A €900m plan, which involves the closure of all psychiatric hospitals, is set to begin within weeks. Barry O'Keeffe reports
The first definitive moves to transform psychiatric health services in the Republic, costing more than €900 million, will begin within weeks, Minister of State for Health Tim O'Malley has pledged. He also says monies for the plan, which will see mental hospitals closed and sold off, will be ringfenced for mental health services.
The plan, which was approved by Government last week, will be implemented on a phased basis. It will include selling off 15 hospitals, including the Central Mental Hospital in Dundrum and St Ita's in Portrane, the Republic's largest psychiatric hospital.
Mr O'Malley, the Minister of State for Health and Children with special responsibility for mental health, will oversee the plan. He says an implementation committee will be appointed within weeks. This committee will report to him and Health Minister Mary Harney twice a year, to update them on what progress is being made on the plan.
The plan will implement the recommendations of a report called A Vision for Change. This report was carried out by an expert group, including health professionals, to define future health policy and recommend changes. It is expected to transform how people with mental health problems are treated and will be effected on an incremental basis over the next 10 years.
The focus will be to move people into the community and to strengthen and bring together the services they require. It is estimated that one in four of the population is affected by mental health problems at some stage in their lives.
Mr O'Malley says valuing the 15 mental hospitals will begin shortly, but will not be a process which will take long.
He says not all of the hospitals will be sold on the open market, as some will be used for other purposes including providing health services.
The plan recommends recruiting 1,800 extra staff to provide mental health services. Of the total €900 million-plus which the plan will cost over 10 years, around €21 million a year (over the next seven years) will go towards providing staff. Personnel required will include psychiatrists, physiotherapists, psychologists, psychiatric nurses and social workers.
Mr O'Malley says the Government is already showing its intent by allocating €25 million towards staff recruitment this year. Providing the services in general will cost around €150 million a year, and €800 million will be provided for capital needs, such as building new acute units with 50 beds for every 300,000 people.
Mr O'Malley is happy that the Exchequer will provide all funding necessary. "I am happy that we will get bridging finance where necessary," he says.
The Minister says when he was appointed, the funding was provided on an annual basis, so nobody knew what they were getting in the longer term. It is now being provided on a multi-annual basis.
Ireland spends around 7 per cent of its health services budget on mental health, whereas in Britain and elsewhere in Europe, the norm is more 12-13 per cent.
The expert group recommends an increase to around 8.4 per cent, which the Minister is confident he will get. He also says these monies will be sufficient to provide the services necessary.
He declines to go into great detail, but says comparing figures from Britain is somewhat misleading. "For example, the monies spent on drugs in this area, on the GMS [ General Medical Services] system alone, is €150 million per year, but this money is part of the social welfare budget," he says.
The Minister says the community- based approach to mental health, whereby people with mental problems are treated in the community, has been operating on a gradual basis for many years.
About 20 years ago, approximately 12,000 people were in mental institutions, but this figure has fallen to about 3,500.
He says he wants to reassure relatives of those who are long-stay patients in institutions that a step-by- step approach will be taken to moving them. "Nobody need fear that people will be moved out of these places with nowhere else to go."
The services will be provided and proper places in the community will be provided, he says. "Not everybody will be able to move back into the community," he says, "but we will supply secure places to look after their needs."
The Minister defends moving the Central Mental Hospital to the grounds of the proposed new prison in north Dublin. He says there is a long tradition of mental hospitals and prisons being in proximity. He acknowledges that some feel it could add to the stigma he and the expert group are trying to eradicate, but says the opportunity has arisen and it makes sense.
"They will be completely separate, with their own separate entrances, staff, etc," he says. "If it is a state-of- the-art hospital, it doesn't really matter where it is," he adds.
The hospital was mooted about a year ago. Mr O'Malley defends the delay, saying it took time, but work will begin shortly. "We have to decide what the fastest way of building it is, through direct funding or a public private partnership."
He says one of his first decisions is to close the Central Mental Hospital. "It was built in 1859 and is the most appalling Dickensian building," he says. "Nobody should be expected to live there."
Mr O'Malley says that in the past, the approach to people with mental health problems was to treat them with medication and put them in mental institutions. "That was best practice in many cases," he says, "but best practice did not lead to best outcomes for patients."
He says psychiatrists and others are now doing a lot more talk therapies, counselling rather than primarily medication. The new approach advocates that services should be community based and delivered by well-trained properly staffed, community-based multidisciplinary teams.
Mr O'Malley says if people with a medical card have mental problems they go to a GP, but he or she cannot send them for counselling, even if the parties want it. "There is no provision for counselling," he says.
The Minister says he has been heartened by the response to date to what is a very comprehensive report. "A lot of GPs have admitted they are not properly trained to deal with mental health issues and the Irish College of General Practitioners is developing training in this area."
The Government has only recently resolved a somewhat bruising clash with psychiatrists over agreeing recruitment of extra staff.
They were needed to replace those who will be carrying out work on behalf of the Mental Health Tribunals which are assessing those involuntarily detained long-term in mental hospitals.
What makes him confident that the Vision for Change plan will run smoothly? "The majority of service providers are very happy and very supportive of this report," he says.
"There may be some human resources issues," he says, "but I am confident they can be overcome.
"I hope really vulnerable people will not be used as pawns," he adds.
Hospitals set to close
• Central Mental Hospital, Dundrum, Dublin.
• St Brendan's Hospital, Grangegorman, Dublin.
• Newcastle Hospital, Co Wicklow.
• St Loman's, Mullingar, Co Westmeath.
• St Ita's, Portrane, Dublin.
• St Fintan's Hospital, Portlaoise.
• St Bridgid's Hospital, Co Louth.
• St Joseph's Hospital, Co Limerick.
• St Connal's Hospital, Letterkenny, Co Donegal.
• St Davenet's Hospital, Co Monaghan.
• St Finian's Hospital, Co Kilkenny.
• St Canice's Hospital, Co Kilkenny.
• St Luke's, Clonmel, Co Tipperary.
• St Otteran's, Co Waterford.
• St Senan's, Co Wexford.
• St Brigid's, Co Galway.
• St Stephen's Hospital, Co Cork.