Mental Health Commission launches new human rights-based approach to mental health care6 December 2023
Launch coincides with publication of annual ‘Restrictive Practices’ monitoring report
Together with the World Health Organization (WHO), the MHC has this morning launched training in a human rights-based model of mental health care in Ireland that they hope will transform how Ireland approaches and cares for people who experience mental illness, or who are facing mental health difficulties.
Experiencing a mental health difficulty can result in barriers and challenges which result in unequal or qualified access to human rights. These barriers can take many forms ranging from lack of access to appropriate services and coercive or restrictive practices such as physical restraint. The WHO and MHC are calling for a new approach which recognises these challenges and works to remove or minimise them.
Organisations from the public, private and NGO sectors across the country gathered in Dublin to pledge to promote a human rights-based approach to mental health care across the State.
Taking place in advance of World Human Rights’ Day this Sunday - which this year will mark the 75th anniversary of one of the world’s most groundbreaking global pledges, the Universal Declaration of Human Rights – the launch coincides with the publication of the MHC’s 2022 Restrictive Practices Activity Report, which documents the declining use of these practices across 67 inpatient mental health centres in Ireland.
Speaking this morning, the Chief Executive of the Mental Health Commission, John Farrelly, said that there is a global movement taking place that is empowering people to promote the human rights of people with mental health difficulties.
“The MHC, as the regulator of Irish mental health services, has given a strategic commitment to a human rights-based approach that is aligned with Ireland's commitment to the UN Convention for the Rights of Persons with Disabilities (UNCRPD), which affirms and protects the human rights of people with disabilities, including those with long-term mental health difficulties,” he said.
“The new approach that we are launching this morning – the World Health Organization’s ‘QualityRights Initiative’ - is designed to support people to understand a human rights model of mental health. Specifically, how organisations and individuals can constructively and collaboratively contribute to advancing the rights set out in UNCRPD.”
“This is a unique countrywide approach that already has the support of key stakeholders including the Health Service Executive, the National Ambulance Service, An Garda Síochána, the Irish Prison Service, the Irish Courts Service; as well as government, private and not-for-profit organisations.”
Dr Michelle Funk, Head of WHO’s Policy, Law and Human Rights Unit, said that she is greatly encouraged that the MHC is driving this initiative forward in Ireland on behalf of people experiencing mental health difficulties. She said that she is especially enthused that Ireland is building on the experience of the 20 countries that are already rolling out the training by introducing some new innovations that can intensify its impact.
“That the MHC has reached out directly to first responders to ensure their involvement is something that we have not seen before,” she said. “In addition, the signing of a pledge is unique and drives home the message that when organisations and individuals do agree to promote QualityRights, it is a serious commitment and will, if implemented correctly, vastly improve the lives of people facing mental health difficulties.”
2022 Restrictive Practices Activity Monitoring Report
The MHC also published a monitoring report this morning that documents the use of restrictive practices across 67 inpatient mental health centres in Ireland in 2022. The report is the fourteenth such publication by the MHC and forms part of its remit to report independently on the quality and safety of mental health services in Ireland. Mr Farrelly said several positive messages could be taken from the 2022 activity report.
“Overall, in Ireland, the number of restrictive practices continues to decline, and we are encouraged to observe that the number of episodes of physical restraint and the number of residents that are physically restrained have continued to decrease since 2019, countering a previous trend of increase between 2008 and 2018. While there was a 16% increase in seclusion episodes in 2022, the number of patients who were secluded has decreased.”
In 2022, there were a total of 4,309 restrictive practices recorded nationally, which involved 1,653 residents of approved centres. This represented a decrease from 2021, where there was a total of 4,636 episodes, involving 1,803 residents.
In terms of intervention types, there were 2,945 episodes of physical restraint in 2022. This represents a decrease from 3,460 episodes in 2021 (a 15% decrease). A total of 1,078 people were physically restrained in 2022, compared to 1,145 people in 2021 (a 6% decrease).
At a national level, physical restraint is used more frequently and widely than seclusion. Episodes of physical restraint and the number of residents undergoing physical restraint have continued to decrease since 2019.
The use of physical restraint has continued to decline between 2019 and 2022 with respect to the number of episodes, duration of episodes and number of people restrained.
There were 1,364 episodes of seclusion reported by 26 approved centres in 2022, a marginal increase from the 1,176 episodes reported by 27 services in 2021. However, in 2022, 620 people were secluded, a decrease from the 645 people secluded in 2021.
The use of mechanical restraint continues to be rare and the use of this form of restraint continued to decrease in 2022. This practice has also been banned by the MHC in inpatient centres for children.
“The MHC will continue to monitor the use of all forms of restraint to ensure that approved centres operate within the rules and codes of practice. Enhanced reporting requirements, which were rolled out in January 2023, will support closer scrutiny of the activities of approved centres in this area,” said Mr Farrelly.
Due to the international developments around human rights, the advancement of person-centred care, and evidence demonstrating that restrictive practices can have harmful physical and psychological consequences, the MHC in September 2022 published revised rules governing the use of seclusion and mechanical means of bodily restraint, and a revised code of practice on the use of physical restraint, which came into effect on 1 January 2023. These revised rules are informed by a rights-based approach to mental health care and treatment and outline the principles which must underpin the use of restrictive practices, including that all approved centres must recognise the inherent rights of a person to personal dignity and freedom in accordance with national and international human rights instruments and legislation.
“Our revised rules and code of practice sets updated evidenced-based criteria and requires greater oversight by registered proprietors of the use of restrictive practices within their services. We are already seeing evidence that this is having an effect on the further reduction in the use of restrictive practices in 2023,” said Mr Farrelly.
Individuals and groups can access and take WHO’s QualityRights training at this link: QualityRights
To access the Restrictive Practices Report click on the link The Use of Restrictive Practices in Approved Centres Activities Report 2022