Seanad Éireann - Volume 145 - 29 November, 1995

Adjournment Matters. - Security at Psychiatric Hospitals.

Mr. Kelleher: I raise the issue of Government funding to the Southern Health Board for security in psychiatric [775] hospitals for a simple reason. I come from an area in Glanmire which has one of the largest psychiatric units in the Southern Health Board area. The people of Glanmire and the residents in the vicinity of the hospital are very concerned, not just for themselves but for the safety of the patients in the psychiatric unit. It is apparent that there is no security available either for the residents in the vicinity of the hospital or the patients themselves.

I will cite some extreme examples. A few weeks ago a patient left St. Stephen's Hospital at 5 p.m. and proceeded down a very dark road to a local hostelry where he consumed some alcohol. On the way back the patient decided that he could no longer journey towards the hospital in Glanmire and decided to sleep in a car parked outside a house near the hospital. The occupant of the house range St. Stephen's Hospital and could find nobody to whom he could speak about the patient. This patient had been committed to St. Stephen's Hospital yet nobody was able to come and collect him. It eventually fell to the resident concerned to take the person in the car back to the hospital.

St. Stephen's Hospital is held in high regard by the local community. It was a general hospital from 1976 until recently, and prior to that it was a sanatorium for people suffering from TB. The situation has now come to a head. If St. Stephen's Hospital is to function as a psychiatric unit where patients are allowed to move freely between the hospital and the local village or the city, some form of security and scrutiny must be put in place. Being psychiatric patients, these people are not as responsible as the Southern Health Board would like to think. They are inclined to wander and create difficulty for people travelling on buses to and from Cork city.

I am not only speaking for Glanmire because the overall situation in the Southern Health Board area is that there is no security and no monitoring of patients in psychiatric units. We all agree that patients should be allowed [776] freedom. Integration in the community is of vital importance and is recommended by members of the medical profession. However, we must be realistic. Psychiatric patients who are committed to a hospital for treatment at least deserve the respect of some form of security and scrutiny whereby the health authorities know their whereabouts. At present there is no such system in the Southern Health Board area, particularly in St. Stephen's in Glanmire where patients wander around at all hours of the night and in dangerous terrain.

There have been some tragedies in St. Stephen's Hospital. The gardaí and local people in Glanmire have spent nights searching for patients who did not return to the hospital. The area includes a wood and a river. I have spent a few hours at night searching my own land for patients and, at this stage, it has gone beyond the realms of reality.

There was a recent welcome proposal — I welcome any form of advancement regarding child care — to establish a unit at St. Stephen's Hospital for children who have been abandoned or children detained by the Southern Health Board under the Child Care Act. However, there was no form of consultation with the local residents in the Glanmire area. I mentioned to members of the Southern Health Board and the staff that the people of Glanmire have been very supportive of this hospital and its activities over the years. However, when a proposal was put to the Southern Health Board the residents in the area were not consulted. This new child care unit will house up to eight children with behavioural problems and there is still no security in the psychiatric unit. Something will have to be done. Either the hospital will close or the residents will have to revolt, for their own safety and that of the patients which is the primary concern.

In 1991 some patients went missing and for many weeks we could not ascertain whether they just left the premises or had been collected by relatives. In the end they were found dead. The [777] authorities could not confirm or deny what had happened to the patients until local people found their remains in a river. I fully support the integration of psychiatric patients and allowing them freedom to do as they please but there must be some form of monitoring. I am confident that what is happening in St. Stephen's Hospital, which is one of the largest psychiatric units in the Southern Health Board area, is also happening throughout Cork and Kerry.

I make a plea to the Minister that some form of funding be provided. Everybody is supportive of the psychiatric services that the Southern Health Board is trying to provide, but I ask the Minister and his officials to ensure some funding is provided as the security and monitoring of patients is of paramount importance.

The bus service from the city to the local Glanmire village passes the St. Stephen's Psychiatric Hospital. However, there have been many cases of psychiatric patients, due to their condition, intimidating and frightening students and young people travelling on the bus to school or their place of work. That is unacceptable.

There are genuine fears in the community which I would explain and elaborate on if I had time. I appeal to the Minister to make some funding available immediately to the Southern Health Board, to permit it to provide safety and security for psychiatric patients, and the residents in the vicinity of St. Stephen's Hospital.

Minister of State at the Department of Health (Mr. O'Shea): There are a number of aspects with regard to the provision of security in psychiatric hospitals. First, there is the need to protect vulnerable patients who are resident in psychiatric hospitals from breaches in security from outside. Second, there is the need to provide secure facilities for that small proportion of patients who present with challenging behaviour. Finally, there may be concern about threats by psychiatric patients to the general public.

[778] I am informed by the Southern Health Board that it has no specific difficulties with regard to security in psychiatric hospitals in its region. The board is satisfied with the level of security it provides to its psychiatric patients. It informs me that the only building for which it has had to provide special security in case break-ins occurred was the Grey Building in Our Lady's Hospital, Cork city, which had become derelict and which, the Senator will be aware, was recently sold by the board.

At national level, a working group is currently examining the care of patients with disturbed behaviour with a view to drawing up a national policy on the care of such patients and to recommend the kind of secure accommodation appropriate to their needs. The working group is expected to present a report to the Minister for Health in the middle of next year. This development should be seen in the context of an evolving mental health service which has moved in a short period from acting as a catch all for much of society's ills to a service which can answer the mental health needs of individual patients.

The Southern Health Board is satisfied with the services currently available to its patients who present with challenging behaviour. Following a clinical assessment of individual patient need, appropriate intensive facilities are available to this small number of patients in hospitals in Cork city and Killarney, County Kerry. The board intends to open a secure unit in the grounds of St. Stephen's Hospital, Cork, for children who would be detained there on foot of court orders.

The Senator will be aware that in 1995, the High Court ordered the Southern Health Board to detain a young girl who was out of control and whose needs could not be met within the existing range of child care services. The board pleaded that it did not have a suitable facility to provide the care required in a secure setting. The court allowed the board time to put in place an appropriate facility to provide for the girl's needs and ordered her to be placed in Oberstown [779] Reformatory, operated by the Department of Education, pending the development of the service by the board.

The Southern Health Board established a project team to develop a special intensive care unit for out of control children. The team examined a number of sites and selected a location for the unit at St. Stephen's Hospital, Cork. The 1995 Child Care Action Plan for the board included approval of the necessary resources to develop the facility. Work on the refurbishment of the unit is proceeding and phases I and II of the development will be completed before the end of the year.

The special care unit will operate independently of the psychiatric service provided in St. Stephen's Hospital, with security commensurate with both the needs of the community and the children placed there. If there are any specific problems with regard to security at specific facilities, and the Senator has outlined difficulties in respect of St. Stephen's Hospital, I would invite him to bring them to the attention of the Southern Health Board who will follow up the matter.

Mr. Kelleher: I thank the Minister for his reply, which was centred on the new child care facility. This is not the problem. I am concerned with security for the present psychiatric patients located at St. Stephen's, Cork. I will raise the matter with the Southern Health Board, but I also wish to appeal to the Minister to ensure funding that is so urgently required is provided to ensure that psychiatric patients are safe in their surroundings.

Mr. O'Shea: There is no specific problem in the Southern Health Board area, but if the Senator makes his concerns known to the board, raising the cases he mentioned, it may or may not come back to my Department with a proposal. I ask the Senator to make the local health board aware of the difficulties.