Inadequate mental health services must be ‘urgently improved’

Mental health services for older people in Ireland suffering from illnesses such as depression, dementia and anxiety are inadequate and must be urgently improved, according to a new report by the Mental Health Commission.

Authored by the Inspector of Mental Health Services, Dr Susan Finnerty, the report highlights an ‘alarming’ under-provision of acute mental health beds for the elderly and ‘serious under-resourcing’ of community mental health services for the same population.

Because the Covid-19 pandemic continues to chiefly impact on older people, the report also warns that the elderly must be provided with more single-room accommodation in residential and acute mental health care settings, and adequately staffed community teams and other supports to enable them to stay at home as long as possible. The rapid transmission of the virus, higher mortality rates, self-isolation, social-distancing and quarantine has presented what the report describes as ‘a perfect storm’ for the mental health of older people, all of which can exacerbate the risk of mental health problems.

Notwithstanding the ongoing and very severe risks that the pandemic continues to present to the elderly, the central thrust of the Inspector’s report focuses on the inadequacy of current services for Ireland’s older population. This potential impact of this current under provision is thrown into sharp relief when Ireland’s ageing population is considered.

The report highlights what it describes as serious under-resourcing of community mental health services for older people. In total, there are 43 older people teams across the country, which is just 66 percent of the number of teams recommended by ‘A Vision for Change’. Of the teams that do exist, they are only staffed to 54 percent of what is recommended by the same policy.

The report also points out that Ireland has 1.2 dedicated acute mental health beds for older people per 100,000, compared with six per 100,000 in England and 9.7 in Northern Ireland.

“The current delivery of some in-patient mental health care to older people in general adult mental health units - rather than in dedicated units - constitutes a risk to the safety of older people and does not meet their therapeutic needs. Even when variations across culturally-similar countries are allowed for, Ireland has an alarming under-provision of acute mental health beds for older people,” Dr Finnerty remarked.

The report also flagged what it described as a ‘dearth’ of liaison teams for older people with mental health issues across Ireland’s hospital network, something which Dr Finnerty describes as a ‘core service’ for every acute hospital.

With over 90 percent of older adults with dementia experiencing behavioural and psychological issues such as anxiety and depression, the report underlined the inadequacy of memory services, pointing out that over 50 percent of counties do not have a memory clinic.

“The report clearly demonstrates that we are currently not providing an integrated nationwide, comprehensive mental health service for older people in Ireland. Our parents, grandparents and older people generally deserve the best care and treatment that this country can provide, but it is clear from this report that we have a lot of work to do.

“Best practice recommends that care should be provided where possible in a community setting close to home, but the service is just not there in many areas, and our older generation continue to suffer as a result,” Chief Executive of the Mental Health Commission, John Farrelly, said.

With many older people suffering from a combination of mental, physical and other difficulties, the report calls for a single integrated system of needs assessment and service provision that aims to promote alignment and collaboration between the care sectors.

In relation to Covid-19, Dr Finnerty warned again that centres must put strong infection prevention and control measures in place, as well as providing more single en suite accommodation to prevent progression of the disease, while they must also endeavour to provide adequately staffed community teams and supports to enable older people to stay at home as long as possible.

 

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