The State’s inspector of mental services, Prof Jim Lucey, is speaking about taxation and learning to drive.
It would not be good enough, he says, to pass only 80 per cent of the tasks in the driving test and still get a full licence. The same goes for paying just some of your taxes. “The tax man wouldn’t accept that,” he adds. “He’d have your house and he’d be right.”
So why, Lucey asks, is it acceptable that a third of Ireland’s 66 acute mental health centres are compliant with less than 80 per cent of minimum standards?
“We have got 22 of the centres, and rising, falling below that standard,” he says. “What does it mean in practical terms? It means you can’t go to one of these centres and be assured of privacy, of therapeutics, of safety. That can’t be right.”
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Sitting at a table in his office in Dublin 4, almost a year into his role as inspector, Lucey is quite critical of the status of Irish mental health centres, saying it is “potluck” as to whether someone will receive quality treatment.
Lucey has worked in the field of mental health for 40 years, as a clinical professor of psychiatry at Trinity College, an associate professor at the Royal College of Surgeons in Ireland and as a consultant psychiatrist at St Patrick’s University Hospital.
He is disappointed that “the highest level of noncompliance ever” was found last year by the Mental Health Commission. But the real issue, he says, is the impact this has on those most in need.
“I need them to go to a safe place, to a therapeutic space, to a place that actually contributes to their recovery, their dignity. That is not a prison cell but is a therapeutic zone. That’s a minimum; it’s not idealistic.”
Ireland has moved away from the institutionalisation of people with mental illnesses, with the promise of integrated care being provided in the community. This vision, Lucey says, has not been borne out in reality.
“One of the things we have done is we have taken the money we have and the people and in a piecemeal, patchwork way we have invested in facilities of one kind or another,” he says, adding that acute units are at a “critical point” of dilapidation.
However, there are some positives to note. There was a 25 per cent reduction in seclusion, where a patient is isolated in a locked room, last year and a 9 per cent decrease in the use of physical restraint, his 2023 annual report noted.
Reducing these practices is important when seeking to reorient mental healthcare with a human rights-based approach, which the State is trying to achieve.
“Mental healthcare is good news. I’ve had a wonderful life working in mental health and seeing people getting better,” Lucey says. “The reward for any clinician is the person getting better. That’s the dividend. You see more of that in mental health. This is not a bad news story. The dial has to be turned.”
There is also a lot of therapeutic innovation coming through, he says, stressing the importantance of having staff capable of providing these so people in need can access them.
Lucey says the State currently spends €1 of every €20 of the health budget on mental health care, a figure that he believes needs to double. Staff shortages means many patients are unable to get access to the therapeutic interventions they require, resulting in a “huge problem” with overprescribing of medication to help ease distress.
“If you diminish the therapeutic input, you increase the reliance on the pharmacological nursing input,” he adds.
A spokeswoman for the Department of Health said the total allocation for mental health services for this year is more than €1.3 billion, “a record funding level and an increase for the fourth year in a row”.
“Between year-end 2019 and March 2024, mental health services have seen a net growth of 916 posts, 86 per cent of these posts are for those involved directly in client care,” she added.
The commission regulates only 1 per cent of mental health services in Ireland. Its role is due to be expanded under the forthcoming Mental Health Act which, it is understood, will see it tasked with regulating Child and Adolescent Mental Health Services (Camhs) and community residences.
When this happens is another matter given the publication of the Bill has been delayed yet again, with the department spokeswoman saying it will go to Government for approval to publish before the end of this month.
Lucey says promises made around mental health are “disingenuous”.
“What works in mental health works in all acute care. It’s five things: it has to be connected, hopeful, have integrity, meaning and empowerment – it has to Chime,” he said. “But currently the hopes are false hopes. The integrity of these promises was not there. We need a real genuine commitment to mental health.”
So, is the system, in its current iteration, working? Lucey is emphatic when he answers “no”. Aspects of it work, he says, and the staff are “great”.
“But how can you say the inspector finds acute mental health centres are more likely than not to be in premises that are dilapidated and not meeting minimum standards and say that’s working? This isn’t working. We have to shout stop.”
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