An inquiry established by the State’s mental health watchdog into two psychiatric hospitals has found evidence that intellectually disabled residents were being inappropriately administered tranquilisers to control their behaviour.
The report into standards at St Michael’s Unit, South Tipperary General Hospital in Clonmel and St Luke’s Hospital, Clonmel also found widespread failures to provide proper standards of care to residents.
The inquiry, commissioned by the Mental Health Commission, was prompted following concerns over the number of fractures suffered by residents at the hospitals.
Among the main findings of the report are that:
- Wards were unnecessarily locked
- Seclusion was being used too often
- Patients were forced to wear nightclothes during the day-time
- No comprehensive needs assessments or care plans for residents were in place
- There was a lack of needs-based therapeutic or recreations activities
The report did not find evidence that the number of fractures among residents were non-accidental. However, it said environmental defects were not properly addressed, increasing the risk of injury to patients.
The report sets out a series of time-bound steps for both hospitals – which provide care to just over 180 patients – to meet in order to comply with regulations.
Failure to meet these steps could allow health authorities to close, or de-register, the hospitals at a later date.
Chairman of the Mental Health Commission, Dr Edmond O’Dea, said it would work with all interested parties to develop quality mental health services in South Tipperary.
“Government policy is to move towards the closure of institutions such as St Luke’s and to move towards a community-based care and treatment model,” he said.
“For this to happen, community mental health services must be provided and funded… even in these difficult economic times, there is a need for the continue development of mental health services to ensure people with mental illness received appropriate care and treatment.”
The report itself was highly critical of the care provided to intellectually disabled residents, who accounted for one third of long-stay patients.
In some wards, it found evidence that patients were being administered tranquilisers – benzodiazepine – to control the behaviour of patients in the absence of needs-based therapeutic and recreation activities.
On the issue of the overuse of locked wards, it found there was no policy governing this practice. The report says the lives of residents were “impoverished” because their choices, freedoms and opportunities were restricted more than was necessary for their care and treatment.
On staffing, it said consultant psychiatrists had limited time for long-stay ward responsibilities because of time commitments. Agreed nurse staffing levels were often not achieved because of unexpected absences and a 20 per cent shortage of trained nurses.
On the subject of the hospital environments it found that in St Michael’s Unit the décor was monotonous, quiet areas and activity rooms were insufficient and dormitories for care of severely ill residents during the day were unsuitable.
At St Luke’s Hospital, it found that in general it was unsuitable as a home or for the provision or person-centred care. Most dormitories were bleak, with few personal items and little personal space. It found: “One dormitory lacked curtains. There were insufficient baths and showers. The areas outside wards were neglected. Vulnerable residents were put at risk by observation difficulties, caused by poor ward design and by sharing accommodation with others with challenging behaviour.”
The reports were commissioned following concerns expressed by clinical risk manger in 2004 on fractures suffered by a number of residents, almost all unseen by staff.
The pattern of injuries appeared to be unusual and the incidence was reported as being among the highest in local psychiatric hospitals.
Managers and clinical staff at the hospital did not meet until 2005 to discuss the report. A specialist orthopedic report commissioned, but was not received until October 2006.
It concluded that the injuries were unlikely to on-accidental and that more information was needed to evaluate the original report.
Today’s report notes that there had been little further investigation and that several recommendations contained in the 2004 report had been addressed.
“The incidence of fractures has not changed substantially, but comparison with other hospitals is not available at present. The inquiry team has identified a number of potential risk to residents and concluded that the safe and welfare of residents had not been given sufficient priority.”
Minister of State with responsibility for Equality, Disability & Mental Health, John Moloney said the report highlights very serious issues. "Aspects of the service provision described are totally unacceptable in a modern mental health service and they will be addressed without delay," he said.
"The findings of this report send out a clear message that we need to implement
A Vision for Changeurgently, not just in Clonmel, but nationwide. As well as investment in infrastructure there must be changes in work practices. Structural barriers to reform, whatever their source, will be tackled," he said.
In a statement, the HSE said it welcomed the report and would work closely with the Mental Health Commission in transforming mental health services in Tipperary.
The HSE announced in January it planned to close St Luke's and invest €20 million in community-based mental health services. The funds are to be raised through the sale of hospital lands.
It has established an advisory group of mental health experts to advise the project team.
"The HSE are committed to implementing our plan, announced in January, that by the end of 2010 all patients at St Luke's will have community based care provided to them appropriate to their individual needs," said clinical director of South Tipperary mental health services, Dr Michele Brannigan.