Campaigners say the rights of patients detained in psychiatric hospitals against their will are being violated because of delays in changing 60-year-old legislation.
International comparisons show Ireland's rate of involuntary detention is alarmingly high, almost twice that of England's and several times higher than in other EU countries. Latest figures show there were 2,500 involuntary admissions - or 11 per cent of all admissions - to psychiatric hospitals in 2003. The figures also suggest that the rate of involuntary admissions is almost three times higher in the north west of the country than it is in the south western area of Dublin.
Disturbingly, a significant proportion of these patients did not have a mental illness. A recent analysis of the overall involuntary admission figures by the Health Research Board shows that 7 per cent of patients were people addicted to alcohol but without an accompanying mental illness.
Paddy McGowan, founder of the Irish Advocacy Network, says mental health legislation dating back to 1945, which does not adequately protect the rights of detained patients, is still effectively in force.
"A prisoner has more rights than a mentally ill patient under this legislation. A detained patient is deprived of the most basic rights," he says.
John Saunders, of Schizophrenia Ireland, says the high detention rates are a major cause for concern. The lack of funding for the mental health sector and delays in moving psychiatric care away from institutional settings and into the community are key factors behind the high rates, he says.
Plans to modernise the existing system of involuntary hospital admissions have still not been implemented despite the enactment of reforming legislation in the 2001 Mental Health Act. Under this legislation mental health tribunals will review decisions on involuntary patients within 21 days of their detention. Experts in the field say delays in Government funding and a lack of co-operation by hospital consultants have slowed down the adoption of the new system.
The Minister for Health Mary Harney, told the Dáil recently that at least 50 psychiatrists were needed to participate in the tribunals, but just a fraction of this number have indicated that they will do so.
While some campaigners blame psychiatrists and over-reliance on institutional care for the high rate of involuntary detentions, the Irish College of Psychiatrists says the reasons are more complex. A spokesman points to elements such as the rate of community services, bed availability, and social or demographic factors.
There is evidence that an emphasis on community-based rather than institutional care can lead to a sharp drop in involuntary admissions. This is illustrated by the work of consultants such as Dr John Owens, in Co Monaghan, who has helped oversee a dramatic fall-off in the number of involuntary detentions by redistributing resources so that more patients could be looked after at home or in the community.
Brid Clarke, of the Mental Health Commission, the State watchdog, says reducing the rate of involuntary admissions is one of the key issues the organisation is addressing.