Address by Micheál Martin, TD, Minister for Health and Children on the occasion of his visit to the Central Mental Hospital

I am very pleased to have the opportunity to visit the Central Mental Hospital (CMH).

The Central Mental Hospital is probably the oldest forensic secure hospital in Europe having opened in 1850. As you are aware the service is funded by the Eastern Regional Health Authority and since 2000 is managed by the East Coast Area Health Board. It was established under the terms of the Central Criminal Lunatic Asylum (Ireland) Act 1845. These powers were updated by the Lunatic Asylums (Ireland) Act 1875 and adapted and extended by the Criminal Justice Act 1960 to give the Minister for Justice, Equality and Law Reform the power to transfer prisoners to the hospital when required

The Hospital admits patients from the criminal justice system and also from the psychiatric services under the provisions of the Mental Treatment Act, 1945. In addition to inpatient care, the hospital provides a consultative assessment service for the prison service and for hospitals throughout the country.

I am informed that the CMH admits approximately 150 patients per year, the majority from the prison system. In addition to inpatient services based at the CMH, consultant-led liaison services and outpatient clinics are provided to the Dublin prisons. Additional forensic consultant psychiatrist posts have been approved in recent years with a view to extending in-reach services within the prisons so only those with severe mental illness and in need of appropriate hospital care will be transferred to the CMH. Providing the in-reach services to the prisons should facilitate patient access to services of a quality equivalent to local psychiatric services.

I understand that a multidisciplinary team approach to care is being developed here at the CMH, with the hospital providing an active programme of assessment and rehabilitation geared towards each patient’s needs. Individual care plans are in use, addressing the physical, psychological, interpersonal and social needs of the patient. Rehabilitation is encouraged through the use of the hospital school, woodwork, industrial therapy and recreation departments.

I am aware however that, as the prison population has expanded in recent years, the services of the Central Mental Hospital have come under increasing pressure, resulting in delays in the transfer of mentally ill prisoners to the hospital. The shortage of in-patient psychiatric beds for prisoners was commented upon by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), during its recent visit to Ireland.

In response to the concerns expressed by the CPT and with a view to eliminating delays in the provision of in-patient psychiatric care to prisoners, the Government established a special committee to draw up a Service Level Agreement on the admission of mentally ill prisoners to the Central Mental Hospital. This Committee comprises representatives of my Department, the Irish Prison Service, the East Coast Area Health Board and the Department of Justice, Equality and Law Reform. I understand that the Committee’s work is nearing completion.

I accept that the physical conditions here at the CMH are not satisfactory. As has been pointed out by the Inspector of Mental Hospitals on numerous occasions, most of the old building is quite unsatisfactory for its current purpose and conditions in some parts of it are unacceptable. Since 1999, €500,000 has been spent on the refurbishment of the Hospital, but there is an acceptance by all parties that a more substantial redevelopment is required.

In December, 2000, the East Coast Area Health Board, in conjunction with the Eastern Regional Health Authority, the Department Of Justice, Equality and Law Reform and my Department established a group to advise on proposals for the future of the CMH. They took into account national and regional services provided by the hospital, linkages with community psychiatric services and with the criminal justice system, new mental health legislation, the training role of the CMH for medical, nursing and paramedical staff and future accommodation and resource requirements. The group concluded its work last year and its report was submitted to the Eastern Regional Health Authority and to my Department. The report included plans to modernise, refurbish and extend the existing building at the CMH and to provide a new residence on the campus. Overall capacity is projected to increase from ninety to 120.

I have accepted, in principle, the main thrust of the report of the Review Group and last month I requested that the East Coast Area Health Board establish a project team to progress the matter as quickly as possible.

I am pleased to learn that this Project Team had its inaugural meeting today. The Team consists of representatives from my Department, the Eastern Regional Health Authority, the East Coast Area Health Board, the Irish Prison Service and the Chief Executive Officers of the Health Boards. The Team´s remit will be to critically examine all options for the redevelopment of the hospital, (including the proposals put forward by the Review Group), to put together a design brief for the redevelopment, and to examine various financing options, including the possibility of a Public Private Partnership. This task is a challenging one, but one that is long overdue and I wish the Project Team every success in their work.

In conclusion, I would like to thank you once again for the opportunity to visit the Hospital.