Dáil Éireann debate -
Thursday, 5 Oct 2000

Vol. 523 No. 3

Adjournment Debate. - Mental Hospitals Report.

Mr. Neville

I thank you, a Leas-Cheann Comhairle, for giving me the opportunity to raise the issue of the report of the Inspector of Mental Hospitals for the year ending 31 December 1999.

The treatment of those in need of psychiatric care in the State falls far short of the standard which people in deep crisis deserve. The standard of treatment is a disgrace. In his report, the Inspector of Mental Hospitals has castigated the level of service being provided for this section of society. For example, the inspector has drawn attention to areas of concern in the quality of service provided. These include the substandard nature of some long-stay accommodation. He has also pointed out many locations in which patients spend their lives where the standard of furnishing and decor is unsatisfactory.

These long-stay institutions are in a bad state of repair and are symbolic of a different era. All pre-1900 psychiatric institutions should be closed and replaced with modern purpose built hostels for long-stay patients. Facilities should be created in general hospitals for all acute admissions. Modern specialist secure facilities should be made available for the relatively small number of long-term severely disturbed patients.

The changes should include the rationalisation of the system whereby young patients, functional psychotic patients and patients with intellectual disabilities share the same wards. This rationalisation should take place immediately because it is not right that people with different types of conditions are kept together, despite their need for different specialised treatments. People with intellectual disabilities are not mentally ill and should not be in a psychiatric hospital. There are still approximately 300 such patients in psychiatric in-patient care, excluding St. Joseph's unit at St. Ita's Hospital. This is a totally unacceptable situation. The inspector takes a serious view of this degradation of appropriate care delivery to both patient groups. The inspector pointed out that the clinical review of long-stay patients on a regular systematic basis is essential. It is important that the rehabilitation of long-stay patients is not neglected.

As regards elderly people, the physical disabilities of their age rather than any major psychiatric impairment is their main problem. The Government should introduce a policy of de-designation from the psychiatric services and establish high quality services for older people to deal with their physical ailments. This has long been advocated by the Inspector of Mental Hospitals for these patients. No progress on this issue was made in 1999. This should not be tolerated and the Minister should act immediately.

It is not acceptable that there is concern about documentary matters on patient care issues, such as case note entries and the recording of reasons for seclusion and for extending temporary patient reception orders. The reason patients are not given their own clothes shortly after admission has again been raised in this report. It is not acceptable that there is a poor level of communication with relatives, that there is not any complaints procedure or mechanism in some services and that there is not any public display of patients' rights, as set out in the Mental Health Act, 1945. The Minister must ensure this is corrected immediately.

The inspectorate has always been committed to moving away from a traditional mental care delivery system which was dominated by the doctor nurse model, while at the same time realising that the nursing profession will continue to provide the bulk of 24 hour treatment and care for the mentally ill. I ask the Minister to respond to the inspector's view that there is much evidence that other skills, such as those of psychologists, social workers and occupational therapists, are necessary components of service delivery. Without them, adequate treatment and management in the broader sense is more difficult. The absence or shortage of such professionals in many mental health services represents a serious reduction in service quality. What measures will the Minister introduce to ensure that multi-disciplinary teams are available, as advised by the inspectorate?

The inspectorate points out that it has been known for a long time that persons suffering from psychiatric illness have a higher mortality and poorer life expectations than the general population. It is of concern that there were 37 deaths in in-patient care in 1999, of which 14 were suicide. Surely this level of suicide in our mental institutions is totally unacceptable. The Minister must immediately examine why there is such a high level of suicide while people are in the care of State institutions.

Dr. Moffatt

I thank Deputy Neville for raising this issue on the Adjournment. I am taking this debate on behalf of the Minister, Deputy Martin.

The report of the Inspector of Mental Hospitals for the year ending 31 December 1999 was laid before both Houses of the Oireachtas on 28 July 2000. In accordance with legislation, a copy was also forwarded to the President of the High Court. In his report for 1999 the inspector notes the continuing decline in the number of patients in psychiatric in-patient facilities from 5,101 at the end of 1998 to 4,768 at the end of 1999. There were more than 24,000 admissions to these facilities in 1999, of which approximately 6,700 were first time admissions. The proportion of patients being admitted to acute psychiatric units in general hospitals continued to increase and in 1999 accounted for 35% of admissions. A further 15% were admitted to private hospitals. The number of involuntary admissions at approximately 2,400 remained constant at 10%.

The inspectorate continued to fulfil its statutory duty to visit each catchment area mental health service at least once during the year and the private hospitals and Central Mental Hospital twice a year. The report is a summary of the inspector's findings following his inspection in 1999. While the majority of services were given two to three days' notice prior to the inspection, a number of inspections were unannounced.

A number of welcome developments were reported in many of the health board regions during 1999. Examples in the eastern region included the opening of the new acute psychiatric unit at Tallaght general hospital, a nine bed sub-unit for the psychiatry of later life at St. James's Hospital, a day hospital on the campus of St. Vincent's Hospital, Fairview, and two new health centres in the Kildare service. In other health board areas a new sector headquarters in Bailieboro, County Cavan, was welcomed, as was the opening of a new community residence in north Cork. At the time of inspection, the north Lee catchment area in Cork was on the threshold of its most important development for years – the planned opening of the new acute psychiatric unit in the Mercy Hospital. I am pleased to inform the House that this unit opened in April 2000.

While the inspector acknowledged the progress that has been made in the provision of acute units in general hospitals, 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 accelerate. The Minister would be in agreement with the inspector on this point and intends to facilitate further significant development of the services under the national development plan.

Concern was expressed in the report at difficulties in recruiting qualified psychiatric nursing personnel, which were particularly acute in the eastern region. However, over £1 million has been provided for local and national marketing campaigns undertaken by the nursing careers centre and the schools of nursing around the country. The success of these campaigns is evident from the fact that the schools of nursing have since succeeded in filling a record 254 training places in psychiatric nursing in 1999 and this record figure was exceeded this year, rising to 300. Increasing the annual intake of student psychiatric nurses is a key element in the Government's strategy for addressing the current shortage of nurses.

The House will have noted that the report of the Inspector of Mental Hospitals for 1999 was published four months earlier in the year than the 1998 report. I take this opportunity to congratulate the inspectorate and all those who contributed to the preparation of the report for the timeliness of its publication. The Minister welcomed the publication of the report of the Inspector of Mental Hospitals for 1999 and acknowledged the crucial role that the inspectorate, as an independent body, plays in providing an accurate and detailed account of services in the mental health sector. The report shows that much still needs to be done in the provision of comprehensive facilities and services. The Minister agrees with the Deputy on the deficiencies he has outlined. It is the Minister's stated intention to facilitate the health boards, as far as possible, in bringing about the improvements and developments identified by the inspector.

I thank the Deputy for raising this issue and I have no doubt the Minister will address the issues as soon as possible throughout the coming years, especially under the national development plan.