Statement by Mr. Tim O´Malley, T.D., Minister for State at the Department of Health and Children on the Report of the Inspector of Mental Hospitals for the year ending 31st December, 2001 to Seanad Éireann

Thank you for allowing me this opportunity to make a statement to the Seanad on the Report of the Inspector of Mental Hospitals 2001.

Under the provisions of Section 247 and 248 of the Mental Treatment Act 1945 the Inspector issues an Annual Report on psychiatric hospitals and services and the care of patients therein. The Report assists in bringing to our attention those areas within the mental health services which require particular and sometimes urgent attention.

At the beginning of the 2001 Report the Inspector provides an overview of the mental health services and on a range of issues likely to impact on the provision of services. The report then proceeds to provide details of activity within each individual service. Each health board is allocated a separate chapter, with a chapter also being devoted to registered psychiatric hospitals. A presentation of the latest statistical information on the psychiatric services is also included in the Report.

I can confirm to the House that substantial progress has been made in addressing the matters raised by the Inspector in the 2001 Report. One of the recurring themes in the annual reports of the Inspector has been the standard of accommodation provided for patients in the old style mental hospitals. “The Psychiatric Services – Planning for the Future” published in 1984 recognised that old institutional hospitals are unsuitable for the delivery of a modern mental health service and developed the concept of a comprehensive community orientated psychiatric service. The new National Health Strategy Document “Quality and Fairness – A Health System for You” published in 2001, includes a commitment to prepare a national policy framework for the further modernisation of the mental health services, updating the 1984 policy document, Planning for the Future. Work on the development of this new National Policy Framework is due to commence in the coming months.

In his 2001 report, the Inspector of Mental Hospitals referred to the continuing decline in the number of patients in psychiatric in-patient facilities, from 4,522 at the end of 2000 to 4,256 at the end of 2001. There were 26,037 admissions to these facilities in 2001. The number of involuntary admissions at approximately 2,597 remained constant at ten per cent.

The shift to a community oriented mental health service as an alternative to institutional care for persons with mental illness is making steady progress. New mental health centres, day hospitals and other facilities have been set up and at the same time additional community-based residential accommodation has also been made available. At present there are approximately 400 community residencies providing over 3,000 places. There are also approximately 200 day hospitals/day centres, providing over 3,500 places. However, it is recognised that further significant improvements in providing alternative facilities are needed as a matter of urgency. While there continues to be a steady decline in the number of patients in psychiatric hospitals, the rate of progress in developing community based alternatives to this institutional service needs to be accelerated.

Substantial capital funding under the National Development Plan has been allocated to the development of mental health facilities. Approximately €190m is being provided over the lifetime of the plan which will enable the further provision of acute psychiatric units attached to general hospitals and the provision of additional community-based facilities.

The Inspector refers to the ongoing relocation from of old institutional mental hospitals to acute psychiatric units attached to general hospitals. Since the publication of Planning for the Future in 1984 18 new acute psychiatric units, attached to general hospitals have opened. During 2001, further new acute psychiatric units were completed or nearing completion at St. Luke´s Hospital, Kilkenny; Mayo General Hospital, Castlebar and at Portlaoise General Hospital . It is expected that each of these units will become available to the respective mental health services shortly. Construction of new acute psychiatric units is also well advanced at James Connolly Memorial Hospital, Blanchardstown and at St. Vincent´s Hospital, Elm Park. At the time of inspection in 2001, the few remaining patients at Our Lady’s Psychiatric Hospital in Cork were due to transfer to a newly refurbished unit at the former St. Anne´s Unit in Shanakiel in Cork City, facilitating the final closure of Our Lady´s and I am pleased to report that this process has now been completed.

Priority is being given to the development of mental health services for the Psychiatry of Later Life and the child and adolescent psychiatric services. Additional resources have been made available by my Department to enable on-going developments in these services. The increase in the number of people living to advanced old age requires the development of specialist mental health services to meet their specific needs. Later life Psychiatry Services have been expanded in recent years and €1.831m is being provided in 2002 towards the provision of additional consultants in later life psychiatry. The Inspector of Mental Hospitals recommends this development in his 2001 Report.

An additional €6.061 million was allocated in 2002 to further develop the Child and Adolescent Psychiatry services. This funding will provide for the appointment of additional consultant psychiatrists in Child and Adolescent Psychiatry and for the development of multi-disciplinary teams to focus on specific areas, such as Attention Deficit/Hyperactivity Disorder (AD/HD). A Working Group has been established by my Department to review child and adolescent psychiatry provision and to finalise a plan for the further development of this service. The Group published their First Report in March 2001.

This first Report of this group emphasises that the treatment of ADHD/HKD is an integral component of the provision of a comprehensive child and adolescent psychiatric service. It recommends the enhancement and expansion of the overall child and adolescent psychiatric service throughout the country as the most effective means of providing the required services for this group. It also recommends that priority should be given, in the first instance, to the recruitment of the required expertise for the completion of existing consultant-led multi-disciplinary teams. The Report also calls for closer liaison and interaction with the education system and other areas of the community health services.

In its first Report, the Working Group also examined the issue of in-patient psychiatric services. It recommends that a total of seven child and adolescent inpatient psychiatric units for children ranging from 6-16 years should be developed throughout the country. It is envisaged that the focus of the centres will be the assessment and treatment of psychiatric, emotional or family disorders including major adjustment disorders, anxiety disorders, mood disorders, eating disorders and schizophrenia.

At present, four of these child and adolescent psychiatric in-patient units are at the planning stage and project teams have been appointed to oversee their development. The proposed units are to be based at Bessborough House, Cork, Limerick Regional Hospital, Merlin Park Hospital Galway and St. Vincent´s Hospital, Fairview, Dublin.

In addition to the above, the Working Group is at present considering the provision of services for 16-18 year olds and its report on this important issue is expected shortly.

The Working Group on Child and Adolescent Psychiatry also proposes to examine the needs of persons suffering from eating disorders and how appropriate services can be developed in the short, medium and long term. The working group has invited submissions from interested parties on how the needs of persons suffering from an eating disorder can best be met.

Additional revenue funding of €24.447 million has been made available to the mental health services for 2002 to address specific areas highlighted by the Inspector of Mental Hospitals in his Report as requiring special attention. These include:

  • the development of community mental health services
  • the expansion of child and adolescent services
  • the provision of liaison psychiatry services in general hospitals,
  • the development of later life psychiatry, and
  • Suicide and suicide prevention programmes.

This funding represents a 350% increase on the addition funding allocated in 1999 (€6.98m) and will further enhance the significant improvements which have been made in recent years.

€10.473m million was allocated in 2002 towards the further development of community based mental health services primarily for the establishment of additional multi-disciplinary teams and the recruitment of additional staff to strengthen existing services. The lack of multi-disciplinary teams in many areas of the mental health services has been highlighted by the Inspector of Mental Hospitals in this Report.

At national level, priority is being given to education awareness and to promoting a better understanding among the public towards mental health thereby facilitating a greater and more positive acceptance of the transfer of mental health services from institutional to community based settings. Links with the voluntary sector continue to be strengthened, both at national and local level, and an additional €1.529m has been made available in 2002 to strengthen these links and services. There is ongoing co-operation between the boards and several voluntary organisations such as Mental Health Ireland, AWARE, GROW, and Schizophrenia Ireland.

There are growing moves to provide advocacy services in Ireland. This, although still embryonic, is most advanced for people who experience mental distress. Within mental health services an advocate can be someone who can represent and defend the views, needs, wishes, worries and rights of individuals who do not feel able to do this themselves. Funding of €0.251m was provided in 2002 for the first time for Mental Health Advocacy Services. The National Health Strategy “Quality and Fairness – A Health System for You” includes a commitment that mental health advocacy services will be encouraged and resourced.

Suicide is a serious social problem in this country. There were 448 deaths from suicide in 2001. These figures are disappointing in that they indicate an increase of 35 on the 2000 figure. The figures highlight the need to intensify our efforts and to put additional resources in place for suicide research and suicide prevention programmes. The high incidence of suicide in the general population is not confined to Ireland but is a growing global problem. Apart from the increase in the overall rate of suicide in Ireland, a disturbing feature is the significant rise in the male suicide rate. There has been a significant increase in the rate of suicide among young males. These are worrying trends which require further research so that better strategies are developed to help people who are particularly at risk.

Since the publication of the Report of the National Task Force on Suicide in 1998 there has been a positive and committed response among both the statutory and voluntary sectors towards finding ways of tackling this tragic problem. A Suicide Research Group has been established by the Chief Executive Officers of the health boards. Resource officers have been appointed in all health boards with specific responsibility for implementing the Task Force´s recommendations. Additional funding of €1.110m was provided in 2002 towards suicide prevention programmes in the health boards and towards research aimed at improving our understanding of this issue. Nationally, since 1997 over €6m has been provided by the Department of Health and Children for suicide prevention activities.

The Inspector of Mental Hospitals has recommended that the most appropriate way of addressing the needs of mentally ill persons before the courts and in custody is through the development of a high-quality forensic psychiatric service. There are now five consultant forensic psychiatrists in the Dublin region and steps are being taken to provide special interest consultant forensic inputs to Cork and Limerick prisons.

The National Health Strategy “Quality and Fairness – A Health System for You”, contains a commitment that the Department of Health and Children and the health boards will work in close collaboration with the Irish Prisons Authority in improving the health of the prisoner population, within the framework of the recently published report of the Expert Group on the Structures and Organisations of Prison Health Care Services in Ireland.

In relation to medical manpower, the Inspector welcomed the report of the Forum on Medical Manpower and the establishment of a Medical Manpower Committee. One of prime recommendations of the Forum is the commitment to provide, as far as possible, first-line consultant services so that mental health services, like other medical and surgical services, come to be consultant-delivered as well as consultant-led. At the end of 2001, there were 261 permanent consultant posts in psychiatry in the public mental health service and, of these, fifteen had been approved during the year 2001, bringing the total of new consultant psychiatrist posts approved in the five-year period, 1996 to 2001, to fifty-seven.

While the Inspector expressed concern at the inadequate skill mix and lack of flexibility within many mental health services, he welcomed the introduction of new measures aimed at attracting and retaining nursing staff and the development of higher level courses for nurses wishing to follow a clinical career path. November 2001 was a significant month in the history of nurse education and training in Ireland. For the first time, it was agreed that the registration programme in psychiatric and disability nursing would be at degree level. This new degree programme will replace the three-year diploma programme.

In response to some of the ongoing concerns expressed by the Inspector over many years, legislative change is now underway.

The Mental Health Act, 2001 was signed into law in July, 2001. The Act provides for the establishment of the Mental Health Commission, which was established with effect from 5th April 2002. The Commission is an independent statutory body whose primary functions are to promote, foster and encourage the establishment and maintenance of high standards and good practices in the delivery of mental health services and to protect the interests of people who are detained for psychiatric care and treatment. While the detailed work programme of the Commission is a matter for the Commission itself to determine, I understand that one of the priorities for the Commission over the next year will be to put in place the structures required for the operation of Mental Health Tribunals.

The Commission will also be recruiting an Inspector of Mental Health Services, as provided by the Act, and assisting him/her in putting a system of annual inspections and reports in place.

I believe that both the Mental Health Commission and the new Inspector of Mental Health Services have the potential to play a pivotal role in the further modernisation of mental health services. The current Inspector of Mental Hospitals has already begun this process. I would hope and expect that the new Inspector, when appointed by the Commission will build on that work in the years to come.

The Mental Health Act, 2001 will require the new Inspector of Mental Health Services to carry out an annual review of all mental health services including community residences and day centres as well as acute in-patient facilities. A Register of Approved Centres, in which each hospital or in-patient facility providing psychiatric care and treatment must be registered, will be maintained by the Mental Health Commission. Regulations will be made specifying the standards to be maintained in all approved centres, including requirements in relation to food and accommodation, care and welfare of patients, suitability of staff and the keeping of records. The execution and enforcement of these regulations will be the responsibility of the Mental Health Commission, through the work of the new Inspector of Mental Health Services.

The new Inspector´s review of the services, including reports of inspections carried out, will be published along with the Mental Health Commission´s annual report and will be laid before both Houses of the Oireachtas.

The current Inspector, as an independent office holder, plays a crucial role in providing an accurate and detailed account of services in the mental health sector throughout the country. It is my intention to facilitate the health boards in as far as possible to bring about the improvements and developments identified by the Inspector.

Finally, I would like to thank the House for affording me the time to make my maiden speech on such an important issue as the Report of the Inspector of Mental Hospitals.

Thank you.