Review finds ‘critical risks’ at mental health centres

Concerns have been raised around the welfare of residents in two mental health facilities in Cork and Dublin after inspectors identified problems in relation to staffing availability, consent to treatment and individual care plans.

A review of St Finbarr's Hospital on Douglas Road in Cork by the Mental Health Commission warned of a "critical risk" at the centre due to a lack of staff training in risk management. Limited staff availability also meant residents could not access their bedrooms until 10pm.

The bedroom area was locked from 9.15am-10pm meaning that the 21 residents in the centre could not access their bedrooms during this time, notes the report. A proposal was made in 2017 to recruit a “twilight” member of staff to allow access to bedrooms from 6pm but this has not yet been implemented.

Inspectors write that the number of staff at the centre and their respective skills did not adequately address the residents’ needs and that not all staff had received training in areas “deemed essential” under the relevant regulation. Clinical staff had not been trained in individual risk-management processes, clinical risks were not identified, assessed, treated, monitored and documented in the risk register and there was no emergency plan with specified responses from staff to possible emergencies and evacuation procedures.

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Residents at the centre were not comprehensively assessed within seven days of admission, meaning there was no assessment of their current physical health, their medical, psychiatric, and psychosocial history and whether they were on medication, among other issues.

An inspection of Bloomfield Hospital in Rathfarnham, Dublin, also warned of a critical risk around the consent of treatment from residents. Inspectors who visited the 114-bed facility in February and March 2018 found that certain clinical files did not include a record of discussions with patients regarding the effects of their medication, including risks and benefits.

One form included details of a discussion with a patient around the benefits of medication but not the risks. Three forms did not confirm whether the patients understood the nature, purpose and likely effects of their medication, while four forms did not contain evidence that the responsible consultant psychiatrist had undertaken a capacity assessment.

Staff were not trained in care for residents with an intellectual disability and not all staff were trained in fire safety, basic life support or management of violence and aggression, writes the report.