The failure to close outdated mental health institutions is just a symptom of the neglect of the health sector’s poor relation
THEY ARE relics of an era known as the “great confinement”. Yet, well over a century later, many of these Victorian-era institutions remain.
Despite well-meaning efforts by staff, these buildings are clearly inadequate for the purpose of providing treatment to vulnerable people with serious mental illness in accordance with internationally accepted human rights standards.
Since the early 1980s, it has been national policy to close large psychiatric hospitals, to provide care in the community and to deliver acute in-patient care when needed in modern units in general hospitals.
Yet, as reports by the Inspectorate for Mental Health Services show, at least 15 of these outdated institutions continue to be used for hundreds of vulnerable patients almost 25 years after they were slated for closure.
Take St Loman’s hospital in Mullingar. Its main building, a granite-grey edifice constructed in 1847, contains two wards. When inspectors visited this year, they were concerned at the “continued use of these wards, which were dilapidated, desolate and depressing, and unsuitable for accommodating residents and providing them with care and treatment”.
It was evident from meetings with management, staff and residents that the service was striving to improve care and treatment provided to residents, but with no additional funding to rectify deficits or plan for the future.
Worse still, they found little sign that conditions were going to change any time soon. Inspectors reported that St Loman’s had developed a detailed capital development plan that was to be financed by the sale of hospital lands. Yet funds raised through the sale of several acres of land had not been reinvested in the local mental health services.
This, inspectors said, removed any hope of beginning the capital development plan.
The paralysis and neglect surrounding St Loman’s is reflected in the treatment of residents at other outdated institutions across the State.
Progress in providing appropriate alternative accommodation is hopelessly delayed. This, though, is just part of a wider malaise across the traditionally maligned mental health sector.
In terms of quality of care and treatment for patients across the mental health service, little has changed. This is despite the adoption of the State’s blueprint for modernising mental health services, A Vision for Change, by the Government four years ago.
This seven- to 10-year plan promised much. As well as shutting down the old Victorian institutions, it recommended modernising the service by introducing fully staffed community-based mental health teams to offer home-based services to people with mental health problems; new local mental health centres and residential units for those with chronic mental illness; a recovery-based approach to mental health; and a service where users and their carers would be involved in their day-to-day care.
Despite centralisation of health services, inspectors have found comprehensive community-based services are still lacking in most parts of the country. There has been little real progress in spreading resources, financial or staffing, more equally across regions.
Apart from some local successes, no meaningful attempt has been made on a national basis to tackle the restrictive work practices that still operate in some parts of the country, impeding the implementation of new initiatives.
It’s not all about money and staffing, though. Most significantly, inspectors have in the past pointed to a failure of management at the highest level of the Health Service Executive for “lumping” mental health services into a catch-all category of “primary community and continuing care”.
This, they say, has caused confusion and misunderstanding within the health service, muddied objectives and reduced the capacity of the service to change.
For people like former inspector of mental hospitals Dr Dermot Walsh, there is a sense of deja vu surrounding many of these findings. He consistently raised concerns over standards of care and the organisation of services in the years before the new Inspectorate for Mental Health Services came into being.
“Much of it down to the lack of proper management and accountability. There is administrative confusion. We do not have clear lines of delineation saying who should do what . . . in this environment, mental health services have suffered, particularly from manipulation of funds,” he told The Irish Times.
Damaging as the inspectors’ findings are, there are some causes for hope.
The HSE has moved to appointed a “lead person” for mental health and the Government has announced fresh plans to ring-fence proceeds from the sale of mental health properties and reinvest in mental health.
There are some excellent examples of the provision of care in high-quality, modern buildings, notably the psychiatric unit of St Luke’s in Kilkenny, according to inspectors. In addition, many services are actively planning and moving towards full compliance with the law.
Progress may be painfully slow, but it is coming. Previous generations of mentally ill patients were failed due to official neglect of the mental health service. Perhaps this time there will be a recognition that to do so again – even at a time when budgets face unprecedented pressure – would be unconscionable.
