Two psychiatric units’ approach to physical restraint ‘totally unacceptable’

Mental health inspector says ‘critical risks’ found at St Vincent’s and Connolly hospitals

  Elm Mount Unit at St Vincent’s University Hospital had two areas of non-compliance rated as critical risk, relating to individual care plans and to the code of practice on physical restraint. File photograph: Nick Bradshaw

Elm Mount Unit at St Vincent’s University Hospital had two areas of non-compliance rated as critical risk, relating to individual care plans and to the code of practice on physical restraint. File photograph: Nick Bradshaw

 

The policies of two psychiatric units in relation to the physical restraint of patients have been described as “totally unacceptable” by the State’s mental health inspector after the issue was rated in both as a “critical risk”.

The Mental Health Commission published five inspection reports on Thursday by Inspector of Mental Health Services Dr Susan Finnerty, identifying a total of 41 areas of non-compliance.

Elm Mount Unit at St Vincent’s University Hospital had two areas of non-compliance rated as critical risk, relating to individual care plans and to the code of practice on physical restraint.

The Department of Psychiatry at Connolly Hospital Blanchardstown had two areas of non-compliance rated as critical risk. They related to rules governing the use of seclusion and the code of practice on the use of physical restraint.

At the St Vincent’s unit, the inspector said there was one case of a child being physically restrained.

“The parent/guardian was informed as soon as possible, child protection policies were in place, but the policies did not address appropriate training for staff in relation to child protection,” the inspection report said.

The report also said there were “numerous errors in the prescribing, storage and administration of medication, which had the potential to lead to more serious medication errors”. There were also “serious deficits” in care planning for residents.

“On admission, all residents were restricted from wearing day clothes until reviewed by the consultant psychiatrist, even though a risk assessment had been completed. This was a blanket restriction that impacted on residents’ choice and dignity,” the report said.

It noted 2018 was the fourth consecutive year that the approved centre was not compliant with the code of practice on the use of physical restraint. Eight elements of non-compliance were found in the inspection.

‘Gender sensitivity’

At Connolly hospital, inspectors found that two male nurses subjected one woman to physical restraint and that “cultural awareness and gender sensitivity were not demonstrated when considering the use of and when using physical restraint”.

The development of individual care plans (ICPs) at the Connolly unit was also found to be unsatisfactory and not all residents felt they had access to or were involved in the creation of their care plans.

“This is the fourth year in succession that the approved centre has been non-compliant with Regulation 15 on individual care plans for residents, which is unacceptable,” the inspector said.

Dr Finnerty said: “It is really disappointing that we have identified such a high level of non-compliance, and worrying that four areas of non-compliance were rated as critical risk.”

“The use of seclusion and physical restraint should only occur in exceptional circumstances and the processes and procedures surrounding their use are of the utmost importance to ensure the safeguarding and wellbeing of patients. Non-adherence to the rules and codes set out is totally unacceptable,” she added.

“Individual care plans are based on a clear concept of setting goals and identifying treatments which guide towards the recovery of a patient. It is not acceptable that patients do not have fully complete ICPs and it is particularly worrying that this is the third year in a row that Elm Mount Unit in St Vincent’s was found to be non-compliant with this regulation.”

The commission said it had acted on findings of the reports by using its enforcement powers to attach conditions and ensuring implementation of corrective and preventative action plans.

The Mental Health Commission is an independent statutory body. One of its main functions is to protect the interests of people using mental health services particularly where a person is admitted against their will.