The head of the Central Mental Hospital has agreed with the president of the High Court, that while the State has closed its mental hospitals, it has "failed to provide an alternative".
While there is "stress-testing" of an alternative plan for private firms to fill the gaps left by the closures, people are falling through the cracks, Professor Harry Kennedy agreed in exchanges with Mr Justice Peter Kelly.
Asked was the stress-testing at the expense of those needing services, he agreed. “It’s hard to say any person is happy with it.”
All 94 beds in the CMH are full, it has a waiting list of 24 people and cannot take a psychiatrically ill man whose case was before the court, Dr Kennedy, who is Clinical Director of the CMH, said.
The man’s behaviour, including inflicting a head injury on his mother requiring stitches after hitting her with a chair, and writing her name in blood on a wall, was “challenging and violent” but not sufficiently serious to meet the criteria for admission to the CMH, he told the judge. Had his mother’s skull been fractured, that would meet the criteria.
Ireland has two forensic beds per 100,000 of population when most other Northern European countries have ten so the CMH is "extremely selective" to ensure the right people are in the right place. Describing the system as a "Cinderella" one "is no misnomer", he added.
The CMH is intended for people who, based on strong evidence, represent a “significant danger” and he did not consider this man met those criteria.
It was not uncommon for people to fall through cracks in mental care and find themselves in prison often for minor things, he said. A solution can be found with time and impetus, usually involving a long term care place appropriate to needs.
While the various parts of the HSE are not always well co-ordinated in finding solutions, things are improving, he added.
Dr Kennedy was giving evidence in a hearing of an urgent application by the HSE for orders permitting detention of the man in a psychiatric unit. The man is currently in prison and the orders were sought in the event he receives a non-custodial sentence from the District Court when he appears before it on Thursday for a criminal offence.
Maria Dillon, solicitor for the HSE, said various voluntary organisations and hospitals who previously dealt with the man were refusing to take him because of his challenging and violent behaviour. While it had been recommended he be placed in an acute unit of a particular psychiatric hospital, its director was opposed to taking him for similar reasons but would abide by any court order.
Having heard all the evidence, the judge said he was confronted with a “Hobson’s choice”.
While mental hospitals have been closed down, the necessary services are not being provided to look after people who would have been detained there, he said.
As there was no place available in the CMH and no other alternative and he could not “in conscience let the man walk loose”, he would direct his placement in the acute unit.
That did not affect the District Court’s jurisdiction over what orders it considered appropriate to make in this case, he stressed. Irrespective of whether a custodial order is made, an appropriate plan must be put in place for the man’s long term care.
The man previously received a substantial settlement of proceedings brought after he suffered an acquired brain injury in a road traffic accident some years ago. As a result, he exhibited very strange, violent, and sexualised behaviour and his mother was afraid of him, the judge noted.
Because the man was made a ward of court, with his settlement paid into court, there are monies available to go towards his care, the judge said. The court was told he was running up debts by informing drug dealers he had monies coming under the settlement but no funds would be paid out to discharge any drug debts, he stressed.
