Psychiatric services poor relation in health system

FOR many years it was believed that all we needed to do was to close down our drab Victorian psychiatric hospitals and provide patients with modern and therapeutic living conditions to help their recovery.

The outdated hospitals are now mostly shut.

But as the annual report of the Mental Health Commission has revealed, psychiatric services remain the poor relation of our health services.

Far from reaching the quality of care expected of a 21st century service, it is beset by restrictive and life-denying practices that have swapped one institution for another.

One of the most distressing parts of the report, which acknowledges the dedication and good work of many staff, is that the community homes to which patients were transferred offer little by way of rehabilitation.

There is little chance for residents to live a normal life.

Quite starkly, the commission says these vulnerable people are “forgotten”.

Much the same description could be applied other glaring parts of the system.

The watchdog describes how patients in psychiatric units, which are now attached to general hospitals, can end up living behind locked entrance and exit doors.

They may be forced to remain in one part of the unit and have no means of getting fresh air in a garden because they must stay indoors.

Others are deprived of keys to their bedrooms. They cannot make themselves a cup of coffee or have a snack during the day.

Their property may be searched when they have been out.

Another area of concern is the use of seclusion which varies across psychiatric units.

Some of them never use it because their staff are trained in de-escalating behaviours that can lead to aggression or self-harm.

However, the frequency with which patients are left in seclusion and the length of time they must spend in severe conditions is now a worry.

A seclusion room is bare except for a special mattress.

A patient can be dressed in refractive clothing, which is a dress made of safety material and compromises their dignity.

Heat, light and ventilation are controlled from the outside and communication is through an intercom system.

The commission is clear that lack of appropriate and mandatory training of staff is likely to contribute to the risk of a patient ending up in seclusion.

The report highlights the crisis in child and adolescent mental health services.

Some areas have no waiting times to see a child psychiatrist but others can face a delay of 15 months.

Huge gaps in staff mean many children with mental health problems that could be addressed are at risk of seeing their distress worsen, with potentially serious consequences as they get older.

Why are our mental health services in such a state?

Commission chairman John Saunders believes there needs to be radical culture change.

The neglect is obvious in how dirty so many units are.

He pointed out that basics, such as ensuring facilities are clean, cost little.

There is also the issue of funding and how the money is spent. The mental health budget in Ireland is still low compared to the UK.

But it is not all about money, but a will to change.