‘This isn’t working. We have to shout stop’: Inspector of mental health services says standards not being met

State mental services commissioner Professor Jim Lucey talks about taxes and learning to drive.

According to him, it would not be enough to pass only 80 percent of the tasks of the driving test to obtain a full license. The same would apply if only a few taxes were paid. “The taxman would not accept it,” he adds. “They would take your house and they would be right.”

So why, Lucey asks, is it acceptable that a third of Ireland’s 66 acute mental health facilities meet less than 80 per cent of minimum standards?

“We have 22 centres and the number is increasing and falling,” he says. “What does that mean in practical terms? It means that you cannot go to one of these centres and be assured that your privacy, therapy and safety will be guaranteed. That cannot be right.”

Sitting at a table in his office in Dublin 4, almost a year after taking up his post as inspector, Lucey is highly critical of the state of Ireland’s mental health facilities, saying it is a matter of luck whether anyone will receive quality treatment.

Lucey has worked in the mental health field for 40 years, as Clinical Lecturer in Psychiatry at Trinity College, Associate Professor at the Royal College of Surgeons in Ireland and as Consultant Psychiatrist at St Patrick’s University Hospital.

He is disappointed that last year he found “the highest level of non-compliance in history” by the Mental Health CommissionBut the real problem, he says, is the impact this has on those most in need.

“I need them to go to a safe place, a therapeutic space, a place that really contributes to their recovery, to their dignity. Not a cell, but a therapeutic area. It is a minimum, it is not idealistic.”

Ireland has moved away from institutionalising people with mental illness and promised integrated care in the community. This vision, says Lucey, has not materialised.

“One of the things we’ve done is taken the money that people already have and, in a piecemeal way, we’ve invested in facilities of one kind or another,” he says, adding that acute units are at a “critical point” of deterioration.

There are, however, some positives to highlight. Last year, seclusion, where a patient is kept isolated in a closed room, was reduced by 25 percent and the use of physical restraints by 9 percent, according to its 2023 annual report.

[ Patients in mental distress safer in community than in most specialised treatment centres, watchdog says ]

Reducing these practices is important if we are to reorient mental health care with a human rights approach, which the State is trying to achieve.

“Mental health care is good news. I’ve had a wonderful life working in the mental health field and seeing people get better,” Lucey says. “The reward for any doctor is that the person gets better. That’s the dividend. You see it more in the mental health field. It’s not bad news. We need to change course.”

There are also many therapeutic innovations taking place, he says, stressing the importance of having staff capable of providing them so that people in need can access them.

Ms Lucey says the state currently spends €1 in every €20 of its health budget on mental health care, a figure she says should be doubled. Staff shortages mean many patients cannot access the therapeutic interventions they need, leading to a “huge problem” of overprescribing drugs to help alleviate distress.

“If therapeutic support is reduced, dependence on nursing pharmacological support increases,” he added.

A Department of Health spokeswoman said the total allocation for mental health services this year was more than €1.3 billion, “a record level of funding and an increase for the fourth consecutive year”.

“Between the end of 2019 and March 2024, mental health services have seen a net growth of 916 positions, 86 percent of these positions are for people directly involved in customer care,” he added.

The commission regulates just 1 per cent of mental health services in Ireland. Its role will be expanded by the forthcoming Mental Health Act, which is understood to task it with regulating Child and Adolescent Mental Health Services (Camhs) and community-based residential care.

When that happens is another matter, as the publication of the draft bill has been delayed once again, with the department’s spokeswoman saying it will be sent to the government for approval for publication before the end of the month.

Lucey says promises made around mental health are “false.”

“What works in mental health works in all acute care settings. There are five things: it has to be connected, it has to be hopeful, it has integrity, it has meaning and it has empowerment; it has to resonate,” she said. “But currently the hopes are false. The integrity of these promises has not been fulfilled. We need a genuine and real commitment to mental health.”

So is the system, in its current form, working? Lucey emphatically says no. Some aspects of the system work, she says, and the staff is “excellent.”

“But how can you say that the inspector considers that acute mental health facilities are more likely to be located in dilapidated facilities that do not meet minimum standards and say that this is working? This is not working. We need to shout ‘enough!’”