Government working on online mental health services

The Government is working on a "radical" transformation of mental health services by directing sufferers to the internet rather than visiting doctors and counsellors, Minister of State for Mental Health Jim Daly has said.

Responding to the latest damning findings on care in Ireland from the Mental Health Commission, Mr Daly said using online applications to tackle the crisis was a key focus.

“There is a chronic shortage of consultant psychiatrists worldwide, it is a struggle every country is having, so I’m trying to look at new ways of doing what we do,” he said.

“One of the main focuses for me since becoming minister is to look at the online space, of delivering mental health online.”

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Mr Daly told RTÉ Radio One you "can't take somebody's appendix out" online "but you can deliver mental health services" through the internet.

“I am trying to radically transform the delivery of these services,” he said.

The government is also working “at building a lower level of infrastructure” for mental health services, which focuses on earlier intervention targeting young people before issues worsen, he added.

‘Forgotten about’

Mr Daly was speaking as the latest annual report by the Mental Health Commission showed the number of children placed in adult mental health units rose by 20 per cent last year despite repeated calls for the practice to end.

It also noted some patients who languish in institutionalised settings have been “forgotten about” by the State and society.

"The lack of any real progress and commitment on these matters undermines the fundamental human rights of people using mental healthcare services," said chairman John Saunders.

The commission carries out regular inspections of care settings and has long been a critic of conditions. It has called for unacceptable waiting times and difficulty accessing emergency beds to be addressed.

Its report also highlights “widespread use” of seclusion, physical restraint and dirty and dilapidated facilities.

But of particular concern is the system’s treatment of young people. During 2017 there were 82 admissions of children to 19 adult units, rising from 68 the year before; 6 per cent of those - or about five cases - were aged 15 or younger.

These people appear to have been forgotten by both the mental health services and by society

Although that number has dropped from a high of 247 in 2008, the commission said admitting any child to an adult service is unsatisfactory.

“A contributory factor to the continued admission of children to adult units is a shortage of operational beds in dedicated child units,” it said.

It noted the inability of Child and Adolescent Mental Health Services workers to admit children after hours, “thereby forcing” them to look to adult units instead. Such a situation, it said, is a “clear breach of the human rights and dignity of the child” and had remained a concern for “many years”.

Also of concern were the 1,300 vulnerable adults with mental health issues s accommodated in community residences which it said were unregulated and mostly institutionalised settings with “little or no rehabilitation”.

The Mental Health Commission carries out regular inspections of care settings and has long been a critic of conditions.

“These people appear to have been forgotten by both the mental health services and by society,” it said.

Lack of progress

Overall, this corner of the health sector had demonstrated “either nonexistent or slow” levels of progress.

In total, 62 of 64 approved centres were found to be non-compliant with one or more legislative requirements

The report raised the “careless lack of attention” in some facilities to basic issues of cleanliness and dilapidation.

“Overall compliance with regulations and rules had only improved by 2 per cent since 2016,” said the commission.

“A disturbingly high number of in-patient units were dirty and poorly maintained, with associated implications for infection control. This is a deterioration since 2016. Physical care of patients had worsened. Care plans were, in the most part, paper exercises which were not collaborative or addressed recovery.”

In total, 62 of 64 approved centres were found to be non-compliant with one or more legislative requirements.

Mr Saunders said a number of the issues had been consistently raised in annual reports since 2012 and the commission was now calling on the Government to initiate a transformational programme.

The Health Service Executive said while it acknowledged a slight increase in admissions of under-18s to adult units in 2017, overall admissions for under-18s was down from the previous year.

There had been improvements to services, it said, including the launch of the Best Practice Guidance for Mental Health Services and the National Framework for Recovery in Mental Health.

It said an additional 20 beds are planned for the new children’s hospital and an additional 10 forensic beds in the National Forensic Mental Health Service.