High risk non-compliances reported at Central Mental Hospital

We published an inspection report on the Central Mental Hospital this morning, which found the Dublin facility to have three high-risk non-compliances.

Two other reports also published today found one high risk at the St. John of God Hospital in Stillorgan, while inspectors found two high-risk non-compliances during a focused inspection at the Lois Bridges eating disorders treatment centre in Dublin 13.

The report on the Central Mental Hospital found that the buildings at the Dundrum centre were not fit for purpose for the care and treatment of service users experiencing mental illness. The MHC has an active condition to the centre’s registration for its closure.

“We are all waiting for the National Forensic Mental Health Service to transfer from Dundrum to its new facility in Portrane, which we understand will take place in the near future” said the Inspector of Mental Health Services, Dr Susan Finnerty. “Many of the aspects criticised in the Central Mental Hospital report are down to the unsuitable premises that this centre continues to operate in. The sooner the Portrane centre is registered and starts to admit patients, the better for all concerned.”

John Farrelly, Chief Executive of the Mental Health Commission, said: “Our inspectors supported by our regulatory enforcement team will continue to follow up on high risks identified to ensure that all providers implement services which are person centred from the first day of admission.”

The Central Mental Hospital, which is part of the National Forensic Mental Health Service, is situated in Dundrum, Dublin. It comprises of several buildings, mainly Victorian and dating back to 1852.

Although registered with the Mental Health Commission for a bed capacity of 106, the hospital had an operational capacity of 93 beds at the time of inspection. This latter capacity was, to some degree, required to facilitate COVID-19 measures.

The centre’s overall compliance improved to 89% in 2021. This was a significant improvement from the 74% it recorded for the previous year. However, there were three high risk non-compliances observed upon inspection.

The regulation related to premises was given a high-risk rating. The centre was not kept in a good state of repair externally and internally. Maintenance was on a reactive basis, and there was no planned programme of general maintenance, decorative maintenance, cleaning, decontamination, and repair of assistive equipment. However, many improvements had been made to the fabric of the building despite its impending closure.

Some resident bedrooms were too small and there was not enough room for residents’ belongings in each bedroom. For this reason, each resident had a locker in another area of the unit in which to store their belongings.

Privacy was also rated as a high risk. Not all bathrooms, showers, toilets, and single bedrooms had locks on the inside of the door. Unit 1 residents did not have access to private showering facilities as the two showers provided were located in one open-plan bathroom. Both showers had shower curtains, but the residents had to share a communal area for dressing and undressing.

The final high risk related to the facilities used for seclusion of residents. Seclusion facilities were not furnished, maintained and cleaned to ensure respect for resident dignity and privacy. There were two seclusion rooms which were small, outdated, and in need of modernisation.

Among numerous quality initiatives observed, a virtual reality (VR) programme for patients provided for community outreach and orientation to assist patients in their recovery programmes and contact with the community. The use of VR technology also enabled patients to get a perspective on the new hospital.

St. John of God Hospital is an independent not-for-profit psychiatric hospital in Stillorgan, County Dublin. The hospital consists of seven wards: Carrickfergus suite, St. Brigid’s suite, St. Camillus suite, St. Joseph’s suite, St. Paul’s suite, St. Peter’s suite and Riversdale suite. The centre delivers a range of general adult mental health and specialist services, including addiction therapy, dialectical behaviour therapy, psychiatry of later life and eating disorder specialties.

The centre recorded an overall compliance rate of 89% in 2021, which was down slightly on the 94% it received in 2020. Of the four regulations that were non-compliant, one was rated as a high risk.

The high risk related to the code of practice for admission, transfer and discharge. In the case of one patient, the discharge plan did not include an estimated date of discharge. A comprehensive discharge summary was not issued within 14 days; instead, it was issued four weeks after the discharge had taken place. There was also no timely follow up appointment scheduled for the resident upon being discharged.

The centre was also non-compliant with the code of practice related to the admission of children. The clinical file of one child resident was examined who was admitted to the centre on three separate occasions since the last inspection. Age-appropriate facilities were not provided by the approved centre. The was rated as a moderate risk.

Among the quality initiatives at the hospital, the occupational therapy department developed on online hub of leisure and self-management resources for residents. Audio files of activities such as yoga, mindfulness, meditation, relaxation techniques, journaling and creative writing could be accessed at any time by residents.

Lois Bridges is an independent therapeutic service specialising in the treatment of eating disorders and is located close to Sutton, Co Dublin. It was first registered as an approved centre by the MHC in January 2019. After the annual inspection, which took place in February 2021, the centre received an overall compliance rating of 86%, which was 14% lower than its 2020 rating. The centre recorded four non-compliances, which included two critical risks - one for risk management and one for staffing. As part of the centre’s application for re-registration, which must happen every three years, the MHC undertook a focused inspection to assess the centre’s progress with conditions and corrective and preventative action plans to address the non-compliances.

There were three conditions attached to the centre. These related to the admission of residents; access to necessary services and specialists; and the admission policy relating to high-risk residents with a body mass index score of less than 13. The centre was not in breach of any of these conditions.

The focused inspection found a high non-compliance with risk management as not all required elements in the risk policy were included. The risk policy contained some inaccuracies which could lead to confusion in the practice of managing risk. The service maintained a risk register and while incidents and adverse events were recorded, they were not always completed in their entirety or were not risk -rated in a standardised way. Clinical incidents were reviewed by the multidisciplinary team at their weekly meetings; however, a detailed record was not maintained of the review and recommended actions. Some of the omissions in the centre’s risk practices correlated with the absent elements in the risk policy. The risk policy was not always implemented, and it did not always match the centre’s practices.

The centre also received a high-risk non-compliance with the code of practice on admission, transfer, and discharge. The centre was non-compliant as the admission policy did not include the procedure for involuntary admissions, a pre-admission assessment protocol for planned admissions, and a referral letter protocol for planned admissions, while admission assessments were not fully documented in resident’s clinical files.

The MHC continue to monitor the arrangements that it has put in place to bring the centre into compliance.

You can read our full statement here. 

Central Mental Hospital Inspection Report 2021

St John of God Hospital Inspection Report 2021

Lois Bridges Focused Inspection Report 2021