The Mental Health Commission has said people using services are too often seen as "second class citizens" as its latest report showed many relying on old, dirty and outdated facilities.
Last year the Commission took 40 enforcement actions against 31 Approved Centres in response to critical risks in areas of practices relating to premises, staffing and the privacy and dignity of residents.
It also secured its first-ever prosecution under the Mental Health Act 2001 on foot of findings that patients were "deprived of basic dignity and human rights by being secluded in a dirty, malodorous, badly-lit and badly-ventilated room".
"Unfortunately, based on the data, the pattern of poor practice in relation to seclusion and physical restraint is not limited to one or two centres, but is more widespread," the Commission's chief executive, John Farrelly, said.
"The Commission has commenced a process to ensure that the system changes and that services become increasingly compliant with the rules. It is clear that a significant amount of premises are no longer suitable and need to be replaced."
The report shows there were 2,390 involuntary admissions to an approved centre last year. From January 2019, an extra safeguard was introduced that if a patient is detained on an order for up to six months, they are entitled to an additional review by a tribunal if still detained after three months. Yet only 16% of the total number of patients eligible for an additional review sought one.
"The uptake is considerably less than expected," the report stated.
According to the report, 563 deaths of people using mental health services were reported to the Commission last year - 166 related to approved centres and 397 to other community mental health services. Also, 168 deaths were reported to the MHC by the services as ‘suspected suicides’.
The Commission was also notified of 41 Serious Reportable Events: 11 causing a serious disability associated with a fall, nine of sexual assault on a patient or other person; eight stage 3 or 4 pressure ulcers; five criminal events resulting in death or serious injury; five sudden unexplained deaths or injury which result in serious disability; two classed as 'other'; and one death or serious disability associated with a patient absconding.
The total number of admissions of young people to approved centres in 2019 was 497, an increase from the previous year, while there were 54 admissions of children to 15 adult units, a decrease compared with the figure for 2018.
But given the small number of CAMHS beds, the report said: "Children and young people in crisis are left with the unacceptable ‘choice’ between: an emergency department, general hospital, children’s hospital, or an adult in-patient unit."
It also said the failure to fully commence the Decision Support Service meant "hundreds of people continue to be taken into wardship, thousands of people remain vulnerable to financial and other abuse, hundreds of thousands of people lack the formal frameworks to plan ahead, and to be supported to the fullest extent to make decisions about their own lives."
The MHC said that while significant progress has been made towards implementation, "we all need to act now to be ready for commencement".