2022 Annual Report: HSE mental health centres must focus on key areas of compliance or risk being de-registered

Public mental health services must improve compliance in four key areas or face a real risk of being removed from the register of approved mental health centres, the Mental Health Commission has warned in its 2022 Annual Report.

The report - which has been published this morning and includes the annual report of the Inspector of Mental Health Services - shows that there has been an overall and continued improvement in compliance across all services when comparing pre- and post-COVID-19 pandemic figures.

However, in keeping with the MHC’s 2021 annual report, four regulations had compliance rates lower than 70%, something that the Chief Executive of the Mental Health Commission, John Farrelly, says the public system can no longer ignore if the State hopes to meet what he underlines are minimum standards for the provision of mental health services to its citizens.

“Notwithstanding that providers should be generally applauded for the significant work they have undertaken in recent years to improve overall compliance, we can now undeniably say that there are four key areas – premises, risk management, individual care planning, and staffing – where standards are simply unacceptable, as they were in 2021 and in many years prior to that,” said Mr Farrelly.

“Services, particularly in the public system, must drill down and focus on these areas over the coming months. We would expect that the HSE concentrate first on the centres that have low standards in care planning and premises. The overriding message from today’s report is that centres who have performed poorly in these areas need to comply with these regulations or face the real prospect of not being re-registered. Being compliant with these and other regulations – which, lest we forget, are the minimum standards – is the very least that people living in the areas served by these centres deserve.”

Institutional care

In her report, the Inspector of Mental Health Services, Dr Susan Finnerty, strongly cautioned against an apparent inclination by some providers towards providing institutional care for vulnerable groups of people.

Acknowledging that it is easier and cheaper to admit a person who requires some level of support to a large mental health centre with 20 or more beds than it is to source a more appropriately-sized supported residence, she said: “There is a real risk that we are beginning, as we did in the past, to once again re-institutionalise people who are mentally ill, elderly, or who just do not ‘fit in’ to society.

“As a country, we urgently need to provide all our citizens with rights-based personalised care in their own communities when they need it, or risk, once again, becoming a society that locks away its vulnerable citizens.” 

Premises

The report shows that just 27% of centres were compliant with the regulation on premises, a further drop from 2021 when 33% of centres were compliant with the same regulation.

“Compliance with the regulation on premises has been low over the past five years, most particularly in a number of HSE premises,” said Mr Farrelly. “Many of our premises are simply not fit-for-purpose for a modern mental health service and this is something that we have been saying for many years and will continue to do so until things change. To be clear, a targeted, funded strategic capital investment programme is urgently required now in our public system.”

Individual care planning

Just over 30% of centres were non-compliant with the regulation for individual care planning. “While there is clear clinical leadership evident in some centres - and the individual care plan is the blueprint for the resident’s care, treatment and eventual recovery - in others, the basic concept of care planning does not seem to have been understood or appreciated. Goals are vague and meaningless and obviously not developed with residents,” said Mr Farrelly.

The MHC has written to the HSE seeking an updated action plan to address the significant issues raised in its annual report, particularly around premises, individual care plans, staffing and risk management practices

2022 Annual Report