Lack of rehabilitation services for mental health patients criticised

A large number of people remain “trapped” in inpatient mental health units, often for years, due to a lack of rehabilitation services for them, according to a damning new report.

Less than half the specialist rehabilitation teams that were promised over a decade ago have been set up and in some areas little or no staff are available to help people with mental health issues, the report by the inspector of mental health services, Dr Susan Finnerty, says.

The short-sightedness of not providing adequate services has led to long-term neglect of people with serious and enduring mental illnesses, she says.

“There are 23 rehabilitation teams nationally; 48 per cent of what is required under current mental health policy. Of those teams, none is staffed to recommended levels. Many areas have no access to rehabilitation services, leaving people with enduring mental illness no prospect of reaching their full potential, attaining employment or education, a satisfying social and community life, or living in suitable housing with appropriate levels of support.”

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Minimal improvement

The 2006 mental health policy, A Vision for Change, envisaged the development of specialist rehabilitation and recovery mental health services, but Dr Finnerty says there has been minimal improvement in the number of teams over the last decade.

The 23 teams in existence are “poorly staffed”, the service has been “grossly under-resourced” and provision of care pathways is “mostly absent”, she says. No teams have been set up in Co Wicklow and staffing levels are less than 30 per cent of what was recommended in the midwest, Cork/Kerry and the midlands.

“We have people trapped in the acute system of inpatient mental health care because the services are not in place for them to be discharged,” according to Dr Finnerty.

The report, published on World Mental Health Day on Thursday, says a relatively small proportion of people receiving mental healthcare need rehabilitation – about one in seven, for example, in the case of psychosis. The problems they face include treatment-resistance symptoms such as hallucinations, delusions or loss of motivation, cognitive impairments, co-existing problems such as substance abuse, and homelessness.

The lack of rehabilitation mental health services has resulted in about 10 per cent of people with enduring mental health illness remaining in acute inpatient units, often for months or years after the acute phase of their illness has been treated.

Human rights issue

“Others are left with families, often with ageing parents, who cannot provide the support and care needed.”

Criticising an “out of sight, out of mind” attitude among some referring teams and senior managers in the HSE, Dr Finnerty said there appeared to be no planning to provide a comprehensive rehabilitation pathway.

In the end, she says, the lack of provision in this area is a human rights issue. “The right to access appropriate mental healthcare, the right to choose where to live, the right to education/training and access to employment, the right to privacy and the right to live to the full of one’s potential, have not been adequately provided for many people with an enduring mental illness and who cannot access mental health rehabilitation services.”

The Mental Health Commission, which appoints the inspector of mental health services, has written to the HSE seeking an action plan to address the concerns raised in the report.