MHC strengthens medication management safeguards in approved centres following Inspector’s review
Prof Lucey now urging services to work towards new standards
The MHC has today published a report by the Office of the Inspector of Mental Health Services into the ordering, prescribing, storing and administration of medicines in Ireland’s approved inpatient mental health centres.
Although compliance rates with this regulation (Regulation 23) were close to 80% in the three years from 2022 to 2024, the Inspector introduced new criteria in 2024 relating to the use of high-dose antipsychotic medication following concerns regarding its use in some Child and Adolescent Mental Health Services (CAMHS). Following the introduction of these additional criteria, 53.7% of all approved centres subsequently met the new standards when inspected during 2025.
The Inspector of Mental Health Services, Professor Jim Lucey, said: “While noting the drop in 2025 compliance rates, this was not entirely unexpected as it coincided with the strengthening of Regulation 23, and new requirements in areas such as standardised medication policy suites; routine medication safety audits; and access to drugs and therapeutics oversight committees.
“In raising the bar for our service providers at this time, we accept that all 67 centres will need some time to implement and meet the new standard, and we do acknowledge the efforts to date of those working at the coal face of our inpatient mental health services and their commitment to meeting these new requirements.
“It is equally important that the public understand that thousands of prescriptions for medications are administered safely, and without incident, to residents in Ireland’s 67 approved centres each week. This safe prescription and administration of medication is a credit to the clinical and managerial staff, including medical nursing and pharmacy working together in centres throughout the country.
“It is also fair to state that concerns related to medication and administration errors are rarely raised with my office. In the past 12 months, among hundreds of unsolicited communications from the public received by the Inspectorate at the MHC, those relating to medication concerns was small.
“Despite this, we must always recognise that there is potential for any concern relating to medication to be significant. Medication incidents, while uncommon, may still have serious consequences and therefore must remain an important and ongoing concern for my team and I.”
Specifically, the review has found that approved centres whose medication practice was policy driven, subject to regular audit, and overseen quarterly by a drugs and therapeutics committee, were significantly more compliant than other centres which did not have these governance structures in place.
The review also highlights growing awareness of risks associated with certain prescribing practices, including high-dose antipsychotic treatments, polypharmacy and rapid tranquilisation.
The results of the review have already informed updates to the 2026 guidance provided to inpatient services by the MHC, called the ‘Judgement Support Framework’, introducing new requirements for standardised medication policy suites; routine medication safety audits; and access to drugs and therapeutics oversight committees.
The Inspector has also advised the MHC to take appropriate steps to create a new Code of Practice regarding the use of rapid tranquilisation in approved centres. All these measures aim to support providers in achieving compliance and ensuring that medication practices are grounded in human rights, safety, and best clinical evidence.
Inspector Lucey added: “This review highlights both the strengths of current practice, and areas where improvement is required. Medication plays a vital role in mental health treatment, but it must always be managed safely, consistently, and with strong clinical governance. By strengthening policy, audit, and oversight, we can better protect patients and support high-quality care across all approved centres.”
The Chief Executive of the Mental Health Commission, John Farrelly, said: "The Inspector’s timely review emphasises that access to safe, well-governed medication is a fundamental right for people using mental health services. It also highlights the need for continued vigilance, particularly in the context of evolving clinical practices and increased scrutiny of pharmacological interventions.
“This review provides clear evidence of what works - and where improvements are needed. The MHC is committed to working with services nationwide to strengthen standards, reduce risks, and ensure consistent, high-quality care.”
The review by the Office of the Inspector of Mental Health Services into the ordering, prescribing, storing and administration of medicines in approved centres can be accessed at this link: Ordering, prescribing, storing and administration of medicines in approved centres: A review by the Office of the Inspector of Mental Health Services
