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Home > Mental Health Commission annual report 2017: including report of the Inspector of Mental Health Services.

Mental Health Commission. (2018) Mental Health Commission annual report 2017: including report of the Inspector of Mental Health Services. Dublin: Mental Health Commission.

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Major transformational change needs to happen in the provision of mental health care services or Ireland will continue to provide a level of unsafe and substandard services, which are not aligned to best practice and breach the fundamental rights of a vulnerable group of people who require such services, according to the Mental Health Commission report.

Setting out a number of issues, which have been consistently highlighted in the Commission’s annual reports since 2012, John Saunders, Chairman of the Mental Health Commission said, “The Commission is now calling on the Government with the Health Service Executive, as the statutory provider of services, to initiate a major transformation programme to deal with the service issues highlighted in this and previous reports of the Commission.” “There is a glaring and inconsistent pattern of standards in service provision. The lack of any real progress and commitment on these matters undermines the fundamental human rights of people using mental health care services,” he said.
The issues include:
• The inappropriate admission of children into adult mental health in-patient services.
• Inadequate staffing and variable funding in community child and adolescent mental health services, leading to unacceptable waiting times, and forcing young people into emergency services.
• The continuing inability of some services to put in place an individualised care plan and therapeutic programme, which are the cornerstone of a recovery focussed person centred service as per national policy.
• The widespread use of restrictive practices such as seclusion and physical restraint as a normalised behaviour in services which lack sufficient numbers of staff and/or appropriately trained staff.
• The fundamental and careless lack of attention to basic issues such as dirty and dilapidated premises, which do not ensure adequate privacy and where there has been a disappointing drop in compliance from already low levels.
• The provision of services to vulnerable people with long-term mental illness who are accommodated in 24-hour community residences that are not subject to regulatory oversight.

“Now more than ever, it is necessary to address systemic issues that hamper the delivery of services and the development of newer, more appropriate ones. Progress in many significant areas has either been non-existent or slow, leading to the continued provision of poor quality
services for people who use mental health services and their family members. Reform of the Mental Health Act 2001 is now a matter of urgency as significant numbers of people are now using unregulated mental health care day and residential services. This situation increases dramatically the risk of abusive or neglectful incidents occurring,” he concluded.
Commenting on the report, Rosemary Smyth, MHC Interim Chief Executive, said, “In 2017, we identified a general trend of improvement in services’ compliance with regulatory requirements. It is encouraging to see progress, however, there has been little improvement in some areas such as the provision of staff training and the overall maintenance of premises, which is of great concern to us.”

Inspector of Mental Health Services report:
The Inspector of Mental Health Services and/or her team visit and inspect each approved centre at least once a year and reports to the Commission on compliance with code of practice, rules and regulations.
Commenting on the findings of the inspections Dr Susan Finnerty, Inspector of Mental Health Services said, “While there were some areas of the mental health service that provided good care, I have a number of concerns about the provision of mental health services in Ireland. Of great concern is that I found the services for children and adolescents were generally inadequate, poorly funded and not responsive to the needs of young people and their families.
Issues include:
• The difficult process of sourcing a CAMHS bed, especially in an emergency situation was frustrating, time consuming and often resulted in a young person being admitted to an adult mental health unit.
• The number of children admitted to adult units increased from 68 in 2016 to 82 in 2017.
• Community CAMHS teams were understaffed and funding for CAMHS services varied from €40 per capita in one area to €92 per capita in another area, with no rationale for these variances and resulting in inequality of care
• Waiting times for a CAMHS appointment varied from no waiting time in one area to 15 months in another.

The paucity of services for young people is unacceptable and must be addressed as a matter of urgency.
Overall compliance with regulations and rules had only improved by 2% since 2016. There was a disturbingly high number of in-patient units were dirty and poorly maintained, with associated implications for infection control. This is a deterioration since 2016. Physical care of patients had worsened. Care plans were, in the most part, paper exercises which were not collaborative or addressed recovery.

Over 1,300 vulnerable adults with mental illness were accommodated in community residences that were unregulated, mostly institutionalised settings with little or no rehabilitation or prospect of moving to more independent living. These people appear to have been forgotten by both the mental health services and by society.
Most in-patient units struggled to ensure that they were staffed safely and adequately at all times and most community mental health teams did not have the recommended multi-disciplinary staffing.
“It is disappointing to have to report that there are such basic deficits in mental health provision in 2017, with little indication that the situation will improve. Increase in mental health funding, addressing stigma, provision of person-centred care, effective recruitment and retention drives, improved compliance with regulation and immediate addressing of deficits in the CAMHS are all urgently required,” Dr Finnerty concluded.

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