Inspection reports

Mental Health Commission publishes five inspection reports

Serious issues observed regarding premises, access to physical healthcare, and staffing

The Mental Health Commission (MHC) has this morning published five inspection reports on approved inpatient mental health centres that show serious non-compliances with regard to regulations on premises and staffing, and issues with regard to access to physical healthcare.

The reports released today focus on the Acute Mental Health Unit at Cork University Hospital (CUH), Cork City (58% overall compliance); St Anne’s Unit at the Sacred Heart Hospital in Castlebar, Co. Mayo (73%); St Catherine's Ward at St Finbarr’s Hospital in Cork City (77%); Haywood Lodge, Haywood Road, Clonmel, Co. Tipperary (81%); and St Bridget’s Ward and St Marie Goretti’s Ward at the Cluain Lir Care Centre, Mullingar, Co. Westmeath (88%).

Selected good practices and quality initiatives observed during the inspections included the development and introduction of a physical restraint management booklet in January 2023 (in line with the new MHC Code of Practice on the Use of Physical Restraint); the roll-out of a six-week ecotherapy group where residents connected with the outdoors to improve their wellbeing; and the introduction of ‘getting to know me’ booklets for residents, which were then forwarded upon discharge to long-term care facilities to assist with the continuity of person-centred care.

However, there were common themes of concern across all five centres, including two critical and two high risk non-compliances for the regulation on premises; two critical and one high risk non-compliance for the regulation on therapeutic services and programmes; and three high risk non-compliances for the regulation on staffing.

The Chief Executive of the Mental Health Commission, John Farrelly, said he was disappointed to note the poor results around premises, which continues to be an issue of concern. “Not one of these five centres was compliant with the regulation on premises, with some areas nowhere close to the standard that we would deem acceptable,” he said.

“It was particularly concerning to note that across all centres, ligature points were not minimised to the lowest practicable level based on risk assessment. Apart from that, the presence of cobwebs, dirty floors, stained and worn chairs, ripped and scuffed linoleum floorings and the fact that three bedrooms required a full refurbishment is not acceptable. We must work harder to ensure comfort and dignity for all residents and patients of mental health services in Ireland.”

The Director of Regulation for the Mental Health Commission, Gary Kiernan, pointed to the critical and high-risk non-compliances for the regulation on therapeutic services as being of particular concern, adding that residents of mental health services have a right to access therapeutic services such as occupational health, dietetics and psychology, in accordance with their individual care plan.

“Unfortunately, we noted in some centres that not all residents’ physical and psychosocial health needs were being met,” he said. “We know that people with a mental illness will typically die between 15 and 20 years earlier than someone without a mental illness so it is absolutely essential that service providers ensure ready access to essential healthcare services such as physiotherapy, speech and language therapy, and dietetics. That patients in some centres are being denied access to these services is a breach of human rights and we will take action where service providers do not ensure access to the appropriate therapeutic services.”

Mr Kiernan also noted that all five centres were non-compliant with the regulation on staffing, something, he said, that service providers must move fast to address. “In four out of the five cases, the reason for non-compliances revolved around staff training, or lack thereof. The provision of up-to-date training for staff to ensure the centre meets the basic and mandatory requirement for compliance is essential for the safety and wellbeing of residents.”

Non-compliances observed during inspections included a critical risk non-compliance with the regulations on premises and risk management, along with three high-risk non-compliances – including one for staffing - at St Anne’s Unit; high-risk non-compliances for premises and staffing, amongst six in total, at St Catherine's Ward; four critical risk non-compliances for premises, individual care planning, therapeutic services and programmes, and the maintenance of records, at the Acute Mental Health Unit at Cork University Hospital; a critical risk non-compliance for therapeutic services and programmes - and two high risk non-compliances, including one for premises - at Cluain Lir; and two high risk non-compliances at Haywood Lodge, including one for therapeutic services and programmes.

The MHC requires corrective and preventive action plans (CAPAs) from all services where non-compliances are identified, each of which must address each non-compliance specifically. The MHC monitors the implementation of these CAPAs on an ongoing basis and requests further information and action as necessary. Enforcement action is taken when the MHC is concerned that the care and treatment provided in an approved centre may be a risk to the safety, health and wellbeing of residents, or where there has been a failure by the provider to address an ongoing area of non-compliance. All critical risk issues are considered by the MHC’s Regulatory Management Team (RMT) as a matter of course. Enforcement actions commonly arise from inspection findings, quality and safety notifications, and compliance monitoring. Enforcement actions available to the MHC range from the aforementioned CAPAs (at the lower end of enforcement) to removing an approved centre from the register and/or pursuing prosecution (at the higher end).

 

Links to the individual approved centre's reports

Link to the full statement Mental Health Commission publishes five inspection reports

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