Concern at mental health system lacking a meaningful care plan

PEELING paint on dilapidated buildings, children stuck in adult wards, nurses running fundraisers to try to improve their patients’ comfort.

This wasn’t envisaged for the mental health system in the Planning for the Future policy document of 22 years ago. It is, however, the present for a significant number of the 20,000 patients admitted to residential psychiatric care in Ireland in an average year.

About 40% of all patients admitted last year spent three months or less in hospital so the turnover is frequent, but still, at any one time, there are about 3,475 inpatients, around 550 of which have been detained against their will.

Under the provisions of Planning for the Future, they should only be hospitalised when acutely ill and then transferred for longer- term care and recovery to small residential care facilities in their community.

They should have a wide range of medical and therapeutic supports so that their treatment programme is only partially dependent on drugs, with multi-disciplinary teams of psychologists, counsellors, occupational therapists, educationalists and GPs all working alongside the psychiatrist.

Everyone would be appropriately placed in a setting that suits their age and condition and there would be an optimistic attitude to the potential for recovery rather a presumption that the patient would never get well.

The latest report of the Inspector of Mental Health Services confirms the future didn’t work out as planned.

All large psychiatric hospitals were supposed to have closed but only four had shut, the inspector, Dr Teresa Carey, writes.

She continues: “Multi-disciplinary teams are only partially staffed in most areas and specialities.”

The inspectorate is concerned about the continued admission of patients to the country’s 95 long-stay wards, which care for about 1,800 people.

These house people with long-term illness, intellectually disabled people who were wrongly admitted many years ago and other patients who only need community care but have grown too old and frail to be catered for outside a hospital. The report calls the practice “unacceptable”.

“This leads to an inappropriate mix of patients with differing needs and the risk of these new patients becoming long stay and it further extends the life of these large hospitals.”

It mightn’t be so bad if these wards were well resourced, but the report finds otherwise. “Within many of these long stay wards there is a lack of therapeutic activities, lack of any multidisciplinary team input, lack of regular physical and psychiatric assessment in some hospitals, few assessments for future placement and lack of a meaningful care plan.

“A significant number of these wards have poor physical environments with poor sanitary facilities. The inspectorate has recorded peeling paint, leaking ceilings, holes in walls and floors, drab decor, poor hygiene, no curtains around beds and lack of personal possessions and privacy.

“Some wards are locked despite the fact that only one or two patients in the ward require that level of close observation.”

The inspectorate also visited 127 community residences, home to about 1,700 people. Some places have as many as 30 residents and operated just like wards “with institutionalised designs and practices and little individual rehabilitation”.

A “significant number” of intellectually disabled people wrongly placed in psychiatric care years ago remained in psychiatric institutions, and others were cared for in “settings that are not approved, which do not have a statutory inspection and are outside the legislative framework that protects their rights”.

There is a shortage of inpatient beds for children and teenagers with mental illness who have to travel to either Dublin or Galway for care and until changes come into effect this November, teenagers aged 16 or over will continue to be placed in adult facilities.

Elderly patients face a similar lack of age-specific care, with some excluded from specialist treatment on age grounds alone.

The one positive feature, however, was the dedication of staff despite difficult circumstances.