Unfulfilled Hopes: A Comparison of Two Reports

on Thursday, 31 July 2003. Posted in 1999

Scroll down this page to compare these two reports.

 

Extracts from

The Psychiatric Services -Planning for the Future(1984)

Psychiatric HospitalsMany of the hospital buildings are old and have poor facilities. Improvements are urgent and necessary in the interests of the patients and staff…. For patients who continue to live in psychiatric hospitals…a wide range of programmes of activation and rehabilitation is needed, whether to prepare them for a more independent life in a community setting or to raise the quality of their lives in hospital.

Extracts from

Report of Inspector of Mental Hospitals (1997)

"The Inspectorate cannot stand over conditions pertaining to St Brendan\'s Hospital and the Board are urged to double its efforts in an attempt to close St Brendan\'s" (p.6) "Conditions in St Loman\'s (Palmerstown) have continued to deteriorate to the point where some relatives have refused to have patients admitted to the hospital and have taken them home instead" (p.8) "The admission facilities in St Senan\'s (Wexford) were unsatisfactory. There was no privacy and severe overcrowding. Bathroom facilities were grossly inadequate, day space was extremely limited, there were no facilities for visitors to meet with their relatives, interview and other offices were non-existent and ECT had to be administered in beds, virtually in full view of other patients" (p.107)"Conditions in Unit 11 of St Joseph\'s, Portrane, had deteriorated since the previous inspection. The condition of the toilets was unacceptable: seats were missing from the toilets, the boards at the back of the toilets were smeared with faeces and a terrible stench emanated from the area. There were no taps or handles on the wash-hand basins, no soap and no towels. Windows which had been broken were boarded up. One exit door (a fire exit) had been boarded up with plywood…No lights were functioning in one of the day-rooms and toilet areas. Patients were groping around in the toilet in the dark" (p.42)"Once again, it was emphasised that the living accommodation in four wards of the main building in St. Loman\'s Hospital (Mullingar) were unacceptable and should be vacated as soon as possible." (p.60). "In the long-stay wards, care was almost exclusively of a custodial nature…the male wards were grim, dark and gloomy". (St. Mary\'s, Castlebar) (p.137).

 

Planning for the Future (1984)

Community Based Support ResidencesEach sector team should provide a range of residential accommodation in the community..to house former hospital patients and to cater for the needs of mentally ill persons living in unsatisfactory accommodation in the community.(9.27.1)A busy general hospital is a poor social environment in which to live for a long time. The in-patient service for new long-stay patients should be located in high support hostels. These hostels provide long-stay care in the community as an alternative to long-stay care in psychiatric hospitals…The development of high support hostels is an important step in the transition to a time when the large psychiatric hospitals will no longer be needed and we consider that they should be regarded as a priority for development.(7.25, 7.49.6, 9.17)

 

 

Inspector of Mental Hospitals (1997)

"More medium and high-support residential accommodation was required"(Vergemont Clinic) (p.27)The inadequate provision of alternative residential facilities and community support structures had placed pressure on the existing acute psychiatric unit, in spite of the very low admission rate. Pressure on beds had led to..patients..not being admitted due to a lack of beds, being transferred to other hospitals, being discharged early, patients on temporary release unable to return to the hospital because their beds were occupied. An enormous amount of time was spent searching for beds in other hospitals"(Kildare) (p.20)"Additional medium and high support residential facilities (need) to be provided"(West Galway Mental Health Service) (p.135)"The provision of a high-support community residence…would have the support of the Inspectorate"(Mayo Mental Health Service) (p.137)"Sixty five percent of long-stay patients (in St. Stephen\'s Hospital, Glanmire) were over sixty-five years of age and it was likely they would remain in St. Stephen\'s due to the virtual absence of community-based alternatives…There were no high-support or medium-support residences in the catchment area"(Western Health Board) (p.115)It was hoped that two further high-support residences would be acquired for long-stay, older patients in St. Otteran\'s (Waterford). It was felt that the majority of the "disturbed" patients in St. Enda\'s Ward would be suitable for community residential accommodation. (p.103)

Multi-Disciplinary Approach

There should be a multi-disciplinary approach to the treatment of mental illness. Each psychiatric team should have a consultant psychiatrist as its leader and should include the services of psychiatric nurses and have access to the services of clinical psychologists, social workers, occupational therapists and a health administrator.(2.6.2, 2.2)

"Once again it is necessary to refer to the lack of clinical support services in the social work, psychology and occupational therapy fields in many services…it is quite impossible to provide multi-disciplinary teams without such professionals". (p.4). "There was a lack of multi-disciplinary team work in the service which was highlighted by the absence of social workers, psychologists and Inspector of Mental Hospitals (1997)occupational therapists and physiotherapy services for older patients at St Senan\'s (Wexford)" (p.108)"The lack of professionals, other than doctors and nurses, in the Waterford mental health service was deplorable" (p.104)"A truly multi-disciplinary team needed to be established (in Tipperary Mental Health Service). One psychologist was employed in the service but there were no occupational therapists, social workers or other professionals" (p.101)

In-Patient Service in General Hospitals

Ideally, the in-patient service for all admissions should be provided in psychiatric units in general hospitals.(7.9)

 

"The slow rate of progress in providing quality, general hospital based care for acute psychiatric illness in the Dublin area is a cause for concern". (p.5)"It is a source of regret that the provision of an acute psychiatric unit in Mullingar General Hospital is still several years away". (p.8)"It is imperative that a unit be provided as soon as possible in Ennis General Hospital". (p.8)"This matter (a psychiatric unit in Sligo General Hospital) is now all the more urgent…". (p.9)"Plans for a psychiatric unit at St. Luke\'s Hospital, Kilkenny..have been completed but building has not yet begun". (p.10)"Planning has commenced in relation to the provision of acute psychiatric treatment facilities at Wexford General Hospital". (p.10)"There has been no progress towards the provision of a general hospital psychiatric unit in Mallow Hospital". (10)"…in relation to the provision of acute admission facilities in Portiuncula Hospital…it is hoped that progress on this unit will be made as soon as possible". (p.11)

Crisis Intervention Service

A crisis intervention service should be available to every sector…A crisis intervention service provides access to expert psychiatric help on a 24-hour basis without having to admit a person to hospital. This service is an important support facility for general practitioners and other primary care workers in enabling them to cope with critical situations…(5.26.6, 5.22)

"It is imperative that in the years to come, large metropolitan areas such as Dublin, Cork, Galway and Limerick should have a twenty-four hour emergency service available to primary care and other community-based agencies whereby a psychiatric team, working in conjunction with the gardaí where necessary, are available to deal with community-based emergencies". (p.4)

Planning for the Future (1984)

A Community Oriented Service

The psychiatric service should be community-oriented i.e. it should enable people to avail of a full range of services while continuing to live in their own homes.(3.14.1)

Inspector of Mental Hospitals (1997)

 

"Admissions from the Dublin South-East catchment area continue to come to St. Brendan\'s, (Grangegorman) because of the unsatisfactory nature of acute facilities in that catchment area". (p.6)"The Kilkenny service urgently needs both day hospital and day centre mental health facilities in Kilkenny City but no progress has been made in this direction during the past year". (p.10)

Mentally Handicapped Persons

Mentally handicapped persons in psychiatric hospitals should be segregated from the mentally ill and provided with programmes of care and activity appropriate to their needs.(7.49.9)

"Provide community residential accommodation for the forty-five patients with a mental handicap who are still patients in St. Brigid\'s (Ballinasloe)". (p.130)"The plan to re-locate patients with a mental handicap from St. Finian\'s (Killarney) to more appropriate care settings to be expedited". (p.114)"Many of the wards that remained open contained quite an inappropriate mix of patients: patients with a mental handicap, long-stay functional psychotic, older patients and newly admitted acute patients from the admission ward were all placed together". (St. Luke\'s. Clonmel) (p.99)"The rest of the patient population at St. Senan\'s (Wexford) comprised, in the main, older patients and patients with a mental handicap. Both these groups should be designated or at least become the focus of specialised services for their particular group. However, the clinical director of the service disagreed with this assessment". (p.108)"Other principal elements (of a plan for Carlow/Kilkenny mental services) concerned the provision of premises for patients with a mental handicap…" (p.94)"On 31st December 1996, there were 131 patients in St. Brigid\'s (Ardee) and thirty one were patients with a mental handicap" (p.79)

Sectorisation

The psychiatric service should be organised on the basis of sectorisation. This means that a psychiatric team should provide a comprehensive service to the population living in a particular district.The psychiatric team should, where possible, be based in the sector. (4.13.1,4)

"Preliminary plans to sectorise the catchment area (St. James\'s Hospital) had been drawn up but no progress had been made…". (p.22)"The lack of community facilities in the various sectors made the development of a sector-based service difficult". (Vergemont Clinic) (p.27)

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Working Notes is a journal published by the Jesuit Centre for Faith and Justice. The journal focuses on social, economic and theological analysis of Irish society. It has been produced since 1987.