Community services Community-based services for the mentally ill are not treating patients effectively, according to the Inspector of Mental Health Services, Dr Theresa Carey.
At the annual conference of Mental Health Ireland in Limerick at the weekend, Dr Carey said an effectively functioning community- based service should reduce admission rates to hospital.
"At present, we know that 75 per cent of those certified to hospital are known to the mental health services and a similar percentage experience more than one admission. This is a clear indicator that the services are not addressing the underlying issues and effectively treating patients," she said.
Of particular interest to the inspectorate was the development of mental health services where users were involved in decisions about their treatment and care and where all those with a mental illness had the right to care in a way that respected their freedom and dignity.
"The key to ensuring these needs are addressed is through the development of a high quality service that is community-based," Dr Carey said.
Dr Carey said the inspectorate was concerned with needs of particular groups which were particularly vulnerable.
These included those with enduring mental illness who were often poorly served by current services, those with mental illness who broke the law and who may end up inappropriately in prison or in unacceptable conditions in the Central Mental Hospital, children and adolescents who may be placed in adult wards and those with learning disability who may have to get the care they need in another country.
"The needs of such groups must be addressed in a responsive and particular way, establishing specialist groups if necessary," she said.
Prof John Monaghan, national vice-president of the Society of St Vincent de Paul, said each day SVP members saw people trying to cope with the burden of mental illness.
The SVP operates 18 hostels for the homeless throughout the State catering for 1,200 people each night. A recent survey of 75 residents in the larger hostels found that 56 per cent had addictions, mainly alcohol- related, 49.9 per cent had mental illness and 21.3 per cent had both, he said.
"The instance of mental illness among hostel residents, men and women, has increased in recent years. This would appear to be as a direct result of the closure of long- stay psychiatric units and the release of patients into the community," he said.
Hostel residents who were refugees or asylum seekers were likely to have experienced trauma and stress and up to 20 per cent of refugees were reported to be the victims of torture with consequent effects on their mental health.
"This aspect of the refugees' experience is not widely acknowledged or addressed in the provision of services," Prof Monaghan said.
The Ombudsman, Ms Emily O'Reilly, said she was disappointed at the lack of progress in bringing forward legislation on the national health strategy Quality and Fairness - A Health System For You.
On the issue of mental health and the right to complain, she said: "I would like to see the development of the role of an independent patient advocate, facilitating the patient's movement through the process, matters concerning treatment, therapies, medications, social welfare benefits, family relationships and domestic concerns." she said.
"We get only a handful of complaints from general hospitals and hardly any from the psychiatric hospitals - a fact in itself which underlines the worrying absence of a complaints culture in the health sector generally," she said.
In the past five years, less than a dozen complaints had been received from the mental hospitals within their remit, she said.
The Minister of State at the Department of Health and Children, Mr Tim O'Malley, said the Government was committed to the provision of quality care in the area of mental health.