Most mental health facilities in Ireland are dirty, smelly and poorly maintained, according to the latest annual review by the inspector of mental health services, Dr Susan Finnerty.
Dr Finnerty said the degree of dirtiness and shabbiness is unacceptable and shows disrespect for patients' dignity.
Seven out of ten in-patient mental health services registered by the Mental Health Commission remained “dirty, malodorous and poorly maintained” last year, her report states.
Also, a number of centres remain unsuitable and not fit for purpose.
Dr Finnerty points out that overall compliance with regulations by the centres increased from 76% in 2017 to 79% last year.
“That is positive and we welcome those trends,” she said.
“However, there is a significant number of approved centres which have, on a consistent and sustained basis, failed to provide the most basic and fundamental aspects of a service, such as privacy and cleanliness.”
Dr Finnerty said there is no justification for some of the low levels of compliance highlighted in her report: “It points to a significant governance and management deficit within our mental health services."
Dr Finnerty said the commission will continue to work with the providers but it is difficult to see how some of the lowest compliant centres can be registered in the future without significant improvement.
Only 46% of supervised residences were in good physical condition and 19% need urgent maintenance and refurbishment.
Hope and dignity are key elements of any mental health services and, from the evidence of this report, not all approved centres are providing that – either through the service itself, or the physical buildings in which they operate.
The Mental Health Commission's annual report also highlights ongoing concerns about child and adolescent mental health services.
There were 408 people under the age of 18 were admitted to approved centres last year - a decrease of 31 compared to 2017.
However, 84 children and adolescents were admitted to 18 adult units during the year.
The commission's chief executive, John Farrelly, said the placement of any child in any adult unit indicates a gap in service provision: “A child or adolescent's first introduction to mental health care should not be through a service or building which is not specifically equipped to deal with their needs."
Of the 27 centres that continued to use seclusion last year, 67% were non-compliant with the rules.
There were 52 (81%) centres that used physical restraint last year but just one in five (19%) were compliant with the code of practice.
Last year the commission initiated its first ever prosecution against a centre under the Mental Health Act 2001 after finding that some patients were deprived of basic dignity and human rights by being secluded in a room that was dirty, malodorous, badly lit and badly ventilated.
Mr Farrelly said the commission has started a process to ensure that the system changes and becomes more compliant with the rules.
There were 2,435 involuntary detentions last year, with the highest number of admissions among people aged between 35 and 44. There were 2,337 such admissions in 2017.