Unless fundamental changes are made, the St John of God's Order could be in breach of European human rights directives, writes Mark Hennessy.
Surrounded by some of his Cabinet colleagues, the Taoiseach, Mr Ahern, will tomorrow, amid considerable fanfare, launch the European Year of People with Disabilities in the Mansion House.
The EU-funded year is designed to raise awareness of the rights of the disabled, "reflect on what should be done to promote equal opportunities" and highlight their positive contribution.
However, the other side of life for the mentally and physically disabled in Ireland is represented by a sharply critical report on St Mary's, Drumcar, Co Louth, which has been seen by The Irish Times.
Run by the St John of God's Order, St Mary's cares for 256 patients varying in age from 19 to 60, at its centres in Drumcar and at Riverside, Dunleer.
The document, which was commissioned by the Order itself from two English companies, 1066 Consultancy and Healthcare Consultancy, was presented to the Department of Health shortly after its completion last November.
It makes for sobering reading.
Some of the patients are epileptic, some have IQs of less than 20, some are prone to injure themselves, some are autistic, some are schizophrenic. Some in their 40s already have Alzheimer's. Some are very aggressive.
Demanding "fundamental changes" in the home's culture, the UK consultants warn that St Mary's, which is currently 100 staff short, uses straitjackets to restrain patients and locks them into their rooms.
"The present shortage of staff leaves the organisation at risk of potential harms to clients and staff due to lack of supervision," says the report.
But staff alone will not cure all of the ills of St Mary's. "However, the increase in the staffing levels must be undertaken in conjunction with some fundamental changes to the culture and staff attitudes if the increase in staffing is to make a meaningful difference to the quality of life of the residents," the report goes on.
Currently, whole wings are left unattended, particularly at night, while staff struggle to cope with demand elsewhere, "leaving the residents at risk, particularly those with epilepsy and the potential to self-harm".
The "over-use of mechanical restraints" to subdue difficult patients during the day, and particularly at night, is strongly questioned by the English consultants.
"There was evidence that some staff use restraint, in the form of all-in-one suits, more than other staff as a matter of routine. The organisation could be in violation of European human rights directives," the consultants write.
"The mixture of violent and aggressive residents with more passive and introverted residents puts the latter at a disadvantage, as staff spend the greater percentage of their time with the demanding residents.
"Also, these residents are intimidated by the more aggressive residents. The quality of life for all these residents would be improved if they lived with people of similar disabilities and abilities."
The lack of stimulation available to patients is causing serious problems at St Mary's. "As a consequence, their behaviour becomes more aggressive, destructive and violent.
"At night, many of these residents are locked or shut in their room and unable to open the door unaided. We believe that in the event of a fire the mortality rate would inevitably be high and the organisation culpable."
Pushing for action as a matter of urgency, the experts continue: "Custodial practice has become the normal routine, and staff need to ensure that they are supporting the resident to lead a life that is as fulfilling as possible and includes his/her physical, psychological, social and spiritual needs.
"There is a lack of research and evidence-based practice, which needs to be part of the organisation's approach to improving the quality of care for the residents."
Currently, St Mary's should have 203 full-time staff, but it has 197. Following an analysis of data for 2001 and 2002, and a week on-site last September, the consultants believe St Mary's should have 287 staff.
Although St Mary's is below its currently funded staffing levels, the gaps are even more pronounced in key nursing grades. It should have 160 staff nurses. Instead, it has just 114.
"There is heavy reliance upon seasonal workers, shortage of nursing staff and a lack of evidence-based practice supported by a clinical nurse specialist.
"The result is that practice is out of date, the care is custodial, restraint is common practice and residents' needs are not always met," the experts complain.
Warning that the safety of patients is at risk, they go on: "It is strongly recommended that 30 whole-time equivalent nursing staff are recruited to cover the night shift, as a matter of urgency, as the present staffing levels put the residents' safety at risk."
Last night the St John of God head of St Mary's, Father Fintan Brennan-Whitemore, said: "This is a very difficult place for staff to work.
"Patients are getting older. Their needs are becoming more demanding. And their needs are not static. If you come back here in two years' time, St Mary's will not need 97 staff, but, say, 115."