Mechanical restraint use at children’s mental health unit ‘worrying’ - inspector

The use of mechanical restraints in a Dublin mental health centre for children and teenagers is a “worrying development”, according to an inspector with the Mental Health Commission.

The Linn Dara inpatient unit in Cherry Orchard was mechanically restraining young people using soft arm and leg cuffs, inspector Susan Finnerty found during an announced visit last July.

Dr Finnerty said the use of such tools at the Child and Adolescent Mental Health Service (CAMHS) was a “significant concern”. Nationally the practice is confined to the adult forensic mental health services and even then “only in very limited circumstances”, such as during transportation to the Central Mental Hospital, Dr Finnerty said. International guidelines “strongly recommend against” the use of mechanical restraint in children, she added.

“That mechanical restraint is being used in the delivery of general mental health services, and particularly in a child and adolescent centres, is a worrying development,” she said, adding that positive behaviour support and other alternatives are preferred approaches.

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One young person was being restrained with arm and leg cuffs for extended periods of times to protect others from injury. This was being used at night even when the young person was asleep. On three separate occasions the patient’s consultant psychiatrist was not notified of the use of restraint as soon as was practicable. Where the use of restraint was initiated by a registered medical practitioner, it did not follow a patient and risk assessment, nor was it always recorded in the clinical file, according to the report.

The chief executive of the Mental Health Commission, John Farrelly, described the mechanical restraint as “traumatic, counter-therapeutic and dehumanising”. It has “no place in a person-centred recovery focused mental health service, let alone in the care and treatment of a young person”, he added.

The Linn Dara psychiatric unit caters to a maximum of 24 young people under the age of 18 and has had a high compliance rate over several years, the report notes. The centre received an overall rating of 92 per cent compliance in its most recent inspection, but it had one example of “high-risk non-compliance” of the rules governing mechanical bodily restraint.

Inspectors also found that seclusion facilities were not maintained and cleaned to ensure respect for a young person’s dignity, as there were fluid stains on the walls.

In Co Cork, a psychiatric intensive care unit received an overall compliance rating of 74 per cent, with 11 areas of non-compliance, two of which were deemed “critical”. Following a process of regulatory escalation initiated by the commission, the Health Service Executive (HSE) agreed the Carriag Mór centre in Shanakiel would be reduced immediately from 18 beds to 10, with further bed reductions in due course.

The arrangement facilitates improved privacy, dignity and safety conditions for residents while “critical and necessary” upgrades get underway, the commission said in a statement.

During an announced visit last October, inspectors found that the overall physical environment of Carraig Mór had not been developed with due regard to the specific needs of residents. The 10-bed male dormitory did not provide residents with personal space, and residents had no facilities to make phone calls in private settings.

The communal dining room was too small to host all of the occupants at once, which could be an issue where challenging behaviour occurred in the dining room, the report notes. It was also flagged that fire doors were being held open with chairs and wedges.

Meanwhile, inspectors of the Vergemount Mental Health Facility in Ranelagh, south Dublin, found a series of hazards, including an exposed electrical wire close to a bathroom sink.

Therapeutic services, including social work and psychology, were “limited in supply and insufficient” and were “not directed at restoring and maintaining optimal levels of physical and psychosocial functioning of residents”, the inspectors noted.

The centre’s overall compliance rating dropped by 16 per cent since 2019 to 63 per cent. Inspectors recorded 11 issues of non-compliance, two of which were “critical” and eight which were rated as “high”.