Averil Highlights Crisis in North Dublin Mental Health Services in the Seanad (21/6/13)


Senator Averil Power: I welcome the Minister of State to the House. I am disappointed the Minister for Health, Deputy Reilly, is not here as this issue relates to his geographical area. However, I ask the Minister of State to highlight the issues for the Minister on my behalf.
The reason I have tabled this matter is the need to discuss the chaotic situation regarding mental health services in the north Dublin area. This is the result of a major shortage of psychiatric beds, under-staffing and HSE policy regarding psychiatric referral. Currently, there is a huge shortage of psychiatric beds in north Dublin. We have the lowest ratio of psychiatric inpatient beds per head of population in the entire country, with just 13.5 per 100,000 people. The Minister of State may be familiar with the area and be aware there are huge levels of social deprivation in the north Dublin area. Demand is huge and is increasing daily, as it is in other parts of the country, due to the toll the recession is taking on people and the resulting mental health distress they suffer.
As a result of the shortage of beds currently, patients with psychotic disorders have had to wait up to five days in accident and emergency units and medical wards and on trolleys in Beaumont in order to be admitted to hospital and provided with an inpatient bed. This is both a result of the lack of sufficient inpatient beds and of a HSE policy that ensures the only way people can access the inpatient service is to go through accident and emergency units. This is a disaster. Instead of taking referrals straight into the inpatient service, as happened in the past, the policy now is that patients must go through accident and emergency services.
As the Minister of State can imagine how distressing the situation is for people in significant mental distress or who may be suicidal to end up in a chaotic emergency department and to be stuck there for three or four days before they can get the proper mental health service they need. This flies in the face of everything that should be in place. A calm, supportive environment should be in place for patients with mental health problems the minute they try to access services. They should not be put through accident and emergency services. A new centre in Beaumont, the Aisling centre, is due to open later this year, but even when it opens, we will still have the second lowest ratio of inpatient mental health beds in the country. This is unfair, particularly given the demographic make-up of the area and the extent of the need.
I also want to raise another issue I hope the Minister of State will bring to the attention of the Minister, namely the crisis situation that also exists in the community mental health service. I have here a letter that was returned to a GP who tried to refer one of his patients to the psychiatric service in Beaumont. The hospital replied and said that the patient’s difficulties were more appropriate to the community mental health team so the GP tried to get a referral through the community mental health service. The response he got was:


I wish to acknowledge receipt of your primary care psychology referral for the following client [gives details]… Due to the moratorium on staff recruitment in Dublin North-East, we are regrettably unable to accept the above referral or any further primary care psychology referrals until further notice.


The situation now is that the community mental health service in Dublin North is not even accepting referrals into the service, no matter what situation people are in.

That is shocking and frightening, given the level of distress and pressure people are under. I am sure that, like me, the Minister of State, Deputy John Perry, has been visited at his clinics by such persons. It is frightening that a person with a mental health problem who wishes to access the service cannot do so. It is regularly stated people must be encouraged to avail of support when they need it. The people concerned want to avail of the service but cannot access it. There is a crisis.
I hope the Minister of State will indicate that some progress will be made on the issue.

Deputy John Perry: I thank the Senator for raising this topic. North Dublin mental health services provide a range of adult mental health services within the specialties of general psychiatry and psychiatry of old age and a rehabilitation psychiatry service within the settings of service user homes, acute in-patient facilities, day hospitals, day centres and supported community residences. The delivery of services is guided by A Vision for Change which provides the strategic direction for the future delivery of mental health services and by the HSE national and Dublin north east service plans 2013 which set out national and regional priorities. While implementation of A Vision for Change and the reform of mental health services are priorities for the Government, implementation of A Vision for Change has been somewhat slower than originally expected. It has been delayed by a number of factors, including the changed economic context, constraints in public spending and the moratorium on recruitment. Nonetheless, a great deal of progress has been made with the accelerated closure of old psychiatric hospitals and their replacement with bespoke new facilities better suited to modern mental health care.
In 2012 a special allocation of €35 million was provided for mental health services, primarily to further strengthen community mental health teams in adult and children’s mental health services, to advance activities in the area of suicide prevention, to initiate the provision of psychological and counselling services in primary care, specifically for people with mental health problems, and to facilitate the relocation of mental health service users from institutional care to more independent living arrangements in their communities, in line with A Vision for Change . Some 414 posts were approved to implement the €35 million package of special measures which resulted in an additional 87 WTE posts and an additional €6 million was provided for Dublin north east mental health services.
Budget 2013 provided a further €35 million for the continued development of mental health services and more than 470 additional staff will be recruited to implement these measures. HSE Dublin North East has been allocated an additional 104.5 WTEs and almost €7.3 million to progress the agreed objectives for the national service plan 2013 investment of €35 million in mental health services. I acknowledge that the service is operating within a challenging environment and faces a number of critical issues in relation to acute in-patient bed capacity, staffing resources and infrastructure. However, the opening of the new 44 bed acute psychiatric unit at Beaumont Hospital later this year will assist greatly in alleviating the current capacity issues being experienced by the service. The service has also recently benefited from the allocation of an additional 13 allied health professional posts as part of the mental health investment initiative to enhance the existing community mental health teams and is awaiting the appointment of 10.5 clinical nurse posts under the national clinical programme. Also, three nurses are expected to commence on the graduate nursing programme in the next number of weeks.
It is acknowledged that the mental health service in north Dublin faces a number of challenges. However, management and staff are working proactively to ensure these issues are addressed and an efficient and effective service is provided.

Senator Averil Power: I appreciate that the Minister of State is replying on behalf of the Minister for Health, Deputy James Reilly. However, I am disappointed with the reply provided for him which does not reflect the reality on the ground. While reference has been made to the additional posts allocated, they have been in the pipeline for some time and are not yet filled. The reply does not reflect the urgency of the crisis in terms of the number of people seeking access on a daily basis to the service and who cannot get it. It is cold comfort to them knowing that posts might eventually be filled. I ask the Minister of State to bring the attention of the Minister for to the letter from the GP which I read which points out that despite the work in train, the harsh reality is that patients cannot access services and that the community health team is not taking on new referrals. I ask that something be done about this immediately. As stated, while it is welcome that additional beds are being provided, the number of beds in the area will still be the second lowest in the country. Therefore, much more needs to be done. This matter requires a far greater response than that provided by way of the Minister of State on behalf of the Minister.





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