'Unacceptable' facilities and buildings undermining mental health services

John Farrelly, chief executive of the Mental Health Commission, said it is important to ensure physical infrastructure is 'fit for purpose'. Picture: Jason Clarke

Old and unstable buildings are holding back upgrades to mental health facilities in some parts of the country, according to a new report by the Mental Health Commission.

The report, written by Dr Susan Finnerty, the inspector of Mental Health Services, looks at premises used for in-patient mental health services and found that in addition to problems with physical infrastructure, some centres have unclean buildings and/or a poor systems of maintenance, some to an "unacceptable" degree.

In addition, many buildings have been designed to address safety concerns, but are not suitable for the facilitation of effective infection prevention and control, a key consideration in the current pandemic.

Longstanding or outdated design flaws in buildings reviewed for the report include the presence of ligature anchor points, poor ventilation, and insufficient or unsuitable furniture.

The physical size and shape of some buildings can also influence "social density", which in turn is a major factor in potential aggressive behaviour.

According to the report, attempts to reduce hostility behaviour should no longer be limited to security features such as locks, observation windows, violence-proof doors and isolation rooms, and more focus should be placed instead on the design of buildings.

Dr Finnerty said: "Because many centres are not purpose-built for therapeutic healthcare, we have facilities with poor lines of sight, long corridors, small sitting rooms, limited outdoor space, and multiple occupancy bedrooms.

“One centre has a nine-bed dormitory. Others have bedrooms that are cramped, with little space between the beds, resulting in lack of privacy and dignity. Some units have only limited access to an outdoor area, with service users at one Cork unit dependent on staff to take them to a nearby green area as the centre has no outdoor space," she added.

A poorly designed facility that prevents privacy, is noisy, and has other stressful features, can intensify the stress of mental illness and involuntary confinement. This can, therefore, worsen levels of aggression."

The report highlights how Irish in-patient facilities have a limited supply of single, en suite bedrooms – something it said "may be the single most important design intervention for facilitating privacy and reducing crowding stress and aggression in inpatient psychiatric wards”.

The sector has struggled to achieve high levels of compliance with regulations relating to premises in recent years, whereas newer facilities opened in the past five years are more likely to provide the kind of care the MHC said should be available to all.

Chief executive of the Mental Health Commission John Farrelly said: "Outside of this report, we already know that centres that were non-compliant with the regulation on premises in 2019, such as the adult mental health unit in Sligo, Aidan’s Residential Unit in Waterford, and Blackwater House in Monaghan, have all since become compliant.

“This is largely because they have moved into new purpose-built centres and is partly the reason why overall compliance has increased from 20 services out of 65 in 2019, to 36 services in 2020.” 

He said increased funding would be needed to address the shortcomings in a number of centres, as well as ensuring adequate safety from the impact of Covid-19.

“It is important that the physical healthcare infrastructure is fit for purpose in this respect too, by providing adequate bed spacing, isolation and single-room capacity to minimise the spread of infection," he said.