Analysis: the lack of specialist psychiatric services has profound consequences for the most vulnerable patients, writes Carl O'Brien, Social Affairs Correspondent
You don't have to go far to find the disturbed casualties of our failure to properly develop specialist psychiatric facilities.
You can find them in our prisons, A&E units, Garda stations, or on the side of the street.
Anywhere, it seems, except in secure, appropriate, properly-resourced psychiatric facilities.
The number of mentally ill patients who end up acutely suicidal or violent and in need of a secure facility is small. Just a tiny proportion of those admitted to psychiatric hospitals each year fit into the category.
Yet, the shortage of secure beds to deal with these patients can have profound consequences for the health service, the public, staff and, most of all, patients themselves.
The main unit in Dublin for admitting violent or disturbed psychiatric patients who have not committed a crime or who are not in the judicial system is St Brendan's Hospital.
Staff shortages mean bed capacity has reduced from 24 to 14.
These 14 beds are, however, blocked by long-term patients, meaning there is nowhere to send an acutely disturbed person who becomes violent.
The situation is just as bad in many other parts of the country. A secure unit is Cork, for example, is full of long-term cases and is not in a position to admit patients in need.
Limerick, too, has its problems and has been treating disturbed patients in less than secure settings.
The Health Service Executive (HSE) says the difficulties in Dublin are a temporary problem and has been trying - unsuccessfully - to recruit and retain sufficient numbers of staff to open the beds.
In the long term, it says it is developing a new unit which will deal with such patients, although this has been talked about since the 1990s.
Indeed, the need for a proper forensic psychiatric service - a branch of psychiatry that specialises in managing the risk posed by disturbed and difficult-to-manage patients - has been obvious for years.
Blow the dust off the 25-year-old blueprint for developing the mental health service, Planning for the Future, and you'll see that it recommended four secure units in various locations counrywide. And two years ago, the latest blueprint, A Vision for Change, said five such modern units were required.
Health professionals consider these units to be the psychiatric equivalent of an accident and emergency unit in a general hospital: it's a vital arm of the service where patients are temporarily cared for with higher staffing levels in a modified environment before, hopefully, recovering and moving into a general psychiatric hospital.
To date, there is no sign of them.
There is a site office at St Brendan's, where one of the units is due to be developed, although they have been talking about it since the 1990s, say local health professionals.
It would be encouraging if there were signs of progress in this, the most neglected arm of the health service.
Yet, spending plans for this year show no major additional funds for the sector. The biggest losers of this, once again, will be the most vulnerable of patients, who will continue to receive sub-standard treatment in the most inappropriate of settings.