‘It doesn’t work. Screaming it has to stop’: Mental health service inspector says standards not met

State Inspector of Mental Services Professor Jim Lucey talks tax and learning to drive.

Passing only 80 percent of the driving test tasks and getting a full license is not a good thing, he said. The same goes for paying some of your taxes. “The taxman won’t accept it,” he added. “He would have your house, he would be right.”

Lucy asks why it is acceptable that a third of Ireland’s 66 acute mental health centers comply with less than 80% of the minimum standard.

“We’ve got 22 centers and growing and are below that standard,” he said. “What does that mean in practical terms? It means you can’t go to one of these centers and be guaranteed privacy, treatment or safety. That can’t be right.”

Sitting at her desk in her office in Dublin 4, Lucy, who has been working as an inspector for almost a year, is quite critical of the state of Ireland’s mental health centres, saying it is a “dire” whether or not someone can get quality treatment.

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

He was disappointed last year that the Mental Health Commission had found “the highest level of misconduct”. But the more important issue is the impact it will have on those who need it most.

“I need them to go to a safe place, a therapeutic space, a place that will actually contribute to their recovery and their dignity. It’s not a prison cell, it’s a therapeutic place. It’s the bare minimum; It’s not idealistic.”

Ireland has pledged to provide integrated care in the community and has refused to hospitalize the mentally ill. This vision did not materialize, says Lucy.

“One of the things we’ve done is we’ve taken the money and people we have and invested in one type of facility in a piecemeal fashion,” he said, adding that acute units are “in critical condition.” breaking point”.

However, there are some positives to consider. Its 2023 report found that seclusion of patients in locked rooms fell by 25 percent last year, and the use of physical restraints fell by 9 percent.

[ Patients in mental distress safer in community than in most specialised treatment centres, watchdog saysOpens in new window ]

Minimizing these practices is essential as the government seeks to transform mental health care in a human rights-based approach.

“Mental health is good news. I have had an amazing life working in mental health and seeing people get better,” says Lucy. “The reward for any doctor is someone who gets better. That’s a dividend. You see it more than in mental health. It’s not bad news. You have to turn the tide.”

In addition, many new treatment innovations are emerging, he said, stressing that it is important to have a skilled workforce to provide access to those who need help.

Lucy said the state currently spends €1 in every €20 of its health budget on mental health services, and believes this figure needs to be doubled. Staff shortages mean many patients cannot access the treatment they need, leading to a “huge problem” of over-prescribing drugs to ease suffering.

“If you reduce therapeutic inputs, you increase reliance on pharmacologic nursing inputs,” he added.

A Department of Health spokeswoman said this year’s total allocation for mental health services exceeded €1.3 billion, “a record amount of funding and the fourth consecutive year of growth”.

“Between the end of 2019 and March 2024, mental health services saw a net increase of 916 posts, with 86 per cent of those posts being for people directly involved in client care,” he added.

The commission only regulates 1% of mental health services in Ireland. Its role is expected to be expanded under the forthcoming Mental Health Act, which is understood to include regulating Child and Adolescent Mental Health Services (Camhs) and community accommodation.

When that happens, the publication of the bill has been delayed again, and the department’s spokesperson said it will seek government approval to publish it before the end of the month.

Lucy said the promises made on mental health were “unfair”.

“Mental health benefits work in all acute care. It has five things: it has to be relatable, it has to inspire hope, it has to be honest, it has to have meaning, it has to have power – it has to have Chime. “But right now, hope is a false hope. The integrity of those promises just wasn’t there. We need a real commitment to mental health.”

So, is the system working in its current iteration? Lucy answered with an emphatic “no.” As he put it, many aspects are effective and the staff is “amazing”.

“But how can you say that an inspector is more likely to be in a building that’s broken and not meeting minimum standards? It’s not working. We have to shout stop.”