Mental health report warns of gap between public and private standards

Mental health facilities run by the Health Service Executive (HSE) are lagging behind independent and private providers in standards of care, an oversight body has warned.

The annual report of the Mental Health Commission (MHC) said a gap emerged last year between the HSE and independent providers both in terms of the quality of premises and the level of care for individuals.

Private providers also tend to have higher overall compliance rates with MHC standards than HSE-run mental health facilities, according to the report.

MHC chief executive John Farrelly said that, while there had been investment in premises, the current approach to improvements in HSE centres is “inadequate”.

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The gap can only be closed by a targeted, funded strategic capital investment programme for the public system, he stated.

The report also identified a “marked difference” between the standards of care provided in HSE community healthcare organisation (CHO) Area 5 (South Tipperary, Carlow/Kilkenny, Waterford and Wexford) where the compliance rate was 97 per cent.

This compared to 82 per cent in the CHO Area 4 consisting of the counties of Kerry, North Cork, North Lee, South Lee and West Cork.

Speaking on RTÉ Radio’s Morning Ireland Mr Farrelly said the situation around the country was that private and independent centres were highly compliant of the regulations, particularly with regard to premises and individualised patient care, however, that was not the case with HSE-run premises. The commission has been trying for a number of years to improve services in Cork where five of the HSE premises were “really unsuitable”, he added.

“People who don’t have private health insurance will be going into those premises in Cork which are also low in terms of individualised patient care, meanwhile someone who lives in the Dublin area, where the majority of private and independent centres are, who has private health insurance, they have much better choice and access and that’s not equitable and it’s not fair.”

Mr Farrell praised improvements in the CHO5 area. “Some years ago that area was in trouble but they invested in new buildings, they invested in their governance and management structure. The chief officer there pulled special teams together to bring the whole place up and it worked. So you would have to beg the question then if it can happen in one CHO area why can’t it happen in the other.”

The commission implemented 42 enforcement actions last year, of which seven were critical risks around premises, said Mr Farrelly. “What we do is we put an action plan in place, if that doesn’t work we then escalate it up to the regional, but in Cork it’s at the national level.

“Even in dealing with the HSE at national level we’re not assured that Cork will come into line. Quite simply it needs a targeted, funded, strategic capital investment and not in the way it’s being done at the moment where the people of Cork will be told in 10 years’ time you have something or we have to close your centre because it’s not good enough.”

The HSE’s process for putting buildings in place and maintaining them needs to change, he added.

“Over the last number of years we’ve increased the compliance rate up to 80 per cent across the country, there’s nothing lower than 68 per cent, but we’re trying to extract the data. So now what we’re saying is it’s about individualised care planning,” he said.

“It’s not just having a building and putting someone in and giving them medicine, it’s about an individualised care programme for them in proper buildings and premises that are well staffed. We now have it down to three or four sentinel issues so people are listening, but at the same time we have to make sure that the local system responds appropriately.

“If the HSE is capable of doing it in one area they can do it in another area. People talk about Sláintecare, but it’s not going to make a difference in Cork if the buildings are not up to scratch”.