Risks in relation to fire safety and ligature anchor points in some centres

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Risks in relation to fire safety and ligature anchor points in some approved mental health treatment centres are of particular concern, Dr Susan Finnerty, Inspector of Mental Health Services, said in her annual report for 2021.

“What inspectors find in relation to these risks should be recognised and remedied by the service to make an approved centre safe, not wait until the annual inspection identifies them and enforcement action takes place.

Such knee-jerk response to adverse findings of an inspection does not indicate good governance. In CHO 4 (Cork) multiple serious risks and poor environments across five approved centres has required repeated focused inspections and escalating enforcement actions to compel the HSE to begin to remedy the non-compliances. These enforcement actions have had to continue into 2022,” she said.

Dr Finnerty said there had been several new approved mental health treatment centres built in the past 3-4 years which provided a modern environment, including communal and private spaces with rooms for leisure and therapeutic activities. However, there were a considerable number of outdated, unsuitable buildings which had suffered years of environmental neglect. Progress was slow on replacement of buildings or on renovations to bring them up to a modern standard.

“We see how difficult it has been to isolate and restrict movement in mental health units that do not have single, en suite rooms or sufficient space during the COVID-19 pandemic. Mental health units have had to reduce their bed numbers to obtain sufficient space to manage the pandemic in 2021 as well as in 2020. This has had knock-on effects in waiting lists for inpatient treatment. We can assume that the health service will face further COVID-19 waves as well as other viral outbreaks. The need, therefore, for effective infection control within hospitals should be a major priority in the future redevelopment or building of new inpatient units. New builds by the HSE are providing mostly single en suite bedrooms but a number of older approved centres remain with multi-occupancy bedrooms.”

Dr Finnerty said that inspection of mental health services had found a very slight increase in the average compliance with regulations since

2020 and over a 5-year period, average compliance with regulations had increased by 14%.  “Despite COVID-19, high compliance levels were

maintained in 2020 and 2021, although it should be pointed out that the majority of inspections in 2020 and all inspections in 2021 were announced.

A total of 11 approved centres achieved 100% compliance. In CHO 5, four approved centres achieved 100% compliance, as did four approved centres in the independent sector.  All adult approved centres were noncompliant with the Code of Practice relating to the Admission of Children. This reflects the unsuitability of adult mental health inpatient units to provide appropriate child centred care. This included lack of appropriate facilities and lack of appropriate therapeutic services and programmes.

Dr Finnerty said there was no evidence of a therapeutic benefit associated with the use of restrictive practices and interventions that compromised a person’s liberty should only ever be used as a last resort and for the shortest time possible. The MHC commenced a review of the rules

on restrictive practices in 2021 and this work continues in 2022.

She said that over the past two years there had been a marked improvement in compliance with the rules governing the use of seclusion.

The current Mental Health Act (2001) did not allow for the making of rules for physical restraint, with the result that there could be no enforcement

should non-adherence to the Code of Practice on Physical Restraint occur. However, it was anticipated that the imminent revision of the Mental Health Act would include the provision to make rules for the

use of physical restraint.

The Inspector said compliance with the Regulation on Individual

Care Plans had remained persistently low, with negligible change in 2021, where 36% of approved centres were non-compliant with this regulation.

“The HSE states that care planning and the individual care plan document are essential to person-centred recovery-based care within inpatient

and community residential settingsand have provided a step-by step guidance in how to develop and review an individual care plan. Despite this. the HSE has failed to significantly improve care planning for service users over the past five years, with 36% of approved centres non-compliant with the regulation on individual care plans. This shows poor leadership and accountability.”