Almost 26,000 Irish citizens were admitted to mental institutions last year. Many of them are among the most vulnerable citizens in our society, deserving of our special vigilance and care. How we treat these citizens is a profound indictment of our society and our values.
In St Mary's Hospital, Castlebar, mental patients are accommodated in large Victorian rooms that combine sleeping accommodation, dining space, day facilities and a nurses' station in one area. On October 6th last year, when the hospital was surveyed by the Inspector of Mental Hospitals, there were two patients in bed dying in the day area occupied by the other patients.
Many of the older patients in St Mary's are not in need of psychiatric care, rather of geriatric care; but, for administrative convenience, they are registered as psychiatric patients.
In St Loman's Hospital, Mullingar, the inspector found three units were unacceptable for psychiatric care. In one ward, St Finian's, he found the furniture was dilapidated and shabby, curtains were missing or falling off the rails . . . Patients, visitors and staff lacked privacy, and there was no meaningful occupational or rehabilitative therapy for patients.
The inspector found conditions in St Edna's Ward in St Loman's "unacceptable" and noted that this had been mentioned in numerous previous reports and no improvement had been made. Commenting on practices at St James's Hospital in Dublin, he wrote: "Attention must once again be drawn to the paucity of medical note-taking by consultant psychiatrists in patients' case notes, particularly where critical decisions were made in relation to admissions, treatments and discharges etc.
"In some instances patients were treated in hospital and discharged without any entries by consultants in the case notes. This means there was no objective evidence that the patient was ever seen by a consultant, which had obvious quality-assurance and medico-legal implications."
The report is replete with similar critiques of the mental institutions throughout the State: "The [psychiatric care] of later-life patients was not appropriately catered for in [a unit in St Vincent's, Elm Park, Dublin]; it must be emphasised that the accommodation at Vergemount was inadequate, overcrowded and unsuitable for the care of acute patients; the temporary facility for long-term patients in the nurses' home at St Brendan's Hospital (Grangegorman) was inappropriate and the building was in a poor state of repair both structurally and decoratively; St Finan's Hospital (in Killarney) continued to be a cause of concern and the patients who were living in these conditions should be resettled in a more satisfactory environment; in-patient accommodation in St Michael's Unit, St Joseph's Hospital, Clonmel, continued to be a source of concern and this unit needs to be extensively remodelled or replaced."
About 2,500 citizens are involuntarily committed each year to these institutions, on the basis of the most casual appraisal of the justifiability of their initial detention and the renewal of their detention.
Thousands are subjected to treatments, including electro-convulsive therapy, without their consent or their proxy consent. Thousands are prescribed drugs on an arbitrary basis, and their prescriptions are not reviewed for years.
Two politicians did attend a conference organised by the Irish Council for Civil Liberties last Saturday on human rights and mental health patients. They were Liz McManus (Labour) and Fergus O'Dowd (Fine Gael). Fergus O'Dowd said there should be an Oireachtas committee inquiry into conditions in mental hospitals.
Last Friday, Dr Dermot Walsh took me to task for a construction I put on a section of his report which dealt with drug prescriptions in mental institutions.
The relevant part of his report reads: "The Inspectorate felt drug-prescribing in some locations is often arbitrary and made without regard to appropriate clinical diagnosis. The number of patients, particularly long-stay patients, who are on numerous drugs simultaneously, often at high dosages, was striking. In some instances, the prescriptions had not been reviewed for some considerable time.
"It is important to review medications at frequent intervals. There appeared to be an increasing number of sudden deaths in psychiatric hospitals, some of which were attributed to drug-related effects." This is taken from the final paragraph on page 3 of the 1998 report.
I interpreted this as suggesting that the indiscriminate prescription of drugs in high dosages, particularly to long-stay patients, was linked to the increasing number of sudden deaths attributed to drug-related effects. In a letter to this newspaper last Friday, Dr Walsh disputed this and claimed there was an innocent (my word) explanation for the rise in sudden deaths attributed to drug-related effects (sudden collapse and death in younger patients taking psychiatric drugs in recommended dosages, for which there is no satisfactory scientific explanation).
It would have been helpful if in his report he had not clearly linked the rise in sudden deaths to the arbitrary prescription of drugs in high dosages. I do not want to get into argument with Dr Walsh, however, because over the years he alone (with a few exceptions such as Annie Ryan) has been protesting about conditions in mental institutions, and nobody (including myself) paid any attention to him.
Dr Walsh has also clarified that the protracted delay in the publication of his report (the 1998 report was published only in November, having been submitted to the Department of Health and Children in late March. The Department has so far failed to respond to my question as to why this delay occurred).
The psychiatrists involved clearly have some explaining to do about the "arbitrary" prescribing of drugs "without regard to appropriate clinical diagnosis". And also about the failure to review medications often for years on end.
If a similar criticism were made of accountants, they would have an inquiry.
Dr Dermot Walsh will answer listeners' questions on his report on Tonight with Vincent Browne tomorrow night at 10 p.m. on RTE Radio 1
Vincent Browne can be contacted at vbrowne@irish-times.ie