Speaking on the publication of the report of the Inspector of Mental Health Services for 2008 Dan Neville TD Fine Gael spokesman on mental health said that the report highlights the Government’s failure to honour its commitment to introduce the recommendations contained in the expert report on the development of the mental health services in A Vision for Change. He stated that “this is especially so in Limerick
“The basic unit of any mental health staff is the individual interaction between a person with a problem and another person professing the ability and training to alleviate the problem. The quality of that professional on an individual basis in the Limerick Mental Health service is, therefore of paramount importance. We are fortunate that the quality of those professionals working in Limerick is of the highest standard
“ It is not acceptable that the Health Services and the Government has always treated the mentally ill people in an appalling manner and mental health services have consistently been the most neglected quarter of the health sector. The economic downturn is no excuse for inaction. Many reforms require leadership rather than resources, while changing attitudes towards people with mental health problems will not involve any economic burden. Changes are urgent for those entitled to a humane and responsive mental health services. The Minister for Health and Children and the Government must honour its commitment to the people to do so.
The report is critical of the failure of the Limerick Mental Health Services to introduce the recommendation of the 2007 report. It is not acceptable that
- There has been no further recruitment of multidisciplinary staff for mental health teams.
- The service has not progressed the closure of St. Joseph’s hospital and ensure appropriate placement for the remaining residents. This was included in the business plan and had also been identified as a priority. The inspector pointed out that there had only been a decrease of five residents since the inspection in 2007 and it is difficult to see how this closure could be achieved in the future
- There were 14 people with intellectual disability still remaining in different wards throughout St. Joseph’s hospital and there was little prospect of these residents transferring to the appropriate intellectual disability service.
- The composition and organization of the forensic team to account for the needs of the population has not been achieved.
- The development of a high observation unit was due to commence in spring of 2009. This has not taken place
- The developing of a computerized information system including the recruitment of staff, training initiatives, meetings of a multidisciplinary forum has been deferred due to prohibition on further staff appointments
- The psychiatry of later life team was currently in the Elderly Care Service instead of mental health. No other psychiatry of later life team in the country was in this position. The move to mental health had been discussed for a number of years and this had resulted in uncertainty in future planning for the service
- The day hospital was located in St. Camillus’ hospital and was functional only one day a week
- There was no care plan in four of the five adult sectors in Unit 5B and as a result therapeutic activities were not linked to care planning for these residents. This was despite extensive activity in the unit.
- There was no occupational therapist in the unit
- Not all residents had an access to therapeutic activities required to meet their needs in St. Joseph’s hospital
- The condition of St. Joseph’s hospital was not in compliance with the Regulations although efforts were being made to remedy this.
- As the unit was not an age-appropriate facility for the admission of children, Unit 5B did not comply with the Code of Practice for the admission of children. This unit is not suitable for children and the nearest children’s unit is in Galway approximately 80km away.
- The condition of St. Joseph’s hospital continued to deteriorate, although there was ongoing work to improve the facilities.
- Feedback from the Irish Advocacy Network (IAN) which provided a service to in-patients, day hospitals and day centers had been positive with most service users finding staff supportive. Service users through IAN reported that there was little awareness of care plans, not enough information about medication and a lack of talking therapies. They also complained that Unit 5B was always locked, and they were often bored. Some service users said that nursing staff were too busy to talk to tem for very long, that time with medical staff was too short, and they saw different doctors all the time. Service users in St. Joseph’s Hospital reported very few activities, especially in the locked wards.
The inspector stated that the basic decency of mental health staff at an individual level and the tradition of care and compassion for the less fortunate are not in question.
The Inspector’s repot concluded
There had been some innovative care practices initiated in the Limerick mental health service. These included the shared care arrangements between general adult mental health services and rehabilitation, the intensive case management in one sector and the clinical rehabilitation day programme.
The appointment of two consultants was welcome although the lack of appointments of other multidisciplinary team members was disappointing.
The lack of progress in closing St. Joseph’s Hospital was evident. The plan to obtain community residences, to arrange appropriate care for those with intellectual disability and to source nursing home care remained a plan in 2008, but with little progress in achieving these arrangements. Meanwhile 77 residents remained in St. Joseph’s Hospital as well as 75 residents in 24-hour supervised residences. The decrease of only five residents in St. Joseph’s Hospital in 12 months was particularly surprising as this hospital was earmarked for urgent closure by the HSE. The vastly improved
conditions for residents who were in St Martin’s Ward, which had been severely criticised in 2007, were very welcome, and imagination and dedication was obvious in its design.
There was evidence of service user involvement in advising the multidisciplinary forum and in the consumer panel.
Advocacy services were well supported in the service.