee on Health and Children regarding those in long-term psychiatric hospital care with few people to speak on their behalf. They are all in the older facilities and they need our help.
I am pleased to see more effort being made to seek the views of service users. There is a good section on this in the report and the inspectorate interviewed people in the Irish advocacy network who speak on behalf of people in psychiatric hospitals. The Central Mental Hospital was mentioned and I am pleased at the efforts that have been made by the relations and friends of patients there to get the conditions improved. This would not have happened without their help. It is regrettable the hospital is to be used as a major financial cash cow to fund the new institution in Thornton Hall because it is internationally agreed it is foolish to locate hospitals and prisons adjacent to each other. That is not considered good practice, but now is not the time for talking about that.
Service users everywhere appear to have the same complaints. Patients do not receive information, they are given little choice about their care plans and frequently do not get much by way of diagnoses from their psychiatrists. Often they have difficulty in understanding what is being said. They are not adequately informed about their medication or its side effects. The Minister of State will be well aware from his professional experience that there can be serious side effects from anti-psychotic drugs, neuroleptics and so forth. It is not right that patients are not being made aware of this. Also, they are angry that frequently alternatives to medication are not offered. We know there is very little talk therapy, psychoanalysis or counselling in many institutions and in many psychiatric facilities within the community. There are complaints about doors being locked unnecessarily. This humiliates people and it is an issue that has to be addressed. Smokers complain about the lack of facilities for smoking indoors. Another serious issue is the lack of suitable placements on discharge. I appeal to people not to object to planning permissions for facilities in their areas for discharged psychiatric patients. One in four of us is likely to experience psychiatric illness at some time and the majority of patients make a very good recovery. These are people who share the community with us, and we should behave in a better manner. Many patients experience difficulty getting follow-up care because of the distance they live from the institution, and there is also a lack of support for their families.
Involuntary admissions is a thorny issue. There were 2,830 such admissions last year, a small reduction on the previous year but still high by international standards. This is traumatic for both the patients and those who must have them admitted, be they family, friends, doctors or whoever. We must try to reduce the number of involuntary admissions. Another serious issue concerns patients who are regraded from voluntary to involuntary admissions within hospitals, and no data are included. We need this information.
Approximately 60% of patients involuntarily admitted are men; the gender difference is noteworthy. Men are inclined to experience the more serious illnesses such as schizophrenia, psychotic episodes and so forth, but one must also consider that frequently they are single people, with fewer family members, peers and social support. Can we not do more for these people? The tribunals are not in place yet. Have we got sufficient independent psychiatrists to give second opinions? We certainly cannot rely on people who work in the same hospitals. We are all aware of the difficulty experienced in securing independent advice in relation to the Neary case in Drogheda. That cannot be allowed to happen again.
We know from international reports that patients who are intellectually disabled have a high incidence of mental health problems. The inspector is scathing on this issue. There are only two facilities in the country, namely, Stewart's Hospital and St. Joseph's Unit in St. Ita's Hospital, Portrane, suitable for patients who are intellectually disabled and have mental illness. We talked on the Order of Business about the lack of inspection of nursing homes for the elderly. The lack of inspection of facilities for the intellectually disabled is unacceptable. The majority of them are non-statutory or voluntary institutions, and while great credit is due to those involved in running them, the inspector's report indicates that a great deal more needs to be done by way of inspection. The report states that if patients in some of these institutions had individual assessment - it is dreadful to think people are being mass assessed - approximately 50% would be found to have a mental illness. This is terrible and many of them are on long-term medication which it appears was not being reviewed frequently enough. The report had similar criticisms of the facilities for the elderly with mental illness and, as regards the places described as community centres for those discharged, it stated these places could not be regarded as proper community care. The people are in wards of 20 to 30, which could just as easily have been described as long-stay wards out in the community. We must not congratulate ourselves for having moved people out of large hospitals when they are not in adequate facilities. The number of beds for such people will have to be reviewed. There are not enough beds n the psychiatric sector and there is a lack of resources for treating people in the community.
The primary care strategy was introduced under the remit of the former Minister for Health and Children, Deputy Martin. How many primary care teams have been set up? It is laughable, but there are scarcely half a dozen in the country. These were to be the panacea for everything, with psychologists and so forth available to people in the community. General practitioners were to be able to refer patients immediately to such centres. A considerable number of children with behavioural disorders are not treated until they are teenagers, when they may have developed serious psychotic problems. What we have set up outside the major hospitals may not be adequate.
I congratulate all those involved in compiling this report and I hope we take seriously its weightier criticisms.
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