Legislation cutting high rates of involuntary admissions to psychiatric hospitals has still not been implemented despite being enacted two years ago, writes Carl O'Brien
The Mental Health Act (2001) provides for tribunals which would help protect the rights of patients by independently reviewing all decisions to detain a patient on an involuntary basis or to extend the period of detention.
However, support groups and psychiatrists say no funds have been made available to establish tribunals and, as a result, 60-year-old legislation which does not offer protection for patients is still in force.
Dr John Owens, chairman of the Mental Health Commission, which will have the authority to review all detention decisions, yesterday expressed frustration at the lack of resources.
"We are impatient to get going. We've been up and running for over a year now, and are anxious to do our business.
"The commission will be the first time there has been an independent body with national responsibility for detention, but also ensuring there is a high quality mental health service."
The lack of funding is not restricted to plans to restructure the mental health service. Just 7 per cent of the health budget is spent on mental health services, though one-in-four people suffer from a mental illness.
There are also major variations in the way the sector is resourced. Some more rural health boards, for example, spend up to €170 per head of population, while those in larger urban areas spend just €45 to €50.
"We punch below our weight and we always have. Mental health services are often seen as less important than the rest of the service. The percentage funding reflects the low pecking order of the mental health service.
"Because services tend to be underprovided and the places they are provided are often in poor condition, it adds to the perception of psychiatry as a slightly inferior thing," Dr Owens said.
The low priority of the mental health sector was also reflected by the failure to fully implement the Planning for the Future report (1984), which promised greater community care and alternatives to psychiatric hospitals.
That was nearly 20 years ago. Dr Owens said a new model was needed to meet the needs of today's population and tackle the alarming numbers of mentally ill who end up homeless once released back into the community.
"Planning for the Future is played out now; it's old hat. We need a different kind of model by moving services into the community and allowing people to be looked after in their own homes.
"Our psychiatric services still seem to be too bed-based, too based on medication, while there are not enough specialists.
"The net emphasis should be on the user. Home and community is the first priority. Services should be available there and family members should be empowered to deal with problems. If patients are dealt with in that way, they respond. No one likes going into a mental hospital."
While the commission will be seeking to bring about change, it hopes to work in conjunction with staff and health boards rather than taking them on.
In the meantime, the commission is hoping that long-promised structures in the Mental Health Act will materialise. And it says the rise in the voice of patients and their advocates will ensure that the sector is not neglected as it has been in the past.
"I hope there'll be a real leap forward over the next few years. Apart from the Mental Health Commission being set up, patients are becoming more like consumers and demanding better services. What's required now is a big investment, not just of money but of vision to bring the service forward."
Case study:
Joan, a former involuntary patient in a psychiatric hospital
Joan still remembers the thrill of feeling rain on her skin for the first time in years after being locked up inside a mental hospital against her will.
"I stood there, I wasn't wearing a jacket, and got soaked to the skin. I felt like a child on Christmas morning. I know most people complain about the weather, but I never do," she recalls.
Now 42 years of age, she looks back on the nine years spent as an involuntary patient as a dark chapter of her life which she would prefer to forget but cannot.
"It's like you've a stamp on your forehead for life. There are countries which I can never travel to because I won't get a visa.
"If there is a job vacancy and two people are going for it, chances are they won't give it to the person who was mentally ill," she says.
"To me being kept in a locked ward was worse than being in prison. If you break the law and commit a crime, you go to prison. Yet, you can be locked up in hospital if you're ill and have done nothing wrong. No one should have a right to do that to someone."
She was admitted to hospital in her early 20s suffering from severe depression. After repeatedly trying to kill herself by taking overdoses or attempting to drown herself, her family agreed to sign her into a locked ward.
It meant being forced to take medication, undergo electroconvulsive therapy against her will, and being searched after any contact with a visitor.
"My condition didn't improve or deteriorate. It just stayed still. I couldn't understand why the staff would want to keep me alive.
"There was nothing to live for. We were just like wild animals, there was no future, every day was the same. It could have been January or June, you had no way of knowing."
As a result of the closure of the Victorian hospital where she was detained, she was moved to a smaller unit in the Cork area. Due to bed shortages she was moved out of a locked ward. She was later released and settled back into the community with great difficulty.
While she admits she would not be alive today if she was not kept in involuntary detention, she says there must be alternatives to taking away someone's basic freedom.
These days things have improved dramatically for Joan. She is working, providing support and advice to mentally ill patients and their families. She finally feels like she has some control over her life.
"I try to turn a negative into a positive. I use my own time in hospital to try and give hope to others. Families tell me that my experience gives them great hope.
"If it means that one person doesn't go through what I went through, that would be something."