Targeted, funded strategic capital investment programme required for public mental health services

Mr. John Farrelly
Mr. John Farrelly

A targeted, funded strategic capital investment programme was required for our public mental health system, to ensure every person in Ireland had equal access to a consistent quality of care, according to Mr. John Farrelly, Chief Executive of the Mental Health Commission.

A top-level view of the work of the Mental Health Commission in 2021

had shown a gap emerging between independent providers and the HSE, particularly in relation to premises and individualised care planning, he said, writing in the MHC annual report of 2021.

“While we recognise the investment in premises to date, the current approach to structural improvements in a significant number of HSE centres is inadequate,”  he said.

“Once again, our inspection team has found that there is inadequate engagement by services with care planning in a meaningful way. The level of compliance with the associated regulation has been consistently

low for many years, something that is largely down to the lack of input by multidisciplinary teams. This is an area that services need to

come to terms with if we are to truly achieve an appropriate standard of individualised patient care.”

There were 2,657 inpatient beds for the care and treatment of people with  a mental illness or disorder in 67 centres registered with the Mental Health Commission across the country at the end of 2021, according to the annual report.

There were 98 CAMHS beds nationally –  62 in Dublin, 20 in Galway, and 16 in Cork.

There were 786 adult beds in the independent sector, of which 770 were in Dublin. There were also 106 registered forensic beds and 91 mental health intellectual disability(MHID) beds. These beds were in Dublin, with a national catchment.

There were 64 instances of overcapacity in 2021 and 22 child admissions to 11 adult units. In 2021, there were 32 admissions involving 27

children to 11 adult units, with  some children  admitted on more than one occasion.

There were 2,549 Involuntary Admissions to Approved Centres and 35% of applications for involuntary admission were from an Garda Siochana. There were 1,910 Mental Health Tribunals held, 1,869 orders were revoked before hearing (49.7%),  1,910 orders went to hearing (50.3%), and  203 orders were revoked at hearing.

A total of 471 deaths of people using mental health services were reported  to the MHC  in 2021.  Of these, 174 related to approved centres and 297 related to community mental health services.  Fifty-eight percent of deaths reported in 2021 related to male residents. The average age of

a resident was 61 years of age. The youngest resident was 18 years of age, and the oldest resident was 101 years old.

Death by suicide may only be determined by a Coroner’s inquest, which may take place several months after the death. However, in 2021, there were 127  deaths  reported to the MHC by services as a ‘suspected suicide’ and 30 of these related to residents of approved centres. Approved centre deaths include those that are reported within four weeks of a resident’s discharge.

All approved centres are required to notify the MHC of serious reportable events that occur in their service (SREs, HSE 2015). In 2021, 41 SREs were reported to the MHC in relation to 23 approved centres.

In 2021, there were 333 programmes of ECT for 229 residents in 16 approved centres.  Eighty-two percent of residents who were administered ECT in 2021 were voluntary residents at an approved centre at the time of commencement of the ECT programme.

In 2021, there were 3,460 episodes of physical restraint involving 1,169

residents in 47 approved centres.  There were 25 episodes of mechanical restraint involving 10 male residents. All episodes of mechanical restraint were reported by the Central Mental Hospital. The total duration of mechanical restraint was 49 hours.

Sixty-four per cent of approved centres had over 90% compliance with each of the 31 mental health regulations requirements and no service had less than 68% compliance with regulations.

The Commission said that a number of regulations were identified as having poor compliance rates. In 2021, regulations with compliance rates between 70 and 80 per cent included therapeutic services (76%) and privacy (71%). Regulations with compliance rates lower than 70% were risk management procedures (64%), individual care plans (64%), staffing (61%) and premises (33%). Compliance with Regulation 22 (Premises) in particular has been low over the past five years, with an average  compliance rate of 35%.

Furthermore, 10 services were inspected on the admission of children to adult services in 2021, and all were found to be non-compliant with

the code, which governs this area. Reasons for non-compliance included services not providing age-appropriate facilities and a programme of

activities appropriate to age and ability.

During the year the Commission took 42 Enforcement Actions actions in

response to incidents, events, and serious concerns. These actions related to 20 approved centres.

The Department of Health’s total allocation to the MHC for 2021 was €15.432m. The outturn for 2021 in the MHC was €15.070m. Due to COVID-19 there were cost savings related to general expenses and

a reduction in travel and subsistence claims for mental health tribunals as tribunal hearings were held remotely.