HSE mental health delay ‘like waiting for Godot’

THE head of the Mental Health Commission has described waiting for action by the Health Service Executive as like “waiting for Godot”.

Commission chairman Dr John Owens accused the HSE of “paralysis” when it came to mental health issues after a year of inaction on a Government policy report which called for radical improvements in services and supports for psychiatric patients.

“Many of us are disappointed that the policy document, a year afterwards, is still not substantially moved on,” he said. One of the problems he highlighted was the lack of a management structure within the HSE to manage the changes the report recommended.

“In the absence of that management structure there is a paralysis,” he said. “It’s like waiting for Godot. Something has got to happen soon or no-one will have a lot of faith that things will ever change.”

Dr Owens was speaking at the publication of research jointly carried out by the Mental Health Commission and the Health Research Board into the lives of people receiving care in residential community mental health facilities.

The number of places in community residences has tripled in the past 20 years so that there are now just over 3,000 people living in such facilities — roughly the same number who are being cared for as inpatients in psychiatric hospitals.

The Happy Living Here report is the first ever to assess community residential services from the point of view of the residents. Its chief finding is reflected in the title as most residents reported being happy with their living arrangements.

However it also points out that the majority felt they had no alternative as the prospect of living independently was never explored.

Other key findings were that the majority felt they had no input into their treatment or care and most felt they were capable of doing more for themselves and by themselves than their regime allowed.

One of the authors of Happy Living Here, Dr Donna Tedstone Doherty, said it was questionable whether the needs of residents who were ready for rehabilitation and greater independence could be met under the current set-up where they were mixed with patients in need of continued care.

She said there was a “lack of a recovery philosophy” and called for the urgent establishment of rehabilitation and recovery teams to wean people off care and help them regain their independence through social activities, training, work and ultimately a return or move to their own home.

The report says residents should also be encouraged to look after their own finances and to attend social events.

Visiting hours and general house rules should also be reviewed to ensure residences “provide as homelike an environment as possible”.

A review of health and safety regulations should also be carried out as residents in some facilities were barred from using kitchen facilities which hampered their rehabilitation.

Privacy is also an issue which needs to be addressed. No resident should be forced to share a bedroom if they would rather be alone.

The HSE said it had already spent €26 million on the recommendations of the 2006 report. “A great deal of progress has already been made with continued implementation being strategically developed and formulated. Sustained roll-out will continue during 2007 with a further €25m being allocated to achieve the report’s proposals.”

The statistics

* Schizophrenia (62%) and depression (11%) were the main diagnoses.

* Almost half were aged 46-35, a third were over 65 and one in 11 were under 35.

* Only 5% were in paid employment and just 15% in sheltered employment.

* The average length of time coping with mental illness was 27 years.

* The average length of time in current residential setting was seven years.

* 61% were in high support residences with an average of 15 residents.

* 29% of residences did not provide access to public phones.

* 14% of residents were moved to a lower level of care in the previous year.