The use of drugs as the only treatment for psychiatric patients has been criticised by the Inspector of Mental Hospitals.
In his report for 2000 the Inspector, Dr Dermot Walsh, says junior doctors prescribe drugs for psychiatric patients without being given sufficient guidance on what they should prescribe.
Criticising "the predominance of drug treatment", he says this is often the only treatment available. "Many patients have complained that they don't have the option of psychotherapy or psychological treatments which they feel would be of greater help to them," he writes.
"To some extent, the legitimacy of this complaint is obvious," he says, adding that this is a result of training programmes which focus solely on drug treatments. He acknowledges, however, that many nurses have acquired skills in psychotherapy during or after their training "and use them to good effect".
"Very few mental health services in Ireland are truly innovative or willing to attempt new approaches to delivering mental healthcare," he says. A "refreshing" exception, he continues, is the Cavan/Monaghan mental health service. In developing community and rehabilitation programmes, "these service providers have brought a level of enthusiasm to service delivery which is refreshing and which has resulted in a decline in the necessity for acute in-patient care."
Dr Walsh also complains of the placement of young persons who are out of control "but do not suffer from a formal psychiatric illness" in adult psychiatric units.
In one instance in the North Eastern Health Board area, "as a result of a court order, a group home occupied by psychiatric patients was vacated and the patients located elsewhere in order to provide accommodation for such a youngster.
"This state of affairs, determined by the lack of appropriate residential facilities for such young persons, was highly undesirable and should be addressed through the provision of appropriate facilities as soon as possible," he suggests.
Other points raised by Dr Walsh in his report include:
Too many patients are admitted involuntarily compared to the practice in other countries. Where appropriate, people should always be offered the facility to admit themselves voluntarily.
A shortage of rehabilitation services for psychiatric patients has led to "a lot of suffering and disablement" for them and their families. It is essential that enough hostels, including high support hostels, be provided.
Older long-stay patients rehabilitated from psychiatric hospitals into community residences generally tend to remain there and do not become homeless.
People with mental handicaps continue to be accommodated in psychiatric hospitals, especially in the South-Eastern Health Board.
People with both a mental handicap and a mental illness "can often be denied the treatment they need" because of a "territorial" attitude by specialist services which often reject them.
The report can be downloaded from the "publications" section of the Department of Health and Children website at http://www.doh.ie
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