Alarm over use of security staff to restrain patients

Inspectors have expressed alarm that a mental health unit has been using security staff to physically restrain residents.

In a report into the acute psychiatric unit of the Mid-Western Regional Hospital in Ennis, Co Clare, the Inspector of Mental Health Services found two security staff were engaged in ordering and initiating the restraint of patients in some instances.

While this practice was originally introduced for the management of one individual, the 39-bed unit had since used security personnel in restraint of other residents.

Inspectors said it was alarming that in some instances these staff were the only people involved in restraint of residents without the oversight of nurses or doctors. This signified a “serious lack of knowledge by the service in respect of the code of practice on the use of physical restraint”, the report found.

Refurbishment

There did not appear to be a policy on the use of security personnel, inspectors found, and management was urged to ensure the centre complied with rules on restraint and seclusion.

“Physical restraint must only be initiated and ordered by registered medical practitioners, registered nurses and other members of the multidisciplinary care team,” it said.

The inspection took place last July but was only recently published by the Mental Heath Commission, the State's watchdog for psychiatric services.

Overall, the report found the unit was in need of repainting and refurbishment of showers.

“The interior decoration of the unit was in need of attention, with evidence of peeling paint, missing floor tiles and stained and grubby shower areas,” the report found.

However, it was reported that a programme of refurbishment of showers and painting was due to begin in the near future.

The unit was also found to be in breach of a condition requiring all residents to have an individual care plan. The report said this was a “serious breach” which needed to be rectified in order for the unit to continue to be designated as an approved centre. In addition, the provision of therapeutic services was not always linked to a resident’s individual care plan.

However, inspectors said there was evidence that the service had made a significant effort to improve the use of care plans, which it welcomed.

A more positive finding was that residents had access to a programme of activities including relaxation, exercise, art therapy and discussion groups, as well as to individual social worker sessions.

In addition there were three garden areas which were attractive and well maintained.

Conditions satisfied

Two other conditions attached to the continued operation of the unit in previous years were addressed to the satisfaction of inspectors.

These conditions included a requirement that all residents be accommodated in suitable sleeping quarters and a prohibition on the transfer of residents to another approved centre to alleviate bed shortages.