17 February 2005
Dr. Henry: I welcome the Minister of State to the House and his speech on this issue. I am grateful to the Leader of the House for acceding to my request to debate the 2003 annual report of the Mental Health Commission. I wish such a debate was held automatically. When I was first elected to the Seanad 12 years ago, the report of the Inspector of Mental Hospitals was never debated in the Oireachtas. I am sure the Minister of State is aware that the reports were not even printed at one stage in the past. It was a useless exercise to employ people to put a great deal of work into such reports because nobody took any notice of them. The work of the commission is an important part of our health service. I would like the Seanad to be obliged to discuss its report every year.
I appreciate that the Mental Health Commission has not been established for very long. The House has considered the first report of the Inspector of Mental Health Services. It is important to note the change in name to refer to mental health “services” rather than mental “hospitals”. The final report of the Inspector of Mental Hospitals has yet to be published. The change in name reflects the change from providing institutional care to providing as much care as possible in the community. It is important to inspect services, rather then just institutions. I am delighted to have an opportunity to address this matter today.
As the Minister of State pointed out, the expert body on mental health policy is formulating a new national mental health policy. I wonder how it is going. I am sometimes concerned that when certain bodies are established, not much action is taken for a very long time. I would like to know how much progress the expert body is making.
I am pleased by the some of the actions taken by the Mental Health Commission to date. I am glad it supported the smoking ban because it felt patients and workers in mental health institutions are as entitled to a smoke-free environment as everyone else. Other developments are progressing at a snail’s pace, however. For example, what has happened to the proposal to establish mental health tribunals, which was one of the most important aspects of the Mental Health Act 2001? The Minister of State is aware that under the Act, the cases of people involuntarily admitted to hospitals — there are hundreds, rather than thousands, of such people — have to be reviewed within 21 days by a mental health tribunal comprising a psychiatrist who is not the psychiatrist who was involved in admitting the person, a lawyer and a lay person.
Interviews have taken place with lawyers and lay people but it is apparent that the dispute between the Minister for Health and Children and the various consultants over the historical liabilities associated with the Medical Defence Union has put a stop to any interviewing of psychiatrists for the positions in question. This dispute has been ongoing for well over a year. I dread to think about how much longer there may be a delay in establishing the tribunals. They are terribly important. One of the major reasons for introducing the Mental Health Act 2001 was to update the Act of 1945. We have been found to have been in breach of the European Convention on Human Rights. Will the Minister of State outline the position on the tribunals in his reply?
Today is the second anniversary of the introduction in this House of the Criminal Law (Insanity) Bill but we still have not proceeded to Report Stage, bearing in mind that the European Convention on Human Rights ordains that such legislation should be enacted urgently. I do not agree with a great deal of the legislation. I tabled many amendments on Committee Stage and have also tabled amendments for Report Stage. The Minister for Justice, Equality and Law Reform only listened to our complaints about the Bill and did not give any replies on Committee Stage. We will have to have a Report Stage that is more like a Committee Stage, but we will not have the chance to reply to the statements of the Minister more than once. This is a great disappointment to me.
An Audit of the Pathway to Involuntary Admission published in 2002 did not discuss the position on legal aid for people admitted involuntarily under the Act. Is anything happening in this area? Consider the views of the committee on intellectual disability and mental health services. I do not believe the Minister mentioned in his speech anything about people with an intellectual disability in addition to a mental illness. This is not uncommon. We still have people with an intellectual disability in psychiatric institutions although people in both categories are being segregated more than they used to be. I am sure the Minister of State wishes the placing of those with intellectual disabilities in psychiatric institutions were not happening as much as I do. There are significant differences in the way both categories should be dealt with. This matter must be addressed urgently. It is described as being a priority for the commission. How significant a priority is it in reality?
I was delighted that there was a conference on child and adolescent psychiatry. We realise more and more frequently that early intervention is essential in the treatment of mental illness if the best possible outcome is to be achieved, as is the case with all illnesses. The Inspector of Mental Health Services, Dr. Carey, pointed out the woeful lack of inpatient beds for children. Some of the children in question can be very seriously ill and in need of inpatient treatment.
I am quite sure the Minister of State will be aware of an interesting survey carried out in Clonmel recently by the social services, the purpose of which was to determine the extent of mental illness in children in the area. I compliment those involved in the study. They examined children aged between one and a half years and 18 years and found that up to 20% of children had a significant mental illness problem. They did not choose Clonmel because they believed there was a problem peculiar to the town, they picked it because it had a good urban-rural mix. I have not seen the details of the report. I have only seen the press reports but they seem to indicate that there is a serious problem that needs to be addressed.
Bullying has been discussed. It is a very significant cause of suicide among children and teenagers. A very good pilot scheme to introduce anti-bullying measures in schools was carried out in the area under the jurisdiction of the former North Western Health Board, mainly in Donegal. Despite the fact that it was found to be extraordinarily effective there has been no effort to extend the scheme to the rest of the country.
Bearing in mind the various disciplines associated with mental health, we must question the effect of the decision to refuse 80 children places in secondary schools in Limerick, the city from which the Minister of State comes. What will this do to their self-esteem? Their parents must be in a state of terror. The transition from primary to secondary school is reckoned to be extraordinarily important. I have often heard educationalists argue that it would be better to have remedial teachers for pupils in the first year of secondary school than in the more senior classes in primary schools because if they despair when they enter the first year of secondary school, the situation is dire. The Government is not taking the matter of child and adolescent mental health seriously enough. We are allowing issues that are perfectly obvious to us all to continue to arise.
The Inspector of Mental Health Services rightly pointed out the major contribution to improving standards in mental health services made by the former Inspector of Mental Hospitals, Dr. Dermot Walsh, and his assistants, Dr. Liam Hanniffy and Mr. Michael Hughes. Reports from as recent as ten years ago contain complaints about the sharing of clothes and underwear and unsatisfactory food, for example. In more recent years, one finds these problems no longer arise. Therefore, the work of Dr. Walsh and his assistants certainly needs to be recognised. I look forward to seeing their final report.
It is important to examine the activities of the psychiatric services in conjunction with this report. The 2003 report has been published recently. I am sure the Minister of State, like me, was interested to see the variations in treatment around the country. What was most noticed by the press was the difference in the frequency of the use of electroconvulsive therapy. It is virtually never used in some areas, yet is used quite frequently in others. It was interesting to note in the report that areas with the most complaints frequently had the most requests for information under the Freedom of Information Act. It is important that staff working in mental health institutions understand that patients and their relations, or whoever is acting on their behalf if they are not in a position to make inquiries themselves, are entitled to information on their treatment and the admission policies of various hospitals.
We have frequently spoken about the public perception of mental illness and mental health. Promotion is required in this area. Many voluntary groups are trying to lessen the stigmatisation of those with mental illnesses. I applaud the work done by many of these groups, including Schizophrenia Ireland, Aware and Amnesty International. I commend the efforts made at school level to point out the importance of mental health. The commission has a very serious role in promoting mental health, not just in dealing with ill health. I hope it will address this.
I recall the launch of Planning for the Future. It is good that there are more community-based residential schemes throughout the country and more day hospitals. More people are being treated at home and more are being treated by interdisciplinary teams than was hitherto the case. This must be difficult for those who have been working in psychiatry for some time to accept because psychiatrists in particular are used to working as individuals with individual patients. However, it has been recognised that interdisciplinary teams, which include therapists, psychiatric nurses and community psychiatric nurses, produce the best results. While it is challenging for everyone, I hope it is appreciated that the skills mental health service staff will need to acquire will be important to the development of psychiatry in this country, as will their contributions.
The Inspector of Mental Health Services mentioned various areas, including the psychiatry of old age. This will become more important as people live longer and there is a shortage of psychiatrists in this area.
Rehabilitation of people with severe and enduring psychiatric illness and psychosis is difficult because, if possible, one wants to treat them at home. Binge drinking and abuse of drugs, which may be important factors in suicide, are omitted, as are eating disorders.
It is regrettable that this report did not address forensic psychiatry which is seriously underdeveloped. There is only one facility, the Central Mental Hospital, which is the subject of serious concern. The facilities in the hospital are dreadful. There is a preservation order on the main building which has no sanitation. It is exactly as it was when Queen Victoria came to the throne. While such accommodation is unacceptable, is it right to move a hospital to a prison complex? This may happen and if it does, the hospital may be governed by the Prison Service.
At least one third of the people in that hospital have not been involved in crime but have been put there for their own safety or that of others. This needs to be carefully considered. There are no low-security facilities in the country to which some people could be diverted from the courts or prison, or to which people from the Central Mental Hospital can be discharged. Meanwhile, we must take care not to incarcerate people who do not need to be incarcerated simply because we have no low-security units. This is important.
The pressure on beds in the Central Mental Hospital has resulted in many people with a psychiatric illness who are in prison being treated there and not in a hospital. It is a help that psychiatrists go into the prison but it is not enough.
While I welcome any increase in money spent on mental health services, recent figures from the Department of Social and Family Affairs show that the amount of money spent on long-term disability payments for those with mental illness was higher than the total spent on the mental health services, including the upkeep of buildings.
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