The Central Mental Hospital (CMH) was today accused of infringing the rights and dignity of patients through lock-ups, seclusion and a blanket approach to care.
A report into conditions and treatment at the south Dublin facility revealed women were especially poorly cared for and subjected to isolation in rooms without toilets or daylight.
Dr Jean Parrott
The report - compiled by the Committee of Inquiry into Current Care and Treatment Practices in the Central Mental Hospital - said patients are routinely stripped naked during seclusion and denied appropriate sanitary protection.
Inspectors, who spent 18 months at the hospital, said many practices were not of an acceptable standard and rarely did staff use an alternative to seclusion.
Dr Janet Parrott, chair of the inquiry team, noted the chief areas of concern. She said the worst areas were seclusion of patients, particularly the way women are isolated, overnight lock up and patients being left locked in rooms when they need to use the toilet since slopping out ceased.
"The women's unit is too small. It's not fit for purpose even more so than the rest of the hospital and the staff can't properly care for patients there, " she said.
But Dr Parrott said management at the CMH agreed with this. Following an 18 month investigation, inspectors criticised staff for forcing patients to go outside for cigarette breaks even if they are non-smokers and imposing restrictions on access to the grounds.
They said seclusion was overused in some wards, staff failed to use it as a last resort and on all occasions the practice is not audited. They also criticised the practice of isolating new patients on the admission wards. Dr Parrott noted a blanket approach to care practices and treatment of patients.
Low-risk patients are treated in much the same way as those who are high-risk, and she also noted the stigma of the mental hospital still exists with the public perception that patients are not patients but inmates. Dr Parrott said: "There is still a legacy of a rule based system, a rigid rule based system, for example no patients can walk unrestricted in the grounds regardless of the level of risk."
The report said the practices criticised required urgent attention and change by the Health Service Executive and the local management team, but they also accepted some improvements had already been made.
In a statement the HSE noted improvements which had been made including dedicated ward nurse management structure to provide clear lines of accountability on each unit. A significant increase in nurse staffing levels and compliance with the Mental Health Commission's new guidelines on seclusion which came into effect on November 1, 2006.
A team is also being set up to review all the recommendations of the report. The Mental Health Commission said they will be writing immediately to the HSE seeking a detailed action plan with specific time frames to address the areas of concern. And at least three inspections will be carried out at the Central Mental Hospital this year.
Labour Party spokeswoman on health Liz McManus described the report as "deeply disturbing" and called on the HSE and Minister Mary Harney to state how they will act on its recommendations.
Ms McManus said: "It is abhorrent that in this day and age a facility treating the very sick is so inadequate. It is to the Government's shame that they have allowed patients be treated for so long in such grotesquely Dickensian conditions."
"It must be remembered that this facility is a hospital not a penal institution. Ultimately standards in mental care facilities must be as good as those provided in any other hospital or healthcare facility," she added.