Mental healthcare - Conditions remain appalling

It is 22 years since the almost Dickensian conditions of mentally-ill patients were identified as being in radical need of an overhaul.

In the intervening years, practically nothing has changed and a policy document, Planning for the Future, may as well never have been committed to paper, as so little has been the cognisance given to the fundamental improvement it envisaged.

What has been outlined in the annual report for last year by the Mental Health Commission and Inspector of Mental Health Services is an appalling indictment of the lack attention mental healthcare has received by successive governments.

The report is trenchant in its criticism of the treatment of some of the 20,000 people admitted to psychiatric care each year, and especially the long-stay patients.

It is depressing reading. It amounts to an interminable litany of fundamental fractures in the system, pointing to a disturbing lack of cogency, a service in disarray and a mental health service which is an embarrassment.

The report highlights the outdated services that patients have to endure, lacking adequate funding and staff; they are poorly regulated in a regime that offers them little optimism for recovery.

There are dilapidated buildings, new patients admitted straight into long-term care, an over-reliance on medication, infrequent access to consultants, and a complete lack of psychologists, counsellors, social workers and occupational therapists.

It has been official policy since 1984 to replace all large mental hospitals with small community residences, but this has only resulted in just four closures. In many cases, the newer residences merely replicate for patients the experience of the hospital ward.

A cynical bureaucracy has used this policy, not for the good of patients who are just relocated, but to merely facilitate the closure of the institutions.

A disturbing trend illustrated in the report were the massive disparities in admission rates.

It has led John Saunders, chairman of Irish Mental Health Coalition, and director of Schizophrenia Ireland, to describe the increase as “horrific.” It also underlined the fact that this country lacked a recovery-oriented service that would deal with treating patients’ condition and returning them to their community where they could be rehabilitated.

At any given time there are around 3,475 inpatients, and about 550 of them have been detained against their will.

There may be hope on the horizon, however.

It was announced by the Tánaiste and Health Minister Mary Harney that all people admitted involuntarily to the mental health services will be legally entitled to an independent review.

This was promised in the Mental Health Act 2001, and will eventually, though belatedly, be implemented next November.

About the only positive aspect to emerge was that care staff were praised, but even here there was a caveat. Dr Teresa Carey, Inspector of Mental Health Services, said senior medics and managers would have to change their attitude and work practices to bring about reform.