Sub-standard accommodation, lack of proper therapy programmes, no proper multidisciplinary care, lack of privacy, poor bathroom facilities and understaffing are among the service deficits Ireland's 'forgotten patients' have to endure in many of our mental health units across the country.
This is according to the latest report , for 2008, from the Inspector of Mental Health Services.
The inspectorate is part of the Mental Health Commission, which oversees what is often seen as the 'Cinderella' of the Irish healthcare system, often starved of funding and of public and media attention.
Such neglect may well reflect residual stigma from less enlightened times still unfairly associated with mental illness, as well as the type of official neglect that has in the past seen funding ringfenced for mental health taken away to plug funding holes in other parts of the health system.
However, we should be grateful that, unlike the acute hospital system that gets most of the public's attention, the mental health service at least has an official system of regulatory oversight.
This means do get a detailed published report of what is happening in each mental health unit and an update on improvements that may or may not have been made since the previous Inspector's report. We are still some way from this type of regulatory oversight being introduced in our public acute hospitals, although these are due to have a licensing stystem by around 2012.
The latest Inspector's report, based on visits to the mental health units mostly in the latter half of 2008, shows improvements are being made and that there are high standards of care in many units, but that others fall seriously short in certain key areas in providing optimal care for a very vulnerable group of patients.
Some patients are still housed in the old-style outdated psychiatric units, most of which have now been phased out. Those remaining are long overdue for closure and for their patients to be transferred to more appropriate settings.
The following is a brief snapshot of some of the findings from the latest 2008 Inspector's report:
Three wards were still open in the psychiatric hospital (St Dympna's), which is an old building, the report notes. The Inspector noted that the Kelvin Grove unit for patients with intellectual disability had, as recommended, been closed down since the previous inspection. However, the 2007 recommendation that a full multidisciplinary team in rehabilitation had not yet been acted upon. The report notes that plans for the closure of St Dympna's were to have been presented recently to the HSE. Residents on one ward in St Dympna's were interviewed and said they carried out no activities during the day apart from watching TV, walking, and listening to music.
The Inspectorate noted again unacceptable conditions within St Ita's Hospital in Portrane and was disappointed to note that the fabric of the building remained unchanged. "Piecemeal maintenance and decoration had little impact on the quality of the environment for residents." There were insufficient bathing facilities in the acute admissions wards and the furniture in one unit was unacceptable. A number of residents in one unit had no bed screens in place. One resident had been denied her liberty for a period of time with no recorded review, despite her status as a voluntary patient, according to the report. The location of CCTV monitors did not support privacy. The report notes that the saga of when in-patient acute beds will be transferred from St Ita's to a new unit in Beaumont Hospital is continuing, with the unit still not provided at Beaumont. There was a deficit in total nursing staff numbers.
While some improvements in patient care policies were noted, there was still a lack of individual multidisciplinary care plans for residents. Patients interviewed agreed that the condition of the hospital building was unacceptable and that there was a lack of showers and toilets.
Despite the closure of a ward, there had been no decrease in the number of long-stay residents in St Otteran's Hospital and therefore little progress towards closure, the Inspector noted. There were no individual care plans for patients. There was an absence of privacy in one ward at St Otteran's.
St Finan's Hospital in Killarney continued to provide care in six wards despite previous assurances that one ward, Our Lady's, would be closed and residents transferred to another unit. The Inspectorate could see no justification for keeping Our Lady's ward open.The Inspector stressed that current mental health policy is that all of the old psychiatric hospitals should close, but noted ther were no specific timeframes for transfer of residents at St Finan's to other appropriate settings.
Privacy was an issue on one ward in St Finan's where there were four residents sharing a dormitory with no means of securing privacy from each other while dressing, undressing or sleeping.
The Inspector of Mental Health Services report can be viewed in full at...http://www.mhcirl.ie
See also," Looking after the forgotten service"...http://www.irishhealth.com/article.html?id=14557
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