Why didn’t the HSE act sooner?

THE 230-page report of the 18-month inquiry conducted on behalf of the Mental Health Commission into conditions at the Central Mental Hospital at Dundrum makes grim reading.

It depicts horrific conditions, with the rights and dignity of patients being seriously infringed by the standard of clinical care, a lack of proper resources, and an outdated custodial culture.

The conditions depicted are essentially Dickensian, with the emphasis being placed on custodial concerns rather than on therapeutic care. The report found that patients were subject to levels of security that were not required by an assessment of risk.

The level of seclusion of patients to prevent them doing harm to themselves or others was disproportionately high in comparison with similar hospitals in Britain. All patients, other than those in the rehabilitation area, are locked in their rooms overnight from nine o’clock.

If they wish to use the toilet, they must bang on their door, often for up to half-an-hour, to attract the attention of staff and escort them to the toilet.

The banging frequently disturbs the sleep of other patients.

There is no privacy in the toilets, with people having to bathe in communal areas, or use the toilet in the view of others. The conditions for women are particularly degrading, with no real privacy. There is no policy to prevent women patients being stripped by male staff, and if women are considered a threat to themselves, they are stripped of all clothes, including underwear, to prevent self-strangulation.

Patients in lower security wards have been reluctant to report conditions for fear of being punished by being moved to higher security wards.

There are also problems with the electricity supply leading to frequent power failures in one of the wards, while another ward is particularly cold and draughty due to gaps in the windows. Members of staff have frequently been afraid to highlight problems, fearing it could damage their careers.

The custodial culture has been allowed to develop over the 150 years since the hospital was built, but the Health Service Executive (HSE) contends it will implement the recommendations of the report and that it has already introduced new guidelines on seclusion. A Capital Development Project Team has been set up to oversee the construction of a new, purpose-built facility over the next five years.

The response of the HSE would seem to suggest that the report is already having an impact, but it is a disgrace that it required an external report to highlight the deficiencies. Why were those not tackled sooner? There must be accountability in such matters, if only to ensure that they do not happen again.