The commission’s report raises serious concerns over the lack of access to the Child and Adolescent Mental Health Service and fears over unregulated 24-hour community residences in which an estimated 1,300 people live.
These and other long-running issues prompted commission chairman John Saunders to query whether the Government and service providers ever intend to bring about “meaningful change”, adding that “the commission is strongly of the view that there is apparently little heed given to the commentary of the commission by the Department of Health or Health Service Executive”.
In his foreword to the report, Mr Saunders states that the commission is “dismayed at the pattern of issues that have been consistently highlighted in annual reports dating back to 2012”.
These include the inappropriate admission of children into adult mental health in-patient services, inadequate staffing levels, dirty and dilapidated premises, and widespread use of restrictive practices such as seclusion and physical restraint “as a normalised behaviour in services”.
It found that 82 children were admitted to 21 adult units last year — an increase from 68 in 2016. The most common reason reported was an immediate risk to self or others combined with unavailability of a bed in a child unit. Of 28 involuntary admissions of children to approved centres, four were to adult units.
Speaking ahead of the publication of the report today, Mr Saunders said: “The buck stops with the Government and the Department of Health and the minister.
“People are hearing what we are saying, but I don’t think they are listening to what we are saying.”
One key aspect is the budget allocated to mental health. While it was increased in the last budget, it is still below the recommended level and the EU average. Mr Saunders said there had been some progress in certain areas and incremental improvements across the board over a longer period of time, but serious deficiencies remain.
Chief among those are services to vulnerable people with long-term mental illness accommodated in 24-hour community residences not subject to regulatory oversight, which the report refers to as “a glaring and inconsistent pattern of standards in service provision”.
“If we have a service like that definitely there is a greater risk of something happening that is either an accidental event or an abusive event,” he said.
As for the issues with the Child and Adolescent Mental Health Service, inspector Susan Finnerty, said between 50% and 75% of children with severe mental difficulties can go into adult life carrying those problems with them, meaning early intervention is vital to avoid facing “a lifetime of risk”.
HSE unable to provide number for residences
The Inspector of Mental Health Services has said it is "incredible" and "unsatisfactory" that for a number of years the HSE has been unable to even provide a figure regarding the number of 24-hour residences around the country.
The Report of the Inspector of Mental Health Services - incorporated into the annual report of the Mental Health Commission - highlighted issues at the centres, including that just 44% were in good physical condition and 19% required urgent refurbishment. Residents were not free to leave in 14% of residences and only 59% of residences offered all those living there single-room accommodation.
According to the report: "As we had failed for 2015 and 2016 to get an accurate list centrally from the HSE, we sought information from each CHO individually in 2017.
"Again, when we came to inspect 24-hour residences in 2017, this information was inaccurate."
In 2005 there were 127 24-hour supervised residences and last year the Inspector and her team estimate there were 118 such residences remaining.
Speaking ahead of the publication of the report today, Dr Susan Finnerty, Inspector of Mental Health Services, said her team compiled their own list "literally by going out and visiting them all".
The report also highlighted concerns over access to CAMHS and how staffing shortages have periodically closed in-patient CAMHS beds. Young people often had to be admitted to CAMHS units far from their homes and families, with someone in Letterkenny facing a 500km round-trip to the nearest CAMHS in-patient unit in Galway.
It said three of the five CAMHS approved centres used seclusion and that it was often difficult for referral agencies to source a CAMHS bed even when beds were empty, adding it was "frustrating, time-consuming and often resulted in a young person being admitted to an adult mental health unit."
Across the services generally, the Inspector’s report noted 47 notifications of seclusion exceeding 72 hours, while 41 approved centres were non-compliant with the Code of Practice on Physical Restraint.
Some 427 deaths were reported to the MHC last year, including 212 sudden and unexplained deaths, including 153 suspected suicides.
Thirteen suspected suicide deaths occurred within a week of their discharge from an in-patient service, while nine deaths reported as suspected suicides occurred while the person was on leave or absent without leave. The MHC took 57 enforcement actions in relation to 28 approved centres and 34 of these related to Serious Reportable Events.