Sunday 19 November 2017

Mental health inpatients decrease by 88pc in 50 years

The cost of healthcare is weighing heavily on the elderly
The cost of healthcare is weighing heavily on the elderly
Eilish O'Regan

Eilish O'Regan

THE latest census of Irish psychiatric units and hospitals shows 2,401 patients were resident on the night of the survey. The newly-published report, based on the March 31, 2013 census, points out that this contrasts with a figure of 19,801 in 1963.

"This represents a reduction of 88 per cent since 1963 and a reduction of 14 per cent since 2010," the Health Research Board revealed. "The death of older long-stay patients and their non-replacement by new long-stay patients is a contributory factor in the decline in in-patient numbers.

"In 2012 alone, there were 153 deaths in Irish psychiatric units and 59 per cent of the individuals concerned were aged 75 years and over.

"Almost half of these deaths occurred following a length of stay of five years or more in hospital. In the period 2010–2012 there were 411 deaths in total in Irish psychiatric units and hospitals."

Men accounted for over half (55 per cent) of all in-patients on the latest census night.There has been no real change in the gender breakdown of patients over the last 50 years, with males typically accounting for 55 per cent of patients, said the report.

One-third of in-patients were aged 65 years and over on census night; 17 per cent were aged 55–64 years; an additional 17 per cent were aged 45–54 years.

There were 15 per cent aged 35–44 years; 12 per cent were aged 25–34 years; 3.5 per cent were aged 20–24 years, and 1.6 per cent were aged 18–19 years.

"There was one person under 18 years of age resident in adult psychiatric units and hospitals on census night. There were an additional 63 children and adolescents resident in child and adolescent units ."

It found that the 75 year and over age group had the highest rate of hospitalisation, at 180.4 per 100,000, followed by the 65–74 year age group, at 125.3 and the 55–64 year age group, at 87.4.

The 20–24 year age group had the lowest rate of hospitalisation on census night, at 28.6 per 100,000. Nearly six in ten of all residents on census night were single, 20.5 per cent were married, six per cent were widowed and three per cent divorced.

In the report, Dr Dermot Walsh, the former inspector of mental hospitals, said that in 1963 the bulk of in-patients were long-stay, with over 70 per cent there for over two years and over 60 per cent for over five years.

"In contrast, only 37 per cent of patients in 2013 had been in hospital for more than one year (long stay), with 15 per cent of these in the new long-stay category (between one and five years) and 22 per cent for over five years (the old long stay)," he said.

He said that in 1963, excluding the 2,232 in-patients labelled as 'mental deficiency', schizophrenia accounted for 62 per cent of in-patients.

"By 2013 this proportion had fallen to 31 per cent but still accounted for, by far, most in-patients. Additionally, schizophrenia accounted for 41 per cent of all long-stay in-patients, that is those resident for over one year, and for 44 per cent of those hospitalised for over five years – the old long-stay."

Dr Walsh said predicting when older public hospitals will finally close is hazardous and dependent on major local initiatives. In addition, some long-stay patients remain in units other than the old 19th century buildings, and their need for rehabilitation and more appropriate placement, community-based, as recommended in the latest policy document, A Vision for Change, remains an unachieved objective.

"As far as the private hospitals are concerned, the two largest are committed to acute care only and, with the remainder specialising in care for the elderly, the issue of reduction in long-stay does not arise," he added.

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