Every year, the Mental Health Commission is required to inspect and regulate all approved centres across the country. There are many different types of approved centre providing a range of mental health services.
There are also other forms of mental health services that, for example, are provided day hospitals and 24-hour nurse-staffed community residences. In this section we will cover what an approved centre is, what types of approved centre there are, what does it mean to be a resident in an approved centre, other types of mental health services available, and how the Mental Health Commission inspects and regulates mental health services.
What is an approved centre?
An approved centre, as defined in Section 62 of the Mental Health Act 2001, is a hospital or other in-patient facility that is led by a consultant psychiatrist and whose primary role is the care and treatment of persons with a mental illness or disorder. Under Sections 63 and 64 of the 2001 Act, every in-patient mental health facility in Ireland must be registered with the Mental Health Commission as an approved centre and certain criteria must be met before a centre can be approved by the Mental Health Commission and added to the Register of Approved Centres. No facility is permitted to operate if it is unregistered.
Different Types of approved centres
There are varying types of approved centre providing different services, including: general adult mental health services; child and adolescent mental health services, commonly referred to as CAMHS; forensic psychiatry services and intellectual disability services. As the name suggests, general adult mental health services provide care and treatment to persons aged 18 or older who present with a mental illness or disorder. Child and Adolescent Mental Health Services provide assessment and treatment for young people and their families who are experiencing mental health difficulties. While a broad range of services support the mental health of children and adolescents, the term ‘CAMHS’ is usually applied very specifically to services that provide specialist mental health treatment and care to young people up to 18 years of age through a multi-disciplinary team.
Forensic psychiatry services provide assessment and treatment of people with mental disorder and who show antisocial or violent behaviour. Key elements of this service include the interface between mental health and the law, affording expert evidence in civil and criminal courts, and the assessment and treatment of mentally disordered offenders and similar patients who have not committed any offences. Intellectual disability services provide care and treatment to persons that have both a mental health diagnosis and intellectual disability. Within the varying types of approved centre there are differing services available with each, including psychiatry of later life services for older persons, long-stay services, rehabilitation services, and addiction services such as eating disorders. While most approved centres in the country are operated by the HSE, some are privately run. The register of approved centres can be found here on our website.
What does it mean to be a resident?
A resident is someone that has been admitted to and is receiving treatment in an approved centre. On admission, a resident will be informed about the approved centre and its services and, together with a multi-disciplinary team, they will develop an individual care plan for their treatment. Under the Mental Health Act 2001, a resident admitted to or receiving treatment in an approved centre must have their best interests considered before any decision about their care and treatment is made. Residents have a broad range of rights whilst in an approved centre, including, but not limited to: the right to be treated with dignity and respect; the right to be listened to by all those working on their care team; the right to take part in decisions that affect their health; and, the right to be fully informed about their legal rights, admission, and treatment.
How does the Mental Health Commission regulate approved centres?
The Mental Health Commission strives to ensure its principal legislative functions are achieved through the registration and inspection of approved centres. Section 51(1)(a) of the Mental Health Act 2001 (the 2001 Act) states that the principal function of the Inspector shall be to “visit and inspect every approved centre at least once a year in which the commencement of this section falls and to visit and inspect any other premises where mental health services are being provided as he or she thinks appropriate”.
Each approved centre is assessed against all regulations, rules, codes of practice, and Part 4 of the 2001 Act as applicable, at least once on an annual basis. Inspectors use a triangulation process of documentation review, observation and interview to assess compliance with the requirements. Where non-compliance is determined, the risk level of the non-compliance is assessed. The Inspector& and assistant inspectors also assess the quality of services provided against the criteria of the Judgement Support Framework.
Following the inspection of an approved centre, the Inspector and assistant inspectors prepare a report on the findings of the inspection. A draft of the inspection report, including provisional compliance ratings, risk ratings and quality assessments, is provided to the registered proprietor of the approved centre. Areas of inspection are deemed to be either compliant or non-compliant and where non-compliant, risk is rated as low, moderate, high or critical. All published inspection reports can be found here on our website.
The registered proprietor is given an opportunity to review the draft report and comment on any of the content or findings. The Inspector takes into account the comments by the registered proprietor and amends the report as appropriate. The registered proprietor is requested to provide a Corrective and Preventative Action (CAPA) plan for each finding of non-compliance in the draft report.
Corrective actions address the specific non-compliance(s), while preventative actions mitigate the risk of the non-compliance reoccurring. CAPAs must be specific, measurable, achievable, realistic, and time-bound (SMART). The approved centre’s CAPAs are included in the published inspection report, as submitted. The Mental Health Commission monitors the implementation of the CAPAs on an ongoing basis and requests further information and action as necessary. If at any point the Mental Health Commission determines that the approved centre’s plan to address an area of non-compliance is unacceptable, enforcement action may be taken.
Other types of mental health services
There are a wide range of community mental health services, which differ from approved centres. Community mental health services include, but are not limited to, 24-hour nurse-led residences, general adult community mental health teams, Child and Adolescent Mental Health Services teams, specialist teams, day hospitals and centres, home based treatment teams, and medium or low support residences. Currently, out of all other community mental health services, only 24-hour nurse-led residences are inspected on a three year rolling cycle using the same triangulation process as with the inspection of approved centres.