The mental health service for Dublin South West, one of the most highly populated areas in the State, had only one clinical psychologist last year, according to the report of the Inspector of Mental Hospitals for 2001.
Tallaght and Clondalkin, each with a population bigger than some cities, had no psychological service, the inspector, Dr Dermot Walsh, found.
He also complains about "depressing" and insecure facilities in the psychiatric unit at Tallaght General Hospital.
The Mayo Mental Health Service, on the other hand, won praise from the inspector, who describes the progress it has made as "a revelation" and who, unusually, did not find it necessary to make any recommendations at all for improvements.
Dr Walsh points out that Dublin South West has a population equal in size to that of some entire health boards. Yet it had access to only one clinical psychologist. "This service was spread too thinly across the various sectors, and no psychological service was provided to the Tallaght or Clondalkin sectors. This was a very unsatisfactory situation and should be rectified as a matter of urgency," he says.
The practice of locking a patient in a room on his or her own, known as seclusion, was not used in the psychiatric unit in Tallaght Hospital in 2000 but was used "quite extensively" last year, Dr Walsh found.
"The seclusion rooms were stuffy, lacked adequate ventilation, had a number of blind spots and had damaged venetian blinds," he writes.
"All of this, along with the colour of the walls and doors, painted a depressing picture.The seclusion rooms were not secure, and two large bolts had to be fitted to the external doors. In addition, the rooms were not very clean".
Two of three patients he interviewed at Tallaght complained of insufficient interaction with nurses.
"Superficial as these patient interviews might appear, rightly or wrongly, one got the distinct impression that what used to be the bedrock of psychiatric services generally - the nurse-patient relationship - was beginning to break down," he says.
"It would be an enormous retrograde step were it to be true and were it to continue."
Staff at the Central Mental Hospital are almost certainly acting illegally when they continue to detain prisoners whose sentences have expired, he writes. Such patients must be discharged and, if appropriate, be admitted to their local psychiatric hospital on a non-voluntary basis subject to the usual legal safeguards, he wrote.
"The 2001 inspection of the Mayo Mental Health Service was a revelation," he says. Workshops, day hospitals and community residences were all operating to a high standard. He had particular praise for the community residences, which were of good quality, comfortable and well-designed.
Patients in St Theresa's Unit in St Mary's Hospital, Castlebar, all "reported an active involvement in decisions affecting their care and treatment and all felt they were receiving adequate care in St Theresa's Unit."
