June 25, 2010

One tenth of staff leave mental health service

Gary Culliton


‘Abandon hope all ye who enter’ is unfortunately over too many of our mental health inpatient facilities, reports Gary Culliton

Some 700 staff left the mental health services in 2009 – 10 per cent of the entire workforce, according to the latest Annual Report of the Mental Health Commission (MHC).
“We had hoped that when people left it would free up posts and money,” said Commission Chief Executive Hugh Kane. “This is not happening.”

According to the report, this ‘precipitous decline’ in numbers associated with delays in recruiting health and social care professionals, adversely impacts on the delivery of high quality care. “Unfortunately and ironically, when cuts are made, it is the progressive community services which are culled, thus causing reversion to a more custodial form of mental health service. Multidisciplinary community mental health teams are still deficient in numbers and, where they exist, in staffing.”

There has been a drop of €53 million in spending on the sector in this year’s HSE Service Plan, compared to 2009 levels, and some of this drop can be accounted for by lower wages. However, capacity was decreasing as people left, said Kane, adding that certain categories of nurses, for instance, could retire early at age 55 and they were not being replaced.

Unsuitable buildings
Noting very little improvement in standards in approved centres for inpatients, the MHC report recommended patients should no longer be housed in unsuitable buildings. As a first step towards addressing the problem, no new acute admissions should be made to St Ita’s Hospital, St Brendan’s Hospital or St Senan’s Hospital from January 1, 2011.
“While the number of people residing in old, unsuitable and dilapidated buildings has continued to reduce, the fact that vulnerable people still reside in these conditions is deplorable,” the report said.

In 2008, the Commission’s Inspectorate encouraged the MHC to seek project-managed, time-lined specified, action plans for closure and replacement of older buildings. The Commission sought such plans, but the majority of those it received were ‘disappointing in their lack of specificity’.

“Whatever (weak) justification can be made for maintaining in unsuitable settings, those individuals who have been residing on a long-term basis in these institutions and have acquired a degree of familiarity with their surroundings – regarding them as ‘home’ – there can be no justification whatsoever in admitting for the first time an individual in acute crisis, to such surroundings. A first step towards the closure of these types of buildings may be to cease new acute admissions,” the MHC said.
“Whereas the key ingredient in the concept of recovery is the encouragement of hope, admission to these units is more akin to the abandonment of hope as described by Italian poet Dante.”

The securing of €50 million from the Department of Finance to fund development of community based facilities by Minister of State John Moloney was welcomed by the Commission. The intention is to repay the money to the Department through the sale of older institutions and the land around them.

The Commission was also pleased at the Minister’s announcement that the new Central Mental Hospital would not be built beside the proposed new prison at Thornton Hall in North County Dublin.
“Choosing this location would unnecessarily stigmatise patients of the new hospital,” the Commission’s report stated.

In 2009, 14 Executive Clinical Directors (ECDs) were appointed within the mental health services. Of these, 13 will have clinical responsibility for ‘super-catchments’ of between 200,000 and 400,000 people. The remaining post is the National Executive Clinical Director for Forensic Mental Health Services, Prof Harry Kennedy.

In 2009, the number of applications for involuntary admission by authorised officers rose marginally from 4.6 per cent in 2008 to 5.8 per cent in 2009. Applications by a spouse or relative fell from 63.9 per cent to 61.8 per cent, while applications by members of the Garda Síochána fell only slightly, from 22.8 per cent to 22.6 per cent.
“This virtually unchanged position is disappointing,” the MHC concluded in its Annual Report.

Child & adolescent care
The phasing out of the admission of children and adolescents to adult centres is now well underway and will be complete by the end of 2011. “This practice of admitting young people to inappropriate adult institutions has been of concern to us, to service users and their families and to mental health practitioners for many years,” according to Kane. “We are very pleased that this is now ending completely.”
In 2009, 200 under 18s (of whom 12 were under 16) were admitted to adult units. This compares to 2008 when 247 under 18s (of whom 24 were under 16) were admitted to adult units.

The new report also noted that the number of involuntary admissions in 2009 was 2,024, a 1 per cent rise on the 2004 involuntarily admitted in 2008. The 2008 figure had shown a 6 per cent fall from the 2,126 involuntarily admitted in 2007.