Mental Health Commission finds three critical and eight high risk ratings at three mental health centres29 April 2021
We have released inspection reports this morning of three mental health centres which identified three critical and eight high risk ratings across the facilities.
The Inspector of Mental Health Services, Dr Susan Finnerty said: “It is disappointing to see all three centres concerned were non-compliant on the regulation for individual care plans. Care planning is an integral part of a patient’s treatment. To have plans that don’t mention any goals or without any input from the resident or their family is unacceptable.”
One of the centres, St. Ita’s Ward in Ardee accounted for the three critical risks recorded in the reports. Although St. Ita’s was predominately a rehabilitation unit, the centre had also been operating as a short term overflow ward due to a multifactorial bed crisis within the Louth/Meath mental health services and appeared to provide a different level of treatment to residents depending on what team in the facility was providing care.
Commenting on the reports, the Chief Executive of the MHC, John Farrelly, said: “It has been repeatedly acknowledged that it is unacceptable for service users to receive different levels of care from one approved centre to another, but for one centre to provide diverging levels of treatment to different groups of its own residents is extremely worrying.”
St. Ita’s Ward is a single storey building on the campus of St Brigid’s Hospital in Ardee, Co Louth. Although the centre is registered for 20 beds, it was only operating with 10 beds at the time of inspection. The centre is primarily a rehabilitation unit with residents under the care of the community rehabilitation team.
The centre received an overall compliance rating of 77% in 2020, an increase of one percent on its 2019 report.
The centre had also been used as a short-term overflow ward. Residents had been either temporarily transferred or discharged to St. Ita’s and, at times, moved back and forth between facilities to manage beds in another Louth/Meath mental health approved centre.
There was a notable inequality between the care and treatment provided to residents under the rehabilitation team and residents under other Louth/Meath sector teams.
Unlike residents under the care of the rehabilitation ream, residents being treated by Louth/Meath sector teams did not have appropriate access to therapeutic services and programmes, which were directed towards restoring and maintaining optimal levels of physical and psychosocial functioning of residents. These residents’ access to medical treatment, including psychiatric care, was irregular, lacked transparency and, at times, was concerningly delayed.
Five individual care plans (ICPs) were reviewed on inspection. Three of the five ICPs reviewed had been developed by the rehabilitation team and these met all the required standards. The other two ICPs which were under the remit of different Louth/Meath sector teams, did not meet the required standards to varying degrees. Two of the five ICPs reviewed had not been developed by the multi-disciplinary team (MDT) during resident’s admission to the approved centre.
The Jonathan Swift Clinic is located within the St. James’s Hospital campus in Dublin 8. The unit consists of three wards, with a total bed capacity of 47. Connolly, Norman, and Beckett Wards are located on the ground floor of the main hospital building, while the William Fownes Ward is on the first floor. The approved centre has seven multi-disciplinary teams specialising in general adult psychiatry, psychiatry of later life, and rehabilitation and recovery.
The centre received an overall compliance rating of 79%, a four percent increase on the 2019 compliance rating of 75%.
Inspectors found that residents within two of the four-bedded dormitories in Fownes Ward and a four-bedded dorm on Beckett Ward did not have access to adequate personal space. Appropriate signage and sensory aids were provided to support resident orientation needs, although there were insufficient spaces provided for residents to move about, including outdoor spaces.
Ligature points were not minimised to the lowest practicable level, although there was a plan to address this.
Two individual care plans inspected did not identify appropriate goals for the resident and two did not identify the care and treatment required to meet the goals identified, including the frequency and responsibilities for implementing the care and treatment. The centre was rated a high-risk non-compliance on the regulation regarding individual care plans.
The Acute Psychiatric Unit 5B is located within University Hospital Limerick in Dooradoyle, close to the city centre. The main approved centre comprised of four, five and six-bedded dormitory style accommodation, as well as two rooms each containing two beds, and three single rooms.
The approved centre achieved an overall compliance rating of 86% on inspection. This was a significant improvement on the 71% it scored in 2019.
Four care plans did not identify appropriate goals for the resident. In addition, three care plans did not identify the care and treatment required to meet the goals identified, including the frequency and responsibilities for implementing the care and treatment. Four also did not identify the resources required to provide the care and treatment identified.
The centre was rated as a high-risk non-compliant in the rules governing the use of electro-convulsive therapy (ECT). The prescription of ECT did not include the alternative therapies that were considered and had proved ineffective. Moreover, there was no documentary evidence that a cognitive assessment was completed before the programme of ECT.
New initiatives introduced included wellbeing groups to provide service user friendly information through discussion-based workshops and opportunity for engagement in a supported environment.
A wellness recreational and activity pack was developed and was being piloted. The pack incorporates a therapeutic and recreational element that aims to help people who may feel isolated to enable residents to be more engaged during their stay.
You can read our full statement here.