Sir, - Vincent Browne's latest contribution to the debate on mental health (Opinion, December 1st) contains some alarming misinformation. He writes: "Thousands are subjected to treatments, including electro-convulsive therapy, without their consent or their proxy consent." Patients are required to sign a consent form prior to administration of ECT. If patients are unable to give informed consent, as may be the case with the severely ill, they cannot be admitted to a psychiatric hospital without the informed, written consent of a close relative.
Following a hypothetical detention, patients may not be given ECT without the written consent of relatives for this procedure and the opinion of a second consultant psychiatrist. This is the law in Ireland, as outlined in the Mental Treatment Act, 1945. Similar legislation exists in most countries to protect the rights of the mentally ill.
In relation to involuntary detention, Mr Browne states, again without any references, that "about 2,500 citizens are committed each year to these institutions, on the basis of the most casual appraisal of the justifiability of their initial detention. . .". Stringent guidelines are laid down for the detention of individuals with mental illness. In the UK, where media debate has gone beyond a One Flew over the Cuckoo's Nest level, the argument has progressed to the more difficult area of balancing the patient's right to refuse treatment against the right of society to be protected from psychotic individuals who may have violent tendencies. He further states that "thousands are prescribed drugs on an arbitrary basis". If this is a reference to poor clinical practice, Mr Browne is elaborating, in an unmeasured manner, on the comments about continuous review of long-stay patients in the report of the Inspector of Mental Hospitals. If one were objective, one might ask why there are not similar reviews, accessible to the public, in other areas of medicine.
As a practising Irish psychiatrist, I no longer expect objectivity in media debate about mental health issues. I work on the north side of Dublin, where resources in psychiatry are on a par with those in poorest countries in the world. The condition of St Ita's Hospital, which is the only facility for treating mentally ill patients in a catchment area of 250,000, is deplorable. The planned closure of the acute admissions unit and its transfer to Beaumont Hospital 10 years ago never took place. The Department of Health, despite repeated reassurances to the contrary, continues to postpone plans to develop an adequate treatment facility in Beaumont Hospital. This sort of reporting, reflecting widely held misconceptions about psychiatric practice, is more likely to prolong than to ameliorate the situation. - Yours, etc.,
Veronica O'Keane, Consultant Psychiatrist, Beaumont Hospital, Dublin 9.