Mental health strategy has not been implemented, report says

Mental health services and staffing have been greatly reduced despite ambitious government promises and rising demand, according to a new report.

The aims set out in the Vision for Change mental health strategy 10 years ago have not been translated into reality through the creation of proper community mental health services to replace the older institutional model of care, the report says.

Best practice in this regard has not been implemented in any "significant, meaningful or cohesive" way, and this failure has had a very significant impact on the quality of mental health services and care, according to the report by the Psychiatric Nurses Association (PNA) and the Royal College of Surgeons of Ireland.

It says the failure to adequately resource care in the community has caused a blockage of beds in acute units and hostels and the placing of patients “wherever there is a bed, rather than to a unit that best services their particular needs”.

The report says that despite some successes in meeting the recommendations of Vision for Change, especially in relation to care of older people, the standard and availability of services varies greatly across the country.

Large majorities of psychiatric nurses surveyed for the report said they have no access to crisis facilities, outreach teams or early intervention services.

PNA general secretary Des Kavanagh said the system is "hugely chaotic", with occupancy rates of up to 130 per cent in many units.

He said that, in many cases, patients who have been let home for the weekend receive a call to tell them their bed has been taken for an emergency case.

Dumping ground

Mr Kavanagh said prison has become a “dumping ground” for many patients with serious mental health issues, as the number of psychiatric beds has dropped 85 per cent since the 1980s.

The failure to replace staff emerges as a key anxiety for nurses in the study.

“We have 10 retirements coming up, so we are going to be in serious trouble,” commented one nurse in South Tipperary.

A nurse based in the Border counties described as “horrific” the fact that two-thirds of colleagues were eligible to retire in the next two years.

Attacks on staff were destroying the willingness of many to work in mental health, according to another nurse.

“The amount of staff that have been out on sick leave due to being assaulted has led to a huge decrease in our nursing staff numbers in this area, and younger staff who come into Mayo do not want to work in this area.”

The nurse mentioned the case of “a young girl who was only two years qualified and she is out with the possibility of never returning to work at the moment, she was that badly injured”.

Nurses also identified a high level of “bed-blocking” and the “revolving door syndrome” due to a lack of mental health services in the community.

One referred to a patient with Huntington’s who has been accommodated on an acute unit “for years now”, while another said five rehab patients were in a unit “for about three years”.

The current programme for government promises to fully implement Vision for Change, but also to undertake a review of the policy.