Breaches in psychiatric care cited in report

Hospital security guards were used to physically restrain patients in one of the busiest psychiatric units in the State last year, while in another staff were not trained to deal with violence and aggression, putting themselves and patients in danger, the latest reports from the Inspector of Mental Health Services reveal.

The report on the psychiatric unit in Connolly Hospital is also critical of the lack of privacy for patients, unwelcoming facilities for visitors, unacceptably dirty smoking area for patients and the fact that a child was resident in the adult unit on the day of inspection.

Some 13 inspection reports were published yesterday, the fourth batch of reports from the inspector this year. Under the Mental Health Act 2001 the Inspectorate is required to inspect all approved centres for mental health services once a year.

An unannounced inspection on February 11, 2014, found Connolly hospital’s 49-bed department of psychiatry was not compliant with regulations on physical restraint.

Next-of-kin not informed

In one episode of physical restraint, the patient’s next-of-kin were not informed. In another case it was not recorded in a second patient’s file. Neither resident was given the opportunity to discuss their episode of physical restraint with the multi-disciplinary team and there was no evidence the episodes were reviewed by the team.

“The... records indicated that health care assistants and security personnel had assisted in the application of physical restraint on a number of occasions. The department of psychiatry did not address the use of security personnel in this regard, nor was there evidence that these staff had been trained.”

This was a breach of the Mental Health Act regulations.

The report also found bedroom window blinds were broken and “some residents were required to sleep in beds that were open to oversight from wards on floors above, from the... courtyard or from external public pathways.”

There was one child in the unit, in a single room with one-to-one nursing care. There had been 14 child admissions in 2013 and four “thus far” in 2014.

There was a "lack of education and training for staff" at the Aurora Unit in St Joseph's Hospital, Limerick.

An unannounced inspection of the seven-bed unit conducted on June 5 found: “No nursing staff had been trained in the prevention and management of aggression and violence, despite the fact that this was a ward for residents with challenging behaviour. This was a danger for both residents and staff.”

Entirely unsatisfactory

On May 13, in St Fintan’s Hospital in Portlaoise, a female resident was sleeping in a male dormitory with only a curtain around her.

“This was entirely unsatisfactory and impacted on her privacy and dignity,” says the report.

In St Brigid’s Hospital, Ardee, Co Louth, the “majority of the individual care plans were very poor and did not meet the requirements” of the legislation. “It was clear that there was little understanding among staff of the care planning process.”

The 46-bed unit was inspected on April 29 and 30.

An unannounced inspection of O’Casey’s Rooms in Fairview, Dublin, a 24-bed unit for elderly residents transferred from St Ita’s in Portrane, took place on February 18.

“The environment did not adequately meet the needs of mental health residents. The layout did not permit socialisation. There was no adequate garden space. This made for an impoverished environment and diminished quality of life for the residents, some of whom would see out their days in this service.”

There was evidence of “carelessness or lack of knowledge” in the completion of patients’ records in the 52-bed acute psychiatric unit in Tallaght hospital. It had an unannounced inspection on June 10 and 11. The “privacy and dignity” of patients were “compromised by the absence of curtains” in the unit.

A full list of inspection reports from the Mental Health Inspector can be found at www.mhcirl.ie