The HSE was going through a period of organisational restructuring, which was an opportunity for progress in mental healthcare that should not be missed, according to Prof. Jim Lucey, Inspector of Mental Health Services.
“It is time for the HSE to carry out a focused examination of approved centres persistently found in breach at critical levels. Closer attention to these underperforming approved centres would transform the national picture, he wrote in the 2024 annual report of the Inspector of Mental Hospitals, which has been published by the Mental Health Commission.
The Inspector said substantial capital investment would be needed to implement commitments made in documents such as Sharing the Vision and Sláintecare.
“As Inspector, I welcome the commitments renewed this year to enhance the capital programme for mental health. The need for this investment is inarguable. The data are compelling.”
He said his inspection had shown the standard of premises was breached at a critical level in six centres and at a high level in 28 approved centres. Staffing standards were breached at a critical level in four centres and at a high level in 18 centres.
Neither the staff nor the residents of approved centres, where these breaches occurred could reliably mitigate these deficits in physical or human capital resource, and yet professionally they adapted to the consequences arising from years of under-investment.
“The staff and the residents in these approved centres have my respect and support for their continuing good work. The sources of these breaches in capital (both physical and human) are funding deficits beyond the influence of residents and outside the scope of staff.
“It is clear to this Inspector that substantial capital investment will be needed to implement commitments made in documents such as Sharing the Vision and Slainte Care.
“In the meantime, it is for us to continue and to renew our fellowship around our mental health. This is after all our biggest unmet health need. Our awareness of its priority has never been greater.
“In this report I have described many hopeful signs of progress while noting several approved centres moving in the right direction. With the anticipated changes promised in legislation I look forward with fresh enthusiasm to a new era, a time of transformation in Irish mental healthcare.”
Prof. Lucey said the majority of approved centres was largely compliant with minimum standards; however, persistent high volumes of non-compliance in a small cohort of HSE approved centres was obscuring this national picture and the positive image that lay beneath.
There was, he said, evidence of progress in human rights-based standards of mental healthcare.
“Real progress is being made in many approved centres across the country. During inspection, I have found uplifting examples of quality services, where compassionate care is given by professionals with kindness and skill to those with acute mental health difficulty.
The majority of approved centres is substantially compliant, and many are making progress towards genuine human rights-based standards of mental healthcare. Underneath the headline figures there are many signs that a new generation of humane, justified, therapeutic mental healthcare professionals is emerging.
Through annual unannounced nationwide inspections and subsequent corrective and preventative action plans (CAPAS) coordinated by the MHC we are witnesses to restored levels of compliance and timely resolution of breaches in many approved centres.
Prof Lucey found a steady and sustained reduction in the use of restrictive practices in approved centres in Ireland.
There are good reasons to be uplifted by this progress which is indicative of widespread positive change in Irish mental healthcare.
“Evidence of this development can be found within many approved centres and throughout the MDT, for example, in nurse practice development, where training has moved away from old punitive methods of institutional care, towards more enlightened trauma-informed, human rights-based clinical practice.”
Writing about some centres which were greatly improved, Prof. Lucey said, “I found compelling evidence of young, highly enthusiastic and dedicated staff being motivated by senior experienced health professionals and encouraged to be ambitious for therapeutic forms of mental healthcare practice.T his new generation of professional carers will surely become the advocates for human rights-based healthcare in our country.”
Several approved centres including centres led by the HSE with high levels of acute demand performed well in 2024.Six approved centres achieved full compliance on inspection and many HSE centres that struggled in the past to meet minimums have made progress towards full compliance in 2024.
The report showed that there ere was a total 366 non-compliances in 2024.
“This year, the total number of non-compliances rated ‘low’ has fallen from 38 in 2023 to 35 in 2024, and the number of non-compliances rated ‘moderate’ has also fallen from 136 in 2023 to 125 in 2024.
“However, the number of non-compliances rated ‘high’ has risen from 156 in 2023 to 168 in 2024, and those number of non-compliances rated ‘critical’ has risen from 32 in 2023 to 38 in 2024.
Non-compliances rated critical were found in largest volume in five HSE approved centres and one independent provider.
Positive experience of the cycle of inspection and regulatory enforcement in approved centres elsewhere shows that constructive change is possible where the leadership is enlightened and committed to supporting such progress.
The Inspector’s report noted that an estimated 51,000 people in mental health crisis present annually to emergency departments in Ireland. Managers of emergency departments throughout Ireland reported to the Inspector on their experience of increasing mental healthcare demand.
The data reveal a high degree of variation in mental healthcare service in Irish hospital emergency departments. Substantial variations exisedt in the timing and nature of mental health assessment, care planning and in the response to children who presented in crisis .Inconsistency of this scale was having a negative impact on access to unscheduled care.
The report recommends greater investment in community alternatives to emergency departments for urgent and unscheduled mental healthcare. The Inspector’s report reiterates concerns expressed previously by the MHC regarding deficits in unscheduled mental health service for children in Ireland.
