The Mental Health Commission (“MHC”) is an independent statutory body whose primary function is to foster and monitor high standards of care and good practice in the delivery of mental health services, and to ensure that the interests of those involuntarily admitted are protected, pursuant to the Mental Health Act, 2001 (“2001 Act”).
The MHC this week published its 2015 Annual Report, which included the Report of the Inspector of Mental Health Services (“the Reports”). At the launch, Chairman of the MHC, Mr John Saunders said that “in relation to the Government’s policy on mental health, A Vision for Change, that there is now considerable commitment to the policy at national and regional level within the HSE and within the statutory, voluntary and independent sectors. A great deal of clinical and administrative activity had yielded positive progress. However, notwithstanding this commitment much needs to be done to ensure the delivery of consistent, timely and high quality services in all regions, and across a full range of specialities and age groups”.
Mr Saunders also referred to a “move from a purely medical model to a more holistic bio-psychosocial one”.
Patricia Gilheaney, the MHC Chief Executive, referred to the difficulty in recruiting and the lack of mental health professionals in the jurisdiction, which is an ongoing challenge.
The Reports deal with the following key areas:-
While 61 approved centres (a hospital or other in-patient facility for the care and treatment of persons suffering from mental illness or mental disorder) were inspected in 2015, only 6 were compliant with all legislative requirements. It was acknowledged that progress was being made but noted that the number of centres in full compliance is disappointing. During 2015, standards of service also fell below what is acceptable in 5 areas; individualised care planning, privacy, staff training, safety of premises and the control and administration of medication.
Concerns were also raised in relation to the involuntary admission to residential care which Mr Saunders stated should be a last resort intervention.
2. Admission of Children
The Code of Practice for Admission of Children states that no child under eighteen years is to be admitted to an adult unit in an approved centre, unless there are exceptional circumstances. During 2015, there were 95 admissions of children to adult units. Mr Saunders commented that “This situation is unacceptable and needs to be addressed as a matter of urgency”.
3. Areas of High Compliance
Areas where high compliance were achieved included: religion; visits; communication; children’s’ education; insurance; certificate of registration; governing the use of ECT; food and nutrition; food safety; clothing; recreational activities; care of the dying; mental health tribunals; identification of residents; and general health.
The Reports emphasise that the MHC adopts a responsive approach to regulation. The MHC endeavours to support approved centres to comply with all legislative requirements and to improve the quality of services provided. The MHC’s enforcement tools include the following:-
- Corrective and Preventative Action Plan (CAPA)
- Immediate Action Notice
- Registration Conditions
- Removal of the approved centre from the register
- Prosecution of the Registered Proprietor
5. Mental Health Tribunals and Legal Aid Scheme
The 2001 Act introduced a provision for free legal representation for adults during independent reviews, which are conducted during their period of involuntary admission. This independent review is conducted within 21 days of an admission or renewal order before a three person Mental Health Tribunal consisting of a lawyer as chair, a Consultant Psychiatrist and one other person. Prior to the independent review a legal representative is appointed by the MHC for each person admitted involuntarily, unless he or she proposes to engage one privately. In this case an independent medical examination by a Consultant Psychiatrist, also appointed by the MCH, will have been completed.
In the year 2015 9% of orders reviewed by the Mental Health Tribunals were revoked.
6. Court Appeals
The patient may appeal a decision of the Mental Health Tribunal to the Circuit Court. There is a continuing increase in the number of Circuit Court appeals being brought on behalf of patients. The High Court has held on a number of occasions that the question to be determined by the Circuit Court is whether the patient “is” suffering from a mental disorder on the date of the hearing.
The MHC’s legal aid scheme is available to patients wishing to bring appeals, irrespective of whether those appeals are likely to be successful. The MHC is also liable for the costs of defending such appeals on behalf of the Mental Health Tribunal. The MHC’s practice has been to grant legal aid to a patient wishing to bring an appeal under the 2001 Act. The MHC considers this approach to be in line with its functions of protecting “the interests of persons detained in approved centres under this Act”.
7. Joint Standards for the Notification and Management of Patient Safety Incidents between the MHC and the Health Information and Quality Authority
Following discussion with the Department of Health it was agreed that the MHC and HIQA would develop joint standards for the notification and management of patient safety incidents which comprised three elements:-
- Reporting of patients safety incidents including serious reportable events
- Open disclosure
- The conduct of reviews of patient safety incidences
Both Reports are very detailed and the above is a synopsis of some key areas in the Reports.
For the full report please click here.
To read the press release please click here.