September 7, 2010

OPINION: Three reports on mental health published this summer paint a harrowing picture of a system in urgent need of prioritisation, writes COLM O'GORMAN 

THE SUMMER months are often regarded as being light on hard news issues, and more focused on weather-watching, festivals and family features.

However, during summer 2010 a series of grave reports on the mental health service in Ireland were published. Between them, they catalogued a series of serious failings – “inhumane” conditions within some inpatient units, disproportionate funding cuts, an “alarming” slip backwards in relation to reform and a lack of accountability and transparency within the system.

There was limited news coverage in reaction to these three reports. But now the summer is over, we cannot allow their findings to be consigned to oblivion along with all the other seasonal stories. Such serious issues warrant full-scale action, otherwise people experiencing mental health problems within Ireland will continue to be failed.

First off the mark in June was the annual report of the Mental Health Commission, Ireland’s independent watchdog. Perhaps more worrying than the report’s comments about poor standards was the fact that the inspector for mental health services observed regression in the way services were provided. Within inpatient services, the report highlighted “slippage” in a number of areas, including staffing, therapeutic services and programmes, recreational activities, privacy and premises. He also drew attention to the disproportionate impact staffing cuts were having on the progressive community mental health teams that have been promised since the early 1980s. This is, he said, “causing a reversion to a more custodial form of mental health service”.

The report also discussed how recovery was not at the heart of the mental health system – an admission that would have caused outrage if applied to any other health service. “While individual practitioners almost universally at a start of a career in the mental health services would have no difficulty in espousing these values [of recovery], often the system of processing mental illness tends to overcome this early idealism and enthusiasm.” Put simply, how we treat mental ill-health in our hospitals is systematically destroying staff commitment.

A month or so later, the independent monitoring group published its annual review of the progress of mental health reform in line with Government policy, outlined in A Vision for Change. It acknowledged some positive activity, but announced there had been “little substantial progress” during 2009.

Adding to the bleak picture painted by the Mental Health Commission, the monitoring group’s report pointed out that mental health spending was just 5.3 per cent of the overall health spend. Not only does this reflect a continuing decrease over the last number of years, but it also falls far short of the 8.4 per cent spend recommended in A Vision for Change.

The group did welcome the appointment of a national assistant director for mental health and acknowledged some limited progress, particularly in relation to child and adolescent mental health services. But despite this progress, we must not forget that during 2009, 200 young people under the age of 18 were admitted to adult inpatient units – a clear abuse of their human rights.

The group also expressed concern about the potential impact the new director could have when there was such a lack of clarity around the authority of the post, which crucially does not include budgetary power. Without the ability to decide how the mental health budget is spent, how will this post deliver change?

And time after time independent observers note how difficult it is to get information, facts and figures from the HSE in relation to mental health. The inspector for mental health services described the whole funding for mental health services as “opaque and almost incomprehensible”. This continued lack of transparency and accountability has to be challenged, because without it, meaningful improvement to services cannot be achieved.

Both the commission and the monitoring group blame the structures and processes for the problems, and not the individual members of staff, the vast majority of whom are committed to providing a better service but are working within a clearly flawed system.

The third and most recent report on mental health services was from the Psychiatric Nurses’ Association. This report described a service that was at the back of the HSE queue when it came to priority. It, too, noted the lack of focus on recovery within the system, accusing the HSE of actions that were “antagonistic” to the stated ambitions of A Vision for Change.

The headline-grabbing part of the association’s report related to violent incidents that required the deployment of security personnel and even gardaí in riot gear, but less reported was the association’s acknowledgement that this was due to inadequate facilities and staffing. It pointed to the adverse effect this had on the majority of patients, whose very recovery, it said, was “threatened by the frightening and threatening hospital environment”.

Dignity, respect and human rights must be at the heart of our mental health service. Community-based mental health services are necessary to successfully challenge the prejudice and discrimination faced by people with mental health problems, since they integrate service users into their communities rather than keeping them isolated. Hospitalisation should be provided only when needed, and in modern general hospitals.

The economic argument can act as a useful smokescreen for such problems, but that cannot remain an excuse. We welcome the commitment of the Minister with responsibility for mental health, John Moloney, to the closure of old hospitals. This must be supported by a wider programme of reform.

Amnesty International Ireland is campaigning for a law to be introduced that will ensure the continued reform of our mental health services and guarantee the shift from an over-reliance on hospital-based care to comprehensive community-based services.

The bottom line is that despite A Vision for Change providing a clear programme of reform for the mental health services, this programme is not being pursued. Instead, the series of reports released over the summer paint a harrowing picture of a system in urgent need of Government prioritisation.

The summer is now over and the country is back in business mode. These reports need to be taken seriously, as they not only point out serious human rights concerns, they also reveal that the lives of people in Ireland are being unfairly and unjustly compromised.

We can’t pretend we don’t know this is happening. We know. There would be outrage if this happened in cancer care, and there should be outrage now. The Government must make an immediate back-to-Dáil commitment to prioritise mental health.

Colm O’Gorman is executive director of Amnesty International Ireland 

Irish Times – Tuesday, September 7, 2010