On 20 June 2018, The Mental Health Commission (“MHC”) published its 2018 Annual Report (the “Report”).
The Chief Executive of the Mental Health Commission, John Farrelly, warns in the Report about significant governance and management deficits within Irish mental health services. He has said that it is difficult to see how some of the country’s in-patient mental health units could be registered in the future without significant improvements in levels of compliance.
Mr John Saunders, Chairman of the MHC notes that while some parts of Ireland and some service providers are getting things right, there is further work to do in order to ensure that all persons have access to appropriate mental health care in all parts of Ireland.
Mr Saunders also recognises important developments that occurred in 2018 to include the first steps in the development of the MHC’s new strategic plan ‘to regulate and engage to promote, support and uphold the rights, health and well-being of all people who access mental health and decision support services’ and the creation of a clear pathway for the establishment of Ireland’s Decision Support Service (DSS). However, he also highlights that the level of change in our mental health service provision is uncoordinated, ad hoc and slow. He emphasises that there are three key challenges for the mental health care system in Ireland which are as follows:
The following areas of concern regarding compliance by Approved Centres with the MHC regulations are identified in the Report:
2018 Themed Report – 24-hour supervised residences for people with mental illness
In 2018, the MHC carried out inspections of 54 24 hour supervised residences across a number of Community Healthcare Organisations. The MHC was very concerned with the lack of privacy for residents as they found that 91% of residences shared rooms with no privacy within those shared bedrooms.
The MHC found that there are continuing breaches of human rights in 24-hour supervised residences with regard to the right of privacy, the right to a clean, well-maintained accommodation, the right of services 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.
Child admissions to adult units
The Report notes that there were 84 child admissions to 18 adult units in 2018. This was an increase from 2017 where there were 81 admissions. The reason for the majority of admissions to adult units is due to an immediate risk to the young person or others, or due to the lack of a bed in a specialist CAMHS unit.
The MHC took 44 enforcement actions relating to 23 approved centres in 2018 which was an increase on 2017 during which 23 enforcement actions occurred. The report notes that the increase was due to the increased collection of high-quality compliance data across a number of years leading to enforcement based on trends of ongoing non-compliance. The majority of enforcement actions (73%) arose out of annual regulatory inspections. Other enforcement actions arose out of quality and safety notifications, compliance monitoring and focused inspections.
Decision Support Service (“DSS”)
During 2018, extensive work was undertaken in preparation for a fully operational Decision Support Service. This included organisational design, scoping the service, project governance, scoping ICT infrastructure, defining the regulatory framework, undertaking stakeholder engagement and mapping out customer journeys.
The Decision Support Service is provided for under the Assisted Decision Making (Capacity) Act 2015 (‘2015 Act’). The 2015 Act establishes a statutory time specific and issue-specific assessment of capacity and sets out important guiding principles, emphasising privacy, autonomy, and minimal intervention. The supports provided for and monitored by the Decision Support Service will help to ensure that people are afforded the fundamental human rights to make their own decisions as far as possible about their personal welfare and their property and affairs.
The 2015 Act is largely not yet commenced. However, certain sections have been commenced, which include the appointment of the Director to allow for the establishment of the Decision Support Service. The Director was appointed in October 2017 and has a number of specific functions and responsibilities set out under Part 9 of the 2015, including providing information and promoting public awareness.
The full publication of the Mental Health Commission’s Annual Report 2018 can be accessed here.
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