The Woods cover-up
Replying to the Magill expose of the state of mental hospitals the Minister for Health, Dr. Michael Woods, stated in the course of a written answer in the Dail on November 12, that a number of hospitals had been successfully adapted and renovated and provided a service of "the highest quality" but that "significantly, perhaps" none of these featured in the Magill investigation.
Four of the country's leading psychiatrists, Dr. Ivor Browne, Dr. Jim Behan, Professor Tom Fahy and Professor Bob Daly, have all stated that the Magill expose was representative of the state of mental hospitals generally. If anything, they say, it was understatement of the squalor and dilapidation that prevailed in them.
A psychiatrist, employed in the health service and who therefore wishes to remain anonymous, described the Minister's response to the Magill article as "an insult". Another psychiatrist, also employed in the health service and also wishing to remain anonymous, described Dr. Woods' reaction as "offensive, unworthy of any Minister, indicative of Dr. Woods' inability to face facts".
The full text of the Minister's statement, made in reply to a quest,ion from Deputy Michael O'Leary, TD was:
No action has been taken by my Department as a direct result of the recent media reports on psychiatric hospitals to which the Deputy's question refers. My Department in conjunction with the health board has an ongoing programme of up-grading accommodation in the mental hospitals - £11 million of capital resources has been expended on these hospitals in the ten year period ended on 31st December 1979. In addition, health boards provide for the maintenance and renovation of existing buildings in their revenue budgets. The majority of our mental hospitals were built in the nineteenth century and consequently are difficult and expensive to maintain. A number of health boards have succeeded in adapting and renovating accommodation with a high degree of skill and dedication and therefore the services provided in these hospitals are of the highest quality. Significantly, perhaps, none of these hospitals featured in the media reports referred to by the Deputy. N or indeed did any of the better units in the hospitals visited feature in these reports. Much remains to be done in some hospitals and I in tend to pursue vigorously with the health boards concerned the problems with improving these units.
The significance of the £ II million which has been allocated for capital expenditure on the mental hospitals over the last 10 years can best be appreciated in the context of the fact that it would cost £10 million to maintain St. Brendan's Hospital alone in its present state of dilapidation, where buildings are unsafe, ceilings have fallen in on patients' beds and squalor and disintegration predominate. It would cost £20 million to replace Our Lady's Hospital in Cork (see accompanying photograph).
In an interview with Magill, Dr. Ivor Browne has said: "For years the Department of Health have stubbornly refused to accept and implement plans for the development of a modern community based psychiatric service as a result they have long since over and over again spent the price of this modern service by mere tinkering with outdated institutions. Consequently, we are still left today with antiquated and decaying institutions built like prisons for custodial care and inherently incapable of upgrading to modern psychiatric requirements. Tinkering with such a system in the face of modern alternatives is intolerable and to continue so tinkering with it would be a crime against the weak, the poor, the old and indeed against the good name of Ireland."
Much of the £11 million spent in the past ten years has been used on acute units. The proportion of patients to benefit from these areas varies from; 5 per cent at St. Mary's, Castlebar to : 20 per cent at St. Brigid's, Ballinasloe. Psychiatric units at the Regional Hospitals of Cork and Galway, funded out of the general hospital allocation are described by one psychiatrist as "showpieces of which the Government may boast even though between them just eighty patients are accommodated." It costs about £457 to maintain a patient at the Regional in Cork as compared to £112 per week in Our Lady's Hospital.
Psychiatrists were unable to point to psychiatric hospitals where "services of the highest quality" exist as stated by the Minister for Health to abound in "a number of health boards". Two or three hospitals were the most any psychiatrist could name as providing an adequate service. St. Dympna's Hospital in Carlow is held up as an admirable example. Dr. Blake, the Chief psychiatrist, explains that this hospital caters for 330 patients and facilities are adequate for the local population to be served.
Since the late 1960's Health Boards in each region have been producing reports on how the psychiatric services could be improved. A Report from the Eastern Health Board is due out this month and will reach the Minister for Health early in 1981, in time to be considered before the next budget. Since 1967 the Eastern Health Board has been producing successive detailed reports and plans for the decentralisation of the Psychiatric Services from an institutional to a community base, none of which have been implemented to any significant degree by the Department of Health. Recommendations made in 1970 would if implemented then have cost £1.5 million. The same needs exist today on a greater and more urgent scale at an estimated cost of £30 million.
The last Report in 1978 contained over one hundred policy recommendations and fifty specific proposals over a five year period. Three years later less than ten of these have been implemented.
Dr. Jim Behan, Chairman of the Eastern Health Board Committee which prepared both the 1978 Report and the latest edition now warns that "The Department of Health must now take this as notice that they are facing a £30-£35 million Development Programme which they cannot evade by pouring a few million pounds into old institutions which have long outlived their use."
Dr. Behan states that "in the Health Act of 1970, responsibility for policy making was transferred from the local
Health Authorities to central Government. The then established Health Boards fell victim to a process of centralisation in which, by controlling the allocation of resources, the civil servants effectively control policy making. An imbalanced distribution of resources to various sectors of the health services resulted in the scandalous state of neglect in the psychiatric services, as portrayed in the October edition of Magill.
"Since 1970 the annual expenditure on voluntary and general hospitals of the private sector has risen to four times the non-capital allocation and sixteen times the capital allocation
made to the psychiatric services. Voluntary and general hospitals are directly funded by the Department of Health, outside the control, scrutiny or accountability of the Health Boards.
This imbalanced allocation of public funds warrants referral to the Committee of Public Accounts to establish
if it is in breach of the Health Act.
"Responsibility for this imbalanced allocation of resources rests equally on successive Ministers for Health and on the Secretary of the Department of Health, Dr. Brendan Hensey. The Minister carries the ultimate statutory responsibility but I contend that the Secretary of the Department must be considered to be culpable for the present state of neglect of the psychiatric services. I believe the personal policy of Dr. Hensey in developing the Health Services in Ireland is to develop the General Hospital system to the exclusion of the psychiatric and geriatric services. The Secretary does not understand or believe in these latter services. It is unprecedented to name a senior civil servant in a controversy such as this. However, a new principle arises when Central Government takes over control for policy making and allocation of resources to the exclusion of publicly accountable elected local bodies such as Health Boards; when civil servants effectively make policy by Ministerial default, they must become publicly accountable for their actions. The Minister for Health can over rule his Secretary, but successive Ministers have found their Secretary's policy to be politically expedient as there are votes in the general hospital sector but not in the psychiatric and geriatric services."
It was not until 1979 that, as Minister for Health, Mr. Charles Haughey met an Eastern Health Board deputation to discuss the 1978 Plan for the develop men t of the psychiatric services. "He explained to this deputation that he did not have the required £25 million for the development of a modern psychiatric service and asked the Committee to reconsider their proposals and to return with a cheaper version of the plan spread over seven to ten years, utilising rented accommodation rather than building new premises." Dr. Behan explains that "it was pointed out to Mr. Haughey that the proposed plan for the Eastern region at £25 million in 1978 terms represented the financial equivalent of one of the four major general hospitals he proposed to build in this region over the next four years at a
cost of over £ 100 million."
Now that this Report has been revised, Dr. Behan states that "if, when it is presented to Mr. Haughey's successor, he again pleads that he does not have £30 million to invest in the psychiatric service, whilst continuing to invest over £120 million in building four general hospitals in the Eastern region, the Government will be facing a charge of moral bankruptcy over their treatment of the psychiatric services."
Main points of the forthcoming 1980 report:
THAT THE HEALTH BOARD:
*Formally advise the Minister for Health that the Psychiatric Service has been chronically neglected since
the establishment of the Health Board in 1970.
*Take cognisance of the fact that the very existence of a state of neglect of the psychiatric and geriatric services is irreconcilable with the moral values and social conscience of this country.
*Reaffirm its policy to decentralise the Psychiatric Service from an institutional to a community base, providing a full range of treatment facilities in each community sector (to include acute and long stay in-patient units, day hospitals, residential hostels, group homes and rehabilitative services).
*Advise the Minister that the present conditions in the psychiatric service constitute a breach of fundamental civil rights for patients.
*Implement its statutory right and obligation to lay down minimum standards of treatment services in its area, imposing on the Department of Health the legal onus for providing the necessary resources.
*Should not defend any action taken against it for failure to provide minimum acceptable and necessary to levels of treatment facilities until adequate resources are provided, but should enter a plea of statutory in-competence in its defence
*Demand that greater autonomy for policy making and control over adequate levels of resources be returned to the Health board and its role in the policy making process be upgraded to the status of equal partner.
*Demand that the senior administrative structures of the Department of Health be restructured to provide a balanced Health Service Development Policy.
*Request that an Assistant Secretary be appointed to the Department of Health be appointed by an interview process which will ensure that they have a balanced understanding of all areas of Health Policy.
*Request that the Health Act 1970 or the Constitution be amended to provide a “right to treatment” charter requiring minimum levels of treatment facilities for the psychiatrically ill, mentally handicapped and aged.
* Request that the Mental Health Association be given a grant by the Health Board to enable it to pursue, in court if necessary, the provision of an adequate psychiatric service.
*Request the Minister to direct the Voluntary Health Insurance Board to stop discriminating against the psychiatrically ill, the handicapped and the long stay patients by the inadequate level of insurance cover provided for these groups.