An "almost total absence" of community mental health supports across the State has been criticised in a new discussion paper from the Mental Health Commission (MHC).
In addition, there is a major deficiency in the number of acute beds for older patients, the paper suggests.
While acknowledging current provision of public acute adult mental health beds is broadly in line with recommendations in A Vision for Change – a strategic policy document published in 2006 – it suggests access to these beds is both “insufficient” and “inadequate” due to a lack of specialist resources.
"When A Vision for Change was conceived, it highlighted significant gaps in the provision of specialist rehabilitation teams and recovery-oriented services," according to MHC director of standards and quality assurance Rosemary Smyth.
“In order to address these concerns, specific recommendations were made for the provision of community supports along a continuum of care, including crisis houses, intensive high-support hostels, rehabilitation high-support hostels, specialist rehabilitative units, and psychiatric intensive care units.
Ms Smyth says a comparison of current provision with the resources recommended by A Vision for Change reveals “an almost total absence of these types of supports in each mental health area”.
As a consequence, the review suggests prolonged stays of people experiencing mental illness in acute mental health units is having a significant impact on access to beds. for this reason, regardless of the total number of registered mental health beds for adults, there are “serious concerns” about access and availability.
"It is clear that access to public acute mental health beds for working-age and older-age adults in Ireland is insufficient and inadequate," said Ms Smyth.
The paper finds that despite a recommendation to provide 15 intensive care beds as part of the development of four national combined intensive care rehabilitation facilities, not one unit has been developed.
Inadequate provision of psychiatric intensive care units continues to result in the most severely unwell people with challenging behaviour not having access to intensive care in an appropriate facility, it says. “This upsets the milieu of what should be calm and therapeutic acute units.”
The availability of 56 older-age adult beds was identified, less than half the 127 beds envisioned in 2006.
Not one of the nine Community Healthcare Organisations (CHO) was meeting the recommended number of dedicated older-age adult acute mental health beds, the paper finds. Of greatest concern, it says, is that three purpose-built acute units for older adults are being used for other purposes.
"The care and support required for the recovery of, for instance, an 80-year-old is substantially different to that of an 18-year-old," said John Farrelly, chief executive of the MHC. "The use of non-age appropriate placements has the potential to create unsafe environments."
MHC chief executive John Farrelly told RTÉ Radio’s Morning Ireland that accident and emergency departments should be “the last door, not the first door” during a crisis.
“It is not good enough in modern Ireland.”
He pointed out that 12 per cent of patients in acute units were staying there for more than six months, some for up to two years and one patient had stayed for five years. “Most have enduring mental illness.”
If there was an adequate crisis service then patients would not be in acute beds, he said. Vulnerable people were being pushed to the margins. “It’s a really good policy [Vision for Change],” he said. But there needed to be accountability and a greater drive to implement its proposals, he added.
“There’s no point in having a policy if it’s not being applied.”
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