FORENSIC MENTAL HEALTH


downfall – because the demand was then to accommodate many more people, simply dividing the same amount of resource by much larger patient numbers. The result was an impoverished, and frankly, dysfunctional, service.” Prof. Kennedy added: “Most people remember the emerging sociology of the closed institution, which is how they were by the time they were dysfunctional. An inward- looking and rather defeatist approach to treatment – the therapeutic nihilism went with that impoverished environment. So, in modern times, very often what happens – as when the CPT party toured the Central Mental Hospital – is that people see truly appalling, dirty, poorly maintained, falling- down buildings and think: ‘Well, nothing good could be happening here’.


Makings of a ‘successful’ hospital “However, conversely,” the Professor added, “it doesn’t follow that a beautiful, bright, light, airy, modernist, inspiring building will necessarily be a successful hospital. There’s a huge amount of nihilism about the whole idea of hospitals.” While ‘a lot of the reforms in intervening years had benefited a lot of patients’, what remained was ‘a large minority’ in anybody’s caseload with really quite severe, hard-to- treat illnesses. He said: “And nobody has been thinking about them for the last 70 years.” He continued: “It’s actually quite


There have been some interesting positive developments, but scientifically, it’s been in the doldrums. For example, there’s still little recognition that severe mental illnesses like schizophrenia are life-shortening; people with such illnesses lose about 16 years of life expectancy, compared with those who don’t, and we’re not making much progress here


rewarding to see the worried well and have some psychological interactions with them, and they go away feeling better, but entirely different to see people with neurodegenerative disorders and genetic illnesses, for whom you know the best you can do is improve their quality of life; there isn’t a cure. People coming into mental healthcare nursing, and even some psychiatrists, often don’t realise this is where most of the time, effort, and budgets still go.” While good pastoral care and activity such as grief support work were important, they weren’t of much benefit to those with life-shortening severe mental illnesses – such as schizophrenia and bipolar affective disease. Prof. Kennedy feels there is ‘a kind of collective denial that these illnesses exist’. I asked next about his 20 years as


Executive Clinical Director of Ireland’s National Forensic Mental Health Service. He explained: “When I took over as Clinical Director from Dr Charlie Smith


in 2002, the Dundrum buildings were frankly so terrible that what we made our priority addressing what we did in them – essentially modernising care and treatment. Firstly, we clarified the boundaries between our service and the prison service; clarifying that we are indeed a hospital, run by the health service, not the Department of Justice or the Prison Service; just making that clear to all took a year or two. We then introduced a pre-admission assessment system, only admitting people we had first assessed to ensure they actually did have mental illness.” This saw the amount of violence fell rapidly. Prof. Kennedy said: “We also brought in modern practices I’d introduced in North London – such as a system for what we called ‘stratified therapeutic security’.


Three key elements to safety This, he explained, refers to ‘the three key elements that make any hospital safe’.


RYNO® 2-SEATER The wide stance of the new Ryno® 2-seater


allows users to sit side-by-side with their peers and caregivers, helping to build relationships, supporting therapeutic aims.


An integrated draining channel aids water run-off, making the 2-seater suited to indoor and outdoor use.


123KG


Weighted for safety


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THE NETWORK | NOVEMBER 2023 13


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