The first major report of the recently established Inspector of Mental Health Services makes for disturbing reading. Mental health, often regarded as the "Cinderella" of the health sector, has traditionally been at the back of the queue when it comes to the allocation of resources.
As well as detailing this historical underinvestment, the report provides a snapshot of a service beset with management deficiencies, poor planning, lack of accountability and a lack of specialist mental health services. Lack of basic information gathering means it is impossible to distinguish between services that are performing well or performing poorly.
All of these failures are having a serious negative effect on the quality of services to patients, which vary dramatically in different parts of the country. Patients, for example, are more likely to be admitted to a long-stay hospital, be detained against their will, or receive prescribed electro-convulsive therapy in some health authority areas rather than others. Underfunding has also resulted in a service where too much care is still provided in inappropriate institutional settings.
Conditions which would be unacceptable in acute hospitals are still tolerated in places like the Central Mental Hospital in Dundrum, St Brigid's Hospital in Ballinasloe and St Joseph's Intellectual Disability Service in Dublin. Plans to move care away from these institutional settings and into the community are also failing in many cases.
The low priority given to mental health reflects the continuing stigma surrounding mental illness, poor advocacy on behalf of patients and the lack of political will to address the problems of the sector. The inspector's report makes a number of recommendations which would go a long way towards providing a quality mental health service.
Tackling the erosion of national funding is one of them. Despite the fact that a huge burden of disability is caused by mental illness, this is not reflected in the health budget. The World Health Organisation estimates that between 20 and 25 per cent of total health-related disability falls in the domain of mental health. Yet current funding in Ireland, as a proportion of the overall health budget, is about 7 per cent.
There is also an obligation on health professionals to participate in the radical reforms needed in completing the move from institutional to community-based care. However, a dispute with consultants over the introduction of mental health tribunals, aimed at safeguarding the rights of patients involuntarily detained in psychiatric hospitals, is hardly encouraging.
The inspector's first report makes the case for an agreed, costed and timed modernisation plan for mental health services. It is to be hoped that it will inform and influence the new blueprint, to replace the 20-year-old Planning for the Future strategy, due to be completed before the end of the year.