Ireland's mental health institutions have been again heavily criticised in a damning report on conditions inside them.
annual report of the Inspector of Mental Health Services
According to the Inspector of Mental Health Services, patients in long-stay wards in the State's psychiatric hospitals are the "forgotten people" of the mental health service.
The inspector's 2005 annual report, published with the Mental Health Commission's annual report today, also says the lack of governance in both management systems and clinical systems in the mental health service is "both evident and disturbing".
The report says it is "not acceptable" to the inspectorate, or to the Mental Health Commission, that annual reports should recount the same deficiencies in mental health services "year on year".
Inspectors visited 95 long-stay wards in psychiatric hospitals caring for some 1,800 patients in 2005.
"These wards and units cater for people with varying needs - those with enduring mental illness, some with an intellectual disability and some requiring specialist care for the elderly.
"Very few patients on these wards and units are under the care of specialist teams," the report states.
None of those with intellectual disability were under the care of "appropriate specialist teams," it said.
The report also says most patients in long-stay wards, many of them elderly and vulnerable, have not undergone any formal assessment of their care and accommodation needs, and most do not have an integrated care and treatment plan.
"Most long-stay wards are located in large psychiatric hospitals built in the mid-1800s. The physical conditions of many of these wards are poor, with inadequate sanitary facilities, lack of privacy and absence of personal space.
"In a few cases, conditions on the wards are extremely poor, with leaking ceilings, damp, peeling paint, holes in the walls and no curtains around beds. Some wards are locked, in the absence of clinical risk assessment, and in a small number of hospitals patients were locked in their bedrooms at night, again, in the absence of risk assessment," it states.
"Efforts had been made in some wards to make the accommodation as comfortable as possible, but they remain unsuitable and inadequate as accommodation."
The report continues: "Patients in long-stay wards, some of which are needlessly locked, remain a vulnerable group of people living in poor conditions with little in the way of therapeutic assessment, therapeutic activities and multidisciplinary care planning. They are to a considerable extent the forgotten people in the mental health service.
"Many have lost contact with family, their friends and their community of origin, and so lack the vital support and advocacy role that such personal contacts provide."
The report says a new "Vision for Change" policy to reform the organisation of mental health services will ensure that the current situation "where no group takes account for management failures" will come to an end.
It notes that "large tranches" of the "Planning for the Future" policy, which is over 20 years old, have not yet been implemented and "no-one has ever been held accountable for the failure to fully implement this national policy.
"We still have large mental hospitals like St Luke's Hospital in Clonmel, St Loman's Hospital in Mullingar and St Stephen's Hospital in Cork that are not only still open, but have significant numbers of remaining long-stay beds which are still actively used.
Annual report of the Inspector of Mental Health Services
"There is no accounting for the continued and vigorous existence of these facilities 20 years after national policy dictate that they should be closed.
"The development of multi-professional teams as the cornerstone of service delivery was a central tenet of "Planning for the Future", yet, nowhere in the country have fully staffed teams been delivered," the report states.
The report also says hospital admission rates do not reflect the 20-year-old policy to move to a more community-based model of care.
In 2005, inspectors found some services "fell significantly below an acceptable standard of patient care" and notified them immediately to the Mental Health Commission.
These services were contacted and were told how to immediately rectify the situation, the report says.
"Each service was informed that an unannounced follow-up visit would occur within three months, to assess progress, and where necessary further interaction between service managers and the commission took place after these visits."
The report says "ongoing interaction" will be an important part of the inspection process and that services consistently showing evidence of poor management and clinical governance will be called to account.