Mental health

The 2005 report of the Mental Health Commission reveals shocking conditions and shocking neglect. By Vincent Browne

In 1981 a new mental health act was passed by the Oireachtas to guarantee the rights of people admitted involuntarily to mental hospitals. The provision of the act providing safeguards for patients' rights, was never brought into effect. In 2001 another mental health act was passed by the Oireachtas, providing detailed safeguards for patients admitted involuntarily to mental institutions. The safeguarding provisions of the act have still not been introduced, in part because of a refusal by psychiatrists to participate in the procedures outlined. However, this obstruction has now been overcome and it is expected the provisions of the act will be implemented by 2007.

This is announced in the 2005 report of the Mental Health Commission. In the introduction to the report the commission chairman, John Owens, a psychiatrist, comments on the psychiatric services as "inappropriately institutionally-based, lacking true, multidisciplinary, community mental-health teams, with limited user involvement and poorly structured, inadequate management systems".

Referring to people with severe mental illnesses he writes: "These people still make up the majority of in-patients and, while many have been discharged to alternative community residences, this has often been an exercise in relocation, serving the priority of closing mental hospitals rather than a treatment and rehabilitation exercise in its own rights.

"There are now in the region of 3,000 people living in community residences. Many of these individuals lack personal care plans and regular clinical review. The treatment of these people is too often restricted to the narrow, medicated-based model."

The commission report includes the report of the Inspector of Mental Health Services, Teresa Carey. This is the most damning report on the mental health services published in many years.

Referring to several large mental hospitals that are still in being she writes: "There is no accounting for the continued and vigorous existence of these facilities 20 years after national policy dictated that they should be closed."

She writes later: "It is not acceptable… that annual reports of the inspector should recount the same deficiencies year on year."

Later: "Most patients in long stay wards have not undergone any formal assessment of care and accommodation needs and most do not have an integrated care and treatment plan. In some cases regular psychiatric and medical reviews have not taken place…

"Most long-stay wards are located in large psychiatric hospitals built in the mid-1800s. The physical conditions of many of these wards are poor, with inadequate sanitary facilities, lack of privacy and absence of personal space. In a few cases conditions on the wards are extremely poor with leaking ceilings, damp, peeling paint, holes in the walls and no curtains around the beds…

"[These] are, to a considerable extent, the forgotten people in the mental health service. Many have lost contact with their family, their friends and their community of origin, and so lack the vital support and advocacy role that such personal contacts provide."