Mental Health Commission finds six high-risk non compliances across four centres

We have this morning published inspection reports on four of the country’s inpatient mental health centres and found six high-risk non-compliances and eight moderate-risk non-compliances across all four units.

The Inspector of Mental Health Services, Dr Susan Finnerty, said that therapeutic services and programmes are an essential part of the road to recovery. “It is concerning to find two centres receive high-risk non-compliances on the regulation with regard to therapeutic services,” she said. “Residents need access to social work and occupational therapy as part of their treatment, and approved centres need to ensure multi-disciplinary teams are available to patients.”

The Chief Executive of the Mental Health Commission, John Farrelly, said many centres across the country have had to reduce resident numbers to facilitate COVID-19 social distancing and isolation measures and to facilitate one resident per room. However, as we start to move back to normality, it is now time, he believes, to address the urgent need for suitable premises.  

“The pandemic has highlighted a number of inadequacies in our mental health services, and we have learned that shared accommodation is not suitable for keeping people safe. It is critical that premises for mental health residents are of an appropriate standard. Shared accommodation, dormitory-style bedrooms, old unsuitable premises, and shared bathrooms are not suitable to meet the requirements for a modern, inpatient mental health service.”

The Admission Unit and St Edna’s Unit are located on the grounds of St. Loman’s Hospital in Mullingar and provide a total accommodation for 44 residents. St Enda's Unit provides continuing care for male residents, most of whom have been in the centre for several years. At the time of the inspection, there was an occupancy of 15 residents. The Admission Unit had reduced bed capacity to 21 beds to facilitate COVID-19 social distancing and isolation measures and is an acute facility providing treatment for male and female residents. At the time of the inspection, there was an occupancy of 13 residents.

The centre received an overall compliance rate of 86% which was up 3% from the compliance rating in 2020. There were three conditions attached to the centre at the time of inspection. The approved centre was not in breach of its conditions but was non-compliant with two regulations related to premises.

The centre received five non-compliances on inspection, comprising four moderate and one low-risk rating. The centre received a moderate-risk non-compliance for the regulations on privacy, premises, risk management, and the use of seclusion. The inspectors found that fire evacuation drills had not taken place since 2019, and ligature points, identified as a medium risk, were not minimised to the lowest practicable level based on risk assessment. Additionally, the windows of the visiting room, dining room and assessment rooms which were overlooked by public areas did not have privacy blinds.

The Cluain Lir Centre opened in 2012 and is located on the grounds of St. Mary’s Care Centre in Westmeath. While the approved centre was registered for 42 residents, the capacity has been temporarily reduced to 36 because of COVID-19 restrictions so that all residents could be accommodated in single, en suite rooms.

The building is shared with old age care facilities which included sharing the central reception, a church, and catering facilities. However, residents from Cluain Lir had limited access to therapy facilities because of a lack of clarity as to their entitlement to use these rooms. Access to a large therapy room was only permitted two days per week. The centre did not have a dedicated tribunal room and residents could not access the external garden space at the back of the large therapy room.   

The centre received an overall compliance rate of 91%; a decrease on its 100% compliance rating it received in 2020. There were no conditions attached to the centre at the time of inspection.

However, the centre was non-compliant with the regulations on premises, and therapeutic services, for which it received two high-risk ratings. Reasons for the high-risk rating for therapeutic services included that the programme of activities was predominantly recreational and there were insufficient recovery-oriented therapeutic programmes provided by appropriately qualified professionals. This programme was led by the nursing staff and was not multi-disciplinary in its delivery.

The centre received a high-risk rating for premises as hazards were not consistently minimised. The risk associated with slates falling from an adjacent HSE building into the Cluain Lir garden meant that residents of the centre did not have full or free access to the garden.

The report noted that the centre did not provide an acceptable corrective and preventative action plan within the required timeframe to address the high-risk rating for premises. The MHC will follow up in relation to same and will escalate accordingly.

Ginesa Suite is located on the St. John of God Hospital campus in Stillorgan, Co. Dublin. The centre is situated on the first floor of the main building. It is registered for 12 beds and there were six residents present at the time of the inspection. It provides treatment to young people aged from thirteen to seventeen years of age from all over Ireland.

The centre received an overall compliance rating of 88%, which was the same compliance rating it received in 2020. There were no conditions attached to the centre at the time of inspection.

The centre received four non-compliances on inspection, two moderate-risk and two high-risk. The moderate-risk non compliances related to regulations on premises and medications. The high-risk non compliances related to the regulations on therapeutic services and staffing as residents did not have any access to social work and occupational therapy services since late 2020. The therapeutic services provided were not directed towards restoring and maintaining optimal levels of physical and psychosocial functioning of residents. At the time of the inspection there was an occupational therapy manager, but this individual did not provide occupational therapy services to Ginesa Suite.

The report noted that the social work post was filled on the Monday after the inspection and the occupational therapist post has since been recruited and is due to commence duty in 2022.

The Adult Mental Health Unit at Sligo University Hospital is a purpose-built facility which opened in October 2020. Accommodation comprises of 25 single en suite bedrooms and there were 23 residents present at the time of the inspection.

The centre received an overall compliance rating of 88%, the same rating it received in 2020. There were no conditions attached to the centre at the time of inspection.

The centre received two moderate and two high-risk non-compliances. The centre received high-risk non compliances for the regulation on individual care planning and Part 4 of the Mental Health Act 2001, which relates to consent to treatment. In relation to the high-risk rating for care planning, residents’ individual care plans inspected were found to be inadequate. The centre was high-risk non-compliant with consent to treatment as one involuntary patient’s records did not document that the responsible consultant psychiatrist had assessed the patient’s capacity to consent to receive treatment.

You can read our full statement here. 

Admission Unit & St Edna's Unit, St Loman's Hospital Inspection Report 2021

St Bridget's Ward & St Marie Goretti's Ward, Cluain Lir Care Centre Inspection Report 2021

Ginesa Suite Inspection Report 2021

Adult Mental Health Unit, Sligo University Hospital Inspection Report 2021