Scandal in our mental hospitals is revealed

The State has been involved in the wilful and, possibly, criminal neglect of vulnerable people in its care, says an official report published last week. The report suggests that, because of such neglect, citizens have died. It further reveals that citizens continue to be deprived of their liberty, often without elementary inquiry into the justifiability of such deprivation.

These revelations are contained in the Report of the Inspector of Mental Hospitals for 1998, which was laid before the Oireachtas on Friday. So far, the revelations have given rise to not a tittle of comment or complaint.

Under the Mental Treatment Act, 1945, the inspector is required to inspect mental hospitals every year and issue a report. One would have thought the report would be published shortly into the following year. All the more so, indeed, given conditions in mental hospitals and the abuse of citizens' constitutional rights that the inspections reveal. But no. The report for 1998 has been published only in the past week, almost a year after the inspections.

The reason for this is that the independent inspector feels obliged to give the responsible authorities every opportunity to consult on the form of the report before its publication.

This facilitation is taken further by the practice of giving several days' notice to the institutions about to be inspected. It is hardly surprising, therefore, that the report conveys a sense of pulled punches. In spite of this, a genuine scandal is revealed about how the State treats thousands of its most vulnerable citizens.

In the section of Chapter 1 of the report headed "Quality Care Issues" it is stated: "The Inspectorate felt drug-proscribing 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. There appeared to be an increasing number of sudden deaths in psychiatric hospitals, some of which were attributed to drug-related effects."

This reveals a degree of wilful negligence of possibly criminal proportions. The clear suggestion is that such wilful neglect might have caused the deaths of some of these citizens.

Immediately following this is another staggering remark, stated almost off-handedly. "The re-certification of involuntary (temporary) patients should always be carefully evaluated and recorded in case notes." This refers to patients who are involuntarily committed to mental institutions, people deprived of liberty itself, supposedly because of a temporary mental incapacity.

There is reason to be concerned anyway about the extent of such practice in Ireland (2,500 people are involuntarily admitted each year to mental institutions), but the suggestion that these people are re-certified without "careful evaluation" and that such re-certification is not even recorded in case notes is astounding.

The remark is followed with the observation: "The Inspectorate feel that in some services the practice of consultants in (regard to medical note-taking) falls short of what might reasonably be considered good professional practice."

What is going on here? How is it that vulnerable citizens are given drugs on prescriptions that are long out of date; given numerous drug doses simultaneously; that some are dying suddenly because of the effects of these drugs; and that consultants are falling short of elementary professional practice in relation to note-taking? How is it that this is going on and the Inspector of Mental Hospitals refers to this in an off-hand manner, that the Department of Health and the Minister for Health make no mention of this in their commentary on the report?

How is it that the deprivation of liberty of citizens is being continued without elementary inquiry into its justifiability and that the Department and Minister for Health have no observation at all to make on the issue?

Brian Cowen's comment on the report is entirely self-serving, referring to those parts that reflect favourably on his Department while ignoring the other elements. In a piece of unconscious irony, the Minister states: "The health services aim to achieve the best quality of life for each individual through the provision of high-quality, patient-centred services, and the work of the Inspectorate helps to ensure that high standards are maintained in our mental health services."

High standards? On page 22 of the report there is the following comment on the Central Mental Hospital in Dundrum, Dublin: "Despite some recent painting and redecorating, conditions in much of the old building were unsatisfactory. The day area in Unit 1 was simply unacceptable in terms of decor, furnishings and general accommodation. The seclusion rooms in the same unit were also totally unacceptable.

"Much of the sleeping accommodation in the old building was of poor quality, furnishings were lacking, the walls were peeling and there was no storage space for clothes. All the rooms had `night pots' with the resultant practice of `slopping out' in the mornings due to inadequate room sanitation."

By the way, "seclusion" means "the placing of a patient in any room alone and with the door or exit locked or fastened or held in such a way as to prevent egress for the patient".

The report notes in relation to Dundrum: "The level of seclusion in the hospital was very high, with more than 300 episodes recorded in 1998." There is more in this report of the Inspector of Mental Hospitals, and maybe the Oireachtas will get around to noticing it when it lifts its eyes from the John Ellis affair.

Postscript: In this column last Wednesday I wondered if it were possible that Fianna Fail ministers might have bolted from the graveside of Jack Lynch on Saturday, October 23rd, to attend a fund-raising function at Leopardstown racecourse.

Regrettably, the answer is: yes. Bertie Ahern was flown on the Government jet from Cork Airport to Dublin Airport, whence he was chauffeured to Leopardstown. Six other members of the Government boarded a helicopter in Cork and were ferried straight to the racecourse. I am told Fianna Fail paid for the helicopter. Some way to commemorate the passing of a revered former president of the party.

Vincent Browne can be contacted at vbrowne@irish-times.ie