The number of acute psychiatric beds in hospitals should be significantly reduced and the development of psychiatric services in the community favoured, the Government-appointed expert group on mental health services is set to recommend.
The Expert Group on Mental Health, which is due to report within weeks, is also expected to recommend major reforms to the way services are delivered and organised around the State.
Final draft recommendations to be considered by the group later this month maintain that the development of advanced programmes for the provision of care in the community "will impact considerably on the requirement for acute beds".
The draft report maintains that when these proposed community facilities and services are in place, that "an acute bed requirement of 50 per 300,000 would seem to be a realistic planning norm".
It suggests that child and adult psychiatry would also have a requirement for about 250 beds nationally. It also proposes that psychiatry of learning disability would require units of 12 beds per 350,000 population. The draft also maintains that about 140 places in low secure units would be needed for patients who are "enduringly disturbed".
At present there are more than 3,000 beds in public psychiatric hospitals and units around the country.
The draft report recommends that in future, services should be organised through a series of district mental health catchment areas, each covering a population of 250,000-350,000.
These larger catchment areas are essential, it says, to provide a full and comprehensive range of specialty services.
The draft proposes that the catchment areas be run by a new multi-disciplinary management team comprising administrators, a senior doctor, a senior nurse as well as a psychologist, a social worker, occupational therapist and an expert user of the system.
It recommends that care should be provided through community mental health teams with expertise across a range of disciplines.
At national level, the draft recommends that mental health services come under the control of the primary and community care programme of the Health Service Executive, even though many are based in hospitals.
The expert group, which has drawn up the draft proposals, was established in 2003 by Minister of State Tim O'Malley to produce a new national policy on mental health services.
The draft maintains that the new advanced community care programmes will have a considerable impact on the need for acute beds.
It says that home-based treatment programmes for acute illness are being established as well as out-reach services for those with severe enduring illnesses. A range of alternative residential facilities for those with an extensive range of continuing disabilities already exists. It maintains that crisis housing is in the planning stage as an alternative to the use of acute admission beds.
The draft report is strongly critical of the organisation and management of existing services.
It maintains that "there are gross disparities of resources across different catchments of the country".
It also maintains that there are quite substantial variations in the competency of service management in different areas.
The draft maintains that given the perceived overall limited funding available, that catchment areas and sectors had become defensive and excluding with no incentive for flexibility in placing the central emphasis on the needs of individual patients. These rigidities had caused difficulties for mobile or homeless people in urban areas.
It says multi-disciplinary teams in the community are few and far between and service plans are often aspirational and lacking in rigour.
