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Dáil Diary no 38- 28 May 2015

Wexford Mental Health Crisis – Government in Denial, All Spin, No Substance…

I asked Minister Kathleen Lynch if there were any plans to establish an acute mental health unit in Wexford, and what solutions she could offer to the crisis in mental health services in Wexford at the present time. There are no acute beds, not enough community based services, and nowhere to go for people in serious crisis, except A&E. Mental health funding as a proportion of the overall health budget in Ireland has traditionally been low relative to other countries, and between 2006 and 2013 cutbacks saw it fall from 7.2% to 5.3%. Back in 2006, A Vision for Change was predicated on 8% of the health budget being spent on mental health.

The HSE seems to rely on voluntary services to pick up the slack as budgets for mental health are cut. ‘It's Good to Talk’ is a low cost counselling service based in Wexford, staffed by 28 volunteers. It opened in 2012, and since then they've facilitated 10,000 or so counselling sessions. They can have up to 24 sessions a day in the service. The then Minister for Health James Reilly officially opened the service in April 2012. At the opening ceremony, he told the crowd assembled that the HSE was just delighted to fund the service –it never has. But the HSE are perfectly prepared to refer patients to the service. The service is in desperate need of funding, and has repeatedly sought some, but none has come.

The Government seem to be able to find billions to give to failed banks. The Government-owned NAMA has had no problem selling distressed assets to foreign investment funds at fire sale prices, at the taxpayers’ expense, inflating the rental market in the process. But somehow they can't find the money to fund mental health services, and they can't find the money to do anything about the deprivation that so often has a serious impact on people's mental health. People are dying, now, across the country and in Wexford; collateral damage of this Government's policies. These people don't have the time to wait around for a trickle down of wealth that will never come. Wexford needs more funding, and more services, and it needs them now.

The Minister’s response to my questions was deeply disappointing. To be honest, I have usually found Minister Kathleen Lynch to be good, but I was taken aback with her response and attitude on this occasion. She answered none of my queries and was brutally dismissive of the glaring problems relating to mental health in Wexford.

When I put it to the Minister that Wexford’s suicide rate was double the national average, unemployment was at 23% compared to the national average of less than 10%, and that we had one of the highest levels of teenage pregnancy and illiteracy – she replied that she wasn’t responsible for the other pieces. This brought home for me the stark reality that there is a serious absence of joined-up thinking in this Government.

The Government are in denial, they are not being honest, and it just isn’t good enough. Here’s the full transcript of our exchanges in the Dáil today-

Mick Wallace: “ I accept putting patients in acute mental health beds is not ideal or seen as best practice. When A Vision for Change, a good document, was published in 2006, it looked away from locking up people behind walls and drugging them to their eyeballs. The plan, however, was that the acute bed units would not be done away with until there was enough support and facilities in the community to replace them. This has not really happened and A Vision for Change has remained just that, a vision.
Deputy Kathleen Lynch:  The HSE Waterford-Wexford mental health service serves a population of nearly 280,000. The executive is continuing its approach to develop integrated mental health care across both counties.
The significant funding provided by this Government is enabling Waterford-Wexford mental health services to implement the recommendations of A Vision for Change, to move from a traditional hospital-based model to a more patient-centred and community-based care.
In 2010, the acute mental health unit in St. Senan's Hospital, Enniscorthy, County Wexford was amalgamated with Waterford mental health services to provide a 44-bed acute inpatient mental health unit in University Hospital, Waterford. In addition, arrangements are in place whereby service users who live in north Wexford, and who attend Tara House mental health services in Gorey and require acute inpatient admission, have access to Newcastle Hospital, County Wicklow. Overall, 49 acute inpatient beds are available in the area which meets the requirements set out in A Vision for Change. Development of community mental health services include day hospitals and associated services at Wexford, New Ross, Enniscorthy and Gorey.

In addition, mental health services covering Wexford include Tara House in Gorey, Carn House in Enniscorthy, Summerhill in Wexford, Maryville in New Ross and a suicide crisis assessment nurse service available in Wexford. The latter provides a skilled mental health nursing service for those in suicidal or self-harm situations. This is based at the emergency department in Wexford General Hospital where there is a liaison nurse-led, seven-day service. In July 2014, a new purpose built crisis respite unit opened in Enniscorthy, providing ten respite beds for service users referred through a community mental health team, for respite care.

The Deputy will be aware that the Health Service Executive has statutory responsibility for the planning and delivery of services at local level, and that any new service or capital development proposals can only be considered and prioritised in the context of the annual HSE national service plan, and the multi-annual health capital budget. I understand that the HSE has already supplied the Deputy with a more detailed response on 28 April 2015 to his recent parliamentary question on this matter.

Mick Wallace: There are day hospital services in Wexford, as the Minister of State has listed, but they are closed after 5 o'clock in the evening. To gain access to those services people need a referral letter from their general practitioner. What is a family supposed to do if a family member is in acute crisis and suicidal? The person has to go to an accident and emergency department and sit in a corridor or on a trolley waiting to be assessed. As there is no consultant psychiatrist in Wexford General Hospital, the psychiatric liaison nurse will have to ring Waterford hospital to consult a psychiatrist there. If it is decided that the person in crisis needs to go to an acute bed in Waterford, they are sent off and will have to go through the accident and emergency department in that hospital also. Therefore, a Wexford patient will have to go through two accident and emergency departments. It has happened in the past that people sent to Waterford hospital from Wexford General Hospital were sent home, having travelling all the way there while in acute distress. It is all a bit mad. It is not a good service.
Back in 2009, Susan Lynch, the HSE manager of mental health and elderly services, said that an acute ward in Wexford General Hospital was more than a proposal, that it was in the HSE's south capital plan, but it never happened. It fell off the lorry. Why did it not happen?

Deputy Kathleen Lynch:  I am responsible for many things but I am not responsible for what happened back in 2009.

Mick Wallace:  I did not say that the Minister of State was responsible.

Deputy Kathleen Lynch: I do not know what happened to that proposal. I speak not only to HSE people but to the people who deliver the service on the ground and I speak to one person in particular in Wexford on a regular basis. An investment of more than €18 million has been made in Wexford. A Vision for Change was published in 2006 and I believe it needs to be updated, but I have to say that if I listened to every request for an acute hospital I would reopen every psychiatric hospital in the country. On the other hand, I have a magnificent new unit in Cork in which people will not work, which is illogical in regard to psychiatric services. Wexford is well served with day hospitals, as the Deputy rightly said. There is a respite unit, crisis houses and an assessment nurse which many other places do not have. Also the ECD who runs the service in Waterford is an incredible man. When I ask him questions such as the one the Deputy has asked, and I will inquire about it with him, he tells me there has never been a case where somebody needed to be admitted who was not admitted. There may be instances where people need to be assessed and returned to their own community and I have no doubt that happens. I will make further inquiries on foot of the Deputy's parliamentary question.

Mick Wallace:  People have died because they were not admitted. People have committed suicide in Wexford. The Minister of State has said that Wexford and Waterford are well served, but, according to the HSE's mental health division plan for 2015, spending per capita in the mental health area in the region is €148. That compares to €223 in Carlow-Kilkenny, €198 in south Tipperary and €206 in Mayo. The average number of acute beds per thousand of population across the country is 0.21 and it is 0.16 in Waterford-Wexford. People in Wexford who have to go through two accident and emergency departments are at a disadvantage to people in Waterford who only have to go through one accident and emergency department. Also, people in Wexford have to travel to Waterford and Wexford is one of the poorest served areas. This area has a suicide rate of double the national average and an unemployment rate as of today of more than 23% while the national average is now below 10%. That is incredible.

It has one of the highest levels of teenage pregnancy and one of the highest levels of illiteracy. The service is not good enough. I am serious about this.

Deputy Kathleen Lynch:  I am only responsible for the mental health end of it, as the Deputy will know, I am not responsible for the other pieces.

Mick Wallace: That is the knock-on effect.

Mick Wallace

 

 

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