Mental Health Reform, the national coalition for mental health has expressed grave concerns about a number of issues highlighted in the latest inspection report from the Mental Health Commission.
According to the Inspection Report on the Department of Psychiatry, at the Midland Regional Hospital in Portlaoise, residents were kept in seclusion for more than 60 hours or 2 days at a time. The unit was also found to be non-compliant in relation to the prescription and administration of medications, obtaining consent for treatment, and with the code of practice for administering Electro Convulsive Therapy (ECT).
Commenting on the findings Dr Shari McDaid, Director of Mental Health Reform said, “The findings in this report are shocking and give rise to serious concern for the human rights of residents in the Portlaoise Unit.
Dr McDaid continued, “The fact that there were sixteen occasions in 2015 where individuals endured seclusion in excess of 60 hours is very disturbing. Furthermore, the lack of compliance with consent provisions and with the code of Practice on administering ECT, which were judged by the Inspectorate to be breaches of high risk, is extremely worrying.
According to the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment (CPT): “mechanical restraint and seclusion should under no circumstances exceed 24 hours.”
In its 16th general report published in 2006 the CPT noted “placing a patient in seclusion may produce a calming effect in the short term, but is also known to cause disorientation and anxiety, at least for certain patients. In other words, placement in a seclusion room without appropriate, accompanying safeguards may have an adverse result. The tendency observed in several psychiatric hospitals to routinely forego resort to other means of restraint in favour of seclusion is of concern to the CPT.”
The World Health Organisation (WHO) states that seclusion and restraint should be used “as a last resort only, for the shortest time necessary and never as a punishment”.
The MHC Inspection report also highlighted “potential for serious risk” associated with the use of the medication prescription and administration records (MPARs) at the Portlaoise unit.
As part of the inspection the MHC carried out a review of individual MPARs which according to the report confirmed a number of errors and uncertainties in the prescription and administration of medications at the centre.
According to the report “Among these were the use of separate prescription and administration records, the use of alphabetic codes to identify medications, and the mixing of p.r.n. (as required) and statim (given immediately) medications. Due to serious concerns …on the part of the inspection team at the potential for serious risk associated with the use of the current MPAR, a notice of serious concern was issued to the approved centre. The centre responded on 17 December outlining proposals to address the concerns raised.”
The unannounced inspection, which took place in December last year, also found that in relation to voluntary patients receiving ECT, while there was a written record of capacity to consent, “there was no record of separate cognitive assessment being undertaken prior to each administration of ECT. In the case of one resident receiving ECT, there was no signed consent for anaesthesia and no documentary record of assessment by an anaesthetist.”
Furthermore, the inspectors found that there was lack of compliance with procedures for obtaining consent for treatment under Part 4 of the Mental Health Act, 2001. The inspectors noted that subsequent follow-up showed the consent omission had “remained un-remedied for a further six weeks” after the initial inspection.
Mental Health Reform is also concerned at the seemingly high number of children being inappropriately admitted to the adult unit at Portlaoise.
Overall in Ireland, a total of 95 children were admitted to adult mental health units in 2015, however in its report on Portlaoise the MHC notes that in the 18 months since the last inspection in June 2014 a total of 21 children had been admitted to the approved centre.
According to Dr McDaid, “We understand that the MHC has escalated this issue to the National Directorate on a number of occasions and is expecting a lengthy report from the approved centre on the issues raised within the next week. It is vital that the MHC uses all of its available powers to ensure that the human rights of children and adults are being protected within mental health inpatient units.”
About Mental Health Reform
Mental Health Reform is the national coalition promoting improved mental health services and the social inclusion of people with mental health difficulties. The coalition currently has 54 members. See www.mentalhealthreform.ie for more details. Mental Health Reform acknowledges the support of the Department of the Environment, Community and Local Government’s Scheme to Support National Organisations 2014-2016.
For more information please contact:
Communications and Campaigns Officer,
Mental Health Reform,
Tel: (086) 171 1920 / 01 874 9469.