One-third of all referrals for psychiatric assessment from the accident and emergency department in Dublin's Mater Hospital are homeless people, according to a study due to be published shortly. Carl O'Brien, Social Affairs Correspondent, reports.
The findings are likely to lead to renewed focus on the lack of community support for patients discharged from psychiatric institutions or hospitals. Support groups such as Aware say many mentally ill people are ending up homeless due to a lack of health or welfare intervention.
Dr Patricia Casey, a consultant psychiatrist at the Mater Hospital, said the hospital was finding it increasingly difficult to cope with the number of psychiatric referrals.
The figures in the Mater Hospital study represent a 20 per cent increase since the last study of its kind was conducted at the hospital. "It means that some people are being discharged earlier than they might normally be. The average stay is around 14 days, but often we can't keep patients in for that long," she said.
"When you're in a situation where you are discharging people before you should be, and if they're not supported by families or are living on their own, there is a danger that they become homeless."
Aware, which offers support to people affected by depression, said many patients who end up homeless find they are unable to access help from health authorities.
"Those who are homeless may not reside within the functional area of a health board. It is credible that such persons, who are among the most vulnerable in our society, would be excluded from the services they so desperately require," the organisation said in a statement.
Of the 5,000 homeless in Ireland, about 40 per cent - 2,000 people - are believed to have mental health difficulties. The problem has become more acute with the closure of large-scale psychiatric institutions since the 1980s, when health authorities decided patients could be better cared for in the community.
However, while the number of institutional beds has fallen from around 20,000 to 2,000 over the past 20 years, support groups say there has been insufficient investment in community support.
The Mater, with a catchment area of between 25,000-30,000 people in north inner city Dublin, has the greatest concentration of homeless mentally ill people in the State.
The hospital has 15 beds in its acute psychiatric unit and is now contracting a small number of beds in the private sector to cope with the rise in demand.
Dr Casey said the shortage of beds and early discharges were also creating a potentially dangerous situation.
"If it's two in the morning and a homeless person comes in because they are psychotic and found wandering the streets, we often have nowhere to put them. A junior doctor can sometimes spend hours ringing to find some suitable accommodation. More often than not they have to be admitted or we keep them overnight in casualty," she said.
"It's a hugely risky situation we're dealing with: if we send them out they may harm themselves or others. They are acutely ill and they should be in hospital," she said.
"The homeless should deserve the same standards of treatment as everyone else."