No more admissions to outdated asylums

ACUTE ADMISSIONS to outdated mental asylums have finally ceased following decades of stinging criticism over their often dilapidated living conditions.

In his annual report published yesterday, the Inspector for Mental Health Services, Dr Patrick Devitt, said the winding-down of old mental hospitals was continuing and anticipates that all remaining institutions could be closed within a few years.

While admissions have ceased, there will still be about 114 long-term patients residing in former mental asylums by the end of this year.

The closure of these facilities forms part of the State’s policy to reorientate mental health services away from an institutional model of care to specialist community care.

In general, the annual report of the Mental Health Commission – which includes the report of the Inspector of Mental Health Services – provides a positive view of progress over recent years, with better conditions, stronger safeguards for detained patients and greater involvement of people in their care.

However, it is concerned there are still too many admissions of children to unsuitable adult units, not enough focus on promoting a recovery-based approach to mental health, and major pressures on services due to staffing cutbacks.

During 2011 there were 2,057 involuntary admissions, or detained patients, to inpatient facilities, up from just over 1,950 last year.

The main reason for detention was schizophrenia or delusional disorders (50 per cent), followed by mania (24 per cent).

While there was a small rise in detained patients, in general there has been a steady downward trend in the numbers being admitted to psychiatric hospitals on both a voluntary and involuntary basis.

Official figures for 2011 will be available later in the year.

There has also been a reduction in the number of children or adolescents admitted to adult facilities unsuitable for their needs.

Last year 132 under-18s were admitted to adult units. This is down from 217 in 2007.

The commission said the addition of new child and adolescent units over recent years has helped reduce the number of inappropriate placements.

In general, the commission found that compliance with rules, regulations and codes of practice has continued to improve. However, it found that some services had regressed.

This, the Inspector of Mental Health Services said, may be an indication of “compliance fatigue, poor governance or lack of staffing.”

Of the 64 approved centres, just three – St Patrick’s Hospital, St Edmundsbury Hospital and Willow Grove child adolescent unit – were fully compliant with rules and codes of practice. These three centres are under the governance of St Patrick’s Hospital

However, 23 centres had either minimal or no compliance with standards.

In these case, management teams were called in to meet the Mental Health Commission to account for their performance and draw up plans to improve standards.

Dr Edmund O’Dea, chairman of the commission, said that in general the mental health sector was starting to see the benefits of a cultural shift toward an approach that promotes the recovery of patients, rather than simply the management of patients, as being at the heart of mental health services.

“The concept of recovery is central to modern thinking and practice in the area of mental health, and while we are seeing a shift in pockets around the country this has yet to permeate throughout the country,” he said.

Yesterday’s report was welcomed by the Mental Health Reform campaign group, but it said there was an urgent need to appoint a long-promised director who would be responsible for modernising services.

Orla Barry, director of the group, said the Government’s commitment of €35 million for developing community mental health services was in jeopardy without the immediate appointment of a director for mental health.