No defence of the dirt at St Kevin's

It was the dirt that was indefensible. The other bleak, awful conditions in Kevin's 3, at Our Lady's Mental Hospital in Cork - paint peeling off the walls, broken windows, dilapidated and torn furniture, crude beds, no privacy - were all explained away. The claim was "Kevin's 3 has been due for closure for five years and, definitely, it will be closed by October/November, so there is no point spending money on it". But that could not explain the dirt.

I was taken on a tour of the psychiatric hospitals in Cork on Saturday last and had been warned about St Kevin's. At a conference the previous day, organised by the Cork Advocacy Network and attended by over 600 people, several speakers from the floor spoke of Kevin's 3, how as psychiatric patients they had been sent there as a "punishment", how the locked wards there induced terror in them, how the bleakness of the surroundings deepened their misery.

One woman said during a break that her child had been removed from there recently to the new St Michael's Unit at the Mercy Hospital because he had got an infection and she was determined that he should not be returned to Kevin's 3 and wanted to resist that by whatever means she could deploy.

The head of communications at the Southern Health Board, Norma Deasy, who came on the tour of the hospitals on Saturday, had said we would see "the good, the bad and the ugly" - Kevin's was the bad and the ugly. She said there was no excuse for conditions there. Michael Laide, the senior executive officer for psychiatric services in Cork city (recently appointed, he emphasised), and Ned Kelly, the assistant chief nursing officer, agreed there were no excuses.

From a balcony outside the dining room on Kevin's 3 there is a magnificent view of Cork city and of the hideous Cork County Council offices. The balcony, too, was littered with filth - bits of clothing and other detritus.

In the wards there were no cupboards, even for personal clothing - the only furniture apart from the beds were dilapidated small lockers. There were no curtains between the beds and therefore no privacy of any kind for the patients. I was told that there could not be curtains because the curtain rails would be dangerous - patients might try to hang themselves from them.

In one ward on a floor above there was one curtain rail around one bed. Then the explanation for the absence of curtains changed to a cost argument. It would cost about £3,000 for a six-bed ward to install curtains and, since the unit would be closed down in October . . . For five years the same argument has been used for doing nothing about conditions in Kevin's.

Upstairs in Kevin's 5 conditions are almost as bad. Again filth, not everywhere but in lots of places. No curtains, no cupboards, dilapidated furniture, fluorescent lights. There is just a single comment in the most recent published report (for 1999) of the Inspector of Mental Hospitals about Kevin's. He says that conditions there were "most unsatisfactory".

Norma Deasy, Michael Laide and Ned Kelly, who graciously showed me around, will feel it is ungenerous to single out St Kevin's without highlighting the new unit at St Michael's, part of the Mercy Hospital, and the other psychiatric hospital in the Cork city area, St Stephen's.

The physical conditions at St Michael's are indeed marvellous - they give real meaning to the cliche "state of the art". It is a magnificent new building, overlooking a branch of the Lee, with gleaming wards, rooms and corridors. At St Stephen's (a converted sanatorium in Glanmire) conditions are also very good, for the most part.

AT the conference on Friday, more than 30 people spoke from the audience to tell of their traumas at the hands of the psychiatric services or spoke of the traumas endured by family members. There was real anger at the psychiatric profession - how psychiatrists treat patients as symptoms and not as persons, how patients are never consulted about their treatment, about the reflexive resort by psychiatrists to chemical solutions, about the absence of therapies and counselling. One man said he had the same psychiatrist for 14 years and had met him only once, and then for less than three minutes.

Psychiatrists may dismiss these complaints but how do they cope with a remark in the 1999 inspector's report, in the section dealing with the North Cork Mental Health Service, where he comments on poor medical note-taking: "Some of the long-stay patients had no medical note entries for over four years. The case notes of three recently admitted patients had no consultant entry and one of these medical notes might be taken to imply that patients were not afforded a formal clinical interview with their consultant."

What does that say about the level of service afforded the patients by the doctors concerned? And one further point: would it occur to the psychiatric profession that there is something wrong with the service they provide State-wide when the level of readmissions to hospitals is so high? On average - on the basis of a sample of some of the main institutions around the country - the level of readmissions to psychiatric hospitals as a proportion of total admissions is over 75 per cent. Might this not suggest that there is something seriously amiss?