Mentally ill people need modern clinical care

Quite rightly, the fact that Pat Joe Walsh bled to death unnecessarily in Monaghan General Hospital generated outrage

Quite rightly, the fact that Pat Joe Walsh bled to death unnecessarily in Monaghan General Hospital generated outrage. No intensive care bed could be located in any hospital although there were beds available, writes Breda O'Brien.

However, when it comes to beds for mental illness, as opposed to physical illness, there seems to be far less concern.

Some months ago, professor of psychiatry Patricia Casey described the chaos she and others face in the Mater hospital. On one occasion Prof Casey had three seriously mentally ill patients in A&E all weekend. Each patient had to have an individual nurse assigned to them at all times because they were a threat either to themselves or others.

If we wish to reduce the stigma attached to mental illness, we might start with affording acutely ill people the dignity of appropriate modern clinical care.

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Prof Casey and other psychiatrists are often reduced to a humiliating form of human horse-trading to secure desperately needed beds.

For example, an extremely ill patient needs admission to Hospital A but there is no bed. Other hospitals are contacted for assistance. Very frequently Hospital B will only accept a person who is well enough to be close to being discharged. Sometimes this may result in a patient close to discharge being woken in the middle of the night in Hospital A. He or she will be asked if they mind being transferred, there and then, to Hospital B so as to make the bed available for somebody much more ill.

Negotiation between hospitals often takes a considerable length of time. Meanwhile, the patient being cared for in the inappropriate environment of a busy A&E department in Hospital A may deteriorate with potentially negative consequences for the patient or possibly others.

How can we accept this at a time of unprecedented national wealth?

Fine Gael and Labour published a joint policy document on mental health this week, Reaching Recovery. It is important that mental health is put on the political agenda provided that it is not a vote-gathering exercise. It is also important to acknowledge the long-term commitment of deputies such as Fine Gael's Dan Neville.

All through the document the emphasis is on community care and the more recent model of home care. The model of community care proposed in this document is already in existence, however imperfectly. While remaining an ideal, evidence is uncertain that it secures better outcomes, and research shows that the staff suffer burn-out more quickly.

Moreover, the reality is that it often does not work well in urban areas. Take the case of recent immigrants in poor accommodation or single Irish people living in flats. To have home care you have to have a home, not a run-down but phenomenally expensive one-room bedsit in inner city Dublin.

There will always be a need for in-patient care and this reality cannot be avoided. In a way, to suggest that hospital stays are somehow intrinsically wrong colludes in stigmatising mental illness. There are many people with serious medical conditions who require repeated admissions to hospital yet no stigma attaches to their illnesses. There needs to be a balance between community and home care, and adequate provision of hospital beds when necessary.

It is freely admitted in the preface of the Fine Gael/Labour mental health manifesto that much of it is borrowed from other reports, including two reports commissioned by the Government. What is different about Reaching Recovery is that it declares the amount that will be spent.

Government documents on mental illness rarely tie themselves down by stating what the cost will be. Reaching Recovery promises an additional €10 million for suicide prevention, rising to €20 million after five years.

Yet even this will be nowhere near enough. The document estimates that the annual cost of mental illness in terms of lost productivity is a staggering €11 billion. Any money invested in effective strategies will pay for itself over and over.

However, Reaching Recovery overstates its case when it says: "The published scientific research and the invaluable experience of those working in the area of suicide prevention provide us with clear paths and programmes to help reduce this death toll."

It is true that there is a great deal of ongoing and valuable research, both internationally and in Ireland.

For example, UCD currently has over 10 national and international research projects, ranging from very technical studies to community and educational development projects. Thanks to funding from the charity Turning the Tide of Suicide (3Ts) and under the stewardship of Prof Kevin Malone, UCD has embarked on a study called From Awareness to Knowledge - The Lives Lost Behind the Statistics in which 1,000 families bereaved by suicide will be interviewed. Surprising as it may seem, it has rarely been done internationally.

The story of their loved one freely given by the family will provide new knowledge for the nation. However, at this moment internationally-recognised researchers like Prof Casey would say that we are still not able to demonstrate which prevention strategies work because success seems to vary across countries and cultures.

Much more research is needed before we can say we have definitive answers about what will help to reduce the numbers who die by suicide.

If we are really serious about tackling suicide we need to get serious about research. At the moment we know just about enough to realise how much we don't know.

It is not right that researchers have to scratch around, trying to source funding from multiple sponsors.

For example, it is recognised that early detection and treatment of illnesses like schizophrenia has a major impact on the eventual outcome for the person diagnosed. Yet pilot projects that were attempting to cut the amount of time before young people in particular are diagnosed and treated had to be initially delayed and scaled back due to lack of funding.

Any attempt to promote mental health and to reduce suicide rates is going to cost dearly. Not as dearly, though, as the heart and soul-crushing pain of thousands of families in Ireland today.

We will know that we are getting somewhere when the obvious problems in our mental health service rouse the kind of public and media attention that nowadays seems to be reserved for the Ryder Cup.