Wednesday, April 29, 2009

Tipperary Mental Health Inquiry

There have been various media reports recently concerning the report of a Mental Health Commission inquiry into St. Michael’s Unit, South Tipperary General Hospital, Clonmel and St. Luke’s Hospital, Clonmel. (See for example Irish Times ; RTÉ ; Irish Mental Health Coalition press release).

The inquiry follows a similar report on the Central Mental Hospital in 2006.

The Tipperary report made findings which included the following: A high number of residents have sustained fractures; wards were unnecessarily locked; seclusion was being used too often; patients were forced to wear nightclothes during the day; there were no comprehensive needs assessments or care plans for residents.

A number of legal points arise from the report. For example, it is significant that the Mental Health Commission (press release) has proposed to attach conditions to the continued operation of the two approved centres requiring the Health Service Executive to produce a plan with precise timescales to address breaches in regulations, rules and codes of practice found by the Inspectorate of Mental Health Services during its inspection in late 2008. The Commission would require a quarterly report on the achievement of targets set in the plan.

Under the Mental Treatment Act 1945, the Inspector of Mental Hospitals could issue reports which were critical of mental health facilities, but there was no direct process for requiring improvement in those facilities. The new procedure under the Mental Health Act 2001 contains a process for improvement, by way of attaching conditions to registration, and the possibility of removal of a centre from the register. The CEO has said that the Commission is taking a "graduated response" approach (Annual Report 2007, p.8)

The report also highlights the over-use of locked wards. For example: "Although very few residents were detained under the Mental Health Act 2001 several ward doors were locked and staff referred to residents being ‘allowed out’ or given ‘parole’, when they should have been free to come and go as they wished." (para.13.1.3)

The problem of de facto detention of "voluntary" patients is as yet unresolved in Ireland. The European Court of Human Rights has found in H.L. v United Kingdom that certain deprivations of liberty of 'informal' patients in England breached Article 5 . Ireland urgently needs new legislation to close the so-called "Bournewood gap", but the scheme of the Mental Capacity Bill contains no proposals on this topic.

As Fergus Finlay rightly said in his RTE Drivetime radio column, if this was a story about animals, it would have exploded all over the news.