The Irish ‘Vision for Change’, 2006 mental health policy document proposes a framework for promoting mental health and a recovery approach to inform every level of service provision. Comprehensive assessment by the rehabilitation and recovery multidisciplinary team with active involvement of the service user is crucial in the identification of needs, goals and recovery factors. This paper outlines importance of a comprehensive assessment tool, which helps to guide the service user towards identification and achievement of their goals while encompassing the recovery ethos.

Objectives: Although there are many published reports about the human cost of schizophrenia, there are far fewer estimates of its economic cost, particularly in Ireland. The aim of this study was to provide a prevalence-based estimate of the costs associated with schizophrenia in Ireland during 2006.

Method: Using standard Cost of Illness (COI) procedures we compiled data from many sources including the Health Research Board, the Department of Health and Children and other government publications. Costs relating to health and social care, informal care, lost productivity, premature mortality and other public expenditures were included. Where national data were unavailable, we used bottom-up data from a geographically defined catchment area study and, in some instances, costs from two catchment areas were averaged. We did not measure human or intangible costs.

Results: The estimated total cost of schizophrenia was €460.6 million in 2006. The direct cost of care was €117.5 million and the burden of indirect costs was €343 million. The cost of lost productivity due to unemployment, absence from work and premature mortality was €277 million. Within indirect costs, the expenditure on informal care borne by families was €43.8 million.

Conclusions: Schizophrenia is not a very common condition but is an expensive one. This is attributable to its young age at onset, relatively low mortality rate and high severity particularly in terms of its impact on future employment. Measures to improve outcomes coupled with measures to improve employment such as supported employment strategies may impact significantly on the cost of schizophrenia. The study is limited because the national unit costs of many variables are not directly available and these Irish data are likely to be an underestimate. However, the results are comparable with a 2005 cost of illness study UK study.

Objectives: To provide normative data for older national (primary) school children, broken down by age and gender, for the Children's Depression Inventory-Short version (CDI-S) and revised norms for the Children's Depression Inventory-Parent version (CDI-P) and its subscales.

Method: Forty-three randomly selected national schools took part in this study. Participants were 1,255, fifth and sixth class, Irish national school children who completed the Children's Depression Inventory Short Form (CDI-S). In total 1,018 parents completed the corresponding parent form, the Children's Depression Inventory-Parent version (CDI-P).

Results: Norms for the CDI-S and the CDI-P subscales were produced. Revised norms for the CDI-P are proposed. Results revealed no significant age or gender difference in depressive symptomatology as measured by respondent's CDI-S and total CDI-P scores. Parent's ratings of their children's depression levels (CDI-P) and children's self-reported depression levels (CDI-S) were significantly correlated. The CDI-S and CDI-P displayed good internal reliability.

Conclusion: Results indicate the utility of both the CDI-S and the CDI-P for assessing depressive symptoms in national school children in Ireland. This study confirms that national school children do display symptoms of depression. School based policies, materials and services supporting and promoting positive mental health should be developed, implemented and resourced.

Objective: The aim of this study was to determine the rates of osteopenia and osteoporosis and other general health problems in a long-stay male psychiatric unit.

Method: All 15 patients underwent a semi-structured clinical interview and a full physical examination including calculation of Body Mass Index, central obesity (abdominal circumference) and blood pressure measurement. All patients had blood sampling examining FBC, U&E, LFTs, TFTs, PSA, prolactin, lipid profile and glucose. The rates of metabolic syndrome were calculated according to the International Diabetes Federation consensus worldwide definition. Bone mineral density was determined in the lumbar vertebrae and left hip by DEXA scanning.

Results: The prevalence of osteopenia or osteoporosis was 46%, and bone mineral density was inversely correlated with serum prolactin levels (r = -0.595, p = 0.041) and chlorpromazine equivalence (r = -0.645, p = 0.017). The prevalence of obesity was 53%, while central obesity was present in 87% of patients. Metabolic Syndrome was present in 27% of patients.

Conclusions: More attention should be given to diagnosing and treating osteopenia and osteoporosis in patients on long-term antipsychotic agents and preventative measures should form part of any treatment regime in these individuals. Frequent input from dietitians should also be available for long-stay psychiatric inpatients to reduce the prevalence of obesity.

Objective: All patients who resided in state provided long-stay care in Ireland were required to pay the state for that care until 2006. In 2001 the Irish Ombudsman and Information Commissioner had highlighted the issue of the entitlement of people with medical cards to provision of free long-stay care. The Health Repayment scheme was subsequently set up in 2006 to facilitate the repayment of long-stay charges wrongly paid by patients. Issues of mental capacity arise particularly in the context of long-stay psychiatric patients applying for repayment of long-stay charges. Our aim was to devise a test suitable to assess the capacity of an individual to make an application for refund charges.

Method: There was no specific test in existence to assess the capacity of an individual to make an application for refund of charges. A suitable test was devised based on the available literature which assessed whether the person understands the ‘nature and effects’ of making a refund application. Fifty-eight long-stay patients were deemed to be entitled to apply for a refund.

Results: Staff identified 47 (80%) patients as possibly lacking the capacity to make an application. Of these, 14 patients (29.8%) were found to have capacity to make an application (mean age 58.5 years) with 33 (70.2%) found to lack capacity (mean age 73 years). Of those with capacity 50% had a diagnosis of schizophrenia/schizoaffective disorder. None had cognitive impairment of degenerative origin. Of those who lacked capacity 45.5% had a diagnosis of dementia. All of the patients with dementia who were assessed were found to lack capacity whereas 59% of those with a diagnosis of schizophrenia/schizoaffective disorder lacked capacity.

Conclusion: A substantial number of long-stay psychiatric patients may lack the capacity to make particular decisions. In this study the group who lacked capacity were an elderly group with dementia common. This process raised a dilemma about how a patient without capacity to make a refund application can then manage the money claimed on their behalf and whether guardianship safeguards are necessary.

Objective: Depressive symptoms in schizophrenia have previously been associated with a perceived lack of social support. The aim of this study was to explore the relationship between perceived social support and depressive symptoms in schizophrenia; to assess the psychological wellbeing of their carers; and to examine the quality of the relationship between the patients and their carers.

Method: Individuals with schizophrenia (n = 17) were assessed on the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS), a measure of perceived social support, the Significant Others Scale (SOS) and the Quality of Relationship Inventory (QRI).

Results: The mean score on the BDI for patients fell within the moderate-severe range and the mean range on the BHS fell within the moderate range. Family and friends were perceived as supportive resources by patients. There was no significant relationship between patient depressive symptoms or hopelessness and perceived social support. Carers of patients did not report high rates of depressive symptoms or hopelessness.

Conclusions: These findings do not support the previous finding of an association between depressive symptoms and a perceived lack of social support in schizophrenia.

Developing effective models of identifying and managing physical ill health amongst mental health service users has become an increasing concern for psychiatric service providers. This article sets out the general professional and Irish statutory obligations to provide physical health monitoring services for individuals with serious mental illness. Review and summary statements are provided in relation to the currently available guidelines on physical health monitoring.

The Irish College of Psychiatrists recently reported that “the needs of people with learning disability and offending behaviour pose a huge challenge to service providers. The vulnerability of people with a learning disability who come into contact with the criminal justice system is well described and noted.” The College noted that “the population with learning disability who offend does not easily fit into existing services” and reported that “the majority of service providers strongly supported the urgent development of a forensic learning disability service.”

The challenges presented by individuals with learning disability and offending behaviour are not specific to Ireland or to this period in history. The purpose of the present paper is to explore issues related to learning disability and offending behaviour in 19th- and early 20th-century Ireland.

More specifically, this paper presents original, previously unpublished case material from the archival medical records of the Central Mental Hospital, Dublin in order to illustrate specific aspects of the institutional experience of individuals with learning disability who were charged with offending behaviour in nineteenth-century Ireland.

The Central Mental Hospital, Dublin was established as the Central Criminal Lunatic Asylum in 1845 under the provisions of the Lunatics Asylums (Ireland) Act (1845). Individuals were to be committed to the Central Criminal Lunatic Asylum if they were declared ‘guilty but insane’ at time of trial or offence, or if they developed mental illness and became difficult to manage while in detention elsewhere. The Central Criminal Lunatic Asylum opened its doors to admissions in 1850 and by 1853 there were 69 male and 40 female inpatients.