Dáil Éireann debate -
Tuesday, 7 Dec 1999

Vol. 512 No. 3

Adjournment Debate. - Inspector of Mental Hospitals Report.

Mr. Neville

I thank the Chair for giving me the opportunity to raise this matter. The report of the Inspector of Mental Hospitals for the year ending 31 December 1998, published in November, reveals a serious and disturbing picture. It is an indictment of the State's treatment of one of the most vulnerable groups in our country – the mentally ill. Those patients have been neglected, ignored and stigmatised for decades. As of 31 December 1998, 5,110 patients were in psychiatric hospitals and acute units.

The inspector expressed his concern at the lack of multi-disciplinary teams in many of the mental health services. It is not acceptable that, for example, one health board with four mental health services has no social worker in any of them. This has been repeatedly drawn to the Minister's attention yet no action has been taken. It is not acceptable that psychological services are poorly represented and in some cases non-existent. What plans, if any, has the Minister to deal with matter? It is unfair to ask the Minister of State at the Department of the Taoiseach to respond to this issue, which is the responsibility of the Minister for Health and Children.

At a time of highly developed medical treatment in general hospitals, it is nothing short of sheer discrimination, bordering on abuse, that drug prescribing in some locations is often arbitrary and made without regard to appropriate clinical diagnosis. The inspector was concerned at the number of patients, particularly long stay patients, who are on numerous drugs simultaneously, often on high doses. In some instances, the prescription had not been reviewed for some time. Does the Minister accept that medication should be reviewed at frequent intervals and that failure to do so is a sign of serious negligence which should be investigated by his Department?

The inspector reported an increasing number of sudden deaths in psychiatric hospitals, some of which were attributed to drug-related effects. Does the Minister agree that the description by Vincent Browne in The Irish Times of this gross abuse, is correct? He stated that “the Inspector's comment implies that very serious crimes, either manslaughter or criminal negligence may have been committed”.

Medical note taking and keeping medical records is an important tool in the management of modern medical systems. I am extremely concerned at the inadequacy and quality of medical note taking in some mental health services. This relates particularly to consultant input both on or shortly after admission to hospital and subsequent clinical reviews and progress. Surely this approach should not be tolerated? Will the Minister outline to the House the action he intends to take on foot of this information?

There were 504 suicide victims in 1998, an increase of 14% on the previous years. One of the key recommendations of the National Task Force on Suicide was that steps should be taken to make the health services, including mental health services, more accessible to the public, particularly the young, who may perceive them as not readily available to address their needs at times of crisis. Psychiatric community services, especially in rural areas, are totally inadequate and are the Cinderella of the health services. There are inadequate day hospitals and community residential facilities for persons with psychiatric disorders. It is not acceptable that in some hospitals as many as half the acute psychiatric beds are occupied by persons who do not need such a high level of in-patient care. A major reason for this is the absence of appropriate alternative residential facilities.

The services to our fellow citizens who are suffering from mental illness is disgraceful and is adding to the stigmatisation of people who are suffering from a psychiatric disorder. The Minister must, as a matter of urgency, deal with and respond to this scandal. The abuse of people is horrifying, particularly when it is done by the system to the most vulnerable citizens in our society, who deserve special vigilance and care. How we treat these citizens is a profound indictment of our society and our values.

I refer to the situation in the mid-west. No progress has been made in implementing a development plan which would involve the gradual relocation of mental health services, which are currently on the campus of St. Joseph's Hospital. There is no objective to provide other services in the mid-west area.

While I appreciate the Minister of State responding to this matter, I am disappointed the Minister for Health and Children is not here.

Mr. S. Brennan

The Minister for Health and Children, Deputy Cowen, sends his apologies. However, I will draw his attention to the Deputy's comments. Nobody in this House or in the country doubts Deputy Neville's sincerity or the great work he has undertaken, almost single-handedly, on these issues for many years. Most of his colleagues in the House admire the way he has done that. He has pioneered a genuine concern in this area.

The report of the Inspector of Mental Hospitals for the year ending 31 December 1998 was laid before both Houses of the Oireachtas on 5 November 1999. In his report the inspector noted the continuing decline in the number of patients in psychiatric in-patient facilities from 5,192 at the end of 1997 to 5,101 at the end of 1998. There were almost 26,000 admissions to these facilities in 1998, of which approximately 6,000 were first admissions. The proportion of patients being admitted to general hospital units continued to increase and in 1998 accounted for approximately one third of all admissions. A further 15% were admitted to private hospitals. The number of involuntary admissions at approximately 2,500 remained constant at 10%.

A number of welcome developments were reported in many of the health board regions during 1998. Examples of these developments included the opening of new community residences in a number of the mental health services in the Eastern Health Board area, the purchase of the extensive day facility in Portlaoise town, the acquisition of further residential accommodation in the Clare mental health services and the opening of a refurbished residence in Strokestown, County Roscommon. Although the inspector acknowledged the significant progress that has been made in the provision of community mental health centres, day hospitals and community residential facilities for persons with mental health disorders, he stated that the rate of progress needs to be accelerated.

During 1998 the inspectorate published the document, Guidelines on Good Practice and Quality Assurance in Mental Health Services, which stressed the areas of performance which were felt to be important for patient care and which needed improvement in some cases. The importance of patients' rights across a broad range of issues was stressed and the responsibility of mental health services in such matters was highlighted. The document was distributed to all mental health service providers.

Concern was expressed by the inspector at the lack of multidisciplinary teams in many mental health services, particularly in the area of psychology and social work services. The Department provided additional resources to health boards in 1999 to enable some improvements in paramedical support to be put in place. It was hoped to continue with this initiative as resources permitted. On 1 December 1999 the Minister for Health and Children announced that an additional £1.4 million was being allocated in 2000 to address this issue.

The problem of homeless mentally ill persons, particularly in large urban areas such as Dublin, was highlighted in the inspector's report. The Eastern Health Board had made efforts to address the problem by providing a residential unit for the homeless mentally ill in St. Brendan's Hospital and a new day service at Usher's Island in Dublin. The specialised outreach service for this group of people who work closely with voluntary agencies was in its infancy but was considered an essential service. In response to the inspector's concerns, additional resources have been allocated to the Eastern Health Board for 2000 to provide an additional specialist team for the homeless service.

On its publication, the Minister welcomed the inspector's report and acknowledged the crucial role the inspectorate, as an independent body, played in providing an accurate and detailed account of services in the mental health sector throughout the country. The Minister stressed the importance of publishing the inspector's reports as soon as possible in the year following inspection and said he had asked the inspectorate to finalise the 1999 report at the earliest possible date.

Following the publication of the inspector's report, controversy has arisen about the issue of sudden deaths occurring in the mental health services. In The Irish Times on 17 November one of its columnists drew attention to a statement contained in the report which noted the increasing number of sudden deaths in psychiatric hospitals, some of which were attributed to drug-related effects. From this statement the columnist drew some alarming conclusions. In the circumstances and in order to allay any anxiety that public comment on this matter may have caused to psychiatric patients or to their relatives or friends, the Inspector of Mental Hospitals felt it was important that his remarks be clarified.

In his response the inspector states that it has been known for a long time that persons suffering from psychiatric illness had a higher mortality and poorer life expectation than the general population. This raised mortality is due to a variety of causes of death, some the consequence of health damaging lifestyles associated with psychiatric disorder, such as cigarette smoking, alcohol or drug abuse, faulty dietary habits and self-induced or community determined social exclusion. These factors result in greater mortality from cardiovascular diseases, cancers and other less common causes of deaths. To these must be added sudden causes of death, such as suicide and deaths believed to be drug-related, both of which have increased in this country in recent years. These latter two causes of death are by statute reported to the Inspector of Mental Hospitals when they occur in psychiatric hospitals and units in general hospitals.

Since 1983 sudden deaths among patients suffering from psychiatric illness have increased from 23 in 1983 to 36 in 1998. Of those deemed on clinical grounds and by coroners to have been due to suicide, the numbers have gone from 15 in 1983 to 20 in 1998.