Mental Health Commission scathing on patient care

Watchdog notes rise in child admissions by 20% and those ‘forgotten’ by State and society

The number of children placed in adult mental health units rose by 20 per cent last year despite repeated calls for the practice to end.

The Mental Health Commission, in its 2017 annual report published on Wednesday, also noted some patients who languish in institutionalised settings have been "forgotten about" by the State and society.

"The lack of any real progress and commitment on these matters undermines the fundamental human rights of people using mental healthcare services," said chairman John Saunders.

The commission carries out regular inspections of care settings and has long been a critic of conditions. It has called for unacceptable waiting times and difficulty accessing emergency beds to be addressed. Its report also highlights “widespread use” of seclusion, physical restraint and dirty and dilapidated facilities.


Dedicated child units

But of particular concern is the system’s treatment of young people. During 2017 there were 82 admissions of children to 19 adult units, rising from 68 the year before; 6 per cent of those - or about five cases - were aged 15 or younger.

These people appear to have been forgotten by both the mental health services and by society

Although that number has dropped from a high of 247 in 2008, the commission said admitting any child to an adult service is unsatisfactory.

“A contributory factor to the continued admission of children to adult units is a shortage of operational beds in dedicated child units,” it said.

It noted the inability of Child and Adolescent Mental Health Services workers to admit children after hours, “thereby forcing” them to look to adult units instead. Such a situation, it said, is a “clear breach of the human rights and dignity of the child” and had remained a concern for “many years”.

Also of concern were the 1,300 vulnerable adults with mental health issues s accommodated in community residences which it said were unregulated and mostly institutionalised settings with “little or no rehabilitation”.

“These people appear to have been forgotten by both the mental health services and by society,” it said.

Overall, this corner of the health sector had demonstrated “either nonexistent or slow” levels of progress.

In total, 62 of 64 approved centres were found to be non-compliant with one or more legislative requirements

The report raised the “careless lack of attention” in some facilities to basic issues of cleanliness and dilapidation.

“Overall compliance with regulations and rules had only improved by 2 per cent since 2016,” said the commission. “A disturbingly high number of in-patient units were dirty and poorly maintained, with associated implications for infection control. This is a deterioration since 2016. Physical care of patients had worsened. Care plans were, in the most part, paper exercises which were not collaborative or addressed recovery.”

HSE response

In total, 62 of 64 approved centres were found to be non-compliant with one or more legislative requirements.

Mr Saunders said a number of the issues had been consistently raised in annual reports since 2012 and the commission was now calling on the Government to initiate a transformational programme.

The Health Service Executive said while it acknowledged a slight increase in admissions of under-18s to adult units in 2017, overall admissions for under-18s was down from the previous year.

There had been improvements to services, it said, including the launch of the Best Practice Guidance for Mental Health Services and the National Framework for Recovery in Mental Health.

It said an additional 20 beds are planned for the new children’s hospital and an additional 10 forensic beds in the National Forensic Mental Health Service.

Mark Hilliard

Mark Hilliard

Mark Hilliard is a reporter with The Irish Times