7th November, 2002
Dr. Henry: I welcome the Minister of State and am delighted that his maiden speech to the House is on this topic. I noticed his interest when he spoke yesterday on the cross-Border report encouraging a positive attitude towards mental health. I am sure that the Minister of State will put a great deal of work into this area while in his current position.
I thank the Leader of the House for organising this debate. This is the first time there has been a debate on the report of the Inspector of Mental Hospitals in Government time. As the reports must be presented before the Houses of the Oireachtas under the 1945 Act, that is pretty shocking. None of the reports were debated until I was able to get that to happen from 1996 on. Those debates have made the area of mental health a more important one. I know that the Leader of the House will ensure that the reports are given proper prominence. This may be the last report of the Inspector of Mental Hospitals because the new legislation may bring a report of the inspector of mental services by next year. However, I would not bank on that as matters such as this can go slowly.
Professor Dermot Walsh and his assistant, Dr. Liam Hanniffy, should be particularly thanked for the work they have put into these reports over the year. Compiling the report involves going announced and unannounced to mental hospitals and other institutions to look at conditions, and talking to staff and patients. They are to be applauded for what they have done.
There have been huge improvements in the mental health services in the last 18 years. The Department of Health and Children, the hospitals involved, the health boards, staff and the growing number of patient advocacy organisations all deserve praise. I am glad the Department will give more money this year to advocacy organisations because, if public opinion is behind these groups, it is much easier for improvements to be made in health services.
I do not know what time the Minister has had to look at previous inspector's reports. They made for dreadfully dreary reading. I realise that there has been a huge decrease in the number of inmates in these hospitals. Most of the matters raised in the past related to filthy conditions, broken lavatories, lack of privacy for patients, lack of personalised clothes and name-tags and patients who did not know who was looking after them. There are virtually no complaints like that now. The lack of personalised clothing is now mentioned only in relation to St. Brendan's and St. Ita's.
Some areas should be particularly praised. Senator Feeney was right to talk about the fantastic improvements in Sligo, Leitrim and Donegal. Mayo is another county where unbelievable work has been done. Terrible things were written about St. Mary's in Castlebar until a few years ago but the inspector said that there was no need to make any recommendations for that institution as it was making such progress on its own.
It was depressing to hear Senator Bannon talk about problems in getting patients into the community and objections being made about patients going to houses in certain areas. The Senator should not think that the problem is only in Longford. Where I live in Dublin 4, a house is to be bought for people being discharged from psychiatric hospitals. I was depressed to be contacted by a local institution to ascertain, as I live nearby, whether I would be supportive if there were problems raised about people going into this house. I am glad that there have not been problems there but this issue is being raised not just in rural areas but elsewhere also.
It is good that the general health of the population in these hospitals is looked after much better than in the past. For example, it is known that those with mental illness have a lower life expectancy than others but it is good to see that efforts are being made to ensure no-smoking areas are being made available for them and that work is no longer rewarded with cigarettes. That was a very bad idea, although not as much was known then about the damage that smoking can do.
Praise is due in many areas and it is most rewarding to see that the effort put in is now bearing fruit. However, I am concerned by one omission from the Minister's speech. There was no reference to the Central Mental Hospital which is the big black spot in the mental health services. I have said in the past that I believe there is a turf war ongoing between the Department of Health and Children and the Department of Justice, Equality and Law Reform to see which can do least for the mentally ill in the Central Mental Hospital and in the prisons.
I understand that Ireland is in trouble with the European Committee for the Prevention of Torture due to the fact that we have so many mentally ill people in padded cells in prisons. I thought there had been agreement recently at Cabinet level that an intensive forensic care unit was to be set up in the Central Mental Hospital where, I was told, 30 beds were needed. There will of course be a price tag on that because, even with the great increase in the number of forensic psychiatrists, there is a still a shortage in this area and in that of psychiatric nurses. Some 26 nurses are needed and this has led to the closure of many beds so that the hospital is only able to take 75 patients at the moment. I hope it is not heard in Strasbourg that the prisons are probably keeping more people in padded cells now. We must deal with this matter at once.
I constantly hear about the new Bill on the treatment of the mentally ill before the courts and in prison. However, in July 2001 when the last Mental Health Act went through, Members were told that the new Bill on the treatment of the mentally ill before the courts and in prison would be before the House that autumn. There is still no sign of it one autumn later. I was foolish not to have asked which autumn was referred to.
It is worrying that Ireland appears to have the highest incidence in Europe of mentally ill people in prisons. About 160 of the 11,500 admissions to prison last year were of people described as mentally ill. Efforts were made to transfer these people to the Central Mental Hospital but there was frequently no room. The 1999 report from the Department of Justice, Equality and Law Reform on the IQ levels of those in our prisons showed that some 28% had an IQ level of 70 or below. There is an odd situation in our prisons and, while I realise this is not the Minister of State's area, there is a dreadful gap between the Department of Justice, Equality and Law Reform and the Department of Health and Children about what is happening to the mentally ill and the intellectually disabled in prisons. The Minister of State should liaise with his colleague on that.
I am alarmed that there was no mention by the Minister of State of what the inspector sees as the serious misuse of section 208 of the Mental Health Act, 1945, the legislation we work under at present. I refer the Minister of State to pages 38 and 41 of the report where it states that section 208 allowed for the transfer to the Central Mental Hospital from local psychiatric services if the latter felt they did not have appropriate facilities to treat such patients. The transfers became possible under a Supreme Court judgment in 1994 and these patients were generally considered to be a danger to themselves and others because of their mental illness.
Following the judgment the inspectorate considered it wise to issue guidelines for the transfer of the patients from local psychiatric units to the Central Mental Hospital. The guidelines were intended to prevent the abuse of the transfer system. Unfortunately, as the inspector says, some disquieting features were noted in the case notes of these patients. About 20% of the patients in the Central Mental Hospital at the moment are there under section 208. The report states:
Firstly, the guidelines as issued by the inspectorate did not appear to have been used, or if they were used the appropriate transfer forms, as suggested by the inspectorate were not completed and hence not copied to the inspectorate as advised. Secondly, there appeared to have been little or no formal liaison between the referring hospital personnel and that of the Central Mental Hospital during the patients' stay. Such liaison should exist so that the patients could be discharged from the Central Mental Hospital at the earliest possible opportunity. Thirdly, and more significantly, a worrying practice appeared to have been developed whereby patients admitted to the Central Mental Hospital from the prison services, on reaching the end of their sentence and not having been deemed fit for discharge, were placed on a temporary detention form and sent to an appropriate mental hospital, usually St. Brendan's. Section 3 of the temporary forms were then completed and the patients were transferred back to the Central Mental Hospital under section 208 of the Mental Treatment Act, 1945.
The inspector goes on to highlight the fact that consultants frequently tried to get patients back to their own psychiatric hospitals and were refused and suggests that we must get some medium type secure units for these patients. Practice is at variance with the legislation and I ask the Minister to have a look at that.
The inspector also pointed out that people in the Central Mental Hospital were frequently put into seclusion by nursing staff and the form signed retrospectively by junior doctors. This he said was a bad idea. Old hospitals are emptying and the inspectorate points out that it might be a good idea, since some of the patients left in them are really only institutionalised elderly patients whose mental illness is no more, if parts of these institutions could be adapted to dealing with the elderly. He points in particular to St. Finan's in Killarney where 60% of the 200 patients are over 60.
Another interesting topic brought up was the situation in regard to alcoholism. The inspector says acute cases should not be treated in mental hospitals but in general ones. He queries the long occupancy of people with alcoholic problems in our mental hospitals. We should look at this carefully because these patients occupy many acute beds which are thus unavailable for people with serious mental illnesses.
We also need to keep working at the separation of the mentally ill and those with intellectual disability. Slow progress is being made in this area. Senator Feeney pointed out that we now have two separate degree courses for nurses in this area. The two patient groups do not require the same sort of care. This option may not be expensive and in these days of adjustments it may be possible for the Department to keep working at achieving this.
It is tremendous that we have got some acute wards going at last. I share Senator Feeney's enthusiasm for the one in Tallaght but ask what is happening in places like Beaumont. Beaumont must be nearly 20 years old yet we are still waiting for its acute ward to open. The inflexibility of staff, and others, sometimes leads to this sort of problem. In Tallaght the ward was empty for about three years while agreement was sought with psychiatric nurses. Nurses need to be more flexible.
We also need a mother and baby unit. The last tri-annual report in England of maternal mortality reported 15 suicides and said it thought this was a grave under-estimate. If women who get post-natal psychosis or depression attempt suicide it is usually something grim such as hanging. Two thirds of these women hang themselves. We have a small unit in St. Patrick's but we need more. It is often when the crisis is over that such persons commit suicide. I ask the Minister to look at this area.
I was delighted the Minister mentioned adolescents and children. We have about 49 teenagers in adult units all over the country. People have contacted me about the lack of facilities for children with psychiatric illness. It is not asking too much to seek such facilities. The Minister mentioned this and we must get working at it as soon as possible because the earlier illness is treated the better.
Suicides in mental hospitals were mentioned. Relatives of these patients frequently feel that they were not adequately informed about the situation. I have had complaints from two people. The daughter of one of them committed suicide on the private hospital's premises. In the other case the person's brother left the public hospital and committed suicide. Both relatives were dissatisfied. We also have the problem of sudden deaths of which we had nine, three of them drug reactions.
The Minister mentioned liaison psychiatry which is important. We must get it going, particularly in accident and emergency units, an area that seems to be forgotten. Seriously ill patients often come into accident and emergency units. It is difficult to deal with them there and to transfer them on to somewhere else without psychiatric help. Efforts are being made to deal with the homeless and another consultant psychiatrist has been appointed in the Dublin area to give help.
I ask that the Minister do as much as possible to help and support the carers and families of people with mental illness. The patients are frequently discharged back into the community as a result of shortages of psychiatric nurses. While the families and carers are willing to take people home they are often expected to take up the burden without adequate support.
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