There is a bitter irony in the fact that most Covid-19 deaths have taken place in settings that are intended to provide care for vulnerable people.
At this time, there is no benefit to allocating blame, but rather we need to learn quickly and act swiftly to protect those most at risk: people who are older or unwell.
The events in some care homes have been particularly tragic, and as regulator of inpatient mental health units, I want to ensure that we don’t see the same pattern in our facilities.
As of last Friday, April 24, 58 of all mental health services (176 in total) had reported suspected or confirmed cases, while twelve Covid-19 related deaths had occurred in such facilities. As the public health crisis continues, we are very closely monitoring the testing of patients and staff across the sector.
In Britain the Royal College of Psychiatrists warned this week that without access to appropriate personal protection equipment (PPE) and testing, deaths among inpatients and mental-health personnel could potentially end up as high as in other care homes. Here the Mental Health Commission and the Health Information and Quality Authority were given additional powers on March 27 to rate the risks in different facilities. One of the many areas we are looking at is whether or not the units have adequate PPE and staff.
We are doing all we can to ensure that the risk is reduced at the 65 approved inpatient mental health units and 111 24-hour community residences. Combined, these facilities care for more than 3,800 service users across the country. Our approach is to identify risks and require the HSE to mitigate them; this has served patients well to date, but we need to keep our guard up at all times.
We know that community residences are shared facilities where the coronavirus can spread easily, so it‘s important that the vast majority of these units have contingency plans in place.
The pandemic has shone a light on our collective human behaviours and underlying attitudes. We have seen that the vast majority of people have pulled together over the last few weeks and months.
However, I am also worried about a line of thinking, perhaps unintentional, that is apparent in these difficult days. Every evening, people all over the country tune in to their TVs to hear the latest figures and statistics. Very often our figures are accompanied by a caveat that the majority of people who are dying are elderly or have an underlying condition. The median age of the day’s fatalities is given, and is typically in the late 70s or early 80s.
Unintentionally, this caveat has become a source of solace for the vast majority of the population who are fit and well and below that median age. We may be subliminally sending a message out about how we view our older people or those who have an underlying condition.
The language of resources is now a dominant theme. We hear that scarce resources must be used well to benefit the majority from a public health perspective as we battle this pandemic.
From my work over the last 30 years, I have learned that the protection of the most vulnerable is key to maintaining a civilised society. Older people, those with a disability or homeless people on the margins deserve a higher and more intensive degree of protection and indeed resources. The same applies to people using mental health services. A ruthlessly efficient response is not always a civilised response.
The message, though unintended, that some people may not be saved due to their age or underlying condition is one which we need to ensure does not solidify, unchallenged, in our collective consciousness. We need to know that older people or those with disabilities in residential institutions, those in mental-health facilities and the staff caring for them, are receiving the same protection in terms of PPE, for example, as those in hospitals.
The question of who joins the queue for critical, intensive or palliative care is one which needs deep thought and wise counsel. It is not just a medical issue but a moral, ethical and existential issue. I am acutely aware of the issues our health professionals must consider when they are weighing up these decisions. In the services regulated by the Mental Health Commission, the priority is providing the right level of care and compassion for each individual at the right time in their journey.
I welcome all the work to help the majority stay as healthy and well as can be in their homes. I understand the concept of preparing to unwrap and help restart our economy. But to me, consciously protecting our most vulnerable citizens is also a necessity and something that future generations will judge us on.
It is clear that there are pressures in situations where staff have to isolate, while delays add to the pressure of providing full staffing complements. We also have concerns with the design of some of the facilities. For example, a number of centres have dormitory-style sleeping arrangements which would not be suitable for isolation purposes. We are aware that these services are working actively to reconfigure facilities to provide single-room accommodation where possible, and the commission is doing whatever it can to facilitate this.
The need for our most vulnerable people to be shrouded and protected by our strongest professionals and community volunteers, using the full resources of the state, is one we must ensure is alive in the public consciousness.
John Farrelly is chief executive of the Mental Health Commission