Lecture 3 Developments in Irish Mental Health Care

MSc in Mental HealthMental Health & Social Policy : MSc in Mental Health Mental Health & Social Policy Lecture 3: Developments in Irish Mental Health Care 1900-2000


Developments in Irish Mental Health Care 1900-1945 : Developments in Irish Mental Health Care 1900-1945 Continued increase in inmates to 1914 with slight fall during WW I and II (Daly & Walsh, 2004) Ministers and Secretaries Act (1924) Asylums transferred to the control of the Minister for Local Government renamed the Department of Local Government and Public Health Local Government Act of 1925 Asylums became mental hospitals. Minister for Local Government set up a Commission on the Relief of the Sick and Destitute Poor, including the insane Poor (CRSDP).


1st Report of CRSDP (1927): Recommendations : 1st Report of CRSDP (1927): Recommendations Overcrowding unacceptable – No hospital to exceed 1000 residents Auxiliary hospitals to be built to ease overcrowding ‘Boarding-out’ of patients recommended Acute mental illness should be treated in general hospitals. A single unifying, consolidating Act needed to replace 19th Century legislation Provision for voluntary admission into State system


1945-1960s : 1945-1960s Inspector of Mental Hospitals established Mental Treatment Act (1945) passed Continued rise in admissions until 1958 (.7% of population in 1958) Overcrowding endemic Treatment and therapy limited 11% of hospital residents ‘intellectually disabled’ Half (10,670)classified as schizophrenic 1960 one-fifth of all admission were over age 65. Frequent admissions from homes for unmarried mothers and similar locations


Mental Hospital Patients 1914-1962 : Mental Hospital Patients 1914-1962


Crisis? What crisis? : ‘I am compelled to say at this stage that the overcrowded conditions for our patients in St Brendan’s are contrary to every modern idea of human society.’ Medical Superintendent, St Brendan’s Hospital, (1957) ‘The uphill struggle to modernise these hospitals, to relieve overcrowding and to achieve a satisfactory standard continues, but there is still a long way to go before our services can be regarded as adequate.’ Inspector of Mental Hospitals, (1960) Crisis? What crisis?


Commission of Inquiry on Mental Illness Report 1966 : Commission of Inquiry on Mental Illness Report 1966 Greater emphasis on community based services Integration of psychiatric services into general hospitals Development of outpatient services Rehabilitation of long-stay patients Establishment of specialist services (alcohol, drugs, children etc) Improvements in staff training and education Easing of admissions procedures


Policy & practice changes1960 -1970 : Policy & practice changes 1960 -1970 High rates of admission to be investigated by MSRB Census of inpatients initiated 1963 First report: Activities of Irish Psychiatric Hospitals and Units 1965–1969 (O’Hare & Walsh, 1972). 1971National Psychiatric In-patient Reporting System (NPIRS) introduced


In-patient population 1963-2004 : In-patient population 1963-2004


All & 1st Admission rates 1965-2002 : All & 1st Admission rates 1965-2002


1980s: Re-assessing the system : 1980s: Re-assessing the system 1981 Failure to replace the 1945 Act with the Health (Mental Services) Act 1981 Study Group on the Development of the Psychiatric Services 1984 The Psychiatric Services: Planning for the Future marks shift towards community orientated services


Study Group on the Development of the Psychiatric Services (1984) : Study Group on the Development of the Psychiatric Services (1984) …staff and public attitudes have tended to concentrate effort on hospital care as a result of which community facilities are relatively underdeveloped. The hospitals were designed to isolate the mentally ill from society and this isolation still persists


Study group proposals : Study group proposals Comprehensive, community oriented, sectorised service to be established Prevention and early identification Assessment, diagnostic and treatment services In-patient care/Day care/Out-patient care Community based residence Rehabilitation and training


The ‘sector’ : The ‘sector’ Comprehensive psychiatric service to a population within a geographical boundary Multidisciplinary team within each sector serving a population of 25-30000 Integrated with GP community care and voluntary services In-patient treatment in psychiatric units of general hospitals


Programme for Economic & Social Progress 1991 Priorities for Mental Health : Programme for Economic & Social Progress 1991 Priorities for Mental Health Additional places in day centres, workshops and supported hostels Further development of child and adolescent psychiatric services The development of community alcoholism programmes The further development of alternative approaches to the delivery of psychiatric services. Continued development of specialist assessment and rehabilitation units associated with main acute general hospitals


Admissions by hospital type1965-2002 : Admissions by hospital type 1965-2002


Green Paper on Mental Health 1992 : Green Paper on Mental Health 1992 Embraces the community based orientation of the 1984 report Attempts to reconcile local practice with international, human rights principles on the treatment of the mentally ill. Leads to : 1995 White Paper ‘A New Mental Health Act’ 1998 Guidelines on good practice and quality assurance in Mental Health Services


State of play at the turn of the century : State of play at the turn of the century Admission numbers reached a peak in 1986 at 29,392 and have been steadily declining ever since. From 1991 onwards rates have been steadily decreasing with the exception of 1996. All admission numbers increased over the 37-year period, from 15,440 in 1965 to 23,736 in 2002. Rates increased from 535.4 in 1965 to 605.9 per 100,000 in 2002.


A Cinderella service? : A Cinderella service?


Forthcoming attractions : Forthcoming attractions The Mental Health Act 2001 Mental Health Commission Mental Health Tribunals Inspectorate of Mental Health Services