Breen raises concerns regarding the Closure of the Orchard Lodge Facility in Kilrush

November 19th, 2009 - Pat Breen

Deputy Pat Breen: I thank the Ceann Comhairle for facilitating this debate. While attitudes to mental health have changed over the years, a recent national survey undertaken by St. Patrick’s University Hospital, which examined the attitudes to, and perceptions of, mental health, found that even in 209 there continues to be a stigma against people who suffer from mental illness. More than one third of people surveyed believe that those suffering mental illness are of below average intelligence and a further one third said they were not willing to accept someone with a mental health illness as a close friend. A total of 40% of respondents would discriminate against someone with a history of mental illness when it came to hiring him or her and 40% felt seeking help and undergoing treatment was a sign of failure.
These findings are an eye opener and they are disturbing. Considering that on average one in four people will suffer from a mental health issue in his or her lifetime, it shows how important it is to dispel these myths. Considering that, on average, one in four people will suffer from some mental health issue in their lifetime it is important to dispel these myths. Former US President Bill Clinton once said, “Mental illness is nothing to be ashamed of, but stigma and bias shame us all.” The best way of dispelling this stigma is to move away from institutionalising people with psychiatric issues and to integrate them into our communities.
In 2002, when Our Lady’s Hospital in Ennis closed, The Orchard Lodge Hostel, a high support unit was set up in Kilrush. The unit currently supports 17 people, 11 of whom are over the age of 65 years. They have all settled into Kilrush and for the first time in their lives they have a place they can call home. They can go about their daily business, they have freedom, they can go into the local shop to collect their newspaper, have a pint in the local pub or sit and chat over a cup of coffee with their friends.
The freedom these people quite rightly now enjoy is being made possible by the care and attention they receive from the team of dedicated staff who look after them. Reports in recent days suggest that these people, who are the most vulnerable in our society, are now going to pay the price for the failure of the Government and the HSE to fund the provision of mental health services in County Clare, that the Orchard Lodge in Kilrush is going to close down and that these people are going to be forced into other facilities where they will not have the same freedom.
I cannot understand this. It is a backward step. Does the Minister realise the anguish this will cause to these people and the trauma they will suffer if they have to leave their familiar surroundings?
I understand that a review of the entire provision of mental health services in Clare is currently under way and that this review is driven by the 21.3% decline in the number of nurses working in the service over the past 22 months. Surely any review of psychiatric services should be driven by what is in the best interest of patients and their families.
Last February, over 20 geriatric patients were moved from unit 6 of St. Joseph’s Hospital in Ennis to a private nursing home in the town and now there is concern that another unit is about to close at St. Joseph’s in order to accommodate patients from Cappahard Lodge in Ennis. Gort Glas in Ennis is also closing I understand, and patients from there are going to be transferred to Cappahard.
Depression has increased as the recession takes hold in this country and I have been inundated with pleas for help from many families who are finding it more and more difficult to access basic help for mental illness because of the lack of resources. A local eminent psychiatrist recently warned that the reduction of €4 million in funding for the Clare mental health service, down from €26.7 million in 2008 to €22.85 million in 2009, will mean that there will be no money for capital projects such as hostels or rehabilitation programmes for a number of years. He also warned that some patients could be forced to wait up to six months to attend a public psychiatrist or counsellor. Some of the multi-disciplinary teams in Clare are not fully staffed, in spite of the Government’s commitments under the Vision for Change programme and the reality is that the acute psychiatric unit at Ennis General Hospital is stretched to the limit with no step-down facilities in place and we are still without proper 24/7 access to social workers to help families in crisis.
Short-sighted cuts in mental health care for the most vulnerable members of our society will cost this Government more in the longer term, not to mention the cost to those with mental illness and their families, who continue to suffer in silence.
I am delighted to see the Minister of State with responsibility of mental health in the House this evening. I ask him to clarify here in this House tonight, first of all, what is the situation regarding the Orchard Lodge facility, second, when will the review of mental health services in County Clare be completed and, as part of that review, will the Minister ensure that adequate resources are allocated to the Clare mental health service in the forthcoming budget?

Minister of State at the Department of Health and Children (Deputy John Moloney): I thank Deputy Breen for raising this matter as it provides me with an opportunity to outline the plans for further development of mental health services in County Clare. To put the issue into context I should recall that A Vision for Change, the report of the expert group on mental health policy has been accepted by Government as the basis for the future development of our mental health services. While much has happened and much has changed economically in the three years since the report was launched, it remains a progressive document and our roadmap, charting the way forward for our mental health services. A Vision for Change proposes a new model of service delivery which is patient-centred, flexible and community based. The report proposes a holistic view of mental illness and recommends an integrated multi-disciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems. Extensive consultation with service users, their families and service providers informed this policy.
The most pressing priority voiced during the consultation process was the need for an accessible and user-friendly mental health service where service users can be respected as active partners in their own recovery and where they can avail of interventions to enable them remain meaningfully involved in their own communities.
Of course mental health services are provided in many settings, including acute in-patient facilities, day hospitals, day care centres, low support and high support community accommodation. While A Vision for Change recognises that acute hospitalisation will always be required to serve a minority who need intervention in safe, therapeutic settings, it also acknowledges the desire among service users, their families and carers to see an expansion of mental health service options established in local communities so that comprehensive care can be provided.
To turn to Orchard Lodge, in line with best practice, the HSE is currently engaged in a review of mental health services in County Clare with a view to ensuring that the most appropriate services are provided for service users, in the context of their changing needs. The HSE has consulted and engaged with carers, families and clinical and nursing staff and provided opportunities for them to put forward their views and to have a constructive input in the review process. At present there are 16 residents in Orchard Lodge and following individual clinical assessments it has been concluded that 11 of the residents, given their changing needs, would be more appropriately cared for in an older persons setting. It is therefore proposed to refer these residents to the older persons placement panel for consideration as to the most appropriate care setting for each individual. The remaining five residents who at this point require ongoing mental health care, will be accommodated in appropriate rehabilitation facilities.
While it is proposed to discontinue the residential facility at Orchard Lodge, I should clarify that there are no plans at present to change other services provided on this site, including the day service and the west Clare catering service. I should also explain that the closure of the residential facility will release mental health nursing staff and allow for their re-deployment to other areas where nursing staff are required and thus ensure best use of our valuable resources.
While I accept that the prospect of change can be daunting for service users and staff alike, I think we need to look at the bigger picture and recognise that the change which is proposed by the HSE is for the better. If we want to implement our national mental health policy, A Vision for Change, we need to be able to move forward and embrace change. Our major driver must be to meet the changing needs of individual service users and improve the quality of their care.
The residents of Orchard Grove have been clinically assessed and it has been determined that their needs would be better served in a different therapeutic setting. The HSE, to their credit, are proactively responding to the changing needs of these particular clients and are trying to provide the best possible care to them in the most appropriate setting. I am confident that the HSE will continue to engage actively with stakeholders and that notwithstanding the considerable challenges it faces, a satisfactory solution will be devised to the ultimate benefit of all concerned.
I fully appreciate Deputy Breen’s concern regarding the stigma attached to mental illness. I intend putting forward a national programme to deal with that issue in January. I also intend to take an overview of the Vision for Change. With six years remaining for the programme, it is timely that we review its successes and acknowledge that the original reform has not been what we hoped it would be

Deputy Pat Breen: The facility to which these people will be transferred is outside the town. They will not have the freedom of movement they enjoyed in Kilrush. Tonight’s news is very disappointing in that regard. They integrated very successfully in Kilrush.

Deputy John Moloney: I thank the Deputy.