Mental health services in Ireland are chronically under-funded and of poor quality, according to a new report on health services for people with disabilities.
The proportion of Government health spending in the mental health area has declined significantly from 10.6 per cent in 1990 to 6.8 per cent last year, according to the report.
It also found a continuing lack of services and choice in general for people with disabilities, many of whom were receiving no aid or help at all.
The Government's own statutory agency, The national Disability Authority (NDA), which commissioned the report, described the level and quality of services as "unacceptable".
The report, written for the NDA by Dr Jane Pilinger, found "a general absence of a modern service" in the mental health area.This was coupled with "inadequate provision of community based services" needed in order to move away from institutionalised care. The report also highlighted the continuing "inappropriate" placement of people with intellectual disabilities in mental hospitals because of a lack of appropriate day and residential accommodation.
It said the chronic under-funding of mental health services should be urgently addressed by the Department of Health.
The report did find there had been improvement in mental health services for homeless, former prisoners, young and older age groups.
Services for people with physical disabilities fared better, the report found, rising from 9.6 per cent of total health expenditure in 1990 to 12.5 per cent last year.
Despite an overall increase in funding to 1.7 billion in 2003, the report found there were a considerable proportion of people with disabilities who were receiving no aid or assistance from the health services.
"It is only when substantial care needs exist, or where there is an absence of family or informal care support, that services are provided," it found.
There was also a lack of choice and control available in disability, health and mental health services.
Overall, despite some positive developments, including community based services, "there remains a continued under-funding of core services and in many cases poor quality services".
Ms Angela Kerins, chairwoman of the NDA, said the current lack of services resulted in a large number of cases in which volunteers, disability organisations and family members have to plug service gaps, is considered unacceptable by the NDA.
"People with disabilities want services . . . which promote independent living, are community based and are provided equitably," she said.
The report makes 73 recommendations, including a set of new standards for disability services and extra funding.
The collection and co-ordination of data is a key recommendation in the report, which highlighted a lack of statistical information on the availability and demand for disability services.
In some cases, there was even a lack of information on the length of waiting lists for some disability services, according to the report.
This lack of basic information about the lives and experiences of people with disabilities meant that proper planning of services has not occurred in the past, according to Ms Kerins.
The report, which is the third in a series commissioned by the NDA highlighted the continued "dominance" of the medical model in Irish health services.
There is also a considerable variation in the provision of services across health boards, and poor co-ordination between various service providers.