Children still being placed in adult psych unit

The controversial placing of children in an adult psychiatric unit at University Hospital Limerick (UHL) is continuing despite the practice being condemned by the Mental Health Commission.

The commission noted five children had been admitted to the Acute Psychiatric Unit 5B at UHL since a previous inspection in 2017 when it had criticised the practice.

Children, however, continue to be admitted to the unit notwithstanding the absence of age-appropriate facilities and a programme of activities. Inspectors who visited the 42-bed unit last November could not find any documentary evidence to show a child’s view was being heard.

Children did not have access to child advocacy services and clinical files did not record that they had their rights explained.

A mental health policy document, A Vision for Change published in January 2006, recommended children be admitted to age-appropriate inpatient facilities.

Inspector of Mental Health Services, Dr Susan Finnerty said admitting any child to an adult service should only occur in exceptional circumstances.

“A contributory factor to the continued admission of children to adult units is a shortage of operational beds in dedicated child units,” she said.

In 2017, the MHC said the continued admission of children and adolescents to adult mental health units remained a totally unacceptable but common feature of mental health care practise in Ireland.

During the unannounced visit, last November, inspectors also recorded the unit was not kept in a good state of repair, both externally and internally. There was damaged flooring, cracked glass on a door observation panel, poor ventilation and internal paintwork was unfinished.

A cleaning schedule had been implemented since the previous inspection and while the unit was clean inside, outside areas were dirty.

One of the gardens had a lot of cigarette butts and other rubbish. The main garden was dirty including the seating area.

There was no evidence to show all residents were consulted about their individual care plans.

University Hospital Limerick.
University Hospital Limerick.

Also, seven of the nine plans inspected did not identify the resources required to provide the care and treatment identified.

Dr Finnerty said care plans were a crucial part of supporting and helping the recovery process.

The unit provided the MHC with corrective and preventive plans to address areas of non-compliance and the commission will seek an update in three months.

Meanwhile, inspectors also found the Lakeview Unit in Naas General Hospital, Co Kildare was too small and the layout unsuitable for the care and treatment of people with mental illness.

Television could only be accessed after 8pm in the downstairs sitting room which had 11 chairs for a unit with 29 residents.

Due to the layout, it was considered necessary to operate as a closed facility with locked external doors and with limited access to the garden.

Occasionally, overcrowding had led to the use of the seclusion room as a bedroom for residents who did not need to be there which was against the rule governing the use of seclusion.

The commission’s director of standards, Rosemary Smith, said overcrowding was a safety concern and was not good for the health and wellbeing of residents.

“The commission subsequently issued an immediate action notice to address these concerns and has been monitoring this issue on an ongoing basis,” she said.

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