Same old story for mental hospitals

IN 2000, I spent many weeks traipsing around the country visiting psychiatric hospitals for an article on the mental health services.

It was summer. The country was in full bloom and full boom. All those 00 cars. All those new shopping centres. Tower cranes everywhere, monuments to our new prosperity.

And then you’d come to the edge of the town. And there you’d find another vast monument, this time Gothic and imposing. Once you crossed the threshold you quickly left boomtown behind.

When I sat down to write the article months later, the memory of visiting drab wards and dreary hospitals blurred into each other. There were differences - sometimes marked, more often subtle - between different places. But the one chastening and horrible thought evoked by them all was: ‘People, human beings, live out their lives in these places.’

The article, when it appeared, said nothing new. Since 1987, the report of the Inspector of Mental Hospitals has consistently highlighted the woeful inadequacies of the services. The subliminal message is clear: the most vulnerable people in our society are doomed to live out suspended lives.

Yesterday, the report of the inspector, Dr Teresa Carey, for 2004 was published. Like her predecessor, Dr Dermot Walsh, Dr Carey does not hold back.

She points to an urgent need for a radical overhaul of the services, points to a range of ‘issues’ (problems, in other words) that are common throughout the service. The major ones include a lack of accountability for failure to deliver services, under-investment, lack of input from patients; shortfalls in specialist services and management deficiencies.

It’s true that the service has not stood still. In 1984, a decision was made to move care from hospitals to the community. That has happened but remains an unfinished project. The numbers of residents in hospitals has fallen from 14,000 to 3,556. That’s still too many.

And moving them from hospital to community isn’t the panacea. The Inspectorate notes the experience in other countries.

“The closure of long-stay wards resulted in patients with severe mental illness dropping out of care or receiving inadequate care and support. There were concerns that many became indigent, lived on the streets or in hostels for the homeless.

“In Ireland,” the inspectorate continues, “it is clear that the move towards community-based care has not always been successful”.

There, the Inspectorate is being diplomatic.

There are huge variations in standards between regions. Some inexplicably cleave to the traditional bed-based system. Most areas have serious staffing shortages. The community-based multidisciplinary team - which should form the cornerstone of the service - remains an aspiration rather than a reality in too many places. Many of the service plans are out of date (and their targets remain unreached year-after-year).

In individual hospitals, the same criticisms recur again and again. Some wards and hospitals (including the Central Mental Hospital) should have been closed years ago.

On the face of it, this Government has made some progress on those with intellectual disabilities. The numbers in mental hospitals have fallen from 501 in 2003 to 366 by the end of 2004. But that is only part of the story.

According to the inspectorate: “It is stated Government policy in this country that persons with an intellectual disability should not be resident in mental hospitals. As a result, large numbers have either been discharged or have had the units in which they live “de-designated”, ie no longer considered to be part of the mental health service.

“The inspectorate is concerned that this programme has resulted in large numbers of people with an intellectual disability who also have a mental illness being deprived of necessary mental health care. The inspectorate is also concerned that while the numbers of intellectually disabled persons in mental hospitals is declining, there are still large numbers living in other institutions run by the State or by voluntary agencies.”

In other words, they have been shunted from one institution to another. But their situation has actually worsened because the new institution is not subject to inspection.

That’s not progress. It’s arithmetic.