‘Victorian’ conditions criticised in major psych unit

Tue, 26 Feb, 2019 - 06:30

Conor Kane

Conditions found by inspectors in a HSE psychiatric unit were the “physical manifestation of the lack of care” afforded to vulnerable mental health patients for too long in this country, a judge says.

In the first case of its kind, the Mental Health Commission (MHC) successfully took action against the HSE under the Mental Health Act over the conditions at St Luke’s Psychiatric Unit in Kilkenny.

The case prompted MHC chairman John Saunders to say: “As a regulatory body, it is entirely unacceptable to find conditions that you would have expected to find in a Victorian workhouse in a mental health service in Ireland in 2019.”

Verbal evidence, as well as photographs submitted to the court by MHC’s assistant inspector, Martin McMenamin, detailed just how bad conditions were.

Among the findings were:

In a room used for electro-convulsive therapy (ECT) inspectors were “almost assaulted” by a “heavy, pungent smell” which made them retreat outside to catch their breath. The smell was found to be coming from a colostomy bag left in a clinical waste bin;

In a seclusion room, Mr McMenamin found dirt ingrained on the floor and hardened patches of “what I take to be food substances”. He said “the floor was tacky, shoes were sticking to the floor” and the room had not been cleaned properly “for quite a while”;

The air in the seclusion room was “stale and heavy” and there was no natural light. The inspector asked staff to pull up a blind which was covering a window, but they couldn’t as the blind wasn’t working properly. “The ventilation system was clogged with debris and dirt,” he said;

Cobwebs in a room and staining on the walls which was “possibly bodily fluid”;

A dormitory had a shelf where a partially-filled urine bottle was sitting alongside cups used by residents for drinking.

The HSE pleaded guilty at Kilkenny District Court to two charges relating to physical conditions at the unit and two charges relating to not having a consultant psychiatrist sign patient seclusion orders within 24 hours of the seclusion taking place, as is required by law.

Judge Brian O’Shea fined the HSE a total of €5,200.

“The inspectorate function of the Mental Health Commission is a hugely important one,” he said.

“For too long in this country, mental health issues have been ignored and stigmatised. The testimony of the inspectors and photographs [taken during the inspection] are the physical manifestation of that lack of care. What makes this worse is that the facilities here are those that house the most vulnerable people. Those people matter and the environment in which they are cared for matters.”

He added that, were it not for the inspection process, there would be “no mechanism” to bring such conditions to the outside world.

After the case, the chief executive of the MHC, John Farrelly, said: “I have spoken before about there being a legacy of disrespect for mental health patients in some cases, and the conditions found in this unit on this particular day suggest no other explanation.

“It is not acceptable that our inspectors found such a dirty seclusion room on day one of their inspection and returned to find it in the same state on day four... No arguments about lack of staffing or resources offer any excuse for what we found in Kilkenny in November.”

The HSE apologised for “the shortcomings identified as part of November 2018 inspections” and accepted the concern expressed by MHC. It said it has started a €1m capital programme at the Kilkenny unit which would be finished in May.

“This investment will address deficiencies identified during inspection processes and will include a comprehensive decorative maintenance programme across the facility, to ensure full compliance with MHC set regulations in respect of privacy and premises,” said the HSE.