Mental Health Commission reports ‘downward trend’ in patient services

The MHC received 46 reports of over-capacity compared to 33 during 2022. 73.9% came from the Acute Psychiatric Unit 5B, University Hospital Limerick and Acute Psychiatric Unit, Ennis Hospital together. Picture: Stephen Collins/Collins

Mental health patients face negative experiences in centres struggling with staffing, risk management, unsuitable premises, and gaps in care planning, the Mental Health Commission (MHC) has warned.

Some 94 serious events were reported last year ranging from 42 sexual assaults to six incidents of pressure ulcers for patients.

In the MHC’s annual report for 2023, it called for “planned, strategic investment” at in-patient services.

It includes the first report from Inspector of Mental Health Services, Professor Jim Lucey. He criticised a downward trend in meeting minimum standards. “These low rates are linked to a history of poor governance, inadequate investment levels, and an outdated regulatory framework long overdue for revision,” he said.

“In reality, governance and management has not kept pace with patient needs, expectations, and rights.”

Out of 66 centres inspected, 22 had less than 80% compliance rates compared to seven in 2021.

Inspections identified “a deteriorating picture with consequences for service user experience”, he said.

Enforcement action was taken 52 times at 29 centres. Some 61% did not have appropriate staffing and 73% had below-standard buildings.

Prof Lucey called on providers “particularly the HSE, to mobilise the capital programmes required” for this. In his experience staff are “dedicated, qualified and honourable”.

The MHC received 46 reports of over-capacity compared to 33 during 2022. 73.9% came from the Acute Psychiatric Unit 5B, University Hospital Limerick and Acute Psychiatric Unit, Ennis Hospital together.

In relation to Child & Adolescent Mental Health Services (Camhs) he said: “I have, as of yet, received no new powers of inspection or regulation.” This was a key issue in a report issued last year by his predecessor.

Some 14 children were admitted to 11 adult units, compared to 20 the year before.

The MHC found a 25% reduction in seclusion with 475 people placed in a room for periods of between five minutes and 158 days.

Last year, 529 people using mental health services died — in the community and in centres — with death by suicide suspected in 178 situations.

The report shows 3,638 orders for a mental health tribune. Applications for involuntary detention by gardaí went down by 4%.

They added: “Applications from HSE ‘Authorised Officers’ increased by just 2%, which is disappointing.”

The HSE welcomed the improvements noted in some areas. “We acknowledge the key role of our HSE colleagues in the mental health teams across the country who have enabled these improvements,” a spokeswoman said.

She added: “We know there are areas needing further improvement, and HSE Mental Health is developing a detailed action plan in response to the MHC findings.” A sum of €29.6m was allocated in 2024 from the capital budget for mental health. A rolling minor works programme is funded with €14m for 2024 for community and inpatient