Patients Spending Decades In Mental Units

Most people would assume that a stay in a psychiatric hospital nowadays would be for a relatively short period,and that not very many people in mental hospitals would be long-stay patients. Advances in mental healthcare now mean that more and more patients with mental health problems are treated in primary care or in community facilities, and usually if your condition is serious enough to warrant a hospital stay it will not be for long.

However, statistics show that many patients are still spending very long periods in psychiatric centres; in fact some have spent a large proportion of their lives there. And concern is also being expressed that while many of these very long-stay patients date from a bygone era when care options were less advanced than they are today, concern is being expressed that the number of ‘new long-stay’ patients in mental health units is still relatively high.

Statistics recently produced by the Health Research Board (HRB) show that 63 psychiatric hospital in-patients classified under ‘discharges/deaths’ last year had been in hospital for more than 25 years.

While the number of separate deaths and discharges in this category of patients is not specified, it is understood that roughly half of these patients would have died, mostly due to age taking its course, and half were discharged to community residences or nursing homes.

The last census of psychiatric hospitals, carried out in 2001, and due to be updated shortly, showed that there were then 630 patients resident in psychiatric centres who had been there for more than 25 years. The next census, due to be published within the next few weeks, is likely to show a further decline, largely due to the effects of ageing, in the number of institutionalised patients who have spent a large part, or indeed most of their lives in mental hospitals.

There were 229 deaths in psychiatric hospitals last year. The statistics do not give a breakdown of cause of death or the precise number or deaths according to length of time spent in psychiatiric units.

Dr Dermot Walsh, principal investigator with the HRB and the former Inspector of Mental Hospitals told that there were some patients who would have been in psychiatric hospitals for 30 to 40 years, and until recently, a very small number who would have been in a mental hospital for 50 years or more. The HRB statistics do not give details of precise length of patient stay beyond 25 years or more.

According to the latest annual report from the Mental Health Commission, almost one-third of residents in psychiatric units are long-stay, having been in hospital more than five years.

But why do some patients spend so long in mental hospitals?

According to the HRB statistics on discharges and deaths in psychiatric hospitals last year, the majority of discharges/deaths in patients who had been in hospital for one year and over were in respect of patients diagnosed with schizophrenia, with the remainder largely made up of diagnoses of intellectual disability, depression or alcoholic disorders.

In the category of patients who were in hospitals for 25 years and over, of the 63 people who died or were discharged last year, the vast majority either had schizophrenia or intellectual disability.

According to Dr Walsh, these patient numbers are diminishing as age takes its toll. In many cases, he said, these patients represent the vestiges of the old institutionalised model of psychiatric care. Dr Walsh said the majority of these very long-term residents in psychiatric centres would have been admitted many years ago with schizophrenia or intellectual disability; many of those with schizophrenia would have been admitted in their late teens or early twenties, when the condition usually first emerges.

In the past, the treatment options would have been more limited than today and these patients then became institutionalised; also, as parents or family members died, many of the very long stay patients would have had nowhere else to go, according to Dr Walsh. While over the years some of these patients would have been relocated to community facilities, there would be a minority of patients who could not easily be resettled in the community and remained in psychiatric hospitals, he added.

Referring to the 63 patients classified under ‘deaths/discharges’ in 2005, Dr Walsh said not all of these patients would have died–some would have been transferred to nursing homes or to community residences, as the psychiatric services continued to reduce the number of old-style large mental hospitals and seek alternatives to long-stay institutionalised care for those patients who remain there.

Dr Walsh said there would be a number of patients who had been in psychiatric hospitals for 30 to 40 years or more and until recently he knew of a very a small number of patients who had been there for 50 years and more.

According to John Saunders of Schizophrenia Ireland, most of the very long stay patients in psychiatric care would have been originally diagnosed with psychosis or schizophrenia. “They would be institutionalised and would require a high degree of physical care.” Mr Saunders said that while it is important that these people were are facilitated to live out their lives in as much comfort and care as possible, emphasis needs to be placed on preventing current patients becoming long-stay patients,

He pointed out that the Mental Health Commission report for 2005 noted the sizeable proportion of ‘new long-stay’ patients; those in hospital for one to five years (17% of psychiatric patients). Mr Saunders said it is important that these patients are not allowed slip into becoming very long-stay, institutionalised patients.

The Mental Health Commission report shows that in 2005, of the 1,129 patients in psychiatric care for more than five years, 551 were 65 years and older, but 576 were between the ages of 18 and 64.

The HRB figures show that in addition to patients with schizophrenia and intellectual disability spending very long continuous periods in hospital,there are also patients with conditions such as depression and alcoholic disorders spending more than a year in hospital.

The HRB figures show that of the discharges/deaths last year in patients who had been more than a year in a psychiatric hospital (classified as long-stay patients), 165 had schizophrenia, 47 had intellectual disability, 42 had depression and 16 had alcoholic disorders. Two of the 63 patients who died in psychiatic care last year had originally been diagnosed with behavioural and emotional disorders of childhood and adolescence and four came under the ‘unspecified’ diagnosis category.