Mark Harrold calls for the implementation of one quality system for everyone with a learning disability in Ireland--independently accountable and universally equitable.


The October 2000 issue of Frontline carried extensive coverage of various quality systems in place around the country purporting to deliver ‘quality’ services to mentally handicapped people. Reading about the various systems one would get the impression that Ireland is ahead of the pack when it comes to looking after our most vulnerable citizens. But behind the smiling faces in the photographs is a story so horrific that it is barely comprehensible. Perhaps that is why we persist in peddling this lie of quality because the truth is so appalling that the whole mental handicap industry should be hanging its head in shame. How much longer are we going to produce glossy brochures of happy clients presenting posies to celebrities and politicians? The client with Down Syndrome is usually picked for that job because it looks better for the publicity shots. How long more are we going to turn our backs on the hundreds of voiceless people in institutional care in this country? What sort of industry is it that will peddle a range of highly selective quality systems on the one hand, while turning a blind eye to the grossest abuse of basic human rights against mentally handicapped people in institutional care on this island?

In the articles on quality systems we read about clients who have searching questions asked of them in order to establish what is the best job for them. Why do we never read about those cases of recurring bone fractures at an institution, none of which have been explained to families despite their avid enquiries? We never hear of those who are in locked wards with fellow victims, all of whom are overly medicated and extremely disturbed because they rarely, if ever, leave the ward. They never wear their own clothes and endure the most appalling sanitation. We never hear about the person who died of blood poisoning in a nursing home where they had been placed, against the family’s wishes, when in the latter stages of Alzheimer’s disease. We never hear about the many others whose families have long since abandoned them to these institutions to hide their ‘shame’, or whose parents have died and nobody comes to visit any more. We seem to be oblivious to the thousands who have died in these institutions without as much as a name engraved on a wooden cross.

Perhaps the articles on quality systems serve to highlight the inequities which exist within the overall system. Agencies choose what system of quality will fit into their particular set-up. It is quality by design. And if a person does not happen to match the profile of what is on offer, they are not allowed into the system. They will not be asked the searching questions or have their cute responses read out at the next conference on quality systems. Why is there not one set of standards which applies across the whole country? In Dublin one only has to travel eight miles to compare one type of service which aspires to provide a dignified and humane lifestyle to those in its care with another which contains its people in the most disgraceful institutional conditions. There is no appreciable difference in the level of disability in the respective establishments.

Elsewhere in the same issue of Frontline, we witness the large contingent of still-smiling Irish faces at a conference in Seattle attending workshops on, among other topics, ‘best practice’. One must ask when the industry will address the worst practices which currently exist. There are those within the industry who seem intent on maintaining the status quo. Many upper middle class lifestyles are being supported in the maintenance of these disgraceful institutions. In the absence of any real accountability, these circumstances will continue. There seems to be little motivation to change. However, these people are not the only perpetrators of this abuse of the human rights of a significant section of the mentally handicapped people of Ireland. Where are the condemnations of these conditions by professional and clinical bodies? The silence has been deafening from those who could make a difference. Indeed, when the full story is finally told of the horrific abuse of the human rights of mentally handicapped people in institutional care in this country, the question will be asked as to why so many so-called professional bodies remained so quiet for so long. The fence cannot take the strain any longer. There are simply too many people on it. I would urge all professional bodies to act on this issue while their credibility is still reasonably intact. And I call for the implementation of one quality system for all mentally handicapped people in Ireland which will be independently accountable and universally equitable.