Mental Health Commission publishes three new inspection reports into mental health facilities

We published three inspection reports today which identified three high risk and one low risk non-compliance ratings at three of the State’s inpatient mental health units.

All three of the mental health centres, which are located in Kilkenny and Waterford, achieved high overall compliance rates, the reports found.

The Inspector of Mental Health Services, Dr Susan Finnerty, said that while two of the centres had slight declines in their overall rates, one had maintained a perfect rating. “This is the second year in succession that Aidan’s Residential Healthcare Unit in Waterford has secured a 100% rating on our inspection, which is a credit to the staff at the centre, and its facilities.”

The Chief Executive of the Mental Health Commission, John Farrelly, praised all the services for their high rates of compliance but warned that the high risk non-compliance in relation to seclusion showed that “we can never let our guard down in relation to individual privacy and dignity.”

Overall compliance at the Department of Psychiatry at St Luke’s Hospital in Kilkenny fell slightly from 94% in 2020 to 91% this year, the inspection report found. The average rate of compliance across all approved centres was 87% in 2020.

St Luke’s was found to have three high-risk instances of non-compliance which related to premises, staffing, and the rules governing seclusion facilities. A high-risk rating is the second highest level of non-compliance.

The Department of Psychiatry is located on the grounds of St Luke’s General Hospital in Kilkenny City. The centre serves the catchment areas of Carlow, Kilkenny, and South Tipperary. Thirteen consultant-led multi-disciplinary teams admitted residents to the centre, which comprises two units: the 25-bed Sycamore unit and the 19-bed Oak unit.

The report found that ligature points were not minimised to the lowest practicable level, despite this issue having been previously identified in an audit report. The overall premises were found to be kept in a good state. However, the communal television room in the Sycamore Ward, which has capacity for 25 residents, was not appropriately sized.

Staffing was also non-compliant due to the fact that six of the 13 teams at the centre did not have an appointed psychologist. This meant that “the number and skill mix” of staff was “not sufficient to meet the psychological needs of all residents”.

The rules governing the use of seclusion facilities were found to be non-compliant in relation to the area of privacy and dignity. The privacy blinds were open when the seclusion room was in use, and the area outside the room was accessible to all individuals on the unit, even when the room was in use. The observation panel on the door of the seclusion room was clear glass, meaning that the inside of the room could be viewed by anyone in the vicinity.

Plans have been put in place at St Luke’s to address the high-risk issues raised in the inspection report. A new communal space is being provided, and funding is to be secured to minimise the remaining ligature points. Psychology staffing has been increased since the report and further action will be taken in this area. Changes are also being made to the way in which the seclusion facility is operated.

The report found that St Luke’s had introduced several quality initiatives during the period. Various items of new medical equipment were purchased, and in conjunction with the Irish Advocacy Network, electronic tablets were made available to support service users to access advocacy services. A new garden shed was also purchased to facilitate the horticulture programme for residents.

St Gabriel’s Ward, located in the grounds of St. Canice’s Hospital in Kilkenny, is a 20-bed facility, built in the 1980s. It accommodates residents under the psychiatry of later life and continuing care and is a dementia friendly centre with a number of specific initiatives for the care and treatment of elderly people.

Overall compliance at St Gabriel’s Ward declined marginally from 100% last year to 97% in 2021, according to the inspection report.

St Gabriel’s was found to have one low-risk incidence of non-compliance by the inspectors in relation to the premises. The centre was not consistently maintained in good decorative order as there were scratches on a radiator in one bedroom and some chipped paint on a relaxation room wall. There was also a lack of storage space, which meant that hoists were stored in the main bathroom in one of the areas of the centre.

Plans are in place to address the issues raised in the inspection report. Painting to address specific issues was due to take place last month, and a new maintenance programme is in place. Space has also been reconfigured to allow hoists to be stored elsewhere and a dedicated storage space is contained within plans to extend the areas of St Gabriel’s Ward.

The centre introduced a number of quality initiatives during the year. Due to COVID-19 restrictions, St Gabriel’s engaged remotely with the Alzheimer’s Society to bring programmes such as ‘Bringing Joy’ and ‘Mindful Memories’ to residents. St Gabriel’s also introduced a booklet entitled ‘Remembering Yesterday Living Today: Getting to know me in my own unique way,’ which was used as a tool for residents and their families to explore the resident’s lifespan and life experiences through therapeutic reminiscence. The centre also secured a public innovation funding grant to incorporate a dementia-friendly garden to maximise the outdoor space for residents and their families.

Aidan’s Residential Healthcare Unit, which opened in April 2020 on a site formerly known as St. Patrick’s Hospital in Waterford, is a 20-bed residential care facility. At the time of the inspection, the majority of residents were under the care of two psychiatry of later life teams.

Aidan’s maintained its overall compliance rating of 100%, compared to the average rate of compliance of 87% across centres in 2020. Aidan’s was found to be compliant in all areas that were considered within the inspection report.

Aidan’s quality initiatives during the year included the introduction of a therapeutic/reminisce train in the form of smart screen with software and which simulated a variety of different train journeys. Along with written formatted menus, a new pictorial menu booklet had been produced and introduced for residents. Through the HSE COVID Care Concert national initiative, there were also regular concerts for residents.

All three inspections were carried out during the COVID-19 pandemic. Due to public health restrictions, certain activities within the three approved centres in question were not able to take place. The inspectors took these restrictions into account when assessing compliance with Regulations, Rules and Codes of Practice.

You can read our full statement here.

Department of Psychiatry at St Luke’s Hospital Inspection Report 2021

St Gabriel’s Ward Inspection Report 2021

Aidan’s Residential Healthcare Unit Inspection Report 2021