The new Inspector of Mental Hospitals, Professor Jim Lucey has called on the proprietors of Ireland’s Acute Mental Health Residential Centres, particularly the HSE, to mobilise the capital programmes required to remedy the deficits in their premises and to do this without further delay and in the interests of all those using their centres.
However, he said there was evidence of good quality care in many of Ireland’s approved centres. “This is true in those rare centres with full compliance but also in many other centres. Supported staff are compassionate staff and they care for their patients every day in intelligent, humane and ethical ways. My inspections found widespread evidence to conclude that those working in approved centres in the Republic of Ireland are making the best of very difficult circumstances. As Inspector I wish to acknowledge and thank every one of them for their therapeutic work.”
He said the findings of his 2023 inspection programme raised serious concerns for the users of acute inpatient mental health services and for the staff who work in them.
He found the low rates of regulatory compliance in approved residential centres were linked to a history of poor governance, inadequate investment levels and an outdated regulatory framework long overdue for revision.
“In reality, governance and management has not kept pace with patient needs, expectations and rights,” he said writing in his first annual report for the Mental Health Commission.
“The continued failure to achieve compliance with minimum standards, based upon legislation which came into effect in 2006 is a cause for concern.
“Standards in these acute services should no longer fall below the regulatory minimum. The time has come for wholehearted embrace of modern standards of care and for meaningful investment in acute mental health services in Ireland.”
Professor Lucey said only 27% of approved centres met minimum standards as regards premises and only 39% met minimum staffing requirements.
“The Inspectorate has been calling for meaningful address of this breach regarding premises for several years and yet the evidence of poor premises persists. My first report repeats this finding and so now I repeat the call for a genuine remedy.”
The inspection found substantial variation in compliance with regulations across the country and across the HSE’s Community Healthcare Organisations (CHOs). The average compliance rate for HSE CHOs was 83%. This compared to average compliance rates in approved centres operated by independent providers at 91%.
Sixty-six approved centres were inspected in 2023. Only five centres achieved 100% compliance and less than 39% of approved centres were more than 90% compliant with regulations,
Professor Lucey said the inspection findings regarding regulations were not uniformly negative. Many regulations were complied with fully across the vast majority of centres. The regulations which were in compliance differed materially from those ten regulations most frequently in breach.
“At inspection, I found that most centres achieved full compliance with most regulations. Closer examination of the data shows that 19 regulations were found compliant in more than 85% of centres and in ten of these regulations a compliance rate of 100% was achieved across all centres.”
He said his report sought to highlight this discrepancy by focussing upon the ten most frequently breached regulations and the percentages which met standards for these regulations.. These were Therapeutic Services ,79% met standards, Records 77% met standards, CCTV 76% met standards, Medication 73% met standards, General Health. 73% met standards, Privacy, 71% met standards, Individual Care Plan 59% met standards,: Risk, 56% met standards, Staffing 39% met standards and Premises 27% met standards.
“Breaches of these regulations relate to clinically important standards likely to be highly relevant to service-user experience. Deficits in these regulations are therefore the most urgent and pressing sources of jeopardy for those involved in the therapeutic alliance, specifically, those receiving care as well as those providing it. Since these regulations are person-centred, breaches in these areas are humanly impactful.”
Compliance with all four codes of practice covering the use of physical restraint, ECT for voluntary patients, the admission of children to adult units and the admission, transfer and discharge of residents from approved centres, averaged just 57% in 2023. However, it was heartening to note that, in general, the use of restrictive practices was declining in approved centres.
Professor Lucey said that resulting from the findings and in response to incidents, events and serious concerns arising in 2023, the MHC regulator made 52 specific enforcement actions.
