HSE fined over condition of Kilkenny psychiatric unit

Conditions found by inspectors in a HSE psychiatric unit were a physical manifestation of a lack of care afforded to mental health patients, a judge has said.

A seclusion unit used to detain troubled patients at St Luke’s psychiatric unit in Kilkenny was found to have ingrained dirt on the floor, no natural light and a ventilation fan clogged up with dirt during an unannounced inspection last November.

The HSE pleaded guilty at Kilkenny District Court to two charges relating to physical conditions at the unit and two charges relating to the failure to have a consultant psychiatrist sign patient seclusion orders within 24 hours of the seclusion taking place, as was required by law.

Judge Brian O'Shea fined the HSE a total of €5,200 following the prosecution, the first of its kind taken by the Mental Health Commission under the Mental Health Act.

The court heard that more than €1 million has been spent by hospital management on remediating the problems found by four inspectors last November.

“The inspectorate function of the Mental Health Commission (MHC) is a hugely important one,” the judge said.

“For too long in this country, mental health issues have been ignored and stigmatised. The testimony of the inspectors and photographs [taken during the inspection] are the physical manifestation of that lack of care.

“What makes this worse is that the facilities here are those that house the most vulnerable people. Those people matter and the environment in which they are cared for matters,” the judge said, adding that were it not for the inspection process, there would be “no mechanism” to bring such conditions to the outside world.

Sub-standard conditions

The judge said that a comment made by assistant inspector Martin McMenamin that the state of the facility in Kilkenny “runs counter to everything a hospital should stand for” speaks volumes about the offences detected.

He didn’t accept an “over-capacity argument” put forward by the HSE as part of the reason for the sub-standard conditions at the time “as much more than an excuse”.

Giving evidence, Mr McMenamin submitted photos to the court.

These showed, in the seclusion room, “ingrained dirt on the floor” and “hardened patches of what I take to be food substances”. He said “the floor was tacky, shoes were sticking to the floor” and the room hadn’t been cleaned properly “for quite a while”.

The air in the seclusion room was “stale and heavy,” Mr McMenamin said, and there was no natural light. “The ventilation system was clogged with debris and dirt,” he said.

There were also cobwebs in the room and staining on the walls which was “possibly bodily fluid”.

Another photo showed a corridor floor whose edges were “very heavily contaminated with dirt,” the inspector said, and there was an electrical switch with a hole underneath it which “would present a hazard to a vulnerable person who might have been able to cause harm to themselves”.

A dormitory had a shelf where a partially-filled urine bottle was sitting alongside cups used by residents for drinking.

The inspectors visited a room used for electro-convulsive therapy (ECT) but were “almost assaulted” by a “heavy, pungent smell” which made them retreat outside to catch their breath. On investigation, the smell was found to be coming from a colostomy bag which had been left in a clinical waste bin in the ECT room.

Shane Costelloe SC, for the HSE, said “a remarkably different picture” was now in place regarding the conditions at St Luke’s psychiatric unit, compared to last November.

The judge fined the HSE €1,800 on each of the two charges relating to conditions at the unit and €800 on each of the two charges relating to the non-signing of seclusion orders.

MHC chief executive John Farrelly, said it was “a landmark day” for mental health services and welcomed the judge’s comments on the “stigma” faced by mental health service users.