THE BRUTAL death's of two female patients, living in sheltered accommodation attached to St Brendan's Hospital, has sent a shock-wave through the entire population. Those who will feel it most acutely are those employed in, and receiving care from the psychiatric services. It may even shake confidence in the policy of promoting community-based services.
For over a decade there has been a determined effort to modernise psychiatric care in Ireland. The current policy of accommodating certain patients in sheltered, community-based settings has its origins in the recommendations of a Psychiatric Services Review Committee. Its report, Planning for the Future, was published in 1985 by the Department of Health.
This laid the foundations for the move away from the large, imposing buildings that had traditionally been the mainstay of services for the mentally ill. In the past the options were extremely limited: patients were either in hospital or at home, with nothing in-between.
The 1985 report recognised that advances in the care of the mentally ill allowed certain categories of patients, who could not live at home, to live quite autonomously outside the traditional psychiatric facility. The committee stated that it firmly believed that many [selected patients] could be suitably placed in community residences if the recommended preparatory measures were implemented.
The modern community residences can basically be broken down into three types, offering high, medium and low levels of support. The house where the murders took place offered low level support.
In such accommodation the residents have a great deal of autonomy. For example, they pay rent, do their own laundry and cook their own meals (though they might get a mid-day meal at a sheltered workshop). Essentially they live quite independently.
A great deal of work goes into preparing residents to live in such a setting. Much thought goes into selecting who might live with whom. On-going assistance is given in the form of a community liaison professional, most probably a community psychiatric nurse.
By and large, this policy has been implemented with enthusiasm by all the professional groups within the psychiatric services, with relatively few problems arising. Indeed, Ireland has been more successful than the UK, in per capita terms, in moving towards community placements.
For the patients too, the change has been a success. One piece of research, conducted some years ago by a Canadian doctor based in Ireland, found that the patients were very clearly happy with the change, even allowing for some wrinkles in the system.
This has been a good policy shift and one of which we can feel" proud. It would be very regrettable if these appalling killings were to adversely affect the success of the "open-door" policy ad by the 1985 report.
The question can be asked if these women were more at risk of attack precisely because of their, psychiatric histories. Would a less vulnerable woman be more quick-witted and therefore better able to defend herself? While this question may arise, it is misplaced. Focusing on the personal characteristics of the women in question is to place the responsibility for the attack on the victims.
Most women feel afraid of personal assault, whether physics or sexual. Many in Dublin, for instance, are slow to use multistorey car parks at night. The Automobile Association has, recently run a campaign aimed at women on this precise issue. One of its helpful hints to women is to reverse into parking spaces so that they can get away quicker in an emergency.
The real question Irish society needs to address is why so many women should have to take such measures for their personal safety? Men never think twice about such, things.