Mental Health Commission finds two inpatient centres in Dublin to be ‘unsuitable for provision of modern mental health service’

The Mental Health Commission has published inspection reports for eight approved centres based in Dublin which have identified five centres with overall compliance rate of 90% and over.

The inspections found 27 non-compliances with regulations across the eight centres, with inspectors finding that two centres were not suitable for mental health services.

Of the eight approved centres inspected, one critical risk non-compliance identified related to the regulation on premises and nine high risk non-compliances related to the regulations on individual care planning, premises, privacy, staffing and the code of practice relating to consent to treatment.

In relation to the two centres identified by inspections to be unsuitable for mental health services, and the critical and high-risk non-compliances for the regulation on premises, the inspections found bedrooms not appropriately sized, insufficient personal space in four-bedded dormitory bedrooms, limited space for residents to move about, rooms not ventilated, premises not maintained in good structural and decorative condition, ligature points not minimised, limited access to outdoor space, premises not kept in a good a state of repair externally and internally and centres not clean and hygienic.

The Inspector of Mental Health Services, Dr Susan Finnerty, said that despite all the efforts of staff in providing excellent care and the high overall compliance rates, if the buildings are not suitable for mental health services it is not possible to be compliant with the regulations.

“While we recognise the investment in premises to date, the current approach to structural improvements is inadequate. To ensure every person in Ireland can access an environment conducive to recovery we require a funded strategic capital investment programme.”

Chief Executive of the Mental Health Commission, Mr John Farrelly referred to the trend of increasing compliance ratings in five of the approved centres inspected.

“There is an overall trend of increasing compliance with regulations in approved centres in Ireland. This increase is positive evidence that regulation works in increasing standards and quality of care for patients. To address the non-compliance findings set out in the inspection reports, there is an urgent need for leadership and governance to address the thorny issue of unsuitable premises.  Unless there is investment in a small number of buildings in the State, approved centres will continue to be non-complaint with regulations, and we will continue to fail the patients in these centres.”

St Patrick’s University Hospital is an independent hospital and part of the St. Patrick’s Mental Health Service and is located on Steven’s Lane in Dublin. The approved centre is registered to accommodate 241 residents. The centre has 8 wards with fourteen consultant psychiatrist-led multi-disciplinary teams. There are specialist eating disorder team, psychiatry of later life team and addiction inpatient services as well as acute and general admissions.   The centre received an overall compliance rate of 97%, the same rate it received in 2021.

There were no conditions attached to the registration of the centre and no ongoing escalation and enforcement actions at time of inspection. The centres café, Q Café received the Gold Medal Award which recognises and rewards excellence in hospitality and catering operations across Ireland.

St Patrick’s Hospital, Lucan is located within large grounds in Lucan, Co. Dublin. At the time of the inspection the approved centre was closed to admissions and was providing care to residents from St. Patrick’s University Hospital, who were isolating because of COVID-19. There were no residents in the approved centre at the time of inspection however, the centre had accommodated residents since the last inspection. The centre received an overall compliance rate of 100%, for the third year in a row. There were no conditions attached to the registration of the centre and no ongoing escalation and enforcement actions at time of inspection. The inspection noted a number of quality initiatives including the provision of webinars for families and advocates around information and advocacy for family recovery.

Elm Mount, St Vincent’s Elm Mount Unit is located within the campus of St Vincent’s University Hospital Elm Park, Dublin. Although registered for 39 beds, the approved centre was operating with an operational capacity of 36 beds. The unit was sub dived into three areas: Elm Mount Upper with 18 beds, Elm Mount Lower with 12 beds and a six bedded psychiatry of old age unit. Three of the beds in Elm Mount Lower were for the care and treatment of residents with an eating disorder.  The centre received an overall compliance rate of 91% a decrease of 6% on its compliance in 2021. The centre received three non-compliances: one high-risk related to premises and two moderate-risk non-compliances with regulations. There were two conditions attached to the registration of the centre in relation to the regulations on premises and staffing at the time of inspection. There were no ongoing escalation and enforcement actions at the time of inspection. The centre was not in breach of either condition but was non-compliant with the regulations on premises and staffing.

Le Brun House and Whitethorn House, Vergemount Mental Health Facility is located within the grounds of Clonskeagh Hospital, Dublin. The approved centre consists of Whitethorn Ward, which provides the continuing care of adults with enduring mental health needs and Le Brun House, a specialist mental health service for people over the age of 65. Significant improvements had been undertaken to the fabric of the building which included extensive redesign and refurbishment of the internal garden in Le Brun House. However, the accommodation was not suitable for delivering a modern mental health service, in particular for elderly people. The centre received an overall compliance rate of 90% an 11% increase on its compliance rate in 2021. The centre received three non-compliances; one high-risk related to premises and two moderate-risk non-compliances with regulations. There were no conditions attached to the registration of this approved centre and no ongoing escalation and enforcement actions at time of inspection.

Ashlin Centre is a 46-bed approved centre located in the grounds of Beaumont Hospital and is a separate facility with different governance and reporting structures. It comprises of two units, Sheehan Unit and Joyce Unit. The Sheehan Unit is an eight-bed facility dedicated to psychiatry of old age and the Joyce Unit, is a 38-bed facility for general adult admissions. Eight beds in the Joyce Unit are high dependency beds. The centre received an overall compliance rate of 94% and increase of 9% on its compliance in 2021. There was one condition attached to the registration of the centre which related to individual care planning. At the time of inspection, the centre was not in breach of the condition, was compliant with the regulation and there were no ongoing escalation and enforcement actions. The centre received one high-risk non-compliance related to privacy, and one moderate-risk non-compliance with the regulations.

Jonathan Swift Clinic is located within the St. James’s Hospital campus. The approved centre consists of three wards, with a total bed capacity of 47. Connolly Norman is a nine-bed psychiatry of later life unit; Beckett Ward is a 16-bed step down/pre-discharge ward and William Fownes Ward is a 22-bed acute admission ward. Following the inspection, the Becket ward was temporarily closed due to staffing shortages, with relocation of residents to appropriate community accommodation. The centre received an overall compliance rate of 84% down seven percent on its compliance rating in 2021. The inspection found that the premises is unsuitable for the provision of mental health services. The centre received five non-compliances; a critical non-compliance with the regulation on premises, a high-risk non-compliance for individual care planning; two moderate-risk non-compliances and one low-risk non-compliance with regulations.  There were three conditions attached to the registration of the centre at the time of inspection related to the regulations on premises. The conditions required that the centre shall implement a programme of maintenance to ensure the premises are safe and meet the needs of the resident group. This included that the centre was required to provide a progress update to the MHC on the programme. There were no ongoing escalation and enforcement actions at time of inspection.

Department of Psychiatry, Connolly Hospital is located on the lower ground floor of Connolly Hospital in Blanchardstown and provides acute in-patient care in 47 beds. Resident accommodation is on two wards: Ash Ward and Pine Ward, with accommodation for 21 residents each. A high dependency unit with accommodation for up to five residents, is attached to Ash Ward. The centre received an overall compliance rate of 76% a nine percent increase on its compliance rating in 2021. The centre received eight non compliances with regulations; two high-risk for privacy and premises; five moderate-risk; and one low-risk. There were two conditions attached to the registration of this approved centre at the time of inspection related to staffing and premises and the provision of a quality improvement plan. The centre was not in breach of the conditions and there were no ongoing escalation and enforcement actions at the time of inspection.

Bloomfield Hospital is a 123-bed, voluntary independent non-profit hospital in Rathfarnham, Dublin. It provides treatment for residents with serious and enduring mental illness and is a national facility for the care of patients with Huntington’s disease. There was one condition attached to the premises at the time of the inspection related to an overall compliance plan which has resulted in a range of measures and initiatives to improve compliance and ensure resident safety. Significant changes and improvements have been made to the governance and leadership arrangements. A new Clinical Director was appointed on 17 January 2022, a new Chief Executive Officer was appointed on 21 February and improved oversight and monitoring structures implemented. The MHC continues to closely monitor the condition updates. The centre received 5 non compliances with the regulations; three high-risk for premises, staffing and consent to treatment; one moderate-risk, and one low-risk and an overall compliance rating of 85% a decrease of 6% from its compliance rating in 2021.