Irish Examiner view: State falling behind in provision of mental health care

Report reveals a worrying gap between independent providers and the HSE

People with mental health struggles are not receiving the care that they need.

By any yardstick you care to apply, working with mentally ill people is a tough and demanding role requiring empathy, understanding of what can be complex behaviours, and physical and emotional resilience. And it is not becoming any easier, judging by by the contents of the 2021 Mental Health Commission report for Ireland.

The MHC’s latest audit of activity covers a substantial part of the period encompassing the Covid-19 pandemic, pressures induced by lockdown and a loss of personal liberties within a patient sector that can already be subject to constraints beyond the experience and imagination of many of us.

The commission produces a substantial analysis of the challenges it faces in dealing with individual patient care and the multiple examples of personality disorder which require differing levels of treatment. And, worryingly, it concludes that the State is falling behind in its provision.

It warns that a gap is emerging between independent providers and the HSE, particularly in relation to premises and individualised and consistent care planning. While some efforts have been made to increase investment, the current approach to structural improvements in a significant number of HSE centres is inadequate. Capital expenditure is falling behind and engagement with care planning falls short.

Need for leadership

There is, says the MHC, an essential “need for enhanced leadership and governance”. But is there any area of public life where this is not the case?

Their services cover a formidable list of responsibilities: acute adult mental health care; continuing mental health care; psychiatry of later life; mental health rehabilitation; forensic mental health care; mental health care for people with intellectual disability; child and adolescent mental health care (Camhs).

At the end of 2021, there were 2,657 inpatient beds across the country while there were 786 adult beds in the independent sector, of which 770 were in Dublin. The National Eating Disorders Recovery Centre had an allocation of six beds.

Deaths tell a different story. Some 58% of deaths reported in 2021 related to male residents. The average age of a resident was 61 years of age. The youngest resident was 18 years of age, and the oldest resident was 101. This is a huge range for nursing staff to manage.

Electroconvulsive Therapy (ECT), a medical procedure in which an electric current is passed briefly through the brain via electrodes applied to the scalp to induce generalised seizure activity, remains a prevalent treatment in Irish institutions. In 2021 there were 333 programmes of ECT for 229 residents in 16 approved centres. This compares to 300 programmes of ECT for 239 residents in 2020. The youngest was 22 years old and the oldest 95. There were a total of 2,282 individual ECT treatments, compared to 2,329 in 2020. Nearly 87% took place with the patient’s consent.

Seclusion

Seclusion, where a person is placed or left in a room alone with the exit door locked or are otherwise prevented from leaving, is also audited by the MHC. It found that last year there were 1,884 episodes of seclusion involving 654 residents in 27 approved centres. The shortest episode reported was three minutes, while the longest was 5,237 hours (218 days). 

The Inspector of Mental Health Services has to be notified if a resident is secluded for a period exceeding 72 hours. The MHC received 49 notifications from seven approved centres of seclusions that lasted longer than 72 hours in 2021.

The annual report shows an organisation struggling to do its best with a shortage of resources. Successful trials to use video-conferencing for tribunal hearings were wrecked by the HSE cyber attack which meant a return to communicating by fax machine, resulting in hundreds, often thousands of pages being faxed to and from approved centres each day.

Mental health and its support, will become an ever greater challenge with increasing pressures created by the cost of living, housing, and European war. The Mental Health Commission is on the front line of that experience. It must not become an increasingly privatised response.