Dublin mental health centre falls short on physical restraint code

A Dublin mental health centre has failed to comply with the code of practice on physical restraint for four consecutive years, an inspection report has found.

The 39-bed Elm Mount Unit at St Vincent’s University Hospital said the issue was now high risk.

Two episodes were recorded by the Mental Health Commission (MHC) where the staff member responsible for leading the physical restraint did not monitor the person's head or airway, and that this went undocumented.

In another case, inspectors noted, the physical restraint was not reviewed by members of the multidisciplinary team and recorded correctly.

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Generally, Mount Elm, which includes psychiatry of old-age and eating disorder services, was found to be in compliance with regulations at a rate of 67 per cent this year, compared to 63 per cent compliance in 2017 and 59 per cent in 2018.

There was also concern regarding the administration of medicine, specifically deficits in the prescription and administration record “which could potentially lead to medication errors”.

“There was not enough space for residents to move about in the psychiatry of old-age unit, or in the external courtyard,” it said.

Mount Elm was one of three inspection reports by the MHC published on Tuesday.

The Sligo-Leitrim Mental Health in-patient unit, a 32-bed acute facility, is in a building dating from the 1930s, and deemed unsuitable for providing a modern service.

Among its shortcomings, inspectors found, were that interview rooms where assessments were undertaken and where medical staff had resident meetings, were used as bedrooms. This was also the case with the seclusion room.

Opportunities were not provided to residents for indoor and outdoor exercise.Exercise equipment for men was broken, did not exist in the female ward, and accompanied walks were staff dependent and “rarely took place”.

Patient records had errors in medication prescription and clinical files were poorly maintained, so much so that it posed a risk to patient safety, the report found.

Overall, compliance with regulations reduced significantly from 79 per cent in 2018 to 66 per cent in 2019. “There has been no overall improvement in three years.”

‘Significant improvement’

Building work has commenced on a new approved centre on the campus of Sligo University Hospital.

However, at St Gabriel's Ward, St Canice's Hospital in Kilkenny – a 20-bed facility catering for residents aged from late 50s to late 80s – a "very significant improvement" in compliance was noted. This rose from 58 per cent in 2018 to 88 per cent this year.

"Overcrowding in approved centres reduces the dignity and welfare of patients and is something that is unacceptable," said MCH chief executive John Farrelly.

“Overcrowding in the female unit in Sligo-Leitrim and an increase in the number of people admitted with advanced stage dementia to Elm Mount due to the closure of a service in the Dublin region, is poor strategic planning for the mental health service and people deserve better.”