26 January 2005
An Leas-Chathaoirleach: 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 for the inadequate funding and staffing of the Jonathan Swift centre for psychiatric patients attached to St. James's Hospital, Dublin 8.
Dr. Henry: I welcome the Minister of State, Deputy Tim O’Malley, of whose interest in the area of mental health I am aware.
The Minister for Health and Children has made a resolution of the chaotic situation in accident and emergency departments a major objective of her term of office. However, this problem is caused by a lack of staff, beds and funding in other areas. Too frequently we focus on physical rather than mental problems. I applaud the Minister’s action in respect of the Ballymun health centre. This centre was to be a pilot scheme in respect of primary care but it remained unopened for between two to two and a half years because of a turf war between the local authorities and the Department of Health and Children. I am delighted the Minister applied common sense to the situation and I have written to her to indicate my pleasure with the initiative she has shown.
There are other areas outside of primary health care which are causing problems in the context of accident and emergency services. Bed shortages in acute hospitals are an important factor but we must also address the issue of people with mental illness and the way in which they are being seriously short-changed. Some of these individuals end up in accident and emergency departments which worsens a chaotic situation.
I wish to refer to the example of the Jonathan Swift clinic of the department of psychiatry in Trinity College which is based at St. James’s Hospital and which deals with a catchment area covering the south inner city. This is an area with many socio-economic problems. As the Minister of State is aware, poor mental health is frequently associated with socio-economic conditions. The catchment area to which I refer is discriminated against in respect of certain basic psychiatric services.
Other parts of the country have far more facilities available to them, particularly those relating to rehabilitation, assertive outreach, community services, family therapy, long-stay accommodation, etc. Without these facilities, patients are at increased risk of relapse with, as the Minister of State is aware, attendant risks such as attempted suicide, which lead to further admissions to accident and emergency departments, increased use of alcohol and other drugs and a diminished quality of life. Patients with these problems who attend the accident and emergency department at St. James’s Hospital are referred to the Jonathan Swift clinic. This means there is a chaotic cycle of inadequate support and funding.
Funding for this community service runs at approximately 50% of the national level per patient. As everyone is aware, funding for mental health has decreased in the past ten years from 9% to less than 7%. In the United Kingdom, funding for mental health services amounts to between 12% to 14% of the health service budget.
Mental illness is very common. Depression causes more days lost from work than any other illness. The cost to the Department of Social and Family Affairs of paying long-term benefit for those out of work due to mental illness is less than the funding provided for mental illness services by the Department of Health and Children, including the provision for the upkeep of buildings. Immigrants suffer high levels of mental ill health and many immigrants live in the south inner city. The service is severely stretched. Homeless people and those with psychiatric conditions who come to the accident and emergency department in St. James’s Hospital consume much in the way of resources before general patients are dealt with. A total of 30% of acute psychiatric inpatient beds are blocked by long-stay patients in St. James’s Hospital because there are neither staff nor financial resources in the community to enable them to be discharged.
Mental health services in Cavan-Monaghan are rightly given much praise. There is one non-consultant hospital doctor in psychiatry per 11,500 of the population in this region. In the St. James’s Hospital catchment area the figure is one per 22,167, representing nearly half as many doctors to patients. The figure for Tallaght, which also has problems, is one per 16,667. Those working in community psychiatry in St. James’s Hospital leave because it is impossible for them to do their job. People are frequently urged to obtain psychiatric help in the early stages but what happens if it is not available?
Funding for the clinic was reduced by 5% in 2003. There is a low level of nursing staff. For example, Kerry employs 250 nurses for a population of 125,000 while the Jonathan Swift clinic has 65 nurses for a population of 133,000. St. James’s Hospital has the lowest provision of consultants and NCHDs for psychiatric patients.
Is it fair to treat such vulnerable people so badly? Are they not as valued as those who live in more affluent areas? The situation does not just demand equity, it demands that the service be given greater than average resources. Will the Minister of State explain why this has not yet happened?
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