Those who remain in such facilities are the elderly and often the most vulnerable patients.
The Irish Examiner has learnt that, as late as June, St Finan’s hospital in Killarney, Co Kerry, which is in use since 1849, and has been blacklisted by Mental Health Commission inspectors for many years, is still taking admissions from the psychiatric unit at Kerry General Hospital.
It is understood four patients were admitted over the course of a week in June, as there was nowhere else for the patients to go.
Though most wards at St Finan’s have closed, 20 people remain in the sprawling, dilapidated building, while another 20 reside in a separate building on the hospital grounds, built in the 1970s. Sources say the old building is “falling down” and that heating and lighting costs are mammoth.
Staff at all levels are frustrated, disenchanted and upset at the living conditions of the residents in their care and of the working conditions they had to face each day.
This is compounded by the fact that a new unit built by the Kerry Mental Health Association, also on the hospital grounds, has been lying idle for two years due to a lack of resources.
Sources expressed frustration and anger that it has not opened as promised.
In many areas, such is the pressure to close old hospitals, that sources maintain that patients are once again being inappropriately placed and it is a case of “moving the problem from A to B”.
Elderly people with mental health problems are being moved to private nursing homes which, it has been suggested, might not be able to cope with the needs of the patients.
For example, in Dublin, elderly patients were moved from another black-listed hospital, St Ita’s, which lies on isolated grounds in rural Co Dublin, but the plan is that they will be moved back to the campus next year to a new unit.
In Carraig Mór, in Cork city, 21 so-called “voluntary” patients ranging in age from 30 to 78 live on an upstairs ward.
They were moved there from the now closed Victorian-era Our Lady’s Hospital in Cork. The unit they live in now was once part of the buildings of the old hospital.
Similarly at St Stephen’s Hospital, Glanmire, in Cork, there are about 71 long-stay patients.
Originally a sanatorium located on extensive grounds in a rural setting, elderly patients were earlier this year moved from Heatherside Hospital, in Buttevant, which was closed, to both St Stephen’s and St Mary’s Orthopedic Hospital in Cork city.
These “second-generation” institutions stand accused of once again warehousing people inappropriately.
Consultant psychiatrist Dr Siobhán Barry said that although these people are probably not used to anything but institutional living, it is still wrong to move them out of one institution and into another.
“The problem was that people never got reintegrated and so remained in these places, and the potential for real tragedy is that this could still be happening today.”
Plans to sell the last remaining hospitals — such as St Ita’s and St Finan’s — with large land banks never came to fruition and now, with the collapse in the property market, the HSE has been left to work with them rather than fully close and sell them and their extensive lands.
Because of this, says Dr Barry, long-stay residents continue to live in dilapidated and often deeply impoverished and stigmatising environments instead of community-based residential facilities.
Another issue with this cohort of older patients is that they are classified as voluntary, even though they have essentially been detained for many years.
Mental health law expert Dr Darius Whelan said these people urgently need to be classified as involuntary patients.
“If you take Carraig Mór, there is a unit where all the patients are classified as voluntary. They are long-stay residents but regarded as voluntary as they were admitted under the 1945 act. Even under current act, there is no requirement that they be assessed under the tribunal system.”
Dr Whelan said all patients deprived of their liberty must be entitled to a form of periodic review. He said, however, there would be a cost involved in this as it would mean more tribunals, so this could be the reason why the situation is not remedied.
CONSULTANT-led home-based crisis intervention teams are set to be developed in Waterford, Wexford, Carlow, Kilkenny and Tipperary during the course of next year, the Irish Examiner can reveal.
The seven day services, with an on-call facility at night, will provide assessment and intervention for people with acute illness, enabling treatment in a home environment.
Other services being developed include three high support residences at St John’s Community Hospital, Enniscorthy, Co Wexford.
Two houses will accommodate 13 people with severe intellectual disabilities and challenging behaviour who are currently living in St Senan’s Hospital. A third house will accommodate a further 13 long stay patients from St Senan’s. It is hoped they will be available for occupation in July 2012.
A community nursing unit is being developed next to Wexford General Hospital to accommodate 20 mental health places for older people.
A comprehensive plan is also in place for the delivery of modern services in south Tipperary which has a €20m investment package to re-configure services.
A 10-12 bed high support hostel will be built, as will a 40-bed community nursing unit to replace St Luke’s Hospital in Clonmel with modern community-based facilities.