Inspections of six inpatient units found six critical and 29 high-risk non-compliances
Concerns around risk management, staffing and restrictive practices such as the physical restraint of patients have been found in inspections of six inpatient mental health centres around the country.
The inspection reports, published by the Mental Health Commission (MHC), uncovered six critical and 29 high-risk non-compliances across a number of rules, regulations and codes of practice.
The reports focussed on St Loman’s Hospital in Westmeath; the Department of Psychiatry at St Luke’s Hospital in Kilkenny; the Department of Psychiatry at Letterkenny University Hospital; the Acute Psychiatric Unit at Tallaght University Hospital; Sliabh Mis Mental Health Admission Unit at University Hospital Kerry; and St Michael’s Unit at Mercy University Hospital, Cork.
There were common themes of concern across all six centres, which included failings in regulations for risk management procedures and staffing, and in the general area of restrictive practices.
Four of the centres together were found to have six high-risk non-compliances relating to restrictive practices – three for the rules governing the use of seclusion, and three for the code of practice on the use of physical restraint.
The MHC’s Director of Regulation, Gary Kiernan, reminded providers that the rules governing the use of seclusion and mechanical means of bodily restraint, and a revised code of practice on the use of physical restraint, came into effect at the start of 2023.
“While we have witnessed an overall reduction in the use of restrictive practices in recent years, some centres are still receiving critical-risk and high-risk non-compliances in this area and we are urging those service providers to take immediate steps to bring their services into full compliance with the new rules.”
Non-compliances observed during the inspections included:
- Eight high risk non-compliances with the regulations on individual care planning, therapeutic services and programmes, privacy, staffing, general health, risk management procedures, the code of practice on the use of physical restraint, and with the ordering, storing, prescribing and administration of medicines at St Loman’s.
- One critical risk non-compliance with the regulation on risk management procedures, and one high risk non-compliance with the regulation on premises at St Luke’s.
- Six high risk non-compliances with the regulations on individual care planning, staffing, risk management procedures, the code of practice on the use of physical restraint, with the regulation on the maintenance of records, and with rules governing the use of seclusion at Letterkenny.
- Two critical risk non-compliances with the regulations on premises and risk management procedures; and seven high risk non-compliances with the regulations on clothing, general health, individual care planning, privacy, staffing, with the rules governing the use of seclusion, and with the code of practice on the use of physical restraint at Tallaght.
- Five high-risk non-compliances with the regulations on privacy, risk management procedures, staffing, the maintenance of records, and with the rules governing the use of seclusion in Kerry
- Three critical risk non-compliances with the regulations on privacy, premises and risk management procedures, as well as two high risk non-compliances with the regulations on CCTV and staffing in Cork.
St Loman’s had the lowest overall compliance, of just 64 per cent, followed by Tallaght (65 per cent) and Kerry (69 per cent).
The highest compliance was found in St Luke’s (89 per cent), followed by Letterkenny (74 per cent) and Cork (72 per cent).
The Inspector of Mental Health Services, Prof Jim Lucey, confirmed that all six centres inspected were found to either have critical or high-risk non-compliances with the regulation on risk management procedures.
“Most of the centres were non-compliant with this regulation because the registered proprietor did not ensure that the centre’s risk management policy was implemented throughout the approved centre, particularly, it was noted, when it came to fire safety,” he said.
“Our inspections discovered that daily fire checks and regular fire evacuation drills were not being carried out, while we also discovered faulty fire doors. There is little point having a comprehensive policy in place to counteract a potential fire outbreak unless management is confident that the policy can be properly implemented if such an event occurs.”
Mr Kiernan noted that five of the six centres had high-risk non-compliances relating to the regulation on staffing.
In all five cases, a common reason for non-compliance centred around the fact that the registered proprietor did not ensure that all staff were trained, or had access to training, that would enable them to provide care and treatment for patients and residents in accordance with best contemporary practice.
“The provision of up-to-date training for staff in such areas as basic life support, fire safety, and management of violence and aggression so as to ensure the centre meets the minimum requirement for compliance is essential for the safety and wellbeing of residents. We must see improvements by more centres under this regulation,” he said.
