Two of the State's ageing psychiatric hospitals will be closed each year under the Government's plan to develop community mental health care services, Minister of State for Mental Health John Moloney has pledged.
Mr Moloney today marked the third anniversary of the publication of the Government's Vision for Changeplan to reform mental health services with the admission that progress to date had been slow.
But he said he expected to name by April the first two psychiatric hospitals that would close, resulting in the relocation of patients to more suitable community facilities.
Mr Moloney also made a commitment to "ring-fencing" funds from the sale of lands around the psychiatric hospitals for the development of mental health services.
A number of psychiatric institutions have already been closed and patients have been transferred to alternative community facilities.
Some 1,485 people remained in inappropriate conditions at psychiatric hospitals throughout the State as at the end of September 2008, according to Department of Health figures.
Closure plans have already been developed for nine hospitals in the HSE South area and for four in the Dublin-North East area.
Closure plans are also being considered for St Loman's Hospital in Mullingar and Newcastle, Co Wicklow.
In the HSE West area, many of the large psychiatric hospitals have already been closed and patients transferred to alternative community accommodation.
A closure plan for St Brigid's Hospital has been signed off by management and unions.
Mr Moloney also said today the admission of teenagers to adult psychiatric hospitals would be stopped by the end of 2010 with the opening of new beds at a number of units in Cork, Galway and Dublin.
He acknowledged there was no new funding to implement the Vision for Changeplan this year because of the economic climate, but he insisted funds realised from the sale of lands around psychiatric hospitals would be put back into mental health services.
Some €42 million has been raised in recent years from the sale of four properties - St Loman's Hospital, the Verville retreat in Clontarf, and two others.
"This funding needs to be made available now to fund new mental health infrastructure if we are to progress A Vision for Changein the next few years," Mr Moloney said.
The Minister said he "fully accepted" that the closure programme for the psychiatric hospitals had been talked about "for some time". But two hospitals would be publicly notified of their closure by April and he had almost signed off on this, he said.
Mr Moloney said that whilst the values of the properties in question had no doubt declined in the current economic environment, there was also "real interest" from developers in the lands attached to them.
He said he had been approached by developers interested in a "very valuable landbank" in Wexford, in which they saw "huge potential".
"I think the most important part of today is that we are still conscious of the fact that people still reside in these institutions."
An independent group set up to monitor the Vision for Changeplan, last year criticised the HSE for what it said was the "absence of clear, identifiable leadership" to implementing it. It said the model followed by the HSE in implementing the national cancer strategy should also be followed to implement the mental health plan.
That body also said the HSE's implementation plan for the mental health policy was, in some areas "selective and vague" and with "too little detail and too many timelines that lack ambition". A new implementation plan, due for publication by the end of 2008, will not now be ready for another "two to three months", Mr Moloney indicated today.
The independent monitoring group also expressed concern that some €24 million of the additional €51.2 million provided to the HSE for mental health resources in 2006 and 2007 was not used for the purpose intended.
The minister acknowledged today there had been problems with the "diversion" of such funds within the HSE. He said he had been assured as recently as last week that some 94 per cent of the €51.2 million in funding had now been put in place.
"I want to put it on record that as Minister for Equality, Disability and Mental Health, I expect to see tangible evidence on the ground which reflects this substantial investment in mental health," he said.
He said he was committed from now on to holding meetings every three months with those responsible for the implementation of the policy, to monitor its progress.
On the question of the possible appointment of a national director of mental health, as recommended in the Vision for Change plan published by an expert policy group in 2006, Mr Moloney said he was in favour of such an appointment was was trying to "firm up that commitment".
He acknowledged that the importance of such a role had been compared with the position held by Prof Tom Keane as director of the national cancer control programme, but he noted resources were currently "scarce".
"I do believe that for us to direct Vision for Change"I feel that the way forward would be a director of mental health.
While he recognised the "huge involvement" of the HSE in managing the mental health programme, he said it needed "a hands-on approach".
"I don't expect it to be in place for the next seven years, but I certainly see a role for somebody driving change for the first two years - the next two. I can't say there will be [a director], but I am trying to have somebody appointed. But I have to firm up that commitment.
Mr Moloney also announced that community mental healthcare teams will operate alongside primary health teams in 20 new primary care centres to be put in place by the HSE this year.
The HSE said a “comprehensive” implementation plan for A Vision for Change covering 2009 to 2013 had been completed and key priorities for this year included the formation of new mental health catchment areas under the direction of a clinical director.
Since 2006, an additional 18 adult community mental health teams had been created, facilitating a “person-centred” approach to care and treatment, the HSE said. It said there had also been significant improvements in mental health services for children and adolescents.
The revenue budget for mental health services is in excess of €1 billion, the HSE said.
The Irish Mental Health Coalition welcomed the commitment to reinvest funds from the sale of psychiatric hospitals, but called on the Minister to provide additional details and to begin “real and urgent” reform of mental health services.
IMHC chair John Saunders questioned whether the €42 million had already been transferred to the HSE, and if not, asked when that would happen.
Mr Saunders also asked what provisions had been made for the 1,500 people residing in the psychiatric hospitals set for closure.
“From a recent IMHC report Late for an Important Date, it is clear that mental health services have been experiencing a painfully slow reform process and basic accountability is absent. The result is that people using services, their families and carers are struggling to access services which meet the most basic standards laid down for mental health services.”
The Mental Health Commission welcomed some progress on A Vision for Change, but said it remained disappointed at the slow progress of the implementation of the Government’s policy in other areas.
MHC chairman Dr Edmond O’Dea said “the long and inexplicable delay by the Health Service Executive (HSE) in delivering on its core recommendations causes us concern, three years on”.
“At this stage the commission would have expected to see more substantial indicators of real change.”