Address by Mr. Micheál Martin, T.D. Minister for Health and Children on Private Members´ Motion on Disability

A Chathaoirligh,

I would like to thank my colleague, Minister Tim O´Malley for allowing me to share his time, thereby providing me with the opportunity to speak on the important issues relating to the provision of services to people with mental illness.

I would also like to thank the Deputies who have already contributed to this debate. I think it is fair to say that there is broad agreement here tonight on the need for further improvement in our mental health services.

Most people would have to agree that people with a mental illness are among the most vulnerable groups in our society. Our health and personal social services, including the mental health services, are, first and foremost, about people – the patients and clients who receive the services, and the professional, administrative and support staff who provide them.

We live in a society that is consumer oriented. All State services, including the mental health services must be responsive to this trend. The consumer in the psychiatric service is the patient and his or her family and friends. Just as the power of the consumer has made itself felt throughout the market economy, so is it now being felt in the mental health services. The growing service user movement in mental health is yet another strand to this development, and one which I welcome.

A major criticism of current mental health services relates to the standard of accommodation provided for users in the old style mental hospitals, which are totally unsuitable for the delivery of a modern mental health service. While there continues to be a steady decline in the number of patients in psychiatric hospitals, the rate of progress in developing alternatives to this institutional service has been a cause for concern. These are the recurring themes in the Annual Reports of the Inspector of Mental Hospitals and I am determined to continue the development of a comprehensive, community-based mental health service. I fully recognise that much needs to be done to bring about the necessary improvements and developments.

As Minister O´Malley has already informed the House, approximately €190m is being provided over the lifetime of the National Development Plan for mental health services. A significant part of this funding has gone towards the development of acute psychiatric units linked to general hospitals as a replacement of services previously provided in psychiatric hospitals. In addition to the nineteen acute units already in place, a number of units are currently at various stages of development. This funding will also provide for more community facilities such as mental health centres and community residences, which will accelerate the phasing out of the old psychiatric institutions.

Reference has already been made to the need for a comprehensive review of the mental health services. This was highlighted in the National Health Strategy, “Quality and Fairness – A Health System for You”. The Strategy acknowledged that there is now a need to update mental health policy to take account of recent legislative reform, developments in the care and treatment of mental illness and current best practice. The Strategy gave a commitment that a national policy framework for the further modernisation of the mental health services, updating the 1984 document, will be prepared. As you have already heard from Minister O´Malley, it is intended that a review group will be established shortly to undertake this work.

The enactment of the Mental Health Act, 2001 in July 2001 was a very significant achievement and I was happy to steer its passage through the Houses of the Oireachtas. This Act represented the first significant reform of mental health legislation in this country for more than 50 years. The Mental Health Commission, which I established in April 2002, is now the main vehicle for the implementation of the provisions of the Mental Health Act and its establishment is, I believe, an important milestone in the development of our thinking in relation to mental illness in modern Ireland. It is my firm belief that the ongoing work of the Commission will lay the foundations for achieving a sustained improvement in the quality of care provided in our mental health services.

The primary objective of the Mental Health Act is to address the civil and human rights of the mentally ill. I would like to take this opportunity to touch on a few important aspects of the Act. Its purpose is twofold. Firstly, the Act provides a modern framework within which people who are mentally disordered and who need treatment or protection, either in their own interest of in the interest of others, can be cared for and treated. In this regard, the Act brings Irish legislation in relation to the detention of mentally disordered patients into conformity with the European Convention on the Protection of Human Rights and Fundamental Freedoms.

The second purpose of the Act is to put in place mechanisms by which the standards of care and treatment in our mental health services can be monitored, inspected and regulated.

The detailed work programme of the Mental Health Commission is a matter for the Commission itself to determine, in accordance with its statutory functions under the Mental Health Act. However, the Commission has indicated that one of its priorities over the next few years is to put in place the structures required for the operation of the Mental Health Tribunals.

The Mental Health Tribunals, operating under the aegis of the Mental Health Commission, will conduct a review of each decision by a consultant psychiatrist to detain a patient on an involuntary basis or to extend the duration of such detention. The Mental Health Commission is currently recruiting an Inspector of Mental Health Services, as provided by the Act, and will be assisting him/her in putting a system of annual inspections and reports in place.

The success and effectiveness of the policy to develop a comprehensive community-based mental health service is dependent on the active involvement of voluntary organisations, who are concerned with the welfare of the mentally ill in the community. I welcome the opportunity to re-emphasise the Government´s commitment to encourage in any way it can, the activities of our many voluntary organisations both at national and local level. The commitment and dedication of independent, voluntary organisations is to be commended and their input is invaluable, not only in providing support for those most vulnerable in our society, but also in heightening awareness of the difficulties encountered by those suffering from mental illness.

My Department recognises the critical role played by the voluntary sector and emphasises the importance of health boards continuing to support and work closely with voluntary groups. The recently published Amnesty International Report acknowledges the funding which is being made available by my Department to support groups and organisations such as Schizophrenia Ireland, Mental Health Ireland, GROW and Aware to heighten awareness and develop support services for service users and carers.

I see it as a key task of the health services not just to treat mental illness but more importantly, using the principles of health promotion, to try and improve the mental health of the population at large. Mental health promotion is a very broad concept as it emphasises the promotion of the psychological health and well being of individuals, families and communities.

There is a growing awareness and concern throughout the country about mental health matters and the National Health Promotion Strategy, 2000-2005, in conjunction with the Health Strategy “Quality and Fairness”, sees mental health as being equally as important as physical health in the overall wellbeing of a person.

The promotion of positive mental health will contribute significantly to combating the ignorance and stigma which often surrounds mental illness. Better understanding of mental illness encourages people to access professional help sooner rather than later and this facilitates early recovery. Eventually, with time and education, the stigma associated with mental illness may fade further away, allowing sufferers and their families to participate fully in society in every way.

I would like now to touch on the very important issue of mental health services for prisoners. Earlier this year I was pleased to have the opportunity to visit the Central Mental Hospital (CMH), probably the oldest forensic secure hospital in Europe having opened in 1850. The Hospital admits approximately 150 patients per year, 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 aware 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. In response to this concern, 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.

On the occasion of my visit in February, I accepted that the physical conditions 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.

A Review Group set up by the East Coast Area Health Board submitted its report on the matter to the Eastern Regional Health Authority and the Department of Health and Children in 2002. The report includes plans to modernise, refurbish and extend the existing building and to provide a new residence on the campus.

I have accepted, in principle, the main thrust of the report of the Review Group and a special project team representative of all the main stakeholders has been established to progress the matter as quickly as possible. The team has now commenced its work and is currently examining options for the financing of the project, which is expected to cost in the region of €35m.

In conclusion, I would again like to stress this Government´s commitment to the development of services for those suffering from mental illness. I am determined to build on the substantial progress to date so that this Government can work to bring about a mental health service worthy of the Ireland of the 21st century.

Go raibh maith agaibh.

Minister O´Malley´s Speech