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Mental Health

Use of physical restraint among non-compliances identified at mental health centres

The reports by the Mental Health Commission cover six centres across Ireland.

THE MENTAL HEALTH Commission (MHC) has found six critical and 29 high-risk non-compliances across a number of rules and regulations in inspections of six inpatient mental health centres across Ireland.

The MHC published annual inspection reports on the centres on Friday. 

Non-compliances reported included the use of physical restraint and seclusion.

Each approved centre registered by the Mental Health Commission must be inspected at least once a year, by law.

Following inspections, the HSE must submit a Corrective and Preventative Actions (CAPAs) plan to the MHC to address areas on non-compliance.

Non-compliance with the regulations and safety codes in place for mental health centres is measured from critical (being the most severe) to high, moderate, and low. 

Non-compliances reported 

Three critical risk non-compliances were reported at St Michael’s Unit, Mercy University Hospital. The regulations in question were on privacy, premises and risk management procedures. 

Tallaght University Hospital was found to have two critical risks in the areas of regulation on premises and risk management procedures, while one critical risk non-compliance was found at the Department of Psychiatry at St Luke’s Hospital Kilkenny. That non-compliance was over regulation of risk management procedures.

The highest reported compliance rate across the six centres was 89% in St Luke’s Hospital. 

St Loman’s Hospital in Westmeath was reported to have the lowest overall compliance rate of the six centres surveyed at 64% – down from 74% in 2022. In 2019, compliance was placed at 89%. 

The report found that St Loman’s did not always have the required number of nurses on site, and that not all staff were trained in fire safety, basic life support, or the management of violence and aggression.

The centre was found to be at a high-risk of non-compliance regarding the use of physical restraint. The MHC found that in one episode in which physical restraint was used, appropriate emotional support was not given to the person in question.

Not all residents at the centre had a comprehensive initial assessment on admission.

Overall compliance rate elsewhere 

The overall compliance rate at the Acute Psychiatric Unit of Tallaght University Hospital was down to 65% from its 77% rating in 2022. The centre was previously at 56% in 2019, but was as high as 97% in 2020.

Two critical non-compliances were recorded at the hospital, relating to regulations on premises and risk management procedures. Seven high-risk non-compliances were also recorded in connnection with regulations on clothing, general health, individual care planning, privacy, staffing, the use of seclusion and the use of physical restraint.

Dirt, debris and mould were observed in the centre during the inspection.

Eight out of 50 patients in the centre had not been monitored in accordance with clinical guidelines, with one resident not being assessed within six months.

St Michael’s Unit in Mercy University Hospital Cork was reported to have a 72% overall compliance rate, up from 69% in 2022, despite the MHC having found three critical non-compliances present in the unit.

The report found that there was a presence of mould in two of the shower rooms, and the centre was in poor structural and decorative condition.

Fire drills were not conducted on a regular basis, and the requirements for the protection of vulnerable adults had not been implemented as training for all staff in the sexual safety policy had not been implemented. 

The two other hospitals included in the reports were the Department of Psychiatry (DoP) at Letterkenny University Hospital and Sliabh Mis Mental Health Admission Unit at University Hospital Kerry.

The DoP at Letterkenny University Hospital was found to have six high-risk non-compliances with the regulations on individual care planning, staffing, risk management procedures, the code of practice on the use of physical restraint, the regulation on the maintenance of records, and with rules concerning the use of seclusion.

Sliabh Mis was found to have five high-risk non-compliances with the regulations on privacy, risk management procedures, staffing, maintenance of records, and with the rules relating to the use of seclusion.

HSE response 

When contacted, the HSE told The Journal that HSE Mental Health Services “are committed to the delivery of quality and safe mental health services”.

It acknowledged that the MHC plays a role in indentifying areas for improvement in its mental health services across the country.

“The HSE will continue to work in a targeted way, in partnership with our approved centres, to implement the corrective and preventative action plans (CAPAs) and address issues that have been identified including in relation to staff training,” it said.

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