The recent report of the Inspector of Mental Hospitals for 1999 shows that the psychiatric service still has a long way to go before it achieves the same status as that part of the health service which deals with physical illness. While lengthy waiting lists for surgery are rightly a cause for concern, the waiting lists for acute psychiatric beds do not attract the same attention. In some regions, half the acute psychiatric beds are occupied by long-stay patients who should be in community residences, according to the report. There are, however, too few community residences. The status of psychiatric services is crucial. Communities agitate for casualty units and health centres. When did a community agitate for a residential unit for psychiatric patients?
Progress towards providing acute psychiatric units in general hospitals has been slow for some years, the Inspector found. Last year, only one such unit opened, at Tallaght General Hospital, almost two years late. Each delay has its own specific cause - often to do with industrial relations - but the core problem seems to be that there is no external, public pressure to have them resolved quickly.
An example is that of non-residential services in the community. They can enable people to be treated on a day basis, provide places from which to work with people in their own homes, and give mental health education to those who would benefit from it. By providing activities during the day, they can also give a break to families who may be under immense strain caring for a member with a psychiatric illness. Yet the Inspector found that some of these centres are under-used and occupied for only a small proportion of working hours. The buildings have been provided but it would seem the money to operate them to the maximum has not.
The fact that about 300 people with mental handicaps are still accommodated in psychiatric hospitals is a particular injustice about which much has been said over the years. Yet there are still people with mental handicaps sharing accommodation with patients suffering from psychotic illnesses.
The Inspector, Dr Dermot Walsh, notes that there are plans to rectify this situation in the Kerry and Limerick Mental Health Services but he rightly states that health services in other areas need to make more efforts in the same direction. In general, Dr Walsh has found, funding a new service for psychiatric patients does not guarantee that it will be brought into operation within any reasonable timescale. Unwarranted delays in moving matters through the planning process and obstruction from bodies representing various interests, are among the factors which compromise the standard of care for patients and their families. This results in needless suffering by these patients and leaves families feeling they have been abandoned or neglected by psychiatric health services. This will only change if the public is prepared to give mental and physical health services the same status and find the money to manage the system more effectively.