If mental health sufferers and their families had political clout, there would be no need for the Inspector of Mental Health Services, Dr Susan Finnerty, to berate the State for falling down on the provision of adequate resources for the very people who need them most.
Underlining the glaring inadequacies of the system, she hammers home the point that there is not enough manpower, not enough management, not enough communication and not enough direction within the system.
For the umpteenth time, concerns are voiced about the plight of long stay patients in institutions. Their sad predicament is graphically illustrated by the fact that a third of patients have been held in wards for more than five years. Poignantly, they are described by Dr Finnerty as the “forgotten people”. With €800 million a year going towards mental health services, it could obviously be spent more productively.
The report acknowledges the acute awareness among carers about the deficiencies of the system. Yet, despite the fact that integrated care planning is now required by law, the vast majority of catchment areas lack multidisciplinary services.
Out of 32 mental health divisions, only two have adequate staffing levels. In the other areas, there is a need to engage psychiatrists, occupational therapists, psychiatric nurses, social workers, speech and language therapists and psychologists to care for the needs of patients.
Politically, the problem is that many aspirations enshrined in the Mental Health Act 2001, which finally came into force last year, have yet to be translated into practical services on the ground.
Aspects of this legislation are laudable, especially the long overdue initiative to give mental health sufferers greater rights. Significantly, teething problems which hampered the business of tribunals set up to examine each case appear to have been overcome as 50 tribunals a week have been held since November. Above all, this reflects the desire of mental health patients to have their cases reviewed.
While almost one-in-eight patients are in institutions on grounds of intellectual disability, their needs tend to be neglected and they lack such basic services as occupational therapists and social workers.
According to Dr Finnerty, staff morale is a serious problem within the service, with many disillusioned about their role. While attitudes are changing in the area of mental health, it is painfully clear that, in many respects, this is not reflected on the ground.
Over the years, the number of inpatients has plummeted dramatically, from 20,000 in 1963 to a residual group of 3,300 with roughly the same number in the community. Disturbingly, some in community care appear to be utterly neglected, wandering the streets by day, apparently thrown back on their own meagre resources for survival.
It is not good enough for politicians to condemn practices which have gone on within the mental health service and not give those working at the coal face the wherewithal to do something about the problem.
There is an absence of logic in the way mental health resources are applied. This underlines the urgent need, not alone to beef up staffing levels, but for joined up policies to ensure resources are properly deployed.
Framing legislation is one thing — delivering the resources to ensure that services are provided is another matter altogether. Successive governments have lacked the stomach to acknowledge the scale of this problem.
It is time the Coalition delivered on its promise of a new era in mental health services in Ireland.