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'Second-class citizens': Report finds significant issues in 'outdated' and 'dirty' mental health centres

The commission took 40 enforcement actions against 31 centres which were non-compliant last year.

Image: Shutterstock/Chanintorn.v

THE ANNUAL REPORT from the Mental Health Commission has revealed major shortcomings in the provision of mental health care across the country, with over two-thirds of centres found to be non-compliant with regulations. 

The Commission has revealed that it took 40 enforcement actions against 31 centres in 2019, which included issues relating to premises, staffing and the privacy and dignity of residents.

It also engaged in the first-ever prosecution under the current Mental Health Act on foot of findings that patients were “deprived of basic dignity and human rights by being secluded in a dirty, malodorous, badly-lit and badly-ventilated room”.

Some 45% of enforcement actions arose from regulatory inspections conducted by the Inspector of Mental Health Services. A further 43% of enforcement actions arose from compliance monitoring.

“This year’s report once again demonstrates that the needs and wants of mental health service users are not being prioritised,” said John Farrelly, chief executive of the commission.

“The Commission has consistently and repeatedly underlined the failings in our mental health system year after year, yet these shortcomings are yet to be acted upon in any meaningful way.

The report evidences that our mental health service users are still being treated like second-class citizens in this country.

The Mental Health Act 2001 sets out the standard of care which must be provided to an individual in hospital or care with mental health issues. A number of reforms have since been made to the original act.

In total last year, some 65 approved centres were inspected along with 18 unregulated 24-hour supervised residences. The commission found that there was 78% overall national compliance. 

However, there were 22 risks labelled as critical over the year, while 69% of centres were found to be non-compliant with the regulation on premises, 48% were non-compliant with regulations on care plans, 58% were non-compliant with the regulation on general health, and 48% were non-compliant with the regulation on record maintenance. 

Furthermore, some 79% of the 28 centres which used seclusion rooms were found to be non-compliant, while 50% of the 58 centres which used physical restraint were found to be non-compliant. 

“It is clear in my annual review – as it has been in previous years – that a significant number of our premises are no longer suitable and need to be replaced,” said Dr. Finnerty, Inspector of Mental Health. 

“Of the 69% of in-patient units that were non-compliant with the [regulation on premises], 33% were dirty. Findings included a dirty seclusion room, unclean bathroom facilities, litter in outdoor areas and offensive odours. Ten approved centres were not adequately lit, heated, or ventilated.

This is an ongoing problem, year on year. It is simply not good enough that people who are extremely unwell are forced to reside or recover in wards or rooms that are unclean, malodorous or poorly maintained.

She added: “Continued poor compliance with the regulation on individual care plans needs to be tackled on a number of fronts.

“Perhaps most importantly, there needs to be a change of culture. The patient’s care plan should be seen as the blueprint for their care pathway. And it should be viewed as the patient’s care plan, not the clinician’s.”

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The commission said it wrote to the HSE to request an action plan which addresses the shortcomings in its report. 

It noted the significant issues around seclusion and restraint, the standard of the premises, and matters of staffing and care plans. 

Commenting on the report, the CEO of campaign group Mental Health Reform, Fiona Coyle, said: “[This] marks another year where we have failed to make a meaningful impact on the delivery of fundamental improvements in mental health services in Ireland.”

“Behind every number in this report is a person whose rights and dignity are not being fully respected,” she said.

“Each and every individual who uses our mental health services deserves appropriate care and support which promotes their rights to autonomy, respect and self-determination.”

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