Instead of resolving the situation, a litany of concerns has been drawn up for the Health Service Executive (HSE) and the Mental Health Commission (MHC) over the operation of the tribunals, which in some cases appear to be generating problems rather than solving them.
For decades, the detention of patients in psychiatric hospitals against their will was the hidden scandal of Ireland’s archaic mental health service.
Rumours of family squabbles over money, land or unmade wills, usually circulated whenever a local person was committed to a psychiatric institution. Unsurprisingly, on occasion such rumours were well founded. For the unfortunate individual concerned, it meant a lifetime behind the locked doors of an asylum.
In a bid to address this vexed issue, the State introduced new legislation under the Mental Health Act, 2001, with the aim of bringing the treatment of psychiatric patients out of the dark ages.
The new measures involved panels or mental health tribunals designed to review the status of involuntarily detained patients. For the legislation to work it was essential for various interests, including psychiatric consultants and nurses, as well as members of the legal profession, to co-operate closely. Transparency was also an essential ingredient, if the light was to penetrate this dark corner of the health service.
However, a confidential document compiled by health officials on the basis of complaints from psychiatric consultants working with the new tribunals, shows such co-operation is lacking to an alarming degree. Aired in the current edition of the Irish Medical Times, the report pinpoints a large number of problems during the short lifetime of the tribunals set up late last year. There is strong criticism of legal representatives on some tribunals.
In one instance, a lawyer questioned whether a patient required counselling. Other complaints included giving institutions short notice of their visits or arriving unannounced. Lawyers are even charged with refusing to provide identification to show healthcare workers who they were.
Arguably, there may be some merit in arriving at a mental health institution unannounced, if only to maximise transparency and guard against obfuscation. But there can be no excuse for refusing to provide health officials with the necessary identification.
Difficulties have also arisen over documentation, including the insertion of information on other patients in the files of cases under scrutiny. In one alarming botch-up, a courier left confidential documents about a tribunal on a doorstep in the wrong area.
According to consultants, hundreds of outpatient appointments have had to be cancelled because of the short notice of tribunal hearings. They also complain of being kept in the dark before such meetings about mental health reports from independent psychiatrists on patients who were involuntarily detained.
The HSE admits there are ‘teething problems’ but insist the new system is working in the majority of cases. Arguably, such problems could have been avoided had the HSE heeded warnings against rushing the formation of tribunals “on a wing and a prayer” last November.
Given the vulnerability of mental health patients, there is an onus on both the executive and the commission to iron out these difficulties as a matter of urgency. Moreover, it is vital the professionals involved should co-operate fully.
All concerned have a duty of care to serve the best interests of mental health victims in a society where some of the most vulnerable people have been locked away against their will and forgotten.