Concern over poor mental health rehab services

They have been "grossly under-resourced"
  • Deborah Condon

The Inspector of Mental Health Services has expressed her disappointment at the "continued lack of development" of mental health rehabilitation services in Ireland.

The aim of rehabilitation is to enable a person with mental health problems to maximise their potential to live a full and active life within their family, community, education and/or workplace. This can include inpatient and community care and the focus is on improving quality of life and levels of social inclusion.

However, according to a new report by the Inspector of Mental Health Services, Dr Susan Finnerty, Ireland is failing in this area.

She explained that while there have been many developments in mental health treatments in recent years, "some people continue to present with particularly complex problems that require longer-term care". However, many are simply not receiving appropriate care.

"Early access to rehabilitation interventions has been associated with better functional outcomes and making rehabilitation available across the continuum of care may reduce health costs by shortening hospital admissions, reducing activity limitations and improving quality of life.

"It is disappointing, therefore, to observe the continued lack of development of mental health rehabilitation services in Ireland," she said.

She noted that the long-term neglect of people with severe and enduring mental health problems has negative outcomes for the service users and their families, and has a financial cost to the State. This is because funding ends up being "diverted to providing long-term care in highly staffed, costly residential care instead of in therapy, training and support for people living in their own homes".

Dr Finnerty pointed out that the 2006 national mental health policy, A Vision for Change, which was meant to provide a blueprint for services in the future, recommended a total of 48 rehabilitation teams based on current population.

"Today, we have only 23 very poorly staffed teams. Our only specialist rehabilitation inpatient units are privately provided, with the HSE funding beds providing an out-of-area service, a practice which has been strongly criticised internationally.

"We have over 1,000 people in highly supervised residences with little or no prospect of moving to more independent living due to lack of both adequately resourced rehabilitation teams and suitable accommodation," she noted.

She said that there are areas with no access to rehabilitation services at all. For example, in Donegal, there is no rehabilitation team and just four nursing staff are providing a recovery service "as best they can and with few resources".

Meanwhile, there is a "large cohort of people" in continuing care inpatient units who could live in more independent accommodation, "but do not have access to rehabilitation and recovery-focused care to enable them to do so".

As a result, some people are "trapped in the acute system of inpatient mental healthcare because the services are not in place for them to be discharged".

Dr Finnerty also pointed out that there is an unknown number of people with enduing mental illness who are living on their own or with families, who need rehabilitation services in order to fulfill their potential "to live satisfying lives in their own communities".

She said that the frustration of those affected, including rehabilitation staff, is evident nationwide.

"To provide a rehabilitation service, there must be adequate supported housing with varying levels of support, an adequate number of rehabilitation teams to provide the service, adequate number of suitably trained staff, and funded evidenced-based therapeutic programmes. To date, these have not been provided to an acceptable level," she insisted.

Dr Finnerty acknowledged that a new Model of Care for the provision of rehabilitation services was launched last month. However, she emphasised that this is a development in a service that has been "grossly under-resourced and where provision of care pathways have been mostly absent".

"It will be imperative that funding is made available to implement this, and that there is prioritisation of providing care pathways for people with severe and enduring mental illness, rather than simply providing highly supported residential care.

"The short-sightedness of not providing adequate mental health rehabilitation services, from both a human rights and a financial viewpoint, is quite astounding," she added.

Dr Finnerty's report, Rehabilitation and Recovery Mental Health Services in Ireland 2018/2019, can be viewed here.


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