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GAZETTE
SEPTEMBER 1981
service for one third of the national population is the
financial equivalent of just one of these new general
hospitals.
There is international evidence available to show that
countries that had a similar long-stay psychiatric problem
in their mental hospitals and in which the alternative
community-based psychiatric service was subsequently
implemented, the long-stay population has been cut by
over 80%, falling to a few hundred long-stay in-patients.
Applying such knowledge to our national long-stay
mental hospital population of some thirteen to fourteen
thousand people, we can see just one measure of the
unnecessary human and financial cost of an outmoded
institutional approach to the care and treatment of the
mentally disabled.
In simple financial terms, at today's
prices the cost of keeping one long-stay patient in a
mental hospital throughout his life is approximately £j
million.
A community-based psychiatric service,
underpinned by adequate facilities, will not only minimise
the unproductive cost to the exchequer inherent in our
existing institutional system, but is highly likely to
reintegrate people into a community and working life with
personally fulfiling and economically viable attributes,
such as the grdwth of personal autonomy and
responsibility.
As well as the financial cost of perpetuating an out-
dated institutional approach to psychiatric care, in human
terms alone it has been internationally recognised for
many years that prolonged and unnecessary confinement
in a mental hospital actually destroys the benefits in
treatment brought about by modern developments in
psychiatric therapy. These can bring the treatment of
patients to a certain level, but when it is necessary to
progress the patient to a range of community-based
rehabilitation facilities and when these are not available,
resulting in the long-stay detention of a patient in hospital,
then that patient's therapeutic progress is reversed. Such
patients deteriorate into the pathological condition of
being "institutionalised". This chronic state of
demoralisation, apathy and total dependency on the
institution and its staff destroys any sense of personal
identity, self confidence or self-respect. It produces and
continually reinforces a sense of failure in the patient,
creating feelings of rejection and alienation from family
and society. Paradoxically, this very condition,
maintained and perpetuated by the current policies of the
Department of Health, provides justification in the minds
of the hidden decision makers that the right place for
people with such a "hopeless" prognosis is, indeed, as an
inmate of a 19th century mental hospital.
Given the clear knowledge that 19th century
institutions cannot provide for modern treatment, that
prolonged stay in such institutions is damaging and that
comparatively
inexpensive
modern
community
alternatives are available, one must ask why have
repeated plans for the implementation of these modern
facilities been ignored and delayed by the Department of
Health? Why do successive Ministers for Health and the
Secretaries of their Departments persist in a 19th century
policy of containment of the mentally ill, even though
such a policy clearly infringes on basic civil rights,
offends human dignity and negates the very purposes of
treatment for which the person has been admitted and
detained?
Responsibility — Why and how has this happened?
The genesis of the problem lies in the existence and
perpetuation of a two-tiered health service in Ireland.
Despite the common denominator that they are both run
on tax payers' money, there is little co-ordination or
integration between the services provided; these services
cater for different sectors of the population and, up to
now, have operated in very contrasting styles. The upper
tier or "private sector" is largely comprised of those
voluntary bodies and general hospitals which are under
proprietary or private ownership. That they are the
prestigious, fashionable and elitist section of the health
services is not so much a criticism as a statement of fact
which has to be recognised. This is a position which they
have secured for themselves on the strength and efficiency
of their organisation and the independence and autonomy
with which they operate. These in turn are derived from
the degree of local control and management over their
own affairs which such voluntary bodies and institutions
have acquired and jealously guard in their relations and
negotiations with the Department of Health.
The lower tier "public sector" of the health service, run
by the various Health Boards, is the direct successor of
the Poor Law system in its administration, image, funding
and clientele. Seriously and chronically under-resourced,
it has to cope with the lower socio-economic groups and
the poor of Irish society, amongst whom the mentally ill
and infirm figure prominently. It is a fact that 90% of the
thirteen to fourteen thousand long-stay inmates of Irish
mental hospitals are catered for in the public sector. The
public sector health service is statutorily obligated to
provide, from increasingly inadequate resources, what
progressively becomes an inadequate service for patients
relegated to second-class citizenship in second-class Poor
MEDICO-LEGAL
SOCIETY
The
October Meeting
will be held at
The United Services
Club, St Stephen's Green, Dublin 2
on
29th October,
1981,
at 8.15 p.m.
Topic: "Irish Coroner System — has it outlived its use-
fulness?"
Speaker:
Dr. Jack Harbison, State Pathologist.
•
The
November Meeting
will be held at
The U.S.C.
on
26th November, 1981.
Topic:
"Keening for Forensic Science".
Speaker:
Professor James E. Starrs, Professor of Law
and Forensic Science, George Washington
University, Washington D.C.
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