End-of-life care causes concern at mental health centre

Inspections have raised concerns over the standard of food at the Central Mental Hospital and, in some circumstances, undignified care for the dying at another mental health facility.

End-of-life care causes concern at mental health centre

Six inspection reports by the Mental Health Commission showed a generally high standard of care and good practice, but also highlighted areas of non-compliance, including the 103-patient Central Mental Hospital (CMH), Dundrum.

One area of non-compliance was related to the provision of food. According to the report: “Service users were provided with meals during the day but complained that there was no food available in some of the wards between 6pm and 8am. Sandwiches were provided at 7pm on one ward whereas other wards only served a cup of tea.

“The approved centre was non-compliant with this regulation because patients were not provided with any food after their 5pm meal, meaning that they were not provided with food and drink in quantities adequate for their needs.”

Overall, the CMH was not compliant with regulations in six instances but compliant in the other 24.

The report said: “During the inspection, the kitchen areas in individual units were dirty and posed a risk of cross-contamination. Uncovered food was observed in one kitchen where flies were observed. Although the main kitchen was clean and maintained to a good standard of hygiene, the ward kitchens were dirty. All bins were kept in an open position, exposing waste and attracting flies. There was no evidence that food safety audits had been undertaken.”

It also said the premises were not clean, hygienic, and free from offensive odours and pinpointed some cases where bedrooms were of an inadequate size, some shortcomings in staff training, and instances where ligature points had not been mitigated. It said that, in one case where physical restraint was used, a registered medical practitioner did not complete a medical examination of the patient within three hours.

The report into the Highfield Hospital in Whitehall, Dublin 9, meanwhile, found the service provided there was of a generally high standard but it said there was a high risk attached to the non-compliance with regulations when it came to care of the dying.

According to the report: “Residents’ deaths were not always handled with dignity and propriety, as they were not always offered a single room to receive end-of-life care. If single rooms were not available in the approved centre, the resident received end-of-life care in a four-bed shared room.

“The bed screens in the four-bed shared rooms did not afford privacy as the mobile screens were too low, and this meant there was difficulty in accommodating the needs of each resident’s representatives, family, next of kin, and friends during end-of-life care. In one room, the large pull-across screen was broken which meant that only two of the beds could be given privacy but only one at a time.”

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