Mental Health Commission to hold public consultation on seclusion and restraint

1,796 people were secluded and/or restrained in facilities last year, with 5,029 episodes of physical restraint involving 1,143 people physically restrained.

The Mental Health Commission said it would hold a public consultation on the use of restrictive practices, such as seclusion and restraint, after its latest report shows 6,747 episodes were reported to it last year.

The figure represents a slight decrease on the figure for 2018, but the MHC has consistently said restrictive practices should only be applied in very limited and exceptional circumstances.

According to the report, published on Friday, 1,796 people were secluded and/or restrained in facilities last year, with 5,029 episodes of physical restraint involving 1,143 people physically restrained. 

There were also 1,719 episodes of seclusion in 2019, including 225 episodes where a person was secluded for more than 24 hours and 61 episodes where a person was secluded for over 72 hours.

The MHC said that while the number of incidents of physical restraint last year fell compared with the figure for 2018, the use of physical restraint has risen by 42% since 2008.

Mechanical restraint

Incidents of seclusion also decreased last year, while the use of mechanical restraint was higher in 2019 than in 2018, albeit very low overall. Only the Central Mental Hospital reported the use of mechanical restraint, with all 18 episodes – which combined lasted just over 34 hours – involving the use of handcuffs.

Chief executive of the Mental Health Commission John Farrelly welcomed the modest decreases in the number of incidents reported, but said: "It is also clear that episodes of physical restraint and seclusion are not decreasing at a rate that would suggest that these practices are slowly but surely disappearing from our mental health services. 

If we are serious about all but eradicating restrictive practices, then we have to upgrade many of our buildings and increase staff training. The MHC has called out these weaknesses year after year, but still they exist."

He said the MHC intended to review and modify the relevant rules and codes of practice so as to reduce episodes of restrictive practices across the country’s mental health services, beginning in early 2021.

Meanwhile, in a separate report also being launched today, the National Advocacy Service for People with Disabilities (NAS) has said housing and accommodation remain the biggest issues for people with disabilities.

NAS provided full representative advocacy support in 1,018 cases last year, a rise of 11%, while its national phone line received 2,141 calls.

Housing and accommodation

The NAS Annual Report says that 50% of all the cases its advocates worked on in 2019 involved issues related to housing and accommodation. That included support for people with intellectual disabilities or autism in the homeless system and those in residential settings or in acute hospitals because of a lack of alternatives. In one case study, a woman said she contacted NAS as "I was living in a long-term care facility on a locked ward, where I felt like I was a prisoner."

NAS advocates also repeatedly faced the issue of a lack of resources from the HSE for personal assistance hours and home care packages. NAS also became involved in cases of alleged neglect, mobility issues and decision-making capacity.

NAS also operates the Patient Advocacy Service since October 2019, offering free, confidential empowerment advocacy to users of HSE-funded public acute hospitals who want to make a formal complaint about the care they have received.

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