The chief executive of the Mental Health Commission, John Farrelly, has called for greater investment in beds in mental health services, but also in community services.
“Instead of doing a bit of work and stopping, we need to focus on drilling down and building more units”, he told RTÉ radio’s Morning Ireland.
Mr Farrelly was discussing the latest annual report from the Commission which found that independent privately-run mental health centres offered a better level of care than HSE-run facilities allowing people with health insurance or financial means, being able to access the country's high-performing centres.
The report recommends investment into HSE-run inpatient mental health services was required to ensure that people, regardless of their financial means, have access to a similar standard of mental health care.
Mr Farrelly said that the situation around the country was that the private and independent centres, (with 600 to 700 beds) were highly compliant of the regulations particularly with regard to premises and individualised patient care, however, that was not the case with HSE-run premises.
The Commission has been trying for a number of years to improve services in Cork where five of the HSE premises were “really unsuitable”, he added.
“People who don't have private health insurance will be going into those premises in Cork which are also low in terms of individualised patient care, meanwhile someone who lives in the Dublin area, where the majority of private and independent centres are, who has private health insurance, they have much better choice and access and that's not equitable, and it's not fair.”
Mr Farrell pointed out that some counties have done very well – for example in the CHO5 area (which includes Tipperary, Carlow, Kilkenny, Wexford and Waterford).
“Some years ago that area was in trouble, but they invested in new buildings, they invested in their governance and management structure, the chief officer there pulled special teams together to bring the whole place up and it worked, so you would have to beg the question then if it can happen in one CHO area why can't it happen in the other.”
The Commission implemented 42 enforcement actions last year, of which seven were critical risks around premises, said Mr Farrelly. “What we do is we put an action plan in place, if that doesn't work we then escalate it up to the regional, but in Cork it's at the national level.
“Even in dealing with the HSE at national level we're not assured that Cork will come into line. Quite simply it needs a targeted, funded, strategic capital investment and not in the way it's being done at the moment where the people of Cork will be told in 10 years' time you have something or we have to close your centre because it's not good enough.”
The HSE’s process for putting buildings in place and maintaining them needs to change, said Mr Farrelly.
“Over the last number of years we've increased the compliance rate up to 80 percent across the country, there's nothing lower than 68 percent, but we're trying to extract the data, so now what we're saying is it's about individualised care planning, it's not just having a building and putting someone in and giving them medicine
"it's about an individualised care programme for them in proper buildings and premises that are well staffed. We now have it down to three or four sentinel issues so people are listening, but at the same time we have to make sure that the local system responds appropriately.
“If the HSE is capable of doing it in one area they can do it in another area. People talk about Slaintecare, but it's not going to make a difference in Cork if the buildings are not up to scratch”.