THE PRACTICE OF physically restraining and secluding patients in Ireland’s in-patient mental health facilities spiked by 57% over the past 10 years.

A new report by the Mental Health Commission has revealed a dramatic increase in the use of seclusion, mechanical restraint and physical restraint since the commission began reporting on the prevalence of restrictive practices in 2008.

A total of 7,499 episodes of seclusion and restraint were reported to the Commission last year. This represents a jump of 79 episodes on the previous year and a massive increase compared to the 4,765 instances reported in 2008.

The report also revealed significant year-on-year increases, with episodes of physical restraint jumping by 18% over the last year. A total of 5,665 episodes were recorded in 2018 compared to 4,773 in 2017.

Physical restraint was used in 85% of centres around the country last year, a 4% increase on 2017, while 1,207 people were physically restrained during the year, 82 more people than in 2017.

Seclusion

The commission found that nearly half of all approved mental health facilities locked patients alone in rooms and there were 1,799 episodes of seclusion last year. This was a massive 29% increase on 2017 when there were 1,392 episodes of seclusion.  

There were also 317 episodes where a person was secluded for more than 24 hours, and 81 episodes where a person was secluded for over 72 hours, both significant jumps on the previous year.

The Mental Health Commission is tasked with ensuring that restrictive interventions are only used where strictly necessary, and that any interventions are undertaken safely, and in line with specified rules and codes of practice.

While praising the open culture of reporting, the Chief Executive of the Mental Health Commission, John Farrelly, also said that the report evidenced a lack of oversight and governance in the use of restrictive practices by the Health Service Executive over a 10-year period.

“We also have to acknowledge that we have a cultural issue when it comes to the use of restrictive practices in this country that we need to tackle without delay,” he said.

When one considers that there is no evidence of a therapeutic benefit associated with the use of restrictive practices, and limited evidence of restrictive practices reducing behaviours of violence and aggression, it is disappointing to note that episodes of restrictive practices in this country have increased by 57% in just 10 years.

Farrelly noted that the commission took the decision to prosecute the HSE after inspectors reported hair, hardened food and other dirt on the floor of a seclusion room at the Department of Psychiatry at St Luke’s Hospital, Kilkenny.

He said that the commission has not found evidence of similar conditions in any other seclusion room since then but the conditions in St Luke’s demonstrated a “clear disrespect for mental health patients”.

He added:

The fact that seclusion is still being used in 42% of approved centres today is a worrying statistic and one that we would like to see drop significantly.

The commission has written to the HSE seeking a clear strategy that will significantly reduce restraint and seclusion in Ireland’s mental health services.