As the reconfiguration of the Galway-Roscommon mental health services has begun with the closure of the first five beds at the acute psychiatric unit in Ballinasloe, the local medical profession continues to fight along with the community to have what they strongly believe is “a seriously flawed decision” overturned.
A request by the senior clinical staff of East Galway mental health services for an independent external review into the HSE West decision to shut down a new €2.8 million acute mental health unit at St Brigid's Hospital in favour of an older facility at Roscommon County Hospital has been refused.
The East Galway GP group has since passed a unanimous proposal calling on the Minister for Health and Children James Reilly to implement an independent review of the scoring system on which the decision was based.
And last week in the Seanad, a Fianna Fáil motion demanding an immediate halt to the closure of beds at the Ballinasloe unit as well as three other units – St Stephen’s Hospital in Glanmire, Co Cork, Carrig Mór Mental Health Unit in Shanakiel, Cork city and Toghermore House in Co Galway – was voted down. The motion also called for a full, independent review of the decision to shut down the unit at St Brigid’s Hospital.
Fine Gael senators Michael Mullins and Fidelma Healy-Eames also called for a stay on the closure of the beds at St Brigid’s so the scoring system could be reviewed due to the lack of public confidence in it.
Bus loads of protestors from the west travelled to Leinster House last Wednesday to voice their opposition to the plans to close the beds while others maintained a vigil outside the Ballinasloe unit.
Phase 1 of the implementation plan for the reconfiguration of the Galway Roscommon Mental Health Services commenced on Monday, January 20th, with the transfer of five acute beds from St Brigid’s to Galway University Hospital. The plan is to transfer all the beds from St Brigid’s on a phased basis and to close down the unit there with an overall loss of seven beds from the system.
A spokeswoman for the HSE said: “A brand new 50-bed acute unit for GUH has full planning permission, allocated funding and full approval to progress.”
Work on the project is due to start this week on the Galway city campus and will be completed in 2015 with a capacity of 50 acute inpatient beds.
Acting clinical director of East Galway Mental Health Services, Dr Margaret O’Grady, pointed out that the East Galway mental health services had the lowest rate of hospital admission in the HSE West region, admitting 256 patients per 100,000 in 2012 compared with 414 nationally and 496 in Roscommon.
High standard of services
This was due, she said, to the high standard of community services which had been built up over the past two decades.
“There were 400 inpatient beds in St Brigid’s in 1998; today there are only 38 including the 22-bed acute unit and 16 beds for the elderly.
“This is as low as it is ever going to go because there will always be people who require admission in times of crisis.
“We find all the spin about tearing down the walls of the institutions very disingenuous, as we’ve been tearing down the walls of services here for the last two decades and now we are being penalised for it.”
Dr O’Grady noted that there was a lot of talk about extra money being “ring-fenced” for mental health services but the reality was that in 1984, 13 per cent of the total health budget was spent on mental health services and in 2012, 5.2 per cent was spent on services.
She told Health+Family that the main issue she and her medical colleagues had was with the scoring system used to make the decision to close the purpose-built 22-bed unit at St Brigid's and retain the beds in Roscommon.
“The criteria used to score the two sites against each other is not understandable from a clinical point of view, particularly the point that scores Roscommon way ahead of Ballinasloe in regard to adjacency to a major or regional hospital.
"This flies in the face of the Department of Health's national policy framework document, Securing the Future of Smaller Hospitals .
“The acute mental health unit at St Brigid’s is about three kilometres from the level three acute hospital at Portiuncula with a 24-hour A&E department while Roscommon is a level two hospital with no A&E facility which means the level of medical care would be lower there.”
She said the big difference between Ballinasloe and other places such as Clonmel and Wexford, where psychiatric inpatient units were being closed down, was that this was the only situation she was aware of where beds were being closed on a site in favour of beds further away from an acute medical facility.
“Patients in Roscommon County Hospital are 57 kilometres via the best roads further away from an acute medical and surgical unit than St Brigid’s.
Patients who deteriorate in Roscommon have to be transferred by ambulance to Galway or Portiuncula for medical care.
“If somebody has acute chest pains, an ambulance will have to be called and they will be rushed past the doors of St Brigid’s to Portiuncula.
“I have formed the opinion that different standards are being applied for patients with psychiatric problems and this is a further stigmatisation of this group,” she said.
Vehemently opposed
Although patient groups are vehemently opposed to the transfer of beds to the already congested GUH campus, Dr O'Grady said the clinicians had no problem with patients being re-sited in the level four hospital from a clinical perspective.
Their main argument was that St Brigid’s was the preferable peripheral site outside GUH and not Roscommon.
Dr Annraoi Finnegan, GP in Marina House Medical Centre, Ballinasloe, is one of a group of 15 local doctors calling for a review of the scoring process used to make this decision.
He said any reasonable person who looked at the criteria used in the process would be aghast as to how the “experts” could have scored Roscommon Hospital higher than the St Brigid’s Unit.
"The decision to close the acute psychiatric beds at St Brigid's seems to be totally illogical. The old St Brigid's institution has been closed down and hundreds of patients have been accommodated in the local community through Vision for Change , but unfortunately patients, for various reasons, do need to be admitted to hospital, usually only for a short time.
“We have highly experienced staff in St Brigid’s, a newly refurbished unit that cost nearly €3 million of taxpayers’ money in a time of economic stringency and the HSE are refusing to allow patients and staff into it.”
