Action needed to prepare for second wave in mental health settings, committee told

Urgent action is needed to prepare for a possible second wave of coronavirus infections in mental health residential settings, the chief executive of the Mental Health Commission has said.

John Farrelly told the Oireachtas special committee on the Covid-19 pandemic there needed to be a review of shared accommodation that did not comply with infection controls.

There had to be clearly defined points of contact and shared protocols for each facility on testing, contact tracing and personal protective equipment, and clear public health guidance specific to mental health settings, including suspending and resuming services, he said.

There were 17 Covid-19 related deaths of mental health residents reported to the commission between early April and July 10th. There were confirmed cases of Covid-19 among staff and residents in 56 or 31 per cent of mental health centres in the State, the committee was told.

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There are 181 residential mental health services, comprising 67 regulated in-patient mental health centres and 114 unregulated community residences, staffed by nurses 24 hours a day.

These account for about 3,900 beds nationally. The commission took on a specific role in monitoring 181 residential mental health services identified as vulnerable to Covid-19 outbreaks.

Mr Farrelly, referring to difficulties in managing the pandemic, said that mental health services were “not fit for purpose and out of date”. Mental health facilities with shared accommodation had a limited ability to isolate residents and promote social distancing during the coronavirus crisis.

“This pandemic has brought into sharp focus the fundamental shortcomings in accommodation for mental health facilities,” he told the committee in his prepared statement.

“Covid-19 has highlighted the significant risks associated with shared, and in particular, dormitory-style accommodation.

“For years, the commission has also been sounding the alarm on other critical deficiencies such as structural safety, lack of privacy and premises that are dirty and in disrepair.”

National governance of contingency plans to manage outbreaks were “a week or two, three maybe” behind and there was a lack of specific public health guidance for mental health settings, Mr Farrelly said.

There were significant delays and inconsistencies in testing and inconsistent continuity of services, and community-based services were suspended, he said.

“People were very much caught on the hop,” he said, but he praised the professionalism of staff in the mental health services during the public health crisis.

“We couldn’t say it was a success because people died,” he said.

Martin Rogan, chief executive of Mental Health Ireland, told the committee the pandemic has had "an extraordinary impact on the mental health and quality of life of the Irish people".

There would be a “tsunami of need” to treat the damage to people’s mental health from the effects of the pandemic, he told TDs in an appearance before the committee on Tuesday.

“All of our lives have been changed by this. It would be very unusual and quite unhealthy if this didn’t provide some degree of anxiety, upset, perhaps anger in some instances,” he said.

He compared the impact and cost of the pandemic to the damage caused by major weather or terror events in the United States to the mental wellbeing of the public.

Mr Rogan said he expects to see “almost a slow-burn effect” from the pandemic with increasing mental health issues emerging over this year as they look back on its “dislocating effect”.

Managers in healthcare were being affected by a new phenomenon known as “moral injury” where a person in a leadership role makes a decision based on the information they had at the time only for new information to later emerge putting their decision in a different light, he said.

This can have “a really corrosive effect” on their ability to lead and make decisions, he added.

“People have been exposed to difficult and graphic circumstances, fast-moving and overwhelming situations,” he said, noting the effect on workers in the healthcare sector.

Mr Rogan said that mental health professionals did not yet have a full measure on the “amplifying effect” of some people’s reliance on alcohol and drug use during the pandemic.

Paul Longmore, acting clinical director of Jigsaw, the youth mental health charity, said it had seen increased referrals from young adults in the 18- to 20-year-old age group who have been particularly affected by the loss of jobs in the retail and hospitality sectors.

Rosemary Smyth, director of standards and quality assurance at the Mental Health Commission, said that 28 residents in mental health facilities and 47 staff tested positive for Covid-19.This was the first week that the commission has had no new cases to report within mental health services, she told the committee.