Thursday, 23 July 1970
Dáil Eireann Debate
Mr. Desmond: asked the Minister for Health if he will comment on the reported statement of the chief psychiatrist of the Dublin Health Authority on 16th July, 1970, that the authority had totally failed to create a service for geriatric patients and for the adult mentally handicapped, that the authority was facing the problem a decade behind the time and that it will be five times more difficult to get nurses to work in the conditions applying in the future; and what action he proposes to take to remedy the serious deficiencies in accommodation and services.
Mr. Lalor: I have seen press reports of a recent meeting of the Dublin Health Authority which attributed to  the chief psychiatrist of that authority the statements referred to by the Deputy. So far as these statements may be taken as being critical of the work of the Dublin Health Authority it is, of course, primarily a matter for that authority, rather than the Minister for Health to deal with it.
As a general comment, I think it is true to say that no country, including those far wealthier than we are, would claim that they have reached a stage where they are fully satisfied with the services that they provide for geriatrics and for the adult mentally handicapped. The chief psychiatrist referred in the quotation to deficiencies in services. The Deputy, I note, puts accommodation before services. There are undoubtedly defects in the quality of some of the accommodation available under public authority and voluntary agencies in Dublin but the problem in the case of geriatrics is more one of developing community supportive services rather than merely adding to the number of institutional beds. Indeed, the statistics available to me make it clear that institutional places in Dublin are on a level considerably in excess of the provision in other parts of the country and approaching double the target indications proposed in the Report on the Care of the Aged.
On the general question of the improvement of the geriatric services, the Report on the Care of the Aged is being actively considered both in my Department and by the various authorities concerned. The programme which I hope to see put into action in this area of growing importance in our health and welfare services, is one to which I attach great importance and I shall be announcing the action to be taken as soon as possible.
In the case of the mentally handicapped, the Dublin Health Authority in common with all health authorities in the country avail of the institutional services provided by voluntary bodies. The Commission of Inquiry on Mental Handicap examined all aspects of the services for the mentally handicapped and recommended that there should be 2,500 places for adults centred at the special residential institutions under the control of these voluntary bodies. Over  1,750 of these places have already been provided and when the schemes at present in progress or in planning are completed the commission's targets for residential accommodation for the adult mentally handicapped at the special centres will be met. In the Dublin area 180 additional places are being provided for adults at these centres.
The Commission of Inquiry saw no objection in principle to the provision of long-term care for the adult mentally handicapped in conjunction with the long-term care of the mentally ill at district mental hospitals provided it would be possible to make available suitable and separate living accommodation for the mentally handicapped. At present, there is a scheme in planning for St. Ita's, Portrane, which is aimed at providing this type of separate accommodation for the adult mentally handicapped. The Dublin Health Authority are examining as a matter of urgency the possibility of the immediate transfer from St. Ita's of geriatric patients who do not require the services of a mental hospital so as to provide alternative accommodation for mentally handicapped patients at present housed in unsatisfactory wards.
I am satisfied that with the participation of voluntary bodies and health authorities in the services and the extension and improvement of facilities, including the provision of trained staff, a satisfactory service will be provided for the adult mentally handicapped in the Dublin area and in the country generally.
Mr. Desmond: In thanking the Minister for his detailed reply may I put it to him that the very trenchant criticism by the chief psychiatrist, Dr. Ivor Browne, contained a great deal of objective analysis of the very significant deficiencies of the psychiatric, geriatric and mental handicap services in the Dublin area and therefore would the Minister make a very special attempt to keep these services, their reform and development under very urgent review having regard to the increase in the number of elderly persons in the population of Dublin and the substantial services currently being developed in the country?
Mr. Lalor: As the Deputy will appreciate from the detailed nature of the reply by the Minister and as explained in the reply, this is something that is engaging the Minister's special attention. It will be noted that the reply did not in any way include any return criticism of the comments that were made. No doubt the Minister is fully aware of the fact that there is still a certain amount of leeway to be made up and at present he is using his best endeavours to do that.
Mr. Clinton: Is it not a fact that the reply to the question is couched in such a way as to exonerate the Department completely in respect of any deficiencies there are in these services in the Dublin region? Is it not also a fact that the chief psychiatrist does not agree with the view expressed that there are more than enough places for both psychiatric and mentally retarded patients in the Dublin region, and that he had a “go” at the Dublin Health Authority simply because he could not have a “go” at the Minister and for no other reason? There are proposals in the Department——
Dr. O'Connell: What action is being taken to eliminate the substandard temporary dwelling that has existed for nearly 50 years at Portrane where people are housed in filthy and congested conditions? Will the Minister state what action he has taken on the report to him by the Dublin Health Authority about the elimination of this dreadful place in Portrane?
Mr. Lalor: I am sorry that even with —probably due to—the comprehensive reply, the Deputy obviously gave up listening to it half way through—he did not hear in detail the account of what is being done in this regard. In regard to a number of supplementary questions  by Deputy Clinton, the reply is a statement of fact as to the progress which the Minister and the Department have been making and it is certainly not couched in such terms as to be a defence. It is a statement of what progress has been made and of the plans the Minister has for further progress.
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