Children still ending up in adult mental health facilities

Children continue to be admitted to adult mental health facilities deemed inappropriate to their needs, a new series of reports has found, despite strong criticism of the practice last year.

The Mental Health Commission (MHC), which conducts site inspections, found the practice had continued in a number of facilities during 2017.

It identified Acute Psychiatric Unit 5B at University Hospital Limerick, the Centre for Mental Health Care & Recovery at Bantry General Hospital, the Lakeview Unit at Naas General Hospital and the Ashlin Centre in Dublin as having admitted children despite having no age appropriate facilities.

The Department of Psychiatry at University Hospital Waterford and the Drogheda Department of Psychiatry had also admitted children despite not having appropriate facilities or a programme of activities.

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The MHC is an independent body responsible for protecting the interests of those involuntarily admitted to care facilities.

Reports

Its inspection reports published on Thursday found not one of the nine institutions it reviewed was fully compliant with regulations.

Inspectors found that three children had been admitted to Unit 5B in Limerick since its last inspection.

“The approved centre did not provide age appropriate facilities and a programme of activities appropriate to the age and ability of the child residents and the overall accommodation was not suitable for a child resident,” it said.

Although children were assessed on their educational requirements, no facilities were available for the provision of education.

At Bantry General Hospital, one child had been admitted in 2017 but again, appropriate facilities and activities were not available, including a segregated bathroom.

The report noted that three children admitted to the Ashlin Centre in Dublin had no access to age-appropriate advocacy services.

Last year the MHC said the “continued admission of children and adolescents to adult mental health units remains a totally unacceptable but common feature of mental health care practice in Ireland”.

However the issue is just one of a number outlined by the MHC. Its latest round of reports also looked at problems with individual patient care plans and consent to treatment, particularly electroconvulsive therapy (ECT), formerly known as electroshock therapy.

Other issues that arose in various institutions related to privacy and dignity, the use of physical restraints and end of life care. Not one of nine centres inspected was found to be fully compliant with regulations.

"There are, yet again, considerable levels of non-compliance," said Dr Susan Finnerty, inspector of Mental Health Services. "The regulations, rules and codes are in place to ensure a minimum standard of care. To see continued and in some cases repeated non-compliance with modern standards is unacceptable."

Limerick

University Hospital Limerick was also found to have four residents sleeping in its reception area on the day of the inspection as their bedrooms were locked during the day.

Facilities there were also considered “unacceptable” with a utility room in its old age area having an “overpowering” smell of sewage, as well as stained surfaces, dirty windows and “unkempt” garden areas among myriad identified faults.

For the third consecutive year the hospital was found to be non-compliant with consent to treatment rules.

In the case of one patient, an “assessment of capacity to consent to ECT” was incomplete and there was no evidence a discussion about the treatment took place with the resident or next of kin.

At St Davnet's Hospital, Blackwater House in Monaghan, inspectors found that a GP was not always requested to review residents in declining health.

“None of the files inspected contained the residents’ or their families’ wishes relating to end of life care or Do Not Attempt Resuscitation (DNAR) orders,” its report said.

In two other cases, residents there were nursed in a nine-bed dormitory during the provision of end of life care.