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LAST UPDATE | 25 Jun 2024
CONCERNS HAVE BEEN raised about an increase in the number of reports of alleged sexual assault at mental health centres in Ireland.
There were 42 reports of sexual assault at mental health facilities last year, up from 12 in 2022, according to the Mental Health Commission’s annual report.
The MHC said it engaged with centres where any incidents were reported “to ensure the safety of each resident and to require assurances regarding the wider safeguarding arrangements in place”.
In 2022 and 2023, the MHC contacted approved mental health facilities around Ireland “requesting that they review and update their arrangements for identifying, recording and responding to safeguarding and sexual assault allegations”, the report notes.
Sinn Féin’s spokesperson for Mental Health, Mark Ward, today expressed “grave concerns” over certain findings in the report.
“Worryingly, 42 instances of sexual assault were reported last year in approved mental health facilities This is up from 12 instances in 2022,” Ward said.
He called for “immediate Government action to be taken to safeguard some of our most vulnerable citizens”.
When asked about the increase in reported sexual assaults, a spokesperson for the HSE said there has been “an increased focus on recognising, responding to, and appropriately reporting safeguarding concerns within approved centres; including concerns of sexual abuse” in recent years.
“The HSE is currently devising an adult safeguarding framework to ensure consistency across all mental health services,” they told The Journal.
The report also found that almost 900 patients were physically restrained in mental health facilities in Ireland in 2023, a decrease on previous years.
Some 2,570 episodes of physical restraint involving 884 residents in 53 approved centres were notified to the MHC last year.
The average episode of physical restraint in 2023 lasted for 4.4 minutes. The shortest episode of physical restraint lasted for less than one minute, while the longest was 30 minutes.
The average age of residents who were physically restrained was 35. The youngest resident who was physically restrained was 12 years old, and the oldest was 91.
More females were restrained than men last year – 58% compared to 42%.
For any person who was restrained, it generally happened more than once. The average number of times that a resident was physically restrained was three, according to the report.
Child and Adolescent Mental Health Services (CAMHS) reported the highest number of physical restraints, accounting for 19.77% of all reported episodes last year.
The highest number of physical restraint episodes reported by a single approved centre was at the Linn Dara Child and Adolescent Mental Health Inpatient Unit in Dublin, which accounted for approximately 10.39% of all episodes (267).
The figures are included in the MHC’s 2023 Annual Report which will be published later today.
Physical restraint refers to the use of physical force for the purpose of preventing the free movement of a patient’s body.
Due to the negative impact it can have on a person, the MHC recommends it is only used in “rare and exceptional circumstances as an emergency measure”.
The use of physical restraint was among a number of non-compliances identified following recent inspections at mental health centres.
In 2023, there was an approximate decrease of 9% in the number of reported episodes of physical restraint.
There were 2,830 episodes of physical restraint involving 1,027 residents in 47 approved centres in 2022, 3,460 episodes of physical restraint involving 1,169 residents in 47 approved centres in 2021, and 3,990 episodes involving 1,211 residents in 48 approved centres in 2020.
Many mental health services including CAMHS currently fall outside the scope of regulation set out under the Mental Health Act 2001.
Proposed legislation which would overhaul the 2001 Act has been in train for several years.
Groups working in the sector have raised concerns that the new law may not be passed before the upcoming general election, but the Government has said it is committed to bringing in the legislation.
This proposed law would also expand the MHC’s remit to include the regulation of community services such as CAMHS.
A MHC report by Dr Susan Finnerty published last July found that some CAMHS are “inefficient and unsafe” due to a lack of governance, inadequate funding and failure to reduce preventable harm to young people attending the services.
Minister of State for Mental Health, Mary Butler, welcomed the publication of the report.
“While the report raises some issues of concern in relation to individual care planning, risk management, staffing and premises, progress has been made with services adopting a strong human rights approach to successfully reduce and eliminate restrictive practices in 2023,” Butler said.
In relation to CAMHS, she welcomed the finding that these services are now 100% compliant with individual care planning, and that the number of child admissions to adult units continues to decline.
There were 14 child admissions to 11 adult units last year, compared with 20 admissions to 11 adult units in 2022.
Many mental health facilities failed to meet minimum regulatory standards especially in key areas such as staffing and risk management, according to the Commission’s annual report.
Sixty-six residential centres which care for people with serious mental health difficulties were inspected by the MHC in 2023.
Only five centres achieved 100% compliance. Less than two-fifths (39%) of these approved centres were more than 90% compliant with regulations.
Privately operated centres continued to achieve higher rates of compliance than centres run by the HSE, according to the report.
The centres most and least compliant with regulations:
Professor Jim Lucey, who became the State’s Inspector of Mental Health Services last year following the retirement of Dr Finnerty, said the lack of compliance is concerning.
Writing in his first annual report, Professor Lucey said the issues highlighted by the inspections “raise serious concerns for the users of acute inpatient services… and for those who work in them”.
He said there is “a persistent failure by many approved centres to meet minimum regulatory standards especially in key areas of staffing, care planning, risk management and premises”.
Lucey noted that MHC regulations are based upon legislation which came into effect in 2006, adding:
Still, after 18 years in operation, only a small minority of approved centres regularly achieve full compliance.
He said the continued failure to achieve compliance with minimum standards is “a cause for concern”, noting figures are going “in the wrong direction”.
The most frequently breached regulations include premises (just 27% of centres were compliant), staffing (39%), risk management (56%), and individual care plans (59%).
Twenty-two approved centres had compliance rates under 80% last year. In 2022, nine centres fell below 80% compliance; that number was seven in 2021.
Lucey stated:
The trend of non-compliance in approved centres is going in the wrong direction.
“These low rates are linked to a history of poor governance, inadequate investment levels and an outdated regulatory framework long overdue for revision.”
He noted that acute inpatient mental health centres are “an essential part of our mental health service and always will be”, and standards in these services “should no longer fall below the regulatory minimum”.
“The time has come for wholehearted embrace of modern standards of care and for meaningful investment in acute mental health services in Ireland.”
Responding to the report, a spokesperson for the HSE said there has been “a continued positive trend in some key areas that the MHC monitors”.
“We acknowledge the key role of our HSE colleagues in the mental health teams across the country who have enabled these improvements.”
The spokesperson said there has been “significant investment” in the sector in the last three years. Some €29.6 million was allocated in 2024, up from €17.91 million in 2022.
They added that some areas need “further improvement”, noting that HSE Mental Health is “developing a detailed action plan in response to the MHC findings”.
“This plan will be informed by engagement with the Health Regions and work programmes already underway to deliver on recommendations within Sharing the Vision, our National Mental Health policy.
“This action plan is due to be completed and shared with the MHC in July.”
Under the Mental Health Act 2001, every adult who is involuntarily detained in an approved centre must have their detention order referred to an independent tribunal to be reviewed within 21 days.
The tribunal is made up of three people: a solicitor/barrister as chair, a consultant psychiatrist and another person, often referred to as a lay person.
Some 3,638 orders for a mental health tribunal were made last year, with 1,915 of these orders revoked before hearing, and 1,753 orders going to hearing.
Of the 1,753 orders that went to hearing, 215 were revoked at hearing (12.3%).
The number of applications for involuntary detention by An Garda Síochána went down by 4% in 2023, while applications from authorised officers (AOs) from the HSE increased by 2%.
In recent years there has been a concerted effort in the sector aiming to ensure patients have a greater say in their treatment and decisions made related to their care.
“It is disappointing that applications by AOs have only increased by 2% from 2022 given all of the engagement over the last number of years.
“The decrease in applications by the Gardaí is welcome but it is only a very small move in the right direction and a lot more work needs to be done to continue this trend,” the report notes.
Fiona Coyle, CEO of Mental Health Reform, previously told The Journal there is “widespread agreement” in the sector that the Mental Health Act 2001 is “not aligned with international human rights standards” in terms of issues such as involuntary detention.
“It’s one of the very few pieces of legislation in Ireland where you can deprive people of their liberty. Under the Mental Health Act you can involuntarily detain someone and de facto deprive them of their liberty.”
The Decision Support Service (DSS) was launched in 2023 to help people who face difficulties exercising their decision-making capacity, including people with a mental health issue or an intellectual disability.
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