Only 16% sought mental health detention review

The Mental Health Commission (MHC) annual report says that its key strategic objective is the reform and updating of mental health legislation while upholding and protecting human rights.

1,250 people have been taken into wardship since the Assisted Decision-Making Act 2015 was passed.

There were 2,390 involuntary admissions to approved centres.

The mental health tribunal process vindicates the rights of patients who are involuntarily detained.

Detained

From January 2019, if a patient is detained on an order for up to six months, he or she is entitled to an additional review by a tribunal if still detained after three months.

However, only 16% of the total number of patients eligible for an additional review last year? sought one.

There were 2,024 hearings, and 39 requests for additional reviews.

The request for an additional review must come from the patient or his/her legal representative. All other reviews are mandatory.

Uptake 

“The uptake is considerably less than expected,” the report says, and the Commission plans to review this to see what more can be done to make patients aware of their rights.

In July 2019, the Commission was invited to comment on the Heads of Bill to amend the Mental Health Act, 2001.

The Commission established a working group, led by its head of legal services, to review the Heads of Bill.

Numerous changes were proposed, including ensuring parity of mental health issues with general health issues.

The remit of mental health tribunals and those of the Circuit Court should also be extended for the benefit of patients, the report says.

Reform

It also pushes for reform of the provisions relating to consent and the administration of medication.

The strategic plan also includes extending the Mental Health Commission remit to cover residential and community services.

Ireland’s Decision Support Service (DSS) should set a ‘gold standard’ in Europe, and the MHC aims to deliver a service which puts Ireland to the forefront of protecting human rights.

It wants a DSS that will:

• emphasise personal ‘will and preferences’,
• respect the rights of a person,
• support autonomous decision-making and advance planning.

Enforcement

In 2019, the Commission took 40 enforcement actions against 31 approved centres in response to critical risks in premises, staffing and the privacy and dignity of residents.

The MHC regulatory process includes a cycle of licensing, inspecting and monitoring services.

The Commission secured its first ever prosecution under the Mental Health Act 2001 last year on foot of findings that patients were deprived of basic dignity and human rights by being “secluded in a dirty, malodorous, badly-lit and badly-ventilated room.”

“Unfortunately, based on the data, the pattern of poor practice in relation to seclusion and physical restraint is not limited to one or two centres, but is more widespread,” the report says. 

The Commission believes a significant number of premises are no longer suitable and need to be replaced.

Non-compliant

Of the 45 non-compliant approved centres, 15 (33%) were non-compliant with the Regulation because they were unclean.

In addition, 23 centres (49%) were non-compliant due to poor structural or decorative condition.

MHC received notification of 208 instances of overcapacity related to 13 approved centres, showing the need to upgrade or replace a significant number of in-patient units and put in place modern community mental health services.

Child admissions

There were 54 child admissions to 15 adult mental health units. Of these, 23 were for less than 48 hours.

This compares with 84 admissions to 18 adult units in 2018.

“It is very important that a child or adolescent’s first introduction to mental health care should not be through a service or building that is not specifically equipped to support their needs,” the report says.