Three mental health units, including one for children, became less safe for patients last year, with visible ligature points, lack of care plans, and, illegible records among issues found in reports published on Tuesday.
The Mental Health Commission inspected St Loman’s Hospital, Westmeath, the acute mental health unit at Cork University Hospital (CUH) and the child and adolescent mental health service (Camhs) unit at Merlin Park University Hospital in Galway.
The acute mental health unit in CUH, which had 35 residents at the time of inspection, saw its compliance rate fall from 94 per cent in 2021 to 79 per cent last year.
“The centre had not complied with a national directive in relation to the identification and removal of a specific ligature risk. These specific ligatures were removed by staff during the inspection.”
Meaningful care plan
The centre “did not ensure that all residents had a comprehensive individual care plan” and two patients’ plans had no therapies listed or input from relevant multi-disciplinary-team members. One patient had no meaningful care plan for a week. Some of the patients’ files were bulky, difficult to handle and “many loose pages were ... found ... which did not respect confidentiality of patients”. Residents’ personal property and possessions were not safeguarded and there was no provision for the safekeeping of all personal property.
The Camhs unit in Merlin Park, which had nine residents at the time of inspection, saw its compliance fall from 97 per cent in 2021 to 88 per cent in 2022. Serving countries Clare, Limerick, North Tipperary, Galway, Roscommon, Mayo, Sligo, Leitrim, and Donegal, it is also a national referral centre.
While the unit was compliant with the majority of regulations, its seclusion facilities were not.
“Residents in seclusion did not have access to adequate toilet and washing facilities, as there was no shower facility in the seclusion area. Seclusion facilities were furnished, maintained, and cleaned to ensure respect for resident dignity and privacy, as far as was practicable. Furniture and fittings were not adequately designed to ensure patient safety, as the flooring had a hard surface,” says the report.
“Two of the young people mentioned that staff didn’t always sit down and talk to them when they were upset and were told instead to use their ‘decider’ skills. They asked that staff interact with them more even if they looked okay at the time. The young people also mentioned not having enough activities on the weekend.”
St. Edna’s ward within St Loman’s Hospital provides continuing care for male residents with enduring mental health problems. Its overall compliance rate fell from 86 per cent in 2021 to 75 per cent last year. It had 28 residents during the inspection, of whom 16 had been there more than six months.
Inspectors found, “significant areas where [the centre] did not operate safe practices to reduce the risk of harm to the residents and that effective systems were not always in place”.
“Ligature points ... identified ... as medium and high risks, were not minimised to the lowest practicable level” and in one patient’s medical record “one medication administered to the resident was not recorded, and the clinical file did not contain a documented explanation for this”.
Not all entries on the medical record were legible, says the report and “the name and the date of birth of the resident was illegible on every single page”.
Reduced compliance
Dr Susan Finnerty, inspector of mental health services, said inadequate individual care-planning was an issue across many centres.
“Everyone using mental health services has the right to a care plan that is personal to them. Nationally individual care planning in our mental health service needs improvement. It is essential that we move towards a mental health service which provides every individual with a meaningful care plan.”
It was “disheartening” to see decreased compliance across the three centres.
“Our regulatory team have worked with these approved centres over the past number of months putting corrective and preventive action plans in place so non-compliances can be addressed and conditions for residents improved.”
