Irish organisations pledge to adopt ‘human rights-based approach’ to mental health care

A new training approach to mental health care was launched by the Mental Health Commission (MHC) in Ireland on Wednesday, together with the World Health Organisation (WHO).

Organisations from the public, private and NGO sectors across the country gathered in Dublin to pledge to promote a “human rights-based approach” to mental health care across the State.

The launch coincided with a new report on the use of restraints and seclusion on mental health patients, which shows that episodes of physical restraint and the numbers undergoing physical restraint have continued to decrease since 2019.

Chief executive of the MHC, John Farrelly, said there is a global movement taking place that is empowering people to promote the human rights of people with mental health difficulties.

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“The new approach that we are launching this morning is designed to support people to understand a human rights model of mental health. Specifically, how organisations and individuals can constructively and collaboratively contribute to advancing the rights set out in United Nations Convention on the Rights of Persons with Disabilities,” Mr Farrelly said

The countrywide approach has the support of the HSE, the National Ambulance Service, An Garda Síochána, the Irish Prison Service, the Irish Courts Service; as well as government, private and not-for-profit organisations, Mr Farrelly said.

Dr Michelle Funk, head of WHO’s policy, law and human rights unit, said she was “greatly encouraged” that the MHC was driving the initiative forward in Ireland on behalf of people experiencing mental health difficulties.

The signing of a pledge was unique and showed “a serious commitment and will” to “vastly improve the lives of people facing mental health difficulties”, she said.

Taking place in advance of World Human Rights’ Day this Sunday, the launch coincided with the publication of the MHC’s 2022 report on restrictive practices activity, which documents the declining use of these practices across 67 inpatient mental health centres in Ireland.

The report is the 14th such publication by the MHC and forms part of its remit to report independently on the quality and safety of mental health services in Ireland. Mr Farrelly said several positive messages could be taken from the 2022 activity report.

“Overall in Ireland, the number of restrictive practices continues to decline and we are encouraged to observe that the number of episodes of physical restraint and the number of residents that are physically restrained have continued to decrease since 2019, countering a previous trend of increase between 2008 and 2018,” he said.

While there was a 16 per cent increase in seclusion episodes in 2022, the number of patients who were secluded has decreased.

In 2022, there were a total of 4,309 restrictive practices recorded nationally, which involved 1,653 residents of approved centres. This represented a decrease from 2021, when there was 4,636 episodes, involving 1,803 residents.

In terms of intervention types, there were 2,945 episodes of physical restraint in 2022. This represents a decrease from 3,460 episodes in 2021 (a 15 per cent decrease). A total of 1,078 people were physically restrained in 2022, compared to 1,145 people in 2021 (a 6 per cent decrease).

At a national level, physical restraint is used more frequently and widely than seclusion.

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The report said the use of physical restraint has continued to decline between 2019 and 2022 with respect to the number of episodes, duration of episodes and number of people restrained.

There were 1,364 episodes of seclusion reported by 26 approved centres in 2022, an increase from the 1,176 episodes reported by 27 services in 2021. However, in 2022, 620 people were secluded, a decrease from the 645 people secluded in 2021.

The use of mechanical restraint continues to be rare and the use of this form of restraint continued to decrease in 2022, the report stated. This practice has also been banned by the MHC in inpatient centres for children.

“The MHC will continue to monitor the use of all forms of restraint to ensure that approved centres operate within the rules and codes of practice. Enhanced reporting requirements, which were rolled out in January 2023, will support closer scrutiny of the activities of approved centres in this area,” Mr Farrelly said.

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