After all the rhetoric, we are still struggling with an outdated and under-resourced system, writes CARL O'BRIEN.
AS A parable for our times, the mental health service tells a revealing story. It's almost 25 years since the government pledged to tear down the country's crumbling psychiatric hospitals and transform the most neglected arm of the health service.
There would be well-staffed community residences with 24-hour care; rehabilitation and training programmes for patients; readmissions to hospitals would fall. A humane and caring mental health service awaited.
The report was never implemented. Planning For The Future, published in 1984, suffered death by a thousand cuts. Lacking the political clout of other sectors of the health service, the budget for mental health reform was trimmed within an inch of its life.
Today a similar story is unfolding. It is becoming increasingly clear that the Government's latest blueprint on psychiatric care, A Vision for Change, is meeting the same fate as its predecessor.
It, too, is progressive and ambitious. Over the course of its 200 recommendations, the report suggests putting in place fully staffed community-based multidisciplinary mental health teams to offer home-based services to people with mental health problems; the 15 remaining psychiatric hospitals would be closed down and their funds used to build new community mental health centres and residential units for those with chronic mental illness; service users and their carers would be involved in their day-to-day care.
However, the millions meant for mental health services have been diverted towards meeting cost overruns elsewhere in the health services.
The HSE's recruitment embargo - which is now apparently lifted - has contributed to gaping holes in community mental health teams.
But perhaps most damning of all is the publication of the Mental Health Commission's annual report yesterday, which shows the painfully slow rate of progress in creating a humane service that meets the needs of its vulnerable clients.
More than 1,000 people continue to languish in old psychiatric hospitals under unacceptable conditions, without meaningful access to recreational or therapeutic activities.
The situation is even worse for patients who also have intellectual disabilities. Practices such as seclusion and restraint are carried out in residences with no monitoring, while access to specialist care is almost absent.
Children continue to be admitted to adult psychiatric units, even though senior politicians in government and health experts admit the practice should have stopped years ago.
Particularly disturbing is the state of new community-based services which were supposed to provide a break with the old psychiatric hospitals of the past by providing a range of multidisciplinary services, alternatives to medication and opportunities for patients to participate in their own care and treatment.
It is clear from this report that this is not happening. Most community services are hampered by a lack of staff, poor management and shortage of resources.
Instead of a new era of care in the community, we are creating a new generation of mini-institutions in the community.
It is grossly unfair and hypocritical that health authorities should promote the notion of community treatment, counselling, home-based treatment and rehabilitation - and then not provide these services.
So, after all the reports, blueprints and rhetoric, we are still struggling with an outdated, fragmented, and massively under-resourced system, with no end in sight to decades of institutional neglect.
It would be wrong, however, not to pay tribute to some signs of progress.
Thanks to the implementation of legislation aimed at protecting the rights of patients, patients detained against their will have an automatic right to have their detention reviewed by independent mental health tribunals.
This has resulted in a 25 per cent drop in the numbers of such patients in 2007 compared to 2005.
Inspectors have also noted that while many psychiatric hospitals and care centres have had considerable difficulty in meeting basic legal requirements, there were signs at the end of last year that most services were actively planning and moving towards full compliance with the law.
The coming year will tell us much about the priority that mental health holds both in Government and within the Health Service Executive. Based on the parable of the fate of mental health services in the 1980s, we don't have many reasons to be hopeful.
Yet, these are our most vulnerable and dependent citizens. And they deserve to be offered the best possible programmes of recovery and rehabilitation.
The Government itself signed up to a UN covenant which states that "everyone has the right to the enjoyment of the highest attainable standard of mental health".
It is not sufficient for politicians or health authority officials to criticise old mental health practices when they themselves fail to fund services that would provide patients with alternatives to medication and in-patient care.
Previous generations of mentally ill patients were failed due to official neglect of the mental health service. To do so again, even at a time when budgets face more pressure than they have in recent years, would be unconscionable.
Carl O'Brien is Social Affairs Correspondent