Mental Health Commission’s Annual Report 2017: Major transformational change required

On 25 July 2018, The Mental Health Commission (“MHC”) published its 2017 Annual Report (the “Report”). The Report calls on the Government, together with the HSE as the statutory provider of services, to initiate a major transformation programme to deal with the service issues highlighted in the Report. Mr John Saunders, Chairman of the MHC, notes that major transformational change is required to prevent Ireland continuing to provide a level of unsafe and substandard services, which are not aligned to best practice and breach the fundamental rights of a vulnerable group of people who require such services.

Non-Compliance

The following issues of non-compliance by Approved Centres with the MHC regulations are identified in the Report:
 

1. The inappropriate admission of children to adult mental health in-patient services.
2. Inadequate staffing and funding in community Child and Adolescent Mental Health Services, forcing young people into emergency services.
3. The widespread use of seclusion and physical restraint as a normalised behaviour in services which lack appropriately trained staff.
4. Continued failures to put in place individualised care plans and therapeutic programmes, as per national policy.
5. The lack of attention to basic issues such as dirty and dilapidated premises, which do not ensure adequate privacy.
6. The complete lack of regulatory oversight in community residences providing 24-hour care to people with long term mental health illnesses.

The Report notes that there were 82 child admissions to 19 adult units in 2017. This was an increase from 2016 where there were 68 admissions. Although the 2017 admission rate of children to adult units has dropped from a high of 247 in 2008, the MHC has said that admitting any child to an adult service is unsatisfactory. The Report notes that 88% of Approved Centres which used seclusion did not comply with the Rules Governing the Use of Seclusion. The Report also noted that 69% of Approved Centres which used physical restraint were non-compliant with the Code of Practice on Physical Restraint.

Decision Support Service (“DSS”)

The report highlights the continued work in 2017 towards the operationalisation of the DSS. The DSS is a statutory organisation established under the Assisted Decision-Making (Capacity) Act 2015 (the “2015 Act”), to support decision-making by and for adults with capacity difficulties and to regulate individuals who are providing support to people with capacity difficulties. Ms Áine Flynn was appointed as the Director of the DSS at the beginning of October 2017. The full implementation of the DSS is expected to be completed by the 1st quarter of 2020.

Trends of Improvement

Commenting on the report, Rosemary Smyth, MHC Interim Chief Executive, said, “In 2017, we identified a general trend of improvement in services’ compliance with regulatory requirements.” The MHC also welcomed the €35 million budget allocation in 2017 for spending on additional mental health services. However, the MHC notes that the current level of expenditure on mental health as a proportion of overall health expenditure is still less than the 8.24% envisaged in “A Vision for Change”, the national mental health (2006).

Legislative Developments

To address the above mentioned issues in relation to the use of restrictive practices, such as physical/chemical restraint and seclusion, The Department of Health has prepared the draft Heads of Bill on the deprivation of liberty safeguards. This will form a new part of the 2015 Act. Following a consultation process which closed in March 2018, the Department of Health aims to publish a detailed bill by the end of Summer 2018. The 2015 Act is also expected to be fully commenced by the 1st quarter of 2020. The full publication of the Mental Health Commission’s Annual Report 2017 can be accessed here.