As sound bites go, it was a good one - Tánaiste and Minister for Health Mary Harney getting her retaliation in first by condemning herself out of her own mouth, writes Mary Raftery.
Her comparison of parts of the Central Mental Hospital in Dundrum to Nelson Mandela's cell on Robben Island was guaranteed to garner headlines.
However, the Minister's timing in issuing this certainly justified criticism of the Dundrum facility was interesting. It immediately preceded the publication of the annual report of the inspector of the Mental Health Services, which contains probably the most damning picture yet of an entire system in crisis.
As a result of Ms Harney's colourful analogy, much attention given to the report centred around the Central Mental Hospital, where conditions are so indefensible there isn't even any point in making the attempt. The Minister, of course, has an answer to that: money has been allocated to eliminate slopping out within months, and anyway, the entire facility is being replaced in the near future, probably on the same site as the new Mountjoy complex.
What the Tánaiste might find considerably more difficult to deal with is the extraordinary picture painted by the inspector of the Mental Health Services of chronic mismanagement and glaring maladministration in the area of psychiatric care, for which, of course, the Minister has ultimate responsibility.
Indicating the low priority accorded to mental health, Mary Harney didn't even bother to issue a statement on the inspector's annual report. She showed no such reticence, however, when she announced additional (and much needed) investment in cancer treatment.
Dr Teresa Carey is the new inspector of Mental Health Services, taking over from Dr Dermot Walsh, who for years repeatedly and forcefully criticised the system. What Dr Carey has done in her 550-page report for 2004 is to hone those criticisms into a list of headings, of which the majority - somewhat startlingly - do not relate to the need for additional funding.
Of her eight main problem areas, six relate directly to bad management. These are: lack of information management capabilities within the mental health service; lack of clinical governance systems; management deficiencies within the mental health service; lack of accountability for failure to deliver mental health services efficiently; resource mismanagement; and lack of patient involvement in service planning and delivery.
This conclusion is in stark contrast to what we hear from those running our psychiatric hospitals, namely psychiatrists - that the problems all come down to lack of money. While it is certainly true, as the inspector points out, that the entire area has for decades been starved of funds, it is far from the full story.
Describing management capabilities as "primitive", Dr Carey outlines the phenomenon of warring factions within different health areas refusing to co-operate with each other. What she identifies as an "unhealthy defensiveness" and "isolationist" operate to neglect fundamentally what is of central importance in any quality mental health service - the needs and priorities of those who use the service.
Ann is one of those who has used the service for almost three decades. She has no doubts about who is to blame for the way she was treated. "It's a draconian system. There's a clear divide between them and us, psychiatrists and patients. It's about power and how they have it all and, in my case, they spent years making me feel worthless and defective," she told me.
Ann had been sexually abused by a family member and later as a young woman by a priest. Within a short time, she became profoundly depressed and began what became a pattern of self-harm which lasted for years. "What the system does is degrade you as a person. No one ever bothered to find out anything about my past, or any reason why I was so ill. They labelled me as having a 'retarded personality'. You'd have your odd 15 minutes with the psychiatrist, who wasn't really interested in you, and all you'd get would be more drugs.
"If you didn't get better, they wouldn't bother to find out why, they'd just change the drugs...
"It was only when I got out of the system after 28 years and managed to get psychotherapy, that I began to realise that maybe I wasn't such a worthless person after all."
What is described for hospital after hospital in the inspector's report is a model of treatment which is dominated by the psychiatrist, with little or no input from any other specialist. Psychologists, social workers and occupational therapists are clearly regarded as marginal within the system, and multidisciplinary teams function in only a small minority of facilities.
While it is certainly true that lack of funding plays a significant role here, it is long past time that we began asking fundamental questions of psychiatrists about their largely unchallenged domination of a system which causes so much misery to so many people trapped within it.