Review reveals almost ‘total absence’ of community mental health services

A discussion paper published by the Mental Health Commission has revealed an almost ‘total absence’ of community mental health supports across the State, as well as suggesting a major deficiency in the number of acute beds for older-age patients.

Although the paper acknowledges that the current provision of public acute adult mental health beds in Ireland is broadly in line with recommendations in ‘A Vision for Change’ – the strategic policy document for Irish mental health services published in 2006 – it also suggests that access to these beds, impeded by a lack of specialist resources, is both ‘insufficient’ and ‘inadequate’.

Specific recommendations were made in ‘A Vision for Change’ for the provision of community supports along a continuum of care, including crisis houses, intensive high-support hostels, rehabilitation high-support hostels, specialist rehabilitative units, and psychiatric intensive care units, said Director of Standards and Quality Assurance at the Mental Health Commission, Rosemary Smyth.

“The acute bed recommendations in ‘A Vision for Change’ were based on a full complement of additional specialist and community resources, and these have not been provided in the intervening years.”

As a consequence, the review suggests that the prolonged stays of people experiencing mental illness in acute mental health units is having a significant impact on access to acute mental health beds in Ireland. And for this reason, regardless of the total number of registered public acute mental health beds for adults, there are serious concerns about the access and availability of current mental health bed provision in Ireland.

The paper finds that despite the recommendation by ‘A Vision for Change’ to provide 15 intensive care beds as part of the development of four national combined intensive care rehabilitation facilities (with the rehabilitation unit also having 15 beds), not one unit has been developed.

Similarly, the inadequate provision of psychiatric intensive care units continues to result in the most severely unwell people with challenging behaviour not having access to intensive care in an appropriate facility.

The paper also indicates that the provision of acute mental health beds for older adults in Ireland is severely deficient. The availability of 56 older-age adult beds were identified in Ireland – a provision which is less than half of the 127 beds envisioned by ‘A Vision for Change’.

It also stated that not one of the nine Community Healthcare Organisations (CHO) was meeting the recommended number of dedicated older-age adult acute mental health beds. Of greatest concern, the report says, is that three purpose built acute units for older adults were being used for other purposes.

The paper notes that the lack of acute beds for older-age patients is particularly pertinent when the frequency with which mental illness is reported in this age group is considered, and the fact that one fifth of the Irish population is comprised of individuals aged 65 and over.
“Data from the inpatient census that forms part of this paper highlighted that there were many older-age adults residing in non-specific general adult wards,” said the Chief Executive of the Mental Health Commission, John Farrelly. “However, the care and support required for the recovery of, for instance, an 80-year-old is substantially different to that of an 18-year-old. The use of non-age appropriate placements has the potential to create unsafe environments.”

The paper concludes by stating that long-term political and social commitment is required to ensure the development of a comprehensive range of community and specialist continuum-of-care services which are able to support individuals before, during and after admission to acute mental health beds.

“This requires ring-fenced funding,” said Mr Farrelly. “This in turn will help establish an efficient and cost-effective system which ensures safety and quality of care to patients.

“It is clear that regardless of the number of registered acute adult mental health beds in Ireland, unless action is taken to address the identified factors preventing access to these beds, thereby ensuring a fluent and sustainable mental health system, the current access difficulties will persist and increase.

“It is only through this action can we hope to achieve a more integrated, person-centred and recovery-oriented model of care in this country.”
the community.