The HSE and the Minister for Mental Health and Older People, Mary Butler welcomed the publication of the Mental Health Commission (MHC) 2023 Annual Report and the acknowledgement that there had been a continued positive trend in some key areas that the MHC monitored.
“We acknowledge the key role of our HSE colleagues in the mental health teams across the country who have enabled these improvements,” said a HSE spokesperson.
“There has been significant investment in the last three years. As part of the capital budget €29.6 million was allocated in 2024, an increase from €27.32m allocated in 2023 and €17.91m allocated in 2022. There has also been year on year investment in a rolling minor works programme with a fund of €14m in 2024 (increased from €10m in 2023) available across both community and inpatient mental health services
“We know there are areas needing further improvement, and HSE Mental Health is developing a detailed action plan in response to the MHC findings. This plan will be informed by engagement with the Health Regions and work programmes already underway to deliver on recommendations within Sharing the Vision, our National Mental Health policy.
“In line with the implementation of Sharing the Vision – a Mental Health Policy for Everyone, the HSE will continue to work with the MHC and invest in our Mental Health Services, enhancing our existing services and developing new services to cater for our population’s increasing and emerging needs.”
The HSE said that of the 56 HSE approved centres:
- 19 were 90-100% compliant.
- 16 were 80-89% of compliant.
- 17 were 70-79% compliant.
- 4 were 60-69% compliant.
The MHC reported centres that achieved compliance of 90% and over tended to evidence good use of their resources, good governance and leadership who knew the services, were focused on compliance and put the residents at the centre of care.
There was 97% compliance with Part 4 of the Mental Health Act 2001 which relates to consent to treatment.
“The MHC report highlights four areas of particular concern and the HSE is currently addressing these in the following ways:
Premises
“There has been year on year investment in mental health capital development. While the HSE acknowledges that regulatory compliance regarding premises is presenting particular challenges it continues to prioritise improvements in the physical infrastructure in mental health services.
“There has been significant investment in the last three years [€29.6 million in 2024, an increase from €27.32m in 2023 and €17.91m in 2022].
“An additional fund of €14m in 2024 to invest in a rolling minor works programme across both community and inpatient mental health services.
“The mental health capital planning group has developed a three-year capital plan targeting major infrastructural risks within approved centres and other mental health accommodation. The HSE recognises the requirement for additional major capital investment to deliver on the five approved centres that are deemed in critical noncompliance with Regulation 22 (Premises) over the next five to ten years and in doing so is in active engagement with the Department of Health and the MHC in this regard.
“An oversight structure comprising of the former COO, National Director Access and Integration and National Director Capital & Estates is now in place to monitor progress, identify risks, and provide support to challenges that arise. This will involve progress reporting, and escalation procedures. The membership of both the mental health capital planning group and the oversight group will change in response to the evolving HSE structures and will have significant representation from the Health Regions.
Individual care planning
“It is HSE policy that every patient has an Individual Care Plan (ICP) and in line with Sharing the Vision (StV), Ireland’s national mental health policy, the HSE remains committed to ensuring consistent use of co-produced individualised recovery care plans for all users of specialist mental health services.
“In 2023 the HSE hosted an ICP quality event to consolidate and share good practice from across services.
“A Recovery focused ICP Practice Guide was co-produced with service users, supporters and staff and circulated to all approved centres in Q1 2024.
“Recovery Principles and Practice Training for all Mental Health Staff was launched and made available to services in Q2 2024.
“The HSE has built in an audit of ICPs within the annual audit cycle from 2024. This is being completed by Internal Audit and the final report is due to be issued shortly.
Risk management
“The HSE is committed to ensuring that risk management is embedded both as part of the normal day-to-day business and the strategic and operational planning and performance cycle.
“In March last year, the HSE published its ‘Enterprise Risk Management Policy and Procedures (2023)’, which sets out the policy and procedures by which the HSE manages risk. It incorporates a comprehensive framework for making risk-based decisions that guide the protection and development of high-quality services and their contribution to improving healthcare outcomes.
“Arising from the 2023 MHC annual report, further engagement with Health Regions will be arranged to assess any specific supports required in the area of risk management procedures in approved centres.
Staffing
“During 2023, the Mental Health workforce increased by 385 WTE’s (3.7%). This increase was facilitated by the continued investment via the HSE National Service Plan in Clinical Programmes and other service improvements.
“The sustained investment resulted in an increase of +104 WTE (16.4%) Clinical Nurse Specialist/Advanced Nurse Practitioners nursing during 2023.
“There was a significant improvement in the recruitment of medical consultants with an increase of 33 (+8.3%) WTE to the consultant workforce.
“All 2023 mental health nursing graduates have been offered permanent employment in the HSE and during the period October 2023 to February 2024 an additional 130 WTE were added to the staff nurse WTE profile.
“The HSE has invested €5m annually since 2016 to recruit 130 assistant psychology posts to help in part to alleviate staffing shortages within mental health.
“The HSE Resourcing Strategy ‘Resourcing our Future’ was launched in May 2023 to ensure a sufficient domestic supply of health care staff. The strategy is being implemented by the services locally to maximise the resourcing and delivery of publicly funded health services for the future.
“Despite the recruitment pause in November 2023, the CEO of the HSE has made derogations in relation to a range of essential services. There has already been an increase in the number of psychiatric nurses employed in 2024and the HSE has committed to offering every 2024 graduate psychiatric nurse a position with the HSE, as we have done in each of the last four years.
Other issues highlighted by the MHC
“Compliance with the regulations on medications, privacy and general health are emerging issues. The HSE action plan will include an exploration of this.
“Sexual assault serious reportable events increased in 2023.
“Compliance with rules on seclusion and COP on physical restraint fell.
“Overcapacity notifications increased (46, up from 33 the previous year).
“The HSE has over a number of years prioritised greater focus on physical health monitoring, health promotion and prevention, including for people residing in approved centres. As part of a national service improvement initiative completed in 2019, a standardised physical health assessment form was developed for adults accessing acute services. This was complemented by guidelines to support service users to engage in physical activity, as well as care pathways for tobacco, alcohol, physical activity and relevant national screening programmes. All these resources are available online. In line with national mental health policy, including Sharing the Vision (StV) recommendation 19, the HSE will continue to promote these resources and support services to apply these to support the general health of people with mental health difficulties, including those referred to an approved centre.
“As noted by the Inspector for Mental Health Services, efforts to enhance participation of service users in care planning, will assist to address issues of privacy and medication. One of the critical recommendations in StV and the associated StV implementation plan 2022 – 2024 is recommendation 44, which concerns polypharmacy and the need for GPs, mental health service prescribers and other relevant stakeholders to collaborate to actively manage polypharmacy and to reduce the risk of harm. Informed by existing initiatives, including those included in the HSEs National Medication Safety Programme, work is now underway to scope a programme of work to effectively manage polypharmacy.
“There has been an increased focus on recognising, responding to, and appropriately reporting safeguarding concerns within approved centres; including concerns of sexual abuse. The HSE is currently devising an adult safeguarding framework to ensure consistency across all mental health services.
Minister for Mental Health and Older People Mary Butler, also welcomed the publication of the Mental Health Commission’s Annual Report for 2023.
She said this report of the Mental Health Commission and the Inspector of Mental Health Services provided an important independent insight into how mental health services were performing and where improvements could be made.
Minister Butler said:
“This report is a comprehensive and welcome contribution to our shared common objective of improving the quality and safety of the provision of our mental health services. While the report raises some issues of concern in relation to individual care planning, risk management, staffing and premises, progress has been made with services adopting a strong human rights approach to successfully reduce and eliminate restrictive practices in 2023.
“It is important to highlight that the Health Service Executive (HSE) and private providers continue to pro-actively remedy any concerns raised by the inspection of their services and continue to work to make our mental health services accessible, modern, and person-centred. I very much welcome the findings that all Child and Adolescent Mental Health Services (CAMHS) are now 100% compliant with individual care planning, that child admissions to adult units continues to decline and that five centres were able to achieve 100% compliance across all standards, showing that this high level of standard is possible.”
A spokesperson said, “The report findings indicated that along with the five centres that achieved 100% compliance, 26 centres, including many HSE centres attained 90% or better compliance. The frequency and duration of the admission of children to adult approved centres continued to decrease in 2023. There were just 14 admissions to 11 adult units in 2023, the lowest ever recorded. Many service providers also introduced new initiatives and adopted a human rights approach to successfully achieving a 25% reduction in seclusion and a 9% decrease in the use of physical restraint. Very importantly there was 100% compliance with the rules and code of practice on Electro Convulsive Therapy (ECT). During 2023 there were no overcapacity notifications reported by Independent Centres, CAMHS, Community Healthcare Organisation (CHO) 6, CHO 8 and CHO 9.
“In Budget 2024, €4 million in funding was also secured for minor capital works to ensure appropriate accommodation in services nationwide and meet the needs identified in Mental Health Commission inspection reports which are key in driving continuous improvements in the quality and safety of our services.”
Minister Butler added:
“I wish to thank the Mental Health Commission and the Inspector of Mental Health Services for their continued and long-standing commitment to promote, encourage and foster high standards and good practices in the delivery of all our mental health services in Ireland. On top of the €1.3 billion I secured in Budget 2024, in the Revised Estimates process an additional €10 million was secured for mental health services. This funding is being used to improve all aspects of Mental Health care under our national Mental Health policies Sharing the Vision, Connecting for Life and the HSE Annual Service Plans.”
