Lynn Ruane (Independent) | Oireachtas source

In the 1950s Ireland held the world record for the number of people detained in psychiatric institutions. Thankfully, the majority of the older style Victorian hospitals are now closed and the focus of mental health services is on treating people in the community as close to their homes as possible. In the 1980s, 24-hour supervised residences were opened to accommodate service users who had resided in the old-style psychiatric hospitals, many for long periods. Accordingly, these residences are their homes. It is recommended that such homes be confined to having no more than four residents. However, 40% of the residences inspected by the Inspector of Mental Health Services in 2015 had more than 13 beds. It is important to note that these service users are particularly vulnerable, as many of them have been living with long-term mental health difficulties within institutional settings for most of their lives. However, rather than benefiting from a move to community care, they have, in essence, been forgotten and abandoned by the modern health system which has simply moved from larger to smaller institutions.

Crucially, we do not know how many people are living in these conditions or how many of these residences there are. In its 2015 annual report the Mental Health Commission stated there was a fundamental issue with identifying precisely the number of residences, as well as the number of people living in them. Despite repeated discussions with the HSE, no agreement has been reached on the issue. Additionally, the commission is concerned that some of these residences are too large, have poor physical infrastructure, are institutional in nature and lack individualised care plans. Under the Mental Health Act 2001, the inspector can visit these facilities and report on his or her findings. A service can be requested to provide a quality improvement plan.However, under current legislation, these facilities are not subject to regulation by the Mental Health Commission. This means the Mental Health Commission has no statutory powers over them, unlike inpatient units, which the Mental Health Commission can close down if they breach certain standards of care. The expert group established to review the Mental Health Act 2001 made the following recommendation:

The new Act should give the Mental Health Commission specific powers to make standards in respect of all mental health services and to inspect against those standards. The standards should be made by way of regulations and the regulations should be underpinned by way of primary legislation.

In 2015, the Mental Health Commission inspected 20 24-hour supervised residences. The 2007 HSE report on accommodation for people with disabilities, Time to Move on from Congregated Settings - A Strategy for Community Inclusion, recommends that home sharing arrangements should be confined to no more than four residents in total and that those sharing the accommodation have, as far as possible, chosen to live with the other three people. Some 55% of HSE mental health service 24-hour supervised residences inspected in 2015 had more than ten beds and 40% had more than 13 beds. According to these inspections, only six out of 20 residences inspected were described as in good decorative order, comfortable and homely. A number of residences were institutional in function and environment. For example, chairs were lined up against the walls in a row, bedrooms were devoid of personal possessions, shower facilities were locked, residents were not allowed to lock their wardrobes or bedroom doors.

Only seven, 35% of the residences, had exclusively single bedrooms while 12 had double bedrooms, ten of which had no provision for individual privacy. One residence had two four-bed rooms. The inability to provide residents with a single room impacts on their privacy and dignity. With reference to one of the residences, the inspector reported that the overall state of the residence was poor.

It is recommended that all residents have a yearly medical assessment. In ten of the 20 residences inspected in 2015, the residents had a six-monthly medical check with their GPs, in six residences there were annual medical checks, while in four the residents did not attend a scheduled medical check and attended a GP only if they became unwell. In 14 residences it did not appear that the residents were means tested for charges, and each resident paid the same charge.

In summary, the Mental Health Commission stated that many of the residences inspected were too big, in poor condition and institutional. There was limited multidisciplinary input in over 50% of the residences inspected. Some residents had no care plans or any meaningful activity to occupy them during the day. Many 24-hour supervised residences were failing to provide opportunities for the optimal recovery and rehabilitation of their client populations, as outlined for them in A Vision for Change, which has been in operation for ten years. Recovery in this context reflects the belief that it is possible for all services users to achieve control over their lives, recover self-esteem and move towards building a life where they can experience a sense of belonging and participation. The guiding principles relevant to the housing needs of individuals with mental health difficulties should include citizenship, equity of access, community care including specialist mental health support, co-ordination of support and inclusiveness. The provision of community residential care for vulnerable mentally ill people, who may not be in a position to articulate their wishes, must be on an equal basis with other citizens and such provision should be a priority.

In 2008, the HSE conducted an evaluation, in accordance with the guidance for value for money and policy reviews, of the efficiency and effectiveness of long-stay residential care for adults within the mental health services. The report found wide variations in resource allocation, a significant minority of clients were deemed to be inappropriately placed, low levels of discharges from long-stay residential services to lower level supports and a lack of consistent understanding of or approach to rehabilitation among the residences. I have more to say, but given that I must conclude, I will send it to the Minister of State.