Staff at Cork mental health unit found to be dismissive and negative around patients

A Cork mental health hospital is operating a culture reminiscent of the kind that "might have been provided decades ago", the Mental Health Commission (MHC) has warned.

An inspection of St Stephen’s hospital on the north side of Cork found staff in one unit could be “dismissive” of residents and negative about the likelihood of improvement in their lives.

The MHC inspected the 87-bed hospital between August 3rd and 6th, and conducted a follow-up inspection on unit three, about which it had particular concerns, on August 16th. Following this inspection, it ordered the hospital to reduce admissions to the unit.

Governance arrangements, described as “inexplicable”, were having a “detrimental” impact on patients in the unit, the commission said.

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While others were under management of North Cork Mental Health Services, unit three, which comprised 18 beds for male residents with severe and enduring mental illness, was under North Lee services.

“This had resulted in lack of oversight of the unit, with consequent absence of recovery-focused care,” the report said. “The general demeanour of a small number of staff and the way in which they addressed and communicated with residents was not appropriate at all times. This communication was observed to be dismissive on two occasions.”

The hospital overall was found to be non-compliant with standards, including critical non-compliances on individual care planning and risk management.

Inspectors found the person responsible for risk management was not known by all staff; fire doors in two separate units were both failing to fulfil their function as fire doors, meaning there were not adequate precautions in place to control for the management of fire risk; windows on two units needed to be replaced; and ligature points remained in the centre.

Inspector of mental health services Dr Susan Finnerty said it was clear the centre had "systemic issues when it comes to premises, risk management, therapeutic services and programmes, and individual care planning.

“I was particularly concerned to note the culture in one unit was reminiscent of a model of mental health care that might have been provided decades ago.

“There was a general attitude of negativity about the possibility of improvement in the lives of the residents. There was an emphasis on what they could not do, their potential for aggression, and the fact that they would always require this type of care.

“This resulted in limited therapeutic input for these residents, absence of care based on recovery principles, and an environment that was stark and lacking in comfort. It should really go without saying that we need to completely remove any last vestiges of this attitude and approach to mental health care from our services.”

MHC chief executive John Farrelly said the reports underlined a need for the Health Service Executive (HSE) to improve governance, management and oversight of investment in inpatient mental health facilities in the greater Cork area.

“The HSE has shown in other areas and in other counties within this community health organisation a clear capability to wisely use the funds allocated to it by the State. We will continue to be concerned about patterns of non-compliance across a number of centres in Cork and we continue to monitor this matter closely.”

The HSE did not issue a response to the report.