Scandal of mental hospitals persists

Repeatedly, the Inspector of Mental Hospitals has described conditions in some hospitals as "intolerable", "deplorable" and a "blot on the Health Services" By Vincent Browne

Over 23,000 people are admitted to mental hospitals in Ireland each year. In many instances some of these 23,000 people are accommodated in conditions that the Inspector of Mental Hospitals repeatedly has described as deplorable. In addition, the Inspector has noted in his most recent report (2003) sharply divergent conditions available for private patients in private hospitals and public patients generally.

In particular, he has described conditions in the Central Mental Hospital, Dundrum, Dublin as "intolerable" and has been sharply critical of conditions in several other hospitals, notably St Brendan's Hospital, Grangegorman, Dublin; St Brigid's, Ballinasloe; St Finan's, Killarney; and St Loman's, Mullingar.

For 14 years Dermot Walsh has been reporting annually on the state of mental hospitals in Ireland, as Inspector of Mental Hospitals. For many of those years he has been repeating the same condemnations of conditions and services to the indifference of the Department of Health and Children and the indifference of the government and the Dáil. He published his final report in the autumn – he has retired and the role of the Inspectorate is being taken over by a new Inspector of Mental Health Services – and in it he reiterates some of the more trenchant criticisms he has made over the years.

On divergent standards in public and private accommodation he writes: "The contrast in conditions between private and some public accommodations gave grounds for concern. St Patrick's Hospital, Dublin, an exclusively private hospital and the new ward in St John of God, Stillorgan, reserved for private patients, with their high standards, stood in stark contrast, for example, to the Victorian realities of Ward 1, St Brigid's Hospital, Ballinasloe. In the case of the new admission ward in St Patrick's, the contrast with the acute admission wards of St Brendan's Hospital, a few hundred yards across the Liffey, could hardly have been more striking and clearly brought into focus current inequities in our provision for the different groups".

He notes how the number of patients in psychiatric hospitals has decreased since 1987 when there were 11,114 patients, as compared with just 3,701 at the end of 2003. The removal of mental patients from institutional care to community services has been the strategy of the Department of Health since the 1960s, driven in part by a cost-cutting imperative. However Dermot Walsh comments: "The Inspectorate had been struck by how little rehabilitation took place in community residences and how their management was orientated towards continuing rather than decreasing dependency". He notes also: "Since the 1966 Commission on Mental Illness Report, greater involvement of primary care in detecting and treating psychiatric illness had been a major but generally unachieved aspiration".

In his 2002 report, Dermot Walsh had written the following on conditions in St Brigid's Hospital, Ballinasloe:

"Because of the Inspectorate's concern over many years on conditions pertaining in St Brigid's Hospital, Ballinasloe, and the lack of improvement in matters in that hospital over recent years, the Inspectorate decided to interview senior members of staff individually to ascertain from them their views as to why matters had not improved. In the course of the two days of inspection, as well as inspecting all in-patient locations and a sample of community services in Ballinasloe, the Inspectorate interviewed in a formal manner senior members of the management team of the service.

"As a result of these interviews, the Inspectorate formed the view that the senior management at St Brigid's Hospital was unable to make progress in improving the service because of obstruction by nursing representative bodies and by a perceived lack of support for the management team's initiatives by senior Western Health Board (WHB) management when the nursing organisations intervened, as they frequently did, to obstruct and impede progress.

"In many instances exemplifying this state of affairs, senior figures in St Brigid's individually informed the Inspectorate that they had collectively formulated a policy and plan towards down-sizing and rearranging wards in St Brigid's with a view to the provision of improved and alternative care facilities. When, in December of 2001, they presented this plan to the nursing representative bodies, they were informed, in no uncertain terms, that the nurses would not co-operate in the introduction of any of the mooted changes and that should hospital management attempt to introduce them, there would be immediate, widespread industrial action.

"In the light of this threat, a representative of senior management of the Western Health Board came to St Brigid's, met with senior local management, and suggested that the status quo should remain whilst engaging fully with staff representatives. In effect, nursing representative bodies had virtual control of anything that happened, or did not happen, and therefore local management felt powerless and disenfranchised. It had thus proved impossible to improve conditions in St Brigid's and to move forward with any major plan of improvement.

"Conditions in Wards 1, 2, 3 and 5 could only be described as a deplorable blot on the health services of this country. Ward 1 should long ago have closed; it was used as a male, locked ward, was barren, devoid of any reasonable furnishings or decoration and its occupants remained in this throw-back to the large mental hospitals of a century ago, unoccupied and idle, for the most part. No rehabilitation or serious occupational activities were in place for patients.

"Wards 2 and 3 contained high proportions of intellectually-disabled persons, mixed with those with mental illness. Here, again, conditions were physically very poor and patients had no opportunity of sustained occupation, diversion or rehabilitation. The same story was repeated in ward after ward of the old hospital, although physical conditions were not as abject as in some of the other wards. Very few of these patients left the wards to get fresh air or to go to rehabilitation activities and most of them spent their days unoccupied".

In his 2003 report he writes that following the 2002 inspection he issued a special report on conditions in Ballinasloe to the Minister for Health and Children. Arising from that the Western Health Board established a working group and appointed a project manager. However Dermot Walsh writes: "what was clear to the Inspectorate however was that progress had been slow and the Group would continue its deliberations for some time yet. Conditions in most wards of the old building remained unchanged and staff should not be expected to work or patients be cared for, in them".

As he had done repeatedly in reports over the last decade, he is excoriating about conditions in the Central Mental Hospital in Dundrum, Dublin. "The seclusion accommodation in Unit 1 and Unit 4 was unfit for a mental institution of the twenty-first century. All patients in the old building of the hospital were locked into rooms at night and had to slop out in the mornings, as there was no in-room sanitation.

"The courtyard in the main building, used exclusively by patients in Units 1 and 2, was in a disgraceful condition. Guttering was missing from parts of the building, external doors had not been painted, garden furniture was broken, the grass was covered with litter and the general appearance was unkempt.

"The hospital continued to provide accommodation in surroundings that were unacceptable either in environmental or treatment terms. The Inspectorate had reiterated year after year that conditions in then hospital were non sustainable from a human rights perspective and support for this point of view had come from an international source, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment on its two recent visits to the Hospital".

Commenting on the psychiatric unit at James Connolly Memorial Hospital (JCMH) in Blanchardstown, following a visit there in July 2003, he notes: "The Inspectorate was of the opinion that there were very serious problems with this service. The existing acute admission unit, Unit 9, JCMH was of extremely poor quality and unacceptable for patient care; the Inspectorate had no hesitation in condemning it outright". Later on he notes: "(patients) were being admitted to totally unacceptable conditions in Unit 2 in James Connolly Memorial Hospital, where there was inadequate heating and the roof leaked".

On St Brendan's Hospital, Grangegorman, Dublin, he writes: "Patients continue to be admitted to and cared for in conditions that were unacceptable".

St Loman's Hospital, Mullingar drew the following comments: "Whatever its architectural merit (the hospital) was a grim structure which was not helped by the virtual neglect of the grounds evident on this visit. The female admission unit was in unsatisfactory accommodation. Improvements fell a good deal short of what was appropriate in a modern acute admission facility".

On St Finan's Hospital, Killarney, he writes: "Conditions in St Finan's Hospital were quite unacceptable. This was particularly true of the male wards, St Peter's, St Paul's and St Joseph's. Conditions in Our Lady's ward, where staff were coping valiantly with unsatisfactory conditions also exemplified the unsuitability of this old building to modern practice".

Of St Stephen's Hospital, Glanmire, Cork, he writes of "its fundamental unsuitability for modern psychiatric care". Of the South Lee Mental Health Services he writes: "There were serious deficiencies in this service as a result of very little development during recent years".

On conditions in St Mary's Hospital, Castlebar, he writes of "intolerable conditions prevailing in the intensive care unit in St Mary's Hospital".

Improvements have been made in psychiatric care over the last 40 years but, as Dermot Walsh has repeatedly noted, intolerable conditions prevail throughout the country primarily because of inadequate funding. And that lack of funding prevails because of the indifference of the political system to the treatment of mental patients, because there are no votes in mental hospitals.p