Irish Mental Health Services – Major Problems Remain

Last year, the Inspector of Mental Health Services, Dr Teresa Carey, published her first annual report. It contained details of all of the inspections she had carried out in 2004 and noted a ‘range of issues’ that were having a ‘serious negative effect’ on the quality of services available to people in Ireland with mental health problems. Now one year on, her second annual report has been published. It looks at all inspections carried out in 2005.

So 12 months later, how does the mental health system fare, considering that one in four Irish people will be affected by a mental health problem at some point in their lives? Well it appears that a ‘range of issues’ are still affecting the service.

According to Dr Carey, the 2004 inspections ‘concentrated on fulfilling the statutory obligations of inspecting inpatient units and on obtaining a broad knowledge of services available nationally’.

The 2005 inspections on the other hand covered a broader base and saw her inspecting certain services in more detail, including those available to children and adolescents and the elderly.

The largest area looked at was that of ‘general adult mental health services’. This section is described as the ‘largest consumer of resources and the biggest user of beds’.

In the report, Dr Carey is quick to highlight the difficulties faced by some services due to a lack of essential resources. She also points to the ongoing problem of ‘significant per capita variations’. In other words, the amount spent on each person differs depending on the area they live in.

For example, the funding allocated in 2005 was €493.55 per person in the east Galway area and just €79.21 per person in the Kildare/west Wicklow area.

Funding varies ‘six fold across the country’ and this variation is due largely to the inequitable distribution of resources that are still tied to large institutions that previously served a far greater population, Dr Carey said.

“In the south for example, the bulk of resources in the past was tied to large institutions such as Our Lady’s Hospital in Cork and St Finan’s in Kerry. As a result, the city services of south Lee, north Lee and the small rural service of west Cork are considerably less well off”, she explained.

However apart from these issues, Dr Carey also notes an overall ‘absence of management and clinical accountability’ within the general adult mental health service.

So what of our younger generations? Surely they are well looked after? Quite the opposite, it would appear. “Lack of support for vulnerable families…Support at community and primary care level to assist parents in acquiring knowledge and skills is sorely deficient…Long waiting lists for specialist services.” The list goes on.

“I heard of waiting lists for up to two years or longer. Services are obliged to prioritise more immediate high risk presentations, such as severe mood disorders, early-onset psychotic illnesses and eating disorders. As a result, children with problems that are less serious clinically are left to wait. Many never receive the necessary intervention”, Dr Carey explained.

She pointed out that mild behaviour problems in young children ‘may become more serious behaviour problems in young teenagers’.

The report notes that apart from the deficiencies that exist within the mental health service, issues within the education system also impact on services, such as limited access to the National Educational Psychology Service (NEPS). (This is responsible for providing psychologists to schools.)

“Child and adolescent mental health teams have found that children are being referred to them for assessments that more appropriately would be carried out by the educational service”, the report said.

It also highlights two other issues that have long caused problems for children and teenagers with mental health illnesses – access to inpatient beds and the specific problems faced by those in the 16-18 age group.{mospagebreak}

In relation to beds, the report notes that for many years, there has been ‘an acknowledged lack of appropriate inpatient facilities for that small number of young people who require such specialist care’.

In the past year, inpatient units have been approved for Cork and Limerick, an adolescent unit has opened in St John of God Hospital and one is under consideration for Tallaght Hospital. However the inspector expressed concern that these units appear to be developing ‘in the absence of a clear decision on the number and location of units required nationally’.

She also expressed concern that the issue of beds is being discussed in isolation from broader issues, such as staffing.

In relation to 16-18 year olds, the report noted that this issue ‘generates heated argument’ between child and adolescent psychiatrists and adult psychiatrists.

This group is singled out because in 1945, the Mental Treatment Act considered 16 the age at which somebody could be admitted to a mental hospital on their own volition. However the more modern Child Care Act and Mental Health Act 2001 define a child as someone under the age of 18. As a result, those in the 16-18 age group remain in a type of limbo, neither belonging to one group or the other. A number of these inevitably end up in adult facilities, which are wholly inappropriate for their needs.

The report goes on to cover other groups, including the elderly and those with intellectual disabilities, however the criticisms do not abate.

In fact, Dr Carey notes that large parts of Planning for the Future, the mental health policy document published by the Government in 1984, still have not been implemented over 20 years later. Furthermore, ‘no one has ever been held accountable for the failure to fully implement’ that policy.

“We still have large mental hospitals like St Luke’s in Clonmel and St Loman’s in Mulllingar that are not only open, but have significant numbers of long stay beds which are still actively used. There is no accounting for the continued existence of these facilities 20 years after national policy dictated that they should be closed”, Dr Carey said.

She also pointed out that the development of multi-professional teams were to be the cornerstone of service delivery and were a central tenet of Planning for the Future, yet nowhere in the country have fully staffed teams been delivered.

The list of problems goes on. So will the inspector’s 2006 report, which will be published around this time next year, reveal any improvements or will the ‘range of issues’ affecting the mental health service remain? We can only wait and see.