Inspector concerned over 2,000 people still living in large mental health facilities

Inspector of Mental Health Services Dr Susan Finnerty said it appears disability services have improved more quickly in comparison to psychiatric services.

The Inspector of Mental Health Services has said she is concerned at finding almost 2,000 people still living in large mental health institutions, including elderly people who have lived like this for decades.

The number is in spite of policies dating back to the 1980s for closing congregated settings where residents lack choice around what time they eat or go to sleep.

Dr Susan Finnerty, speaking about the Mental Health Commission’s (MHC’s) annual report (2022) published yesterday, said that they found 28 quite large or very large such centres.

“In most of them you’ve got numbers like 20, 22 or 28 people living together,” the inspector said.

Her concerns do not just focus on whether the centres meet regulation standards.

“When you go away from that and think of the individual people who are living in those congregated settings, I suppose the basic question is ‘would we like to live there?’”, she said.

Some of them are sharing rooms, they are sharing dining facilities. Some of the toilets and bathrooms are shared sometimes. They are really not able to make decisions that affect them for themselves.

The report states many of these residents were transferred to approved centres when the large asylums closed in the 1990s and early 2000s, and are now elderly.

It says there has been “some improvements in the accommodation” and “good success” at change in some areas, but it also highlights concerns around sites including St Catherine’s Ward in St Finbarr’s Hospital in Cork.

Psychiatric services lag behind

Dr Finnerty said it appears disability services have moved more quickly on this in comparison to psychiatric services. “We are concerned”, she said.

“While the numbers have gone down slightly, the number of registered beds remains roughly the same.”

She warned against this, while also acknowledging it can be easier and more cost-effective to admit people who need support to large centres.

“There is a real risk that we are beginning, as we did in the past, to once again re-institutionalise people who are mentally ill, elderly, or who just do not ‘fit in’ to society,” she said.

“As a country, we urgently need to provide all our citizens with rights-based personalised care in their own communities when they need it, or risk, once again, becoming a society that locks away its vulnerable citizens.”

In addition to the residential centres there are also 125 24-hour supervised centres.

“They have about 1,000 people roughly in them, and when you add that to the 900 living in the other congregated settings, you are certainly talking close to 2,000 people in congregated settings,” she said.

The MHC also inspected children’s services. It found 19 child admissions to 11 adult units, which she said compared positively to 32 admissions the year before.

In the report across all services, four regulations had compliance rates lower than 70%, something that MHC chief executive John Farrelly says the public system can no longer ignore if the State hopes to meet what he underlines are minimum standards for the provision of mental health services to its citizens. He said:

We can now undeniably say that there are four key areas — premises, risk management, individual care planning, and staffing — where standards are simply unacceptable, as they were in 2021 and in many years prior to that.

“Services, particularly in the public system, must drill down and focus on these areas over the coming months. We would expect that the HSE concentrate first on the centres that have low standards in care planning and premises.”

A separate final report on Child and Adolescent Mental Health Services (Camhs) is expected in mid-2023, following an interim report which raised concerns in January. Dr Finnerty said across adult and child services: “You can see improvements, the restricted practices are coming down and things are better, but we are just highlighting the things which can be improved.”