Annual Report of the Inspector of Mental Hospitals
Mr Brian Cowen, TD, Minister for Health and Children, today (5 November, 1999) laid the Annual Report of the Inspector of Mental Hospitals for 1998 before both Houses of the Oireachtas and forwarded a copy to the President of the High Court.
The Inspector notes the continuing decline in the number of patients in psychiatric inpatient facilities from 5,192 at the end of 1997 to 5,101 at the end of 1998. There were almost 26,000 admissions to these facilities in 1998 of which approximately 6,000 were first admissions. The proportion of patients being admitted to general hospital units continued to increase and in 1998 accounted for approximately one-third of all admissions. A further fifteen per cent were admitted to private hospitals. The number of involuntary admissions at approximately 2,500 remained constant at ten per cent.
A number of welcome developments were reported in many of the health board regions during 1998 and examples of these developments included the opening of new community residences in a number of the mental health services in the Eastern Health Board area; the purchase of the extensive day facility in Portlaoise town; the acquisition of further residential accommodation in the Clare Mental Health Services and the opening of a refurbished residence in Strokestown, Co Roscommon. Although the Inspector acknowledged the significant progress that has been made in the provision of community mental health centres, day hospitals and community residential facilities for persons with mental health disorders, the rate of progress needs to accelerate. In some hospitals, as many as half the acute psychiatric beds are occupied by persons who do not need such a high level of inpatient care. A major reason for this is the absence of appropriate alternative residential facilities.
The Inspectorate continued to fulfil its statutory duty to visit each catchment area mental health service at least once during the year and the private hospitals and Central Mental Hospital twice a year. The report published today is a summary of the Inspector’s findings, following his inspections in 1998. While the majority of services were given two to three days notice prior to the inspection, in future years the Inspector intends to conduct an increasing number of unannounced inspections.
In 1998, the Inspectorate published the document Guidelines on Good Practice and Quality Assurance in Mental Health Services which stressed the areas of performance which were felt to be important for patient care and which needed improvement in some cases. The importance of patients’ rights across a broad range of issues was stressed and the responsibility of mental health services in such matters was highlighted. The document was distributed to all mental health service providers.
The problem of homeless mentally ill persons was highlighted in the Inspector’s report, particularly in large urban areas such as Dublin. The Eastern Health Board has made efforts to address the problem by providing a residential unit for the homeless mentally ill in St Brendan’s Hospital and a new day service at Usher’s Island, Dublin. The specialised outreach service for this group of people, who work closely with voluntary agencies, is in its infancy but is considered an essential service.
The Inspector referred to the fact that no new acute psychiatric units opened in 1998 although a new unit was ready at the Adelaide and Meath Hospitals, Incorporating the National Children’s Hospital at Tallaght (the unit opened in August, 1999) with a further unit scheduled for completion in 1999 at the Mercy Hospital, Cork. In addition, planning was proceeding on units in Portlaoise, Kilkenny, Sligo, Castlebar, Beaumont and St Vincent’s Hospital, Elm Park.
The Inspector welcomes the increase in the number of training places for psychiatric nurses and intellectual disability nurses and the linking of An Bord Altranais approved schools of nursing with third level institutions. However, difficulties recruiting qualified psychiatric nursing personnel, which was particularly acute in the Eastern Health Board region, was a particular concern. It was hoped that all available student psychiatric nursing positions would be filled in 1999 to ensure the service has a skilled workplace to meet future demand. (All places were in fact filled in 1999).
Concern was expressed by the Inspector at the lack of multidisciplinary teams in many mental health services, particularly in the area of psychology and social work services. The Department has provided additional resources to health boards this year to enable some improvements in paramedical support to be put in place. It is hoped to continue with this initiative as resources permit. The Inspector goes on to highlight a number of other service and quality of care issues which would have been raised with individual service providers. These issues will continue to be pursued with a view to bringing about the improvements required.
Commenting on the publication of the report, Minister Cowen said
“I welcome the publication of the Report of the Inspector of Mental Hospitals for 1998 and acknowledge the crucial role that the Inspectorate, as an independent body, plays in providing an accurate and detailed account of services in the mental health sector throughout the country. The health services aim to achieve the best quality of life for each individual through the provision of high quality, patient-centred services and the work of the Inspectorate helps to ensure that high standards are maintained in our mental health services.” Minister Cowen acknowledged that
“much still needs to be done in the provision of comprehensive facilities and services and it is my intention to facilitate health boards in bringing about the improvements and developments identified by the Inspectorate.”
The Minister stressed the importance of publishing the Inspector’s reports as soon as possible in the year following inspection and said that he had asked the Inspectorate to finalise the 1999 report at the earliest possible date.