THE MENTAL HEALTH Commission has warned that HSE mental health centres must improve compliance in four key areas or they face being de-registered as approved centres.

The warning follows the publication of the MHC’s 2022 annual report.

The four key areas where improvement is needed by some providers is risk management, individual care planning, staffing, and premises.

“We can now undeniably say that there are four key areas where standards are simply unacceptable, as they were in 2021 and in many years prior to that,” said MHC chief executive John Farrelly.

Compliance rates in these four regulations fell below 70%.

Risk management refers to the centre’s ability to ensure efficiency and effectiveness of operations.
60.6% of mental health centres were compliant with this regulation.

When it came to individual care planning, 69.7% of centres were deemed to be compliant.

Chief Executive of the Mental Health Commission John Farrelly described the individual care plan as “the blueprint for the resident’s care, treatment and eventual recovery”.

He said that while there is “clear clinical leadership” in some centres, in others “the basic concept of care planning does not seem to have been understood or appreciated”.

In such centre, he said “goals are vague and meaningless and obviously not developed with residents”.

Only 31.8% of centres were compliant as regards staffing.

The annual report noted that while funding for staffing “has improved over the past few years, community teams are chronically short-staffed through lack of funding and difficulty in recruiting staff”.

The report added that “retention of staff in under-resourced teams is also a problem” and that the HSE’s “recruitment from abroad and use of remote telepsychiatry to try to alleviate difficulty in staffing teams is not enough”.

“It is not sufficient to say that ‘we can’t get staff’ without looking at different ways of making posts attractive and competitive with other jurisdictions,” added the report.

The lowest levels of compliance were found regarding premises, with just 27.3% of centres being compliant.

The report noted that compliance with this regulation has been low over the past five years, “most particularly in a number of HSE premises”, at an average of 35.1%.

It also found that maintenance of the premises of acute inpatient approved centres varied greatly.

While the Adult Mental Health Unit in Sligo has “plenty of space”, other units are described as “not fit for purpose”.

Others still are said to be in need of “extensive refurbishment”.

The report noted that “for most people residing in these premises, this is their home”.

However, it added: “This is not a criticism of the staff who work hard on the ground to provide age-appropriate care and therapeutic interventions and who try and make the approved centre as homely and welcoming as possible”.

MHC chief executive John Farrelly said: “Many of our premises are simply not fit-for-purpose for a modern mental health service and this is something that we have been saying for many years and will continue to do until things change.

“To be clear, a targeted, funded strategic capital investment programme is urgently required now in our public system.”

The MHC has written to the HSE seeking an updated action plan to address the significant issues raised in its annual report, particularly around premises, individual care plans, staffing and risk management practices.

Farrelly added: “We would expect that the HSE concentrate first on the centres that have low standards in care planning and premises.

“The overriding message from today’s report is that centres who have performed poorly in these areas need to comply with these regulations or face the real prospect of not being re-registered.

“Being compliant with these and other regulations – which, lest we forget, are the minimum standards – is the very least that people living in the areas served by these centres deserve.”