NEWS FOCUS:Hundreds of people with intellectual disabilities continue to reside in psychiatric hospitals, 25 years after the practice was due to be phased out, writes CARL O'BRIEN
MAIREAD BRADY’S needs were simple. Despite her intellectual disability, she loved music – especially 1980s pop – as well as arts and crafts. She was open, trusting and very sociable. Her biggest problem was that she suffered from anxiety, but it was nothing that some therapy couldn’t address.
Yet when her family began looking for a residential placement which would help her fulfil her potential, they were told the only option available was her local psychiatric hospital.
“It was totally inappropriate,” says her brother Colm. “She didn’t have a mental illness. Psychiatry is about treating people going through a crisis and stabilising them. But Mairead has Asperger’s. That’s her condition. You can’t medicate it, because it’s not going to go away.”
For a young woman who craved stability and routine, her admission to the psychiatric hospital felt like being plunged into a world of uncertainty and anxiety. Mairead, who was in her early 20s at the time, ended up spending several months in hospital and receiving medication to control her behaviour.
“I’ve no doubt it contributed to the downward spiral she fell into,” he says. “It was a chaotic environment and the opposite of what she needed. I remember one day I arrived with my brother and she was just reciting the rules, again and again and again, almost in a psychotic kind of way. I’d never seen her like that.”
Today, home for Mairead, who’s now 31, is St Peter’s in Castlepollard, a large institution for the disabled. The old building is far from ideal, but she has made significant progress in recent years, in an environment much more suited for people with intellectual disabilities.
“She loves doing arts and craft, or ‘creativity’, as she calls it. We all get the most elaborate, handmade birthday cards from her. She does drama, she’s a great mimic. She’s so much happier in herself.”
Her story isn’t an isolated one. A new report compiled by the Health Research Board shows that 308 people with intellectual disabilities are still residing in psychiatric hospitals.
Of this number, almost 200 require an immediate transfer into more appropriate facilities in the communities, as well as day services or residential support.
But that’s just the tip of the iceberg. Hundreds more are in “de-designated” units – parts of psychiatric hospitals which have simply been reclassified as community units. In addition, more than 3,000 people with intellectual disabilities are still being accommodated in old institutions, like St Peter’s, rather than more suitable community-based settings.
The Government has pledged on numerous occasions to end the practice of placing disabled people in inappropriate settings, such as psychiatric hospitals.
Official policy documents handed over to a UN human rights committee in 2002 show the Government pledged to remove all people with intellectual disabilities from psychiatric hospitals and other outdated institutions into appropriate community-based services within a few years. It never happened.
Officials insist the process is continuing and that investment is being directed towards the area through a multi-annual investment programme. They also say such plans are complex and involve securing new facilities, ensuring the complex needs of disabled people can be met and that staffing levels will be sufficient for this.
For experts like Dr Mark Harrold, a clinical psychologist who specialises in working with disabled people, the idea of institutionalising people with disabilities is a relic of Victorian times.
He says the psychiatric ethos that prevails in some centres for people with disabilities means many residents with challenging behaviour are medicated to control their behaviour, in the absence of proper therapies.
Most other rich countries have a history of placing some of their most vulnerable citizens in institutions. The only difference, he says, is that most of these countries have left this era behind.
Deirdre Carroll of Inclusion Ireland, an organisation representing people with intellectual disabilities and their families, says the level of neglect in some cases is shocking.
She tells the story of a man in his 60s, who has a moderate level of intellectual disability and has episodes of violent and disturbed behaviour.
The lack of a suitable residential place meant he ended up in psychiatric services for many years. It later emerged that the root of his violent behaviour was linked to sexual and physical abuse he suffered while in residential care as a boy.
“His loving parents died not understanding why their son acted in such a frightening way but worst of all he has been condemned to living a half life of great torment though no fault of his own,” says Carroll.
The dangers of inappropriate care for disabled people were laid bare in a recent report by the Mental Health Commission report into St Luke’s psychiatric hospital in Clonmel.
It found that intellectually disabled patients were being inappropriately prescribed long-term drugs such as benzodiazepines and that expertise to deal with people with disabilities was not in place.
In his most recent report, the Inspector for Mental Health Services, Dr Patrick Devitt, said that placing intellectually disabled people into generic residential care was not sufficient.
“Unfortunately, many intellectually disabled people with challenging behaviour have been placed inappropriately in psychiatric hospitals designed for the general adult population without adequate provision of consultant psychiatrist-led specialist teams in intellectual disability,” he wrote.
The slow pace of progress is something which is difficult to take for the families of disabled people. Colm Brady says the families of people who are still inappropriately accommodated in various settings will continue to speak out.
“People with intellectual disabilities don’t make noise or speak out. They don’t have political clout, so they’re always at the back of the queue. It’s unfair because, of all people, they should be looked after first,” he says.
“We take on different roles to try to help. My mother has been fighting for Mairead all her life to get her proper care, to ensure that she’s the best she can be. We’re all fighting for her. At the end of the day, we just want her to reach her potential.”