The number of patients staying in psychiatric facilities continued to decline but there was a failure to develop out-reach and home-based services, the report of the Inspector of Mental Hospitals has stated.
The report showed that 3,701 patients, including those on parole, were resident in public and private psychiatric hospitals and acute psychiatric units on December 31st, 2003.
Of these 3,266 were in health board hospitals.
During the year, there were 23,234 admissions to the in-patient facilities of which 2,349 were non-voluntary.
The majority, 55 per cent, in hospital at the end of 2003 were long-stay patients being continuously hospitalised for over one year, with over one third continuously hospitalised for over five years.
In contrast in 1987, there were 11,114 patients in psychiatric residential care.
The report stated that at the end of 2003, while a small number of services such as those in Cavan/Monaghan and parts of Dublin had evolved towards an up-to-date model of out-reach and home-based care provision, the majority of services were still operating partially developed conservative community models.
"In general, service providers seemed unsure and insecure in their comprehension of the theory and practice of out-reach, home-based, crisis resolution and early intervention initiatives," the inspectorate report commented. On the organisational level, health boards had not considered newer models of care services adopted elsewhere, it stated.
"The inspectorate was struck that little thought had been given to the implications and possible advantages to psychiatric care of the recent proposals on the restructuring of the health services," it stated.
The report also highlighted the contrast between private accommodation and some public accommodation which gave grounds for concern.
St Patrick's Hospital in Dublin, which was private, and a new ward at St John of God's, Stillorgan, also private, with their high standards stood in sharp contrast, for example, with the "Victorian realities" of ward one at St Bridget's in Ballinasloe, "and clearly brought into focus current inequalities in our provision for the different social groups".
The report said there were positive improvements such as the opening of new psychiatric units at St Luke's Hospital, Kilkenny and Castlebar General in Mayo. However, despite the considerable progress in replacing or improving premises, there were still some "in-patient black spots", that were unacceptable for the care and treatment of patients, it stated.
These included most of the Central Mental Hospital, the entire St Brendan's Hospital, almost all the old building at St Bridget's, some long-stay wards in St Finan's Hospital, Killarney, and the current female admission wards in St Loman's, Mullingar, admission wards at St Ita's Hospital, Portrane, Co Dublin, the female admission ward at St Senan's, Enniscorthy, Vergemount Clinic, Dublin, some wards at St Luke's, Clonmel, and some wards at St Joseph's Hospital, Limerick.
There were also gaps in provision for specific groups such as the homeless, prisoners, immigrants, asylum-seekers, the intellectually disabled and mentally-ill and drug abusers.
The report was compiled by the Inspector of Mental Hospitals, Dr Dermot Walsh, and his colleagues Dr Liam Hanniffy and Mr Michael Hughes.
This is the final report under the current inspectorate, which makes way for the Mental Health Commission and a new inspection system.