RECORDS CONTAINING SENSITIVE information belonging to some residents at a mental health facility in Dublin were left exposed on wards, a report by the Mental Health Commission has found.

The commission published four inspection reports into four in-patient mental health units, located in Limerick, Galway, Dublin and Laois.

All four inspections were carried out in February and early March of this year before the Covid-19 pandemic.

Sensitive information

Inspectors carried out an inspection at Highfield Healthcare in Whitehall in Dublin, a 112 bed mental healthcare facility for older people, between 3 and 6 March this year.

The approved centre received an overall compliance rating of 84% in 2020, down from 85% in 2019.

The report found 15 regulations rated as excellent, while there was high non-compliances with three regulations related to individual care planning, staffing, and maintenance of records.

Inspectors noted that records containing sensitive information relating to residents was observed to be unsecured in two wards.

“Boxes of old resident kardexes and handover sheets were stored in an open cupboard, within a resident four bedded dorm area; two residents’ clinical files were left on the nurses’ station unattended; a filing cabinet was left unlocked; a computer desktop was left logged on and unattended, which enabled access to resident information and a list with resident’s full names was left unattended on the nurses station,” the report noted.

A kardex is a medical information system used in healthcare facilities that contains a summary of a patient’s needs.

Building needs to be replaced ‘urgently’

An inspection report at the 15-bed Tearmann Ward, St Camillus’ Hospital, Limerick, found that the building was outdated and in need of modernisation as it does not meet the requirements for a modern in-patient mental health unit for older people.

“There is only one single room and no en-suite toilets. There is no visitors’ room, no staff room, no separate room to conduct admission assessments and space is limited. The building dates back to the 19th century and needs to be replaced as a matter of urgency.”

Inspectors note the staff had made every effort to make it as dementia-friendly as possible.

The overall compliance rating for 2020 was 90%, a drop of 7% since 2019. The report for the centre found 14 regulations rated as excellent; while it was found to be non-compliant on three regulations relating to staffing, visits, and privacy.

Unmet clinical psychology needs

An inspection report at Wood View mental health facility located in the Merlin Park University Hospital campus in Galway found that 13 of the 15 residents had been living at the facility for many years.

The centre received an overall compliance rating of 71% in 2020, a drop of 7% since 2019.

The report found nine regulations rated as excellent with two critical non-compliances in the area of therapeutic services and programmes; and in staffing.

In relation to the critical non-compliance risk rating for staffing, not all staff were trained in infection control and prevention, dementia care, end of life care, resident rights, risk management, incident reporting, fire safety, the management of violence and aggression, and recovery-centred approaches to mental health care and treatment.

The centre was in breach of the condition related to staffing, as the multi-disciplinary team did not include a psychologist.

“The unmet clinical psychology needs were clearly documented within three residents’ individual care plans. One resident was assessed as needing cognitive behavioural therapy. However, there was no resource to provide this therapy to the resident. Where a resident required a therapeutic service or programme that was not provided internally, the centre did not arrange for the service to be provided by an approved, qualified health professional in an appropriate location,” the report noted.

Mix of staffing insufficient for residents

Inspectors at the 28 bed Maryborough Centre, part of St Fintan’s Hospital, Portlaoise centre noted the numbers and skill mix of staffing were insufficient to meet the potential needs of the residents.

It received an overall compliance rating of 91% in 2020, up from 84% in 2019.

There was no psychology input into the approved centre and there was minimal occupational therapy input for residents, the report noted.

It added the numbers and skill mix of staffing were insufficient to meet the potential needs of the residents likely to access the approved centre.

Reports ‘highlight weaknesses’  in premises

Responding to the publication of the reports, the Chief Executive of the Mental Health Commission (MHC) John Farrelly warned that issues around premises for mental health residents must be urgently addressed to protect them from the current progression of Covid-19.

Farrelly said although the four centres were not risk-rating for Covid-19 at the time of the inspections, the reports highlight weaknesses in the areas of premises and accommodation and staff training.

“Sweeping changes in all these areas are required in order to best protect residents against Covid-19, and particularly when we are dealing with elderly patients.

“Shared accommodation, dormitory-style bedrooms, old unsuitable premises, and shared bathrooms are not suitable to meet the requirements for a modern, in-patient mental health unit for older persons with or without the ongoing threat of a deadly virus,” he said.