THE COVID-19 PANDEMIC has exposed the urgent need for investment and reform of mental health services in Ireland, the Mental Health Commission has said.

The organisation’s 2020 Annual Report, which will be published later today, also expresses concerns about “a significant jump” in applications made by An Garda Síochána to involuntarily detain patients.

The figures show that, for the first time, the highest number of applications to involuntarily detain people came from An Garda Síochána. In all, there were 1,919 admission orders for involuntary detention from the community last year, with 32% of these initiated by gardaí.

The report also raises concerns about the poor physical standards and unsuitability of many buildings to allow for the proper care and treatment of people with mental illness, and limited and delayed access to inpatient and community mental health services.

The MHC says 2020 saw “considerable improvements in compliance across most units”, but warned that this may not be a true reflection of standards and quality in services as the pandemic resulted in some aspects of compliance monitoring being suspended, and the requirement that all inspections be announced to services in advance.

“The pandemic has caused profound suffering and stress amongst residents, staff and services,” the Chief Executive of the MHC, John Farrelly, said.

Farrelly complimented services for “their resilient, collaborative, flexible and committed efforts” during the pandemic, but added: “It is clear that the impact of the virus in 2020 laid bare in stark terms where our mental health system requires urgent attention, investment, revision and reform.”

He said the rise in the number of applications made by gardaí to involuntarily detain people is “extremely concerning to see and even more so given that it happened during Covid-19 when people who required treatment might have been even more vulnerable and an intervention by Gardaí could have led to additional distress”.

Both the expert group that reviewed the 2001 Mental Health Act six years ago, and the current Heads of Bill to amend the same Act, recommend that the only person to sign applications for involuntary admission to an inpatient centre should be an authorised officer of the health service.

“The thought process behind this is that it will have the effect of lessening the burden on families and carers, while it will also reduce the involvement of gardaí in the admission process,” Farrelly explained.

“Instead, in every year since 2007, the lowest number of applications to detain someone against their will have come from the HSE’s authorised officers. It is abundantly clear, therefore, that this part of the Act has never been properly implemented and this area needs particular focus and scrutiny ahead of the publication of the amended Act.”

The MHC has written to An Garda Síochána seeking a meeting with Commissioner Drew Harris to discuss this matter and to determine if members of the gardaí can avail of suitable training.

‘Unsuitable, run-down centres’

The annual review of services by the Inspector of Mental Health Services, Dr Susan Finnerty, focused on a broad range of matters including ongoing issues with individual care plans; the impact on services as a result of the pandemic; and concerns about buildings.

The Inspector’s report highlighted the fact that compliance with individual care plans was only 59%, with little improvement over the past three years.

“Although individual care plans are provided for almost all inpatients with a mental illness, the quality is poor in most centres,” Dr Finnerty said.

“There is a failure by services to ensure that people with a mental illness have an individual care plan that enables recovery and involves the person in caring for their own mental health. In short, there is a lack of leadership, training, and attitude in this area and this must change without delay.”

The Inspector’s report also showed how Covid-19 demonstrated the unsuitability of mental health buildings, which had the lowest level of overall compliance nationally (55%) compared with all other regulations.

The MHC said many facilities are suffering from years of neglect and lack of funding, resulting in people with a mental illness living in or receiving treatment in unsuitable, run-down centres.

Dr Finnerty said: “We now find ourselves in the position where a large amount of funding is required across the country to render facilities acceptable for mental health care and treatment.

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“The standard of facilities that have been built in recent years is high, but too many substandard buildings remain. Funding is now urgently required to either replace or properly renovate the remaining facilities and help move the country further along the line towards a modern mental health service.”

Restrictive practices

The report also shows that while the physical restraint of patients has declined, the number of times patients were secluded increased in 2020. In addition, only 61% of centres were compliant with the rules on seclusion.

The inspector also expressed her serious concern about the introduction last year of mechanical restraint as a restrictive practice in services, which was in one case used to manage the behaviour of a young person. The incident in question involved the use of arm and leg restraints on a young person over a period of several months.

“Mechanical restraint is traumatic, counter-therapeutic, and dehumanising and has no place in a person-centred, recovery-focused mental health service, let alone in the care and treatment of a young person,” Dr Finnerty said.

She added that the Covid-19 pandemic has further restricted access to mental health services.

“As we know, many inpatient centres were forced to reduce their admissions so they could isolate residents when necessary. However, this increased pressure on day hospitals, outpatient facilities and other community services which, once again, brought our under-resourced community services into sharper focus,” Dr Finnerty stated.

The MHC has written to the HSE seeking an updated action plan to address the significant issues raised in their report, and particularly the use of authorised officers, premises, individual care plans, and restrictive practices.