Heart Beat:Recently, I was surprised to discover that many long-term psychiatric patients, unlike the rest of the population, do without GP care.
There are still a few unfortunate souls who live in psychiatric hospitals. Many of these people are too institutionalised to live in the general community again.
If the mental health service is the poor relation of the health service, then these unfortunates are the lowest caste of all.
Often incarcerated for no good reason, they now are condemned to live a twilight existence with constant care, medication and supervision.
Their mental state may be adequately monitored, but their physical state is also entrusted to the care of psychiatrists, who simply do not have the necessary skills.
"A healthy mind in a healthy body" is hardly a new or radical idea but it appears that this maxim does not apply to the long-stay patient.
These middle-aged and elderly people, who have most unhealthy lifestyles, have no GP. If they were fit to live on their own they would receive a medical card and free primary care, but because they cannot do so they are subjected to discrimination.
I was alerted to this by the case of a 62-year-old man, whom I will call Jimmy.
Within two years, Jimmy went from attending an exclusive Dublin boarding school to being a schizophrenic tramp living on the streets for two years.
He is now a long-stay psychiatric patient in the State, is reasonably stable mentally, and will remain in care until he dies.
His brother, who is younger and as fit as a man can be, both mentally and physically, was recently diagnosed with osteopenia (which is a loss of bone density) on a routine bone scan.
When I asked him about his family history he told me about Jimmy, who has had three fractures so far. Now, at this stage, any GP would put the case together in their head in seconds.
Jimmy, with a positive family history of osteopenia, is older, a smoker, gets no exercise - well of course he has full blown osteoporosis, otherwise known as brittle bones disease.
His bones, and especially his vertebrae, are likely to collapse in time, causing him terrible pain and distress.
The most trivial fall can cause a fracture. If this condition is diagnosed it can be stopped in its tracks by medication. But we don't know for sure, because Jimmy has never had a bone scan. His medical care is supplied by psychiatric junior doctors.
Asking a psychiatrist to provide a GP service is like asking David Beckham to play hurling. He might make a fist of it, but it is not really his job. God knows the GPs in this country have enough to do already, but the care of this group of patients really should be entrusted to them.
Long-stay psychiatric patients are tricky. They get very little exercise. They live exclusively on canteen-type food. They smoke. Many of them cannot bear sunlight because of their medication.
So of course they are sitting ducks for osteoporosis, cardiovascular disease, diverticulitis, diabetes, varicose veins and almost anything else you can think of.
They miss out on lipid checks, cervical smears and mammography as well as bone density checks.
If these patients need to go to hospital or need an operation, they can get very disturbed by the stress of it all and become very difficult to handle.
Therefore, prevention and screening are especially important in this group to keep them well. But it would appear that this is not happening.
I asked my friend Dr Tom Reynolds, who is a consultant psychiatrist for the elderly, if Jimmy's case was an exception. He confirmed that unfortunately it is not. He has set up a system of GP care for many of his patients, but cannot provide it for all of them.
It would appear that there is not a system in the HSE to provide this.
The new junior minister in charge of mental health , Dr Jimmy Devins, is himself a GP.
Perhaps he can get things moving. At the very least, a supply of vitamin D and calcium supplements to the chronic patients could reduce their incidence of osteoporosis.
It is not so long ago that the psychiatric services were used as a method of social control. For a country that officially abhorred communism, the policy of official Ireland had a lot in common with that of Joe Stalin. Anyone who was at all disruptive was in danger of being put away.
The brilliant actor and playwright Little John Nee's show The Mental is about to return to the Irish stage for a short run. It tells the story wonderfully of those, past and present, who failed to fit in.
This includes the story of Seosamh McGrianna, the Irish language writer, who spent the last 30 years of his life in St Conal's Hospital in Letterkenny. Go and see it - it's a story about the need to belong.
Surely we could address this need by providing access to basic medical care and stop the discrimination.
Pat Harrold is a GP with a practice in Co Tipperary.
Maurice Neligan is on leave.