Psychiatric patient spent 12 days in isolation without shower

Adults in the psychiatric unit of the Midland Regional Hospital, Portlaoise, were kept in emergency seclusion for up to 12 days, in some cases with blinds drawn and without showering facilities, according to a report from the Mental Health Commission.

Under the Mental Health Act patients may be held “in seclusion” which may include bodily restraint where necessary, for treatment or to prevent harm to themselves or others.

But the commission found some patients were not allowed out of the emergency conditions – effectively solitary confinement – until they had “expressed remorse for their actions” which it found ethically unacceptable.

The commission also found children were accommodated in a high-observation dormitory with adults, and there were no age-appropriate facilities or programmes of activities for them. HSE policy which dictates children be cared for in their own single room was set aside in some cases, an inspection team found.

The “focused inspection” of Portlaoise psychiatric unit in June followed the raising of issues of concern by an earlier, routine inspection in December 2015.

Inspectors’ report

The Mental Health Commission found that between the two inspections 18 male and nine female patients were sent for seclusion on a total of 52 occasions.

The inspectors’ report noted:

* One patient spent 12 days in seclusion without a shower or being allowed visitors

*The same patient said the window blinds were never opened and they cried themselves to sleep.

* Nine individuals had prolonged episodes in seclusion ranging from 80 hours to 576 hours and 30 minutes (more than 24 days).

* One patient was described as “pleasant and engaging” after being in seclusion for 10 days, but remarked that “even in jail I’d get out for exercise”.

*The unit’s three seclusion rooms were located opposite the toilets and screens were used to ensure patients’ privacy during toilet visits, the report said.

The inspectors’ report said the “general principle” was “that seclusion is not prolonged beyond the period which is strictly necessary to prevent immediate and serious harm to the patient or others”. But the report notes this “ was not adhered to” in all cases.

In addition the report said the clinical file for one patient in seclusion noted: “Did not express remorse for earlier actions, to remain in seclusion.” The next entry, over two hours later noted the patient “expressed remorse for earlier actions. Seclusion discontinued.”

Other patients were described as “sullen in manner”; “demanding”; “unremorseful”; “continues to show no remorse for her actions”;“refusing to accept responsibility”.

The report said: “Expressing remorse for incidents that occurred during a period of severe mental illness must not be a requirement for ending seclusion. To do so is ethically unacceptable and excessively coercive.”

The risk level to adults was described as “critical” as was the risk to children accommodated in wards with adults .

The report also found there was non-compliance with regulations covering the making of individual care plans, and the ordering prescribing and administration of medicines.