A RECENT ARTICLE in the Irish Times described a man who spent nearly 2,000 hours in seclusion, while being held as an involuntary patient at St Luke’s Hospital in Clonmel. The article describes how this man was “locked up for more than 100 hours at a time” – meaning over four consecutive days and nights.
Legally, the rights and interests of people using mental health services in Ireland are protected by the Mental Health Act 2001 under the oversight of the Mental Health Commission (MHC). The Act allows approved centres to use seclusion as a treatment as long as they follow the rules made by the MHC. Seclusion is when a patient is placed or left in any room alone at any time with the exit door locked or secured so that he or she cannot leave the room. Seclusion should only be used if it is in the person’s best interests or to prevent the person from harming themselves or others.
The article raises a number of serious questions on how mental health services are provided in Ireland. The practice of seclusion should be a measure of last resort. Its long-term use cannot be regarded as therapeutic. Yet, the Inspectorate of Mental Health Services has noted an increase in the frequency of seclusions lasting longer than 72 hours and occurring more often than seven times in seven days in the Irish mental health services.
As far back as January 2010, a report by the Mental Health Commission pointed to worryingly high levels of seclusion within mental health services in Ireland. In fact, St Luke’s Hospital itself came under criticism in this report for the unnecessary use of patient seclusion.
A year earlier, the commission’s 2009 report described a number of mental health facilities as “entirely unacceptable and inhumane” – a damning indictment. One year later, the 2010 report from the Independent Monitoring Group on A Vision for Change became the fifth report in as many years by that body to criticise the slow progress made in implementing Government policy.
These reports are painting a very clear picture – mental health services in Ireland have not progressed sufficiently. In 2006, the then Government published A Vision for Change, the national policy for reforming Ireland’s mental health services. A move to community mental health services and a reduction in the need for hospitalisation is core to this reform. It proposed big changes to the way mental health services are delivered and to the way people think about mental health. Reform has been slow. Very slow. We must ask: Why?
For one, mental health services have experienced a disproportionate loss of staff as a result of the public sector staff moratorium. Twenty per cent of posts lost in the HSE in 2010 were from mental health services, even though these services represent just nine per cent of the workforce. We are fast approaching a situation in which safe services cannot be guaranteed. It is not a huge leap to make a connection between the shortage of staff and the increase in the use of seclusion.
The shift from the old, Dickensian asylums to community-based mental health services is founded on the principle of recovery – the idea that individuals can reclaim lives to their best extent and be involved in society. The recovery model promotes empowerment, self-help, mental health promotion and a human rights-based approach to mental health service provision. To achieve this, people need supportive mental health services and they also need supportive communities.
In these economically strained times, it is vital that people have easy access to community mental health services. It is estimated that one in four people experience a mental health difficulty during their lives and that the cost of poor mental health to the Irish economy is approximately €2.6billion, or two per cent of GNP annually.
Year after year the Inspector for Mental Health Services and the Mental Health Commission outline critical failures and yet year after year we see little improvement. The impact on the lives of people experiencing mental health problems is profound. The cost of non-reform to the individuals with mental health difficulties, their families, mental health service providers and our society and economy is significant. We must not ignore it any longer.
Orla Barry is the Director of Mental Health Reform, a coalition promoting improved mental health services in Ireland. For more information, visitmentalhealthreform.ie.