Mental health service - HSE cannot afford to ignore advice

There was no psychiatric expert available to the gardaí to advise on the best way to deal with a psychiatrically ill man when they were confronted by John Carthy, an armed manic-depressive, at Abbeylara in April 2000. They ended up shooting him dead.

In the wake of the 2007 Barr Tribunal report into the killing, the Garda Inspectorate published 84 recommendations. Most have been implemented, such as the establishment of trained garda units to deal with sieges and hostage taking. But the three main recommendations in relation to “formal arrangements for a team of mental health professionals” to assist gardaí in a crisis involving a mentally ill person, have yet to be implemented.

The inspectorate stressed that a clear memorandum should be concluded with the Health Service Executive (HSE) without further delay on the assignment of mental health professionals to support garda negotiators if needed in dealing with psychiatrically disturbed individuals. All concerned should make the formal arrangement without further delay, the inspectorate warned, because there is a real danger that the same mistakes could be repeated in the event of a similar incident.

After more than three years, surely the three critical recommendations should be implemented. This is a reflection of the indifference that the HSE has been exhibiting towards mental health.

The Psychiatric Nurses’ Association (PNA) contends that the mental health service is in “free fall”, due to the attitude of the HSE, which is allowing the service to “disintegrate” with no regard for the safety of staff or the quality of care for patients. In the last two years 20% of the psychiatric nurses have retired.

Due to the shortage of male nurses, security companies are being hired to handle the threat posed by some patients. During 2009, members of staff were assaulted 1,314 times. In recent years it has been necessary to call on the gardaí increasingly for assistance in acute and secure units. “We are experiencing crisis after crisis on a daily basis,” warned Des Kavanagh, the general secretary of the PNA. “We have lost 1,500 staff over the last three years and this is rising.”

Despite government promises, the mental health budget is just 5.3% of the overall health budget, as opposed to 8.4% recommended in the Vision for Change. Retired members of staff are being brought back on a part-time basis in order to “maintain some semblance of service to patients,” while highly committed, well-educated, and enthusiastic new graduates have to emigrate in search of work.

The HSE indicated that its national and regional management were reviewing the area of greatest need. In other words, they are drawing up recommendations, but will the recommendations ever be implemented? During the early summer, the Department of Health and Children agreed to exempt the HSE from the government’s recruitment moratorium to hire a 100 psychiatric nurses, but none have yet been appointed.

This is no way to run the mental health service.