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Response to Minister Lynch's Interview on RTE Radio,

Responding to recent comments by the Minister of State, Kathleen Lynch , Psychiatric Nurses Association ,General Secretary , Des Kavanagh, said today (Sunday , 20th April ) 'In my Report to the recent PNA Annual Conference I noted that many nurses in several parts of the country had over the past year expressed serious concerns re the number of suicides occurring in or related to their services. They had advised me that the number of suicides far exceeded what might have occurred in the past. In one service, Carlow Kilkenny South Tipperary, the nurses had actually identified 14 individual cases in less than 18 months.'

Response to Minister's comments.

1. Last week on Rte Radio the Minister dismissed my comments as a product of 'Conference time'.
This was a regrettable comment as it seeks to discredit the messenger rather than listen to the message. Over the last week I have been contacted by service users, families, doctors and journalists thanking me for highlighting the problem. For all of them the problem is a real life experience which needs to be heard, considered and examined and not just dismissed.

2.The Minister stated : ‘I don't accept that people are prematurely discharged, that is a clinical decision one that I don't have any expertise in nor indeed does Des'

- When Senior and experienced nurses tell me that they have been shocked on occasions when some patients are being discharged because based on clinical records and clinical presentation it would normally be the case that that person would remain in hospital for a further week or 10 days, and the decision to discharge is made when there are no vacant to beds and there are extremely ill people awaiting admission then it is reasonable to conclude that the discharge is premature.
- Additionally the Minister is fully aware that Consultant Psychiatrists in North Dublin wrote to her last February advising her of their concerns re the lack of acute beds and pointing out that because of this shortage they were discharging patients precipitously and that this was detrimental to good patient outcomes. (Reported by Susan Mitchell, Sunday Business Post 6th April 2014).

3.The Minister stated : ‘Every adverse incident in relation to mental health is reported to the Mental Health Commission'.
This is not correct. The Code of Practice for Mental Health Services on Notification of Deaths and Incident reporting requires that all approved Centres must report all deaths within 48 hours. All sudden and unexpected deaths of persons attending Day Hospital, Day Centre or currently living in a staffed community residence should be notified to the commission as soon as possible and in any event within 7 days of the death occurring.

There is no system for recording those deaths occurring in discharged persons not attending Day Hospitals and Day Centres, does not include deaths of persons who are being cared for by Home Based, Assertive Outreach teams or attending Outpatient Clinics, and does not include those who were turned away from A&Es.

4. The Minister said - ‘But of the evidence in relation to ………………….not being admitted when people are acutely unwell unless you can produce evidence…………………..we can't investigate every public utterance.'
The Minister is surely aware of the case highlighted last week by the mother of a young man who had survived a number of previous suicide attempts, had previously been treated as an inpatient and was turned away from the A&E in Connolly Hospital on Sunday, April 6th. Coincidentally there were no vacant beds in the Acute Unit that day.

5. The Minister argued that the Carlow Kilkenny Sth. Tipperary services is an award winning service.
I pointed out in my report that the HSE had boasted that this service best replicated what is recommended in Vision for Change. This is extremely worrying and raises questions about either or both the philosophy or implementation of Vision for Change.
The fact that one part of the service won a national award should be welcomed and acknowledged.

6. Mr. Gerry Raleigh, Director of the National Suicide Office in his presentation to the PNA Annual Conference stated that in some A&Es in Dublin 20% of those who register to be seen actually leave unseen.
We know that there are around 12,000 presentations at A&E every year by people who have self-harmed. We know that persons who self- harm are 44 times more likely to complete suicide than the rest of the population. It is also the case that 45% of those who completed suicide had deliberate self-harmed. Yet, we don't know how many of those who leave have deliberately self harmed, how many are suffering from Mental Illness and /or how many of those who leave unseen actually end up in the statistics for suicide.

Conclusion :

On March 6th, 2014 I wrote to Minister Lynch setting out my concerns that the pressure on acute beds is resulting in premature discharges, persons being turned away only to be admitted at a later date in a far worse condition and persons ending up in the Central Mental Hospital via prisons having committed serious crime and asking her :
- What records are kept of such adverse events?
- What Investigations are carried out in relation to such adverse events?
- What learning has been achieved from such investigations?
I concluded that in the absence of a comprehensive response it was reasonable to conclude that :
- There is no system for identifying the number of people who are denied admission to acute units and later complete suicide.
- There is no system for identifying the numbers discharged (prematurely) who proceed to complete suicide.
- There is no system for identifying the numbers denied admission or discharged from the service who become involved in adverse events.

Media Contact
: Derek Cunningham 0862430535