Psychiatric reform - Move mental health out of dark ages

FEW areas of Irish life are in greater need of reform than the State’s Dickensian mental health service.

Yesterday’s signing into law of new legislation setting up an independent tribunal system for patients detained against their will is long overdue.

After much delay, thousands of psychiatric patients being held in mental hospitals against their wishes, will have the right to challenge their involuntary detention. Up to now, they have been denied justice. All too often, their plight was swept under the carpet.

That such unacceptable practices are still going on in 21st century Ireland is a dark stain on the nation’s conscience.

To Ireland’s shame, the need for far-reaching measures to tackle this issue is underlined by the Republic’s unenviable distinction of having one of the highest rates of involuntary detention in Europe.

This depressing scenario has long been a matter of major concern for human rights campaigners and patient support groups. For years, they have lobbied politicians to root out this shocking practice.

But while the tribunal system was flagged in the Mental Health Act of 2001, it has taken five years to give the measure the full force of the law.

Protracted negotiations with consultants have contributed to this undue delay.

Not for the first time, crucial reform measures were held up by a long-running dispute between powerful psychiatrists and the State over pay issues.

But even though that row was settled in January, it will be November at the earliest before the new legislation comes into effect.

Meanwhile, many of the 300 or more people consigned every year to psychiatric hospitals against their will continue to languish there. Overall, out of 3,000 admissions a year to mental institutions here, about 10% are made on an involuntary basis.

Under laws dating back to the mid-1940s, a person can be detained for up to two years in a psychiatric hospital against their wishes. After November, under the new legislation, if a person is detained against his or her wishes, a tribunal can review the situation within 21 days of a detention order being signed.

The review process will be carried out by a panel involving a consultant psychiatrist, a lawyer and a lay person, and will be automatic and independent, according to Junior Minister Tim O’Malley.

It would be hard to exaggerate the significance of the tribunal system in terms of bringing balance and equity to procedures that have been outrageously skewed against the interests of individual patients.

In rural communities up and down the country, family disputes over land often ended with individuals being committed to the ‘lunatic asylum’, as such institutions were called in darker times. Indeed, in some parts of Ireland, patients were three times more likely to be detained against their will.

Arguably, depending on a person’s psychiatric condition, involuntary detention may be required in certain cases.

From November onwards, however, every detained patient will be entitled to demand an independent psychiatric assessment. And if the experts believe someone should not be detained involuntarily, the tribunal can order their release.

As part of the Government’s €900 million plan to transform the country’s psychiatric services, 15 hospitals will be closed and sold off on a phased basis over the coming decade. From then on, patients will have to rely on community-based services.

Internationally, this approach has worked. Ominously, in Ireland when psychiatric patients were discharged into the local community in the past, many ended up living rough on the streets.

Government must guard against a similar fate befalling psychiatric patients who may be released in future as they are among the most vulnerable in Irish society.