Mental health services ‘stagnant’ and in danger of slipping backwards

The country’s mental health services are stagnant and in danger of slipping backwards as a result of dwindling staff numbers and poor governance, the inspector of mental health services has warned.

His comments are in the annual report of the State's watchdog on mental health services, the Mental Health Commission, which raised concern about the state of communitybased services.

Dr Patrick Devitt, inspector of mental health services, said nursing staff numbers continued to dwindle last year, while unfilled vacancies were resulting in professionals being pulled out of community services to plug gaps in inpatient care. This is despite the Government's policy of investing in community-based treatment rather than institutional care.

Community services with access to a range of therapeutic services are considered by most experts to be more suitable than the older “medical model” of hospital-based care.

His comments were echoed by the chairman of the commission, John Saunders, who warned that standards of care would worsen unless community mental health posts were filled.

Community services
Mr Saunders said only a third of the 414 promised community mental health posts due to be filled last year to strengthen community services were in place at the beginning of this year. These posts include psychologists, occupational therapists and social workers.

While most have since been filled, he warned that a backlog was threatening to delay the appointment of hundreds of community-based personnel.

“There is a real danger that standards will fall unless these posts are filled promptly,” Mr Saunders said.

“We have incomplete mental health teams trying to provide multidisciplinary care. In many cases they’re football teams with half their players missing.”

The commission reported progress in several areas such as the development of new inpatient centres for children and adolescents who require acute treatment.

Despite these new services, there were 106 admissions of young people into adult units last year, a practice previously criticised by the commission as “inexcusable and countertherapeutic”.

The commission also expressed concern at “slippage” in the compliance of services with their legal obligation to provide quality psychiatric services.

While many services performed well, the commission used its legal powers to attach conditions to the registration of nine psychiatric services last year. These included a failure on the part of services to have individual care plans for patients or to provide sufficient training for staff.

If these issues are not resolved the commission has the power to deregister or close down a service.

Nine centres
Six of the nine centres have since tackled these shortcomings in care. However, three centres – the psychiatric units at Connolly Hospital Blanchardstown in Dublin; St James's Hospital, Dublin; and University Hospital Galway – have yet to address them, according to the commission.

Dr Patricia Gilheaney, the commission's chief executive, said in general there was a high level of compliance with regulations.

“This is a very effective method at our disposal and, as we work to improve standards, we will continue to use it whenever it is appropriate,” she said.