The lack of mental health services available to patients in the community has been strongly criticised by the independent watchdog for the mental health sector.
Despite Government pledges to close old-style psychiatric institutions and improve community-based treatment, inspectors found that services in most parts of the country were hampered by a lack of staff, poor management and resource shortages.
Just two out of a total of 32 catchment areas were staffed sufficiently to offer a wide range of multidisciplinary services to people experiencing mental health problems, according to the Inspector of Mental Health Services report for 2006.
Meanwhile, there were still hundreds of people in long-stay wards in old psychiatric hospitals who are living in unacceptable conditions without access to recrecreational or therapeutic activities. About 1,700 patients have been in psychiatric hospitals for more than one year, while just over 1,000 have been in hospital for five or more years.
The acting inspector of Mental Health Services, Dr Susan Finnerty, said it was not good enough to condemn old mental health practices while not giving health professionals the resources to provide alternatives, or providing patients with treatment other than medication or in-patient care.
"In-patient units will continue to be the first-line treatment locations, long-stay wards will not close and there will be little or no access to alternatives to medication if community mental health and other multidisciplinary teams are not resourced," Dr Finnerty said in her report.
Multidisciplinary teams typically involve professionals from a range of backgrounds such as psychiatry, occupational therapy, clinical psychology, social work and nursing. Plans to introduce them were suggested in 1984 in the government's blueprint for the mental health services, Planning for the Future.
However, in most areas these teams either do not exist or are understaffed, the report says. In services for children, only basic staffing is available, while there is no staffing available in services for people with intellectual disabilities. "If we accept that best practice is to deliver mental health services through multidisciplinary teams, then we have failed over the past 20 years to provide an adequate mental health service for service users," Dr Finnerty said in her report.
She also raised concerns over the lack of coherent plans for services over the next five years and said there was no evidence that the ad hoc nature of mental health provision in the past will change.
She noted, however, that there has been a change of attitude with services becoming increasingly aware of their deficits. Services, she said, were moving slowly towards integrated multidisciplinary planning.
The Health Service Executive (HSE) welcomed the report which, it said, demonstrated the progress being made towards modernisation of mental health services. It also provided an independent perspective on "where services may need to be further developed".
Martin Rogan, the HSE's national director for mental health, said: "I strongly welcome today's report, which creates an opportunity for HSE services to reflect on progress achieved and focus on any remaining issues which may need to be addressed."
The HSE will invest an additional €25 million in services, employ another 250 new staff members in 2007 and dramatically increase capital spending over the coming year to help modernise the system, Mr Rogan added.
