A “lingering complacency” remains around restrictive practices such as physical restraint and seclusion in mental health services, according to the State’s watchdog.
Some basic and fundamental aspects of care and treatment in mental health services continue to be lacking, some are dirty and in disrepair and service users are not afforded proper privacy during their admission , Dr Susan Finnerty, the inspector of mental health services, said.
“I find it unacceptable that in 2019, we still find service users in long-stay units living in ‘dormitory style’ accommodation, where one shower is shared between 20 people, and to find units which are dirty and in disrepair. This does not respect the basic privacy and dignity of service users.” Dr Finnerty told the Oireachtas health committee on Wednesday.
Dr Finnerty says there have been some positive developments, with a steady increase in compliance levels with regulations at approved centres and the closure of the majority of old psychiatric institutions that were not fit for purpose.
However, a large number of specialist community-based mental health services, in particular 24-hour residences, remain without regulatory oversight or safeguards, despite the vulnerability of those accommodated in them.
Inconsistent
Dr Finnerty also says there is inadequate and inconsistent monitoring of the physical health needs of people with enduring mental illness, and inadequate and inequitable access to essential healthcare services.
Concerns about the provision of child and adolescent mental health services in the community include poor staffing, the number of young people admitted to adult units and variations in funding across different areas, she says.
The Mental Health Commission says there is no therapeutic benefit to the use of restrictive practices such as seclusion or physical restraint and they should only be used as a last resort, where there is a serious and urgent safety concern.
Despite this, physical restraint was used in 81 per cent of all centres last year and in 97 per cent of acute adult services. Seclusion was used in 42 per cent of centres and 65 per cent of adult services.
One in five community residences inspected last year required urgent maintenance and refurbishment.
The commission says an out of hours mental health service for young people in crisis should be set up, and funding should be prioritised to ensure all accommodation in residential centres is safe and fit for purpose.
