Inspector of Mental Health Services report: The standard of care for patients in large psychiatric institutions has been severely criticised by the independent watchdog for the mental health sector.
Despite repeated Government pledges to close these institutions, just four have closed over the past 20 years and patients continue to be admitted to long-stay wards, the Inspector of Mental Health Services has found.
The inspector's 2005 report, published yesterday with the Mental Health Commission's annual report, found that a significant number of these wards were in poor physical condition, with the inspectorate recording poor hygiene, a lack of privacy, peeling paint and leaking ceilings in some wards.
Many of these wards have little or no therapeutic activity, multidisciplinary input, regular physical or psychiatric assessments or care plans for patients.
In addition to psychiatric institutions, the inspectorate visited community residences which provide services to patients who have been transferred from large psychiatric institutions.
While the inspectorate noted high levels of dedication and care from nursing staff in the vast majority of residences, it found large residences were likely to resemble wards with "institutionalised practices" and little individual rehabilitation.
Most residences did not have any active input from a rehabilitation team, while few had any input from multidisciplinary teams. As the report noted: "For most residents, the move to community residences was an exercise in relocation rather than part of a rehabilitation programme."
It also raised concern over specialist treatment, such as services for people with intellectual disabilities. While people with learning disabilities have a higher than average risk of developing a mental illness, there are just two units approved for in-patient care. The remainder of people with intellectual disability and mental illness receive care in "de-designated units" that are not inspected and are outside the legislative framework that protects their rights.
Similarly, there are just two in-patient units in the State for children or adolescents with psychiatric problems. The lack of specialised services has resulted in waiting lists of up to two years, while many are being admitted into adult services.
Some areas of the country had no specialist mental health teams for older people. In general, where there was a specialist service, it was understaffed and unable to provide a full service.
The inspector said it was clear that, overall, access by patients to adequate and appropriate mental health services was restricted by "lack of resources, poor multidisciplinary teams and a lack of specialist mental health teams".
The Mental Health Commission echoed many of the inspectorate's concerns and called for resources to be targeted at the area. Dr John Owens, chairman of the commission, said: "[ We see] those with severe and enduring mental illness as having a special priority in mental health service improvement."