| Republican News · Thursday 31 January 2002
"The state has been involved in the willful and possibly, criminal neglect of vulnerable people in its care," wrote Vincent Browne, reporting on the Inspector of Mental Hospitals' report, published in November 1999. "The report went on to suggest that because of such neglect, citizens had died. It further revealed that citizens continued to be deprived of their liberty, often without elementary inquiry into the justifiability of such deprivation." The report stated: "The inspectorate felt drug-prescribing in some locations is often arbitrary and made without regard to appropriate clinical diagnosis. The number of patients, particularly long-stay patients, who are on numerous drugs simultaneously, often at high dosages, was striking. In some instances, the prescription has not been reviewed for some considerable time." The report also found that there appeared to be an increasing number of sudden deaths in psychiatric hospitals, some of which were attributed to drug-related effects. It went on, as subsequent reports have done, to talk of unacceptable conditions in wards, with paint peeling off walls, where sleeping accommodation doubles up as dining and living space, where there is no storage space for clothing, where night pots and 'slopping out' are the norm. This reality put into prespective the Minister at the time, Brian Cowen's quality assurance that "the health services aim to achieve the best quality, patient-centred services". In a month when the workers who care for disabled people have been driven to resort to strike action, it is scarcely surprising that the situation in mental hospitals has not improved since that first report, which Vincent Browne, to his great credit, brought to public attention. Following that report, the Department of Health evolved a policy of moving patients into the community and closing down beds. This might have seemed the rational approach, given that over half of acute beds in some regions were occupied by long-stay patients who could and should be in community residences. The fact that over 300 patients diagnosed as mentally handicapped were still accommodated in psychiatric units, sharing accommodation with patients suffering psychotic illnesses, made the provision of community care provision all the more urgent. This policy suited the liberal agenda, and was expected to lead to huge savings. The result was that hospital beds were cut drastically, and there are 2,000 less nurses employed in psychiatric care today. Closing acute beds was one thing, but the provision of supported accommodation in the community was another. Last October, there were still only 2,993 places available in the community, compared with 2,382 ten years before. Over a decade, only an additional 612 places had been created for mental health patients leaving psychiatric hospitals. Psychiatric nurses say how the Department of Health thought it was getting health care on the cheap by placing long stay patients in community accommodation. But if the right supports and care are provided, the support necessary for a patient who has lived in a mental institution for over a decade or more, if anything, should increase the costs. d still the shortage of acute beds remains. Progress in providing acute psychiatric units in general hospitals has been dripping slow, as the Inspector's report of 2000 mentioned. That year, only one such unit was opened, in Tallaght General Hospital, and even that was almost two years late. The provision of acute beds in secure units are an even rarer event. If you happen to live in Wicklow, Kildare, West or South West Dublin there are none available. St. Brendan's, the last, is now closed to admissions.
Absence of treatment d it is not just the lack of adequate treatment facilities, but the absence of treatment, which is so disturbing. Only last week, a young man was before the court for choking his infant nephew to death. He was found guilty but insane. His mother in the trial gave evidence of how on the night of the killing she had taken him to a psychiatric hospital, where he had been prescribed medication, but was sent home. Later that evening, he went out and killed the baby as part of a strange fantasy emanating from his psychotic state. A father was sentenced recently for killing his son, who suffered from acute manic psychosis. Only a month before the father shot his son he had signed him into a psychiatric unit, but the son was back within days. The well know tragedy of Brendan O'Donnell, who killed Imelda Riley, her child and Fr. Joe Walsh, is the best known case. As the head of the Psychiatric Nurses Association said: "We turned our backs on Brendan O'Donnell. We discharged him from hospital on the grounds that nothing else could be done. He went into the woods in Clare and stayedthere until he killed people. The system turns its back on people like him. We wait for them to offend and let the courts deal with them." Brendan O'Donnell was sentenced to the Central Mental Hospital in Dundrum, where he later died from an overdose of an anti-psychotic drug, being taken for a mental illness which the jury found he did not have. His personality disorder needed long term care and rehabilitation. But this was expensive.
Homelessness The director of Dublin's Simon Community estimates at that at least half of people who are homeless have severe mental health problems. The number of people using the Simon Community has doubled since the previous year, says their latest report, published last year, and the reasons for becoming homeless for a significant number of people are mental health problems. Some of these people have been discharged from mental hospitals without sufficient support in the community; others have developed mental illness through homelessness. The bureaucracy of the health boards often means that someone who is homeless is also out of reach of medical service of any kind, which is fortunate for the minister because they are not provided anyway.
Need for care and support In last year's report, the Inspector of Mental Hospitals continued to express concern about over-reliance on drugs in the treatment of people with mental illnesses. Schizophrenia Ireland echoed these concerns in a statement last October: "In the majority of cases the only treatment option offered to people with severe mental disorder is the prescription of drugs." They point out that drugs are often central to the recovery process but they are by no means the only tool. "There is a multitude of research which shows that sustained recovery is based not only on effective drug treatment but on the availability of a range of allied interventions such as behavioural therapy, counselling, psychotherapy and other psychological treatments." But these cost money, money in wages, which this government has not been prepared to pay. One experienced psychiatric nurse talks of the neglect of patients through the government's persistent refusal over years to provide even the most rudimentary facilities. For example, simple equipment is witheld on a civil servant's decision. "We'd play football in the wards with a soft ball," she said. "Sure it is all we could do. We had nowhere else to play. We'd even have kind of water fights in the bathroom. You have to remember, many patients have a mental age of childhood. It is activities like these they enjoy, that gives some quality to their lives. They need this kind of care, this kind of therapy. They need a place where they can walk in the grounds safely." But successive Ministers of Health have tried to avoid paying for facilities and staff by hiding the state of our mental institutions, by endlessly ignoring reports and prevaricating on their recommendations, and by postponing decisions on spending. A total lack of government concern for the treatment of the mentally sick in society is at the heart of the matter.
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