Some grim snapshots from our mental health services, supplied by Dr Siobhan Barry of the Irish Psychiatric Association (IPA):
*A large old-style psychiatric hospital in Wexford is no longer fit for purpose yet continues to house in-patients. It was previously fined after sewage leaked from its inadequate sewage facility into the local river. The lift system at the hospital broke down and had to be replaced at great expense. While taxpayers' money is spent on the upkeep of the building, the local community mental health service is poorly developed.
*For more than 20 years it had been planned to move in-patient acute psychiatric care from St Ita's Hospital in Portrane, North Dublin to a new unit at Beaumont Hospital. It emerged recently that the site earmarked for the psychiatric unit is to be used for the planned co-located private hospital. Beaumont says it plans to secure a site on its campus for the psychiatric unit, but 'all has now gone silent' on the original plan, the site earmarked for the unit has gone, and the momentum is lost.
*Funding planned to be used to implement the Government's 'Vision for Change' document on developing mental health services, published two years ago, has been used elsewhere within the health services. Staff numbers promised under the document have not been delivered on.
*Many HSE buildings and lands formerly used for psychiatric care have been 'asset-stripped' by selling them and reinvesting the funds in other parts of the health service.
*Many long-stay psychiatric in-patients are housed in very poor conditions.
*Where old-style psychiatric institutions are being dismantled, corresponding community resources are not being developed.
*Reports on the development of mental health care in Ireland are largely left on the shelf. "There is a sense that once the report is written, the work is done."
Dr Barry, a consultant psychiatrist and spokesperson for the IPA, says the psychiatric services in Ireland have always had a low priority in political and health planning terms and this has not changed in spite of the Government's much-vaunted 'Vision for Change' document of 2006.
She points out that a similar 'vision-type' document, "Planning for the Future' was produced aimed at redeveloping services back in 1984, but fell victim to the health cutbacks of the late 1980s. Now, nearly 25 years on, little has changed, according to Dr Barry.
"At the launch of 'Vision for Change' two years ago it was indicated that certain personnel resources would be put into services. In the first year after the report only one-third of the staff promised for employment in the first year were in place. Two years on, the funding that was supposed to support those staff had been used elsewhere in the health service."
"What we have is a policy document that is very good, but the resources promised to implement it have been frittered away," she told irishhealth.com
It is not just the IPA, but the statutory watchdog, the Mental Health Commission too has been sharply critical of the lack of progress in developing our mental health services.
The Commission pointed out recently that despite the clear need to reorganise and redevelop our mental health services, the HSE's service plan for this year had no specific targets in relation to implementing the 'Vision for Change' policy.
Dr Barry says the IPA's recent report, 'The Lie of the Land' showed that where old mental hospitals and lands were closed down, the resources accruing usually did not go back into mental health services.
"The resources from buildings and lands should have been conserved, ring-fenced and reinvested to build modern health centres, to build day hospitals and in-patient care where that is still needed. But these developments haven't really happened. The implications (of current mental health policy) for the person on the street are that institutions have begun to be dismantled and the corresponding community resources haven't really been developed."
Dr Barry adds that many in-patients in acute beds in psychiatric centres, who may no longer need hospital care, are left 'high and dry, as they cannot be discharged due to the shortage of appropriate community facilities.
This, she says was highlighted in a major report in 1998 but the bed situation has not really changed since then.
The poor conditions which many long-stay psychiatric in-patients have to endure was highlighted in last year's Inspector of Mental Health Services report.
Dr Barry says this "is something I feel the Mental Health Commission has a duty and a responsibility to raise, perhaps more forcefully than it has."
She points out that mental health services are administratively disorganised and there is a lack of management capacity.
"You don't have the management/strategic ability coupled with administrators to execute it. Another problem is there is no one single organisational entity within the HSE for strategic planning and developing mental health services."
Dr Barry points out that the 'Vision for Change' document proposed a national mental health directorate, but this has yet to be established.
She also points to deficits in child and adolescent psychiatry. "You have multidisciplinary teams for this specialty in the community that are very inadequately kitted out."
"Generally, in terms of mental health services, there is a huge disparity in the level of services available depending on where one lives."
So the picture painted by the IPA is a fairly bleak one: asset stripping of precious resources; administrative disorganisation; no real administrative or policy direction; long-stay patients housed in sub-standard facilities; not enough acute beds, underdevelopment of community care; understaffing in many areas, and mental health spending priorities cast aside when money is needed to bale out other parts of the health service.
Says Dr Barry: "while all this is happening we are expected to maintain optimism and morale for ourselves and the patients we look after. It's time we drew attention to the real facts of what's going on."
This is a valuable area of research. Our psychological ill patients need care, treatment and support in a bright, pleasent enviorment within a ward setting that is safe for them. They need a highly caring qualified staff while in hospital and then a multi displinary team to care for them in all aspects of daily living on discharge. If this facility was up and running many of such people may never need hospitilation. Our society could then become a safer place because on discharge a register could be sent to the varies health region or alternative giving particulars, nature of illness, location of person and medication also next to king. Those on medication could be traced via a chip that is only visable to the team and a communication systom could be put in situ so that if the patient moved away from home they could still receive their medication via this systom. This would cost a lot of money which is not available and our government are not prepared to get involved. but I am certain that in many cases this would make a huge difference in our patient's wellfare, more icontrol of their lives, giving them more dignaty and respect as well as making our society a safer place to live. I feel empathy for very ill people who have to be admitted to our present day psychological hospitals who deserve even better than our medical hospitals.
In conclusion I thank you for your honest opinion and wish there were more caring people like you. May God always reward you for your care for the vulnerable.
In conclusion I would appreciate any reserched material on "the impact of familied bereaved by suicide
Mental health hospitals and departments could have a super deluxe standard if money was used for scientifically proven effecitive natural treaments with omega3 essential fatty acids, anti-oxidants like tumeric to treat depression, schizophrenia and other conditions. Money is wasted on drugs that can cause suicidal and homicidal behaviour. There are several review studies that show the grave danger of SSRIs but recently eight well-known Irish psychiatrists made the claim that there was no evidence. This is clear evidence of the state of wilful ignorance in Irish psychiatry.
Fatal and non-fatal suicide attempts in SSRI trials and placebo trials ....suicide, and suicide-homicide after antidepressant medication, ..... Do SSRIs Increase Suicide Risk in Adults?. JWatch General 2005: 6-6 [Full text] ...www.bmj.com/cgi/content/full/330/7488/396