Concern raised over conditions of care residences

A REPORT by the State’s mental health watchdog has raised concern over the conditions of some community residences which are home to more than 3,000 people with mental health problems.

While there has been long-standing criticism over conditions in Victorian-era psychiatric hospitals, there has been much less focus on nurse-supervised community residences which are not covered by statutory care regulations.

New inspections by the Mental Health Commission show the culture in some of these residences is comparable to a “mini-institution”, while inspectors have called for the closure of older buildings which are no longer considered fit for purpose.

In many cases, however, inspectors highlighted good relationships between staff and residents despite poor physical conditions or limited access to therapeutic services.

Overall, inspectors visited 13 nurse-supervised community residences last year, most of which were established to provide more suitable community-based accommodation for long-stay patients in psychiatric hospitals.

Inspectors found most residences were too large to be described as homes and that most residents had to share rooms and had little or no privacy.

In some cases there were serious concerns over whether buildings were fit for purpose. In the case of Ashbrook House in Co Leitrim – a poorhouse dating to the 1840s – inspectors said it should be closed as it was not suitable for long-term living.

Despite this, it said staff had a good knowledge of residents’ needs and preferences and that interaction between staff and residents was “warm and lively”.

Inspectors said community residences in Vergemount, Co Dublin and Merlin Park, Galway, were “more reminiscent of small institutions rather than community residences” and should be improved.

With regard to financial arrangements, inspectors raised concerns over large discrepancies in the amount of rent paid by residents in different houses.

In some places the rent was assessed through a means test, but in others rent ranged from between €60 a week to €153. Some residents were also obliged to pay additional “housekeeping” fees, although this was not a feature in other residences.

Overall, the report recommends that staffing levels of community residences be reviewed.

It says most clients were older, and in some instances the physical health needs of residents were more pressing than their mental illnesses.

Official guidelines state community residences should be under the care of a rehabilitation team in order to place a greater emphasis on recovery. However, only four of the 13 residences were under the sole care of such a team.

Inspectors said it was encouraging that individual care plans had been drawn up and implemented in residences which were under the care of rehabilitation teams.

Overall, the report recommends all premises should have accommodation which provides privacy for residents, particularly in bedrooms. It also says night-time staffing levels should be reviewed, particular in residences where only one nurse was on duty.

While there are no statutory care guidelines for community residences, inspectors said they were keen to ensure the quality of care and treatment for residents in community residences met their needs.

Inspectors also examined day hospitals, which play a key role in the treatment of severe mental illness and can divert admissions from acute psychiatric hospitals.

It found a wide range of therapeutic activities were available in the majority of the day hospitals.

In a small number of day hospitals the provision of information was poor and it was apparent that they had no facilities for providing data on diagnosis or length of stay.