Mental Health Commission finds three critical risk non-compliances at one inpatient centre3 May 2023
The Mental Health Commission (MHC) has today published inspection reports for approved inpatient mental health centres in Westmeath, Kerry and Clare, with one centre found to have three critical risk non-compliances.
The centre received the three critical risks in relation to regulations on therapeutic services, general health, and premises. Following the inspection, the MHC took an immediate enforcement action with the centre. The response submitted to the MHC and the assurances provided were found to be unsatisfactory and the matter was escalated to a regulatory compliance meeting. Following this meeting, acceptable plans were received from the centre and the MHC continues to monitor the situation carefully. There are currently no ongoing escalation or enforcement actions at the centre.
“As the regulator, we take critical risk non-compliances very seriously and will escalate enforcement actions until the non-compliances are addressed,” said the Inspector of Mental Health Services, Dr Susan Finnerty. “It is disappointing that we would find three critical risks at one centre, and the regulatory team is monitoring this centre carefully.”
Addressing high risks identified on restrictive practices at another centre, the Chief Executive of the Mental Health Commission, Mr John Farrelly said: “In September last year, the MHC launched ‘Revised Rules and Codes of Practice on Restrictive Practices,’ which came into effect on 1 January 2023. Restrictive practices may, on occasion, be necessary to maintain safety in the day-to-day environment, but the MHC expects services to take ownership of these revised rules and clearly demonstrate their commitment to their implementation.
“As the regulator, we believe that these new rules and codes represents an important milestone in the continued reduction and, where possible, elimination of restrictive practices from our inpatient mental health services.”
The Cluain Lir approved centre is located on the grounds of St Mary’s Care Centre, across the road from the Regional Hospital in Mullingar. There are two wards within the centre: St Bridget's Ward and St Marie Goretti’s Ward. Cluain Lir provides care and treatment for long stay and continuing mental health care, as well as acute admission for psychiatry of later life. At the time of the inspection, there were 28 residents present. There were no conditions attached to the registration of the centre at the time of inspection.
There was an overall decrease in compliance at the centre from 91% in 2021 to 73% in 2022. There were three critical-risk, four high-risk and two moderate-risk non-compliances with regulations and rules at the centre. The critical-risk non-compliances related to therapeutic services, general health, and premises.
Following the inspection, the MHC took escalation and enforcement actions and issued an immediate action notice. The initial response received and the assurances provided were unsatisfactory. The matter was escalated to a regulatory compliance meeting, following which, acceptable plans were received. The MHC continues to monitor the issues concerned.
Sliabh Mis is an acute admission unit located on the ground floor of University Hospital Kerry, Tralee. The approved centre has two designated multi-disciplinary teams operating from the centre; an adult team and an in-reach psychiatry of later life team. At the time of the inspection, there were 30 residents present, with four patients resident there for more than six months.
There was one condition attached to the centre relating to staffing. The centre was not in breach of the condition but was non-compliant with the associated regulation at the time of inspection.
Overall compliance fell from 76% in 2021 to 71% in 2022. The centre had three high-risk and six moderate-risk non-compliances, and one low-risk non-compliance with regulations and rules. The high risks related to the rules governing seclusion, the code of practice on the use of physical restraint, and Part 4 of the Mental Health Act 2001, which relates to consent to treatment.
The Acute Psychiatric Unit at Ennis General Hospital consists of three separate sub-units: a general acute unit, a high observation unit, and a psychiatry of later life unit. At the time of the inspection, the centre was undergoing a major redecoration and renovation programme. This consisted of a full redesign of two garden areas; a full redecoration and renovation of all indoor communal areas; and the development of a new de-escalation and seclusion suite. At the time of the inspection, there were 37 residents present, with eight patients resident there for more than six months.
There were three conditions attached to the centre at the time of inspection, which related to premises, maintenance, and staffing. The centre was not in breach of any of the conditions, but was non-compliant with all three related regulations.
Overall compliance increased from 71% in 2021 to 86% in 2022. The centre received five non-compliances overall, with one high-risk non-compliance with regulations relating to premises and four moderate-risk non-compliances relating to food and nutrition; staffing; risk management procedures; and the ordering, prescribing, storing and administration of medicines.
The MHC requires corrective and preventive action plans from all services where non-compliances were identified.