Warning over people who are older, mentally ill or ‘do not fit in’ being institutionalised

Older people and the mentally ill are at risk of being placed in mental health centres out of convenience, the inspector of mental health services has warned.

Dr Susan Finnerty has strongly cautioned against an “apparent inclination” by some care providers for putting vulnerable groups of people into institutions.

It is easier and cheaper to admit a person requiring support to a large mental health centre than it is to source a more appropriately sized supported home, she acknowledges in her annual report for 2022. “There is a real risk that we are beginning, as we did in the past, to once again re-institutionalise people who are mentally ill, elderly, or who just do not ‘fit in’ to society.”

[ Inspections find ‘poor practices’ and significant staffing problems in mental health services ]

[ Ireland’s growing mental health crisis for children and young people adds to a system under pressure ]

The report has been published along with the annual report of the Mental Health Commission, which warns that public mental health services must improve compliance in four key areas or face a real risk of being removed from the register of approved centres.

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As in 2021, four areas had compliance rates lower than 70 per cent, something that commission chief executive John Farrelly says the public system can no longer ignore if the State hopes to meet minimum standards for the provision of mental health services.

“Notwithstanding improved overall compliance, we can now undeniably say that there are four key areas — premises, risk management, individual care planning and staffing — where standards are simply unacceptable,” said Mr Farrelly.

Urging public services to focus on these areas in the coming months, he says the Health Service Executive should concentrate first on the centres with low standards in care planning and premises.

“The overriding message from today’s report is that centres who have performed poorly in these areas need to comply with these regulations or face the real prospect of not being re-registered. Being compliant with these and other regulations —which, lest we forget, are the minimum standards — is the very least that people living in the areas served by these centres deserve.”

Just 27 per cent of centres were compliant with the regulation on premises, down from 33 per cent in 2021.

“Many of our premises are simply not fit for purpose for a modern mental health service and this is something that we have been saying for many years,” said Mr Farrelly.

[ Majority of children report difficulties accessing mental health services  ]

[ Mental health services must be prised from grip of psychiatry ]

He also criticised “vague and meaningless” goals set in individual care plans, where just over 30 per cent of centres were not compliant.

The commission inspected 66 centres last year and found none had compliance rates lower than 71 per cent.

There were 2,040 involuntary admissions, compared to 2,549 in 2021, and 33 instances of overcapacity, about half the previous year’s total.

The commission took 45 enforcement actions over incidents or serious concerns in 28 centres last year.

Last year, 498 deaths of people using mental health services were reported, including 147 in approved centres. There were 144 suspected suicides including 26 in approved centres.

Twenty children were admitted to adult mental health units, the lowest figure ever recorded.