Budget, 9th April 2009

Speech by Dan Neville TD, on Financial resolutions of Budget Dail Eireann – 9th April 2009

I am concerned that the Government’s approach to the provision of mental health services is such that it will be confined to the bottom of matters to be addressed on the Government’s desk. In his Supplementary Budget Statement, the Minister for Finance said:

I will terminate the property-related accelerated capital allowance schemes in the health sector. This scheme covers private hospitals, registered nursing homes, convalescent houses and associated residential units as well as mental health centres.

I have two questions for the Government. How much has been allocated for capital allowances on mental health centres? How many mental health centres have been funded through that means? I know of none. I welcome the fact that schemes for palliative care units and child care facilities will remain in place. I respectfully suggest that the schemes for mental health centres and the private mental health institutions, if they were developed, should remain in place, as well as the two other schemes I mentioned, to support the delivery of mental health services. The private sector has not been involved in the mental health sector in the way it has been involved in the general health services. In terms of the need for places and the availability of them in other institutions, the relationship between HSE public sector mental health institutions and private institutions and the non-profit institutions has been non-existent.

In regard to services for the elderly, the HSE contracts out beds for the elderly in private nursing homes. Such an arrangement can work well. Periods of respite care are also provided in private nursing homes. That also works well. Some 28 beds lie idle today in St. Patrick’s Hospital in Dublin, the non-profit psychiatric hospital, while there are waiting lists for psychiatric care. Has the Minister for Health and Children and the Health Service Executive considered contracting beds from the psychiatric services to provide for people on those waiting lists similar to the arrangement that operates in the general health services? There seems to be a barrier to doing that. I do not believe that has ever been explored and now the Minister for Finance has said that the property-related accelerated capital allowance schemes for mental health centres will be terminated. I would like a response to that that would indicate the number of mental health centres that have been allocated capital allowances under the scheme and the cost involved. I believe it will probably be nil. If that transpires to be the case, I question why the allowance schemes are being abolished.

I tabled a parliamentary question to the Minister for Health and Children in the past ten days on the percentage of the total health budget the allocation for mental health services for 2009 represents. I was informed it is 6.7% of the total. Bearing in mind that one in four people at some stage in his or her life will suffer a mental health need, that allocation is abysmal and a disgrace. It is neglectful of those who have a psychiatric illness and their families that only 6.7% of the total health budget is allocated for mental health services, bearing in mind that in the 1960s the allocation was 25% of the health budget and in the 1980s it was 18%. In England and Wales, 12% of the total health budget is allocated to psychiatric services and in Scotland the allocation in that respect is 18%. With our allocation of only 6.7%, we are ignoring the needs in this area.

I draw these percentages to the attention of the Minister, following the debate that has taken place on the supplementary budget. Is there any point of raising this issue any more with the Government? Is there any hope of a response from the Government to the needs of those suffering from a psychiatric condition and their families? In times of plenty we raised this issue repeatedly and got little or no response. Will the Government at least say to me there is no point in continuing to raise this issue because in the current climate the provision for psychiatric services will be ignored?

Last Friday a report of the Committee of Inquiry to Review Care and Treatment Practices in St. Michael’s Unit, South Tipperary General Hospital, Clonmel and St. Luke’s Hospital, Clonmel, including the Quality and Planning of Care and the Use of Restraint and Seclusion, which reported to the Mental Health Commission, was published. If this publication was made in any other area of the health services, there would be a furore over it by everybody including the press and there would be Government statements and responses to it. The Minister of State, Deputy Moloney, in his statement in response to it said that he accepted most of the criticisms of it.

I listened to an interesting comment on the report by Fergus Finlay on the radio programme “Drivetime”, which encapsulated the views of those of us who have read the report. It is a complex report running to some 196 pages and one has to read through it to get the salient points. In his contribution Fergus Finlay spoke about what the reaction to this publication would be if it were about cats and dogs suffering from cruelty in Ireland, caged up for weeks on end with no company, never allowed fresh air or exercise, with their pens not properly cleaned out and the animals dosed with drugs to keep them quiet.

He went on to say that if it had happened in a cats and dogs institution, the story would have exploded all over the news and excited a good deal of anger. He said we would all want to know who was responsible and the Garda would investigate the conditions in which the animals were kept, especially if they were injured. He referred to a news story last week that featured prominently in some newspapers, while it was tucked away in others, about the treatment of psychiatric patients in that institution. It was aired on the RTE News at 6 p.m. but not at 9 p.m.

The Mental Health Commission’s investigation of this undermines any claim that we are a civilised society, given that we treat human beings in the manner as outlined in the report. One cannot read the report and conclude that those people’s lives matter to anybody in authority, whether the Minister for Health and Children, the Department or its agencies. A report published in 2004 highlighted an unusual pattern of injuries to patients. There were many fractures, the incidence of which was highest among local hospitals. These were unidentified non-accidental bone breakages which were detected later in X-rays.

I ask the Minister of State whether the Government will respond to the issues I have raised. When the Dáil returns it should give an hour or two of Government time to discuss the report in detail so that the relevant agencies in the Health Service Executive can respond, and the Minister, Deputy Harney, the Minister of State, Deputy Moloney, if he is in situ, or whoever, can make a statement on the matter the House. All parties should acknowledge that this type of treatment of human beings is unacceptable and should not happen in a civilised society.