A NUMBER OF ‘serious’ human rights breaches have been identified at supervised residences for people with mental illness, including a lack of privacy in bedrooms and substandard accommodation.

A new report by the Mental Health Commission has found there has been only “minimal progress” to address the most basic of human rights for 1,200 of the “country’s most vulnerable people” over the last 14 years.

Human rights breaches outlined in the report include right to privacy; the right to a clean, well-maintained accommodation; the rights of service users to choose where they would like to live; the right to independent living with appropriate supports; and the right to access appropriate care and treatment through access to rehabilitation and recovery services.

Inspector of Mental Health Services, Dr Susan Finnerty, who authored the report, expressed concern about the condition of the residences, as the report found 19% were in such poor condition that it showed disrespect for the residents’ dignity, while 35% required improvement.

In one inspection report a resident’s bedroom was found to be “sparsely furnished with no items other than a torn mattress on the floor and an unused TV behind a screen”. 

Another residence was described as “poorly maintained and neglected in appearance” with windows that were observed to be dirty. Although residents all had their own bedrooms, some “appeared bare and all bedrooms smelled musty”. 

There are 118 of these residences, which are staffed 24 hours a day. They were established during the process of deinstitutionalisation in Ireland from the mid-1980s onward to enable people with mental health problems to live in the community instead of large psychiatric hospitals.

It was expected that the requirement for the current level of 24-hour high-support accommodation would decrease once the housing needs of the cohort of former long-stay hospital service users has been catered for, but this has not happened. 

Today, these residences accommodate more than 1,200 people who have enduring mental illness or intellectual disability. Many have severe and complex mental health problems.

Privacy

The commission’s inspection of 52 of these residences found 43% did not provide single room accommodation for all residents. And 91% of residences that had shared rooms did not provide any privacy – not even curtains between beds – within shared bedrooms.

Dr Finnerty said this is “in clear breach of the right to privacy and is unacceptable in any healthcare facility”.

She said these issues around privacy were of “serious concern”:

I have expressed concern about the excessive number of beds in 24-hour supervised community residents for a number of years now. In 2018, a significant proportion of residences (43%) had 10 or more beds. This was despite the recommendation of the 2006 national health policy ‘A Vison for Change’ that these residences should have no more than 10 beds.

Just 22% of residences provided a key to residents for their bedrooms while almost a third of residences did not allow residents to access the kitchen, even to make a cup of tea or prepare a snack or meal.

“This severely limited a key component of rehabilitation and recovery,” she said.

She said there is an insufficient number of rehabilitation and recovery teams, and a lack of adequate staffing of these teams to provide a comprehensive service.

“Assessments are now carried out to assess residents’ needs but many of these needs are unmet due to lack of resources. Only 43% of residences provided multidisciplinary individual care plans for their residents.”

Unregulated

Finnerty said she remains “extremely concerned” that these residences remain unregulated and that the numbers of residences – and the numbers of people living in them – have not significantly decreased since 2005.

She said needs assessments indicate that many residents could move to smaller more independent accommodation if appropriate resources were in place. 

“However, this is not happening, due in part to lack of appropriate housing, not enough rehabilitation teams and inadequate staffing of existing rehabilitation teams,” she said. 

“The residents of these homes are a vulnerable group of people who are at risk of abuse and yet the provision of their care and accommodation is not regulated.

“This is a serious deficiency, leading to the risk of abuse and substandard living conditions and treatment. Despite the Mental Health Commission highlighting the lack of regulation for many years, this has not been addressed and it remains a critical risk for residents.”