Residents in mental heath facilities need 'meaningful therapies'

Cappahard Lodge: gaps in occupational therapeutic services, says watchdog. Picture: Brian Arthur

Mental health facilities must provide “meaningful” therapies to residents, the Mental Health Commission has warned after significant breaches were identified at HSE long-stay centres in Co Cork and Co Clare.

The mental health watchdog found gaps in occupational therapeutic services at the Owenacurra centre in Midleton, Cork, and in Cappahard Lodge in Ennis, Co Clare, following inspections in February and March, prior to Covid-19 public health restrictions.

An occupational therapist had been leading a rehabilitation programme with residents at the 24-bed HSE-run Owenacurra centre for five hours a week but the service had been discontinued, which represented a "critical" non-compliance.

At the HSE-run Cappahard Lodge, only three occupational therapy sessions were scheduled per month, which represented a "high risk" non-compliance. At the time of inspection, an occupational therapy group was held in four of the previous eight weeks.

The therapeutic services and programmes provided at both centres were not appropriate and did not meet the needs of residents, inspectors found.

We released three inspection reports this morning which found two critical and three high non-compliances across three mental health centres.

Our statement: https://t.co/ITLj96AkwG pic.twitter.com/udYspWRy8s

— Mental Health Commission Ireland (@MHCIreland) December 10, 2020

“Meaningful therapeutic programmes are used to evaluate, facilitate, restore and maintain an individual’s ability to meet demands in his/her life and are agreed with the service user and determined within the individual care and treatment plan,” inspector of mental health services Dr Susan Finnerty said.

There is little point in these programmes being identified and logged in individual care plans if they are not ultimately implemented. 

"It is essential that all services provide what has been agreed with the service user to help them improve and make progress,” she added.

Privacy breaches due to the layout of the Midleton centre were also identified as a "high-risk" non-compliance because a day centre and public offices shared a corridor with residents’ bedrooms. There were also issues with the upkeep of the building.

Despite the breaches, the Midleton centre improved its overall compliance rating by 1% to 80% this year and inspectors rated compliance with three regulations as excellent. Plans are being developed to refurbish the centre by March next year.

At the Ennis facility, the overall compliance rate fell by 10% to 83% this year, with inspectors also raising concern over a failure to update care plans for individuals. Occupational therapy sessions have since resumed at the centre and other therapeutic services have also been rolled out.

Separately, mental health inspectors identified a "critical' breach" at a HSE long-stay facility in Castlebar in Mayo, where a resident was put into isolation without appropriate monitoring.

All the reports in full can be read on our website.

Owenacurra Centre: https://t.co/sn3XgbyEQk

Cappahard Lodge:https://t.co/nC8CpJNVaL

Teach Aisling:https://t.co/2SaYmymN99

— Mental Health Commission Ireland (@MHCIreland) December 10, 2020

The breach was identified at the seven-bed Teach Aisling centre, which was inspected in July during the Covid-19 pandemic.

Inspectors found that a resident was placed alone in a room and prevented from exiting for periods of time, which amounted to seclusion or restraint.

The centre, however, did not comply with any of the rules governing the use of seclusion, including completing the seclusion register, orders for seclusion, ending of seclusion, recording of seclusion, monitoring of a person in seclusion, or clinical governance of seclusion.

The chief executive of the Mental Health Commission stressed that seclusion and restrictive practices should only be used when deemed necessary.

“We have and will continue to caution against any form of restrictive practice unless it is clear that there is no other option available and an individual has to be restrained for their own safety and the safety of others,” John Farrelly said.