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Concerns raised for patients due to ‘total absence’ of community mental health services

The absence of supports such as psychiatric intensive care units is impeding access to acute mental health beds, a new report has found.

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File photo
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THERE IS “AN almost total absence” of community mental health services across the State, according to a new report by the Mental Health Commission (MHC).

The absence of supports such as crisis houses, high-support hostels, specialist rehabilitative units and psychiatric intensive care units is impeding access to acute mental health beds across the country.

The report notes that Vision for Change – a strategic policy document for Irish mental health services published in 2006 – highlighted these gaps but that the issues have not been resolved in the intervening 14 years.

“When A Vision for Change was conceived in 2006, it highlighted significant gaps in the provision of specialist rehabilitation teams and recovery-oriented services,” Rosemary Smyth, Director of Standards and Quality Assurance at the Mental Health Commission, said.

“In order to address these concerns, specific recommendations were made 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.

“When one compares current provision with the resources recommended by ‘A Vision for Change’, it reveals an almost total absence of these types of supports in each mental health area,” Smyth said.

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.

Due to this, regardless of the total number of registered public acute mental health beds for adults, the MHC says there are serious concerns about the access and availability of current mental health bed provision.

“It is clear that access to public acute mental health beds for working-age and older-age adults in Ireland is insufficient and inadequate,” Smyth added.

The report 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.

The paper states: “The inadequate provision of PICU (psychiatric intensive care unit) beds results in the most severely unwell people with challenging behaviour not having access to intensive care in an appropriate facility.”

Older patients

The report 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 further outlined 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,” the Chief Executive of the Mental Health Commission, John Farrelly, said.

“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.

Farrelly said ring-fenced funding is needed to address the problem.

“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,” he added.

Available support 

The HSE said it welcomes the publication of the report but “would like to point out that we provide a wide range of community mental supports across the state”.

A spokesperson said there are 111 general adult community teams, 32 psychiatry of later life teams and 71 child and adolescent community teams (CAMHS) nationally, stating: “These teams support people to remain in their homes and in the community where possible in line with Sláintecare.”

They added that the HSE also provides over 1,000 acute in-patient mental health beds for adults with an additional 74 acute beds for children and adolescents.

The spokesperson noted that the MHC “acknowledges that the current provision of public acute adult mental health beds in Ireland is in line with recommendations in our national policy A Vision for Change”.

“HSE Mental Health provides services across a continuum of care where community-based mental health teams are at the centre of service delivery and we remain committed to improving these important services, within the resources available to us.

“The HSE continues in our commitment to further enhance our comprehensive range of community mental health supports and specialist services in order to support individuals before, during and after admission to acute mental health beds,” the spokesperson said.

Our colleagues at Noteworthy want to explore if Irish people have died because they couldn’t access out-of-hours mental health care. Read more about the proposal, and how you can support it, here.

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Órla Ryan

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