The short-sightedness of not providing adequate mental health rehabilitation services has led to long-term neglect of people with serious and enduring mental illnesses, according to a report by the Mental Health Commission.
In Donegal, a regional investigation shows there is no consultant-led team in rehabilitation and recovery despite A Vision for Change recommendation of two fully staffed teams. This is despite the fact there are well established, well-functioning teams in Cavan-Monaghan and Sligo-Leitrim in the same CHO.
Authored by the inspector of mental health services, Dr Susan Finnerty, the report – entitled Rehabilitation and Recovery in Irish Mental Health Services - demonstrated a continued lack of development in mental health rehabilitation services in Ireland, which she said was disappointing, and which has led the HSE to provide an out-of-area service, a practice that has been strongly criticised internationally.
As part of her report, Dr Finnerty spoke with people who had enduring mental illness and who were frustrated and angry with their lack of progression to more independent living and who were stuck in a system that was not meeting their needs.
“The long-term neglect of people with severe and enduring mental illness has negative outcomes for the service user and their families,” she said.
“Because of the unmet need for rehabilitation, many people with enduring mental illness have repeated admissions to inpatient psychiatric units, are then discharged, to be readmitted when things breakdown again – the so-called ‘revolving door’ of admissions.
“In the long-term, this is counterproductive for both the service user and the already severely under-resourced acute services. The short-sightedness of not providing adequate mental health rehabilitation services, from both a human rights and a financial viewpoint, is quite astounding.”
While the government’s 2006 mental health policy, A Vision for Change, included the development of specialist rehabilitation and recovery mental health services, Dr Finnerty’s report found that there has been minimum improvement in the number of rehabilitation teams in Ireland over the last decade.
“There are 23 rehabilitation teams nationally; 48% of what is required under current mental health policy. Of those teams, none are staffed to recommended levels. Many areas have no access to rehabilitation services, leaving people with enduring mental illness no prospect of reaching their full potential, attaining employment or education, a satisfying social and community life, or living in suitable housing with appropriate levels of support.
“It is also important to note that A Vision for Change was written 13 years ago and does not reflect the development of rehabilitation services internationally and in line with current best practice,” added Dr Finnerty.
The report also referenced that there were no specialised inpatient rehabilitation units in the country up to recently. Although two independent facilities have been opened in Dublin, and one in Cork - within which beds are paid for by the HSE, thereby making them available to all public patients - this had the immediate result of out-of-area placement of people with enduring mental illness.
“This practice, which was started a number of years ago by the NHS, has been severely criticised internationally by regulatory bodies, the Royal College of Psychiatrists, and a number of mental health organisations,” said the chief executive of the Mental Health Commission, John Farrelly.
“As the inspector has detailed in her report, moving people far from their home, and away from loved ones and their treating team for periods of up to two years has a detrimental impact on continuity of care and effective discharge planning.
“It is very disappointing and troubling to see that the inspector found an attitude of out of sight, out of mind among some of the referring teams and senior management in the HSE. Her report states that it was difficult to ascertain exactly what arrangements were in place for discharge from the specialist rehabilitation inpatient units back to the person’s local service.”
The report also left no room for ambiguity on the long-term impact of inadequate rehabilitation services for current service users, stating that if an appropriate rehabilitation service was not initiated, then people will likely remain in continuing care or overly supported accommodation, with the consequent de-skilling and increased institutionalisation that this brings.
Others will be left with families, often with ageing parents, many of whom will not be able to provide the support and care needed. A small but significant number will remain in inappropriate acute inpatient care, unable to move to community living due to the lack of provision of rehabilitation services.
Dr Finnerty stated in her report that rehabilitation staff, without exception, were dedicated, creative and hard-working, using interagency collaboration and accessing community resources to provide a recovery-orientated service for people who used the service.
However, she said that to provide a rehabilitation service there must be adequate supported housing with varying levels of support, an adequate number of rehabilitation teams to provide the service, an adequate number of suitably trained staff, and funded evidenced-based therapeutic programmes. To date, these have not been provided to an acceptable level.
“In the end, the lack of provision of mental health rehabilitation is a human rights issue,” she said.
“The right to access appropriate mental healthcare, the right to choose where to live, the right to education or training and access to employment, the right to privacy and the right to live to the full of one’s potential have not been adequately provided for many people with an enduring mental illness and who cannot access mental health rehabilitation services.”
The Mental Health Commission has written to the HSE seeking an action plan to address the concerns raised in the report.