Use of seclusion and physical restraint in mental health units is ‘cause for concern’

Mental Health Commission report finds that ‘too often’ facilities are ‘dirty and smelly’

A patient at the Central Mental Hospital in Dublin was locked in seclusion for more than 71 days in 2018, according to the Mental Health Commission’s annual report. Photograph: Dara Mac Dónaill

A patient at the Central Mental Hospital in Dublin was locked in seclusion for more than 71 days in 2018, according to the Mental Health Commission’s annual report. Photograph: Dara Mac Dónaill

 

A patient at the Central Mental Hospital in Dublin was locked away in seclusion for more than 71 days last year, according to the Mental Health Commission’s annual report.

There were 73 episodes where seclusion was used continuously for more than 72 hours in mental health facilities last year, it says.

Dr Susan Finnerty, the commission’s inspector of mental health services, said the use of seclusion and physical restraint “continues to cause concern”.

She also said that “too often” during inspections last year the commission found “dirty, smelly, poorly maintained premises and continue to do in 2019”.

There were 64 centres inspected by the Mental Health Commission, an independent statutory body, last year. Overall compliance with regulations rose slightly from 76 per cent in 2017 to 79 per cent last year.

Of the 27 centres that used seclusion, 67 per cent of them were non-compliant with regulations while of the 52 centres that used physical restraint, just 19 per cent were complaint with the relevant code of practice.

The report said seclusion is when a patient is involuntarily confined in a room or area and is physically prevented from leaving, “usually by a locked door but also by staff blocking the door”.

“The seclusion room is usually bare apart from a special mattress. Heat, light and ventilation are controlled from outside the room,” it said.

The majority (70 per cent) of centres were found to be “dirty, malodorous and poorly maintained”.

Dirt on the floor

The report said the seclusion room in the psychiatric unit at St Luke’s Hospital, Kilkenny, was not clean “as there was evidence of hair, hardened food and other dirt on the floor of the room”.

“There were drinks stains on walls and windows in the room. At the time of inspection, the approved centre felt overheated, lacked airflow and ventilation, despite the windows being opened,” it said.

The report said a number of centres remained “unsuitable and not fit for purpose” but there was “some improvement” at others.

John Farrelly, chief executive of the Mental Health Commission, said it is difficult to see how some of the country’s in-patient mental health units could be registered in the future without “significant improvements” in levels of compliance. To operate an in-patient mental health service in Ireland, the service must be registered as an approved centre with the commission.

Low compliance

“There is a significant number of approved centres which have on a consistent and sustained basis failed to provide the most basic and fundamental aspects of a service, such as privacy and cleanliness,” he said. “There is no justification for some of the low levels of compliance evidenced in the inspector’s report. It points to a significant governance and management deficit within our mental health services.”

The report also highlighted a national shortage of mental health staff and ongoing concerns around child and adolescent mental health services. While the total number of admissions of people under the age of 18 to centres was down from 439 in 2017 to 408 last year, there were 84 admissions of children and adolescents to 18 adult units last year.

John Saunders, chairman of the commission, said a more “comprehensive and holistic plan” was required, involving all service providers, the Government, key stakeholders and patients.

“It is evident from the 2018 report that the level of change in our mental health service provision is unco-ordinated, ad hoc and slow,” he said.

Minister of State with responsibility for mental health Jim Daly said the report outlined “very stark failings”.

Mr Daly said draft legislation to amend the Mental Health Act 2001 will be provided to the commission in the coming weeks.