Report finds slipping standards of care in mental health units

Inspection reports into five State mental health facilities published on Thursday found increasing levels of non-compliance with patient care and safety standards.

The reviews were undertaken by the Mental Health Commission, which is an independent body that inspects mental health facilities and standards.

In one centre, four staff members involved in carrying out electroconvulsive therapy did not have appropriate and up-to-date basic life support training. The facility, the Department of Psychiatry in Letterkenny General Hospital, was not using electroconvulsive therapy to treat any patients at the time of the inspection.

The treatment sends small electrical currents through a patient’s brain to induce small seizures with the intention of providing relief for some mental illnesses.

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The 2017 inspection report found there was no assigned consultant anaesthetist who had overall responsibility for the anaesthesia treatment of patients during electroconvulsive therapy.

Overall, the inspection of the in-patient mental health facility in Letterkenny General Hospital found 20 instances of non-compliance with mental health standards and regulations for patient care, up from 12 instances of non-compliance in 2016.

Critical failure

The provision of individual care plans for patients was identified as a critical failure in the Letterkenny facility. Patients’ care plans lacked specification and many contained “generic” broad goals for patient development.

The report found the criteria had not been compliant with statutory mental health standards of care for the last six years.

The group of inspectors also found no evidence that residents who were physically restrained in the centre had been informed by staff of the reasons for their restraint and the likely time duration.

An inspection of St Ita’s 20-bed ward in St Brigid’s Hospital in Ardee, Co Louth found levels of non-compliance had tripled in three years.

The report found non-compliance with 14 standards, compared to just four in 2015. Patient privacy, risk management, and the use of physical restraint were not up to required standards of care in the facility.

The inspection found it was not documented if patients who were physically restrained had received a follow-up physical examination in the required three-hour time-frame by staff.

The report also said “recreational activities were sporadic, limited in choice, and insufficient for residents’ needs”.

“Bathroom and toilet areas were not adequately cleaned or free of offensive odours, and other areas were not clean,” according to the inspection report.

Management of violence

An inspection of Bloomfield Hospital, a 114-bed mental health facility in Rathfarnham, Dublin 16, found there was no evidence agency staff hired to work in the centre had received adequate training in the therapeutic management of violence, or the standards of the Mental Health Act 2001.

The level of non-compliance in the acute psychiatric unit of Cavan General Hospital declined from 15 in 2016, to just 9 standards this year.

The report did highlight “out-of-date medication was found in one of the medication fridges, and medication fridges were not clean” in the unit.

A spokeswoman for the Department of Health said “a programme of corrective actions is now in place in each of the relevant hospitals to ensure that all issues identified in the reports are addressed”.

“This Government is strongly committed to improving all aspects of our mental health services, having increased funding for mental health by over €140 million since 2012,” she said.