Sir, – Joe Humphreys’s excellent piece (“High level of psychosis among remand prisoners”, Front Page, September 14th) highlights the circumstances that result in the mentally ill ending up in prison, rather than mental health facilities. If a revolving door of readmission to prison or hospital is to be avoided, then effective discharge planning is required.
While cost and time can always be an excuse for us healthcare workers, the reality is that we need to make tough decisions as to who we prioritise. Patients who have schizophrenia or psychosis and engage in substance abuse can cause chaos on a psychiatric inpatient unit and often the response is to discharge to homeless services with limited outpatient care.
An alternative care plan led by one key worker could involve assertive outreach by mental health workers who support the patient but who also ensure that social welfare payments are managed initially until the patient’s destructive lifestyle is addressed.
However, this is seldom done as it requires an assessment of patient capacity and that can fluctuate, so without discussion on future health policy regarding the merits of a paternalistic approach to hard cases, as opposed to patient self-determination in all cases, the status quo may remain. – Yours, etc,
FRANK BROWNE,
Adult Mental Health
Interest Group,
Irish Association
of Social Workers,
Pearse Street,
Dublin 2.