Mismanagement of resources, lack of accountability and under-investment in mental health has resulted in a service that is failing to meet many patients' needs, a new report has found.
The first comprehensive annual report by the Inspector of Mental Health Services, Dr Teresa Carey, found substantial variations in standards of clinical practice across the State.
Patients were much more likely to be involuntarily detained in a psychiatric hospital against their will or be prescribed electro-convulsive therapy depending on where they lived, the report found.
"It is clear that in the current situation, the experience of those using the mental health services is a lottery, depending on place of residence," Dr Carey concluded.
The Health Service Executive yesterday said it welcomed the report and that it clearly identified areas of concern and opportunities for improvement.
The report said "primitive" information on hospital activity meant it was impossible to distinguish between services that were performing well or performing poorly.
Figures show there were 3,556 people in psychiatric hospitals and units around the State in December 2004. The figure has been falling steadily over the last 40 years, with patients moving from institutions to community-based settings.
While the move towards community-based care has resulted in better living accommodation for some, Dr Carey said it was clear that the move had not been a success for many patients.
A lack of specialist care resulted in some patients receiving inadequate care and ending up on the streets, in hostels or in prison.
Concern was also expressed at mental health services for people with intellectual disabilities.
Hundreds of intellectually disabled patients have been discharged from mental hospitals in line with Government policy, or into "de-designated" units on the grounds of psychiatric hospitals.
However, the inspectorate said it was concerned that many of these patients with a mental illness were being deprived of necessary mental health care.
Also, it said many elderly patients were being discharged into unapproved settings, such as nursing homes, as part of the "de-institutionalisation" programme. The level of psychiatric care available to these patients was of concern.
It noted that the proportion of the national health budget applied to mental health services has been falling. It now accounts for about 7 per cent of the budget, compared to 9.2 per cent in the North and 11.6 per cent in England and Wales.
It said there appeared to have been "no recognition" by Government departments or health service managers of their obligation to address the issue.
Dr John Owens of the Mental Health Commission said while about €740 million would be spent on psychiatric services this year, the economic cost of mental illness was in the region of €10 billion.
He called on the Government to release sufficient funding to allow for the development of services.
As well as expressing concern at involuntary admission rates, which vary significantly in different areas, the inspectorate said the length of stay for some patients appeared to be excessive.
As part of this pattern, it said it was disturbed by the use of "person of unsound mind" orders for admission in a small number of areas, especially east Galway where 50 such orders were issued last year.
Under these orders, a person may be detained indefinitely in a psychiatric hospital. The inspectorate said use of these orders in east Galway was unacceptable and highlighted the need to protect the rights of detained patients.
