More than one in five inpatients in psychiatric hospitals are detained against their will, according to a national census of mental health services to be published next month.
The high level of involuntary admissions - 22 per cent - is a cause for concern, according to Dr Dermot Walsh of the Health Research Board (HRB) and a former inspector of mental hospitals. The proportion of patients involuntarily detained has risen from 17 per cent in the last census in 1991. However, there has been an overall reduction in hospital admissions during this period.
For many years civil rights campaigners have been concerned about the relatively high rate of involuntary admissions to psychiatric hospitals. But a national review of the legal status of detained patients is due to begin next month by newly established mental health tribunals, aimed at safeguarding patients' rights.
The census shows the number of inpatients has fallen to 3,389, a 22 per cent decrease since 2001. This reflects a long-running trend in which more patients are being cared for in community settings rather than older institutions. The census, carried out on the night of March 31st this year, also shows that:
Agricultural workers had the highest rates of hospitalisation, followed by unskilled groups and farmers. Employers or managers were least likely to be hospitalised. This reflects a trend in which those in lower socio-economic groups have higher admission rates than better-paid workers.
Some 46 per cent of patients had been in hospital for a year or more, while more than a quarter (29 per cent) had been resident in hospital for five years or more.
With more patients moving to community-based facilities or remaining in hospital for a short time, the report projects the number of long-term residents in psychiatric hospitals - about 1,500 - will reduce to almost zero by 2011.
The HSE South area had the highest rate of hospitalisation (131 per 100,000 population), followed by the North-East (113 per 100,000). The lowest rates were in the West (96 per 100,000).
There were wide variations in hospitalisation rates between catchment areas. North Cork had the highest (240 per 100,000), while West Cork had the lowest (15 per 100,000). The contrast may be explained due to a lack of psychiatric facilities in some areas, according to Dr Walsh.
More than 34 per cent of residents had a diagnosis of schizophrenia; 15 per cent had a depressive disorder; 8 per cent had a diagnosis of mania; and 7 per cent had a diagnosis of a mental disorder and intellectual disability.
Another area of concern, according to Dr Walsh, was the high level of admissions in some parts of the State of patients with alcohol disorders. In Newcastle Hospital, Co Wicklow, almost 30 per cent of admissions were related to an alcohol disorder, compared with just 5 per cent at St Davnet's Hospital, Monaghan.
"These differences in admission rates have nothing to do with the degree of alcoholism," Dr Walsh said. "Uncomplicated problems relating to alcohol should be dealt with by generic community service." He said many patients did not have an underlying psychiatric illness where there were high admission rates for alcohol disorders.
