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Press Release

Press release

Trends highlighted in numbers resident in psychiatric units and hospitals

26 July 2011

Fewer overall psychiatric residents, greater proportion of patients resident in general hospital psychiatric units, greater capacity for patients under 18 years, decrease in involuntary admissions and decrease in proportion of long stay patients reported.

There has been a 17% reduction in the number of people resident in psychiatric units and hospitals since 2006. These figures are revealed in a census of Irish Psychiatric Units and Hospitals, published today by the Health Research Board. This equates to 577 fewer psychiatric residents since the last census in 2006 and a decrease of 86% in the past almost 50 years.

This decline reflects successive government policies to grow community psychiatric services as an alternative to long-stay institutional care, alongside the death of older long-stay patients and their non-replacement by new long-stay patients.

Main findings

There were an additional 35 residents in child and adolescent units (under 18 years of age) on census night, bringing the total number of all under 18s residents to 43, an increase from 30 such patients in 2006. This is in line with service developments and policy to increase in-patient capacity for this age group.  

There has been a further reduction in the proportion of patients detained involuntarily since the commencement of the Mental Health Act 2001 in November 2006. Thirteen per cent of all in-patients were involuntary, a reduction in the proportion of involuntary patients from 2006 (22%), representing a hospitalisation rate of 8.6 per 100,000 population.

There has been a 2% increase in the proportion of patients resident in general hospital psychiatric units from 2006 to 2010 coupled with a 5% decrease in the proportion resident in psychiatric hospitals in line with the policy to close the older, more traditional psychiatric hospitals and the provision of in-patient services in psychiatric units in general hospitals.

Although the overall proportion of long-stay (i.e. in hospital for over one year) patients has declined from 1963 to 2010, the proportion from 2006-2010 did not change markedly. Given the policy, as advocated in A Vision for Change, to close the older psychiatric hospitals and the increasing provision of alternative community-based psychiatric services, a greater decline had been expected.  Extrapolating these figures, means there will still be over 300 long-stay patients in in-patient care in 2030, the majority in the larger psychiatric hospitals.

'The Census provides documentary evidence on the rate of progress in achieving the goals as set out in A Vision for Change', says Antoinette Daly, one of the authors of the report.  'As such it is a vital tool for service planning and allows planners to predict possible future bed and hospital requirements'.

According to Mr Martin Rogan, Assistant National Director Mental Health in the HSE,

'It is encouraging to see the reduction in inpatient numbers since the last census in 2006. The reduction in the numbers resident in the older psychiatric hospitals is in line with the policy to move away from the more traditional psychiatric hospitals to more community-based services and psychiatric units in general hospitals. Now that we are witnessing the end of the institution, we must ensure that credible, high quality alternatives are in place to meet our changing mental health needs'.

The overall hospitalisation rates in Ireland (66.3 per 100,000) are similar to rates in the UK - England (60.1), Wales (77.5) and Northern Ireland (63.3) with the exception of Scotland which had a higher rate (93.0).

Other statistics from census night reveal that:

  • Males accounted for over half (53%) of all patients.
  • One third of in-patients were aged 65 years and over.
  • The 75 year and over age group had the highest rate of hospitalisation, followed by the 65 years or over.
  • Almost two-thirds of residents (60%) were single, 20% were married, 6% were widowed and almost 3% were divorced.
  • Agricultural workers had the highest rate of hospitalisation, at 171.5, followed by the unskilled group, at 168.9 and farmers, at 73.1
  • Over one-third of residents had a diagnosis of schizophrenia; 17% had a diagnosis of depressive disorders; 10% had a diagnosis of organic mental disorder and 8% had a diagnosis of mania.
  • Almost half (47%) of patients were resident in psychiatric hospitals, 25% were in general hospital psychiatric units and 20% were resident in private hospitals. The proportion of residents in general hospital psychiatric units has risen from 3% in 1981 to 25% in 2010, while there has been a corresponding decrease in the proportion of residents in psychiatric hospitals, from 90% in 1981 to 47% in 2010.
  • The majority of in-patient aged under 18s (58%) were female, 19% had a diagnosis of schizophrenia, 12% had a diagnosis of eating disorders, 9% had a diagnosis of neuroses and 7% has a diagnosis of depressive disorders.
  • There were 40 patients with no fixed abode; 80% of these were male and 82.5% were single.
  • Almost all (92%) patients with intellectual disability had been in hospital for one year or more and almost 83% had been in hospital for five or more years.
  • Patients from Dublin North-East had the highest rate of hospitalisation, at 77.5 per 100,000 population, followed by HSE South, at 73.8, HSE West, at 59.9, and Dublin Mid-Leinster, at 56.1.
  • Forty-two per cent of all patients were long-stay, i.e. they had been in hospital continuously for one year or more, only slightly down from 46% in 2006.
  • 25% were old long-stay, i.e. had been in hospital for five years or more, again only slightly down from 29% in 2006. Almost half (49%) of those who had been hospitalised for five years or more were aged 65 years and over.

A full copy of the Census report is at www.hrb.ie. Alternatively, for a hard copy of the report, please contact Sharon Kelly by emailing skelly@hrb.ie or by phoning 01 2345152

For more information contact:
Gillian Markey, Communications Manager
Health Research Board
m 00353 87 2288514
t 00353 1 2345103
e gmarkey(at)hrb.ie

Ends
Notes for Editors

The Health Research Board (HRB) was established in 1986. For the last 25 years it has been Ireland's lead agency in supporting and funding health research. The HRB's mission is to improve people's health, patient care and health service through leading and supporting research and generating knowledge and promoting its application in policy and practice. The HRB has supported research which has played a key role in innovation in Ireland's health system and its economic development  

The National Psychiatric In-patient Reporting System database is the only national psychiatric inpatient database in Ireland and has been maintained by the Health Research Board (HRB), since 1971. The seventh national census of Irish psychiatric units and hospitals was carried out on 31 March 2010. All patients resident in 68 units and hospitals operating within the provisions of the Mental Health Act 2001 were enumerated in the census. Rates reported are per 100,000 total population.

 

Breakdown by Hospital type

 

Number

%

General hospital psychiatric units

22

32.4

Psychiatric hospitals

30

44.1

Private hospitals

8

11.8

Central Mental Hospital, Dundrum

1

1.5

Carraig Mór, Cork*

1

1.5

St Joseph's Intellectual Disability Service**

1

1.5

Child and adolescent units

5

7.4

Total

68

100.

*Carraig Mór is an intensive care and rehabilitation unit.

**St Joseph's Intellectual Disability Service is located at St Ita's Hospital - Mental Health Services, Portrane, Dublin.

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