2009 annual report - mhcirl.ie · the commission and their support to me and my staff since my...

Mental Health Commission | Coimisiún Meabhair-Shláinte

2009ANNUAL REPORTTUARASCÁIL BHLIANTÚIL

including the Report of the Inspector of Mental Health Services 2009

Mental HealtH CoMMission

annual RepoRt 2009

including the Report of the inspector of Mental Health services

Part 1

Book 1

the principal functions of the Mental Health Commission, as defined by the act, shall be ‘to promote, encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services and to take all reasonable steps to protect the interests of persons detained in approved centres under this act’.Mental Health act 2001 section 33 (1)

VisionWorking together for Quality Mental Health services

Missionto raise to the best international standards the quality of mental health services provided in ireland and to protect the interests of all people who use mental health services1

1 “mentalhealthservices”meansserviceswhichprovidecareandtreatmenttopersonssufferingfromamentalillnessoramentaldisorderundertheclinicaldirectionofaconsultantpsychiatrist”.Section 2, Mental Health Act 2001.

Contents

Part 1

Chairman’sForeword 7

Introduction–ChiefExecutiveOfficer 9

CommissionMembers(April2007–2012)(Attimeofappointment) 10

Chapter 1 11

MentalHealthCommission:Functions&Structures 12

Chapter 2 17

StrategicPlan2009–2012 18

Chapter 3 23

MentalHealthCommission:ProgressingtheStrategicPlan2009–2012 24

Part 2

Chapter 4 77

NationalReviewofMentalHealthServices2009 78

appendices 89

Chapter 5 241

OverviewofCatchmentMentalHealthServiceswithinHSEArea–CatchmentReportsbyHSEArea 244

Chapter 6 463

AdditionalInformation 465

Books 2-7

ReportoftheInspectorofMentalHealthServicesisavailableonCD-ROM(seebackofreport)

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BooK 1–PART1 Mental Health Commission annual Report 2009

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BooK 1–PART1Mental Health Commission annual Report 2009

Chairman’s ForewordIn2009wemadesomeprogressonanumberoffrontsintheareaofmentalhealth.Howevertheoverallpaceofchangetowardsamodernbest-practicemodelofserviceprovisionisdisappointinglyslow.AswecontinuetooperateinanenvironmentofgreateconomicdifficultyandExchequershortages,theCommissionisdeterminedtocontinuetopressfortheimplementationofGovernmentpolicyonmentalhealth.

TheCommissionhasconsistentlyexpresseddisappointmentatthepaceofimplementationofthekeyGovernmentpolicyintheareaofmentalhealthA Vision for Change.Thecoreofthispolicyisthemovefrominstitutionalcaretocommunitycare.SuchachangeisinternationalbestpracticebutisgivenaddedurgencybecauseofthepoorconditionofsomeofIreland’sapprovedcentres,apointmadeclearlyandrepeatedlyinthereportsoftheInspectorateofMentalHealthServices.

ItisthereforewelcomethattheMinisterofStateJohnMoloneyhasbackedhisclearlystatedsupportforthispolicywithastatementthathehassecuredg50millionfromtheDepartmentofFinancetofundthedevelopmentofcommunitybasedfacilities.TheintentionistorepaythemoneytotheDepartmentofFinancethroughthesaleofolderinstitutionsandthelandaroundthem.Itistobehopedthatthisisthestartofaprocessratherthanaone-offmove.

TheCommissionwasalsopleasedattheMinisterofState’sannouncementthatthenewCentralMentalHospitalwouldnotbebuiltbesidetheproposednewprisonatThorntonHallinNorthCountyDublin.WhileweareverysupportiveofanewCentralMentalHospitalwealwaysbelievedthatitshouldnotbeadjacenttoaprisonforvariouspracticalreasonsandmoreimportantlybecausechoosingthislocationwouldunnecessarilystigmatisepatientsofthenewHospital.

TheCommissioncontinueditsregulatoryrolein2009,withitsInspectorateinspectingallapprovedcentres.ThereportsoftheseinspectionswillprovidethebasisforactionthatcanbetakenbytheMentalHealthCommission.TheCommissionhasmadeitclearthatconditionsinsomeapprovedcentres,inparticularsomeolderones,areentirelyunacceptableandthatiftheydonotimprovetheCommissioncanandwillimposeconditionsonsuchcentres,includingadirectionthattheynolongeradmitnewpatients.ThereportoftheInspectorpublishedhererecognisesimprovementsinsomeapprovedcentreswhichweresoughtbytheCommission,butfindsnodiscernibleoverallimprovementinstandards.Ifrequired,actionwillbetakenduring2010inaccordancewiththeCommission’sstatutorypowers.

Goodstructuresofservicedeliveryultimatelydelivergoodservices.In200914ExecutiveClinicalDirectors(ECDs)wereappointedwithinthementalhealthservices.13ofthesewillhaveclinicalresponsibilityfor“super-catchments”ofbetween200,000and400,000peopleeach,whilethe14thisNationalExecutiveClinicalDirectorforForensicMentalHealthServices.TheExecutiveClinicalDirectorroleisconsistentwithA Vision for Change.Theywillprovideclearclinicalleadership.Ilookforwardtoworkingwiththeseclinicalleadersinfurtheringthedevelopmentagendaformentalhealthservices.

WithintheMentalHealthServicesweareallworkingtowardsensuringthatserviceusers’viewsandexperiencesarecentraltotheservicesandhowtheyareprovided.In2009weworkedonthedevelopmentoftheHeadspaceToolkit,awebsiteandwrittenresourcepacktoassistyoungpeopleavailingofmentalhealthservices.Itisdesignedtoequipyoungpeoplebeingtreatedformentalillnesstospeakupforthemselves,asserttheirrightsandgetinvolvedindecisionsconcerningtheircareandtreatment.Thiswillbelaunchedinearly2010.

During2009wealsodevelopedthefirstNationalMentalHealthServiceCollaborative,aninitiativebringingpolicy-makersandon-the-groundprofessionalstogethertoachieveaparticularpolicyaim.Thiscollaborative,involvingtheHSE,twoDublinHospitalsandtheMentalHealthCommissionisfocussinginitiallyonturningintorealitytheagreedaimthateachpatientshouldhaveanindividuallytailored

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careandtreatmentplanfocusedontheirrecovery.Thistooispartoftheattempttobringpatients’experiencesandindividualneedstotheheartofMentalHealthServices.

TheCommissionbelievesthatapplicationsforinvoluntaryadmissionofpatientsshouldwheneverpracticablebemadebyanauthorisedofficer–anofficeroftheHSEofaprescribedrankorgradewhoisauthorisedundertheMentalHealthAct.Howeverin2009thenumberofapplicationsforinvoluntaryadmissionbyauthorisedofficersroseonlymarginallyfrom4.6%in2008to5.8%in2009.Applicationsbyspouseorrelativefellfrom63.9%to61.8%,whileapplicationsbymembersoftheGardaSiochanafellfrom22.8%to22.6%.Thisvirtuallyunchangedpositionisdisappointing.

FinallyIwouldliketowarmlywelcomeournewChiefExecutiveHughKanetohispost.HughtakesoverfromBridClarkewhoretiredinDecember2009.

ItwasapleasuretoworkwithBridsinceApril2007.ShewasthefoundingChiefExecutiveOfficeroftheMentalHealthCommission,abodyestablishedafter60yearsofwaitingformodernlegislationonmentalhealth.Bridtookoverthisnewbodywithnoroadmaptoguideher,broughtitthroughthechallengesfacingeveryorganisationsetuptoeffectmajorchangeandhasgivenusarespectedanddynamicbodythathasalreadyhadasignificanteffectonmentalhealthpracticeandhasbeguntheworkoffundamentallychangingtheattitudesofserviceproviders,serviceusersandthegeneralpublictomentalhealth.

HughcomestothejobwithgreatexperienceofleadingchangeandacommitmenttoimplementingthemodernvisionofmentalhealthservicesunderpinnedbytheprovisionsoftheMentalHealthAct2001andinlinewiththestrategicprioritiesoftheCommission.Theyaretwodifferentpeoplewhoshareapassionforchangeandasensitivitytotheareainwhichtheywork.IandtheCommissionthankbothfortheircommitmentanddeterminationandwishbothofthemwellforthefuture.

Dr. Edmond O’DeaChairman

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introduction – Chief executive officerIampleasedtointroducetheeighthAnnualReportoftheMentalHealthCommission,whichincludestheReportoftheInspectorofMentalHealthServices,fortheyearendedDecember31st2009.

ThisreportsetsouttheworkprogrammeoftheCommissionduring2009andhowweareprogressingtomeetourstrategicobjectivesassetoutinourcurrentStrategicPlanfortheperiod2009-2012.

AsChiefExecutiveOfficerIwouldliketorecognisetheworkofthestaffoftheCommission.AsanorganisationwehaveawonderfulblendofexperiencedandtalentedprofessionalswhoarefullycommittedtotheobjectivesoftheCommissionandworkhardeachdaytowardstheirachievement.

Thisreportincludesextensiveinformationanddataonallaspectsofouractivity,includingparticularlydataontheinvoluntaryadmissionofadultstoapprovedcentres,theadmissionofchildrenandcompliancewiththeregulationsforapprovedcentres.Theinformationcontainedinthereportshouldbeofassistancetothosewhousetheservices,areinvolvedindeliveringservices,reviewingservicesandplanningthefuturedevelopmentofmentalhealthservicesinIreland.

TheMentalHealthCommissioncontinuestosupportthedevelopmentofresearchwithinthementalhealthservicesandthedevelopmentoflinkagesbetweenservicesandcentresoflearning.ThekeyfocusandaimofourresearchistobringbestpracticeandexcellencetotheforewithintheIrishmentalhealthservices.

TheMentalHealthCommissioncontinuestobeconcernedabouttheslowimplementationofnationalgovernmentpolicyformentalhealthA Vision for Change.Inthecurrentclimatethedevelopmentandprovisionofcommunitybasedmentalhealthserviceswitharecoverybasedapproachmustbegiventheutmostpriority.

ArisingfromconcernsonthepaceofimplementationofA Vision for ChangetheCommissionpublishedareportin2009titled‘FromVisiontoAction?AnAnalysisoftheImplementationofA Vision for Change’.Thisreportcritiquesthecurrentimplementationplansandmakessomerecommendationsonhowtheimplementationplanandprocessmightbeimproved.

TheCommissioncontinuestoworkwithmanystakeholdersincludingserviceusersandotheragenciesbothstatutoryandnon-statutory.Wederivemuchsupportanddirectionforourworkfromthesecolleagues.Iwouldliketothankthemfortheirsupportin2009.IwouldlikeparticularlytothankourcolleaguesintheDepartmentofHealthandChildrenespeciallythoseintheofficeforDisabilityandMentalHealth.

Iwouldliketoalsomentionthosemembersofthemediawhocontinuetoraisementalhealthissues,withoutthisfocusandsupportthedrivetoreducestigmaandbringaboutrealchangeinmentalhealthserviceswouldnotadvance.

AstheincomingChiefExecutiveOfficerIwouldliketoacknowledgetheenormouscontributionmadetotheMentalHealthCommissionbymypredecessorMs.BrídClarkeandtowishherwellinthefuture.

FinallyIwouldliketothanktheChairmanandCommissionmembersfortheirworkandcommitmenttotheCommissionandtheirsupporttomeandmystaffsincemyappointment.

Hugh KaneChiefExecutiveOfficer

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Commission Members (april 2007–2012) (at time of appointment).

Mr. Martin Rogan

AssistantNationalDirector–

MentalHealth

HealthServiceExecutive

Mr. John saunders

NationalDirector

SchizophreniaIreland

Dr. edmond o’Dea

Chairman

PrincipalPsychologist

HealthServiceExecutiveWest

Mr. Brendan Byrne

DirectorofNursing

Carlow/KilkennyMentalHealth

Services

Ms. emile Daly

Barrister-at-Law

* Ms. Daly resigned from the Commission December 2009

Ms. Marie Devine

Bodywhys

Dr. Brendan Doody

ConsultantChildPsychiatrist


DublinMid-Leinster

Mr. padraig Heverin

ClinicalNurseManagerII

MayoMentalHealthServices

Dr. Martina Kelly

GeneralPractitioner

Dr. Mary Keys

Lecturer

NUIGalway

Dr. eamonn Moloney

ConsultantPsychiatrist

HealthServiceExecutiveSouth

Mr. John Redican

ChiefExecutiveOfficer

IrishAdvocacyNetwork

Ms. Vicki somers

PrincipalMentalHealthSocialWorker


Kildare/WestWicklowMentalHealth

Services

Mental Health Commission Functions & structures

CHapteR 1

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Mental Health Commission Functions & structures

1.1 Mental Health Commission

TheMentalHealthCommission,anindependentstatutorybody,wasestablishedinApril2002undertheprovisionsoftheMentalHealthAct,2001.

TheprincipalfunctionsoftheCommission,asspecifiedintheMentalHealthAct,2001aretopromote,encourage,andfostertheestablishmentandmaintenanceofhighstandardsandgoodpracticesinthedeliveryofmentalhealthservicesandtotakeallreasonablestepstoprotecttheinterestsofpersonsdetainedinapprovedcentres(Section33(1)).

TheremitoftheCommissionincorporatesthebroadspectrumofmentalhealthservicesincludinggeneraladultmentalhealthservices,mentalhealthservicesforchildrenandadolescents,olderpeople,peoplewithlearningdisabilitiesandforensicmentalhealthservices.

TheCommissionconsistsof13people,includingtheChairman,whoareappointedbytheMinisterforHealthandChildren.ThecompositionoftheCommissionisasfollows:

Apersonwhohashadnotlessthan10yearsexperienceasapractisingbarristerorsolicitorinthe}}

StateendingimmediatelybeforehisorherappointmenttotheCommission.

Threeshallberepresentativeofregisteredmedicalpractitioners(ofwhichtwoshallbeconsultant}}

psychiatrists)withaspecialinterestinorexpertiseinrelationtotheprovisionofmentalhealthservices.

Twoshallberepresentativeofregisterednurseswhosenamesareenteredinthedivisionapplicable}}

topsychiatricnursesintheregisterofnursesmaintainedbyAnBordAltranaisundersection27oftheNursesAct,1985.

Oneshallberepresentativeofsocialworkerswithaspecialinterestinorexpertiseinrelationtothe}}

provisionofmentalhealthservices.

Oneshallberepresentativeofpsychologistswithaspecialinterestinorexpertiseinrelationtothe}}

provisionofmentalhealthservices.

Oneshallberepresentativeoftheinterestofthegeneralpublic.}}

Threeshallberepresentativeofvoluntarybodiespromotingtheinterestofpersonssufferingfrom}}

mentalillness(atleasttwoofwhomshallbeapersonsufferingfromorwhohassufferedfrommentalillness).

Oneshallberepresentativeofthechiefexecutivesofthehealthboards.}}

Notlessthanfourshallbewomanandnotlessthanfourshallbemen.}}

MembersoftheCommissionshallholdofficeforaperiodnotexceeding5years.

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TwelvemeetingsoftheMentalHealthCommissionwereheldin2009,thisincludedtwo2-daymeetingsinFebruaryandAprilandtwoteleconferences.Commissionmembersattendanceatmeetingswasrecordedasfollows:Dr.EdmondO’Dea(12/12),Mr.BrendanByrne(11/12),Ms.MarieDevine(9/12),Dr.BrendanDoody(7/12),Mr.PadraigHeverin(11/12),Dr.MartinaKelly(7/12),Dr.MaryKeys(9/12),Dr.EamonnMoloney(11/12),Mr.JohnRedican(10/12),Mr.MartinRogan(9/12),Mr.JohnSaunders(12/12),Ms.VickiSomers(8/12),Ms.EmileDaly(0/12)*Ms.Dalywasonmaternityleavein2009.

MembersoftheCommissionalsoparticipateincommitteesestablishedbytheMentalHealthCommission.

1.2 Mental Health Commission Committees 2009

TheMentalHealthCommissionhasestablishedanumberofcommitteestoadviseonarangeofissues.

audit Committee

Mr.GavinMaguire(Chair),Ms.VickiSomers,Mr.PadraigHeverin,Mr.BrendanByrne,Mr.JohnRedican.

World Mental Health Day 2009

Mr.BrendanByrne(Chair),Mr.JohnSaunders,Dr.EamonnMoloney,Dr.MartinaKelly,Mr.MartinRogan,Ms.RosemarySmyth,Ms.MarinaDuffy.

Child & adolescent Mental Health services Committee

Dr.BrendanDoody(Chair),Ms.VickiSomers,Mr.MartinRogan,Ms.MarieDevine,Ms.BrídClarke,Ms.PatriciaGilheaney,Dr.SusanFinnerty,Ms.RhonaJennings.

Forensic Mental Health services Committee

Mr.PadraigHeverin,Mr.JohnSaunders,Mr.BrendanByrne,Ms.BrídClarke.

Mental Health Commission Research Committee

ProfessorPatrickWall(Chair),Dr.JimCampbell,Ms.ElizabethBrosnan,Dr.PatriciaClarke,Dr.ElizabethMcKay,Dr.EadbhardO’Callaghan,Dr.DermotWalsh,Dr.ClaireCollins,Dr.FionaKeogh,Mr.PaddyMcGowan,ProfessorAgnesHiggins,Ms.VeronicaRaineiri.

police and Mental Health services Working Group

Dr.JohnOwens(Chair),Dr.MaryMcGuire,Mr.MartinConnor,Ms.VickiSomers,Mr.DiarmaidMcGuinness,Dr.PhilipWiehe,Mr.GerryCoone,SuperintendentFergusHealy,SergeantMichaelMcNamara.

assisted admissions Committee

Mr.PadraigHeverin(Chair),Mr.BrendanByrne,Dr.EamonnMoloney,Mr.RonanBrowne,Ms.CatherineBourke,Ms.BrídClarke.

Mental Health services Committee

Mr.BrendanByrne(Chair),Mr.PadraigHeverin,Dr.EdmondO’Dea,Mr.JohnRedican,Mr.JohnSaunders,Ms.BrídClarke,Ms.MarinaDuffy.

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Committee on scheme for Mental Capacity Bill

Dr.MaryKeys(Chair),Mr.JohnSaunders,Mr.JohnRedican,Ms.VickiSomers,Mr.MartinRogan,Ms.BrídClarke.

1.3 organisational structure

TheMentalHealthAct2001providesfortheappointmentofaChiefExecutiveOfficerfortheCommissionandtheInspectorofMentalHealthServices.

TheChiefExecutiveOfficer(CEO),appointedbytheCommission,hasresponsibilityfortheoverallmanagementandcontroloftheadministrationandbusinessoftheCommission.TheChiefExecutiveOfficeristheaccountableofficerfortheorganisation.

ThefirstChiefExecutiveOfficeroftheMentalHealthCommission,Ms.BrídClarkeretiredfromtheMentalHealthCommissioninDecember2009oncompletionofher7yearcontract.

Mr.HughKane,wasappointedasthesecondChiefExecutiveOfficeroftheCommissionandbeganhisterminDecember2009.

TheInspectorofMentalHealthServices,aconsultantpsychiatrist,isappointedbytheCommission.TheprincipalresponsibilitiesoftheInspectorofMentalHealthServicesinclude,visitingandinspectingapprovedcentresandotherpremiseswherementalhealthservicesarebeingprovidedasperSections51-53MentalHealthAct2001,carryingoutannualreviewsofmentalhealthservicesintheStateandfurnishingareporttotheCommissionasperSection51MentalHealthAct2001.

TheMentalHealthActalsoprovidesfortheappointmentofAssistantInspectorsofMentalHealthServices.

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Mental Health Commission staff 2009 (enD oF YeaR)

Chief executive officer:Mr.HughKane

inspector of Mental Health services: Dr.PatrickDevitt

Director standards & Quality assurance:Ms.PatriciaGilheaney

Director Mental Health tribunals:Dr.GerryCunningham

Director Corporate services:Mr.RayMooney

Director training and Development: Ms.RosemarySmyth

Consultant psychiatrists:Dr.FionaFenton

Dr.MariaFrampton

Dr.MariaMorgan

Dr.DermotWalsh

Dr.EvelynMcCabe

Dr.MariaMoran

Dr.FidelmaCorcoran

Dr.EugeneMorgan

Dr.NoraCrowleyBarry

Dr.EugeneHill

Dr.EndaDooley

senior administrator office of Ceo:Ms.MarinaDuffy

Mental Health information officer:Ms.DeirdreHyland

senior administrator inspectorate Division:Ms.ColetteRyan

policy officers:Ms.LisaO’Farrell

Mr.DerekBeattie

assistant inspectors:Dr.SusanFinnerty

Ms.MaeveKenny

Mr.PaulCollins

Dr.FionnualaO’Loughlin

Ms.PatriciaDoherty

Mr.SeanLogue

administration: Mr.BrianO’Sullivan

Mr.AdrianMurtagh

Mr.KevinFoley

Mr.AndrewGoodwin

Ms.AnnaWhiston

Mr.StephenSomers

Ms.SandraCurran

Ms.EricaMcCluskey

Ms.BrídFlood

Ms.DeirdreHanratty

Ms.MonicaMartin

Ms.JoannaMacklin

Mr.MathewMorenigbade

Ms.HelenaMoloney

Ms.UllaQuayle

Ms.ÉilisScully

Ms.EmerKelly

Mr.SimonHorne

systems/project Manager – Corporate services:Ms.MarieHiggins

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strategic plan 2009–2012

CHapteR 2

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strategic plan 2009-2012TheMentalHealthCommissionpublisheditsthirdStrategicPlanin2009.ThisplanbuildsupontheworkundertakenduringthetimeframeoftheCommission’stwoearlierstrategicplans.TheseearlierplansfocusedontheactionsrequiredpriortocommencementoftheMentalHealthAct2001.ThecurrentplandefinesthestrategicdirectionoftheMentalHealthCommissionfortheperiod2009-2012.TheStrategicPlanhassixinterconnectedstrategicprioritieswhichtranslateintogoals,andactionsthemandateoftheMentalHealthCommission,pursuanttotheMentalHealthAct2001.

TheCommissionconsultedwithkeystakeholdersinpreparingtheStrategicPlan,andtheirviewsinformedthedevelopmentoftheplan.WithintheorganisationallstaffoftheCommissionalsohadtheopportunitytooffertheirinputtotheplan.TheStrategicPlansetsambitioustargetsfortheMentalHealthCommission.StrivingforcontinuousqualityimprovementisoneofthecorevaluesoftheCommission.Withthecontinuedsupportandcommitmentofallstakeholdersthesestrategicprioritiescanbeachieved.

TheStrategicPlanisguidedbyourVisionoftheMentalHealthSystem,thatisthesystemthatweaspiretohavinginplaceinIrelandbytheyear2020.Thisplancontainsobjectivesandprioritisedactionsfortheperiod2009–2012thatwilldeliversignificantprogressonthejourneytofirstclassmentalhealthservicesandlegalprotection.

Figure 1: The Irish Mental Health System – 2020

Service

Users

Excellent Mental Health ServicesGood Population& Service User

Outcomes

Mental Health Commission

Serv

ice

User

s

Serv

ice

User

s

Service

Users

Coherent Wider

Sectorial Links

Broad Public

Support

SupportiveGovernment & Political

System

ResearchEducation

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2020 Vision – Service Users and their Families and Carers Are Active Participants in the Care Process

strategic priority one (2009-2012) – service users, Families and Carers

PolicyandPlanning:serviceusersandtheirfamiliesandcarersareinvolvedinasignificantway,locally}}

andnationally.

IndividualCarePlanning:serviceusersandtheirfamiliesandcarersareactivelyinvolvedinplanning}}

thecarerequiredtomeeteachindividualserviceuser’sassessedneeds.

2020 Vision – The Human Rights and Best Interests of All Persons Who Use Mental Health Services Are Respected and Protected

strategic priority two (2009-2012) – Human Rights and Best interests

AcommitmenttoHumanRightsisembeddedinallaspectsoftheCommission’sandmentalhealth}}

serviceproviders’policyandpractice.

TheCommissionwillcontinuetoarrangereviewsofinvoluntaryadmissionincompliancewiththe}}

2001Act.

Promoteandsupportadvancesinlegislationtoprotectthehumanrightsofvulnerablepeople.}}

TheCommissionwillcontinuetomonitorRulesandCodesofPracticeissuedpursuanttotheprovisions}}

ofthe2001Act.

2020 Vision – The Quality of Mental Health Services Is Consistent with Best International Standards

strategic priority three (2009-2012) – Quality Mental Health services

Tofacilitateandsupportimplementationofthequalityimprovementstandardsformentalhealth}}

servicesinIreland.(Quality Framework for Mental Health Services in Ireland,MHC2007).

Tocontinuetosupportmentalhealthservicesresearchtobuildknowledgethatleadstopracticalways}}

ofimprovingservices.

Thescopeandprocessofinspectionandreportingiseffectiveinenhancingbothcomplianceand}}

commitmenttocontinuousqualityimprovementsandisacatalystforchange.

Topromoteandsupportthedevelopmentofanationalmentalhealthinformationsystem.}}

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2020 Vision – The Needs and Rights of People with Mental Illness Are Addressed in an Integrated and Cohesive Manner within the Wider Mental Health Domain

strategic priority Four (2009-2012) – Wider Mental Health Domain

Theworkofrelevantstateagenciesandotherorganisationswithinthewidermentalhealthdomainis}}

informedbytheCommission’sstrategyandnationalgovernmentpolicyonmentalhealth,A Vision for Change.

2020 Vision – Public Understanding of Mental Illness Is Enhanced, Stigma Is Diminished and Public Attitudes Are Increasingly Respectful

strategic priority Five (2009-2012) – social inclusion and active Citizenship

Tochallengethebarriersexperiencedbypeoplewithamentalillnesstosocialinclusionandactive}}

citizenship.

2020 Vision – The Mental Health Commission Is Viewed as an Efficient Organisation with the Interests of People with Serious Mental Illness or Mental Disorder at the Forefront of All Our Activities

strategic priority six (2009-2012) – MHC as an organisation

TomaintainandenhancetheMentalHealthCommission’ssystemsandprocessestoensurethe}}

provisionofaqualityservicebytheMentalHealthCommission.

Tocontinuetopromoteaculturewithintheorganisationwhichreflectsdeepcommitmenttothe}}

Commission’sstatedvalues.

ToensurethattheMentalHealthCommissionisstaffedbywelltrained,competentandcommitted}}

people.

TofosterwidespreadunderstandingoftheroleandfunctionsoftheMentalHealthCommission.}}

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Guiding principles and Values of the Mental Health Commission

TheworkoftheCommissionisguidedbytheprinciplesenunciatedinthefollowinginternationalconventions/declarations:

EuropeanConventionfortheProtectionofHumanRightsandFundamentalFreedoms}}

EuropeanConventionforthePreventionofTortureandInhumanorDegradingTreatmentorPunishment}}

UnitedNationsUniversalDeclarationofHumanRights}}

UnitedNationsConventionontheRightsoftheChild}}

UnitedNationsConventionagainstTortureandotherCruelandInhumanorDegradingTreatmentor}}

Punishment

InternationalCovenantonCivilandPoliticalRights}}

InternationalCovenantonEconomic,SocialandCulturalRights}}

UnitedNationsPrinciplesfortheProtectionofPersonswithaMentalIllnessandfortheImprovement}}

ofMentalHealthCare

UnitedNationsConventionontheRightsofPersonswithDisabilities}}

WHOMentalHealthActionPlanforEurope,Helsinki2005.}}

SpecificlegislativeprovisionswhichinformtheworkoftheMentalHealthCommissioninclude;

MentalHealthAct2001}}

EuropeanConventiononHumanRightsAct2003}}

DisabilityAct2005}}

HealthAct2004}}

HealthAct2007(Part14)}}

FreedomofInformationAct1997andFreedomofInformationAmendmentAct2003}}

DataProtectionAct1988andDataProtection(Amendment)Act2003}}

CriminalLaw(Insanity)Act2006}}

EqualStatusActs2000-2004.}}

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Values:

ThecorevalueswhichdefinetheCommission’sethosandcultureandunderpinthedeliveryofservicesbytheCommissionare:

accountability and integrity:TheCommissionoperatesatalltimeswithprobityandinatransparentmanner.

efficiency and effectiveness:TheCommissioniscommittedtoexercisinggoodstewardshipovertheresourcesallocatedtotheorganisation.

equality and Diversity:TheCommissionrespectsthedignityofthoseincontactwithusandvaluespeoplefortheiruniquecontribution.

Confidentiality:TheCommissionpledgestohandleconfidentialandpersonalinformationwiththehighestlevelofprofessionalismandtotakeduecarenottoreleaseordiscloseinformationoutsidethecourseofthatnecessarytofulfilourlegalandprofessionalrequirements:

empowerment:TheCommissionrecognisesthatempowermentliesthroughtheprovisionofinformation,trainingandeducationinanaccessiblemanner.

Quality:TheCommissioniscommittedtostrivingforcontinuousqualityimprovementinallitsactivities.

achieving together:TheCommissioniscommittedtocollaboratingforimprovingthroughongoingpartnership,consultationandteamwork.

Mental Health Commission progressing the strategic plan 2009–2012

CHapteR 3

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progressing the strategic plan 2009–2012

2020 Vision – Service Users and their Families and Carers Are Active Participants in the Care Process

strategic priority one (2009-2012) – service users, Families and Carers

PolicyandPlanning:serviceusersandtheirfamiliesandcarersareinvolvedinasignificant}}

way,locallyandnationally.

IndividualCarePlanning:serviceusersandtheirfamiliesandcarersareactivelyinvolvedin}}

planningthecarerequiredtomeeteachindividualserviceuser’sassessedneeds.

service user empowerment/involvement

TheMentalHealthCommissionrecognisestheimportanceofserviceuserinvolvementinmentalhealthcareandtreatmentandhasidentifiedthisasoneofitsstrategicprioritiesfor2009–2012.Inlinewiththispriority,theCommissionproducedseveralserviceuserinformationresourcesin2009.TheCommissionalsosetupanewserviceuserinformationsectiononitswebsitein2009toreflectthenewresourcesavailable.Detailsofthesenewresourcesaregivenbelow.

service user Guides

In2009,theCommissionproducedtwoserviceuserguidestoaccompanynewcodesofpractice.Weproducedaguidetothecodeofpracticeonadmission,transferanddischarge.ThisguidewasdevelopedinconjunctionwiththeNationalAdultLiteracyAgency(NALA)andwasapprovedfortheuseofplainEnglishbyNALA.

TheCommissionalsoproducedaneasyreadguidetothecodeofpracticeforthoseworkingwithpeoplewithintellectualdisabilitiesandmentalhealthproblems,whichwasdevelopedinconjunctionwithMENCAPintheUKandwaskindlytestedbythePeopleFirstAdvocacyGroupinMonasterevin,Co.Kildare.

“Headspace Toolkit” for Young people

TheCommissiondevelopedarightsandselfadvocacytoolkitforyoungpeopleavailingofinpatientmentalhealthservicesentitledthe“Headspace Toolkit”.Thetoolkitpromotesaselfadvocacyandrightsbasedapproachtomentalhealthcareandtreatment,providingyoungpeoplewithinformationonbeinganinpatient,knowingtheirrights,whatthelawsaysandhowtospeakupandgetotherstolisten.ThetoolkitwasdevelopedinpartnershipwithAdvocacyinSomerset,aUKmentalhealthadvocacycharity,whodevelopedasimilartoolkitforuseintheUK.Theviewsofyoungpeople,mentalhealthprofessionsandorganisationswithaninterestinyoungpeoples’mentalhealthandrightsalsoinformedthedevelopmentprocess.ThetoolkitwaspublishedinDecember2009.Awebsiteversionofthetoolkitwasalsodevelopedwhichcanbeaccessedat:www.headspaceireland.ie.TheCommissionintendstoofficiallylaunchthetoolkitintheBaseYouthCentreinBallyfermotinearly2010.

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information leaflets

TheMentalHealthCommissionpublishedfournewserviceuserinformationleafletsduring2009.ThefourleafletsprovideserviceuserswithinformationontherecentlyrevisedRulesGoverningtheUseofElectro-ConvulsiveTherapy,RulesGoverningtheUseofSeclusionandMechanicalMeansofBodilyRestraint,CodeofPracticeontheUseofElectro-ConvulsiveTherapyforVoluntaryPatientsandtherevisedCodeofPracticeontheUseofPhysicalRestraintinApprovedCentres,whichcameintoeffecton1stJanuary2010.

Thefourleafletsareasfollows:

WhatyouneedtoknowabouttheRulesandCodeofPracticeonElectro-ConvulsiveTherapy;}}

WhatyouneedtoknowabouttheRulesonSeclusion;}}

WhatyouneedtoknowabouttheRulesonMechanicalRestraint;and}}

WhatyouneedtoknowabouttheCodeofPracticeonPhysicalRestraint.}}

AllfourdocumentshavebeenwritteninanaccessiblemannerandhavebeenapprovedfortheuseofplainEnglishbyNALA.

PublicationoftheseleafletsreflectsacommitmentonthepartoftheMentalHealthCommissiontoempowerserviceusersbyprovidingthemwithinformationontheirrightsandaddressesStandard3.1oftheQualityFrameworkforMentalHealthServicesinIreland–“Serviceusersarefacilitatedtobeactivelyinvolvedintheirowncareandtreatmentthroughtheprovisionofinformation”.

national Mental Health services Collaborative

Inthe2008annualreport,theCommissionstatedthatinordertoaddresspoorcompliancewiththerequirementforindividualcareandtreatmentplanstosupportrecovery,ajointproposalforimplementationofstandard1.1oftheQualityFrameworkforMentalHealthServicesinIreland(MentalHealthCommission,2007)hadbeendevelopedbytheCommissioninpartnershipwiththeHealthServiceExecutiveforimplementationin2009.

Standard1.1.–“Eachserviceuserhasanindividualcareandtreatmentplanthatdescribesthelevelsofsupportandtreatmentrequiredinlinewithhis/herneedsandisco-ordinatedbyadesignatedmemberofthemultidisciplinaryteam.”

Thereare24standardsintotal.Theattainmentofthestandardonindividualcareandtreatmentplanning(standard1.1)alsoaddresses,inpart,15oftheremainingstandardsasfollows:

StandardNumber:

1.2 Eachserviceuserexperiencesaplannedentrancetoandexitfromeverypartofamentalhealthservice.

1.3 Eachserviceuserreceivesmentalhealthcareandtreatmentfromacommunitybasedservicethataddressestheperson’schangingneedsatvariousstagesinthecourseofhis/herillnessandrecoveryprocess.

1.5Therapeuticservicesandprogrammestoaddresstheneedsofserviceusersareprovided.

2.1 Serviceusersreceiveservicesinamannerthatrespectsandacknowledgestheirspecificvalues,beliefsandexperiences.

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2.2 Serviceuserrightsarerespectedandupheld.

3.1 Serviceusersarefacilitatedtobeactivelyinvolvedintheirowncareandtreatmentthroughtheprovisionofinformation.

3.2 Serviceusersareempoweredregardingtheirowncareandtreatmentbyexercisingchoice,rightsandinformedconsent.

3.3 Peersupport/advocacyisavailabletoserviceusers.

3.4 Aclearaccessiblemechanismforparticipationinthedeliveryofmentalhealthservicesisavailabletoserviceusers.

3.5 Serviceusersexperiencearecovery-focusedapproachtotreatmentandcare.

4.2 Serviceusersinresidentialordaysettingsreceiveawell-balancednutritiousdiet.

6.1 Families,parentsandcarersareempoweredasteammembersreceivinginformation,adviceandsupportasappropriate.

7.3 Learningandusingprovenqualityandsafetymethodsunderpinsthedeliveryofamentalhealthservice.

7.4 Thecareandtreatmentprovidedbythementalhealthserviceisoutcomesfocused.

8.1 Thementalhealthserviceisdeliveredinaccordancewithevidence-basedcodesofpractice,policiesandprotocols.

TheInstituteforHealthcareImprovement(IHI),basedintheUnitedStates,seekstoimprovehealthcarebysupportingchange.TheIHIinnovatedcollaborativelearningforimprovingqualityinhealthcarebydevelopingthe‘BreakthroughSeries’inthemid1990’s(IHI,2003).Thegenesisofthe‘breakthrough’collaborativeapproachwasthattheIHIwaslookingatdevelopinganapproachthatwouldgobeyondtheirtraditionaltrainingontheessentialsforquality.Theiraimwasto“provideastructureforlearningandactionthatwouldengageorganizationsinmakingreal,system-levelchangesthatwouldleadtodramaticimprovementsincare(IHI,2003.p.2).

TheCommissionandHSEproposedthedevelopmentofaNationalMentalHealthServicesCollaborative(NMHSC)whichadoptstheIHIbreakthroughcollaborativemethodology.Thisinclusiveapproachensuresserviceusersandcarersarecentralandinvolvedinallaspectsoftheproject.During2009StPatrick’sUniversityHospitalandStJohnofGodHospitalLtdexpressedaninterestandjoinedthepartnership.TheNMHSCcommencedwiththeassignmentofaprojectmanageron31October2009andinvolvestheparticipationofrepresentativesitesfromtheHealthServicesExecutive,StPatrick’sUniversityHospitalandStJohnofGodHospitaloveraperiodof18months.AnintegralcomponentoftheNMHSCisthedevelopmentofasustainabilityplanthatwillbecommencedduringtheprojecttoensurethatthegainsmadeareretainedandbuiltuponoverthecomingyearsaftertheprojectisterminated.

Framework for public and service user involvement in Health and social Care Regulation

TheMentalHealthCommissionisamemberoftheHealthandSocialCareRegulatoryForum.ThisForumwasestablishedin2008toprovideamechanismforexploringopportunitiestoharmonisecertainbusinessprocesses,sharebestpracticeandfacilitatecoordinationwhereappropriatebetweenregulatorybodiesintheareaofhealthandsocialcare.ItalsoaimstoshareknowledgeandexpertiseonmattersofcommoninterestwithaviewtoenhancingtheoverallpracticeofhealthandpersonalsocialservicesregulationinIrelandforthebenefitofpublichealth.

27


InresponsetotherecentlypublishedrecommendationsoftheCommissionforPatientSafetyandQualityAssurancethat‘robust and validated patient and public involvement should be a requirement for all health care oversight, scrutiny, quality control and other accountability mechanisms’(CommissiononPatientSafetyandQualityAssurance,2008,R4.4),theForumpublishedaFrameworkforPublicandServiceUserInvolvementinHealthandSocialCareRegulationinIreland.Theframeworkaimstoencouragegreaterserviceuserinvolvementintheworkofregulatorybodies.TheframeworkwasdevelopedbyasubgroupofForummemberschairedbyMs.BrídClarke,thethenChiefExecutiveOfficeroftheMentalHealthCommissionanditisduetobepublishedinJanuary2010.Itisintendedthattheframeworkwillbeavailableonthewebsitesofallregulatoryforummembers.

nsue (national service user executive)

During2009representativesfromtheNationalServiceUserExecutiveandMentalHealthCommissionmetonfouroccasions.Thesequarterlymeetingsareheldtofacilitatetheexchangeofinformationandviewsandtoaidjointworkingbetweenbothorganisations.

28


2020 Vision – The Human Rights and Best Interests of All Persons Who Use Mental Health Services Are Respected and Protected

strategic priority two (2009-2012) – Human Rights and Best interests

AcommitmenttoHumanRightsisembeddedinallaspectsoftheCommission’sandmental}}

healthserviceproviders’policyandpractice.

TheCommissionwillcontinuetoarrangereviewsofinvoluntaryadmissionincompliancewith}}

the2001Act.

TheCommissionwillcontinuetomonitorRulesandCodesofPracticeissuedpursuanttothe}}

provisionsofthe2001Act.

Promoteandsupportadvancesinlegislationtoprotectthehumanrightsofvulnerable}}

people.

Mental Health tribunals

process for involuntary admission (adults)

TheMentalHealthAct2001Actintroducedprovisionsforasystemoffreelegalrepresentationforadultsandindependentreviewsduringtheirepisodeofinvoluntaryadmission1.Thisisperformedbyamentalhealthtribunalduringeachperiodofdetention.Thispartofthe2001Actwascommencedon1November2006.TheCommissionnowhasthreecompleteyearsofdatarelatingtoinvoluntaryadmissionsactivity.Thissectionofthereportprovidesanalysisof2009involuntaryadmissionsandtheirreviewbymentalhealthtribunals,andsomecomparisonswithpreviousyears.

Itisimportanttonotethatthe2001Acthasprovisionsfortwomethodsofinitiatingdetention;anAdmission Order,(Form6)andaCertificate & Admission Order to detain a Voluntary Patient (Adult),(Form13)whichalsodetainsfor21days.ApersonmaybeadmittedtoanapprovedcentreanddetainedthereonthegroundsthatorsheissufferingfromamentaldisorderasdefinedintheAct.

involuntary admission (adults) 2009

Analysiswascompletedonthenumberofadultswhowereinvoluntarilyadmittedusingtheprovisionsofsections9,10,&14oftheActin2009.InsuchadmissionstheadmissionorderismadebyaconsultantpsychiatristonstatutoryForm6,AdmissionOrder,whichmustbeaccompaniedbyanapplication(Form1,2,3,or4)andarecommendationbyaregisteredmedicalpractitioner,(Form5).Therewere1,434Form6AdmissionOrdersnotifiedtotheCommissionin2009.

Detention of a Voluntary patient; section 24 Mental Health act 2001 (2009)

Section24MentalHealthAct2001outlinestheproceduresrelatingtoadecisiontore-gradeavoluntarypatienttoinvoluntarystatus.Insuchadmissionstheadmissionorderismadeonstatutoryform,Form13Certificate&AdmissionOrdertoDetainaVoluntaryPatient(Adult),signedbytwoconsultantpsychiatrists.Therewere590suchadmissionsnotifiedtotheCommissionin2009.

1 Anepisodeisapatient’sunbrokenperiodofinvoluntaryadmission

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Comparisons 2007-2009

Figure2belowsummarisesonamonthlybasisboththeabovecategoriesofinvoluntaryadmissionfor2009,i.e.–Form6Admission Orders,andForm13,Certificate & Admission Order to Detain a Voluntary Patient (Adult).ThenumberofForm6ordersfallwithinarangefrom93to135permonth,andthenumberofForm13ordersfallwithinarangefrom33to62permonth.

Figure 2: Monthly Involuntary Admissions 2009: Form 6 Admission Orders, and Form 13, Certificate & Admission Order to Detain a Voluntary Patient (Adult)

Comparisonwasmadeof2009involuntaryadmissionactivitywiththatforanumberofpreviousyears.Figure3belowsummariesthesecomparisonsonanannualbasisandshowsadecreaseof6%from2007to2008andanincreaseof1%from2008to2009.

Figure 3: Comparisons of Total Involuntary Admissions 2007-2009

Form6AdmissionOrder.Form13,Certificate&AdmissionOrdertoDetainaVoluntaryPatient(Adult).

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0Jan09

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0

623

1503

2007

584

1420

2008

590

1434

2009

Form 6 Admissions

Form 13 Regrade of a Voluntary Patient

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Comparisonof2008with2007showsthedecreaseinactivityisaccountedforbya6%fallsinboththecategoriesForm6Admission Order,andForm13,Certificate & Admission Order to Detain a Voluntary Patient (Adult).Furthercomparisonof2009with2008showstheincreaseinactivityisaccountedforbya1%increaseinboththecategoriesForm6AdmissionOrder,andForm13,Certificate&AdmissionOrdertoDetainaVoluntaryPatient(Adult).

Tables1(a)-1(e)providefurtheranalysisofinvoluntaryadmissionordersin2009byapprovedcentre,byHSEregion,andfortheindependentsector.

Table 1(a): Involuntary Admissions by HSE Regions 2009 (Adults)

Hse West County Form 6a Form 13a total

BallytivnanSligo/LeitrimMentalHealthServices

Sligo 33 22 55

St.Conal’sHospitalLetterkenny Donegal 1 0 1

AcutePsychiatricUnitCarnamuggaghLetterkenny

Donegal 83 22 105

DepartmentofPsychiatryCountyHospitalRoscommon

Roscommon 19 8 27

St.Brigid’sHospitalBallinasloe Galway 24 11 35

PsychiatricUnitUniversityCollegeHospital

Galway 54 21 75

AcutePsychiatricUnit5BMidwesternRegionalHospital

Limerick 82 18 100

St.Joseph’sHospital Limerick 0 1 1

TearmannWard&CurragourWardsSt.CamillusHospital

Limerick 0 3 3

AcutePsychiatricUnitMidwesternRegionalHospitalEnnis

Clare 31 10 41

AdultMentalHealthUnitMayoGeneralHospitalCastlebar

Mayo 51 7 58

AnCoillinCastlebar Mayo 0 2 2

total Hse West 378 125 503aForm6AdmissionOrder.Form13,Certificate&AdmissionOrdertoDetainaVoluntaryPatient(Adult).

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Table 1(b): Involuntary Admissions by HSE Regions 2009 (Adults)

Hse soutH County Form 6a Form 13a total

St.Finan’sHospitalKillarney Kerry 2 0 2

AcuteMentalHealthAdmissionUnitKerryGeneralHospitalTralee

Kerry 59 14 73

SouthLeeMentalHealthUnit,CorkUniversityHospital

Cork 69 28 97

St.Michael’sUnitMercyHospital Cork 56 36 92

St.Stephen’sHospitalGlanmire Cork 12 7 19

CarraigMorCentre Cork 7 5 12

AcutePsychiatricUnitBantryGeneralHospital

Cork 16 5 21

DepartmentofPsychiatrySt.Luke’sHospital

Kilkenny 18 13 31

St.Luke’sHospitalClonmel Tipperary 1 0 1

St.Michael’sUnitSouthTipperaryGeneralHospitalClonmel

Tipperary 60 11 71

St.Senan’sHospitalEnniscorthy Wexford 38 11 49

DepartmentofPsychiatryWaterfordRegionalHospital

Waterford 41 20 61

St.Otteran’sHospital Waterford 4 1 5

total Hse soutH 383 151 534aForm6AdmissionOrder.Form13,Certificate&AdmissionOrdertoDetainaVoluntaryPatient(Adult).

Table 1(c): Involuntary Admissions by HSE Regions 2009 (Adults)

Hse DuBlin noRtH east County Form 6a Form 13a total

AcutePsychiatricUnitCavanGeneralHospital

Cavan 18 6 24

St.Davnet’sHospitalMonaghan Monaghan 11 4 15

DepartmentofPsychiatryOurLady’sHospitalNavan

Meath 22 13 35

St.Brigid’sHospitalArdee Louth 48 14 62

St.Vincent’sHospitalFairview DublinNorth 65 29 94

St.Ita’sHospitalMentalHealthServicesPortrane

DublinNorth 51 14 65

AcutePsychiatricUnit,St.AloysiusWardMaterMisericordiaeHospital

DublinNorth 12 9 21

St.Brendan’sHospital DublinNorth 30 11 41

DepartmentofOldAgePsychiatrySycamoreUnitConnollyHospital

DublinNorth 1 0 1

DepartmentofPsychiatryConnollyHospital

DublinNorth 27 10 37

total DuBlin noRtH east 285 110 395aForm6AdmissionOrder.Form13,Certificate&AdmissionOrdertoDetainaVoluntaryPatient(Adult).

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Table 1(d): Involuntary Admissions by HSE Regions 2009 (Adults)

Hse DuBlin MiD leinsteR County Form 6a Form 13a total

JonathanSwiftClinic DublinSouth 38 25 63

AcutePsychiatricUnitAMNCH DublinSouth 56 28 84

ElmMountUnitSt.Vincent’sUniversityHospital

DublinSouth 49 9 58

LakeviewUnitNaasGeneralHospital Kildare 52 19 71

DepartmentofPsychiatryMidlandRegionalHospitalPortlaoise

Laois 29 10 39

St.Loman’sHospitalMullingar Westmeath 44 5 49

NewcastleHospital Wicklow 35 8 43

total Hse DuBlin MiD leinsteR 303 104 407aForm6AdmissionOrder.Form13,Certificate&AdmissionOrdertoDetainaVoluntaryPatient(Adult).

Table 1(e): Involuntary Admissions by HSE regions 2009 (Adults)

inDepenDent seCtoR County Form 6a Form 13a total

St.JohnofGodHospitalStillorgan DublinSouth 60 62 122

St.Patrick’sHospitalDublin DublinSouth 26 36 62

St.EdmundsburyHospitalDublin DublinSouth 0 1 1

total inDepenDent seCtoR 86 99 185aForm6AdmissionOrder.Form13,Certificate&AdmissionOrdertoDetainaVoluntaryPatient(Adult).

Table2belowshowsTotalInvoluntaryAdmissionRatesfor2009(Adult)byHSEregionandindependentsector,withratesper100,000oftotalpopulation.

Table 2: Total Involuntary Admission Rates for 2009 (Adult) by HSE region & independent sector

total involuntary admission Rate 2009 (aDult)

populationa involuntary admission Rate per 100,000 total population

HSEWEST 503 1,012,413 49.68HSESOUTH 534 1,081,968 49.35HSEDUBLINNORTHEAST 395 928,619 42.54TOTALHSEDUBLINMIDLEINSTER

407 1,216,848 33.45

INDEPENDENTSECTOR 185 N/A N/Atotal(ExclusiveofIndependentsector)

1,839 4,239,848 43.37

total(InclusiveofIndependentsector)

2,024 4,239,848 47.74

APopulationfigurestakenfromCSOcensus2006.

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AnalysisofIreland’sinvoluntaryadmissionratesper100,000oftotalpopulation,includinginvoluntaryadmissionstoindependentsectorapprovedcentres,isshowninFigure4belowfortheyears2007to2009.

Figure 4: Ireland’s Involuntary Admission Rates per 100,000 of total population6 for the years 2007 to 2009.

6PopulationfigurestakenfromCSOcensus2006.

age and Gender

Analysisofageandgenderwascompletedonthefiguresforepisodesofinvoluntaryadmissionin2009.Tables3and4belowsummarisethesefindings.

Table 3: Analysis by Age – Involuntary Admissions 2009 (Adults)

aGe FoRM 6 FoRM 13 total %17–18 1 0 1 0%18–64 1,190 515 1,705 84%65andover 243 75 318 16%total 1,434 590 2,024 100%

Table 4: Analysis by Gender – Involuntary Admissions 2009 (Adults)

GenDeR FoRM 6 FoRM 13 total %Female 629 292 921 46%Male 805 298 1,103 54%total 1,434 590 2,024 100%

50.5

50

49.5

49

48.5

48

47.5

47

46.5

46

45.5

50.14

2007

47.29

2008

47.74

2009

Rate per 100,000 of Total Population

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type of applicant

Analysiswasundertakenofthecategoriesofpersonswhoappliedforapersontobeinvoluntarilyadmittedundersection9oftheActintheperiod2009.Table5belowsummarisesthisanalysis.

Table 5: Analysis of Applicant: Involuntary Admissions 2009 (Adults)

Form number type number %1 Spouse/Relative 886 61.8%2 AuthorisedOfficer 84 5.8%3 GardaSíochána 324 22.6%4 AnyotherPerson 140 9.8%

total 1,434 100%Comparisonofthe2008figuresfortypeofapplicantwiththe2009figuresshowsthenumberofapplicantsbyspouse/relativehasfallenfrom63.9%to61.8%,authorisedofficerrisenfrom4.6%to5.8%,GardaSíochánafallenfrom22.8%to22.6%andanyotherpersonrisenfrom8.7%to9.8%.AnauthorisedofficerisanofficeroftheHSEwhoisofaprescribedrankorgradeandwhoisauthorisedtoexercisethepowersconferredonauthorisedofficersbysection9oftheAct.

Diagnosis

WhentheepisodeofinvoluntaryadmissionisendedbytheresponsibleconsultantpsychiatristrevokingtheorderthepsychiatristisrequestedtoprovidedetailstotheCommissionofthepatient’sdiagnosisusingICD-10diagnosticgroupsonstatutoryForm14,Revocation of an Involuntary Admission or Renewal Order.DetailsofdiagnosesreportedtotheCommissionin2009aresummarisedinTable6below.

Table 6: ICD 10 Diagnostic Groups Coded at Close of Episode (Adults) 2009

iCD-10 diagnostic groups iCD-10 Code total number of episodes

number of episodes (%)

1.OrganicDisorders F00-F09 115 6.8%

2.AlcoholicDisorders F10 32 1.9%

3.OtherDrugDisorders F11-F19,F55 57 3.4%

4.Schizophrenia,SchizotypalandDelusionalDisorders

F20-F29 811 48.2%

5.DepressiveDisorders F31.3,F31.4,F31.5,F32,F33,F34.1,F34.8,F34.9

152 9.0%

6.Mania F30,F31.0,F31.1,F31.2,F31.6,F31.7,F31.8,F31.9,F34.0

435 25.9%

7.Neuroses F40-F48 30 1.8%

8.EatingDisorders F50 3 0.2%

9.PersonalityandBehaviouralDisorders

F60-F69 29 1.7%

10.IntellectualDisability F70-F79 10 0.6%

11.DevelopmentDisorders F80-F89 3 0.2%

12.BehaviouralandEmotionalDisordersofChildhood

F90-F98 Seechildrensections

13.OtherDiagnosis F38,F39,F51-F54,F59,F99 5 0.3%

total 1,682 100%

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Itisofinteresttonotethatthediagnosticgroupwiththehighestratesofinvoluntaryadmissionisthegrouping“Schizophrenia, Schizotypal & Delusional Disorder”sfollowedbythatfor“Mania”.Thisissimilartothefindingsfor2007and2008.

Revocation By Responsible Consultant psychiatrist

Section28providestheconsultantpsychiatristresponsibleforthepatientwiththeoptiontorevokeanorderwheretheybecomeofopinionthatthepatientisnolongersufferingfromamentaldisorderasdefinedintheAct.Wheretheresponsibleconsultantpsychiatristdischargesapatientundersection28theymustgivetothepatientconcernedandhisorherlegalrepresentativeanoticetothiseffect,astatutoryformnumber14,Revocation of an Involuntary Admission or Renewal Order.Analysisofordersrevokedbytheresponsibleconsultantpsychiatristundertheprovisionsofsection28showsthattherewere1,376suchinstancesin2009.Thepatientmayleavethecentreatthisstageorstaytoreceivetreatmentonavoluntarybasis.Figure5belowshowsthenumberofordersrevokedbyresponsibleconsultantpsychiatristsundertheprovisionsofsection28foryears2007to2009.

Figure 5: Number of Orders Revoked by Responsible Consultant Psychiatrists under the Provisions of Section 28 for Years 2007 to 2009

independent Review by a Mental Health tribunal

TheMentalHealthAct2001providesforthepatients’righttoanautomaticindependentreviewofaninvoluntaryadmission.Within21daysofanadmission(orrenewal)order,athreepersonmentalhealthtribunalconsistingofalawyeraschair,aconsultantpsychiatristandanotherpersonreviewtheadmission(orrenewal)order.Priortotheindependentreview,alegalrepresentativeisappointedbytheMentalHealthCommissionforeachpersonadmittedinvoluntarily(unlesss/heproposestoengageone)andanindependentmedicalexaminationbyaconsultantpsychiatrist,appointedbytheCommission,willhavebeencompleted.Therewere1,882hearingsin2009.

section 17 independent Medical examinations

Asanadmissionorrenewalordermustbereviewedbyamentalhealthtribunalwithin21daysoftheorderbeingsigned,theCommissionmustassignaconsultantpsychiatristtoconductanindependentmedicalexaminationassoonaspossibleaftertheorderhasbeennotifiedtotheCommission.Additionally,inaccordancewithsection21oftheAct,allproposalstotransferapatienttotheCentralMentalHospitalmustbereviewedbyatribunalwithin14days.

1600

1400

1200

1000

800

600

400

200

0

1444

12901376

Form 14 Revoke Before Hearing by Responsible Consultant Psychiatrist

2007

2008

2009

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Revoke at Hearing

Analysiswasundertakenofthenumberofordersrevokedatamentalhealthtribunal.Figure6belowshowsthenumberofhearingsonamonthbymonthbasisfor2009andthenumberofordersrevoked(%)ineachmonth.Overall,9%oforderswererevokedatamentalhealthtribunalin2009.

Figure 6: Number Hearings & % of Orders Revoked at Hearing 2009

Cases Brought Before the Courts

Circuit Court appeal

Section19(1)ofthe2001ActstatesthatapatientmayappealtotheCircuitCourtagainstadecisionofamentalhealthtribunaltoaffirmanordermadeinrespectofhimorheronthegroundsthatheorsheisnotsufferingfromamentaldisorder.Theappealcanonlybemadeifthepatientcontinuestobedetained.Therewere46CircuitCourtappealsfiledintheperiodfrom1stJanuaryto31stDecember2009.Someofthesecaseswerewithdrawnduetoordersbeingrevokedbytheresponsibleconsultantpsychiatristorpatientsnotwishingtoproceed.InrelationtothecasesthatwereheardbytheCircuitCourt,noneresultedinanorderbeingrevoked.

article 40.4.2 Cases

Whereapersonbelievesthattheyareunlawfullydetainedthey,oranotherpersonontheirbehalf,mayhaverecoursetothecommonlawwritofHabeas CorpuswhichisembodiedinArticle40.4oftheConstitution.Article40.4oftheConstitutionisaselfcontainedconstitutionalmechanismtotestthelawfulnessofaperson’sdetentionandempowerstheHighCourttoexaminewhetherthepersonisbeingdetainedinaccordancewiththelaw.In2009therewere3Article40.4casesbroughtthatinvolvedtheCommissionand/oramentalhealthtribunal.Ofthese1wasappealedtotheSupremeCourt.IntheSupremeCourtjudgmentthedecisionoftheHighCourt,wherethepatientwasfoundtobeinlawfuldetention,wasupheld.

Judicial Review

Judicialreviewisamethoddevelopedatcommonlawtoenableanindividualwhoisthesubjectofagovernment/statutoryactiontochallengethelegalityofthatactionintheCourts.Thedecisionmusthavebeenmadebyabodyorpersons,withlegalorstatutoryauthoritytodeterminequestionsaffectingtherightsofcitizensandhavingthedutytoactjudicially.Judicialreviewisbroughtinrelationtoboth

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0Jan09

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148 151

171159

150140

166

189

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179

138 138

Apr09

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Jun09

Jul09

Aug09

Sep09

Oct09

Nov09

Dec09

Hearings

% Revoked at Hearing 2009

15% 18% 13% 12% 11%18% 14% 15% 16% 16% 10% 12%

37


legislativeandexecutiveactions.ThesereviewsareheardbyaJudgeintheHighCourtandcanbeappealedtotheSupremeCourt.Itisadiscretionaryremedy.Therewere2JudicialReviewcasesissuedin2009thatinvolvedtheCommissionand/oramentalhealthtribunal.Noneofthosecasesareongoing.

training and Development

Anumberofinductionprogrammesformentalhealthtribunalpanelmembersweredeliveredin2009aspreparationfortheirspecificrole.

InductiontrainingforMentalHealthTribunalConsultantPsychiatristsandSection17Independent}}

MedicalExaminationsinFebruary2009.

FollowingtheMentalHealthTribunalsrecruitmentprocess,inductiontrainingforMentalHealthTribunal}}

PanelMemberswasdeliveredthroughoutAugustandSeptember2009.

Allprogrammeswereaccreditedbytheirrelevantprofessionalbodies.

Panelmemberswerekeptupdatedbythedistributionofinformationandmaterialsthroughouttheyear.

TheMentalHealthCommissionandtheLawSocietyincollaborationdevelopedaContinuousProfessionalDevelopmentseminarforsolicitors.TheprogrammewashostedandaccreditedbytheLawSociety.Thepresentationsfocusedonlegalrepresentativesandbestinterests.Itwasattendedbyseventyfivepractitioners,whoindicatedthattheseminarwasofanextremelyhighstandard.

TheMentalHealthCommissionandtheCollegeofPsychiatryofIrelandjointlydevelopedanddeliveredatrainingprogrammeonMentalHealthTribunalSkillsforresponsiblePsychiatrists’workinginapprovedcentres.TheaimoftheprogrammewastoequipconsultantpsychiatristswhoareresponsiblefordetainedpersonswiththeskillsrequiredtoperformcompetentlyatMentalHealthTribunals.ThirtyfiveconsultantsattendedthecoursewhichwasaccreditedbytheCollegeofPsychiatryofIreland.Therewasaveryhighdemandforthecourse;itisintendedtorepeatthisprogrammein2010.

Rules and Codes of practice

RulesissuedbytheCommissionarestatutoryrequirementsthatmustbeimplementedinapprovedcentres2.The‘2001Act’doesnotimposealegaldutyonpersonsworkinginthementalhealthservicestocomplywithcodesofpractice,butbestpracticerequiresthatcodesbefollowedtoensurethatthe2001Actisimplementedconsistentlybypersonsworkinginmentalhealthservices.Afailuretoimplementorfollowacodeofpracticecouldbereferredtoduringthecourseoflegaland/ordisciplinaryproceedings.TheprovisionsofCommissioncodesofpracticearenotdesignedtosetoutaprescriptivemodeloftheidealserviceortoreplaceclinicaljudgmentbutrathertoprovideguidancetoenableallprofessionalsworkingwithmentalhealthserviceuserstomakedecisionswhichareinkeeingwiththebestinterestsofthepersonandareinlinewithinternationalbestpractice.

TheMentalHealthCommissionissuedseveralrevisedrules,revisedcodesofpracticeandnewcodesofpracticein2009detailsofwhichareprovidedbelow.AsummaryofrulesandcodesofpracticedevelopedisprovidedinTable1.

Revised Rules pursuant to the Mental Health act 2001 – published during 2009

TheMentalHealthCommissionmustmakerulesprovidingfortheuseofelectro-convulsivetherapy(ECT)onapatientasperSection59(2)oftheMentalHealthAct2001.Section69(2)oftheMentalHealthAct2001obligestheCommissiontomakerulesprovidingfortheuseofseclusionandmechanicalmeans

2 “Centre”meansahospitalorotherin-patientfacilityforthecareandtreatmentofpersonssufferingfrommentalillnessormentaldisorder.”(Section62,MentalHealthAct2001).AnapprovedcentreisacentrethatisenteredontheRegisterofApprovedCentresmaintainedbytheMentalHealthCommissioninaccordancewithSection64,MentalHealthAct2001).

38


ofbodilyrestraintonapatient.Bothsetsofrulescameintoeffecton1stNovember2006withthefullcommencementofthe2001Act.Atthistime,theCommissionindicatedthatitwouldkeeptherulesunderperiodicreviewandreviewthemnolaterthantwoyearsaftertheircommencement.

ProspectusConsultantscarriedoutareviewoftheRulesGoverningtheUseofECTandareviewoftheRulesGoverningtheUseofMechanicalRestraintandtheCodeofPracticeontheUseofPhysicalRestraintonbehalfoftheCommissionbetweenSeptemberandDecember2008.Thereviewexerciseincludedanextensivestakeholderconsultation.FollowingconsiderationbytheCommissionofthereviewrecommendations,theCommissionissuedtwosetsofrevisedRulesinOctober2009.

TherevisedRulesareeffectivefrom1stJanuary2010andinspectionsbytheInspectorateofMentalHealthServicesin2010willincludeinspectionofcompliancewiththeseRules.

Codes of practice – published During 2009

admission of Children under the Mental Health act 2001 – addendum

TheCommissionissuedanaddendumtotheCodeofPracticeontheAdmissionofChildrenundertheMentalHealthAct2001inJuly2009.TheaimoftheamendmentistoreflectandclarifytheCommission’spolicyontheadmissionofchildrenpursuanttotheMentalHealthAct2001.

TheamendmenttotheCodeofPracticeisasfollows:

1.Section2.4isamendedtoreadasfollows:

2.4TheCommissionwillreviewthenumberofadmissionsofchildrentoapprovedcentresforadultsfromtimetotime.

2.4.1 Inrespectoftheadmissionofachildtoanapprovedcentreforadults,thefollowingapplies:

Nochildunder16yearsistobeadmittedtoanadultunitinanapprovedcentrefrom1sta)July2009;

Nochildunder17yearsistobeadmittedtoanadultunitinanapprovedcentrefrom1stb)December2010;and

Nochildunder18yearsistobeadmittedtoanadultunitinanapprovedcentrefrom1stc)December2011.

2.4.2 If,inexceptionalcircumstances,theadmissionofachildtoanadultunitinanapprovedcentreoccursincontraventionoftheabove,theapprovedcentreisobligedtosubmitadetailedreporttotheMentalHealthCommissionoutliningwhytheadmissionhastakenplace.ThisreportshouldbeintheformspecifiedbytheMentalHealthCommissionasperSectionBoftheNotificationtotheMentalHealthCommissionoftheadmissionofachildtoanadultunitinanapprovedcentre.

2.Section2.5m)isamendedtoreadasfollows:

2.5m)TheCommissionshouldbenotifiedofallchildrenadmittedtoanapprovedcentreforadultswithin72hoursofadmissionandalsonotifiedofthedischargeofallchildrenfromanapprovedcentreforadultswithin72hoursofdischargeusingtheassociatedclinicalpracticeforms.ProceduresshouldbeinplacetoidentifythepersonresponsiblefornotifyingtheCommission.

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admission, transfer and Discharge

TheMentalHealthCommissionpublishedacodeofpracticeonadmission,transferanddischargetoandfromanapprovedcentreinSeptember2009.ThecodeofpracticeisinlinewiththefirstthemeoftheQualityFrameworkforMentalHealthServicesinIreland,whichistheprovisionofaholisticseamlessservice,andthefullcontinuumofcareprovidedbyamulti-disciplinaryteam.ManyoftheprinciplesandvaluesinaVision for Changearereflectedwithinthecode,suchastheimportanceofinvolvingserviceuserandcarers,adoptingarecoveryapproach,liaisingwithprimarycareandensuringco-ordinationofservicesandcontinuityofcare.

Oneoftheprimaryaimsofthiscodeistocreateamorepositivejourneytorecoveryforserviceusersthroughinpatientmentalhealthservicesbyimprovingthecontinuityandco-ordinationofthecareandtreatmentprovided.Thecodeisrelevanttoallpartnersinvolvedinthedeliveryofmentalhealthcareandtreatment.Thecodeofpracticeisoperationalfrom1stJanuary2010.TheInspectorofMentalHealthServiceswillcommenceinspectionsusingthiscodein2010.

Mental illness and intellectual Disability

TheCommissionpublishedanewcodeofpracticeforpersonsworkinginmentalhealthserviceswithpeoplewithintellectualdisabilitiesinOctober2009.

Thecodeadoptsahumanrightsapproachtothedeliveryofmentalhealthservices.Thekeyprinciplesthatunderpinthecodearethebestinterestsoftheperson,adoptingaperson-centredapproachtocareandtreatment,employingtheleastrestrictiveinterventionandthepresumptionofcapacity.Thecodeprovidesguidanceontheareaofdecision-makingandcapacity,untilsuchtimeasmuchneededcapacitylegislationisenacted.

Thecodeofpracticeiseffectivefrom1stJanuary2010andinspectionsbytheInspectorateofMentalHealthServicesin2010willincludeinspectionofcompliancewiththiscode.

the use of electro-Convulsive therapy (eCt) for Voluntary patients

TheRulesGoverningtheUseofECTapplyonlytotheuseofECTonapersoninvoluntarilyadmittedtoanapprovedcentreinaccordancewithSection69,MentalHealthAct2001.TheMentalHealthCommission’smandaterelatestothequalityofserviceprovisiontoallpersonsinreceiptofmentalhealthservicesirrespectiveofwhethertheirlegalstatusisvoluntaryorinvoluntary.Asaconsequence,theCommissionissuedacodeofpracticeontheuseofelectro-convulsivetherapyforvoluntarypatientsinapprovedcentresinJanuary2008.Thiscode,inmanyrespects,mirroredtheprovisionssetoutundertheSection59(2)rules.

FollowingthereviewoftheRulesGoverningtheUseofElectro-ConvulsiveTherapyandtherevisionoftheserules,theCodeofPracticeontheUseofECTwassimilarlyrevisedandre-issuedinOctober2009.Therevisedcodeofpracticeiseffectivefrom1stJanuary2010.

the use of physical Restraint in approved Centres

AcodeofpracticeontheuseofphysicalrestraintwasfirstpublishedbytheMentalHealthCommissionon1stNovember2006.ProspectusConsultantscarriedoutareviewoftheCodeofPracticeontheUseofPhysicalRestraintinApprovedCentresalongwithareviewoftheRulesGoverningtheuseofECTandareviewoftherulesgoverningtheuseofmechanicalrestraintbetweenSeptemberandDecember2008.Thereviewexerciseincludedanextensivestakeholderconsultation.FollowingaconsiderationbytheCommissionofthereviewrecommendations,theCommissionissuedarevisedcodeofpracticeinOctober2009.

Therevisedcodeiseffectivefrom1stJanuary2010.

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Table 7: Rules and Codes published in 2009

Rules

RulesGoverningtheUseofECT R-S59(2)/01/2009Version2RulesGoverningtheUseofSeclusion&MechanicalmeansofBodilyRestraint

R-S69(2)/02/2009Version2

Codes of practice

AddendumtoCodeofPracticerelatingtoAdmissionofChildrenundertheMentalHealthAct2001

COP-S33(3)/01/2006

CodeofPracticeonAdmission,TransferandDischargetoandfromanApprovedCentre

COP-S33(3)/01/2009Version1

CodeofPractice:GuidanceforPersonsworkinginMentalHealthServiceswithPeoplewithIntellectualDisabilities

COP-S33(3)/02/2009Version1

CodeofPracticeontheUseofECTforVoluntaryPatients COP-S33(3)/03/2009Version2CodeofPracticeontheUseofPhysicalRestraint COP-S33(3)/04/2009Version2

activity Data

Code of practice Relating to the admission of Children under the Mental Health act 2001

Voluntary and involuntary admissions

TherearespecificprovisionsintheMentalHealthAct2001inrelationtotheinvoluntaryadmissionofchildrenthatrequiretheHSEtomakeanapplicationtotheDistrictCourt.DetailsoftheinvoluntaryadmissionprocessareprovidedintheCommission’sCode of Practice relating to the admission of children under the Mental Health Act 20013.TheMentalHealthCommission,sinceitsestablishment,hasconsistentlyhighlightedthelackofsufficientChildandAdolescentin-patientanddayhospitalfacilities.WhilsttheMentalHealthCommissioncontinuestoholdtheviewthattheprovisionofageappropriatementalhealthservicesforchildrenandadolescentsmustbeaddressedasamatterofurgency,itacknowledgestheregistrationofthreeadditionalchildandadolescentapprovedcentresin2009.Insituationswherechildrenareadmittedofnecessity,toapprovedcentresforadults,theprovisionsoftheCodeofPracticeRelatingtoAdmissionofChildrenapplyandtheseincludearequirementtonotifytheCommissionofsuchadmissions.

ToreflectandclarifytheCommission’spolicyontheadmissionofchildrenpursuanttotheMentalHealthAct2001anAddendumtotheCodeofPracticewasissuedon01July2009.Theaddendumprohibitedtheadmissionofchildrenunder16yearsofagetoadultunitsinapprovedcentresfrom1Julyexceptinexceptionalcircumstances.

TheCommissionwasoftheviewthattheaddendumwasrequiredduetotheincreaseinchildadmissionsunder16yearsofagetoadultunitsin2008incomparisonto2007asillustratedinTable8.TheCommissionwasnotifiedofoneadmissionofachildunder16yearsofagefrom1stJulyto31stDecember2009.

notification of the admission of Children

ApprovedcentresforadultsarerequestedtonotifytheCommissionoftheadmissionofachildwithin72hoursofthechild’sadmissionsubjecttoprovision2.5(m)ofthecode.Childunitsinapprovedcentresarealsorequestedtosendamonthlyreportonadmissions.In2009,theCommissionwasnotifiedofa

3 TheMentalHealthAct2001Section2(1)definesa“child’’asapersonundertheageof18yearsotherthanapersonwhoisorhasbeenmarried.

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totalof365admissionsofchildrentoapprovedcentres4.Thisrepresentsa7%decreasecomparedtothenumberofadmissionsfor2008(n=392)althoughitissimilarto2007(n=352).

admissions by unit type and service provider

Table8providesabreakdownofactivityonadmissionsofchildrenin2007,2008and2009.Itincludesthenumberofunitsandtypeofunitsthatadmittedchildrenandthenumberandpercentageofadmissionsbyserviceprovider(HSEAreaorIndependentSector).Thenumberofchildunitsthatadmittedchildrenin2009increasedfromthreeinboth2007and2008tofivein2009.In2009,therewerethreenewapprovedcentresforchildrenandadolescentsenteredontheregisterofapprovedcentrespursuanttoSection64oftheMentalHealthAct2001.TheChildAdolescentIn-patientUnit,StVincent’sHospitalFairviewhaditsfirstadmissioninMarch2009,whiletheChild&AdolescentMentalHealthIn-patientUnit,St.Stephen’sHospitalhaditsfirstadmissioninDecember2009.TheHavenChildren’sResidentialUnitwasregisteredinSeptember2009andtherewerenoadmissionsin2009.

Intermsofserviceprovider,HSEDublinMidLeinsterhadthehighestnumberofadmissionsin2009(n=92)followedbytheIndependentSector(n=83),HSEWest(n=79)andHSESouth(n=68).HSEDublinNorthEastcontinuestobetheproviderwiththelowestnumberofchildadmissions(n=43).

Table 8: Number and Type of Units. Number and Percentage of Admissions by Service Provider.

2007 2008 2009service provider

number and type of units

number of admissions

% of 2007 admissions







Hse Dublin Mid leinster

7adultunits1childunit

78 22.1% 7adultunits1childunit


92 25.2%

Hse Dublin north east

6adultunits 28 8.0% 8adultunits 33 8.4% 7adultunits1childunit

43 11.8%

Hse south 10adultunits

71 20.2% 9adultunits 71 18.1% 8adultunits1childunit

68 18.6%

Hse West 7adultunits1childunit



79 21.6%

independent sector

2adultunits1childunit

102 29.0% 1adultunit1childunit

102 26.0% 1adultunit1childunit

83 22.8%

total 35 units 352 100.0% 36 units 392 100.0% 36 units 365 100.0%

4 Includesapprovedcentresforadults(adultunits),approvedcentresforchildrenandadolescents(childunits)andachildandadolescentunitinanapprovedcentrewhichalsoadmitsadults(childunit).

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Figure7comparesthenumberofadmissionsin2007,2008and2009byServiceProvider.Therewasadecreaseinadmissionsof27for2009incomparisonto2008,with19lessadmissionsintheIndependentSector,adecreaseof12admissionsinHSEWestandadecreaseofthreeadmissionsinHSESouthandHSEDublinMidLeinster.TherewasanincreaseoftenadmissionsinHSEDublinNorthEastbetween2008and2009.Thismayhavebeeninfluencedbytheopeningofanewchildunitintheregioninearly2009.

Figure 7: Number of Admissions in 2007, 2008 and 2009 by Service Provider.

age and unit type

Table9summarisesthenumberofadmissionsbyageandunittypein2007,2008and2009.In2009,55%percentofadmissions(n=200)weretoadultunits;94%oftheseadmissions(n=188)were16and17yearsofageandtheremaining6%(n=12)were15yearsofageorunder.45%ofadmissions(n=165)weretochildunits.Oftheseadmissions,54%(n=89)were15yearsofageorunderandtheremaining46%(n=76)were16and17yearsofage.Therewasoneadmissionofanadultwhowas18toachildunitin2009.

Therewasasubstantialdecreaseinthenumberofchildrenundertheageof15admittedtoanadultunitin2009(n=12)comparedwiththepreviousyear(n=24).ThisislikelyinfluencedbytheaddendumtothecodeofpracticeintroducedbytheCommissioninJuly2009.Elevenoftheseadmissionswerebefore1stJulywithonlyonechildundertheageof15admittedtoanadultunitinanapprovedcentrefortheremainderoftheyear.

Table 9: Numbers of Admissions by Age and Unit Type for 2007, 2008 and 2009

2007 2008 2009

age adult unit Child unit adult unit Child unit adult unit Child unit

≤15 years of age 14 99 24 90 12 89

16 and 17 years of age 203 36 223 55 188 76

total (admissions by unit type)

217 135 247 145 200 165

120

100

80

60

40

20

02007 2008 2009

HSE Dublin Mid Leinster

HSE Dublin North East

HSE South

HSE West

Independent Sector

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Gender

In2009thereweremorefemales,55%(n=202),thanmales,45%(n=163),admittedtoapprovedcentres.Thisisverysimilartopreviousyears.In2008,58%ofthoseadmittedwerefemale(n=229)and42%ofthoseadmittedweremale(n=163).In2007,59%ofthoseadmittedwerefemale(n=207)and41%ofthoseadmittedweremale(n=145).

involuntary admission

Therewereten5involuntaryadmissionsofchildrentoapprovedcentresin2009.OnewasmadeunderSection18(1)oftheChildCareAct1991;theremainderwereunderSection25oftheMentalHealthAct2001.

Thisrepresentsaslightincreaseininvoluntaryadmissionsfrom2008(n=8)andanotableincreasefrom2007(n=4).Sevenoftheseinvoluntaryadmissionsweretoadultunitsandthreeweretochildunits.In2008thereweresixadmissionstoadultunitsandtwowereadmittedtochildunits.In2007,allinvoluntaryadmissionsweretoadultunits.

additional information Regarding Child admission Data

TheCommissionvalidateschildadmissionsdatareceivedfromapprovedcentresbycrossreferencingitwithprovisionaldatareceivedfromtheHealthResearchBoard(HRB).Ifanydiscrepanciesarise,approvedcentresarecontactedforclarificationandvalidation.

Thenumberofadmissionsofchildrenin2008and2009reportedheremaydifferfromthosereportedbytheHRBforthefollowingreasons:

TheHRBreportsonthelegalstatusofchildrenonadmission,whereastheCommissioncaptures}}

changeinlegalstatusfromvoluntarytoinvoluntarythroughouttheperiodofadmissionandreportsonsuchadmissionsonceasaninvoluntaryadmission.

TheCommission’sdataonadmissionsofchildrenonlyincludestheadmissionsofchildrenasdefinedin}}

theMentalHealthAct2001.Section2(1)statesthat“child”meansapersonundertheageof18yearsotherthanapersonwhoisorhasbeenmarried.TheHRBreportonadmissionsofpersonsunder18yearsofageirrespectiveoftheircurrentorpreviousmaritalstatus.

training & Development – Child & adolescent

In2009apresentationwasdeliveredonrequestbytheClinicalDirectorofSt.Joseph’sAdolescentInpatientUnit,St.Vincent’sHospital.ThepresentationfocusedonadmissionofchildrenundertheMentalHealthAct2001,whichwaspartoftheinductionprogrammeforthemultidisciplinaryteam.

notification of Deaths

approved Centres

ApprovedCentresarerequiredtonotifytheCommissionof the death of any residentofanapprovedcentreinaccordancewithArticle14(4)oftheMentalHealthAct2001(ApprovedCentres)Regulations2006andSection2.2oftheCodeofPracticeforMentalHealthServicesonNotificationofDeathsandIncidentReporting.In2009,45approvedcentresnotifiedtheCommissionofatotalof173deaths.TheInspectorofMentalHealthServicesisadvisedofallsuchnotificationsreceivedandsubsequentlyfollows

5 Includestwooccasionswhereachild’slegalstatuswasre-gradedfromvoluntarytoinvoluntaryduringthesameadmissionperiod.Intheseinstancestheadmissionwasrecordedonceasaninvoluntaryadmission.

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upontheinformationprovidedasdeemedappropriate.ThebreakdownofdeathnotificationinformationbyserviceproviderisprovidedinTable10below.

Table 10: Number of Approved Centres and Number of Death Notifications by Service Provider in 2008 and 2009.

2008 2009

service provider number of approved Centresthat notified deaths

number of death notifications

number of approved Centresthat notified deaths

number of death notifications

HSEDublinMidLeinster 7 21 6 22

HSEDublinNorthEast 8 45 9 39

HSESouth 13 54 13 65

HSEWest 8 32 11 23

Independent 6 27 6 24

total 42 179 45 173

Day Centres, Day Hospitals, 24-Hour staffed Community Residences

All sudden, unexplained deaths of personsattendingadayhospital,daycentreorcurrentlylivingin24hourstaffedcommunityresidencesshouldbenotifiedtotheCommissionassoonaspossibleandinanyeventwithin7daysofthedeathoccurring(Section2(b)CodeofPracticeforMentalHealthServicesonNotificationofDeathsandIncidentReporting).

In2009theCommissionwasnotifiedof78deathsinthiscategory.

Basedontheinformationprovided,itwasnotapparentinallinstancesthatasuddenunexplaineddeathhadoccurred.

AlldeathnotificationsreceivedwereforwardedtotheInspectorofMentalHealthServicesinaccordancewithstandardoperatingprocedureswithintheCommission.Table11providesabreakdownofthisinformationbyHSEadministrativeregion.

Table 11: Number of Death Notifications Submitted by Day Hospitals, Day Centres and 24-Hour Staffed Community Residences in 2009

service provider Day Hospitals Day Centres 24 hour staffed community residences

not specified1

HSEDublinMidLeinster

5 2 6 6

HSEDublinNorthEast

0 1 7 0

HSESouth 4 2 8 7HSEWest 3 8 17 2total 12 13 38 15

1Notspecified–thereturnsreceivedindicatedthata‘suddenunexplaineddeath’hadoccurredbutdidnotspecifyifthedeceased

personwasattendingadayhospital,daycentreorresidingina24hourcommunityresidence.

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inspector of Mental Health services

TheInspectorofMentalHealthServicesexaminesalldeathnotificationsandincasessuggestiveofsuicideorviolentdeathrequestsareviewbecarriedoutbytheserviceandacopysenttotheInspectorate.Thesereviewsareanalysedwithaviewtoidentificationofopportunitiesforimprovementinpatientsafety,careandtreatmentandformpartoftheongoingdialoguebetweentheInspectorateandtheservice.

incident Reporting

InaccordancewiththeCodeofPracticeforMentalHealthServicesonNotificationofDeathsandIncidentReporting,approvedcentresprovidetheMentalHealthCommissionwithsix-monthlysummaryreportsofallincidentsoccurringinthecentre.ThereportsreceivedareavailabletotheInspectoratetoinformsubsequentinspections.

Duetothewidevariationinreportingsystemscurrentlyinusethroughoutmentalhealthservicesnationalaggregatedataiscurrentlyunavailable.TheCommissiononPatientSafetyandQualityAssurancewasestablishedbytheMinisterforHealthandChildrenin2007todevelopclearandpracticalrecommendationstoensurethatsafetyandqualityofcareforpatientsisparamountwithinourhealthcaresystem.Theirreport–BuildingaCultureofPatientSafety–waspublishedin2008andapprovedbyGovernmentinJanuary2009.Thereportcontains134recommendationsincluding18whichaddressthereporting,managingandlearningfromadverseevents.AnImplementationSteeringGroupandanumberofworkinggroupswereestablishedtoimplementtherecommendationsofthisreport.TheDirectorofStandardsandQualityAssurancerepresentstheCommissionontheAdverseEventsWorkingGroup.

other approved Centre Data

use of eCt, seclusion, Mechanical Restraint and physical Restraint

ApprovedCentresarerequiredtoreturnaggregatedataontheuseofECT,seclusion,mechanicalmeansofbodilyrestraintandphysicalrestraintundertherespectiveRulesandCodesofPracticeissuedinaccordancewiththeMentalHealthAct2001.

InNovember2009,theCommissionpublishednationalreportsontheuseofelectroconvulsivetherapy;seclusion;mechanicalmeansofbodilyrestraintandphysicalrestraintinapprovedcentresin2008.Theme8oftheQualityFrameworkforMentalHealthServicesinIrelandstatesthat“Systematic evaluation and review of mental health services underpinned by best practice will enable providers to deliver quality services”.TheCommissionmonitorsandreportsontheabovedataactivitytoprovideacurrentpictureofactivitybothwithinindividualservicesandatnationallevelinordertoinformthequalityimprovementprocess.ThenationalreportsareavailableinthePublicationsSectionoftheCommission’swebsitewww.mhcirl.ie.

TheCommissionhasrequestedtherelevantdataactivityfor2009andwillvalidateandpublishitin2010.

scheme of Mental Capacity Bill 2008

TheMentalHealthCommissionwelcomedthepublicationoftheSchemeoftheMentalCapacityBillandtheopportunityfortheCommissiontomakeasubmission.InApril2009theCommissionfurnisheditssubmissiontotheDepartmentofJustice,EqualityandLawReform.TheCommissionhasonnumerousoccasionshighlightedtheurgentneedforcapacitylegislationinIreland.TheCommitteeestablishedbytheCommissionre-convenedinSeptember2009toconsidertheamendedHeadstotheSchemeoftheMentalCapacityBillandthematterwasconsideredattheMentalHealthCommissionmeetingwhichtookplaceinSeptember2009.TheworkoftheCommission’sCommitteeonthismatterwasstillongoingatyearend.

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2020 Vision – The Quality of Mental Health Services Is Consistent with Best International Standards

strategic priority three (2009-2012) – Quality Mental Health services

Thescopeandprocessofinspectionandreportingiseffectiveinenhancingbothcompliance}}

andcommitmenttocontinuousqualityimprovementsandisacatalystforchange.

Tofacilitateandsupportimplementationofthequalityimprovementstandardsformental}}

healthservicesinIreland.(QualityFrameworkforMentalHealthServicesinIreland,MHC2007).

Tocontinuetosupportmentalhealthservicesresearchtobuildknowledgethatleadsto}}

practicalwaysofimprovingservices.

Topromoteandsupportthedevelopmentofanationalmentalhealthinformationsystem.}}

introduction

UndertheprovisionsoftheMentalHealthAct2001,oneoftheprincipaloverarchingfunctionsoftheMentalHealthCommissionistopromote,encourageandfostertheestablishmentandmaintenanceofhighstandardsandgoodpracticesinthedeliveryofmentalhealthservices(Section33(1),MentalHealthAct2001).

ThemandateoftheCommissionencompassestheboardspectrumofmentalhealthservicesinIreland.

inspector of Mental Health services

Section51,MentalHealthAct2001specifiesthefunctionsoftheInspectorofMentalHealthServices.In2009,inlinewithitsstatutorymandatetheInspectorateofMentalHealthServicesvisitedandinspectedeveryapprovedcentre.MeetingswereheldwithLocalHealthManagers(andequivalentmanagersintheindependentsector)andseniorclinicalstaff.TheInspectoratevisitedanumberofDayHospitalsand24-Hoursupervisedresidencesduring2009andheldtwoNationalOverviewmeetingswithseniorclinicalandmanagerialstaffofbothChildandAdolescentMentalHealthServicesandMentalHealthServicesforPersonswithanIntellectualDisability.TheInspectoratealsocarriedoutasurveyofmentalillnessinthehomelesspopulation.The2009InspectorsannualreviewofmentalhealthservicesinIrelandisreportedinPart2,Book1.Thedetailedapprovedcentreinspectionreportsarecontainedinbooks2-7onCDRomandarepublishedontheMentalHealthCommissionwebsitewww.mhcirl.ie.

inquiry

UndertheprovisionsofSection55,MentalHealthAct2001theCommissionmayorattherequestoftheMinister,establishaninquiryinto:

thecarryingonofanyapprovedcentreorotherpremisesintheStatewherementalhealthservices(a)areprovided,

thecareandtreatmentprovidedtoaspecifiedpatientoraspecifiedvoluntarypatientbythe(b)Commission,

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anyothermatterinrespectofwhichaninquiryisappropriatehavingregardtotheprovisionsofthis(c)Actoranyregulationsorrulesmadethereunderoranyotherenactment.

InJune2007theCommissionestablishedaninquirywiththefollowingtermsofreference:

“To review care and treatment practices in St. Michael’s Unit, South Tipperary General Hospital, Clonmel and St. Luke’s Hospital, Clonmel, including the quality and planning of care and the use of restraint and seclusion and to report to the Mental Health Commission.”

TheInquiryreportwasconsideredbytheMentalHealthCommissionatitsmeetingheldinJanuary2009andgivenfurtherconsiderationattheCommission’sFebruarymeeting.ThereportwasadoptedbytheCommissionattheFebruarymeeting.Thereportofinquirywaspublishedon3rdApril,2009andisavailableontheCommission’swebsiteatwww.mhcirl.ie

Subsequently,meetingswereheldbetweenHSEmanagersandcliniciansandtheMentalHealthCommissionandInspectoratewithaviewtofacilitatingimprovementsandrectifyingthedeficitsexposedbytheinquiry.

Alocalprojectteamwasestablishedinconsultationwithanexternalreviewgroupandanexpertinchangemanagement.Asetofprioritieswasidentifiedandshort-termandlong-termgoalsspecified.

Recentinspectionshaveshownthattheshort-termgoalsofachievingcompliancewithstatutoryrequirementsarebeingaccomplished.

Fundingtomovetoamorecommunity-orientedservicehasbeenallocated.

Theoverallqualityoftheserviceandprogresstowardlong-termgoalscontinuetobemonitoredandencouraged.

Register of approved Centres

Asaregulatorybody,akeyfunctionoftheCommissionistoestablishandmaintainaregisterofapprovedcentres(Section64,MentalHealthAct2001).Section63ofthe2001Actprovidesfortheprohibitionofcentres6thatarenotregisteredwiththeMentalHealthCommission.Thedefinitionofcentreisbroadandthereforecautionshouldbeexercisedwheninterpretingthetermapprovedcentreasthetermdoesnotsolelyrefertocentresthatareadmissionunits.

Undertheprovisionsofthe2001Act,acentre’speriodofregistrationshallgenerallybe3yearsfromthedateofregistration.Wheretheregisteredproprietorofacentreproposestocarryonthecentreimmediatelyaftertheperiodofregistrationexpires,he/shemustapplytotheCommissionforregistration.

Theperiodofregistrationof2approvedcentresexpiredduring2009.TheseapprovedcentreswereDepartmentofPsychiatry,ConnollyHospitalandWarrenstownChild&AdolescentIn-patientUnit.BothapprovedcentresappliedforregistrationinaccordancewithSection64(9)ofthe2001ActandbothwereenteredintheRegisterofApprovedCentreson7thDecember2009and14thDecember2009respectively.

KylemoreClinicclosedduring2009andwasremovedfromtheRegisterofApprovedCentresinaccordancewithArticle36(ClosureofanApprovedCentre)oftheMentalHealthAct2001(ApprovedCentres)Regulations2006.TheresidentsofKylemoreClinicweretransferredtotheapprovedcentreinBloomfieldCareCentre.

6 “‘Centre’meansahospitalorotherin-patientfacilityforthecareandtreatmentofpersonssufferingfrommentalillnessormentaldisorder.”(Section62,MentalHealthAct2001)

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ThreenewcentreswereenteredintheRegisterofApprovedCentresduring2009:

AdolescentIn-patientUnit,StVincent’sHospital,Fairview,Dublin3.Thiscentrewasenteredinthe}}

Registeron29thJanuary2009.

TheHavenChildren’sResidentialUnit,Kilcoon,CoMeath.ThiscentrewasenteredintheRegisteron}}

17thSeptember2009andaconditionwasattachedtotheregistration.

Child&AdolescentMentalHealthIn-patientUnit,StStephen’sHospital,Glanmire,CoCork.Thiscentre}}

wasenteredintheRegisteron16thOctober2009andaconditionwasattachedtotheRegistration.

ThetotalnumberofApprovedCentresat31stDecember2009was66.AlistofallapprovedcentresenteredintheRegisterofApprovedCentresisavailableintheRegistrationofApprovedCentressectionoftheCommission’swebsite,www.mhcirl.ie.

Tomaintainawarenessofthelegalrequirementforfacilitiesthatmeetthedefinitionof‘centre’toregisterwiththeCommission,advertisementswereplacedinthreenationalnewspapersinMarchandSeptember2009.

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Continuous Quality improvement

AspartoftheCommission’scontinuousqualityimprovementapproachtodevelopingthequalityofserviceprovision,theStandardsandQualityAssuranceDivisionrequestedeachapprovedcentretoprovideanimplementationplantoaddresstheareasofnon-compliancewiththeArticlesoftheRegulations,RulesandCodesofPracticeidentifiedbytheInspectorofMentalHealthServices.

TheImplementationPlanmustincludetheactionsthatwilltobetakentofullyaddresstheareasofnon-complianceidentifiedintheInspector’sReportandthetime-frame(s)forcompletion.TheprocessinvolvedisoutlinedinFigure8below.

Figure 8: Approved Centre Review Process

• Inspector’s Report received by Standards & Quality Assurance Division.• Report is reviewed to determine areas of non-compliance.

• If the Report identifies areas of non-compliance, an Implementation Plan to address the areas of non-compliance is required.

• The Plan must state what actions will be taken to achieve full compliance and the timeframes for completion.

• The Plan must be returned by a specified date, usually within 31 days.• If the Implementation Plan is not received by this time, a reminder is issued and follow up calls

are carried out as necessary.

• Approved centre registrations are regularly reviewed.• These reviews are attended by the Chief Executive Officer, the Inspector of Mental Health

Services and the Director of Standards and Quality Assurance.• The Inspector’s Report and the Implementation Plan of each centre is discussed.

• Following the Review Meeting, a Decision Meeting is held, attended by the Chief Executive Officer and the Director of Standards and Quality Assurance.

• This meeting is held to make a decision on the current registration of each centre, based on the items discussed at the Review Meeting.

• The Chief Executive Officer and the Director of Standards and Quality Assurance will decide to: (i) make no alterations to the centre’s registration, or (ii) propose to attach a condition or conditions to the centre’s registration, and/or (iii) propose to amend a condition or conditions currently attached to the centre’s registration, or (iv) propose to remove the centre from the Register.

Receipt of Inspector’s

Report

Implementation Plan

Receipt of Plan

Review of Registration

Decisions on Registration

Outcome of Decision Meeting

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Basedonthelearningfrompreviousyears,aStandardisedImplementationPlanTemplatewasdevisedbytheStandards&QualityAssuranceDivisionandissuedtoeachapprovedcentrein2009toassisttheaboveprocess.

During2009,Inspector’sReportsfor64approvedcentreswerereceivedbytheStandards&QualityAssuranceDivision.Outofthisnumber,63Reportsidentifiedareasofnon-compliancewiththeArticlesoftheRegulations,Rules,orCodesofPractice.

StStephen’sHospitalinGlanmire,Co.Corkwastheonlyapprovedcentredeemedfullycompliantwiththeregulations,rulesandcodesofpracticebytheInspectorofMentalHealthServicesin2009.

TheMentalHealthCommission(MHC)andtheInspectorofMentalHealthServiceshaveconsistentlycommentedupontheunacceptablecontinuationofprovisionofmentalhealthservicesinin-patientsettings,thatarenolonger‘fitforpurpose’,ietheolderpsychiatrichospitals/asylums.InJanuary2009,theHSEwasrequestedtoprovidecopiesofclosureplansfortheolderpsychiatrichospitals.ReminderletterswereissuedinMarch,AprilandMay.NineteenclosureplanswerereceivedbytheendofJune.Thequalityofinformationprovidedintheplanswasvariablewithnoneofthemidentifyingtheperson(s)responsibleandaccountableforactioningthevariouscomponentsoftheplans.FollowingareviewoftheplansreceivedbytheChiefExecutiveOfficer,InspectorofMentalHealthServicesandDirectorStandardsandQualityAssuranceaproposalregardingnextstepswasapprovedbytheCommissionatitsmeetingon30Septemberandimplementationisongoing.

Conditions attached to the Registration of approved Centres

In2009,theCommissionattachedconditionstotheregistrationof4approvedcentres.Theseapprovedcentreswere:

St Luke’s Hospital, Clonmel}} Theconditionsattachedrequiredfullcompliancetobeachievedwith:

Articles15,16,18,20,22,26and32oftheRegulations,}}

TheRulesGoverningtheUseofSeclusionandMechanicalMeansofBodilyRestraint,}}

TheCodeofPracticeRelatingtotheAdmissionofChildrenundertheMentalHealthAct2001,}}

and

TheCodeofPracticeforMentalHealthServicesonNotificationofDeathsandIncidentReporting}}

Theseconditionswereattachedwitheffectfrom14thMay2009.

St Michael’s Unit, South Tipperary General Hospital, Clonmel }} Theconditionsattachedrequiredfullcompliancetobeachievedwith:

Articles15,16,18,20,21,22,and26oftheRegulations,}}

TheRulesGoverningtheUseofSeclusionandMechanicalMeansofBodilyRestraint,and}}

TheCodeofPracticeforMentalHealthServicesonNotificationofDeathsandIncidentReporting.}}

Theseconditionswereattachedwitheffectfrom14thMay2009.

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The Haven Children’s Residential Unit, Kilcloon, Co Meath}} Theconditionattachedrelatedtotheprovisionofeducationalfacilitiesforchildren.Theconditionwasattachedwitheffectfromthecentre’sdateofregistration,17thSeptember2009.

Child & Adolescent Mental Health In-patient Unit, St Stephen’s Hospital, Glanmire, Co. Cork}} Theconditionattachedrelatedtotheprovisionofeducationalfacilitiesforchildren.

Theconditionwasattachedwitheffectfromthecentre’sdateofregistration,16thOctober2009.

Whereaproposalwasmadetoattachaconditiontoacentre’sregistration,ortoenteracentreintheRegisterwithaconditionattachedtoitsregistration,correspondencewasissuedtotheRegisteredProprietorinaccordancewiththeprovisionsofSection64(11)andSection64(12)oftheMentalHealthAct2001.

ThesesectionsaffordtheRegisteredProprietorsofthecentrestomakerepresentationstotheCommissionwithin21daysofreceiptofthecorrespondenceandtheCommissionmusttaketheserepresentationsintoconsiderationbeforemakingadecision.UnderSection65,theregisteredproprietormayalsoappealtheCommission’sdecisiontotheDistrictCourtwithin21daysofreceivingnotificationofthedecision.

national levels of Compliance with the Mental Health act 2001 (approved Centres) Regulations 2006

TheMentalHealthAct2001(ApprovedCentres)Regulations2006cameintoeffecton1November2006.Compliancewiththeregulationsislinkedwithregistrationasanapprovedcentre.Thereforeapprovedcentresareobligedtocomply.

Thisreportprovidesacomparisonofcompliancein2009with2007.

In2009,fullcompliance7was90%ormoreforthefollowing12articles:

Article10–Religion(100%)}}

Article30}} 8–MentalHealthTribunals(100%)

Article34–CertificateofRegistration(100%)}}

Article4–IdentificationofResidents(98%)}}

Article33–Insurance(97%)}}

Article14–CareoftheDying(97%)}}

Article7–Clothing(95%)}}

Article8–Residents’PersonalProperty&Possessions(95%)}}

Article12–Communication(94%)}}

Article13–Searches(94%)}}

7 In2007inspectorgradedcomplianceasfollows:compliantyesornoandin2009inspectorgradedcomplianceasfollows:fullycompliant,substantiallycompliant,complianceinitiated,notcompliant.

8 ThelevelsofcompliancewithArticle30isbasedon56approvedcentresin2007and55approvedcentresin2009.TheInspector’sReportsstatedthatArticle30wasnotapplicablein5approvedcentresin2007and9approvedcentresin2009.

52


Article25}} 9–UseofClosedCircuitTelevision(92%)

Article18–TransferofResidents(92%)}}

In2007,compliance10was90%ormoreforthefollowing6articles:

Article10–Religion(100%)}}

Article30–MentalHealthTribunals(100%)}}

Article4–IdentificationofResidents(100%)}}

Article33–Insurance(95%)}}

Article34–CertificateofRegistration(92%)}}

Article9–RecreationalActivities(92%)}}

In2009fullcompliance11waslessthan50%forthefollowingfourarticles:

Article26–Staffing(27%)}}

Article16–TherapeuticServices&Programmes(27%)}}

Article15–IndividualCarePlan(33%)}}

Article22–Premises(44%)}}

Thiscomparesto2007,wherecompliance12waslessthan50%forthefollowingeightarticles:

Article15–IndividualCarePlan(18%)}}

Article17}} 13–Children’sEducation(21%)

Article20–ProvisionofInformationtoResidents(38%)}}

Article6–FoodSafety(39%)}}

Article16–TherapeuticService&Programmes(41%)}}

Article28–RegisterofResidents(41%)}}

Article32–RiskManagementProcedures(48%)}}

Article19–GeneralHealth(48%)}}

9 ThelevelsofcompliancewithArticle25arebasedon33approvedcentresin2007and36approvedcentresin2009.TheInspector’sReportsstatedthatArticle25wasnotapplicablein28approvedcentresin2007and2009.

10 Seefootnote511 Ibid12 Ibid13 ThelevelsofcompliancewithArticle17arebasedon34approvedcentresin2007and36approvedcentresin2009.The

Inspector’sReportsstatedthatArticle17wasnotapplicablein27approvedcentresin2007and28approvedcentresin2009.

53


Thelargestimprovementsincompliancein2009areasfollows:

Article17–Children’sEducation(21%in2007,78%in2009)}}

Article13–Searches(52%in2007,94%in2009)}}

Article28–RegisterofResidents(41%in2007,81%in2009)}}

Article20–ProvisionofInformationtoResidents(38%in2007,73%in2009).}}

Howeverdisimprovementincompliancein2009isnotedasfollows:

Article26–Staffing(79%in2007,27%in2009)}}

Article16–TherapeuticServicesandPrograms(41%in2007,27%in2009)}}

Article9–RecreationalActivities(92%in2007,81%in2009)}}

Article21–Privacy(72%in2007,61%in2009)}}

Article22–Premises(54%in2007,44%in2009)}}

Inrelationtoarticle15(IndividualCarePlan)compliancein2007was18%.Thisimprovedto33%in2008andremainedat33%in2009.

Fullnationalcompliancedatacomparing2009with2007isprovidedinFigures9(a)–(d)inclusive.

Figure 9(a): Comparison of the National Levels of Compliance with Articles 4 to 14 of the Regulations for 2007 and 2009

100%

39%

82%

61%

92%100%

70%

59%52%

62%

98%

89%

70%

95% 95%

81%

100%

88%94% 94% 97%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007 Inspector’s Report 2009 Inspector’s Report

4 – I

dent

ifica

tion

of R

esid

ents

5 – F

ood

and

Nutri

tion

6 – F

ood

Safe

ty

7 – C

loth

ing

8 – R

esid

ents

’ Per

sona

l

Prop

erty

& P

osse

ssio

ns

9 – R

ecre

atio

nal A

ctiv

ities

10 –

Relig

ion

11 –

Visit

s12

– Co

mm

unica

tion

13 –

Sear

ches

14 –

Care

of t

he D

ying

87%

54


Figure 9(b): Comparison of the National Levels of Compliance with Articles 15 to 20 of the Regulations for 2007 and 2009

Figure 9(c): Comparison of the National Levels of Compliance with Articles 21 to 26 of the Regulations for 2007 and 2009

18%

41%

21%

67%

48%

38%33%

27%

78%

92%

83%

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


15 – Individual Care Plan

16 – Therapeutic Services &

Programmes

17 – Children’s Education

18 – Transfer of Residents

19 – General Health 20 – Provision of Information to

Residents


72%

54%

66%

80%

70%

79%

61%

44%

89% 89%92%

27%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

21 – Privacy 22 – Premises 23 – Ordering, Prescribing, Storing &

Administration of Medicines

24 – Health & Safety

25 – Use of Closed Circuit

Television

26 – Staffing

55


Figure 9(d): Comparison of the National Levels of Compliance with Articles 27 to 34 of the Regulations for 2007 and 2009

national levels of Compliance with Rules and Codes of practice

PursuanttoSections59(2),69(2)and33(3)(e)oftheMentalHealthAct2001,theCommissionhaspublishedanumberofrulesandcodesofpractice.

In2009,theInspectorateinspectedcompliancewith2setsofrulesand4codesofpractice.Thisreportprovidesanoverviewofthenationallevelsofcompliancewiththoserulesandcodes.

Thelevelsoffullcompliance(i.e.wheretheInspector’sReportstatedthatthecentrewasfullycompliant)wereasfollows:

CodeofPracticeforMentalHealthServicesonNotificationofDeathsandIncidentReporting–}}

50approvedcentres.

CodeofPracticeontheUseofPhysicalRestraintinApprovedCentres–21approvedcentres.}}

RulesGoverningtheUseofMechanicalMeansofBodilyRestraint–20approvedcentres.}}

CodeofPracticeontheUseofElectro-ConvulsiveTherapy(ECT)forVoluntaryPatients–16approved}}

centres.

RulesGoverningtheUseofECT–11approvedcentres.}}

RulesGoverningtheUseofSeclusion–6approvedcentres.}}

CodeofPracticeontheAdmissionofChildrenUndertheMentalHealthAct2001–5approvedcentres.}}

62%57%

67%

48%

95% 92%

69%

81% 78%86%

75%

97% 100%100% 100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007 Inspector’s Report 2009 Inspector’s Report27

– M

aint

enan

ce o

f Rec

ords

28

– Re

gist

er o

f Res

iden

ts

29 –

Oper

atin

g Po

licie

s and

Pro

cedu

res

30 –

Men

tal H

ealth

Trib

unal

s

31 –

Com

plai

nts P

roce

dure

s

32 –

Risk

Man

agem

ent P

roce

dure

s

33 –

Insu

ranc

e

34 –

Certi

ficat

e of

Reg

istra

tion

41%

56


Thelevelsofnon-compliance(i.e.wheretheInspector’sReportstatedthatthecentrewasnotcompliant)wereasfollows:

CodeofPracticeontheAdmissionofChildrenUndertheMentalHealthAct2001–22approved}}

centres.

CodeofPracticeontheUseofPhysicalRestraintinApprovedCentres–7approvedcentres.}}

RulesGoverningtheUseofSeclusion–6approvedcentres.}}

CodeofPracticeforMentalHealthServicesonNotificationofDeathsandIncidentReporting–}}

4approvedcentres.

CodeofPracticeontheUseofElectro-ConvulsiveTherapy(ECT)forVoluntaryPatients–1approved}}

centre.

RulesGoverningtheUseofMechanicalMeansofBodilyRestraint–1approvedcentre.}}

RulesGoverningtheUseofECT–Noapprovedcentre.}}

FullnationalcompliancedataisprovidedinFigures10(a)to10(g).

Figure 10(a): Levels of Compliance in 2009 with the Rules Governing the Use of Seclusion (n=64).

Fully Compliant

Substantially Compliant

Compliance Initiated

Not Compliant

Not Applicable

6 centres

6 centres

13 centres

5 centres

34 centres

57


Figure 10(b): Levels of Compliance in 2009 with the Rules Governing the Use of Mechanical Means of Bodily Restraint (n=64).

Figure 10(c): Levels of Compliance in 2009 with the Rules Governing the Use of ECT (n=64).

Fully Compliant


Not Compliant

Not Applicable

1 centre

20 centres

7 centres

36 centres

Fully Compliant



Not Applicable

11 centres

6 centres

3 centres44 centres

58


Figure 10(d): Levels of Compliance in 2009 with the Code of Practice on the Use of ECT for Voluntary Patients (n=64).

Figure 10(e): Levels of Compliance in 2009 with the Code of Practice on the Use of Physical Restraint in Approved Centres (n=64).

16 centres

5 centres

1 centre1 centre

41 centres

Fully Compliant



Not Compliant

Not Applicable

21 centres

17 centres4 centres

7 centres

15 centres

Fully Compliant



Not Compliant

Not Applicable

59


Figure 10(f): Levels of Compliance in 2009 with the Code of Practice on the Admission of Children Under the Mental Health Act 2001 (n=64).

Figure 10(g): Levels of Compliance in 2009 with the Code of Practice for Mental Health Services on Notification of Deaths and Incident Reporting (n = 64).

22 centres

3 centres

6 centres

5 centres

28 centres

Fully Compliant



Not Compliant

Not Applicable

50 centres

4 centres

4 centres

6 centres

Fully Compliant



Not Compliant

60


Tables12and13detaileachapprovedcentre’scompliancelevelswiththerulesandthecodesofpracticerespectively.

Inthesetables,thelevelsofcomplianceareabbreviatedasfollows:

Full=InspectorReportstatesthelevelofcomplianceis‘FullyCompliant’.}}

Substantial=InspectorReportstatesthelevelofcomplianceis‘SubstantiallyCompliant’.}}

Initiated=Inspector’sReportstatesthelevelofcomplianceis‘ComplianceInitiated’.}}

Not=Inspector’sReportstatesthelevelofcomplianceis‘NotCompliant’.}}

N/A=Inspector’sReportstatesthattheruleorcodeinquestiondoesnotapply.}}

Table 12: Levels of Compliance in 2009 with the Rules Governing the Use of Seclusion and Mechanical Means of Bodily Restraint and the Rules Governing the Use of Electro-Convulsive Therapy.

approved Centre name seclusion Mechanical Restraint

eCt

approved Centres in the Child & adolescent sectorAdolescentIn-patientUnit,St.Vincent’sHospital Full N/A N/ASt.Anne’sChildren’sCentre Full N/A N/AWarrenstownChild&AdolescentIn-patientUnit N/A N/A N/Aapproved Centres in the Health service executive (Hse) Dublin Mid leinster areaAcutePsychiatricUnit,AMNCH Substantial N/A SubstantialCentralMentalHospital Substantial Full N/ADepartmentofPsychiatry,MidlandRegionalHospital,Portlaoise

Substantial Full Full

ElmMountUnit,St.Vincent’sUniversityHospital N/A N/A SubstantialJonathanSwiftClinic N/A N/A SubstantialLakeviewUnit,NaasGeneralHospital Not N/A FullNewcastleHospital Substantial Full FullSt.Fintan’sHospital N/A N/A N/ASt.Loman’sHospital,Mullingar Not Full FullSt.Loman’sHospital,Palmerstown N/A N/A N/Aapproved Centres in the Hse Dublin north east areaAcutePsychiatricUnit,CavanGeneralHospital N/A Full N/AAcutePsychiatricUnit,St.AloysiusWard,MaterMisericordiaeHospital

Initiated Not Initiated

DepartmentofPsychiatry,ConnollyHospital N/A N/A N/ADepartmentofPsychiatry,OurLady’sHospital,Navan Full N/A N/ASt.Brendan’sHospital Not N/A N/ASt.Brigid’sHospital,Ardee Not Substantial N/ASt.Davnet’sHospital–Wards4,8and15 N/A Full N/ASt.Ita’sHospital–MentalHealthServices Substantial Full N/ASt.Joseph’sIntellectualDisabilityServices,St.Ita’sHospital Full Full N/ASt.Vincent’sHospital Substantial Full N/ASycamoreUnit,ConnollyHospital N/A N/A N/A

61


approved Centre name seclusion Mechanical Restraint

eCt

approved Centres in the Hse south areaAcuteMentalHealthAdmissionUnit,KerryGeneralHospital Substantial N/A N/AAcutePsychiatricUnit,BantryGeneralHospital N/A N/A N/ACarraigMórCentre Initiated N/A N/ADepartmentofPsychiatry,St.Luke’sHospital,Kilkenny Full Full N/ADepartmentofPsychiatry,WaterfordRegionalHospital Full N/A FullSouthLeeMentalHealthUnit,CorkUniversityHospital N/A Substantial SubstantialSt.Canice’sHospital N/A Full N/ASt.Dympna’sHospital N/A Full N/ASt.Finan’sHospital Substantial Substantial N/ASt.Finbarr’sHospital N/A N/A N/ASt.Luke’sHospital,Clonmel N/A Full N/ASt.Michael’sUnit,MercyHospital N/A N/A SubstantialSt.Michael’sUnit,SouthTipperaryGeneralHospital Substantial N/A FullSt.Otteran’sHospital N/A N/A N/ASt.Senan’sHospital Initiated Full FullSt.Stephen’sHospital N/A N/A N/Aapproved Centres in the Hse West areaAcutePsychiatricUnit5B,MidwesternRegionalHospital N/A N/A InitiatedAcutePsychiatricUnit,Carnamuggagh N/A N/A N/AAcutePsychiatricUnit,MidWesternRegionalHospital,Ennis Substantial N/A SubstantialAdultMentalHealthUnit,MayoGeneralHospital Substantial N/A FullAnCoillín N/A Full N/ABallytivnanSligo/LeitrimMentalHealthServices Substantial N/A N/ACappahardLodge N/A Full N/ADepartmentofPsychiatry,CountyHospital,Roscommon Not N/A N/AOrchardGrove N/A N/A N/APsychiatricUnit,UniversityCollegeHospitalGalway Substantial N/A InitiatedSt.Anne’sUnit,SacredHeartHospital N/A Substantial N/ASt.Brigid’sHospital,Ballinasloe Initiated N/A FullSt.Conal’sHospital N/A N/A N/ASt.Joseph’sHospital N/A Full N/ATeachAisling N/A Full N/ATearmannWard&CurragourWard,St.Camillus’Hospital N/A Full N/AUnit9A,MerlinParkUniversityHospital N/A N/A N/Aapproved Centres in the independent or private Charitable sectorsBloomfieldCareCentre–Bloomfield,Kylemore,Owendoher&SwanbrookWings

N/A Substantial N/A

HampsteadPrivateHospital N/A Substantial N/AHighfieldPrivateHospital N/A Substantial N/APalmerstownView,Stewart’sHospital Not N/A N/ASt.EdmundsburyHospital N/A N/A N/ASt.JohnofGodHospitalLimited Initiated N/A FullSt.Patrick’sHospital N/A Full Full

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Table 13: Compliance Levels in 2009 with the: (i) Code of Practice on the Use of Electro-Convulsive Therapy for Voluntary Patients, (ii) Code of Practice on the Use of Physical Restraint in Approved Centres, (iii) Code of Practice for the Admission of Children Under the Mental Health Act 2001, and (iv) Code of Practice for Mental Health Services on Notification of Deaths and Incident Reporting.

approved Centre name eCt physical Restraint

admission of Children

Deaths & incident

Reportingapproved Centres in the Child & adolescent sectorAdolescentIn-patientUnit,St.Vincent’sHospital

N/A Full Full Initiated

St.Anne’sChildren’sCentre N/A Full Full InitiatedWarrenstownChild&AdolescentIn-patientUnit

N/A Not Substantial Full

approved Centres in the Health service executive (Hse) Dublin Mid leinster areaAcutePsychiatricUnit,AMNCH Substantial Substantial Not InitiatedCentralMentalHospital N/A Substantial N/A FullDepartmentofPsychiatry,MidlandRegionalHospital,Portlaoise

Full Substantial Substantial Full

ElmMountUnit,St.Vincent’sUniversityHospital

Full Substantial Initiated Full

JonathanSwiftClinic Full Full Full FullLakeviewUnit,NaasGeneralHospital Full Not Not NotNewcastleHospital Full Full Not FullSt.Fintan’sHospital N/A N/A N/A FullSt.Loman’sHospital,Mullingar Full Not Not FullSt.Loman’sHospital,Palmerstown N/A Not N/A Fullapproved Centres in the Hse Dublin north east areaAcutePsychiatricUnit,CavanGeneralHospital N/A Full Full FullAcutePsychiatricUnit,St.AloysiusWard,MaterMisericordiaeHospital

Not Substantial Not Full

DepartmentofPsychiatry,ConnollyHospital N/A Substantial Not FullDepartmentofPsychiatry,OurLady’sHospital,Navan

N/A Full Substantial Full

St.Brendan’sHospital N/A Substantial Not FullSt.Brigid’sHospital,Ardee N/A Substantial N/A FullSt.Davnet’sHospital–Wards4,8and15 N/A Full Not FullSt.Ita’sHospital–MentalHealthServices N/A Full Not FullSt.Joseph’sIntellectualDisabilityServices,St.Ita’sHospital

N/A Full N/A Full

St.Vincent’sHospital N/A Full Not FullSycamoreUnit,ConnollyHospital N/A N/A N/A Notapproved Centres in the Hse south areaAcuteMentalHealthAdmissionUnit,KerryGeneralHospital

Full Substantial Not Substantial

AcutePsychiatricUnit,BantryGeneralHospital

N/A Initiated Not Substantial

CarraigMórCentre N/A Initiated N/A FullDepartmentofPsychiatry,St.Luke’sHospital,Kilkenny

Full Full Not Full

DepartmentofPsychiatry,WaterfordRegionalHospital

Full Full Not Full

63


approved Centre name eCt physical Restraint


Deaths & incident

ReportingSouthLeeMentalHealthUnit,CorkUniversityHospital

Substantial Not Not Substantial

St.Canice’sHospital N/A N/A N/A FullSt.Dympna’sHospital N/A N/A N/A FullSt.Finan’sHospital N/A Substantial N/A SubstantialSt.Finbarr’sHospital N/A N/A N/A FullSt.Luke’sHospital,Clonmel N/A N/A N/A FullSt.Michael’sUnit,MercyHospital Substantial Substantial Substantial FullSt.Michael’sUnit,SouthTipperaryGeneralHospital

Full Full Not Full

St.Otteran’sHospital N/A N/A N/A NotSt.Senan’sHospital Full Not Not InitiatedSt.Stephen’sHospital N/A Full N/A Fullapproved Centres in the Hse West areaAcutePsychiatricUnit5B,MidwesternRegionalHospital

Substantial Substantial Not Full

AcutePsychiatricUnit,Carnamuggagh Full N/A Substantial FullAcutePsychiatricUnit,MidWesternRegionalHospital,Ennis

Substantial Initiated Not Full

AdultMentalHealthUnit,MayoGeneralHospital

Full Substantial Not Full

AnCoillín N/A Full N/A FullBallytivnanSligo/LeitrimMentalHealthServices

N/A Substantial Not Full

CappahardLodge N/A Full N/A FullDepartmentofPsychiatry,CountyHospital,Roscommon

N/A Not Not Full

OrchardGrove N/A Substantial N/A FullPsychiatricUnit,UniversityCollegeHospitalGalway

Initiated Substantial Initiated Substantial

St.Anne’sUnit,SacredHeartHospital N/A N/A N/A FullSt.Brigid’sHospital,Ballinasloe N/A Full Substantial FullSt.Conal’sHospital N/A N/A N/A FullSt.Joseph’sHospital N/A Full N/A FullTeachAisling N/A Full N/A FullTearmannWard&CurragourWard,St.Camillus’Hospital

N/A N/A N/A Full

Unit9A,MerlinParkUniversityHospital N/A N/A N/A Fullapproved Centres in the independent or private Charitable sectorsBloomfieldCareCentre–Bloomfield,Kylemore,Owendoher&SwanbrookWings

N/A N/A N/A Full

HampsteadPrivateHospital N/A N/A N/A FullHighfieldPrivateHospital N/A N/A N/A FullPalmerstownView,Stewart’sHospital N/A Substantial N/A NotSt.EdmundsburyHospital Full Full N/A FullSt.JohnofGodHospitalLimited Full Initiated Initiated SubstantialSt.Patrick’sHospital Full Full Full Full

64


e-learning

Anextensivelearnersurveyonthee-learningprogrammeontheMentalHealthActwasconductedin2009.Anumberofrevisionstothee-LearningprogrammeweresuggestedtofacilitateabetterwayoflearningaboutspecificprocessestoadheretotheprovisionsoftheMentalHealthAct,2001.ThisfeedbackwillbeusedtoimprovetheoveralllearningexperienceandpromoteamoreacceleratedlearningapproachtolearningabouttheMentalHealthAct,2001.

supporting Mental Health services Research

AResearchStrategyfortheMentalHealthCommissionwaspublishedin2005.TheCommissionviewsmentalhealthservicesresearchasbeingcentrallyimportanttothedevelopmentofhighqualitymentalhealthservices.Buildingcapacityformentalhealthservicesresearchisoneofthefouractionsplansoutlinedinthestrategy.Theotherthreeactionplanswhicharehighlightedinthestrategyare;recordinganddisseminatingknowledgeofbestpracticeinmentalhealthservices,creatinglinksandcollaboratingresearchstandardsinmentalhealthandsettingthementalhealthresearchagenda.

Funded Research projects

During2009theMentalHealthCommissionwasfundingfourresearchprojects.

Dr.SiobhánNíBhríain:MeasurementofneedsintheHSE-SWA:AMeasureofNeedsandCorrelation}}

withInterventioninHomeandCommunity-basedServicesinGeneralAdultPsychiatryandPsychiatryofLaterLife

ProfessorStiofándeBurca:AdultCommunityMentalHealthTeams:DeterminantsofEffectiveness}}

Dr.EnaLavelle:RehabilitationandRecoveryServicesinIreland:amulticentrestudytoinvestigate}}

currentserviceprovision,characteristicsofserviceusersand18monthoutcomesforthosewithandwithoutaccesstotheseservices

Mr.NiallTurner:Aclinicaltrialofsupportedemployment(SE)andtheWorkplaceFundamentalsModule}}

(WFM)withpeoplediagnosedwithschizophreniaspectrumdisorders

In2009theCommissionadvertisedaResearchProgrammeGrantSchemewhichreplacedtheResearchScholarshipScheme.

Theaimsoftheresearchprogrammegrantschemewereto:

Produceoutputswhichwilladdressquestionsofdirectrelevancetomentalhealthservicesandthe}}

mandateoftheMentalHealthCommission;

Producehighqualitymentalhealthservicesresearch;}}

Supportthecreationofresearchpartnershipsbetweenmentalhealthservices,serviceusersandthird}}

levelinstitutions(TLIs);

Supportmultidisciplinary,collaborativeresearchwhichinvolvesserviceusersatallstages;}}

Supportthelong-termdevelopmentofresearchcapabilitiesinmentalhealthservicesresearchbothin}}

TLIsandmentalhealthservices.

65


Focus of the Research Grants

Thefocusoftheschemewastosupportthecreationofresearchpartnershipstocarryoutinnovative,highquality,multi-disciplinarymentalhealthserviceresearchinIreland.TheMentalHealthCommissionidentifiedtwopriorityareasforresearchinthisGrantscheme.

theme a: Research on quality in mental health services

theme B: Research related to the impact of part 2 of the Mental Health act 2001

TheclosingdateforsubmissionstotheSchemewas30thOctober,2009andattheendof2009submissionsreceivedwerebeingevaluatedforalignmentwiththeobjectivesoftheScheme.

Research studies Commissioned by the Commission

During2009ascopingstudyon‘CurrentEducationandTrainingforProfessionalsWorkingintheMentalHealthServicesinIreland’wasconductedbyTrinityCollegeDublin,onbehalfoftheMentalHealthCommission.TherecommendationsofthestudyaretobeadvancedbycommencingdiscussionswiththeHigherEducationAuthority.

Research Committee

TheCommission’sResearchCommitteeheldthreemeetingsin2009.Inlinewiththecommittee’stermsofreferenceitguidedandadvisedtheMentalHealthCommissionontheorganisation’sresearchagendafortheyear.

Mental Health: the Case for a Cross-Jurisdictional approach Combining policy and Research on the island of ireland

During2009,incollaborationwiththeCentreforCrossBorderStudies,theMentalHealthCommissioncontinuedtoexaminethefeasibilityofestablishinganall-islandmentalhealthresearchcentre.AspartofthisprogrammeDr.PatriciaClarkewastheauthorofareportwhichlookedatthecaseforacrossjurisdictionalapproachcombiningpolicyandresearcheffortsontheislandofIreland.Thereportbuiltonpreviousinterestinresearchingall-islandefforts.

Thereportsetoutthecontext,challengesandapproachtotransformationofmentalhealthservicesandrelatedresearchontheislandofIreland.Itcomparedthetwomainmentalhealthpolicydocuments(BamfordReviewintheNorthandA Vision for ChangeintheSouth)andidentifiedsimilaritiesanddifferencesinpolicyapproachacrosstheborder.Thereportalsohighlightedareasofcommonconcern,jointprioritiesforresearchandgapswhichexist.TheReportisavailabletodownloadfromtheCommission’swebsiteatwww.mhcirl.ie.

TheCommissionreceivedverypositivefeedbacktoDr.Clarke’sreportandsubsequenttoitspublicationtheChiefExecutiveOfficeroftheCommissionmetwithrepresentativesfromtheNorthSouthMinisterialCouncilontwooccasionstohelphighlightandprogressmatters.

66


2020 Vision – The Needs and Rights People with Mental Illness Are Addressed in an Integrated and Cohesive Manner within the Wider Mental Health Domain

strategic priority Four (2009-2012) – Wider Mental Health Domain

Theworkofrelevantstateagenciesandotherorganisationswithinthewidermentalhealth}}

domainisinformedbytheCommission’sstrategyandnationalgovernmentpolicyonmentalhealth,A Vision for Change.

“A Vision for Change”

InJanuary,2006,A Vision for ChangethenationalgovernmentpolicyonmentalhealthservicesinIrelandwaspublished.ThispolicywaswidelywelcomedandembracedbyallpartiesastheframeworkfordevelopingmentalhealthservicesinIreland.Thepolicyproposedthereorientationofthedeliveryofmentalhealthservicesawayfromtheoldstylemodelofinstitutionalcareandenvisagesspecialistcommunitycareandtreatmentthataddressesthebiological,psychologicalandsocialfactorsthatmaycontributetoaperson’smentalillness.

During2009thefundamentalchangestomentalhealthservicesasrecommendedinVision for Changehadstillnottakenplace.However,inNovember2009theCommissionwarmlywelcomedthecommitmentmadebytheMinisterofStatewithResponsibilityforMentalHealthMr.JohnMoloneyT.D.toacoreelementofthispolicy–theclosureandsaleoftheState’soldpsychiatrichospitalsandthering-fencingoftheproceedsofthosesalesforthedevelopmentofnewmentalhealthservices,andthetransferofpatientsfromtheoldinstitutionstocommunitybasedsettings.

InDecember2009theCommissionmadeasubmissiontotheIndependentMonitoringGroupforA Vision for Changeandapresentationtothegroupwasplannedforearly2010.

Vision into action Report

InNovember2009theCommissionpublishedapapergivingananalysisoftheprogresstowardsimplementationbytheHealthServiceExecutiveofAVision for Change.

Thepaperacknowledgedthatimplementationofacomplexpolicywithmanyrecommendationsinasystemthatisundergoingsignificantchangeisachallengingprocess.Thepaperoutlineswhatworksinimplementationanddiscussestheextensiveliteratureoneffectiveimplementationprocesses.Thisrequiresco-ordinatedchangeatsystem,organisation,programmeandpracticelevels.

InthepapertheMentalHealthCommissionacknowledgedtheappointmentoftheAssistantNationalDirectorMentalHealthServicesasapositiveindicatoroftheHealthServiceExecutive’sresponsetoVision for Change.However,evidencebasedrequirementsforsuccessfulimplementationarelargelymissingfromtheHSEimplementationplan.ThepaperstatesthattheimplementationplanfromtheHSEshouldinclude:

anoverallsenseoftheHSEvisionformentalhealthservices;}}

astatementofspecificoutcomes;}}

amapofthestepsneededtoachievetheseoutcomeswithrealtargets,timelines,resourcesand}}

responsibleagentsclearlydescribed;

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andfinallyanoutlineofthemeasurablebenefitsarisingfromtheimplementationincludingthe}}

monitoringoftheoutcomesastheyarebeingachieved.

TheabovereportisavailabletodownloadfromtheCommission’swebsiteatwww.mhcirl.ie

Report of Joint Working Group on police and Mental Health services

InSeptember2009theMentalHealthCommissionandAnGardaSíochanajointlypublishedtheReportoftheJointWorkingGrouponthePoliceandMentalHealthServices.Therecommendationsofthereportrequireamulti-facetedapproachfromanumberofagenciesincluding,AnGardaSíochana,theHealthServiceExecutiveandserviceuserorganisations.Therecommendationsemphasisetheimportanceofcollaborationandjointworkingwhilerespectingthedifferentareasofexpertiseandresponsibilitiesofthoseinvolved.FollowingdiscussionswiththekeystakeholdersinvolveditwasagreedtoprogressinitiallywithactioningRecommendation6ofthereportandworkwasongoingatyearend.AcopyofthereportisavailabletodownloadontheCommission’swebsiteatwww.mhcirl.ie.

Resource paper – teamwork Within Mental Health services in ireland

Givenitspotentialbenefitsforserviceusers,thedevelopmentofmoreeffectiveteamworkingwithinthementalhealthservicesinIrelandremainsaprimeconcernfortheMentalHealthCommission.InlateOctober2009theCommissionapprovedthepublicationofaResourcepaperonTeamworkWithintheMentalHealthServicesinIreland.ThispaperfollowedonfromtheDiscussionpaperonMultidisciplinaryTeamworkingwhichtheCommissionhadpublishedin2006.TheResourcePaperwillbeavailableinearly2010.

Mental Health Commission annual training symposium 2009

TheMentalHealthCommissionannualtrainingsymposiumtitled‘PromotingBestInterests–MentalHealthAct2001’tookplaceinNovember2009.Over300delegatesattendedthesymposium.Theguestspeakersandthetitleoftheirpresentationswere:

Professor Terry Carney ProfessorofLaw,UniversityofSydneyBest Interests or Legal Rectitude? Australian mental health tribunal stakeholder & case-flow implications

Professor Phil Fennell ProfessorofLaw,CardiffUniversityLawSchoolCurrent Issues in Mental Health and Human Rights

Ms. Patricia Rickard ClarkeLawReformCommissionerDevelopment of Capacity Legislation in Ireland

Dr. Margo Wrigley ConsultantPsychiatrist/ClinicalDirector,NorthDublinOldAgePsychiatryServiceCapacity: Clinical Decisions and Dilemmas

Professor Elyn R. SaksOrrinB.EvansProfessorofLaw,Psychology,&PsychiatryattheUniversityofSouthernCaliforniaGouldSchoolofLawMy Journey through Madness

Thefeedbackonthesymposiumwasextremelypositive.AllofthepresentationsareavailableinPowerPoint,audioandvideoontheMentalHealthCommissionwebsiteatwww.mhcirl.ie

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MHC submission to the expert Group on Resource allocation and Financing in the Health sector

InJuly2009theMentalHealthCommissionmadeasubmissiontotheExpertGrouponResourceAllocationandFinancingintheHealthSector.

TheCommission’ssubmissionfocusedon:

PrevalenceandEconomicCostsofSeriousMentalIlness/MentalDisorder}}

StrengthsandWeaknessoftheCurrentSystemofResourceAllocation}}

ProposalsforChange}}

other stakeholder Meetings/Consultations

During2009theCommissionheldmeetingswithrepresentativesfromAmnestyInternationalIrelandandtheIrishHumanRightsCommissiontodiscussissuesofmutualconcernandinterest.

TheCommissionparticipatedintheconsultationontheLawReformCommission’spaperon‘ChildrenandtheLaw:MedicalTreatment’whichwaspublishedinDecember2009.TheCommissionwillalsobemakingasubmissioninresponsetothisconsultationpaperinearly2010.

TheCommissionalsocontributedtothefollowingexternalconsultationsbywayofwrittensubmissionsormembershipofadvisorygroups:

AnBordAltranais:Guidancestandardsforthecareofolderpersons;}}

HelathResearchBoard,DisabilityDatabasesUnit:draftResearchprogramme2009-2011;}}

Denmark,NationalBoardofHealth:PanEuropeanQuestionnaire–Usingcoercivemeasuresin}}

psychiatry;

OECD:EU15ReviewofRgulatoryCapacity}}

HIQA/ESRIHealthInformationProject}}

HIQA:NationalStandardsforQualityanSafetyAdvisoryGroup.}}

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2020 Vision – Public Understanding of Mental Illness Is Enhanced, Stigma Is Diminished and Public Attitudes Are Increasingly Respectful

strategic priority Five (2009-2012) – social inclusion and active Citizenship

Tochallengethebarriersexperiencedbypeoplewithamentalillnesstosocialinclusionand}}

activecitizenship.

irish Mental Health Recovery education Consortium

TheTrainingandDevelopmentdivisionrepresentedtheMentalHealthCommissionontheAdvisorygroupoftheIrishMentalHealthRecoveryEducationConsortium(IMHREC).ThepurposeoftheconsortiumwastodevelopanddeliverafacilitatedlearningprogrammeonMentalHealthRecoveryandWRAP(WellnessRecoveryActionPlan).TheroleoftheMHCwastoadviseandsupporttheconsortiuminthedesign,deliveryandevaluationofthementalhealthrecoveryandwrapeducationprogramme.

World Mental Health Day 2009

WorldMentalHealthDayisaninternationaleventwhichisannuallyheldon10thOctober.Eachyearthereisadifferentthemewhichraisesawarenessaboutmentalhealthandwellbeing.The2009WorldMentalHealthDaycampaignfocusedon“Mental Health in Primary Care: Enhancing Treatment and Promoting Mental Health.”

TheMentalHealthCommissionmarkedtheeventbyhostinganeventonOctober10thintheMansionHouse.

Speakersatthe2009eventincluded:

Mr.PádraigÓMorain,CounsellorandJournalist,“Takeaway course in Mindfulness – Exercises to enhance your daily life”

Dr.AntoniaLehane,Generalpractitioner,“Encouraging Good Mental Health”

CarolHunt,JournalistandMentalHealthAdvocate,“Not all in the Mind: A Personal and Holistic Approach to Mental Health”

Ms.PaulaMee,ConsultantDietician,“Nutrition: A Positive Contribution to Mental Health”

Mr.PadraigMurphy,StrengthandConditioningSpecialist,“Improving Wellbeing Through Exercises”

Anumberofstakeholderorganisationsprovidedinformationstandsontheday.Theeventreceivedverypositivefeedbackwithover160peopleinattendance.

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international initiative for Mental Health leadership

TheInternationalInitiativeforMentalHealthLeadership(IIMHL)isa“Government-to-Government”initiativewithsevenparticipatingGovernments.Thepurposeoftheinitiativeistoworktowardsimprovingmentalhealthservicesbysupportinginnovativeleadershipprocesses.IIMHLwillholditsannualExchange&NetworkmeetinginIrelandinMay2010.TheMentalHealthCommissionisoneofthepartnersinsupportingtheexchangeandconference.TheMHCisplanningtohostaleadershipexchangeandanumberofvisitingleadershavesigneduptoattendtheprogramme.

Mental Health awareness

TheMentalHealthCommissionwasrepresentedonthe“MentalHealthAwarenessCampaignSteeringGroup”,establishedbytheNationalSuicideOfficeforSuicideprevention.Theworkin2009focusedoncontinuingandprogressingwiththeyoungperson’scampaign.

Medication safety Forum

TheMentalHealthCommissionwasoneofthestakeholdergroupsoftheMedicationSafetyForumwhichwassetupandfacilitatedbyHIQAin2008.ThetermsofreferenceofthegroupwastoprovidethosewithaninterestinthemedicationuseprocessorinmedicationsafetyinIrelandanopportunitytocometogethertodiscussrelevantnationalissuesanddevelopments.

InkeepingwiththerecommendationoftheCommissiononPatientSafetyandQualityAssurance(CPSQA),regardingtheestablishmentofclearcommunicationstructuresbetweenallbodieswithastakeinthemedicationuseprocessormedicationsafety,itwasagreedthattheMedicationSafetyForumcouldbeharnessedtoassistwiththeimplementationofthemedicationsafetyproject’sobjectives.ThetermsofreferenceoftheMedicationSafetyForumevolvedtoallowthegrouptoactivelycontributetotheimplementationoftheCPSQAreportrecommendations.

Recruitment, induction, education, training and Development project Group

ARecruitment,Induction,Education,TrainingandDevelopmentProjectGroupwasestablishedin2009asasubgroupoftheHealthandSocialCareRegulatoryForum.Thepurposeofthegroupistoconsiderandscopetheareasaroundrecruitment,induction,traininganddevelopmentacrossthemembersoftheHealthandSocialCareRegulatoryForum.In2009aquestionnairewasdevelopedbytheProjectGroupandcirculatedtotheregulatoryorganisations.Resultsfromthequestionnairehighlightedpotentialareaswheretheseorganisationscouldcollaborateinparticulararoundtheareaoftraininganddevelopment.

national Disability advisory Committee

TheDepartmentofHealthandChildrenestablishedaNationalDisabilityAdvisoryCommittee,representativeofpeoplewithdisabilitiesandotherkeystakeholders,whichincludestheMentalHealthCommission.Thepurposeofthecommitteeisto:

Provideaforumtoinformpolicyatnationallevelinrelationtoservicesforpeoplewithdisabilities;}}

FormpartoftheoverallmonitoringmechanisminrelationtotheimplementationoftheNational}}

DisabilityStrategyinsofarasitrelatestothehealthservices;and

AdvisetheMinisterforHealthandChildrenonprogressintheimplementationoftheDisabilityAct}}

2005withinthehealthservices.

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2020 Vision – The Mental Health Commission Is Viewed as an Efficient Organisation with the Interests of People with Serious Mental Illness or Mental Disorder at the Forefront of All Our Activities

strategic priority six (2009-2012) – MHC as an organisation

TomaintainandenhancetheMentalHealthCommission’ssystemsandprocessestoensure}}

theprovisionofaqualityservicebytheMentalHealthCommission.

Tocontinuetopromoteaculturewithintheorganisationwhichreflectsdeepcommitmentto}}

theCommission’sstatedvalues.

ToensurethattheMentalHealthCommissionisstaffedbywelltrained,competentand}}

committedpeople.

TofosterwidespreadunderstandingoftheroleandfunctionsoftheMentalHealth}}

Commission.

expenditure

Thenon-capitalallocationtotheMentalHealthCommissionfor2009wasg19,012,000.ThisfigurewasrevisedfollowingdiscussionwiththeDepartmentofHealthandChildrenduringtheyearasprojectedlevelsofexpenditureinanumberofareasdidnotproceedasexpected.ThiswasinpartduetotheimpactontheCommissionoftheMoratoriumonrecruitmentinthepublicsector.Theprovisionaloutturnfor2009isg17,950,000.

KeyareasofexpenditureincludedMentalHealthTribunals,staffsalaries,legalfees,officerental,I.Ttechnicalsupportanddevelopmentandresearchprojects.Theaccountsfor2009willbesubmittedtotheComptrollerandAuditorGeneralasperSection47oftheMentalHealthAct2001.TheannualauditedfinancialstatementsoftheMentalHealthCommissionareavailableontheMentalHealthwebsitewww.mhcirl.ie.

audit Committee

TheMentalHealthAuditCommitteemetonfouroccasionsin2009toconductitsbusiness.IssuesaddressedbytheAuditCommitteeincludedthereportontheinternalauditreviewofinternalfinancialcontrols,riskmanagement,corporategovernanceframework,reviewoftheMentalHealthCommission’sproceduresforarrangingMentalHealthTribunalsandexpenditureauthorisationlevels.Recommendationsfromtheabovereportswerereviewedandincorporatedintocurrentprocedures.

Freedom of information

During2009theMentalHealthCommissionreceivednineteenrequestsundertheFreedomofInformationActs(1997and2003).Ofthesefifteenweregranted,threewerewithdrawnandonerequestwasrefused.

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Data protection

SixrequestsforinformationwerereceivedundertheDataProtectionActin2009,fiveofwhichweregrantedandonerequestwaswithdrawn.

information Communication technology

During2009theMentalHealthCommissioncontinuedtodevelopitsexistingICTsystemsinordertoimprovequalityofdataandincreaseefficiencyintheareaofMentalHealthTribunalscheduling.Changeswerealsointroducedthatincreasedsecuritylevelsandenhanced‘easeofuse’tothesecureon-lineservicesavailabletoMentalHealthTribunalPanelmembers.

InrecognitionoftheneedtohavecontingencyplansinplaceintheeventofanuntowardincidenttheMentalHealthCommissionrelocateditsDisasterRecoverysitetoamoresecureandresilientfacility.Allsystemsweresuccessfullytestedfollowingthismove.

AninvitationtotenderwasissuedforaproposalforITManagedServiceswhichresultedinasubsequentchangeofsupplierbasedonresultsoftender.TheCommissionsprojecttoreplaceoutofwarrantyserversandreplacethemwithavirtualisedenvironmentin2009hasentereditsfinalstage.

TheCommissionhasutilisedthenationalprocurementnetworktosourceequipmentthroughtheICTframeworkduringtheyear.

Health & safety

TheMentalHealthCommissionhasreviewedandupdateditsHealthandSafetystatement.MeetingsareheldregularlywithstaffsafetyrepresentativesandindividualshavebeensupportedinundertakingtraininginHealthandSafetymattersincludingOccupationalFirstAidtraining.

PersonalEvacuationEgressPlans(PEEP)aremadeavailabletostaff;}}

ErgonomicworkstationassessmentsareavailabletoallstaffasareVDUeyesighttestandeyetests;}}

Manualhandlingtrainingand}} EmergencyEvacuationproceduresarecarriedoutonaregularbasisandstafffeedbackisobtainedtomeasureeffectiveness.

TheMentalHealthCommissionalsohasanumberofproactivemeasuresinplacetoprotectstaffhealthandwellbeingsuchasseasonalFluvaccinationandvaccinationagainsttheH1N1virus.InadditionoccupationalFirstAidtrainingcarriedoutduring2009hasraisedtheawarenessofHealthandSafetyissuesintheworkplace.

staff Development and training

InlinewithitsstrategicplantheMentalHealthCommissioncontinuestosupportstaffandensuremaximumstaffengagementbysupportingstafftraininganddevelopmentinareasthatarerelatedtotheirworkandencouraginglearningandprofessionaldevelopment.

TheStudyAssistanceSchemeappliesincaseswheretheneedtocompleteacourseinpart-timestudyhasbeenidentifiedasnecessarytoenabletheindividualtoincreaseeffectivenessintheirjoborincreasetheirpotentialforfuturedevelopment.

Thepersonaldevelopmentandtrainingplans,developedunderthePerformanceManagementandDevelopmentSystem,aretheprimarymechanismforconsideringtrainingfundingrequests.In200937.5%ofCommissionstaffreceivedsomeassistanceintheirstudies.

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support for staff with Disabilities

TheMentalHealthCommissioniscommittedtoprovidingapositiveworkingenvironmentand,inlinewithequalitylegislation,promotesequalityofopportunityforallstaffoftheCommission.AcensusonthenumberofstaffwithadisabilityemployedbytheCommissionwasundertakenin2009.Thesurveywasbasedonself-disclosureandallstaffmemberswererequestedtoparticipate.TheDepartment’sDisabilityMonitoringCommitteeco-ordinatethesurveyresultsinrespectofthepublicbodiesundertheaegisoftheDepartmentandreporteddirectlytotheNationalDisabilityAuthority(NDA).ThecensusresultswereincludedinareportpublishedbytheNDA.

WhennecessarytheCommissionhasprovidedspecialistequipmentand/ormeasurestostaffthatrequireassistancetoperformtheirduties.ItisthepolicyoftheMentalHealthCommissiontoensurethatrelevantaccessibilityrequirementsforpeoplewithdisabilitiesareincludedinallstagesofthetenderingprocess.

UndertheDisabilityAct2005,theCommissionisrequiredtohaveinplaceAccessOfficerstoprovideassistanceandguidanceforpeoplewithdisabilitiesinaccessingservicesandproceduresinrelationtothemakingandinvestigationofcomplaintsfrompeoplewithdisabilities.AccessOfficertrainingwascarriedoutin2009.

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Mental HealtH CoMMission

annual RepoRt 2009

including the Report of the inspector of Mental Health services

Part 2

Book 1

national Review of Mental Health services 2009

CHapteR 4

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national Review of Mental Health services 2009

Mental Health act, 2001, section 51:

TheprincipalfunctionsoftheInspectorshallbe:

(a) tovisitandinspecteveryapprovedcentreatleastonceineachyearinwhichthecommencementofthissectionfallsandtovisitandinspectanyotherpremiseswherementalhealthservicesarebeingprovidedasheorshethinksappropriate,and

(b) Ineachyear,aftertheyearinwhichthecommencementofthissectionfalls,tocarryoutareviewofmentalhealthservicesinthestateandtofurnishareportinwritingtotheCommission(TheMentalHealthCommission)on

(i) thequalityofcareandtreatmentgiventopersonsinreceiptofmentalhealthservices,

(ii)whatheorshehasascertainedpursuanttoanyinspectionscarriedoutbyhimorherofapprovedcentresorotherpremiseswherementalhealthservicesarebeingprovided,

(iii) thedegreeandextentofcompliancebyapprovedcentreswithanycodeofpracticepreparedbytheCommissionundersection33(3)(e),and

(iv) suchothermattersasheorsheconsidersappropriatetoreportonarisingfromhisorherreview.

1. introduction

ThisisthesixthreportoftheInspectorateofMentalHealthServicesasestablishedundertheMentalHealthAct,2001,andthethirdyearinwhichapprovedcentreswereinspectedagainsttherules,regulationsandcodesofpractice.

2009wasayearinwhichtherewaslimitedchangeofapositivenatureontheground.Nomajorimprovementsinthequalityofcareandtreatmentwerediscernedonasystemicbasis,althoughtherewereindividualexamplesofimprovements.Overall,approvedcentresappearedtounderstandandtohavecometotermswiththerealityofabidingbytherules,regulationsandcodesofpracticeandthiswasreflectedinimprovedcompliance.Disappointingly,though,“slippage”wasnotedinanumberofcentreswherecompliancehadpreviouslybeenachieved.

Discerningchangesinthequalityofcareandtreatmentonanationalbasisisdifficultonayearonyearcomparison.TheNationalMentalHealthServicesmightbecomparedtoarustyoldtanker,thechangeindirectionofwhichmayonlybemeasuredoveralongperiod.Changesmayonlybenoticedindecadesratherthanyears.

And,thereisnodoubtthatwehaveseenimprovementsinthepastdecadewithrespecttonumbersofpatientshospitalised,occupancylevelsinoldpsychiatriccentres,newprofessionalismofmentalhealthstaff,conceptssuchasgovernanceandrecoverygainingcredenceandtheincreasingawarenessofthecentralityoftheserviceuser/patientinthedeliveryofmentalhealthservices.

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2009alsosawanumberofpositive,hopefuldevelopments.Ifevensomeofthishopeisrealised,wemaywellseeinadecade’stimeaNationalMentalHealthServiceofinternationalqualitybasedontheprinciplesofrecoveryandrespectfulofthedignityandhumanrightsofallserviceusers/patients.

2. inspection 2009

TheMentalHealthAct,2001,imposesaminimumstandardontheInspectoratetoinspectallapprovedcentresannually.

Priortotheintroductionoftherules,regulationsandcodesofpracticein2007,theInspectoratehadgonebeyondthisminimumrequirementbyvisitingandinspectingcommunitycentresandmeetingwithcatchmentareamanagementteams.However,theadditionoftheseregulatoryrequirements,onanunphasedbasis,meantthatmuchtimeandeffortwasnowredirectedateducatingandfamiliarisingapprovedcentrestaffwithallaspectsoftheserequirements.

Theinspectionreportsof2007and2008showedadisappointinglevelofcomplianceandunderstandingoftheprinciplesbehindtherequirementsandofthelogisticalaspects.In2009,inanefforttofurthereducatecentres,self-assessmentformsweresenttoeachcentre.Theseself-assessmentswerethencomparedwithInspectoratefindingsindiscussionsfollowingeachinspection.

Additionally,wehadnotedinpreviousyears,theexpresseddisappointmentofcentresat“allornothing”compliancescores.Forthisyear’sinspection,wedeviseda4-pointscaleofcompliance.Centresreportedsatisfactionwiththismeasureasitallowedthemtohaveprogressmeasuredandcredited.

Itissomewhatironicthatwhilethe“goldstandard”ofmentalhealthserviceisonebasedprimarilyinthecommunity,theInspectoratewasspendingmostofitstimefocusingonapprovedcentres.However,itisinapprovedcentreswherethehumanrightsofcommittedpatientsmaybeatriskwithrespecttoautonomy,dignity,libertyandbodilyintegrity.

InordertoreflecttheInspectorate’sencouragementofcommunity-basedmentalhealthservices,wealsoinspectedanumberofcommunityservices.

ThefollowingisalistingofengagementswithservicesoutsideofApprovedCentreinspections:

1. 32catchmentareamanagementmeetings(including1meetingheldwiththeSligo/Leitrimservicesbyvideolink).Attendeesincludedclinicalandadministrativemanagementaswellasrepresentativesofallclinicaldisciplinesandlocalserviceuser/patientadvocates;

2. Inspectionoftendayhospitalschosenonaregionalbasisandthenatrandom;

3. Inspectionofthirteen24-hourresidenceschosenataregionallevelandthenatrandom;

4. CloverhillPrisonMentalHealthService-PrisonInreachCourtLiaisonService(PICLS);

5. Surveyofhomelessmentalhealthservices;

6. NationalmeetingofChildandAdolescentMentalHealthServices(CAMHS)—organisedandfacilitatedbytheInspectorate;

7. NationalmeetingofMentalHealthServicesforPersonswithanIntellectualDisability(MHID)—organisedandfacilitatedbytheInspectorate;

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8. Anumberofapprovedcentresreceivedmorethanoneinspectionduring2009(includinganighttimevisittoClonmel).Thisoccurredwhenareasofparticularconcernwerenotedduringthefirstinspection;

St.Luke’sHospital,Clonmel—2additionalinspections}}

St.Michael’s,Clonmel—2additionalinspections}}

CappahardLodge—1additionalinspection}}

CentralMentalHospital—1additionalinspection}}

St.Ita’sHospital—1additionalinspection}}

9. AnumberofcommunitymentalhealthserviceswerevisitedandtheInspectoratemetwithstaffonaninformalbasistogarnervaluablebackgroundinformation;

10.Self-assessmentsweresoughtfromCAMHSandMHIDservices.

3. encouraging Developments in 2009

3.1 Wewelcometheappointment of a HSE Assistant National DirectorwithresponsibilityfortheimplementationofA Vision for Change.WhilethejobdescriptionfallsshortofpreviouscallsforaNationalDirectoratewithstrongexecutiveandbudgetarypowers,nevertheless,weanticipatethatanumberofreformscanstillbeachieved.Themosturgentofthesereformsare:

Theestablishmentofaprimarilycommunity-basedservice;}}

Theequalisationofresourcesacrossregions;}}

Theimprovementofinformationsystemssotheperformancedatacanbecollectedand}}

comparedacrossregions;

Theimprovementofclinicalandfinancialgovernance;}}

Measurementofqualityoutcomes.}}

3.2 The establishment within the HSE of a Directorate of Clinical Care and Quality.ItisanticipatedthatMentalHealthServiceswillbeanintegralpartofthedeliberationsofthisDirectoratewhoseinitialaimistoauditservicesagainstpracticeguidelinesonanationalbasis.

3.3 The response of the HSE and local management to the Section 55 Inquiry Report into the quality of care and treatment at St. Luke’s and St. Michael’s Hospitals, Clonmel.

Alocalprojectteam,professionallymentored,wasestablishedaswellasanadvisoryteamofoutsidespecialists.Arigorous,project-managed,time-linespecifiedandaction-orientedscheduleofimprovementswasdrawnup.

ThisworkwasfacilitatedandmonitoredduringdiscussionswithrepresentativesoftheInspectorateandtheCommissionoveraseriesoffourmeetingsin2009.

Asaresult,threeinspectionsoftheClonmelapprovedcentresin2009revealsignificantand,sofar,sustainedimprovementsinadherencetorules,regulationsandcodesofpractice.

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Themannerandcontentofthisprojectcouldwellserveasamodelforotherserviceswishingtomovetoamorepatient-centred,community-focusedandmodernculture.

3.4 2009sawtheappointment of 14 “Executive Clinical Directors” (ECD’s),13ofwhomwillhaveclinicalresponsibilityfor“supercatchments”ofapproximately320,000andoneofwhomistheNationalExecutiveClinicalDirectorforForensicMentalHealthServices.Thehopeisthatwiththisarrangement,serviceswithinthenowenlarged“supercatchment”canberationalisedandappropriate,specialisedservicesprovided.TheECD’swillworkcloselywiththeAssistantNationalDirectorandregionaldirectorstoimplementperformanceandqualityimprovementmeasures.Hopefully,theresultwillbesustainedadherencetohighstandardsandlessvariationinclinicalpractice.

3.5 HSE transformation

TheintegrationofformerhospitalandPrimaryCommunityandContinuingCare(PCCC)divisionsshouldhavepositiveimplicationsformentalhealthservices.The2008Inspector’sReportwasconcernedatthe“lumping”ofmentalhealthservicesintoprimarycareandcommunityservices.During2009,wesawmanyexamplesof“raidingofthemonasteries”withrespecttoleakageofmentalhealthresourcestootherservices.Concernwasalsoexpressedattheperceptionthatmentalhealthservicescouldbealmostexclusivelydeliveredataprimarycarelevel.

Itistobehopedthat,inthenewintegratedsystem,especiallywiththeinfluenceofanAssistantNationalDirectorforMentalHealth,theseconcernswillbeaddressedandamorecoherentandtransparentfundingstreamformentalhealthserviceswillbeestablished.

3.6 Anotherpositivesignistheincreasinglyfrequentservice-user reportsofnursingstaffincreasinglyespousingandpracticingtheprinciplesofrecoveryandpatient-centeredness.Weareawarethattheseareasareincreasinglycentralinundergraduatenursingtraining.Theprinciplesappeartobetakingholdincentresthroughoutthecountry.

3.7 WewelcomethesurveyconductedbytheNationalServiceUserExecutiveofover500serviceusersoftheirviewsonvariousaspectsofthementalhealthservices.Thegrowthoftheserviceuserandadvocacymovementsisencouragingandshouldhelptodriveimprovement.

3.8 2009alsosawthepublicationofthefirst audit of HSE Child and Adolescent Mental Health Services.TheauditwasameasureofactivitylevelsinservicesthroughoutthecountryforthemonthofNovember2007andprovideda“snapshot”ofpracticeindomainssuchaswaitinglists,hospitalisationrates,ageprofilesanddiagnosticcategories.

WeareawarethatanotherauditwasconductedinNovember2009andwelookforwardtotheincreasingsophisticationandusefulnessofthisdevelopment.

3.9 Wewelcometherecent budgetary provisionthatmoneyfromthesaleofpsychiatriclandswillbere-investedintothemodernisationofmentalhealthservices.Althoughthevalueofsuchpropertyhasreducedinrecenttimes,soalsowillthecostofacquiringalternativepropertyforcommunitynursingunitsandcommunitymentalhealthcentres.

3.10 Wehavebeenencouragedbytheattitudinal changeofapprovedcentrestaffwhohaveengagedmeaningfullywiththeInspectoratearoundtheachievementofcompliance,inparticularintheareaofindividualcareplanning.

3.11 Theroll-outofnew beds for childreninCork,GalwayandDublinandtheprovisionforcommunityteamsdeservescredit.Toobtainmaximumbenefitfromthesebeds,nationalcoordinationisvitallyimportant.

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3.12 InpreviousInspectorateReports,muchemphasiswaslaidontheimportanceofawide-spreadsystemofinformationtechnology.WearepleasedtoseethattheWISDOMpilotinCo.Donegalisnearingcompletionandhopefullynowamodernefficientsystemcanbeputinplaceacrossthecountry.

3.13 Anotherinterestingdevelopmentin2009hasbeenthecomingtogetherofaconsortium of independent mental health service providersofferingtheirservicesandassistancetotheHSEintheimplementationofA Vision for Change.Inthesestraitenedfinancialtimes,itmightbeappropriatefortheHSEtoenterintodialoguewiththisgroupwithrespecttotheprovisionofservicesformorespecialisedareassuchaseatingdisorder,borderlinepersonalitydisorder,securecareandforensicservicesfortheintellectuallydisabled.

4. areas of Concern

4.1 Buildings –Whilethenumberofpeopleresidinginold,unsuitable,dilapidatedbuildingshascontinuedtoreduce,thefactthatvulnerablepeoplestillresideintheseconditionsisdeplorable.

In2008,theInspectorateencouragedtheMentalHealthCommissiontoseekproject-managed,time-linedspecified,action-orientedandcontinuouslyupdatedplansfortheclosureoftheolderbuildingsandtheirreplacementbyappropriatealternativeaccommodation.TheCommissionsoughtsuchplansandthemajorityofthosereceivedweredisappointingintheirlackofspecificity.

Whatever(weak)justificationcanbemadeformaintaininginunsuitablesettingsthoseindividualswhohavebeenresidingonalong-termbasisintheseinstitutionsandhaveacquiredadegreeoffamiliaritywiththeirsurroundingsregardingthemas“home”,therecanbenojustificationwhatsoeverinadmittingforthefirsttimeanindividualinacutecrisistosuchsurroundings.

Afirststeptotheclosureofthesetypesofbuildingsmaybetoceasenewacuteadmissions.TheInspectoratehaverecommendedtotheCommissionthatby01January2011,allsuchacuteadmissionsshouldceasetoSt.Ita’sHospital,St.Brendan’sHospitalandSt.Senan’sHospital.

Whereasthekeyingredientintheconceptofrecoveryistheencouragementofhope,admissiontotheseunitsismoreakintotheabandonmentofhopeasdescribedbyItalianpoetDante.

4.2 Staffing–Itisestimatedthatapproximately10%ofpsychiatricnursingstaffhaveleftthementalhealthservicesin2009.Thisprecipitousdeclineinnumbersassociatedwithdelaysinrecruitinghealthandsocialcareprofessionalsadverselyimpactsonthedeliveryofhighqualitycareandtreatment.Unfortunatelyandironically,whencutsaremade,itistheprogressivecommunityserviceswhichareculled,thuscausingreversiontoamorecustodialformofmentalhealthservice.

Multidisciplinarycommunitymentalhealthteamsarestilldeficientinnumbersandwheretheyexist,instaffing.

4.3 Rules, Regulations and Codes of Practice–Whilesomeimprovementshavebeennoted,thelevelofcomplianceoverall,afterthreeyears,isstilldisappointing.OnestaffmemberreportedtotheInspectorate,“We’dbedoingwellifitwasn’tfortheregulations…”

ItisnowtimethatanAssistantDirectorofNursing(ADON)orotherseniorprofessionalbeappointedComplianceOfficerineachapprovedcentre.Thisneednotbeafull-timeposition,butsuchanofficerwouldbethepointpersonineachcentreandwouldhaveresponsibilityforensuringcompliancewithallstatutoryrequirements.

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ComplianceOfficersofallapprovedcentreswouldbeinapositiontoliaisewitheachothertostreamlineandcoordinaterequiredpoliciesobviatingtheneedformuchresource-sappinglast-minutepanicandchaos.

Inaddition,becauseoftheslippagenoted,thereisaneedforongoingtrainingandre-trainingintheprovisionsoftheMentalHealthAct,2001,whichmightbeafurtherroleforComplianceOfficers.

4.4 Inconsistencies of Mission and Service Delivery–Againin2009,widevariationswerenotedacrossthecountry.

Thereisanurgentneedforprofessionalbodiesofallclinicalcategoriestoestablishnormsandguidelinesforpractice.These,inassociationwithstricteroperationalstandardsaselaboratedbytheExecutiveClinicalDirectorGroup,shouldreducevariationwhichhasbeencalled“theenemyofquality”.

Often,problemswithexcessiveadmissionstoapprovedcentresariseearlierinthepatientcarepathwayatoutpatientclinicspopulatedbymanywithminormentalillnesswhichshouldbedealtwithatprimarycarelevel.Inaddition,manydayhospitalsfunctionasdrop-inordaycentresanddonotdealwithanappropriatelevelofacuity.Thesemattersneedtobeaddressedurgently.

4.5 Governance –Governancehasbeendefinedasasystemofaccountabilityensuringpatientsafety,highqualityofpatientexperienceandhighqualityofcareandtreatment.Governanceatitsessencemaybedescribedasethicalpracticewheretheinterestsofthepatientareplacedaboveanyother.

Intermsofpatientsafety,whileincidentrecordingtakesplace,itisnotclearthatsufficientaggregationormonitoringofpatternstakesplaceatmanagementlevel.

Qualityofpatientexperienceisonlyrarelysolicitedandfewsystematicmeasuresareinplace.

Qualitymeasurementandassurancearestillfar-offrealities.

4.6 Wearestillconcernedatthecontinuing inappropriate placement of individuals with intellectual disability(ID)inlargeapprovedcentreswithoutaccesstospecialistintellectualdisabilitymentalhealthservices.

Indeed,onanationallevel,thefundingofIDMentalHealthServices“bydefault”andapparently“ex-gratia”bygenericIDservices,appearstobeacommonpractice.Thereisaneedtoclarify,onanationalbasis,whatspecificaspectsofcarefortheintellectuallydisabledconstituteMentalHealthServicesandthentoadequatelyring-fenceresourcetheseservicespreventingduplication.

4.7 CAMHS–WeareconcernedbytheoccupationofscarceCAMHSbedsbyindividualswithnodiagnosablementaldisorderoftenwithsocialproblemswith“nowhereelsetogo”.Thisisinappropriateandpotentiallydamagingtotheseindividualsaswellasdeprivingothersofneededbeds.

Thepracticeofadmittingchildrentoadultapprovedcentrescontinues.RecentHSECAMHSaudithasshown,interestingly,thatalargepercentageoftheseadmissionsarefor16and17-yearolds,anagegroupwithatraditionalpatternofshort-termcrisisadmissionstoadultunits.

Notwithstandingthetraditionalexpertiseofgeneraladultpsychiatristsindealingwiththe16and17-yearoldagegroup,itisstillinappropriatethattheseindividualsbeadmittedtogeneraladultapprovedcentresevenonacrisisbasis.

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WehavebeeninformedbythoseCAMHSserviceswhichhavetakenonthecareof16and17-yearolds,thattheirwaitinglistsforthemoretraditionalchildandadolescentmentalillnesseshaveincreasedsuchthatthemajorityoftheirworknowisindealingwithcrisesintheolderadolescentagegroup.

Inaddition,anumberofCAMHSserviceshaveidentifiedalackoftrainingindealingwiththeproblemsassociatedwiththe16and17-yearoldagegroup.

InthelightofrecentsuggestionsfromProfessorPatrickMcGorry,UniversityofMelbourne,thatservicesbeorganisedaroundthe14-25-yearoldagegroup,itisnowtimeforthegeneraladultandCAMHSservicestositdownandcreativelyresolvethisissue.

4.8 Resource Allocation–WearegratefulforfiguresprovidedbytheAssistantNationalDirectorforMentalHealthServicesshowingthegrossimbalanceintheregionalallocationsoffunds.Evenallowingforthenewaggregationsin“supercatchments”,thereisstillawidediscrepancyinfundallocation.ThewholefundingissueformentalhealthserviceswascriticisedinarecentIndeconReportandisbyzantine,opaqueandalmostincomprehensible.

Ifthetimehascomeforclarityofmissionwithrespecttothedeliveryofservices,thetimemustsurelyalsohavecomeforclarityoffunding.

4.9 Community Detention–AlthoughtheMentalHealthAct,2001,hasmadenoprovisionforcommittalordersrelatingtoindividualsresidinginthecommunity,thispracticeisbeingfollowedonadefactobasisbyanumberofservices.

UndertheMentalTreatmentAct,1945,apatientcouldbedischarged“ontrial”andcontinueunderadetentionorderforupto90days.

TheMentalHealthAct,2001,allowspatientsunderdetentionorderstobeallowedintothecommunitywithspecificwrittenconditions.Thepurposeofthisprovisionwouldappeartohavebeentograduallyre-integratethepatientintothecommunityonacontrolledbasisfacilitatingappropriatedischarge.

However,itappearsthatcertainConsultantPsychiatrists,attheendoftheperiodofdetentionundertheorder,arerenewingtheorderwhilethepatientisstillinthecommunity.Furthermore,itisknownthatsomeTribunalshaveaffirmedtheseorders.

Theneteffectisthatpatients,subjectedtothisstratagem,canbereturnedtothehospitalwithoutthesameproceduralsafeguardswhichwouldhaveappliediftheyhadbeendischarged.Thishassignificantimplicationsforthelibertyinterestsoftheindividual.

Whileotherjurisdictionshavelegalprovisionforsuchcommunityorders,thereis,bynomeans,widespreadagreementthatthesemeasuresimprovethequalityofcommunitycare.

IfsuchmeasuresaretobeintroducedinIreland,theyshouldbepropertydebatedandtheevidenceforandagainstformallyweighed.

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5. other important issues impacting on Quality of Care and treatment

5.1 Recovery – In A Vision for Change,theethosofrecoverywastoimbueallaspectsofplanningandpracticewithrespecttomentalhealthservices.

AlthoughtheconceptwasfirstmostpowerfullyenunciatedbyBillAnthonyin1993,mentalhealthpractitionersstillappeartohaveanimperfectunderstandingorgraspoftheconceptasitappliesinoperationaltermsintheirdailywork.

ArecentSainsburyCentrepublication,“Making Recovery a Reality”1,(containedintheMentalHealthCommissioncomprehensiveinformationpackonrecovery2),aswellasprovidinganexcellentoverviewofthetopic,graspsthenettleofconsiderationof“obstaclestoitsimplementation”.Thereportrecommendsarecovery-oriented“policyimplementationguidetoprovidesimpleguidelinesforpracticeatanindividualteamandservicelevel”.ThisisamatterthatmightbeaddressedbytheExecutiveClinicalDirectorGroupandbytheAssistantNationalDirectorforMentalHealthServices.

BillAnthonyhasgiventhefollowingdefinitionofrecovery:

“It is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness…”3

Whileindividualpractitioners,almostuniversallyatastartofacareerinthementalhealthservices,wouldhavenodifficultyinespousingthesevalues,oftenthesystemofprocessingmentalillnesstendstoovercomethisearlyidealismandenthusiasm.

Itisencouraging,however,thatasignificantnumberofpocketsexistwithintheIrishMentalHealthServiceswherethesevaluesarepracticedonadailybasisandgroupsoflike-mindedidealisticindividualshaveestablishedthecultureofrecovery.Itissignificantthatthesetypesofservicestendtohaveloweradmissionrates,lessrelapses,moreconnectionswithcommunityservices,moreemphasisonserviceuser/patientandfamily/carerinvolvementinservicesandmorefocusonvocationalandsocialissues.

Alsoofsignificance,isthecurrentemphasisinundergraduatenursetrainingontheseprinciplesnowbeginningtobereflectedinpatientexperiences.

5.2 Role of the Pharmaceutical Industry–Intherecentlypublished7thEditionoftheGuidetoProfessionalConductandEthicsforMedicalPractitioners4,theMedicalCouncilstates:

“You are advised not to accept gifts (including hospitality) from pharmaceutical, medical devices or other commercial enterprises....You should be aware that even low-value promotional materials are offered by commercial enterprises with the intention of influencing prescribing and treatment decisions”.

1 Shepherd,G.,Boardman,J.,Slade,M.,MakingRecoveryaReality.2 RecoveryApproachwithintheMentalHealthservices–TranslatingPrinciplesintoPractice,2008.3 Anthony,WA,1993,RecoveryfromMentalIllness:TheGuidingVisionoftheMentalHealthServiceSysteminthe1990’s.

Psychosocial Rehabilitation Journal,16,11-23.4 http://www.medicalcouncil.ie/_fileupload/misc/171109%20Final%20Version%20Ethics%20Guide%20Update%20For%20

Printer.pdf

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WenotethattheMedicalCouncilalsointendstodevelopfurthercomprehensiveguidelinesontherelationshipbetweendoctorsandcommercialenterprisesandwewelcomethisapproach.

Inaddition,wehavereceivedfromSt.Patrick’sUniversityHospitalacopyofapolicydealingwiththerelationshipofclinicalstaffandthepharmaceuticalindustry.Inpreparingthepolicy,researchwasundertakenontheliteraturereflectinginternationalbestpractice.

Thepolicylaysdownforallclinicalstafftherequirementofmaintainingalogofallpharmaceuticalindustry(Pharma)supportreceivedforContinualProfessionalDevelopment(CPD),researchorpaymentforattendanceatadvisorymeetings.Attendanceatnon-CPDPharma-sponsoredmeetingsisprohibited.Clinicalstaffarenotpermittedtoreceivegiftsortohavepapersghost-writtenbytheindustry.Conferencesundertheauspicesofthehospitaldonotacceptindustryfunding.

Thepurposeofthesepolicyrequirementsistopreventtheperceptionbyserviceuser/patientsorcarersofanypotentialconflictofinterestbetweentheprimaryobjectiveofpatientcareandanyobligationtouseaspecificindustry’sproduct.

Itiswellestablishedthattrustandconfidenceoftheserviceuser/patientinthetreatmentteamisparamountinestablishingabeneficialtherapeuticrelationship.Wherethistrustcanbeputindoubtandwhereopportunitiesexisttoeliminatealldoubt,theseshouldbeseized.St.Patrick’sUniversityHospitalshouldbecongratulatedonthisprogressivepolicyanditisrecommendedthatothermentalhealthservicesalsoaddressthematter.

Theaboveisnottosuggestthatthepharmaceuticalindustryingeneraldoesnotmakeavaluablecontributiontothedeliveryofmentalhealthservices.Medicationisregarded,inthemostseriousmentalillnesses,asanecessary,thoughnotsufficient,conditionfortreatmentandrecovery.

TheroleofPharmainsupportingCPDofcliniciansisofvalue.However,itmightbepreferableifcontributionsofdifferentcompanieswerepooledandalessdirectconnectionbetweentheCPDandaspecificcompanywithaspecificdrugwereestablished.ThisisamatterwhichmightbefurtherdiscussedbytheprofessionalbodiesandPharma.

5.3 “Friends”–Wehavebeenimpressedbytheworkofvolunteersbelongingtogroupssuchasthe“Friends”atNewcastleHospital,TheSt.Joseph’sAssociationfortheIntellectuallyDisabled,Portraneandothersimilargroups.Thatlocalvolunteerstakeaninterestinthelocalapprovedcentre,notjustprovidesincreasedcomfortforpatients,butisalsoimportantinreducingthelocalstigmaoftheapprovedcentreandprovidingsomedegreeofinformaloversightorinspectionofthecentre.Historically,almostallmentalhealthresidentialcentresreceivedvisitingcommitteesthroughtheformerhealthboardorlocalhealthauthoritysystem.Managementatthecentreswereobligedtopresentreportstothevisitingcommittee.Thiswasanimportantdisciplineandopportunityformanagementtoaddressgovernanceissues.

Withthedisbandmentofthehealthboardsandthespecialhospitalprogrammecommitteesceasingtovisitcentres,avaluableopportunityhasbeenlost.

ItisrecommendedthattheofficeoftheAssistantNationalDirectorforMentalHealthServicesconsiderthisissuewithaviewtore-implementingsomeformofvisiting/oversightcommitteecomprisedofHSEmanagementstaffandlocalvolunteersandrepresentatives.

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6. Recommendations

6.1 TheroleoftheAssistantNationalDirectorforMentalHealthServicesshouldbeaugmentedtothatofaDirectoratewithexecutiveandbudgetarypowers.

6.2 TheExecutiveClinicalDirectorGroupalongwiththeMentalHealthServiceDirectorateandtheDirectorofClinicalCareandQualityshouldagreeanumberofrobustqualityoutcomestofacilitatemeaningfulcomparisonsbetween“supercatchment”areas.

6.3 Tofacilitatepropergovernance,informationsystemsshouldbeinplaceandrelevantperformanceandoutcomedatashouldbecollected.

6.4 Needs-basedresourcesshouldbeequalisedacrossregions.

6.5 Acoherentandtransparentsystemforthefundingofmentalhealthservicesshouldbeestablished.

6.6 AsystemofongoingtrainingintheprinciplesofrecoveryandthoseunderpinningtheMentalHealthAct,2001,alongwithlogisticalaspectsofimplementationoftheMentalHealthAct,2001,shouldbeestablishedforallprofessionalsinvolvedinpatientcareandtreatment.

6.7 ChildandAdolescentMentalHealthServicesshouldbecoordinatedatanationallevel.

6.8 MentalHealthServicesforPersonswithanIntellectualDisabilityshouldbecoordinatedatanationallevelandhavering-fencedfunding.

6.9 Intellectuallydisabledpatientsinapprovedcentresshouldbeprovidedwithspecialistmentalhealthcareandtreatment.

6.10 Fundingfromthesaleofpsychiatriclandsshouldbeprotectedandredirectedtowardstheprovisionofcommunitynursingunitsandcommunitymentalhealthcentres.

6.11 Communitymentalhealthcentresshouldbeadequatelystaffedwithmultidisciplinaryteams.

6.12 Creativewaysofinvolvingtheindependent/privatesectorinpublicsectorprojectsshouldbeexplored.

6.13 Patientsshouldnolongerbehousedinunsuitablebuildings.

6.14 Asafirststep,nonewacuteadmissionsshouldbemadetoSt.Ita’sHospital,St.Brendan’sHospitalorSt.Senan’sHospitalfrom01January2011.

6.15 Deploymentofstaffshouldbemoreflexiblethanatpresent.

6.16 EachapprovedcentreshouldappointaComplianceOfficer.

6.17 Complianceofficersshouldmeetonanationalbasistocoordinateandstreamlinepolicies.

6.18 TheECDGroupshouldexamineclinicalpracticeswithrespecttopriorities,communitisationofservices,recoveryandproperdemarcationandcoordinationbetweenprimaryandsecondarymentalhealthservices.

6.19 Childrenshouldnotbeadmittedtoadultunits.

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6.20 Themanagementof16and17-yearoldpatientsshouldbenegotiatedbetweentheCAMHSandthegeneraladultservices.

6.21 Theissueofdefactocommunityordersshouldbedebatedtakingintoaccounthumanrightsconcerns.

6.22 Therelationshipofclinicalstaffandthepharmaceuticalindustryshouldbemonitoredbyservicesandappropriatepoliciesputinplace.

6.23 Thepracticeofvisitingcommitteestoapprovedcentresshouldbere-established.

6.24 Arecovery-orientedpolicyimplementationguideshouldbeestablishedatnationallevel.

7.Conclusions

7.1 Ireland’sMentalHealthServiceshaveshownlimitedimprovementover2009.

7.2 However,takingalonger-termview,serviceshaveimprovedoverthepreviousdecade.

7.3 Improvementshaveoccurredinthegeneralareaofattitudesandacceptanceoftheneedforregulationandgovernance.

7.4 Anumberofsignificantareasofconcernstillexistwithrespecttobuildings,staffing,resourceinequities,residualcustodialattitudesandinthetreatmentofchildrenandthosewithintellectualdisability.

7.5 CauseforoptimismexistsintheappointmentofaNationalDirectorforMentalHealthServicesandtheestablishmentofanumberofHSEstructureswhichwillallowtheintroductionofmuch-neededgovernanceofourmentalhealthservices.

7.6 Althoughanantiquatedsystemcontinuestooverpowertheidealisationofmanyindividuals,pocketsofrebelliousnessintermsofembracingtheprinciplesofrecoveryandpatient-centerednessprevailincertainquartersandshouldbeencouraged.

Themajortaskofcompletionofthe2009InspectorofMentalHealthServicesReportwasonlyachievedbythededicationandcommitmentofallmembersoftheInspectorateteam,inspectingandadministrative,whosecontributionisgreatlyappreciated.Thanksarealsoduetoallstaffmembersofmentalhealthservicesbothclinicalandadministrativewithoutwhosecooperationthisreportwouldnothavebeenachieved.

ParticularthanksareduetoColetteRyan,SeniorAdministratoroftheInspectorate.

Dr. patrick DevittInspectorofMentalHealthServices

appenDiCes

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appendix 1: psychiatry of old age: Resource and activity Data 2007 (irish association of Consultants in psychiatry of old age)i) Resource data per service Jan – Dec 2007

service Date

est’d

pop≥65 Con nCHD aCno CMHn sec other1 acute

psych

Beds

Day Hosp l/s Beds

sR sHo psych non

psych

NAHBArea6&7 1989 32,500 3.5 1 2 1(DON) 3 2 1 6 √ 33 67

SWAHBAreas3&½4 1991 20,228 2.5 1 2 0.5 2 2 3 9 √ X X

ECAHBArea1&2 1996 30,000 2 1 3 1 6 3 5 10 √ X 67

MWHBLimerick 1996 19,000 2 1 1 X 2 2 1.5 6 1day/wk X 21

SWAHBArea5&½of4 1998 18,500 1.5 1 1 0.5 2 1.5 7 X √ X X

MHBLaois-Offaly 1999 14,036 11.5 1 1 1 4.2 2.2 2 6 50 14

NEHBCavan-Monaghan 2000 14,289 1 1 1 1 8 2 6 7 1 26 X

SEHBWaterford 2000 14,800 1 1 1 0.3 2 1 2.75 6 X 23 X

SEHBS.Tipperary 2000 10,200 1 X 1 0.2 2 1 1 4 X 23 X

MWHBClare 2000 13,500 1 X 1 1 2 1 1 5 X 34 X

SEHBWexford 2001 15,000 1 X 1 X 4 1 1.5 8 X 14 X

MHBLf/Wm 2001 13,000 1.5 X 2 0.5 4 1.5 1 Access √ 40 X

SHBSouthLee 2001 18,500 1 X 2 PT 3 1 3.6 Access X X X

NWHBDonegal 2002 17,300 1 X 1 1 5 1.5 2.5 Access X X X

NWHBSligo/Leitrim 2002 14,600 1 1 1 1 4 1.5 1 4 √ X X

NAHBArea8 2002 18,600 2 1 3 1 3.5 1.5 3 7 X 56 55

SEHBKilkenny 2002 14,000 1 X 1 X 2 1 1 Access X 24 X

WHBMayo 2002 17,000 1 1 1 0.5 3 1.2 3 5 X 14 X

NEHBMeath 2003 13,000 1 1 1 X 2 1 1 Access X X X

GalwayWest 2004 25,500 1 1 0.5 X 1 0.5 1.25 4 X X X

Louth2 2007 14,200 1 X 1 X 1 1 X X X X X

XResourcesnotprovidedtotheservice.

1Othersincludes:Occupationaltherapy,Socialwork,Psychology,Supportworkers,Behaviourtherapy.

2ServicestartedSeptember2007.

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ii) activity data per service for the year Jan – Dec 2007

service Referrals acute unit/s

admissions

Day Hospital(s) long stay

admissions

(total)

Respite

admissions

CMHn

visits

other services

total DV lV admissions attendances

NAHBAreas6&7 961 655 306 29 110 1578 3 17 3141 Carersgroup

SWAHBAreas3&½4 628 172 456 42 140 2553 5 13 1930 OPD

ECAHBArea1&2 845 600 245 64 71 1025 12 30 4173 -

MWHBLimerick 486 253 233 22 11 209 7 97 1697 -

SWAHBArea5&½of4 487 245 242 X 36 1250 X X 1257 Outreachteam

MHBLaois-Offaly 516 454 62 38 73 838 6 12 3267 Carersgroup

NEHBCavan-Monaghan 439 329 110 23 25 1270 2 0 3828 -

SEHBWaterford 377 225 152 50 X X 7 18 1932 OPD

SEHBS.Tipperary 316 229 87 36 X X 4 0 1255 OPD

MWHBClare 281 19 X X 3 21 860 OPD

SEHBWexford 334 208 126 61 X X 5 0 2704 AnxMnGps

MHBLongford/Westmeath 334 256 78 33 52 1383 0 2 2761

SHBSouthLee X X

NWHBDonegal 590 420 170 22 X X X X 3900 OPD

NWHBSligo/Leitrim 486 306 180 31 63 1254 X X 2700 OPD

NAHBArea8 943 443 500 38 X X 9 29 2508 -

SEHBKilkenny 353 215 138 20 X X 4 0 1860 -

WHBMayo 310 255 55 16 X X 1 0 1506 -

NEHBMeath 212 165 47 5 X X X X 748 -

GalwayWest 212 88 124 7 X X X X 505 OPD

Louth 53 13 40 X X -

XResourcenotavailablesoservicecannotbeprovided.

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appendix 2: individual Care planseán logue, assistant inspector of Mental Health services

introduction

Article15oftheMentalHealthAct2001(ApprovedCentres)Regulations2006(S.I.No.551of2006)placesanobligationontheregisteredproprietorofanapprovedcentreto“ensure that each resident [of the approved centre] has an individual care plan.”TheRegulationsdefinean“individualcareplan”as,

“a documented set of goals developed, regularly reviewed and updated by the resident’s multidisciplinary team, so far as is practicable in consultation with each resident. The individual care plan shall specify the treatment and care required which shall be in accordance with best practice, shall identify necessary resources and shall specify appropriate goals for the resident. For a resident who is a child, his or her individual care plan shall include education requirements. The individual care plan shall be recorded in the one composite set of documentation.”

Compliance with article 15 of the Regulations

CompliancewithArticle15oftheRegulationswasfirstinspectedduringthe2007inspectionprocess.Duringthe2007and2008inspections,approvedcentresweredeemedeithercompliantornotcompliantwithallArticlesoftheRegulations.Figure1below,givesanindicationofthelevelofcomplianceofapprovedcentreswithArticle15followingthe2007inspectionprocess.

Figure 1

Priortothe2008inspectionprocessself-assessmentdocumentationwasforwardedtoallapprovedcentres.Followingreturnoftheseself-assessments,83.6%ofapprovedcentresindicatedcompliancewithArticle15.InordertoassistapprovedcentresandstafftoreachcompliancewithallArticlesoftheRegulations,afour-stageratingscalecomprising:FullyCompliant,SubstantialCompliance,ComplianceInitiatedandNotCompliantwasintroducedintheInspectionprocessofapprovedcentresin2009.Indeterminingcompliance,followingtheinspection,adraftreportwaswrittenwhichwasthenforwardedtotherelevantserviceforfactualcorrection.Followingreceiptoffactualcorrectionsandfollowingediting,reportswerepresentedtotheMentalHealthCommission.Thereportswerethenplacedon

82.3%

Compliant

Not Compliant

2007

17.7%

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theMentalHealthCommission’swebsite.TheMentalHealthCommissionpublishesanannualreportthatincludestheReportoftheInspectorofMentalHealthServices.Therewere66approvedcentresregisteredin2009.64approvedcentreswereinspectedastwohadnotbeendeclaredoperational,thatis,theyhadnotyetadmittedserviceuserstoin-patientbeds.Ofthe64approvedcentresinspected,only31.3%(n=20)werefullycompliantwithArticle15.SeeFig.2.

Figure 2

Followinginspectionsofeveryapprovedcentreoverthreeyears:2007-2009,thelevelofcompliancewiththisArticleisdisappointing.Duringthe2009inspectionprocesstheInspectoratefoundthatdoubt,uncertainty,confusion,lackofmotivationanddisregardforthelawwerefactorsthatimpactedoncomplianceinrelationtothisArticle.Thefollowing,therefore,iswrittenasanaidtothoseapprovedcentresthathaveyettoreachfullcompliancewithArticle15oftheRegulations.Itdoesnotpurporttoofferexpertiseintheareaofcareplanning.

service users: partners in their own Care

A Vision for Change(2006)declaresthat,atanindividuallevel,“the most immediate way that a service user or carer can be involved in mental health care is through the development of their own care plan, in conjunction with a multidisciplinary team.”1OneofthekeyrecommendationsofA Vision for Changeisthat“service users should be partners in their own care. Care plans should reflect the service user’s particular needs, goals and potential and should address community factors that may impede and support recovery.”2Thekeyphraseis“partners in their own care”.Onlytheserviceusercanhavefullknowledgeoftheirpersonalexperiences.Noonecaneverknowanotherperson’sexperiencealthoughmentalhealthprofessionalsoftenactasthoughtheyknowaserviceuserbetterthantheserviceuserknowshimorherself.3Likewise,itisimportanttonotethatmanyserviceusers,particularlyresidentsofoldinstitution-typehospitals,mayexpresssatisfactionwiththeirqualityoflife,butmanymayhaveverylowexpectationsinthisregard.4The Quality Framework – Mental Health Services in Ireland (2007)(QualityFramework),istheMentalHealthCommission’sresponsetothestakeholderconsultationonqualityinmentalhealthservicesentitledQuality in Mental Health – Your Views,whichwaspublishedbytheMentalHealthCommissionin2005.Theme1,Standard1.1oftheQualityFrameworkprovidesthat,“each service user has an individual care and treatment plan that describes the level of support

1 A Vision for Change,p25,3.2.1.2 A Vision for Change,p9.3 Buchanan-Barker,P.andBarker,P.J.(2008)TheTidalCommitments:extendingthevaluebaseofmentalhealthrecovery.Journal

of Psychiatric and Mental Health Nursing15,93-100.4 Wolfe,J.andAssociates,(2009)ReportontheQualityofLifeSurveyofSouthTipperaryMentalHealthServices.Findings4.1.2.

9.4%

31.3%

31.3%

Fully Compliant

Substantial Compliance


Not Compliant

2009

28.1%

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and treatment required in line with his/her needs and is coordinated by a designated member of the multidisciplinary team.”Therearesevenassociatedcriteriawiththisstandard.Itisimportantthatserviceproviders,atalllevels,haveagoodunderstandingandworkingknowledgeoftheQualityFramework.

What is a Care plan?

Apartfromthestatutoryobligation,whenaserviceuserisreceivingtheservicesofanumberofdifferentdisciplinesthereisaneedforacareplan.Theindividualcareplanputsonpapertheneedsandgoalsoftheserviceuserandalsoironsoutorstreamlinesthecarebeingdeliveredbyeachdiscipline.Thus,acareplanmayberegardedasarecovery mapwhichguidestheserviceuserfromapointintheirlifetowardsrecovery.Inturn,eachdisciplinecanseethecareandtreatmentbeingdeliveredbyacolleagueofadifferentdisciplinewhichhastheoverallresultofmakingthecareplanmorestreamlinedandavoidingduplication.

Traditionally,thecareplanhasbeenalmostexclusivelyassociatedwithnursing.Becauseofthestatutoryobligationtohaveanindividualcareplan,thisisnolongerthecase.Thepurposeofanindividualcareplanistoassisttheserviceuser,allprovidersofcareandtreatmentandthefamilymemberorchosenadvocate,whereappropriate,tosteerinthedirectionwhereoptimaloutcomesmaybeattainedfortheserviceuser.

Noplanofcarecanbeundertakenwithoutfirstundergoinganassessmentprocess.Ifassessmentprovesdifficult,foronereasonoranother,followingtheadmissionofaresident(serviceuserwhoisresidentinanapprovedcentre)toanapprovedcentre,apre-assessmentcareplanoremergencycareplanshouldbeformulatedinconjunctionwithanevidence-basedriskassessmenttoensurethehealth,safetyandwell-beingoftheresidentovertheinitial24/72-hourperioduntilamorethoroughassessmentcanbecompleted.Insettingupacareplan,“the needs of each service user should be discussed jointly by the [multidisciplinary] team, in consultation with [service] users and carers, in order to construct a comprehensive care plan. Care plans should be written and agreed between all parties, and include a time frame, goals and aims of the [service] user, the strategies and resources to achieve these outcomes, and clear criteria for assessing outcome and [service] user satisfaction.” 5

the Component stages of a Care plan

(1) assessment – the data collection step

Thekeyworkerassignedtoaresidentshouldcarryoutacompleteandholistic assessmentoftheresident’sneedsinpartnershipwiththeresident.Duringthedevelopmentoftheindividualcareplan,whenitisbeingdiscussedwiththeserviceuserbythekeyworker,thepenmightbeofferedtotheserviceuserasagestureofgenuine empowerment.6Problemsand/orpotentialstrengthsarenowidentified.

(2) planning – the goal setting step to improve outcomes for the service user

Duringthisstage,theresidentandthekeyworkeridentifywaysofovercominganyproblemorproblemsthathavebeenidentified.Foreachproblemidentifiedameasurable goalshouldbeset.Itisimportantthatgoals are realistic.Themethodormethodsbywhichthesegoalsaretobeachievedshouldberecorded,preferablyintheresidents own wordsandnotincomplexprofessionalterminology.

5 A Vision for Change(2006),p.81,9.6.6 Barker,P.andBuchanan-Barker,P.(2005)The Tidal Model: A Guide for Mental Health Professionals.Brunner-Routledge.

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(3) implementation – setting the plans in motion

Goalsaresetoutasameansofovercomingidentifiedproblemsorbuildingonpotentialstrengths.Ifnoproblemcanbeidentifiedthenonemustquestionwhattheserviceusercanhopetogainfromhisorhercontactwiththementalhealthservice.Outcomesaredocumented.Thecareplanningprocessonlyceaseswhentheindividualisnolongerreceivingcareortreatmentfromtheservicewhetherhospitalorcommunitybased.Thecareplanningprocesswillbecontinuedbythecommunitymentalhealthteamifappropriate.

(4) evaluation – analysing the success of the care plan and examining the need for adjustments

Progresstowardsachievingidentifiedgoalsisevaluated.If progress towards achieving desired goals is slow then the care plan can be tweaked accordingly.Ifgoalsareachievedthenin-patientcareandtreatmentmayceaseandcareandtreatmentmaycontinueinthecommunity.Newproblemsthatwerenotapparentmayalsocropupandmayneedtoberesolved.Thisrequirestheentirecareplanprocesstoberepeated.

elements of a Good Care plan

Becauseoneproblemmayabateandawhollydifferentproblemorproblemsmayemerge,careplanningshouldbeanevolvingprocesswhichfacilitatesadaptationandchange.Inotherwords,careplansshouldinvolveahighleveloffluidity.Prescheduledevaluationshouldtakeplacefrequentlyincollaborationwiththeserviceuserandthenecessaryadjustmentsagreed,documentedandsignedbythememberofthemultidisciplinaryteamandtheserviceuser.Incertaincases,unscheduledevaluationwillbenecessarywhenperhapsunforeseencircumstances,forexample,theserviceuserhavingasetbackwhileonleaveathome,mayoccur.Criterion1.1.3oftheQuality Frameworkadvocatesthatthecareandtreatmentplanshouldreflecttheassessedneedsoftheserviceuser,notfromanyoneprofessionalgroupbutfrom the perspective of the multidisciplinary team.Careandtreatmentshouldbedeveloped,implementedandreviewedinatimelymanner,signedbythemultidisciplinaryteammemberwhoistheallocatedkeyworkerandtheserviceuser,andacopy of the care plan kept by the service userunlessthereisadocumentedreasonfornotdoingso.Theresponseoftheserviceusertosupportfromthekeyworkerandinterventionsfromthemultidisciplinaryteamshouldbeevaluated.Progresstowardsmeetingdesiredoutcomesshouldbeclearlydocumented.Anyareaofunmetneedshouldalsobedocumentedintheindividualcareplan.

Benefits of a Care plan

Problemscanbeidentifiedandrealisticgoalscanbesetandachieved.Serviceusersandserviceprovidersbecomemorefocussedonindividualneeds.Serviceusersbecomeinvolvedinthecareplanningprocess,thusfosteringasenseofcommitmentandresponsibilityinachievingtheirpersonalhealthgainandsocialgain.Continuity of careamongtherelevantdisciplinesbecomesmorestreamlined.

Role of the Key Worker

Thekeyworkeris,“the person who co-ordinates the delivery of the individual care and treatment plan. The key worker is responsible for keeping close contact with the resident, family/carer and chosen

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advocate and for advising other members of the multidisciplinary team of changes in the service user’s circumstance.” 7

Thekeyworkerisavitalcoordinatingroleundertakenbyanymemberofthemultidisciplinaryteam.Soimportantisthekeyworkerrolethatitsabsencemayhindercareplanning.The key worker is a source of support for the service user and a link with all other disciplines within the multidisciplinary team.Thekeyworkerisresponsibleforworkingwiththeserviceuser,othermembersofthemultidisciplinaryteamandfamilymemberorchosenadvocatewhereappropriate,inensuringthecoordinationofaneffectiveplanofcare.The role of “key worker” is not a job title but a series of functionstobeundertakentoensuretheeffectivecoordinationofappropriatecareandtreatmentbasedontheindividualneedsoftheserviceuser.Thekeyworkeractsasasinglepointofcontactfortheserviceuserwithwhomtheycanassistinnavigatingtheirwaythroughthementalhealthsystemandengageineffectingrealchoicesandchangetowardsrecovery.The main role of the key worker is to coordinate the delivery of outcomes agreed in the multidisciplinary team review and to ensure that they are recorded in the individual care plan and that they are regularly reviewed.Beinganeffectivekeyworkerinvolvesadegreeofpersonalorganisation.Effectivetimemanagementisaprerequisiteandensuringtheinvolvementandcommitmentofothermembersofthemultidisciplinaryteamisnotalwaysclear-cut.Itcannotbeassumedthatallmembersofthemultidisciplinaryteamwillbeavailableallthetime.Inordertoensurethecoordinationofcareplanningandreview,multidisciplinaryteamswillfindithelpfultoschedulearegulartimeslotforthispurpose.

Conclusion

Thebusinessofanymentalhealthprofessionalisrelativelystraightforward.Mentalhealthcareprofessionalsareinthebusinessofhelpingtheindividualserviceusertoleadamoredignifiedandfulfillinglife.Afullcompliancerateof31.3%nationallyinrespectofArticle15,threeyearsfollowingtheintroductionoftheRegulations,isreflectiveoftheneedforattitudinal,culturalandeducationalchange.TherearemanyhumanresourcesavailablewithineachmentalhealthserviceandaffiliatedthirdleveleducationcentretoputinplaceanindividualcareplantomeettherequirementsoftheRegulations.Theprocessmustalsoinvolvemeaningfulengagementandpartnershipbetweenserviceusers,carersandprofessionals.TheprocessoutlinedclearlyinStandard1.1oftheQuality Frameworkshouldbefollowedthroughout.Having an individual care plan does not necessarily mean having reams of paperwork.Someapprovedcentreshaveachievedfullcomplianceusingoneortwosheetsofpaper.Inconjunctionwiththis,anevidence-basedassessmentandriskassessmentshouldbeused.Fourexamplesofindividualcareplansthatachievedfullcompliancein2009werepostedontheMentalHealthCommissionwebsite.

ThefollowingisalistofthetwentyapprovedcentresthatwerefullycompliantwithArticle15in2009.

CentralMentalHospital,Dundrum

NewcastleHospital,Co.Wicklow

St.Loman’sHospital,Palmerstown

AcutePsychiatricUnit,BantryGeneralHospital

DepartmentofPsychiatry,St.Luke’sHospital,Kilkenny

St.Dympna’sHospital,Carlow

St.Stephen’sHospital,Cork

7 MentalHealthCommission(2009).CodeofPracticeonAdmission,Transfer,andDischargetoandfromanApprovedCentre.

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HighfieldHospital

HampsteadHospital

PalmerstownView,Stewart’sHospital

DepartmentofPsychiatry,OurLady’sHospital,Navan

St.Vincent’sHospital,Fairview

SycamoreUnit,Blanchardstown

AcutePsychiatricUnit,MidwesternRegionalHospital,Ennis

OrchardGrove,Ennis

St.Conal’sHospital,Letterkenny

St.Joseph’sAdolescentIn-patientUnit,St.Vincent’sHospital,Fairview

St.Anne’sChildren’sCentre,Galway

WarrenstownChildandAdolescentIn-patientUnit

St.Luke’sHospital,Clonmel

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appendix 3: overview of 24-Hour nurse-staffed Community Residencesseán logue, assistant inspector of Mental Health services

introduction

Thirteen24-hournurse-staffedcommunityresidences(communityresidences)wereinspectedin2009.Thiswaspartofthecontinuingmonitoringoftheroleandfunctionofthesecommunityresidencesintheprovisionofmentalhealthservicesandisthethirdreportonthistheme.In2005,all127communityresidenceswereinspected.In2007,eachcommunityresidencewasaskedtocompleteaself-assessmentfromwhichdatawascollatedandreported.Finally,in2008,datawasagaincollatedandanalysed.Attheendof2008therewere132residenceswith1,664places.Itwasreportedthatserviceusershadlimitedaccesstorehabilitationteamsindifferentpartsofthecountryandthattheskillmixonteamswaspredominantlymedicalandnursing.Anotherkeyfindingwasthatmanyoftheresidenceswerelarge,withserviceusersaskedtoshareaccommodationwithbetween10and32otherpeople.Therearenostatutoryregulationsgoverningtheprovisionofcareandtreatmentincommunityresidences.

aim of the Report

Theaimin2009wastoinspectthelargestresidencesprovidingfulltimecareineachoftheproposedsupercatchmentareas,toestablishtheaccessserviceusershadtorehabilitationandtoassessthequalityofcareandtreatmentprovidedtothem.TheInspectoratealsoexaminedthelevelofintegrationwithinthelocalcommunity,theconditionofthephysicalstructureandtheoverallphysicalenvironmentofeachpremisesandthelevelofprivacyaffordedtoresidents.

Methodology

BasedontheinformationavailabletotheInspectorate,thirteenresidenceswiththehighestnumberofplaceswereselectedfromeachoftheproposedsupercatchmentareas.Aninspectiontemplatewasdevelopedbasedontheself-assessmenttoolusedin2007.AllresidenceswerenotifiedinadvanceoftheinspectionanditwasreportedbytheservicesthatallserviceuserswereaffordedtheopportunitytobepresentandmeetwiththeInspectorate.Followingtheinspectionadraftreportwaswrittenwhichwasthenforwardedtotherelevantserviceforfactualcorrection.OfthethirteendraftreportssentbytheInspectorate,threewerenotreturned.Thesethreereports,followingastatedtimeframe,weredeemedtohavebeenfactuallycorrectedafter1December2009.

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overview of Residences inspected

Residence number of places

number of residents on day of inspection

age profile of residents

team responsible

Care plan type

HSESouthArdnaDeise 14 13 27-72 Rehabilitation NursingOwennaCorra 32 31 42-93 GeneralAdult NursingPerrottHouse 23 23 Averageage67 GeneralAdult MDTKelvinCourt 17 17 33-71 GeneralAdult MDTHSEWestO’ConnellHouse 25 23 20s-90 Rehabilitation NursingToghermore 23 23 32-80 GeneralAdult MDTClearyHouse 20 12 28-75 Rehabilitation MDTDublinMidLeinsterErkinaHouse 17 16 41-69 Rehabilitation MDTSt.Columba’s 17 17 36-75 Rehabilitation MDTEllerslieHouse 15 11 26-78 GeneralAdult NursingDublinNorthEastAnSolasán 16 16 67-88 GeneralAdult NursingKilrock 12 12 34-88 Rehabilitation MDTSt.Elizabeth’sCourt 26 23 51-95 Rehabilitation NursingEachoftheabovethirteencommunityresidenceswereinspectedin2009andmoredetailedinformationisavailableintherelevantindividualinspectionreport.

Discussion

profile of Residents

Manyoftheresidentshadenduringmentalillnessesandhadspentconsiderableperiodsoftheirlivesinlong-staywardsofpsychiatrichospitalsfromwheretheyhadbeentransferredordischarged.ItisevidentfromtheabovetablethattheageprofileofresidentsvariedconsiderablyexceptinAnSolasáninDundalkandPerrottHouseinSkibbereenwherethereweresimilarageprofiles.Thegendermixwasbalancedacrossallserviceswithoneortwoexceptions.

service user interviews

Overall,themajorityofresidentswhorequestedtospeaktotheInspectorateduringthisseriesofinspectionsweregenerallypleasedwiththeserviceprovidedandwiththestaffwhoofferedcareandtreatment.InKelvinCourt,oneresidentstatedthathe/shehadnotseenadoctorsincehis/herarrivalattheresidence.

access to Rehabilitation

Allthirteencommunityresidencesprovidedon-goingcarewithvaryingdegreesofrehabilitation.Emphasiswasmostlyontheprovisionofasafeandhomelyenvironment.Onlysevenofthethirteenresidenceswereunderthecareofspecialisedrehabilitationteams,allofwhichwereinadequatelystaffedandfellfarshortofrecommendationsinA Vision for Change(2006).Thislimitedtheamountofexposureofresidentstoactiverehabilitationandreintegrationintolocalcommunities.Despitethe

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increaseinthenumberofresidencesusingmultidisciplinaryteam(MDT)careplans,theskillmixofstaffontherehabilitationorcommunitymentalhealthteamsunderwhosecarethecommunityresidencesfell,continuedtoremainmostlylimitedtomedicalandnursingpersonnel.Accesstohealthandsocialcareprofessionalssuchasoccupationaltherapywaslimited,accesstosocialworkwasevenmorelimitedandaccesstoclinicalpsychologyserviceswaseithernon-existentorspecialarrangementshadtobemadeonbehalfoftheresident.Eightofthethirteencommunityresidencesinspected,offeredrespiteplaces.Inallthirteencommunityresidencesinspected,nursingstaffwerefoundtobeproactiveanddedicatedintheprovisionofacaringservice.

the level of integration with the local Community

Anumberofresidencesencouragedactiveparticipationintheirlocalcommunity.InsixoftheresidencesasmallnumberofresidentswereattendingeitherVocationalEducationColleges,cateringcollege,studyingforcollegediplomasorundertakingsupportedemployment.TheInspectoratefoundthatstaffwerepositiveandsupportiveofresidentsattendingcoursesandemploymentandproactiveinassistingresidentsinachievingtheirmaximumpotential.Themajorityofresidentseithershoppedintheircommunityaloneorwereaccompaniedbystaff,dependingontheirphysicalabilityand/orlevelofcapacity.Asmallminoritywereinvolvedinlocalcommunityorganisationsorgroups.

psychiatric Review

Manyreviewsbytheresidents’consultantpsychiatristoccurredfortnightlyoronceamonth.InmostcasestheNCHDattendedweeklyandassuch,wasavailabletoreviewanyresidentuponrequest.InKelvinCourt,inCarlow,althoughtheresidentshadbeendischargedfromSt.Dympna’sHospitalon13February2009,uponinspectionon10September2009,nopsychiatricreviewhadbeenenteredintoanyoftheresident’sclinicalfilesorcareplansexaminedduringtheinspectiondespitethefactthatallresidentscontinuedtobeunderthecareandtreatmentofaconsultantpsychiatrist.Sincethatinspection,itwasreportedthatascheduleofregularpsychiatricreviewshadbeenimplemented.ItispositivetonotethatinotherresidencestherewasevidenceofregularandsystematicreviewofplannedcareandregularMDTreview,althoughasalreadyindicated,suchMDTreviewswerebeingcarriedoutbymostlymedicalandnursingstaff.

physical Care and treatment

TheInspectoratereceivedanumberofenquiriesintothematterofphysicalexaminationswithregardtoresidentsofcommunityresidences.ItistheviewoftheInspectoratethatincaseswhereindividualsareunderthecareofMentalHealthServicesandwhereclinicalresponsibilitylieswiththecommunitymentalhealthteams(CMHTs),thereisadutyofcaretoensurethat,inthebestinterestsofeachresident,accesstoallavailablehealthcareisafforded.Thisdutyofcareextendstophysicalcare.TheNCHDattachedtoeachCMHTshouldbethedelegatedprofessionalaccountableforensuringthatthephysicalhealthneedsofallresidentsarebeingmet.Inallservices,ageneralpractitioner(GP)eitherattendedtheresidenceorresidentsattendedtheirownGP.Physicalhealthexaminationsoccurredannuallyinmostcases,someoccurredsix-monthly,andinonecase,O’ConnellHouseinLimerick,therewasnodocumentaryevidencethatphysicalexaminationshadoccurredinregardtofiveresidents.Inmanysituations,wherethepracticewasfortheresidenttoattendtheirGP,theInspectoratehaddifficultyfindingrecordsoftheseexaminations.WhilesuchdocumentationofphysicalexaminationsmightremainwithintheGPpractice,attheveryleast,staffofcommunityresidencesshouldhaveasysteminplacetoensurethatrecordsofattendanceofaresidentathisorherGParemaintained.InArdnaDeise,inWaterford,theresidents’clinicalfileswereforwardedtotheGPwhentheresidentattendedforphysicalexaminationforthepurposeofdocumentingtheexaminationsandwerethenreturnedtotheresidence.NotwithstandingtherightofaresidenttoconfidentialityindealingswithhisorherGP,inmanyinstances,therewasnodocumentaryevidenceofliaisonbetweentheGPpracticesandstaffbasedatthecommunityresidencesregardingidentifiedfollow-upcare.Inoneexample,inToghermore,Tuam,dateswerenotedinthediarywheneachresidentwasdueavisittotheirGP,andalthoughitwas

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reportedthattheGPsliaisedwiththeserviceonthefindingsofthesephysicalexaminations,norecordofliaisoncouldbefoundinanycareplanorrecordconfirmingthattheresidentactuallyattended.Whereas,aresidentwithcapacityhasarighttorefusetoattendforphysicalexamination,arecordofsuchnon-attendanceshouldbedocumentedandsuchaneventualitydiscussedamongstthemultidisciplinaryteamandagreedactiontakenanddocumentedintheresident’scareplan.Attheveryleast,attendanceornon-attendanceforphysicalexaminationshouldberecordedineachresident’scareplan.

therapeutic services and programmes

Itwaspositivetonotethatallserviceshadaprogrammeoftherapeuticactivities,albeitlimitedinsomecases,oraccesstosuchwasavailableifrequiredbytheresident.Inthemajorityofcases,theresidentsofeachserviceattendedadaycentreforlimitedperiods.Intwocases:ClearyHouseinLetterkennyandEllerslieHouseinBray,allresidentsattendedthedaycentrewithnoaccesstotheirresidenceduringtheworkingday.InClearyHouse,residentshadaccesstoarangeoftherapeuticprogrammesinaccordancewiththeirindividualcareplans.Again,itmustbenotedherethataccesstotherapeuticserviceswasrestrictedbylimitednumbersofhealthandsocialcareprofessionals.

Medication

Althoughthereisnostatutoryrequirementforsuch,therewerenopoliciesontheordering,prescribing,storageandadministrationofmedicines.Inmostcasesmedicationswereprescribedbythreedifferentparties:theconsultantpsychiatrist,NCHDandGP.Eachserviceshouldhaveanup-to-datewrittenoperationalpolicyontheordering,prescribing,storageandadministrationofmedicines.Residentsreportedthattherewasalackofinformationavailabletothemregardingthemedicinestheywerereceiving.Staffreportedthattheinformationcontainedwithinmedicineboxeswasusedtorelayinformationtoresidentsandthatsuchinformationcouldbeelaboratedonanddiscussedinmoredetailwiththeresidentuponrequesttotheconsultantpsychiatrist,NCHDornurse.Howeverstaffneedtobeproactiveinassemblingasystemofinformationonvariousfrequently-usedmedicationssothatresidentsmayperuseiteasilyandthenaskquestionsiftheywishtodoso.Asmallnumberofcommunityresidencesreportedthatanumberofresidentsweremanagingtheirownmedication.

staffing levels

Thepaucityofhealthandsocialcareprofessionalssuchasoccupationaltherapists,socialworkersandpsychologistsacrossallteamshasalreadybeenhighlighted.Nightstaffinglevelswereinadequateintwoofthethirteencommunityresidencesinspected:ArdnaDeise,Waterford,andEllerslieHouse,Bray,Co.Wicklow.Thestaffinglevelofoneregisteredpsychiatricnurseonnightdutyisinadequatetofacilitatethecareofresidentsinthesecommunityresidences.Staffinglevelsatnightshouldcompriseatleasttwomembersofstaff,oneofwhomshouldbearegisteredpsychiatricnurse.Nightstaffinglevelsintheremainingelevencommunityresidenceswereadequate.

the Condition of the physical structure and the overall physical environment of the premises

Themeannumberofplacesavailableinthethirteencommunityresidencesinspectedwas20.Thephysicalstructureoftheseresidencesvariedfromperiodhousesdatingbacktopre-Victoriantimestoconvertedconventsbuilt130yearsagoandfrompreviouslyusedbuildingsinthegroundsofhospitalstomodernpurpose-builtsingle-storeydevelopments.Allresidences,withoneexception,werelocatedinurbanorsuburbansettings.ToghermorewasthreekilometresfromthetownofTuam,includingadistanceofonekilometrefromthepremisestothemaingate.Residentswererestrictedtoundertakingthiswalkduringdaytimeonlyastheareawasunlitatnightandthepathsurfaceuneven.Inthemajorityofcasesitwasreportedthatmaintenancewasgenerallyadequate.Manystaffreportedthatbecausetheresidencesweresomedistanceawayfrommaintenancedepartmentsbasedatmainhospitals,itwasdifficultsometimestoacquireroutinemaintenance.Inemergencysituations,maintenancewasreported

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tobegenerally,verygood.InArdnaDeise,Waterford,therewasevidenceofdampinsomeoftherooms;St.Columba’s,Crumlin,wasanoldbuilding,poorlymaintained;andToghermore,inTuam,alargeperiodresidence,reportedseriousproblemswiththestructureofthepremises,bothinsideandoutsideandproblemsobtainingnecessarymaintenance.Theseissuesarereportedseparatelyintheindividualreports.

the level of privacy afforded to Residents

Althoughmanyresidencesaccommodatedresidentsatnightinsingleandtwinrooms,insomecases,residentswerelivinginaccommodationaffordingthemlittleornoprivacy,sometimeswithuptofiveorevensixpeoplesleepingintheoneroomasinthecaseofToghermoreHouse,Tuam,andO’ConnellHouse,Limerickrespectively.Formanyyearsnow,theInspectoratehasrecommendedthatinbedroomswithtwoormorebeds,residentsshouldbeaffordedsomedegreeofprivacythroughtheuseofprivacycurtainsandsatisfactoryprivacyofbedroomwindowsfromcarpark,gardenandpublicaccessareas.Inmostoftheresidencesinspected,inbedroomswithtwoormorebeds,theInspectoratefoundthatinsufficientresourceshadbeenallocatedtoprovidefortheprivacyrightsofresidentsasindividuals.Measurestoaddresstheseprivacyissuesshouldbeexpedited.Anyproposednewcommunityresidenceshouldaffordeachresidentahighdegreeofprivacy.

Quality initiatives and improvements

Itwaspositivetonotethatallareashadqualityinitiativesandimprovementstoreport,mostareashadareadyandlengthylistofitemsthathadbeenundertakeninrecenttimes.Theseweremany-variedandservicespecific.Ratherthanduplicatingtheseinthisoverviewreport,individualservices’initiativesandimprovementsmaybereadineachoftheindividualinspectionreportsforthecommunityresidences.

Financial arrangements

AllthirteencommunityresidenceswereownedbytheHSE.Eachresidentpaidasetamountofmoneyonaweeklybasistowardsrent.Thereportsonthesethirteencommunityresidencesfoundthatmostresidentshadtheirownbank,postofficeorcreditunionaccounts.Thiswasapositivedevelopmentasitlessenedtheneedfornursingstafftohandleresidents’monies,reducedtheriskofretainingrelativelylargecashsumsonsiteandenhancedtheautonomyofresidents.Thispracticeshouldbereplicatedbyallcommunityresidences.Financialarrangementswerebackedbyawrittenoperationalpolicyinsevenresidences.Itisrecommendedthatallresidentsofcommunityresidencesshouldhaveapersonalbank/postofficeorcreditunionaccountandthateachservicehasawrittenoperationalpolicyandproceduresonlocalfinancialarrangements.

leisure/Recreational activities

Itwasreportedinthemajorityofcasesthatresidentshadaccesstoawiderangeofleisureandrecreationalactivities.Leisureoutingsoccurredregularlyeitherfordaytripsorfortripstothecinema,swimmingandshopping.Accesstolocallibrarieswasalsoreportedinanumberofcases.ManyareashadoccasionalSundaylunchesatlocalrestaurantsandhotels.Localsportingeventswerealsowellattendedinanumberofareas.Residents’birthdayswerealwayscelebrated.

Conclusion

Therewere1,805placesin24-hournurse-staffedcommunityresidencesreportedtotheInspectoratethroughthecatchmentreportsof2009.WiththeanticipatedimminentclosureofremainingVictorianinstitutions,futureplansfornewlycommissionedbuildingsforuseascommunityresidencesneedtobereviewedandplannedcarefully.WhatisnotneededinplaceofVictorianinstitutionsisanemergenceof“mini-institutions”or“wardsinthecommunity”dottedaboutruralandurbancommunities.Theplannersofourmentalhealthservicesmustexerciseavisionandidentifypurposefulhousingforresidentsin

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needofroundtheclockcare.Indeed,inthepresenteraoffallingpropertyprices,theclimatemayberightforembracingthisvisionofresidentialcareinourcommunitiesatalllevelsofsupport.DefendersofthelargercommunityresidencessuchasToghermoreinTuampointtokind,caringandwell-meaningstaff,andasenseofcamaraderieamongstresidentsandstaff.However,suchfacilitiescanonlydeepenanindividual’ssenseofdetachmentfromcommunitylife,increaseattachmenttoamorepaternalisticphilosophyofcareandsmotheranyhopeofeverreachingtheirfullpotentialasindividuals.Thiscangiverisetocautiononthepartofresidentstowardsco-operatingwithmovestoobjectivelymoredesirablesettings.Suchcautiousnessshouldnotbeunderestimatedasitisagenuineconcern.Butthisconcerncanonlyberemediedbytheprovisionandutilisationoffully-staffedspecialistrehabilitationteamsasrecommendedinA Vision for Change.Intheabsenceofspecialistrehabilitationteams,newresidentstotheservicewhoareexperiencingsevereandenduringmentalillnesses,long-stayresidentsincommunityresidencesandmediumandlowsupporthousing,willnotgetthespecialistcareandtreatmentandessentialongoinginterventionstoassisttheminreachingtheirmaximumpotential.

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appendix 4: individual inspection Reports – 24-Hour nurse staffed Community Residences


Mental Health services 2009 inspection of 24-Hour Community staffed Residences

ExecutiveCatchmentArea DublinNorthCentral/NorthWestDublin

MentalHealthServiceInspected NorthWestDublin

ResidenceInspected St.Elizabeth’sCourt

TotalNumberofBeds 26

TotalNumberofResidents 24

NumberofRespiteBeds(ifapplicable) 0

TeamResponsible Rehabilitation

DateofInspection 3November2009

Description

service Description

St.Elizabeth’sCourtwasa24-hourcommunitystaffedresidencelocatedontheNorthCircularRoadinDublin.Theresidenceopenedinitscurrentformin2001andpriortothatitwascomposedofself-cateringbed-sitsownedbyDublinCorporation.Itwasatwo-storeybuildingwithbedroomaccommodationonbothfloors,withdayareaslocatedonthegroundfloor.Itprovidedcontinuingcaretoolderpeopleinthecatchment,manyofwhomhadmovedtherefromotherservicesbecauseofincreasedphysicalneeds.Onoccasiontheresidenceprovidedrespiteforolderpeople.

Thebedroomswereamixofsingleanddoubleroomsandwereingooddecorativeorder.Theresidencewascleanandwellmaintainedthroughout.Anewaccessibleshowerroomhadbeeninstalleddownstairs,makingthistheonlyresidenceinthecatchmentthatwaswheelchairaccessible.Theupstairsaccommodationwasnotsuitableforresidentswithlimitedmobility.Theresidencehadachefandallmealswerecookedonsite.Therewasakitchen,diningroomandsittingroomonthegroundfloor,andalaundryroomwasattached.Therewasaspaciousenclosedgardenwithagazebothatwasusedasasmokingplace.Thisareaofthegardenwasoverlookedbymorerecentlybuiltapartments.Staffreportedthatonoccasiontherewasdisturbancesandlitteringofthegardenarisingfrompartiesincertainapartments.

TherewasadaycentreadjacenttoSt.Elizabeth’sCourtandmanyoftheresidentsattendedit.Theresidencewasalsolocatedclosetolocalamenitiesandmostresidentsmadeuseofthese.Theresidentswerewellknowninlocalbusinessesandstaffreportedagoodandsupportiverelationshipwithlocalbusinesses,shops,pubsandpharmacies.

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Theresidencecouldaccommodate26residentsandonthedayofinspectiontherewere23residents.Theaverageageofresidentswas67years;theiragesrangedfrom51to95years.Theaveragelengthofstaywas6.4years.Therewere14maleresidentsand9femaleresidents.St.Elizabeth’sCourtcateredforolderpeoplewithahistoryofsevereandenduringmentalillnesswhobyandlargerequiredcontinuingcare.Mostoftheresidentshadsignificantphysicaldependencyneeds.

Quality initiatives and improvements in the last Year

Residentsmeetingswerefacilitatedregularly.}}

ResidentswerebeingfacilitatedtoopenbankaccountswithPostbanktoavailofdirectdebitpayments}}

ofcommunityresidencecontributions.

Orderingfromthepharmacyhadbeenstreamlined.Newformshadbeendevelopedinconjunction}}

withalocalpharmacytoreduceincidentsoferrors.

Allclinicalandbathingareaswereequippedwithliquidsoapsandhandtoweldispensers.Alcohol-}}

basedhandsanitisershadbeeninstalled.

Newshoweringfacilitiesandawheelchairaccessibletoilethadbecomeoperationalinthepastyear.}}

HalfoftheresidentswerereviewedinSt.Elizabeth’sCourtbythecommunitycomponentofthe}}

rehabilitationteam.Thisremovedtheirneedtoattendaclinicandimprovedcommunicationofhealthcareinformationbetweenresident,nursingandmedicalstaff.

NewmedicationcardindexeswerebeingimplementedinSt.Elizabeth’sCourtandacrossthe}}

communityresidencesaspartofamedicationmanagementstandard.

Homevotingwasbeingorganisedtofacilitateresidentsvoteonsite.}}

Care standards (Based on MHC Quality Framework and 2008 inspection self-assessments)

individual Care and treatment plan

Allresidentshadanup-to-datenursingcareplanandhadregularmentalhealthandphysicalhealthreviews.Residentswereinvolvedintheirowncareandtreatmentplan.Manyresidents,becauseoftheiradvancedageandphysicalneeds,hadregularoutpatientappointmentsinthenearbyMaterHospital.TherapidaccessclinicinSmithfieldwasavailableforanyoneover65.

therapeutic services and programmes provided to address the needs of service users

1. Asfaraspossibleresidentswereencouragedtoaccessservicesprovidedlocallyoutsidetheresidenceandwithintheircommunity.

2. Theservicehadembarkedonadetailedneedsassessmentofallresidentsincommunityresidences.Anumberofspecificstandardisedassessmentshadbeenusedandtheresultsfortheentireserviceareawereduetobeanalysedtoprovideinformationtoinformcareplanning.

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3. ResidentscouldattendtheAirdNuaandNewCenturyHouse,whichwerevocationalrehabilitationservicesprovidedbyEVEHoldings.TheCabradayhospital,thedaycentreandGoirtínshelteredworkshopwerenearbyontheNorthCircularRoad.TheirproximitywasparticularlyattractiveforresidentsofSt.Elizabeth’sCourtwhohadmobilityissues.

How are residents facilitated in being actively involved in their own community, based on individual needs?

1. Residentsneedswerebeingformallyassessed.

2. Residentshadsubstantiallinkswiththeneighbourhoodandwereencouragedtomaintainlinkswiththeirfamiliesandfriends.Familiesandfriendsoftenvisitedtheresidentsandthiswaswelcomedandencouragedbystaff.

3. Residentsregularlyavailedoftheshops,coffee-shops,pubs,hairdressersandchurchesinthelocality.Manywalkedortooktaxistotheirdestinations.

4. AllresidentsattendedtheirownGPinthearea.

5. AdaycentrewaslocatednextdoortoSt.Elizabeth’sCourtandmanyresidentsattendedanumberoftimesperweek.AmongstthelocalsocialservicesavailabletoresidentsweretheBasinClub(Shine)inBlessingtonStreetandthebefriendingservicehostedbyGoirtin.TheAlexianBrothersalsoofferedacommunitygroupforpeoplewhouseservices.Someresidentswereinvolvedinlocalcommunitygroups.GoirtínalsohostedanumberofcommunitygroupssuchasAA.

6. St.Elizabeth’sCourtwashometoanumberofcatsthatsomeresidentshadtakentolookingafter.

Do residents receive care and treatment in settings that are safe, well maintained and that respect right to dignity and privacy?

1. Althoughtheresidencewaslarge,with26beds,alltheroomswereeithersingleordoubleandwereprivate.Eachresidenthadawardrobeandlockerandtheroomswereindividualisedwithpersonalbelongings.

2. Theservicehadinvestedinimprovingthebathroomsandmakingthemaccessible.

3. Residentswereoffereddownstairsroomswhereindicatedbytheirphysicalhealthneeds.

4. Manyresidentslikedtoshareroomswithotherresidentsandthemaintenanceoffriendshipswasrespectedinthechoiceofroom-mate.Someresidentsdidnotliketoshareandthisoptionwasrespectedandfacilitatedasmuchaspossible.

staffing levels

Full Time in Residence

staff Discipline Day Wte night WteCNM2 1 0CNM1 0 0Nurse 1 1Household 2.5 0Carestaff 1 1Chef 1 0

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Sessional

Discipline number of sessionsConsultantpsychiatrist 1NCHD 1Occupationaltherapist 0Socialworker 0Clinicalpsychologist 0

team input

MostresidentsinSt.Elizabeth’sCourtwereunderthecareoftherehabilitationservice,whichwasrunbytwoconsultantpsychiatristsandcomprisedaSt.Brendan’sHospitalcomponentandthenewNorthWestDublincommunityrehabilitationservice.ThecommunitycomponentoftheservicecomprisedaconsultantpsychiatristandNCHD.EffortswerebeingmadetoextendthemultidisciplinarystafftocovertheentireNorthWestDublinservice.ProgresstowardsthisendwassteadyandalreadyacommonplacementteamhadbeenestablishedtoconductmultidisciplinaryassessmentofplacementreferralstotheNorthWestDublincommunityresidencenetwork.Similarly,theneedsassessmentproject,whichwasongoingatthetimeoftheinspection,wasajointinitiative.

ThecommunitycomponentoftherehabilitationserviceheldweeklyteammeetingsnearbyatitsbaseinWhitepointontheNorthCircularRoad.Communityresidencesfromthecatchment,includingSt.Elizabeth’sCourt,wererepresentedatthemeeting.FouroftheresidentswereunderthecareoftheSt.Brendan’sHospitalrehabilitationcomponentoftheservice.OtherteamswithresidentsinSt.Elizabeth’sCourtheldtheirclinicsinnearbyConollyNormanHouseandtheirweeklyteammeetingsattheirteambases.

Liaisonwasmaintainedwiththeresidents’GPsregardingphysicalhealthandmedicationchanges.

Medication

Theservicehadapolicywithregardtoprescriptioncardindexes.Theprescriptioncardindexeswerereviewedduringtheinspectionandtheywereuptodateandclearlywritten.

Manyresidentsreceivedassistancewiththeirmedications,e.g.heparinandinsulininjections.

Self-medicationprogrammeswereencouragedasmuchaspracticable,butonthedayofinspectionnoneoftheresidentsweredeemedsuitableforself-medicationprogrammes.Theservicehaddevelopedapolicyforself-medicationprogrammes.

tenancy Rights

Residentspaidacontributionof75eurotowardstheirlivingandcareexpenses.Itwashopedthatinthefuturethiswouldbeachievedthroughadirectdebitfrombankaccounts,whichwerebeingsetup.

Theresidencefacilitatedregularmeetingsofresidents.

Therewerefewhouserulesandthesewereincludedintheinformationleafletthatdescribedtheresidenceandthefacilitiesprovided.

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TheHSEpolicyregardingresidents’financeswasinplace.Mostresidentswereinreceiptofstateoroccupationalpensions.Fiveresidentshadtheirpensionscollectedbystaffbecauseofinfirmity.Therewerearrangementsinplaceforthesafe-keepingvaluables.

Residentswereencouragedtoshopforclothesandtoiletriesandoftenrequestedtheassistanceofstaffwiththesetasks.

leisure/Recreational opportunities provided

Residentswerefacilitatedinremaininginvolvedinthecommunityforleisureopportunities.Residentsusedlocalpubs,coffeeshopsandlocalshops.

Withintheresidencetherewereregularcelebrations,forexample,birthdaypartiesandseasonalcelebrations.

Residentswereencouragedtodevelopandmaintaintheirpastimesforexample,someresidentsenjoyedjig-sawmakingandcrochet.

Residentsalsoavailedofthedaycentrenextdoorwheretherewasbingo,opportunitiestokeepuptodatewiththepapersandtoenjoyoneanother’scompany.


Anumberofresidentswerespokentoduringtheinspection.Theyallexpressedpositiveviewsaboutthequalityoftheircareandtreatmentandtheirrelationshipswithstaff.Anumbercommentedontherangeofrecreationalactivitiesthattheyavailedofinthedaycentreorinthelocality.

Conclusion

Althoughthiswasalargeresidencewith26beds,thebedroomswereeithersingleordoubleandhadbeenindividualisedbytheresidents.Thebuildingwasspaciousandhadalargeoutdoorenclosedgarden.AccesstolocalamenitiesanddaycentreswasmadeeasybythecentrallocationofSt.Elizabeth’sCourt.Theresidencewascleanandwellkept.ImportantlytheresidentswhospoketotheInspectoratereportedapositiveexperienceoflivingthere.Theresidentsalllookedwellcaredforandagoodrapportwasobservedduringtheinspectionbetweenresidentsandstaff.

Theresidencewascateringforolderpeopleintheservice.Astheonlyresidencethatwaswheelchairaccessibleinthecatchmentarea,thedemandforplaceswaslikelytogrow,puttingparticularpressureonground-flooraccommodation.WhileitwaspositivetoseejointinitiativesbetweentheSt.Brendan’sHospitalandthecommunity-basedrehabilitationteams,theissueofstaffingneededtobeaddressed.Thecommunity-basedrehabilitationteamcomprisedaconsultantpsychiatristandNCHD.Withthislevelofstaffingitwasdifficulttoseehowprogresscouldbemadeinprovidingacommunity-basedrehabilitationservicethatwouldsupportserviceusersinthecommunity,fosterlinkswithlocalhousingauthoritiesandperhapsshiftthefocusfromresidentialprovisionandfacilitateareductioninthenumberofbedsprovidedinSt.Elizabeth’sCourtinlinewithA Vision for Change,whichof10places.

Recommendations and areas for Development

1. The rehabilitation team should be fully resourced.

109


2. Consideration should be given as to how best to use the vacant space upstairs in St. Elizabeth’s Court so that it does not become dilapidated.

3. Consideration should be given to developing more day rooms or sitting areas on the ground floor so that residents have a choice of space where they can sit and relax rather than all gathering in the one large sitting room.

110



ExecutiveCatchmentArea HSEDublinNorth

MentalHealthServiceInspected NorthDublin

ResidenceInspected KilrockHouse,Howth





DateofInspection 30July2009

Description

service Description

KilrockHousewasalargered-brickperiodhousebuiltin1875withlargematurelandscapedgardens.ItwassituatedinHowth,withseascapeviewsofHowthHarbourandIrelandsEye.KilrockHousewasahighsupportresidencewhichprovidesaccommodationfor12residentsunderthecareofthecommunityrehabilitationteam.Thehousewasalsotheheadquartersoftherehabilitationteamwhichcoversarea8inNorthDublin.Newreferralsweredirectedtotherehabilitationteamwhichmeetsonaweeklybasis.

KilrockHousewasathree-storeyhousewithbedroomaccommodationbothupstairsanddownstairs.Therewasadayroom,kitchenandconservatorydownstairs.Thestaffofficesthathousedthemultidisciplinaryrehabilitationteamwereonthesecondfloor.Bedroomaccommodationcomprisedfourmaleroomswithonesingleroom,twodoubleroomsandonewiththreebeds.Thereweretwofemaleroomswithtwobedsineachroom.Noneofthesharedbedroomshadacurtainseparatingtheroominhalftoprovideresidentswithprivacy.Thereweresixtoiletsinthehouseandtwobathrooms.Abathroomwasbeingredecoratedonthedayofinspection.Therewasonetoiletandshowerroomdownstairs,twomaletoiletsandtwofemaletoiletsandonebathroomandshowerroomupstairswithaccesstoalaundryroom.ThediningroomwasattachedtoakitchenwhereallthemealsweredeliveredfromSt.Ita’sHospitalfromMondaytoFriday.Residentspreparedmealsonsiteatweekendsandonbankholidaysaspartoftheirprogramme.

Therewasawell-maintained,spaciousandprivatelandscapedgardentothefrontofthehouse.Atthebackofthehousetherewerespaciousgroundsandavegetablegardenthathadbeendevelopedandmaintainedbystaffandresidents.Thisfacilityprovidedachoiceofactivitiesandwasparticularlypopularwithsomeofthemenwhowerenotinterestedinsomeoftheotheractivitiesoffered.Therewereplanstoredevelopthegardenstotherearofthehousetofacilitatetherapeuticactivitiesforresidents.

Thephilosophyofcarewastosupportandencourageresidentswithmentalhealthproblemssothattheycanparticipateinallaspectsofdailylivingandtakeanactiveroleinthedecisionsthataffecttheirlives.Theresident’srighttochoosenottoparticipatewasalsoacknowledged.


Thecurrentagerangeofresidentswasfrom34yearsto88years,themajoritywithadiagnosisofschizophrenia.Onthedayofinspection,therewereeightmaleandfourfemaleresidents.Sevenoftheresidentshadbeenresidentinthehouseformorethantenyears.Withtheincreasingageprofileofresidents,thelayoutofthehousemayprovidedifficultiesforthelessable-bodiedresidentsinthefuture.Theresidentswereinvolvedinvariousactivities.MostoftheresidentsattendedtheVocationalTraining

111


Programme,Clubhouse,NationalLearningNetworkcollege,orSuaimhneasonadailybasisandoneresidentwasemployedbythelocalbutcher.


TheproposeddevelopmentoftheoccupationaltherapyserviceinKilrockHouse.}}

Ananalysisreporttoidentifytheneedsofclientswithaviewtoestablishinganappropriatevocational}}

trainingprogramme.

Aservicedevelopmentplanwasinstigatedtodeveloparehabilitationoccupationalservice.}}

Agardeningprogramme,includingthedevelopmentofasensorygarden,rosegardentogetherwitha}}

vegetablepatch.



Allresidentshadarehabilitationteamassessmentandcareplancompleted.Thesewerereviewedapproximatelyeveryweekormoreorlessfrequentlyifrequired.TherehabilitationconsultantwasbasedinKilrockHouseandeachresidentwasdiscussedwiththemultidisciplinaryteamonamonthlybasis.

AlloftheresidentswereregisteredwithalocalGPandstaffreportedacloserelationshipwiththeGP.TherewasgoodaccesstospecialistconsultantsandclinicsthroughtheGP.

Therehabilitationteamhadnoclinicalpsychologist.


Theservicesandprogrammesincludedthefollowing:

gardeningprogramme.}}

personalhygieneprogramme.}}

budgetingprogramme.}}

cookeryprogramme(weekends).}}

smokingcessationprogramme.}}

domesticchoresaroundthehouse.}}

residentmeeting(weekly).Notestakenbyresidenteachweek–shoppingforhouseholdgroceries,}}

healthyfoodshopping,andfoodpreparation.

oneresidentattendedDelvinShelteredWorkshop.}}

oneresidentattendedColáisteDhúlaighandattainedadiplomainArtandDesign.}}

112


oneresidentattendedacateringcourseinPhibsboro.}}

threeresidentsattendedSuaimhneasShelteredWorkshop.}}

allresidentsusedlocalshops/cafes/farmersmarketaspartoftheirsocialprogrammeandintegration}}

intothelocalcommunity.

therewasaccesstovoluntaryagencies,e.g.GROWandMentalHealthAssociation,FriendsofKilrock.}}


ThepremiseswaslocatednearthecentreofHowthvillagewitheasyaccesstoarangeoflocalfacilitiesincludingthetownlibrary,pubs,harbourandshops.TherewasgoodaccesstobusserviceswhichservedNorthDublinandalocalDARTstation.Residentswereencouragedtoattendlocaleventsheldthroughouttheyear.Residentswereinvitedtocommunityfunctionsthroughtheircloselinkswithlocalsocialservices.Someoftheresidentsusedthelocalshopsandlibraryandtherewasaccesstoothersocialactivities.

ThelocalcommunitywasinvitedtoattendbothChristmasandsummerpartiesatKilrockHouse.

Theservicehadbuiltandwasactivelymaintaininggoodlinkswiththelocalcommunitybyparticipatinginlocaleventsandinvitingthecommunityinforspecialoccasions.

SomeresidentswereengagedinVocationalTrainingProgrammesofDelvin,NationalLearningNetworkandRoslynPark.Oneresidentwasindependentlyemployedbyalocalbutcher.


KilrockHousewaslocatedinaquietsuburbanarea.Thehousewaswellmaintained,brightandcomfortablyfurnished.Therewasgoodaccesstorepairandmaintenancestaff.Residents’placementwasdeterminedbyproximitytofamilysupportandvocationaltraining.Residentssharedaccommodationbasedongender,ageandsocialbackground.

Livingquarterswerepersonalisedwithphotographsandresidents’belongings.Curtainswerenotprovidedaroundbedareasandeachresidentwasprovidedwiththeirownstoragespace.

MealswerecookedatSt.Ita’sHospitalfromMondaytoFridayandonsiteatweekendsandonbankholidaysbytheresidents.ThekitchenwasHazardAnalysisandCriticalControlPoints(HACCP)compliant.Achoiceofmealswasprovidedforresidentsandspecialdietswerecateredfor.Thediningroomwasbrightandspacious.

Fireinspectionswerecarriedoutroutinely.Pastoralcarewasavailableonrequest.ArepresentativeoftheIrishAdvocacyNetworkvisitedthehouseonrequest.

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staffing levels


staff Discipline Day Wte night WteCNM2 1 0CNM1 0 0Staffnurse 2 1Cook 0 0Carestaff 1 1

Sessional

Discipline number of sessionsConsultantpsychiatrist 2-3sessionsweekly(12hours)NCHD 2-3sessionsweekly(12hours)Occupationaltherapist 3sessions(12hours)Socialworker OnaneedtoseebasisClinicalpsychologist NoneResearchfellow 2sessions(8hours)

Medication

MedicationsweresourcedinthelocalpharmacyandpaidforbySt.Ita’sHospital.Depotmedicationsweregivenintheresidence.Writteninformationonmedicationswasprovidedbymeansoftheinformationleafletinthemedicationpack.Medicationswerestoredinamedicationroom.Theywereorderedfromthecommunitypharmacyonaweeklybasisunlessotherwiserequired.

tenancy Rights

ThehousewasownedoutrightbytheHSE.Residentsdonothaveatenancyagreement.TheInspectoratewasinformedthatresidentswereinvolvedinallaspectsoflifeinthehouse.Residentssignedacontractagreeingtonoconsumptionofalcoholorillegalsubstances.Thecontractalsoincludedanosmokingpolicyintheresidence.Communitymeetingswereweekly.


TherewasaHSEpolicyandlocalguidelinesinplaceregardingfinancialarrangementsforresidents.Allwereinreceiptofsocialwelfarepayments.Residents’moneydealtwithbystaffwasrecordedinabookandsignedbystaffandtheresident.Themajorityofresidentsmanagedtheirownfinancesthroughtheirpostofficesavingsbook.


Residentshadaccesstoagoodrangeofrecreationalactivities.Therewereregularoutingstothecinema,drives,swimming,Sundaylunchandshopping.Birthdaypartiesforsignificantbirthdayswereheldinthehouse.


ResidentswereinformedoftheinspectionvisitandinvitedtospeakwiththeInspectorate.Oneresidentspokeindepthandexpressedoverallsatisfactionwiththehouse.

114


ThereweretwoserviceusersgroupsresidinginKilrockHouse.ThefirstbeingthosewhowereresidentinthehousepriortotherehabilitationserviceandthesecondserviceusergroupwereindividualsadmittedfromtheCommunityMentalHealthServices.Eachresidentwasinvolvedintheirownrehabilitationteamassessmentandcareplan.Residentshadsignedtheircareplans.

Conclusion

KilrockHousewasabrightwell-maintainedfacilityforbothmenandwomenwithamixedagerangewhowerereferredbythepsychiatricrehabilitationservices.Manyoftheresidentshadbeenthereformanyyearsandhaddevelopedstrongtieswiththeserviceandtheotherresidents.Theatmosphereinthehousewaswarmandwelcomingandresidentsseemedpleasedwiththeservice.Itwasunderthecareoftherehabilitationteamwhichwasunder-resourcedandwithoutaclinicalpsychologist.Residentshadgoodaccesstofacilitiesoutsidethehouseanditwasclearthattheywereencouragedbystafftobeasindependentaspossible.


1. Arrangements should be put in place to ensure privacy in the shared bedrooms.

2. The rehabilitation team should be fully resourced with health and social care professionals.

115



ExecutiveCatchmentArea Cavan/Monaghan,Louth/Meath

MentalHealthServiceInspected Louth/Meath

ResidenceInspected AnSolasán




TeamResponsible Generaladult

DateofInspection 7May2009

Description

service Description

AnSolasánwasbuiltin2002andwasapurpose-builtresidencesituatedinthegroundsofLouthCountyGeneralHospital.Itwasasingle-storeybuildingandhad15beds,includingonerespitebed.Onthedayofinspection,therewere15residentsandoneadditionalresidentwhowasapatientinSt.Brigid’sHospitalinArdee.

Theresidencewasunderthecareoftwogeneraladultpsychiatryteamswhichprovidedcontinuingcaretotheelderlyresidents.


Theagerangeofresidentswasbetween67and88years.Referralforadmissionwasthroughahostelreferralcommitteewhichhadrecentlybeensetuptoconsiderallreferralstosupervisedresidencesinthecatchmentarea.Inviewoftheageprofileoftheresidents,itwasreportedthatresidentsrequiredalotofphysicalnursingcare.Itwasexpectedthatmostresidentswouldremainintheresidenceaslongastheirphysicalrequirementscouldbemet.

Therewasonerespitebedintheresidenceandrespiteofoneweek’sadmissionwasavailable.


Apatientsatisfactionsurveywasconducted.}}

AclinicallearningauditwasconductedforAnBordAltranais.}}

Ahealthpromotiongrantwassecuredin2008andafishaquariumwasinstalledintheresidence.}}

AHSEqualityandriskgrouphadbeensetupandarepresentativefromthestaffofAnSolasánwason}}

thecommittee.

Therewasongoingmandatorytrainingforstaffinrelevantareas,e.g.elderabuse.}}

Integratedfilesforresidentshadbeenintroduced.}}

Anumberofinfectioncontrolinitiativeshadbeendeveloped.}}

116




Residentshadanursingcareplanthatwasreviewedeverythreemonths.Theconsultantoramemberofthetreatingteamvisitedtheresidenceweeklyandfullreviewswereconductedeverysixmonths.Inaddition,reviewswerecarriedoutasrequired.Theseniornurseondutyintheresidenceattendedtheweeklyteammeeting.

Therewasnoprovisiontoconductregularsix-monthlyphysicalhealthreviews.ThephysicalhealthcareofresidentswasattendedtobythelocalGPs.


Nursescarriedoutassessmentsonresidents.Therewasnoaccesstoanoccupationaltherapist.Activitieswerenurseledandincludedactivitiesofdailyliving,newspapergroups,bingosessionsandoutings.


Residentshadopenaccesstothedaycentrewhichwaslocatedinthegroundsofthehospital,andresidentscouldattenddailyiftheywished.TherewasalsogoodlinkswiththelocalAlzheimer’sCentre.

Residentsfrequentlywentshoppingintheareaorinthetown,eitheraccompaniedbystafforindependently.


Theresidencewaswellmaintainedandwellfurnished.Thedecorreflectedthepermanentnatureoftheresidence,whichresidentsregardedastheirhome.Therewere16bedrooms,allsinglewithadequatebathroomfacilities.Residentshadaccesstoapleasantpavedoutdoorareaandtherewasanactivitiesroomwherenursesfacilitatedtherapeuticactivities.

staffing levels


staff Discipline Day Wte night WteCNM2 1 0CNM1 1 1Nurse 2 1Householdstaff 2 0

Sessional

Discipline number of sessionsConsultantpsychiatrist 1aweekNCHD 1aweek,ormorefrequentlyasrequiredOccupationaltherapist 0Socialworker AccesstosocialworkerClinicalpsychologist Accesstopsychologist

117


team input

Teammeetingswereheldweeklyandwereattendedbyamemberofstaffandtheconsultantpsychiatristvisitstheresidenceweekly.NCHDsalsovisittheresidenceasrequired.Six-monthlypsychiatricreviewswereconductedbythepsychiatristonallresidents.Hospitalappointmentswerefacilitatedfortheresidents;achiropodistattendedeverytwomonthsandresidentshadaccesstoaphysiotherapistwhenrequired.Theresidencewasself-staffingintermsofnursingstaff.

Medication

MedicationsweresuppliedonaweeklybasisfromthepharmacistinSt.Brigid’sHospital.Medicationwasdispensedbythenursingstaffbuttherewasaplantointroduceself-medicationtosomeresidents.Additionalmedicationsuchasantibiotics,prescribedbytheGP,wasobtainedthroughthemedicalcardsystem.

tenancy Rights

TheresidencewasownedbyLouth/MeathMentalHealthServices.Communitymeetingsfortheresidentswereheldeveryfewmonths.Therewasacomplaintsboxintheentrancehallforresidentsbutitwasreportedthatveryfewcomplaintshadbeenreceived.Thecomplaintsprocedurewasoutlinedintheinformationleafletwhichwasgiventoeachresident.


Therewasapolicyinplaceregardingfinancialarrangementsforresidents.Anumberofdifferentsystemswereinplaceforcollectionofpensions.Insomeinstances,familymembersorstaffcollectedthepensionfortheresident.Oneresidentmanagedtheirownfinancialaffairs,andintheremainingcases,pensionswerecollectedbystaffinSt.Brigid’sHospital.Residentshadaccesstotheirownmoneyoncethepensionhasbeencollectedandtwostaffmemberswitnessedanyfinancialtransaction.


Residentshaddailyaccesstothedaycentre,whichwasalsolocatedinthegroundsoftheGeneralHospital.TherewassomeinteractionwiththelocalAlzheimer’sCentre.Residentsweretakenonregularoutingsandshoppingexcursions.TheresidencehostedanannualFamilyDayintheresidence.


TheresidentshadbeeninformedoftheInspectoratevisitandtheywereinvitedtospeakwiththeinspector,butnoresidentavailedoftheopportunityontheday.

Therewasinformationonadvocacyservicesintheresidence,buttherewerenoregularvisitsfromanadvocate.

Conclusion

AnSolasánwasabright,well-maintainedandspaciousresidenceprovidingcontinuingcareto16residents.ItwassituatedinapleasantareaofthegroundsontheLouthCountyGeneralHospital,andwasunderthecareoftwogeneralpsychiatristswhovisitedtheresidenceweekly.Becauseoftheageprofileoftheresidents,alotofphysicalnursingcarewasrequired.Psychiatricreviewswereconductedsix-monthly,buttherewasnosysteminplacetoconductsimilarphysicalhealthreviews.Theservicehasbeeninvolvedinanumberofinitiativesandresidentscouldavailofanumberofnurse-ledactivities.

118



1. Residents should have the benefit of occupational therapist input into their care plans.

2. A system should be implemented for six-monthly physical health reviews of residents.

119




ExecutiveCatchmentArea DunLaoghaire,DublinSouthEastandWicklow

MentalHealthServiceInspected Wicklow

ResidenceInspected EllerslieHouse,Bray





DateofInspection 11June2009

Description

service Description

EllerslieHousewasathree-storeyperiodresidencetakenoverforuseasa24-hoursupervisedresidencebythethenEasternHealthBoardin1986.Thefacilityhad15beds,including2respitebeds,andwassituatedinaleafysuburbanareaofBrayfacingapublicpark.Onthedayoftheinspection,therewere11residents:fivemaleandsixfemale.Theresidencewasunderthecareofthegeneraladultteam.

TheaimofEllerslieHousewastopromoteandencouragetherehabilitationofitsresidentsthroughretraininginlifeskillsandrestorethembackintothecommunity,totheservice’sthreelowsupporthouses,ortothefamilyhome.Itwasreportedthatahomelyambiencewasthemainphilosophyoftheresidence.

ReferralsweremadefromthegeneraladultteamandwerediscussedatteammeetingswiththeCNM2responsiblefortheresidence,whoitwasreportedhadthefinalsayontheappropriatenessandsuitabilityoftheadmission.


Theagerangeofresidents,onthedayoftheinspection,wasbetween26and78years.Lengthofstaydependedontheindividualresidentbutwasbroadlyreportedtobefromfourtofiveyears.Theresidencewasnotappropriateforanyresidentwhowasinneedofintensiveorenduringphysicalcare.


AhygieneaudithadtakenplaceinMarchandAprilof2009,withafollow-upduetohappeninthe}}

autumn.

Abathroomhadbeenupgradedtoapurpose-builtshowerroom.}}

Asittingroomhadrecentlybeenrefurbished.}}

Asidegatehadbeenincludedtothegardensideentranceforprivacyreasons.}}

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Theresidents’clinicalfilesweremaintainedatLincaradaycentreandwerenotaccessibletotheInspectorateforexamination.ThecareplaninEllerslieHousewasanursingcareplan.Thiscareplanremainedattheresidenceandwasevaluatedeverysixmonths.Eachresidentwasfullyreassessedeverysixmonths.Progressreportsweremaintainedtwicedailyoneachresident.Eachresidenthadasocialfunctioningsummaryrecordandrelatednursinginterventions,whichwerehighlightedingraphicformatonaperformanceanalysischart.Itwassubsequentlyreportedthatallresidentshadamultidisciplinarycareplan.

Eachresidentattendedtheirowngeneralpractitionerselectedbythemandrecordsofattendanceweremaintainedattheresidencetoensureregularphysicalreviews.

ThemultidisciplinaryteammetatLincaradaycentreeachweek.Itwasreportedthateachresidentwasreviewedatleastmonthlybytheteam.Recordsofthesemonthlyreviewsweremaintainedatthedaycentre.TheCNM2fromtheresidenceattendedthismeeting.


MostresidentsattendedLincaradaycentreonadailybasis.Lincaraprovidedastructuredactivityprogramme.OthersattendedNewDawn,astep-uptrainingcentreforwork-trainingskillssuchascomputers,cookery,purchasingskills,andphysicaleducation.TworesidentswerecurrentlyenrolledinBrayAdultEducationCentre:onewasstudyingcomputerscience,whileanotherwasstudyinggeography.

Aprogrammeoflife-skillstrainingwasconductedattheresidence,placingresponsibilityoneachresidentfortheirindividualactivitiesofdailyliving.Asharedinternaldutyrosterforresidentstotakeownershipofhousekeepingresponsibilitieswasalsoinplace,forexampleputtingoutandbringinginbins,settingtablesformeals,gardenmaintenance,dishwasheremptying,washingupandcleaningdiningroom.


TheresidencewasaperiodhouseinasuburbanpartofBraywithsimilarstylehousessetoutalongatree-linedroadandfacingapublicparkthathadalargegrassyareawhereduringthesummertime,picnicswereheldbytheresidentsandstaff.ItwasreportedthatprivateresidencesontheroadwerefriendlyandsupportivetowardsEllerslieHouse.OnNewYearsEveeachyear,apartywasheldwhichwasattendedbytheneighboursontheroadandstaffandresidents.Itwasreportedthattheresidencehadexcellentcontactswiththecommunityandwerekeptupdatedonupcominglocaleventssuchaschurchfetesetc.

Residentswentfrequentlyintotowneitheraccompaniedbystafforunaccompanied.Oneresident,whohadagoodearformusic,wasamemberofCeoltas.ItwasreportedthatallresidentsweremembersofthelocallibrarywheretheyattendedeachSaturday.

121



Theresidencewasalargethree-storeyperiodresidencebutwaswell-maintained,brightandwell-ventilatedandinagoodstateofdecor.Aconservatoryhadbeenbuiltoverlookingthelargereargarden,whichhadtwoappletreesandapeartree.Asittingroomandshowerroomhadrecentlybeenupgradedtoahighstandard.ItwasreportedthattheresponseratefromthemaintenancedepartmentatNewcastleHospitalwasgood.Thereweretwosittingrooms,eachwithaTVsetandaconservatory.Duringthesummer,mealswereeatenoutdoors,weatherpermitting.Thelaundryareaoffthekitchenwaslargeandfunctional,witharearentranceleadingtothegarden.

staffing levels


staff Discipline Day Wte night WteNursing 1CNM2+1staff 1staffCareassistant 2 0

Sessional

Discipline number of sessionsConsultantpsychiatrist OnceaweekatdaycentreNCHD DailyOccupationaltherapist 0Socialworker 0Clinicalpsychologist Accessuponreferral

team input

ThemultidisciplinaryteammetatLincaradaycentreeachweek.Itwasreportedthateachresidentwasreviewedatleastmonthlybythemultidisciplinaryteam.Recordsofthesemonthlyreviewsweremaintainedatthedaycentre.TheCNM2fromtheresidenceattendedthismeeting.ThestaffnurseatnighttimecouldcontactthenightCNM3atNewcastleHospitalifrequired.

Thestafflevelofonenurseonnightdutywasinadequatetofacilitatethecareof15residentsinahighsupportcommunityresidence.

Medication

PrescriptionswerewrittenbytheconsultantpsychiatristorNCHD.Withregardtophysicalillness,theresident’sGPwascalled.TheGPthenwroteaprescription.Allprescriptionswerefilledbythelocalpharmacyandcollectedbystaff.

DepotmedicationswereadministeredatLincaradaycentreandrecordedintheclinicalfilethatremainedthere.Theadministrationofthedepotwasalsorecordedintheresidence’sdiary.

Informationonmedicationwasprovidedbythemedicalandnursingteams.

Itwasreportedthattworesidentswereselfmedicating.

tenancy Rights

Rentwaspaidbyresidentsonaweeklybasis.Grocerieswerepurchasedbystaffonaweeklybasisusingaprocurementcardthathadbeenissuedtothreestaff.

122


UtilitieswerepaidbyNewcastleHospital.


Eachresidenthadtheirownpostofficeorbankaccount.Mostresidentsmanagedtheirownfinance.Thefinancialarrangementsofthreeresidentsweremanagedbystaff.Inthesecasesthebank/postofficebooksforeachthreeresidentsweremaintainedintheofficeandtwostaffsignatureswererequiredonindividualnotebooksforaccountabilitypurposes.


Thelibrarywasvisitedeachweek.ThereweretwoTVroomstofacilitateachoiceofprogramme.Aquietareacouldbeavailedofintheconservatorythatoverlookedthesideandreargardens.Aselectionofbookswasavailable.Twobroadsheetnewspapersweredeliveredtotheresidenceeachmorning.OntheSundayofeachbankholidayweekend,allstaffandresidentswenttoalocalrestaurantforaneveningmeal.Regularpancakenightswereheldintheresidence.Mainmealsweretakeninthegardenduringthesummerdependingontheweather.Picnicswerealsotakenintheparkacrosstheroadduringthesummer.Onthedayofinspection,aresident’ssixtiethbirthdaypartywasbeingarranged.


Mostresidentshadleftthebuildingbythetimeoftheinspection.Normally,thestafffollowedtheresidentstoLincaradaycentre.NoresidenthadaskedtospeaktotheInspectorate.AnumberofresidentsweregreetedbytheInspectorate.

Detailsofthelocaladvocacyserviceweredisplayed.

Theresidentscollaboratedinthedevelopmentoftheircareplansandco-signedthem.

Conclusion

EllerslieHousewasintegratedintothecommunityandwasindistinguishablefromotherhousesalongtheroad.Neighbourswerereportedtobesupportiveoftheresidenceandmuchcommunityinformationreachedtheresidentslivingwithin.Fromthenursingcareplans,andevidencegarneredduringtheinspection,therewasevidencethatthephilosophyoftheresidence,whichwastopromoteandencouragetheindependenceofeachresidentsoastolivemeaningfullivesinthecommunity,wasbeingpracticed.Thestafflevelofonenurseonnightdutywasinadequatetofacilitatethecareof15residentsinahighsupportcommunityresidence.


1. Staffing levels at night should be increased.

2. Each resident’s clinical file should be accessible on a twenty-four hour basis.

123



ExecutiveCatchmentArea Kildare/WestWicklow,Laois/Offaly,Longford/Westmeath

MentalHealthServiceInspected Laois/Offaly

ResidenceInspected ErkinaHouse,Rathdowney



NumberofRespiteBeds(ifapplicable) 1male


DateofInspection 25August2009

Description

service Description

This24-hourcommunitystaffedresidencefirstopenedin1996andwaslocatedintheheartofRathdowneyvillage.Thehousewasbuiltapproximately130yearsagoandfunctionedasaconventpriortoopeningasacommunityresidence.Itwasatwo-storeyhousewithbedroomaccommodationupstairsanddayroomsdownstairs.Atthetopofthefirstflightofstairs,bedroomaccommodationcomprisedtwomaleroomswithfourbedsineach,withacurtainseparatingtheroominhalfwithtwobedseithersideofthecurtain.Upanotherfewsteps,therewere9singlerooms,1maletoiletandseparatebathroomand1femalecombinedtoiletandbathroom.Therewasanewtoiletandaccessibleshowerdownstairsandanumberofothertoiletsandalaundryroom.Thediningroomwasattachedtoakitchenwhereallthemealsweremadeonsite.

Therewasawell-maintained,spaciousandprivatelandscapedgardentothebackofthehouse.Toonesidetherewasavegetablegardenthathadbeendevelopedandmaintainedbystaffandresidents.Thisfacilityprovidedachoiceofactivitiesandwasparticularlypopularwithsomeofthemenwhowerenotinterestedinsomeoftheotheractivitiesoffered.

Thepremisesalsohousedadaycentrethatcateredforupto25serviceusers.TheBirrsectorteamheldanoutpatientclinicthereeverytwoweeksandtworoomswerealsousedbyteammemberstoscheduleappointmentsinbetweenclinics.Oneoftheroomswasalsousedbyanumberofvoluntaryagenciestofacilitatemeetings.AnearbyrefurbishedhousehadbeenconvertedtohousethedaycentreandtherewasaccommodationfortheBirrteamtoholdclinicsandappointments.Theopeningofthesepremiseswasawaitingstaffing.Thenewlyrefurbishedpremiseswereofaveryhighstandard.Thenewdaycentreandsectorofficeswereduetofreeupmorespaceforusebytheresidents.Thisalsomeantthatresidentswhowereabletoattendthedaycentrewouldbegoingoffsite.

Thephilosophyofcarewastosupportandencourageresidentswithmentalhealthproblemssothattheycanparticipateinallaspectsofdailylivingandtakeanactiveroleinthedecisionsthataffecttheirlives.Theresident’srighttochoosenottoparticipatewasalsoacknowledged.


Twomenandtwowomenwereover65yearsandtheothersixmenandsixwomenwereunder65years.Theyoungestresidentwasaged41yearsandtheoldestwasaged69years.SevenoftheresidentshadbeenaccommodatedtheresinceErkinaHouseopenedin1996andtheremainingninehadbeentherebetweenfivemonthsandfiveyears.

124



Anewinformationbookletwasintroduceddescribingtheresidenceandservicesprovided.Thiswas}}

giventoserviceuserswhowereconsideringaccommodationinErkinaHouse.

AstatementofpurposedocumenthadbeendevelopedthatpositionedErkinaHousewithintheoverall}}

rehabilitationserviceprovisionofLaois/OffalyMentalHealthServices,outlinedtheaccommodationprovided,thephilosophyofcare,mechanismsinplaceforconsultationwithserviceusers,organisationofcare,interventionsoffered,inputfromvoluntaryorganisations,referralandadmissioncriteria,staffinginputandthemodelofcare.

ClientandstaffsurveysintheLaois/Offalyservicehadbeencompletedinrelationtonewcareplans}}

andinformationwasbeinganalysed.TheresidentsandstaffofErkinaHousewereduetoreceivefeedbackwhentheanalysiswascompleted.

SuccessfulliaisonwithLaoisCo.Councilresultedinprovisionofanewboundarywalltothefrontofthe}}

buildingandapedestriancrossingadjacenttothepremisestoenhanceresidents’safety.

Thefurnitureinthesittingroomhadbeenupgradedandroomshadbeenrepainted.}}

Agardeninggrouphadbeenestablished.}}



Allresidentshadarehabilitationteamassessmentandcareplancompleted.Thesewerereviewedapproximatelyeverysixtoninemonths,ormoreorlessfrequentlyifrequired.TherehabilitationconsultantattendedErkinaHouseeveryweekandeachresidentwasdiscussedwithnursingstaff;residentswereseenasrequired.

AlloftheresidentswereregisteredwithalocalGPandstaffreportedacloserelationshipwiththeGPandpracticenurse.TherewasgoodaccesstospecialistconsultantsandclinicsthroughtheGP.

Therehabilitationteamhadnohealthandsocialcareprofessionals,soaccesstoclinicalpsychology,socialworkandoccupationaltherapyinmentalhealthwaslimitedtowhatcouldbeprovidedthroughnegotiationwiththeheadsofdiscipline.TherewassomeaccesstocommunityoccupationaltherapyandsocialworkthroughtheGPservice.


Theactivationareaofferedservicestoresidentsanddayattendees.ThiswasavailablefivedaysaweekandwasrunbyaCNM1andtherewasinputfromtheoccupationaltherapistfromtheBirrteamandasocialskillsinstructorfromtherehabilitationteam.

Anarttherapistfromtherehabilitationteamfacilitatedartandpotteryclassesandarrangedvisitstoartexhibitions.

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Althoughtherewerenohealthandsocialcareprofessionalsontherehabilitationteam,limitedaccesswasfacilitatedbyheadsofdisciplineintheLaois/Offalymentalhealthserviceswherepossible.TherewasalsosomeaccesstotheseprofessionalsthroughtheGP.

Therewasagardeninggroupthatresidentscouldparticipatein.

Therewasaccesstovoluntaryagencies,e.g.GROWandtheMentalHealthAssociation.

TwooftheresidentswereseekingsupportedemploymentthroughtheMidlandEmploymentSupportAgency(soontoberenamedasEmployAbilityService).


Thepremiseswerelocatedinthecentreofthevillagewitheasyaccesstoarangeoflocalfacilitiesincludingthetownlibrary,pubsandshops.Residentscouldgotolocalcabaretsanddances.

Residentswereinvitedtoallcommunityfunctionsthroughtheircloselinkswithlocalsocialservices.SomeoftheresidentsusedthelocallibraryandtherewasaccesstolocalGAAeventsandgolfclubsocialactivities.

ThelocalcommunitywereinvitedtoattendChristmaspartiesandsaleofworksinErkinaHouse.

Oneoftheresidents,anartist,hadalocalartistasmentorandexhibitedhisworkatcommunityexhibitions.

ThelocalcommunitywereinvolvedinfundraisingforErkinaHousethroughtheMentalHealthAssociationandtheLaoisHunt.

Theservicehadbuiltandwasactivelymaintaininggoodlinkswiththelocalcommunitybyparticipatinginlocaleventsandinvitingthecommunityinforspecialoccasions.


CCTVwasusedtomonitortheexternalareasofthefrontandbackdoorforsecurity.

Thepremiseswerewellmaintainedandtherewasgoodaccesstorepairandmaintenancestaff.Thedecorwasinverygoodconditionandwassympathetictothestyleofthebuilding.Alltheroomswerebrightandfresh,withtheexceptionofonedownstairstoiletthatwasinneedofrefurbishment.

Thetwomalebedroomsrequiredfurtherworktoensuretheprivacyofeachresident.

Thehousehadanumberofdayroomsalongwithaspaciousgardenfortheuseofresidents.ItwasanticipatedthatmorespacewouldbecomeavailabletoresidentswhenthedaycentreandBirrteammovedtothenewdaycentre.

Therewasahealthandsafetystatementinplace.

ErkinaHousewasideallylocatedinthecentreofthetowntofacilitateeaseofaccessforresidentstolocalfacilities.

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staffing levels


staff Discipline Day Wte night WteCNM2 2 0CNM1 0 0Nurse 1 1Householdstaff 2 1

Sessional

Discipline number of sessionsConsultantpsychiatrist 1NCHD 0Occupationaltherapist 0Socialworker 0Clinicalpsychologist 0

team input

WeeklyrehabilitationteammeetingswereheldinPortlaoise.Duetoresourceissues,stafffromErkinaHousedidnotattendweeklybuttheyreportedtothemeetingaboutanyconcernsordevelopmentsandtherewasclosecommunicationbetweenthenursingteam.Everyquartertherewasafullmeetingoftherehabilitationteam.Theconsultantpsychiatristattendedeveryweekandsawresidentsasrequired.Theteamhadanarttherapistandsocialskillsinstructorwhohadinputtothedaycentrewheresomeoftheresidentsattended.

Medication

Noneoftheresidentswereonself-medicatingprogrammesatthetimeoftheinspection.

Medicationwasincludedintheresident’scareplanandcardindexreviewswerecarriedout.TheconsultantpsychiatristcarriedoutweeklyreviewsinErkinaHouse.Medicationwassuppliedbyalocalpharmacyandincludedthemanufacturer’spatientinformationsheet.Anumberofresidentsonspecificantipsychoticmedicationhadaccesstoaninformationvideo.

tenancy Rights

TheresidencewasownedbytheLaois/OffalyMentalHealthServices.

Generallythehouseruleswereflexiblebutcouldbenegotiatedonanindividualbasiswithstaff.Thiswasindicatedinthebookletgiventoresidents.Residentswereaskedtoinformstaffwhentheywereenteringandleavingthebuilding.Drugswerenotpermitted.

Communitymeetingsfortheresidentswerefacilitatedasrequiredwhenissuesarose.Therewasakeyworkersysteminplacethroughwhichmostissueswereaddressed.

Thecomplaintsprocedurewasoutlinedintheinformationbookletgiventoresidents.


TherewasaHSEpolicyandlocalguidelinesinplaceregardingfinancialarrangementsforresidents.

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Allresidentshadapostofficeaccount.Fourtofiveresidentsalsohadbankaccounts.Allwereinreceiptofsocialwelfare.

Residents’moneydealtwithbystaffwasrecordedinabookandsignedbystaffandtheresident.


Thedaycentrefacilitatedarangeofrecreationalactivities.

SwimmingwasaccessibleinMonasterevin.

Individualandgroupoutingswereavailable.Residentshadanannualholidaywithstaff.Therewasaccesstoapeople-carriervehicle,whichwassolelyfortheuseofErkinaHouse.

Residentsaccessedthelocallibrary,pubsandshops.

Atnighttherewasaccesstocabarets,dances,pubsandresidentssocialisedwithstaffandlocals.


AnumberofresidentswereinErkinaHouseonthedayofinspection.Oneoftheresidentshadaccesstoaworkshopwhichheusedasastudioforhisart.HeinformedtheInspectoratethathehadbeeninvolvedinseveralexhibitionsandwasplanningafurtherexhibitionsoon.Hewasverypleasedwithhisaccommodationasithadthisaddedbenefitforhim.Hewasfacilitatedandencouragedbystafftopursuehisartisticworkandhadteamedupwithalocalartistwhowasmentoringhimandtheyaccompaniedeachothertoexhibitions.

Eachresidentwasinvolvedintheirrehabilitationteamassessmentandcareplan.Residentshadsignedtheircareplans.

TheIrishAdvocacyNetworkwasactiveintheareaandresidentscouldaccessthisserviceifrequired.

Conclusion

ErkinaHousewasabright,well-maintainedandspaciousresidenceprovidinghighsupportaccommodationforcontinuingcareandrehabilitationto16residentsoftheservice.ItwassituatedinthecentreofRathdowneyandlocalfacilitieswereeasilyaccessible.Itwasunderthecareoftherehabilitationteam,whichwasunder-resourcedhavingnohealthandsocialcareprofessionals.

TherewasnolowsupportaccommodationinthevacinityandresidentshadtomoveontoPortlaosieorTullamore,whichwasverydifferenttotheruralsmalltownenvironmentprovidedinErkinaHouse.Whilethissuitedsome,itdidnotsuitothers.Someresidentshadbeenabletoaccesssocialhousingthroughthelocalsocialservicesandremainedinthecommunity.

Sevenoftheresidentshadbeentheresincetheaccommodationopenedanditwasunlikelythattheywouldprogresselsewhereintheservice.ThispopulationhadoriginallybeenmovedfromSt.Fintan’sHospitalandwereanageinggroup.ThismayposesomedifficultiesinthefutureasthehousewasnotaccessibletothosewithlimitedmobilityandatpresenttheonlyoptionsweretomovetohighsupportedsinglestoreyaccommodationinTullamoreorbacktoSt.Fintan’sHospital,involvingupheavalfortheresidentsaffected.

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1. Alternative arrangements should be put in place to ensure privacy in the shared male bedrooms.

2. The number of residents in Erkina House (17 beds) was high and consideration should be given to lowering these to enhance the quality of life of the residents.

3. The day centre should open as soon as possible so that residents who can avail of this service have somewhere off site to go during the day.

4. The rehabilitation team should be fully resourced with health and social care professionals.

5. More formal time frames should be put in place to ensure regular mental and physical reviews of all residents.

129



ExecutiveCatchmentArea HSEDublinMidLeinster

MentalHealthServiceInspected DublinWest/DublinSouthWestMentalHealthServices

ResidenceInspected St.Columba’s,Crumlin





DateofInspection 1October2009

Description

service Description

St.Columba’swassituatedinthetopfloorofalargebox-likebuildinginitsowngroundsinasuburbanareaofCrumlin.Asaformermonasteryithadaninstitutionalappearance.Thegroundswhichuntilrecentlywereovergrown,werecurrentlybeingrenovatedbyhorticulturalstudents.

Thedownstairspartofthebuildinghousedadaycentreandcommunityoutreachteam.Upstairstheresidencecateredforanageingpopulationwithvaryingdegreesofphysicaldisability,buttherewasnolift.Planstodevelopapurpose-builtresidenceappearedtobeshelved,althoughstaffweresomewhatconfusedaboutfutureplansfortheserviceandtheownershipofnearbysites.Theemphasiswasoncontinuingcarebecauseofthedifficultyofmovingpeopleontoalternativeaccommodation.

Staffalsohadresponsibilityformanagingthemediumsupporthostelnearby.


Theresidencecateredforsevenmaleandtenfemaleresidents,agedfrom36to75years,whohadbeenwiththeserviceforfrom2to20years.Mosthadbeenmovedfromin-patienthospitalcare.Aswellasaprimarypsychiatricdiagnosis,fiveresidentsalsohadintellectualdisability.Mosthadsignificantphysicalillhealthandwereintheolderagegroup.Fiveresidentswerereadyfordischargetonursinghomecarebutthiswasnotpossiblebecauseoffundingissues.Someresidentspresentedwithchallengingbehaviourandupsetotherresidentsbyharassingorshoutingatthem.ThesepeoplesometimesavailedofrespitebedsinLorrhaUnitinSt.Loman’sHospital.


AsaresultoffloodinginJuly,10,000eurowasspentinrepairingtheroof.}}

Themedicalteamhadreviewedpatientmedication.Asaresult,allmedicationregimeshadbeen}}

simplifiedandoneresidenthadhadmedicationdiscontinuedwithoutadverseeffect.

TheteamhadworkedwiththelocalMentalHealthAssociationtodevelopahousingprojectwhichwill}}

helpaccommodatesomeresidents.

Draftmultidisciplinarycareplanshadbeenintroduced.}}

130


Casefileswithmultidisciplinarycareplansaccompaniedresidentswhentheyattendedoutpatient}}

clinicswiththeirsectorteamdoctors,minimisingthelikelihoodofpoorcommunicationleadingtobaddecisionmaking.Communitymentalhealthnurseswhoknewthepatientswerealsopresent.

Adailycommunicationsheetfacilitatedgoodcommunicationbetweenstaffmembersandwaskeptin}}

thepatientnotes.

Oneroomhadbeenadaptedasasmokingarea.}}

Theservicehadbeenreducedbytwobedsinthelastyear,inanefforttoincreasespaceforresidents.}}

Heatinghadbeenintroducedtoashowerroomandabasicpumphadbeeninstalled.}}

Staffcouldavailofongoingtraining.}}



DraftmultidisciplinaryplanswereinplaceandforreviewinNovember.Monthlymultidisciplinaryteammeetingstookplacewiththefullteamattending.However,therangeandeffectivenessoftheseplanswaslimitedbyshortageofmultidisciplinaryteammembers.Theoccupationaltherapistvisitedonceaweekandtherewasnopsychologistattachedtotherehabilitationteam.Thesocialworkertimewassharedwithotherpartsoftheservice.

PhysicalhealthneedswereaddressedbythevisitingGPwhoattendedtheserviceweekly.Staffreportedthathewasverysupportive.Anout-of-hoursmedicalservicewasprovidedbytheDubdocagency.Routinephysicalexaminationswerenotbeingconducted.TheservicecouldlinkwiththepublichealthnurseinPrimaryCommunityandContinuingCare(PCCC).


Anarttherapistattendedonaweeklybasis.Staffreportedthatresidentsvaluethiscontribution,andhadtakenpartinexhibitionsandenjoyedtheirworkbeingdisplayedaroundtheunit.Anannualexhibitionofresidents’artwasheldandrelativeswereinvited.Somemoneyfortheartprojecthadbeenlostbecauseoffinancialcutbacks.

Adancingprogrammehadbeenintroducedforresidentswhocouldnotleavetheunit.

ResidentshadaccesstoTVintheirroomswheretheyprovidedthisthemselves.OtherwiseaccesstoTVwasinthelivingarea.

Anoccupationaltherapistvisitedtheserviceforahalfdayeachweek.

Achiropodistandbeauticianvisited.

Staffreportedthatthetimespentonsocialactivitieshadbeenreducedbecauseofthelevelofdemandonstafffornursingcare.

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Theserviceusergroupmetmonthly.Ithadanindependentchairandstaffattend.Outsideagenciesattendedandgavetalksonavarietyoftopics,e.g.advocacy,socialwelfare,andhousing.

Residentswhocould,tookpartinactivitiesandsocialsorganisedbytheCrumlindistrictbranchoftheMentalHealthAssociationeverysecondweek.Thisgroupalsoorganisedpubquizzes.

Somepeoplecouldleavetovisitlocalshopsorgointotown.Peoplewhoneedit,couldbeaccompanied.

ThePINELprojectfacilitatingsocialskillstraining,organisedbytheKimmage,Walkinstown,Crumlin,Drimnagh(KWCD)Partnership,hadbeendiscontinuedduetocutbacks.

TransportwassharedwithTallaghtforoutingsandtheChristmasparty.


Thebuildingwasoldandpoorlymaintained.TheInspectoratewasinformedthatmoneyhadnowbeenallocatedforsomeimprovements.Theinteriorofthebuildingwasbeingpaintedonthedayofinspection,buttherewasevidencethatthishadnotbeendoneforsometimepreviously.Althoughthereweretwotoiletsandtwobathsandashowerwithatoilet,onlythelatterwasfullyinuse.Thebathscouldnotbeusedastheyweretooinaccessibleforpeoplewithphysicaldisabilities.Therewasthereforeonlyoneshowerforalltheresidents.Thesefacilitieswerelocatedatoneendofthebuildingsothatelderlyorsickpeoplehadtowalkaconsiderabledistancetoaccessthembydayandbynight.TheInspectoratewasinformedthatatenderingprocesswasinhandfortwowetrooms.

Thesluiceroomwasoldandinpoorrepair.

Mostresidentshadtheirownbedroomsbuttherewerefourdoublerooms.Thesedidnothavecurtainstofacilitateprivacy.Somebedsweredivantype,whichwasnotconducivetohygienecontrol.Moresuitablebedshadbeenrequestedbutfundinghadnotbeenforthcoming.Theceilinginsomeroomshadevidenceofdamageinflictedbythefloodsearlierintheyear.Mostroomshadtheirownwash-handbasins,butsomedidnot.Therewereappropriatecurtainsonthewindows.Over-sinkmirrorswereprovidedbutnofull-lengthmirrors.

Muchofthefurniturewasoldandneededtobereplaced.Oneresidenthadboughttheirownbedroomfurniture.Thefamilyofanotherhadpaidfortheredecorationoftheirroom.

Residentshadachoiceofdietandtheirsuggestionshadbeenlistenedtowithregardtochoice.MainmealsweresuppliedbytheBallyfermotresourcecentre.Atweekendsandatnightresidentscouldavailofthehousekitchen.

Staffreportedthatanenvironmentalhealthofficervisitsevery6monthsandimprovementssuggestedhadbeenmete.g.foodwasnowprobedfortemperaturecontrol.StaffwereHazardAnalysisandCriticalControlPoints(HACCP)trained.

Therewasonedomesticstaffmemberchargedwithdailycleaningofthepremises.Whilegenerallytheunitwasclean,thiscouldbebetterinsomeinstances.Nursingstaffreportedthattherewasaneedformorestaff.

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staffing levels


staff Discipline Day Wte night WteCNM2 1 1Staffnurse 1 1Attendant 1 1Domesticstaff 1 0

Sessional

Discipline number of sessionsConsultantpsychiatrist 1every4weeksorasneededNCHD DailyfromdaycentredownstairsOccupationaltherapist 1halfdayperweekSocialworker ByappointmentClinicalpsychologist Aspersectorteam

team input

Multidisciplinaryteammeetingswereheldmonthlybytherehabilitationteam.Managementofindividualpatientswasdecidedbyagreementbetweenthesectorandrehabilitationteams.Decisionswererecordedinnotesandthedraftcareplans,whichaccompaniedresidentstooutpatientsclinics.Inadditionresidents’needswerediscussedwiththeirsectorteamwhentheirteammeetingswereheldinthedaycentredownstairs.Becauseofthenumberofteamsinvolved,preferencewasexpressedforthestrengtheningofthetiesbetweenonesectorteamandtherehabilitationteam.ItwasfeltthetransferofallresidentstothecareoftheCrumlinsectorteamwouldfacilitatetightercasemanagement.

Medication

Themedicalteamreviewedallresidents’medicationsduringtheyear,resultinginsimplificationofthemedicationregimeformostresidents,whileoneresident’smedicationhadbeendiscontinuedwithoutilleffect.

Informationontheirmedicationwasprovidedtoresidents,basedonwhatwasavailablewithmedicationpacks.Whereresidentsidentifieddifficultyinunderstandingthis,staffmembersreportedtheygiveinformationverbally.

Noself-medicationprogrammeswereinplaceasstaffbelievedthiswouldresultinpooradherence.

tenancy Rights

Rentof90eurowaspaidtotheHSE.Noleaseagreementwasavailabletoresidents.

Theusergroup,whichmetmonthly,couldcommentonissuesarising.Attheusergroup’ssuggestion,greaterfoodchoicewasintroducedandachoiceofholidaywasdecided.MembersattendedtheIrishAdvocacyNetworkconferencetwoyearsago.


RentwaspaidbymonthlydirectdebittotheHSEfromresidents’bankaccounts.Whereresidentswerenotabletoaccesstheseaccountswrittenpermissionwasobtainedfromresidentsforstafftodosoontheirbehalf.Smallsumsofmoneywerekeptontheunitforday-to-dayexpenditure.Onadmission,

133


houseruleswerepresentedtoresidentsandsignedbythem.Thiswasinaccordancewiththepolicydocumentwhichwassignedanddated.

TheHSEpaidhouseholdbillsandallowed5,000euroamonthforshopping.

Issuesofcapacitywerereferredtotheconsultantpsychiatrist.


TheservicewasaskedtoforwardinformationtotheInspectoratebutdidnotdoso.


Twoserviceusersinterviewedreportedtheywerehappywiththeservice.

Conclusion

Thisservicewasprovidedinanoldbuildingwhichwasunfitfortheprovisionofamodernmentalhealthservice.Itwasphysicallydeficientinbasicfacilitieswhichshouldbeavailabletoadultssharingaccommodation,particularlywherethesepeoplewereelderlyordisabled,e.g.appropriatebathroomsandalift.Thelackofmove-onaccommodationhadresultedintheserviceoperatingasacontinuingcareratherthanarehabilitationfacility.Allconcernedweretobecongratulatedonthedegreetowhichlinkstothelocalcommunityhadbeenencouraged.However,theincreasingneedforphysicalcarefortheageingpopulationmeantlesstimewasspentinrehabilitation-relatedactivitiesbythenursingstaff.Thediscontinuationoflocalcommunityprojectsduetocutbacksimpactednegativelyonresidents’qualityoflife.


1. The future of the service should be decided and the decision conveyed to staff.

2. The physical deficits of the building should be addressed to bring it into line with modern requirements.

3. Appropriate furnishings should be obtained.

4. Every effort should be made to facilitate the transfer of those residents who need it to more appropriate accommodation.

5. The rehabilitation team staffing should be completed in line with the recommendations of A Vision for Change.

6. The arrangements for sharing care between rehabilitation and sector teams should be reviewed.

7. Six-monthly physical reviews should be conducted and a record that this has been done should be entered into the patients’ notes.

8. Future developments should facilitate single room occupancy for all residents.

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Hse south


ExecutiveCatchmentArea Waterford/Wexford

MentalHealthServiceInspected Waterford

ResidenceInspected ArdnaDéise





DateofInspection 18May2009

Description

service Description

ArdnaDéisewasalargeresidentialhousewith14residentbedsand1respitebedthatopenedasa24-hoursupervisedresidencein1993.Thehousewaslaidoutoverthreefloorsandhadaverylargegarden.Itwasunderthecareoftherehabilitationteam.ReferralscamepredominatelyfromSt.Otteran’sHospitalandtheaimofstaffwastofacilitateplacementinindependentaccommodationforappropriateresidents.


Thecurrentagerangeofresidentswasfrom27to72years.Someresidentshadbeenlivingattheresidencesinceitopenedin1993.Onthedayofinspection,therewereeightmaleandfivefemaleresidents.Withtheincreasingageprofileofresidents,thelayoutofthehousemayprovidedifficultiesforthelessable-bodiedresidentsinthefuture.Theresidentswereinvolvedinvariousactivities.FouroftheresidentsattendedtheactivationunitinSt.Otteran’sHospitaldaily.Thiswasanoccupationaltherapybasedactivitiescentre.OneresidentwasemployedinSt.Otteran’sinthehospitallaundry.


StaffwereimplementingtheSolutiontoWellnessprogrammeforresidents.}}

AllstaffhadparticipatedinamusictherapyprogrammeinconjunctionwiththeWaterfordHealingArts}}

Group.

CareplansforresidentsbasedontheCamberwellAssessmentofNeed(CAN)hadbeenintroduced.}}

Allstaffhadreceivedregulartrainingincardio-pulmonaryresuscitation(CPR).}}

135




AweeklyteammeetingwasheldinSt.Otteran’sHospitalandwasattendedbyamemberofstafffromthehouse.TheCamberwellAssessmentofNeedbasedcareplanhadbeenintroducedbuthadnotyetbeendrawnupforallresidents.Thekeyworkersystemwasinplaceandresidentswerefamiliarwiththeirkeyworker.Currentcareplanswereupdatedmonthly,andincludedriskassessments.Residentssignedtheirindividualcareplans.

Six-monthlyphysicalhealthreviews,includingroutinebloodtests,wereconductedbytheresident’sGP.RecordsofallGPandoutpatientvisitswererecordedintheresident’sfile.

Theconsultantpsychiatristvisitedthehouseeverytwomonths,ormorefrequentlyifnecessary.


FiveresidentsattendedtheactivitiescentreinSt.Otteran’sHospitaldaily,bypublictransportorintheresidence’sownminibus.Oneresidentwenttothedaycentre,andsomeresidentshelpedwiththehouseholdchores.

Residentsinthehousecouldattendmusictherapy,facilitatedbystaff.


Residentsfrequentlyvisitedthenearbylocalshops.Oneortworesidentsassistedwiththeweeklyshoppingforthehouseinalocalsupermarket.Someoftheresidentsalsovisitedthelocalpubonoccasion.

StaffhadestablishedalinkwiththeWaterfordHealingArtsTrustandWaterfordMentalHealthAssociation.TwomembersofthehousemetregularlyintownwithmembersoftheWaterfordMHA.


Thehousewasalargeonewithadequatelivingspace.Therewasalargesittingroomanddiningroom.Residentshadeasyaccesstoalargegarden,whichwasmaintainedbygardenersfromSt.Otteran’s.Bedroomsweremostlydouble,withonetripleroomandthreesinglerooms.Therewasevidenceofdampinsomeoftheroomsandstaffreportedthattherewasnocontractorforcleaningoftheoutsidewindowsofthehouse.

TherewasCCTVmonitoringatthefrontdoorandaroundthefrontofthebuilding,forsecurityreasons.

136


staffing levels


staff Discipline Day Wte night WteCNM/Staffnurse 2 1Householdstaff 1 0

Sessional

Discipline number of sessionsConsultantpsychiatrist 1NCHD 1Occupationaltherapist AccessSocialworker 1

Medication

Medicationsweresourcedinthelocalpharmacyandpaidforthroughthemedicalcardsystem.Depotmedicationsweregivenintheresidence.Writteninformationonmedicationswasprovidedbymeansoftheinformationleafletinthemedicationpack.

tenancy Rights

Eachresidentpaid,onaverage,g70rentperweek.Collectively,thehousethenpaysrentofg1,100permonthtoSt.Otteran’s.Beyondthat,theresidencewasself-sufficient,payingforitsowngroceries,electricity,fuel,anddieselforitsminibus.


Withacoupleofexceptions,staffcollectedpensionsfortheresidents.Residentsthenhadaccesstotheirmoneyintheresidenceasrequired.Twomembersofstaffwitnessedallfinancialtransactionswithresidents.


Residentshadaccesstoagoodrangeofrecreationalactivities.Therewereregularoutingstothecinema,drives,swimming,Sundaylunchandshopping.Birthdaypartiesforsignificantbirthdayswereheldinthehouse.TworesidentswereparticipatinginaphotographycourserunbyMentalHealthIreland.Therewasnointernetaccessinthehouse,whichwasfelttobeadisadvantageforbothresidentsandstaff.


TheserviceinArdnaDéisehadproducedaninformationleafletonthehousewithdetailsoftheethos,staffandrecreationalactivities.AnadvocatefromtheIrishAdvocacyNetwork(IAN)visitedthehouseabouteverysixweeks.Tworesidentsattendaweeklypeersupportgroup.

ResidentswereinformedofthevisitandinvitedtospeakwiththeInspectorate.Anumberofresidentsspokebrieflyaroundthehouseduringthecourseoftheinspection.Oneresidentspokeinmoredepthandexpressedoverallsatisfactionwiththehouse.However,theresidentindicatedthattheywouldlikesomemoreactivitiesinthehouse,forexamplepainting.

137


Conclusion

TheresidenceatArdnaDéisewasacomfortablehousewhicheasilyaccommodatedthenumberofresidents.Therewasevidencethatsomestructuralmattersneededtobeaddressed.Residentshadgoodaccesstofacilitiesoutsidethehouseanditwasclearthattheywereencouragedbystafftobeasindependentaspossible.Thereappearedtobegoodlinkswiththecommercialagencieslocallybutinteractionwithneighboursinthelocalityseemedlimited.Staffreportedgoodaccesstotherehabilitationteamandwerekeentocontinuetheimplementationofthenewcollaborativecareplans.Physicalhealthneedswerewellmonitored,withtheclearcooperationofthelocalGPs.Thestafflevelofonenurseondutyatnightwouldseemtobeinadequateforaresidencecateringfor13residents.


1. The house should be maintained in a good state of repair and current problems with damp should be addressed.

2. Internet access should be made available for staff and residents.

3. An occupational therapist should attend the house on an intermittent basis and implement a programme of activities for those residents who are unable to attend outside activities.

4. Staff levels at night should be increased.

138



ExecutiveCatchmentArea Carlow/Kilkenny/SouthTipperary

MentalHealthServiceInspected Carlow/Kilkenny

ResidenceInspected KelvinCourt



NumberofRespiteBeds(ifapplicable) None


DateofInspection 10September2009

Description

service Description

KelvinCourtwasanewlyconstructedunitforpersonswithanintellectualdisabilityopenedinFebruary2009,andwassituatedinthegroundsofSt.Dympna’sHospitalinCarlowtown.Itconsistedoffourself-containedbungalowsinagatedcomplex,surroundingacentralgardenarea.Threeofthehousescontainfivebedroomswithensuitefacilities,adayroom,diningroom,andancillaryroomsforstorage.Thefourthhousewasdesignedtoprovideaccommodationintwoseparateone-bedroomapartments.Residentsinthishousetooktheirmealswiththeresidentsinoneoftheotherhouses.Therewere17residentsinKelvinCourtandnoresidentwasconfinedtobedonthedayofinspection.

Thehouseswereveryclean,well-maintained,andbright.Eachresidenthadtheirownspaciousroom,withadequatewardrobefacilities.Someoftheroomsdisplayedpersonalitemsbelongingtotheresidents,butthiswasabsentinotherrooms.AlloftheroomshadTVsetsandDVDplayers,andhadbedsthatcouldbeadjustedbyremotecontrol.Communalareaswerecomfortablyfurnished.Eachhousehaditsowngardenatthebackofthehouse.


Alltheresidentswereinlong-termcareandhadbeentransferredfromSt.Dympna’sHospitalinFebruary2009.Theyincludedbothmaleandfemaleresidents.


TheunithadonlybeenopenedsinceFebruary2009.}}

Staffwerereceivingongoingtrainingspecifictotheareaofintellectualdisability,e.g.regulationof}}

sensoryinterventions,multi-elementbehaviouralsupportanduseofmultisensoryequipment.

139




Psychiatric reviews:Althoughnotanapprovedcentre,alltheresidentswereunderthecareofaconsultantpsychiatrist.However,itwasreportedthatnopsychiatristvisitedtheunitonaregularbasis.Anumberofresidents’fileswereexamined.NopsychiatricnoteshadbeenenteredinthefilessincethedischargefromSt.Dympna’sHospitaldated13February2009.Inthecaseofoneresident,therewereacoupleofentriesrelatingtophysicalcomplaintsonly.AfewresidentshadmultidisciplinarycareplansdrawnupinNovember2008,butnofurtherentrieswerenoted.Theservicehaddrawnupalistofmultidisciplinarycareplanstobecompletedoverthefollowingmonths.Sincetheinspection,ascheduleofpsychiatricreviewshadbeenimplemented.

Thefileofoneresidentwhohadbeenthesubjectofanincidentinthepreviousmonthwasnotavailableforexaminationonthedayofinspection.

Physical reviews:AGPattendedtothephysicalcomplaintsofresidentsanditwasreportedthatthisservicewasverysatisfactory.Physicalhealthexaminationshadbeencarriedoutwithintheprevioustwelvemonthsandweredocumentedinthefiles.Theservicehadestablishedasystemofalertingstafftotheneedforphysicalreviews.

Nursing: Nightnursingreportswerewrittenweekly,anditwasreportedthatdayreportswerewrittenaboutthreetimesamonth.


Mostoftheresidentsattendedactivitiesforpartofthedayintheactivitiescentrethatwasadjacenttothehouses.Residentswhohaddifficultyinattendingwithothersweregivenindividualprogrammes.Residentswerealsotakenonweeklyoutingsbythenursesintheunit’sdedicatedwheelchair-accessibleminibus.

How are residents facilitated in being actively involved in their own community, based on individual need?

Socialoutingstolocalcommunityfacilitiestookplaceregularly.


Theaccommodationprovidedtoresidentswasextremelygood.Eachresidenthadtheirownroom,andtherewerecommunalroomsforwatchingTV.

140


staffing levels


staff Discipline Day Wte night WteCNM2 1 –Staffnurses 4 –Healthcareassistants 1 1

Sessional

Discipline number of sessionsConsultantpsychiatrist AsrequiredNCHD AsrequiredOccupationaltherapist 0Socialworker 0Clinicalpsychologist 0

team input

Theunitwasself-staffing.Therewerenostaffassignedtothehousewiththetwoapartmentsduringtheday,butahealthcareassistantwasondutyatnight.Otherhealthprofessionalsrarelyattendedthehouses.

Allresidentswereunderthecareofaconsultantpsychiatrist.However,itwasreportedthatthepsychiatristrarelyattendedtheunit.AGPattendedeverythreeweekstodealwithphysicalailments,andalsoattendedasrequested.NursingstaffpraisedthecommitmentoftheGPinattendingtheunit.

Medication

Medicationwasprovidedfromthecommunitypharmacy.

tenancy Rights

ThebuildingwasownedbytheHSE.


ResidentshadTVsetsintheirroomsandincommunalsittingrooms.Stafftookresidentsonoutingsintheunit’sminibus.


Residentsweregreetedduringthevisit.Residentswhocould,expressedtheirsatisfactionwiththeunit.Oneresidentaskedtospeakinmoredetail.Theresidentreportednothavingseenadoctorsincearrivingintheunit,andwishedtospeaktoadoctor.

Conclusion

KelvinCourtprovidedfarsuperioraccommodationforresidentsthanpreviouslyexperiencedinKelvinGrove,wheretheseresidentslivedpriortotheirmovetointerimaccommodationinSt.Anne’sWardinSt.Dymphna’s.Residentsattendedactivitiesintheactivitiesunitinthegroundsofthehospital.PhysicalhealthneedsweremetbyalocalGP.

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Itwasunclearwhethertheprimarytreatmentbeingprovidedtotheresidentswasapsychiatricone,undertheclinicaldirectionofaconsultantpsychiatrist,orwhethertheprimarynatureoftheservicewastoprovideresidentialcaretopersonswithamentaldisorder,inthisinstance,intellectualdisability.TheunitwascurrentlynotregisteredasanapprovedcentrewiththeMentalHealthCommission.


1. A consultant psychiatrist in mental health of intellectual disability should be appointed.

2. Residents should be reviewed regularly by the psychiatric team, and multidisciplinary care plans should be completed for each resident.

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ExecutiveCatchmentArea NorthLee/NorthCork

MentalHealthServiceInspected NorthLee

ResidenceInspected Owenacurra,Midleton






Description

service Description

Owenacurra24-hourresidenceprovidedlong-termcaretoresidentsadmittedunderthecareofthecommunitymentalhealthteam.Itwasasingle-storybuilding,builtinthe1960s.Itbeganadmittingresidentsin1988.ItwasthefirstresidencetoadmitpatientsfromOurLady’sHospitalinCorkwhenthatinstitutionbegantotransferitspatientstocommunityresidences.AnumberofthecurrentresidentsweretransferredfromOurLady’s.Theresidentshadavarietyofmentalillnesses.


Onthedayofinspection,therewere31residentsranginginagefrom42yearsto93years.Therewere14maleand17femaleresidents.Halfoftheresidentswereover65yearsofage,andapproximately16residentshadbeentransferredfromOurLady’sHospitalinCorkin1988.Themajorityofresidentswerelongstay,butthetwomostrecentadmissionswerein2008.


Sincethelastinspection,theservicehadreplacedtheRopernursingcareplanswithamore}}

collaborativeTidalcareplan.

Ahygieneauditwasconductedin2008inthekitchen.Itsrecommendationswerefollowedup,which}}

resultedinsomechangesinthepracticeoffoodpreparation.

Threenurseshadcompletedadegreecourseinnursing,andonenursehadcompletedamaster’s}}

degree.

Twonursescompletedahandhygienecourseandsubsequentlytrainedtheremainderofnursingstaff.}}

Fourresidentsparticipatedin,andcompletedaNationalLearningNetworkscourse.}}

Othernursesdidcoursesonmedicationintheelderlyandongeriatricnursing.}}

143




Overthepasttwoyears,thenursingcareplanshadchangedtotheTidalmodelofnursingcare.Thiswasacollaborativemodelwhichinvolvedtheresidentintheformulationoftheirindividualcareplan,andwhichwassignedbythem.Themultidisciplinaryteammettwicemonthly,andwasattendedbytheconsultant,NCHD,socialworkerandnursingstaff.Eachresidenthadapsychiatricreviewcarriedouttwiceayear,andafullphysicalhealthreviewdoneyearly,includingroutinebloodtests.Inaddition,amonthlyrecordofweightwaskept.


Activitiesintheresidencewereprovidedbythenursingstaff,andincludenewspaperreadings,relaxationtapes,outings,assistancewithpersonalshopping,andone-to-onetalkswithresidents.

Aboutsixresidentsattendedthepsychiatricdaycentrethatwassituatedacrosstheroadfromtheresidence.Inadditiontoattendingoccupationaltherapyactivitiesinthedaycentre,residentshadaccesstopsychologyservicesthere.Fromtimetotime,theoccupationaltherapistonthecommunityteamcarriedoutassessmentsonresidentsoftheresidence.Thesocialworkerattendedtheresidencethreedaysaweek,andwasalsoavailableonotherdays.

Accesstophysiotherapywasthroughthecommunityservice,althougharrangementscouldbemadeforprivateappointments.Achiropodistattendedeverythreemonthsandresidentswerefacilitatedinattendingdental,opticianandhearingtestappointments.

Overtheprevioustwoyears,fourresidentshadcompletedcoursesintheNationalLearningNetworkcentreinthetown.


The24-hourresidencewasverywellsituatedinMidletontown,attheendofthemainstreet.Able-bodiedresidentscouldeasilyaccesstheamenitiesofthetownandvisitshops,banks,andcinemawithlittledifficulty.ResidentsattendthelocalChristmasoldageparty,andSt.Patrick’sDayparade.


Theresidencewaswellmaintainedandclean.Therewere15singlerooms,andtheremainderofroomswere2-bedor3-bed.Inaddition,twosingleroomswereassignedasrespitebeds.Manyofthesingleroomswerehomelyandpersonalmemorabiliaweredisplayed.The2-bedand3-bedroomsallhadcurtainedpartitions,affordingprivacytoresidents.Thereweretwosittingrooms,adiningroomandamultifunctionalroomwhichalsoservedasavisitors’room.Thebuildingitselfwasmorereminiscentofaninstitutioninlayout,ratherthanahouse.Ithadapleasantenclosedgarden.

Foodwaspreparedonsiteinthekitchen.

144


staffing levels


staff Discipline Day Wte night WteACNO 1 –

CNM2 1 1(acting)Staffnurse 3 2Contractcleaner 2

Kitchenstaff 3

Secretarialstaff 1

Allnursingstaffhadpsychiatrictrainingandanumberweredualqualifiedinpsychiatricandmedicalnursing.Studentnurseswereattachedtotheresidenceaspartoftheirtraining.

Sessional

Discipline number of sessionsConsultantpsychiatrist FortnightlyNCHD 2daysaweekOccupationaltherapist AccessSocialworker OnsitethreedaysaweekClinicalpsychologist Access

team input

Theconsultantpsychiatristattendedtheresidencefortnightly,andtheNCHDwasintheresidencetwodaysaweek.Reviewsofresidentswereheldsixmonthly.

Medication

Psychiatricreviews,includingreviewofmedicationwereconductedsix-monthly.Medicationswerechartedintheresidents’cardindexbytheconsultantorNCHD,whichhadthentobebroughttothelocalGPwhoissuedaprescriptionfortheresident.Thisprescriptionwasthenfilledinthelocalpharmacyanddispensed.Medicationswereadministeredbythenursingstaff.

tenancy Rights

TheresidencewasownedbytheHSE.


Residentspaidmaintenanceof152eurosaweek.Theremainderoftheirpensionincomewaseitherheldinthenurses’officeintheresidence,wheretheresidentcouldaccessit,orwasdepositedinabankorpostofficeaccordingtothewishesoftheresident.Administrationstaffmanagedpatients’privatepropertyonbehalfofthepatient.


TheresidencehadtwoTVsetsandaDVDplayer.Staffhadaccesstotransportfromthedaycentreandwereabletobringresidentsonoutingsandtrips.

145



ResidentsweregreetedbytheInspectorateduringtheinspection,butnonerequestedaninterview.

Conclusion

Owenacurrawasalarge24-hourresidenceinMidletontownwhichprovidedlong-termcarefor32residents.Itwaswellmaintainedandofferedpleasantaccommodationforitsresidents.Therecentintroductionofadifferentplanofnursingcarehadresultedinresidentsbeingmoreinvolvedintheirowncareplan.Residentshadagoodplanofcareforphysicalhealth,butwouldalsobenefitfrominputfromoccupationaltherapy.Whilenursingstaffclearlyprovideactivitiesforresidentsofanon-institutionalnature,thesizeoftheunitandthenumberofresidentsmakeitdifficulttogetawayfromtheappearanceofasmallinstitution;thiswasperhapscontributedtobystaffwearingnursinguniforms.Itwasclearfromthelevelofengagementbynursingstaffintheeducationalprocessthatstaffwerecommittedtoprovidingagoodqualityservicetotheresidents.Thearrangementrelatingtomedicationseemedcumbersomeandresultedinduplicationofservicefrombothmedicalandnursingstaff.


1. A computer and internet access should be provided for staff to enable ready access to information on blood tests, medications, etc.

2. The team attending the residence should be resourced to provide a better staff skill mix, particularly in occupational therapy.

146



ExecutiveCatchmentArea SouthLee/WestCork/Kerry

MentalHealthServiceInspected WestCork

ResidenceInspected PerrottHouse






Description

service Description

PerrottHousewaslocatedinthegroundsofthecommunityhospitalinSkibbereen.Itopenedin1996andwaspreviouslyanacutementalhealthadmissionunit.MostoftheresidentsmovedtoPerrottHousefollowingtheclosureofOurLady’sHospitalinCorkandtheresidencewasregardedastheirhome.HoweveranumberhadmovedtoSolasNua,aresidencethathadamorededicatedrehabilitationfocus.

Theresidentialservicehadrecentlybeenreconfiguredinordertoaccommodateserviceusersaccordingtotheirassessedneed.


Mostoftheresidentswereelderlyandhadbeenintheresidencesinceitopenedin1996.Therewere15menand8womenresidents.Theaverageagewas67yearsandtheaveragelengthofstaywas13years.


Theservicehadbeenreconfiguredasaresultofanongoingresidentialreview.}}

Eachresidenthadanindividualcareplan.}}

AquestionnairewascurrentlybeingrolledoutfromtheWestCorkCooperativeLearning}}

LeadershipGroup.

Acarerspackhadbeendeveloped.}}

Therewasanexcellentgardenconsistingofarelaxationandtherapeuticareaandavegetablegarden.}}

Pet-assistedtherapywasavailabletoresidents.}}

Therewasmusictherapyandarttherapyavailable.}}

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Eachresidenthadamultidisciplinarycareplan.Thereweremonthlymultidisciplinaryteammeetingsandakeyworkersystemwasinplace.

PhysicalexaminationswerecompletedbytheGPevery6months.TheGPattendedonceaweekormoreoftenifrequired.


Therewasastaffmemberdedicatedtotherapeuticactivities.}}

Thereweregardenprojectsinplace.Thisincludedanannualplantsale.}}

Therewereregularrelaxationandreflexologysessions.}}

Regularstory-tellingandmusictherapytookplace.}}

Arttherapytookplaceandthisincludedanannualartexhibition.}}

AmusicinhealthcareprogrammewasduetostartinSeptember2009.}}

Cookeryclassestookplace.}}

VECtutorsattendedonaweeklybasistoprovidetheart,relaxationandgardening.}}


Theresidencewassituatedabout1.5kmoutsidethetownofSkibbereenandmostresidentswereunabletotravelintotownindependently.Therewasnopublictransport.Therewasapeople-carriervehiclebelongingtotheresidenceandsocialoutingstothetowntookplaceatleastthreetimesaweek.


PerrottHousewasoriginallyanacuteunitandthestructurereflectedthis.Mostresidentsdidnothavesingleroomsbutcurtainswereprovidedaroundthebeds.Eachsleepingareawaspersonalised.Eachresidenthadalockedboxforprivatepossessions.

148


staffing levels


staff Discipline Day Wte night WteNursing 3 2x12hours

1x2hoursCareassistants 1 0Activitiesstaff 1 0

Sessional

Discipline number of sessionsConsultantpsychiatrist OnceamonthNCHD OnceaweekOccupationaltherapist OnrequestSocialworker OnrequestClinicalpsychologist 0Physiotherapist Onrequest

team input

Multidisciplinaryteammeetingstookplaceonceamonthandalldisciplinesattended.Careplanswerecompletedatthesemeetings.TheGPattendedonceaweek,ormoreoftenifrequired.Anurseattendedalloutpatientappointmentswiththeresident.

Medication

MedicationwasreviewedonceaweekbytheGP.Noresidentwasself-medicating.Informationonmedicationswasonrequest.

tenancy Rights

ThepremiseswasownedbytheHSEandtheresidentspaidweeklyrentandupkeepof120euro.Eachresidenthadameansassessmentcompletedpriortoanychangesandonanannualbasis.

Therewerewrittenhouserulesaboutsmokingandeatinginthediningroom.Therewasaregularcommunitymeeting.


Alocalpolicyonfinancialarrangementswasindraftform,awaitingsign-off.Eachresidenthadtheirownbankorpostofficeaccountandreceiveregularstatements.Assistancewasprovidedwherenecessarywithregardtowithdrawalsandlodgements.


Recreationalandleisureactivitiesincludedyoga,walking,TV,gardening,andsocialoutings.


ApeeradvocatevisitedPerrottHouseeveryweek.Detailsofcontactfortheadvocateweredisplayedintheresidence.Therewerealsootherrelevantinformationleafletsdisplayed.Theadvocatetookpartinpolicymakinganddevelopmentissuesonbehalfoftheresidents.

149


Residentsstatedthattheywereveryhappywiththeircareandtreatment.TheyalsolikedPerrottHouseasaresidenceandregardeditastheirhome.

Conclusion

PerrottHousewaspartofalargecomplexofHSEfacilitiesandacommunityhospital.Itwassituatedatsomedistancefromthenearbytownandcommunityintegrationwasthereforelimited.Therewasgoodpsychiatric,multidisciplinaryandmedicalinput.Eachresidenthadamultidisciplinarycareplan,thereweremonthlymultidisciplinarymeetingsandawiderangeoftherapeuticactivitiesandleisureactivities.TherewereregularphysicalreviewsandaGPvisitedweekly.

Thepopulationwaselderlywithlimitedpotentialtoliveindependently.Howeveramorerehabilitativeaccommodationwasavailableifnecessary.Thepremiseswereoldandquiteinstitutional.Howevertherewereplanstobuildanextensionwhichwilladdresssomeofthesedifficulties.


1. The local financial policy should be signed off as soon as possible.

2. Renovations to the residence should take place as soon as possible.

150


Hse West


ExecutiveCatchmentArea Donegal,Sligo/Leitrim,WestCavan

MentalHealthServiceInspected Donegal

ResidenceInspected ClearyHouse,Letterkenny





DateofInspection 13October2009

Description

service Description

ClearyHousewasapurpose-builtsingle-storeyresidenceopenedin2000.Thefacilityhad20beds,includingfourrespitebeds,andwasunderthedirectionoftherehabilitationandrecoveryservice.ItwasreportedthattheresidencewasintransitiontofacilitatetheclosureplanforSt.Ciaran’sWardinSt.Conal’sHospital.TheaimofClearyHousewastoprovideaqualityserviceforresidents,holisticinapproach,whichpromotedtherehabilitationofresidentswhileassistingthemtoachievemaximumindependence.Itwasreportedthattheresidentshadinputintodevelopingtheservice’smissionstatement,ethosandphilosophy.ClearyHouseclosedeachdaybetween1130hand1630h.Duringthisperiod,staffandsomeresidentswerebasedinthedaycentreatSt.Conal’sHospital.Itwasreportedthatmostresidentsattendedtheirprogrammesoremploymentduringthisperiodandonlyattendedthedaycentreformealsandmedicationmanagement.Thereweretenlowsupporthousesattachedtotheservicewithnomediumsupportresidence.Itwasplannedtoreconfigurethreelowsupporthousesincloseproximitytooneanotheranddeveloptheseintoamediumsupportclusterwithincreasedstaffingavailableateveningsandoverweekends.


Thereweretenmaleandtwofemaleresidentsonthedayoftheinspection.Theindividuallengthofstaycurrentlyvariedfromsixmonthstonineyears.Theageprofileofresidentswasbetween28and75years.Theservicehadanadmissionpolicythatalsoincorporateddischarges.


Apin-pointalarmsystemhadbeeninstalled.}}

Eachresident’sintellectualdisabilityprofilewaspostedontheirclinicalfile.}}

Residents’medicationswerestoredinindividualcompartmentsinthemedicationcupboard.}}

Themultidisciplinaryteamdocumentedclinicalreviewsinasinglecompositeclinicalfileforeach}}

resident.

151


TheSTEERIrelandindependentadvocacyservicenowattendedtheresidencetwiceamonth.}}

Anewconservatoryandpatioareahadbeendeveloped.}}

Anautomaticemergencydefibrillator(AED)machinewasnowprovidedonsiteandstaffhad}}

undergonetraininginitsuse.

Thefiredoorswerenowautomated.}}

Newpinebedsandwardrobes–builtintheworkshopinSt.Conal’sHospital–hadbeenprovidedto}}

eachresident.

FundinghadbeenaccessedfromthelocalVECforclassesinthedaycentre.}}

Twonewflat-screenTVsetshadbeenpurchased,fundedbytheLottoandbyagenerousdonation}}

fromthefamilyofarecentlydeceasedresident.

Newleatherfurniture,selectedbytheresidents,hadbeenplacedinthecommunalareas.}}



Eachresident,withtheexceptionofanumberofresidentswhohadrefused,hadamultidisciplinarycareplancalledClient’sAssessmentofStrengths,InterestsandGoals(CASIG).Thesecareplanswereregularlyreviewedandevaluatedatreviewmeetingsbytherehabilitationandrecoveryteam.ItwasreportedthattheresidentswhohadrefusedtheCASIGcareplanshaddonesoastheyhadperceivedthemtobeaninitialsteptoleavingtheresidencetolowersupporthousing.AllresidentshadnursingcareplansbasedontheOremLeningermodel.ThreeclinicalfileswereexaminedbytheInspectorateandallhadsix-monthlyphysicalreviewscarriedoutbytheNCHDattachedtotheserviceandregularpsychiatricreviews.Therewasevidenceofmultidisciplinaryinputfromallmembersoftherehabilitationandrecoveryteamintothecompositeclinicalfiles.AllresidentshadtheirownGP.Theconsultantpsychiatristvisitedweekly.


ItwasreportedthattheresidentsofClearyHouseweresupportedandencouragedtomaximisetheirpotential.Thiswasevidencedbythequalityofeachresident’smultidisciplinaryteamassessmentandtheinputoftheteamintocontinuousreview.Mostresidents,apartfromthoseresidentswhorefusedforreasonsindicatedabove,hadakeyworkerfromtherehabilitationandrecoveryteam,forexampleaCNS,occupationaltherapist,orhealthcareassistant.Individualassessmentprogrammesincludeddailylivingskills,householdskills,personalhygiene,budgetingskills,concordancetraining(medicationeducationandmanagement),horticulturetraining,alcoholanddrugrelapseprevention,theStepsprogrammethroughWorklink,andattendanceatCaraHouseFamilyResourceCentre,whichsupportedhealth,well-beingandqualityoflifeoffamiliesandindividualsinLetterkennythroughsocial,recreationalandeducationalactivities.TworesidentswereemployedthroughaVEC-supportedscheme.

ItwasreportedthatresidentsofClearyHousedidnothaveaccesstothekitchenfacilitiesduetoHazardAnalysisandCriticalControlPoints(HACCP)regulationsandthatarequesthadbeenmadeby

152


therehabilitationandrecoveryteamforatrainingkitchentodevelopmoreindependentlivingskillsprogrammesforsuitableresidents.


ClearyHousewassituatedinKnocknamona,aresidentialsuburbonLetterkenny’seastside.Itwasservicedbyapublicbusroutebutitwasreportedthatthisservicewasirregular.Theresidencehaditsownvehicleforthepurposesoftransportingindividuals.TheCASIGcareplansidentifiedeachresident’sstrengths,interestsandgoals.SomeresidentswereattendinganAutumnProgrammeinCaraHouse.Therewasgoodparticipationatgroupssuchasthewalkinggroup,cinemagroupanddance,voiceandmovementgroup.Socialoutingsalsotookplace,whetherforsmallgroupsforSundaylunch,orlargergroupsfordaytripsaway.ItwasreportedthattheannualClearyHouseChristmaspartywaswell-attendedbyneighbours,family,friendsandstaff.


ClearyHousewasawell-decorated,well-maintained,clean,modern,purpose-builtsingle-storeyresidenceopenedin2000.Thebathroomareasandshowerandbathingareaswereverycleanandinagoodstateofdecor.Allresidentswerecaredforandtreatedinasettingthatwassafe.Therewereeightdoubleroomsandfoursinglerooms.Thebedslookedcomfortableandwardrobespacewasgood.Thebedsinthedoubleroomswerewithoutprivacycurtains.

AllareaswithinClearyHousewerewheelchairaccessible.

Mealsusingthecook-chillmethodweredeliveredfromthemainkitcheninSt.Conal’sHospital.Themainmealofthedaywasprovidedatthedaycentre.Atweekends,ClearyHouseboughtintheservicesofacheffromLetterkennyGeneralHospital.Itwasreportedbystaffandresidentsthatthemealsduringtheweekendwereofabetterstandardandqualitythanthecook-chillmealsservedinthedaycentreonweekdays.

staffing levels


staff Discipline Day Wte night WteNursing 2staffnursesand

1CNM22staffnurses

Healthcareassistant 0.8 0Household 1 0Secretarialsupport 4hoursaweek 0

Sessional

Discipline number of sessionsConsultantpsychiatrist 1sessionaweekNCHD 1sessionaweekOccupationaltherapist AsrequiredfollowingMDTreviewSocialworker 0Clinicalpsychologist AsrequiredfollowingMDTreview

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team input

TherehabilitationandrecoveryteamheldacaserevieweveryTuesdaymorningintheWillowsdaycentre.Allmembersofthemultidisciplinaryteamcouldrequestanappointmentslotinadvancefordiscussion.Minuteswerekeptofthismeeting.Theserviceuserattendedthereviewandcareplanmeetings,whichwereheldeveryTuesdayafternoon.Thekeyworkercouldbookanappointmentandinviteallstakeholdersthattheserviceuserrequestedtoattend.ClearyHouseheldout-patientclinicsbytheconsultantpsychiatristandNCHDonceaweek.

Medication

Medicationswerereviewedwheneverrequiredandatleasteverythreemonths.Medicationmanagementtrainingwascarriedoutwithserviceusersbythekeyworkerinpreparationforthestepdowntoindependentliving.Noresidentself-medicated.Theprocessofprescribing,storageandadministrationofmedicationappearedsatisfactory.

tenancy Rights

ClearyHousewasownedbyDonegalMentalHealthServices.ResidentscontributedfinanciallytowardsrentandhousekeepingbytheirindividualfinancialassessmentformswhichwerekeptseparatetotheirclinicalfileinClearyHouse.Thehouserulesdetailedintheresidentinformationbookletwerereasonable.


Eachresidenthadtheirownindividualaccountwithintheserviceandalsotheirownindividualcreditunionaccount.ThefinancialarrangementsofeachresidentwereoverseenandmanagedbyanadministratorwithinthehealthservicebutseparatetoClearyHouse.ThesefinancialarrangementswereexaminedbytheInspectorateandappearedinorder.ClearyHouseusedtheHSE’snationalpolicyonfinancialmanagementincommunityresidences.


Theresidencehadtwolargeflat-screenTVsetsintwocommunalareas.Therewasalsoaconservatoryareaforresidentswhowantedtoavailofsilenceorwhowishedtoread.Therewasanexerciseroomwithatreadmillandanexercisebike.Acomputerwithinternetaccesswasalsoavailabletoresidents.Thewalkinggroup,cinemagroupanddance,voiceandmovementgroupwerewell-attended.Thereweremanyareaswherevisitsbyrelativesandfriendscouldbeaccommodated.Residentsalsotookpartinsocialoutingsandattendedmanylocalsportingevents.Thegardenhadasmokingshelter.Seatingareaswerealsoavailableinthegarden.


ClearyHousehadaresidentinformationbookletthatoutlinedthemissionstatementandphilosophyoftheresidence,theteammembers,dailyroutines,houserules,facilitiesandservicesavailable.Accesstoinformationwasexcellent.Therewasinformationonmanydifferentclinicaldiagnoses.InformationonSTEERandcontacttelephonenumberwasavailable,aswasinformationonmanyvoluntaryandsupportgroups.ResidentswhohadaCASIGcareplanhadinputintothisplanofcareandco-signeditwiththeirkeyworker.

154


Conclusion

ItwasevidentfromtheinspectionofClearyHousethattheresidentswereparticipatingactivelyinrehabilitationandrecovery.Therewasmuchevidenceofexcellentmultidisciplinaryteamworkingthroughthekeyworkersystemandtheregularmultidisciplinaryteamreviews.TheCASIGcareplanswereidealforthecohortofresidentsatClearyHouseanditwasunfortunatethatasmallnumberofresidentshadrefusedtoparticipateintheseassessmentsandcareplans.


1. All beds in dormitories should have privacy curtains installed.

2. The plan to develop the medium support houses should be expedited.

3. The development of a training kitchen for independent living skills programmes for suitable residents should be expedited.

155



ExecutiveCatchmentArea Limerick,NorthTipperary,Clare

MentalHealthServiceInspected Limerick

ResidenceInspected O’ConnellHouse





DateofInspection 10July2009

Description

service Description

O’ConnellHousewasasquare-shapedsinglestoreybuildingopenedin1989,situatedinasuburbanareaofLimerick.Itprovidedcontinuingcareforanolderpopulation.Withinthebuildingwasawellmaintainedgardenthatwasusedtofacilitateresidentsandvisitorswhowishedtosmoke.Aseparatesmokingroomwasprovided.Anindependentdaycentrewassituatedinthebuildingwhichsomeresidentsattended.

Staffreportedthatmanyresidentsregardedtheunitasahomeandthepeoplethereasfamily.Theywereproudofthefacttheyhadrecentlybeenabletoprovidepalliativecaretoalongstayresidentwhohaddiedafewdayspreviously.Shehadbeenwakedintheresidence.Residentshadattendedherfuneralandtheyhadgonetoahotelforamealafterwardattheresident’srequest.

Familiesofsomeresidentsprovidedsupporttootherswhodidnothaveaccesstofamilymembers.

Aquestionmarkliesoverthefuturedevelopmentoftheserviceasitmayapplyfordesignationasanapprovedcentrefortheusebythepsychiatryoflaterlifeteam,whosepatientsweresituatedinSt.CamillusWardinLimerickatpresent.Planswerebeingdevelopedbyservicemanagementtomoveresidentstocommunityfacilitiesinpreparationforthechange.


Onthedayinquestion,therewere11menand12womeninresidence,withagesrangingfromlatetwentiesto90yearsold.Mostwereintheolderagegroup.ManyoftheresidentsweretransferredfromSt.Joseph’sHospital.Someresidentshadbeenlivingthereformorethan20years.


Twoshowerroomswererefurbished.}}

In-servicetrainingwasheldinJuneindiabeticcare.Fournursesattended.}}

Aself-medicationmanagementprogrammehadbeeninitiatedtofacilitatethedischargeofresidents.}}

PalliativecarewasprovidedforoneresidentwhohadlivedinO’ConnellHouseformanyyears,with}}

theaidofthenearbyMilfordHospiceService.

156




GeneralmedicalcarewasprovidedbythelocalGPwhocalledasrequired.HewasaffiliatedwiththeShannondocmedicalservicewhichprovidedcoveroutofhours.

Physicalhealthreviewswerecarriedoutannuallyinmostinstances.However,onthedayoftheinspection,fiveofthesereviewshadnotbeencompleted.Nocopiesofthereviewsornotesthattheyhadbeendonewereenteredintheresidents’files.

Multidiscipinaryteammeetingswereheldmonthly.

Therewasnopsychologyserviceandoneresident’sfamilywereengagingapsychologistprivately.

Nursingcareplanswereinplace.


Nursetherapiststrainedincognitivebehaviouraltherapywereavailabletohelpresidentsdealwithhearingvoices.

Therewerenewspaperandrelaxationgroups.Reminiscencegroupshadrecentlybeentemporarilydiscontinuedbecauseofservicedemands.

Someresidentsattendedtheindependentdaycentrewhichwasnextdoorandavailedofthesnoezelenmultisensoryroom.

Thereweretwovisitingroomsandvisitorscouldalsousethegarden.Staffreportedthereweremanyvisitors,especiallyonSundays.Childrenwerewelcome.


SomeresidentsattendedtheDesmondcommunitycomplexfortheelderly,whichwassituatednextdoortotheresidence.OneresidentworkedthereonaFÁScommunityemploymentscheme.Residentsattendedsocialactivitiesthereintheevenings,e.gforfilms.Theyalsowerefreetogointotownandshopforthemselves.Forthoseresidentsnotabletodothis,alocalshopbroughtaselectionofclothingtothehouseandresidentscouldbuytheirclothinginthisway.


O’ConnellHousewasprovidedinaquietsuburbanarea.Thehousewaswellmaintained,brightandcomfortablyfurnished.Maintenancewasprovidedbythemaintenancedepartment,St.Ita’sHospital.

Therewerefour3-bedrooms,a6-bedroom,andsingleroomswiththeirownsinks.Twoofthethreeseparateshowerroomshadrecentlybeenrefurbished.Oneexistingshowerroomhadbeenretainedattheresidents’request.Betterextractorswereneededforthisroom,whichwasaffectedbycondensationonthedayoftheinspection.

157


Livingquarterswerepersonalisedwithphotographsandresidents’belongings.Curtainswereprovidedaroundbedareasandeachresidentwasprovidedwiththeirownstoragespace.

Akitchenettethatwasoriginallyusedforteachingactivitiesofdailylivinghadmorerecentlybeenusedasadiabetickitchen,duetothedemandsofthecurrentpopulation.StaffliaisedwithaCNSwithregardtodiabeticcare.Mealswerecookedonthepremises.ThekitchenwasHazardAnalysisandCriticalControlPoints(HACCP)compliant.Afishalternativewasprovidedtothemainmeatdishforthosewhowishedit.Specialdietswerecateredfor.Thediningroomwasbrightandspacious.

Fireinspectionswerecarriedoutannually.Thelastreportwasfor5December2008.Recommendationsmadehadbeencarriedout.FirealarmswerecheckedeverythreemonthsbySiemens.

Medicationswerestoredinamedicationroom.Theywereorderedfromthecommunitypharmacyonathree-monthlybasisunlessotherwiserequired.Onthedayofinspection,oneofthefloortileswaslooseanddangerous.However,thiswastoberepairedlaterintheday.

TherewasgoodaccesstoSt.Ita’sgeriatrichospital,whichwasnextdoor.Theirambulance,physiotherapistandpastoralcareservicewereavailableonrequest.

ArepresentativeoftheIrishAdvocacyNetworkvisitedthetrainingcentreregularlyandonrequestvisitedthecommunityresidence.

staffing levels


staff Discipline Day Wte night WteCNM2 1 –CNM1 1 –Staffnurse 2 2Cook 1 –Householdstaff 1 –

Sessional

Discipline number of sessionsConsultantpsychiatrist 1monthlyNCHD 1monthlyOccupationaltherapist 1monthly

(nursetherapistsrungroups)Socialworker 0Clinicalpsychologist 0Other 0

Medication

Six-monthlypsychiatricmedicationreviewscheduleswerekeptbynursingstaff.

Thesereviewswereconductedbythepsychiatrist.However,threesetsofnotesexaminedbytheInspectorateshowednoevidenceofspecificscheduledreviewstakingplace.

TherewasnoevidenceinthenotesthatscheduledannualreviewsbytheGPhadtakenplace,exceptwherethishadbeenenteredbynursesinthenursingnotes.

158


Theonlywritteninformationforresidentsonmedicationwasthatprovidedwithmedicationpacks.Staffsaidverbalinformationwasgiven,butthiswasanareathatshouldbeimproved.

Medicationwasblisterpacked,asaself-medicationprogrammehadcommencedinanticipationofresidentsmovingtonursinghomes.

tenancy Rights

Residentspaid25euroaweektoLimerickMentalHealthServicesforrent,afurther25eurowaspaidforfoodandgeneralupkeepofthehouseand10eurowaskeptforcomforts.Residentsdidnothaveatenancyagreement.TheHSEpaidforlargerbills,e.g.oilandtelephone.Therewerenohouserulesbutresidentswereaskedtoletstaffknowiftheyweregoingout.Therewerenoformalhousemeetings,butinformalmeetingstendedtotakeplacearoundmealtimes.TheInspectoratewasinformedthatresidentswereinvolvedinallaspectsoflifeinthehouse,e.g.therecentfuneral.


Allresidentshadtheirownpensionbooks.Nursingstaffcollectedthemoneyforthosenotabletodosothemselves.Thebalanceoftheirpension,keptintheirownpostofficeaccount,wasaccessiblebythemselvesoronrequest.Apettycashaccountcouldbekeptintheofficeattheresident’srequest.Theregisterforthiswasauditedannuallyandspotchecksweredone.Proceduresandprotocolswereinplace.


Bingo,TV,yoga,filmswereavailableinthenearbyDesmondcomplex.


Theserviceusersinterviewedexpressedthemselveshappywiththeircare.

Conclusion

O’ConnellHousewasabrightwell-maintainedfacilityformostlyolderpeoplewhowerereferredbythepsychiatricrehabilitationservices.Manyoftheresidentshadbeenthereformanyyearsandhaddevelopedstrongtieswiththeserviceandtheotherresidents.Theatmosphereintheunitwaswarmandwelcomingandresidentsseemedpleasedwiththeservice.


1. A record of medication reviews should be entered into the notes by the psychiatrist.

2. All physical reviews should be done at least annually.

3. A record of annual physicals performed should be entered into the notes by the GP.

4. Written information on mental illnesses, treatment, medication and recovery should be provided.

5. Condensation in the shower area should be addressed.

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ExecutiveCatchmentArea Galway,MayoandRoscommon

MentalHealthServiceInspected EastGalwayMentalHealthServices

ResidenceInspected Toghermore






Description

service Description

ToghermoreHousewasanoldperiodresidenceofunknownagebutwhichfeaturedontheOrdnanceSurveymapsof1836.Alargeextensionhadbeenaddedintheearly1980s.Thehouse,setinthemidstofwoodandparklandofabout10hectares(25acres),waspresentedtoaTrusttohaveitusedasacharitableinstitution.ThehousewassubsequentlyhandedovertothethenWesternHealthBoardin1974.AdjacenttothehousewasToghermoreTrainingCentre,acoffeeshop,pitchandputtcourseandthreeBoccecourtswithadjacentcoveredstandforspectators.Thehouseprovidedtwolunchsittingsforresidents,staffandattendeesofthetrainingcentre,whichamountedtoabout100people.

ItwasreportedthatthepurposeofToghermoreHousewastoprovidesafeandcomfortablesurroundingstoresidentswiththeaimofmeetingtheircurrentneeds,planforfutureneedsandtoprovidemeaningfulage-appropriateandresident-appropriateoccupationtoimprovequalityoflifeandencourageindependenceandpersonaldevelopment.Thetrainingcentreprovidedworkandtrainingfacilitiesforpersonswithmentalhealthproblems,physicaldisabilitiesandintellectualdisabilities.

ToghermoreHousewasundertheclinicaldirectionofageneraladultteamandcaredforpersonswithahistoryofenduringmentalheathproblemsintheTuam/HeadfordsectorofEastGalway.


Onthedayofinspection,theageprofileofresidentswasfrom32to80years.Therewereatotalof23residents:12femaleand11male.Lengthofstaydependedontheindividual.TherewereanumberofcommunityhouseslocatedinthetownofTuamwhichprovidedvaryingdegreesofsupport:twohighsupporthouses,twomediumsupporthousesandsixlowsupporthouses.ResidentsofToghermoremovedontothesefacilitiesfollowingassessment.Inothercases,residentsfromlowandmediumsupporthousesmovedintoToghermorefollowingcontinualassessmentbasedonindividualneed.

Respitebedswerealsoavailableforresidentsofprivatedwellingswhowereknowntotheservicetofacilitatefamilyandcarers.Itwassubsequentlyreportedthatinothercases,residentsfromlowandmediumsupporthousescouldavailofrespiteinToghermoreHousefollowingclinicalassessment.


Anannualhygieneaudithadrecentlybeencompleted.}}

Themultidisciplinaryteamcareplanhadrecentlybeenmodified.}}

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Asix-weeksmokingcessationgrouptookplaceonceayear.}}

BreastCheck,throughtheMarieKeatingFoundation,hadprovidedaserviceinToghermoreHouse.}}

Fivenurseshadundergonetraininginphlebotomy.}}

Monthlymeetingswereheldtodiscussissuessuchasmenuplanningandsocialandlivingconditions.}}



Eachresidenthadanindividualmultidisciplinarycareandtreatmentplan,calledaMultidisciplinaryManagementPlan.Allresidentswerereviewedbythemultidisciplinaryteamtwiceyearlyandthisreviewwasdocumentedintheindividualcareandtreatmentplan.

Adailynursingassessmentandnursingcareplanwasalsomaintained.

Itwasreportedthatanattempthadbeenmadebynursingstafftointroduceindividualriskassessments,whichwerepresentbutblankineachclinicalfile.Itwasreportedthatforoperationalreasonsthesehadnotbeencommenced.

ItwasreportedthateachresidenthadtheirownGP.ItwasalsoreportedthateachresidenthadafullphysicalexaminationcarriedoutbytheirGPannually.However,theGPsmaintainedtheserecordsattheirpracticesand,althoughitwasreportedthattheGPliaisedwiththeserviceonthefindingsofthesephysicalexaminations,itwasdifficultfortheInspectoratetofindrecordsoftheseGPvisitsintheresidents’clinicalfiles.


Themajorityofresidentsattendedthetrainingcentreadjacenttothehouse.

Aprogrammeofactivitiesavailableforresidentswhodidn’tgotothetrainingcentrewasoutlinedonthehousegroupstimetable.TheseincludedSolutionsforWellness,relaxation,currentaffairs,asmokingcessationgroup,gentleexercise,musicappreciation,monthlychiropodyvisit,andaweeklyvisitbythehairdresser.

Twoserviceuser-ledgroups,thegardengroupandthewalkingclub,wereregularlyattended.


ToghermoreHousewaslocatedinaruralsettingwithinlandsofabouttenhectares,approximatelythreekilometresfromthetownofTuam.Thetree-lineddrivefromthegatetothehousewasapproximatelyonekilometreinlength,ofunevensurfaceandunlitatnight.Itwasreportedthatsomeresidentsenjoyedthewalkintotownbutmostweredriventothetowncentrebytaxiorbytheservice’sminibus.Itwasreportedthatmanyoftheresidentswerefromaruralbackgroundandenjoyedlivinginthisruralsetting.Itwasreportedthatmanyoftheresidentshadexpressednowishtoliveclosertothetown.

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ToghermoreHousewaslastinspectedin2005.Itwasthenreportedthattheresidence“was in need of extensive refurbishment, e.g. to the electrical system and the roof. The toilets and bathroom area were inadequate and not suitable.”

Onthedayofinspection,itwasreportedthattheelectricalsystemhadundergoneacompleteoverhaulandthattheentirehousehadbeenrewired.

Theroofhadnotbeenattendedtoanditwasreportedthatthereweremanyleaksintovariousareassuchasbedrooms,officesandcorridorareas.

Whilethedownstairstoilet,bathroom,andshowerareashadbeencompletelyupgraded,thisupgradehadnotextendedtotheupstairsmaleandfemaletoilet,bathroom,andshowerareaswhich,onthedayofinspection,wereverycleanbutunfitforpurpose.Thereweresevenstepsleadingtotheupstairsfemaletoilet,bathroom,andshowerareaandthesewerequitesteepalthoughhandrailshadbeenprovided.

ItwasreportedtotheInspectoratethatitwasdifficultforstafftoacquireessentialongoingmaintenanceofthehouseexceptincasesofemergency.TheInspectorateexaminedandacquiredphotocopiesofmaintenancerequeststhathadbeensubmittedoverthepreviousfivemonthsandthathadnotbeenattendedto.Theseincluded:holesinwallsintwomaledormitories,lightfittingslooseoverbeds,toiletseatsmissing,cisternsintoiletswithoutcovers,toilet-paperholdersmissing,faultydoorhandlesonbedroomdoors,looselinoonstepsoutsidethefemaletoilet,anumberofwindowshavingbrokenlatches,ceilingleakingonthemalecorridor,abarspanningastairwayneedingtobeassessed,andthehouseneedingtobepaintedthroughout.

Accommodationinthefemalesectionconsistedofone2-beddormitory,two3-beddormitoriesandone4-beddormitory.Accommodationinthemalesectionofthehouseconsistedof:threesinglerooms,three2-beddormitories,one4-beddormitoryandone5-beddormitory.

Mostdormitorieshadnoprivacycurtainsaroundthebedspaces,whichresultedinresidentshavinglittleornoprivacy.

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staffing levels


staff Discipline Day Wte night WteRPN 4including1CNM2

and1CNM32

Multitaskattendant 1 0Socialcareleader 1 0

Sessional

Discipline number of sessionsConsultantpsychiatrist WhenrequiredNCHD 1weeklyOccupationaltherapist SessionalSocialworker AccessClinicalpsychologist Access

team input

Eachresidenthadanamedkeyworker.Itwasreportedthatateammeetingoccurredeachweek.ThisteamreviewwasattendedbytheNCHD,nurses,occupationaltherapistandsocialcareleader.Thisreviewwasdocumentedinthemultidisciplinarymanagementplan.

Itwasreportedthattheconsultantpsychiatristcalledwheneverrequestedbystaff.ItwasreportedbystaffthattheweeklymedicalcoverbytheNCHDwasadequate.

WeekendandnightmedicalcoverpertainingtomentalhealthissueswasprovidedbytheNCHDatSt.Brigid’sHospital,Ballinasloe,whichwasapproximately55kilometresdistant.

Medication

TheprocessofadministrationofmedicationwithinToghermoreHouseappearedtobesatisfactory.Threemedicationcardindexprescriptionswereexamined.Regularreviewsofprescribingofmedicationsweremaintained.Asignaturebankwasmaintained.

Someresidentsself-medicatedwithplannedinterventionbyaCNM2whoalsosupervisedself-medicationwithresidentsfromtheothercommunityresidences.Eachresident’skeyworkeralsoplayedaroleinthisfunction.

MedicationswereorderedonamonthlybasisbyfiveGPs.TworesidentsofToghermorereceivedtheirprescriptiondirectlyfromtheirGPandcollectedtheirownmedicationsfromthepharmacyinthetown.

tenancy Rights

Allresidentspaidtherentof153europerweek.Thiswasmaintainedbyanadministrator.Allresidentshadaswipesocialwelfarecard.

Staffandresidentsmetonceamonthforanin-housecommunitybusinessmeeting.

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Eachresidentmaintainedtheirownindividualbankaccount,setuponadmissiontoToghermore.Forresidentswholackedcapacity,theirindividualaccountwasmaintainedbytheadministratorwithtransactionsrequiringthesignatureoftwoRPNs,whichwasenteredontransactiondocumentation.ThiswasexaminedbytheInspectorateandappearedsatisfactory.

Theservicehadnolocalpolicyonfinancialarrangements.


ThereweretwoTVsetsavailabletoresidents.Booksandboardgameswerealsoavailable.ManyresidentshadaprivateTVandmusicsystemintheirownbedroom.Therewasapooltableandanairhockeytableavailabletoresidents.Manyresidentsavailedofoutdoorpursuitssuchaspitchandputt,Bocce,walkingandgardening.

ItwasreportedthattheMentalHealthAssociationhadprovidedpilgrimagestoRomeandLourdes.TheynowfocusedonmidweekbreaksinIrelandfortheresidents.

Residentsattendedtheannualploughingchampionships,GAAmatches,pilgrimagestoKnockandindividualsocialoutingsoftheirchoice.


OneresidentaskedtospeaktotheInspectorate.Theresidentwashappywiththecareandtreatment.AllresidentswhowerepresentduringtheinspectionweregreetedbytheInspectorate.

Allresidentssignedtheirmultidisciplinarycareandtreatmentplan.

TheEastGalwayMentalHealthServiceUserGroupmetregularlywithresidentsintheToghermoreTrainingCentre.

TheIrishAdvocacyNetwork(IAN)representativecalledtothehousewhenrequired.

AninformationleafletonToghermoreHousewasavailabletoresidents.

Asuggestionboxwaslocatedonsite.

Itwasreportedthattheservicehadreceivednowrittencomplaints.

Conclusion

ToghermoreHousewasanoldperiodhousewhosepurposewastoprovidesafeandcomfortablesurroundingstoresidentswithenduringmentalhealthproblems.ThehousewassituatedinaruralsettingapproximatelythreekilometresfromthetownofTuam.

Althoughmanygoodpracticedevelopmentshadcommencedsincethelastinspectionin2005,includingtheintroductionofmultidisciplinarycareplanningandmoreserviceuserfocuseddecisionmaking,forexampleserviceuserinputintochoiceofmenu,thephysicalconditionsinsidethehousewereverypoor.Initspresentstateofdisrepair,itwasnotfitforpurposeandneededcompleteandtotalrefurbishment.

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Therewereanumberofseriousoutstandingmaintenancerequeststhatrequiredurgentattention.TherewasalsoanoccupationaltherapyenvironmentalassessmentreportonToghermoreHouse,updatedon18July2007,thecontentsofwhichneededtobeaddressed.


1. A record of attendance of each resident at their GP should be maintained by the service.

2. Each resident should be risk assessed and records maintained by the service.

3. The service should have a local policy on financial arrangements.

4. All beds in dormitories should have privacy curtains.

5. The upstairs male and female toilet, bathroom and shower areas are not fit for purpose and require immediate upgrading. This was a recommendation in the 2005 Report of the Inspector of Mental Health Services.

6. The roof of Toghermore House needs to be upgraded. This was a recommendation in the 2005 Report of the Inspector of Mental Health Services.

7. The interior walls of Toghermore need redecorating.

8. Areas of the walls in two of the male bedrooms need to be replastered immediately and redecorated.

9. The exterior walls of the house need to be repainted.

10. The recommendations in the occupational therapy environmental assessment report on Toghermore House updated on 18 July 2007 should be addressed in full.

11. The outstanding maintenance work which has been requested and submitted by staff since May 2009 must be attended to immediately.

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appendix 5: Mental Health services 2009 inspection of Mental Health Day HospitalsDr. Fionnuala o’loughlin, assistant inspector of Mental Health services

In2009,theinspectorateundertookinspectionsofsomecommunityfacilitiesinadditiontotheinspectionscarriedoutintheapprovedcentres.Aspartofthisprocess,anumberofDayHospitalswereinspected.Onedayhospitalineachcatchmentareawasselectedforinspection,andinall,tendayhospitalsaroundthecountrywereinspected.A Vision for Change(2006)statedthatthecommunitymentalhealthcentreshouldincludeadayhospital,whichcould“offer an alternative to in-patient admission for some service users” (p.96),andrecommendedthat“high quality day hospitals should be provided” (p.98).

Dayhospitalsinthefollowinglocationswereinspected:Athlone;Sligo town;Galwaycity;Carlowtown;Raheny,NorthDublin;Clondalkin,WestDublin;Ballincollig,Co.Cork;Tralee;NenaghandEnniscorthy.

Usingtheconclusionsofthedocument“Psychiatric Day Care – An Underused Option?”(2003)asaguidelinefordayhospitals,atemplatewasdrawnuptoexaminesomeoftheissueshighlightedbytheauthorswhichincludedfactorssuchasthelocationofthedayhospital,openinghours,thenatureofillnessesofserviceusersandnumbersofserviceusersattending.

aspects of Day Hospitals

Location:Allbutonedayhospitalwaslocatedinabuildingseparatefromapsychiatrichospital.ThedayhospitalinCarlowwaspartofSt.Dympna’shospital.Thesectorheadquarterswerelocatedinthedayhospitalinsevencases.Itwasrecommendedthatsectorheadquartersarelocatedinthedayhospitalasthisprovideseaseofaccessforstafftomeetanddiscussmanagementofclients.

Opening Hours:Onlytwoofthedayhospitalsofferedasevendaysperweekservice.Enniscorthywasopenfrom0900hrsto1700hrsdaily,andinCarlow,thedayhospitalwasopenfrom0830hrsto2000hrs.Theremainderoperatedessentiallya0900hrsto1700hrsservice,MondaytoFriday.

Facilites:Fourofthedayhospitalswereabletoprovideahotmealforserviceusers.Themajorityhadtwoorthreeactivityroomsavailable(withtheexceptionofCarlow),andoneservicehadtwelveroomsforactivities(Nenagh).Insomeinstances,theseroomsweremultifunctionalandtheactivityroomsinBallincollig,forexample,werebrightandspacious.

Thedayhospitalsprovidedarangeoftherapeuticservices:anxietymanagement,‘Wellness’groups,psycho-educationgroups,relaxationtherapy,addictioncounseling,stressmanagementandgoal-settinggroups.One-to-onecounsellingwasavailableinmostofthedayhospitals.ServiceusersinCarlowandTraleeattendedthedayhospitalformedicationmanagement.

Out-patientclinicswereheldinfourdayhospitals:Carlow,Enniscorthy,ClondalkinandBallincollig.

Allservices,exceptBallincolligandCarlow,carriedoutdomiciliaryoroutreachvisits.

Numbers of Attendees:Therewasaverylargevariationinthenumbersofserviceusersattending.Somedayhospitalsfocusedonindividualtherapieswhileothersprovidedinterventionsintheformofgroupactivities.ThenumbersofattendeesrangedfromeighttoteninClondalkinandWexford,toaround500inCarlowandNenaghand380inBallincollig.Clearly,notallserviceusersattendedregularly,anditwasrecommendedthatservicesaimtoreviewtheircaseload.

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Allofthedayhospitalshaddischargepoliciesandallbutone(Athlone)hadadmissionpolicies.Inviewoftheverylargecaseloadsinsomecentres,itwasrecommendedthatdayhospitalsimplementtheirdischargepolicyinordertoavoidthesefacilitiesbecomingblocked.

Care Plans:Itwasencouragingtoseethatmanyoftheserviceusersattendingdayhospitalshadindividualcareplansdrawnupbytheirmultidisciplinaryteams.Thiswasthecaseinsevenofthedayhospitalsinspected.Theremainingcentres(Enniscorthy,CarlowandRaheny)usednursingcareplans.

Diagnoses:Informationondiagnoseswasnotavailableinthreeofthedayhospitalsinspected(Carlow,TraleeandWexford),andfullinformationwasnotavailableinallservices.Availablestatisticsonthediagnosesofserviceusersintheotherdayhospitalswererequested:Affectivedisorders,Psychoses,Anxietydisorders,Addictiondisorders,PersonalityDisordersand‘Other’.Theinformationiscontainedinthetablebelow:

affective Disorders

psychotic Disorders

anxiety Disorders

addiction Disorders

personality Disorders

other serious M/i

Nenagh 10% 14% 55% 0 10% 0 24%Sligo 41% 36% 7% 6% 5% 4% 77%Clondalkin 25% 42% 8% 17% 8% 0 67%Ballincollig 55% 35% 10% 0 0 0 90%Tralee n/a n/a n/a n/a n/a n/a n/aAthlone 39% 46% Incl.in

Affective0 11% 4% 85%

Galway 45% 19% 13% 13% 6% 4% 64%Enniscorthy n/a n/a n/a n/a n/a n/a n/aCarlow n/a n/a n/a n/a n/a n/a n/aRaheny 68% 26% 0 0 5% 0 94%(SeriousM/I=Seriousmentalillness)

Thefiguresaboveillustratethenatureofthediagnosesofserviceusersattendingdayhospitals.Intwooftheservices(ClondalkinandAthlone),themostcommondiagnosisofthoseattendingwasapsychoticdisorder;affectivedisorderwasthemostcommondiagnosisinfourcentres(Sligo,Ballincollig,GalwayandRaheny).Inonecentre,Nenagh,anxietydisorderwasthecommonestdiagnosis.ItwasinterestingtonotethatAddictiondisorderwasthediagnosisinserviceusersattendingthreeofthesevendayhospitals(Sligo,ClondalkinandGalway).

Groupingthediagnosesofaffectiveandpsychoticdisorderstogether,thefiguresshowthatseriousmentalillnessaccountforasignificantmajority,(i.e.>75%)ofthecaseloadinfourofthedayhospitals(Sligo,Ballincollig,AthloneandRaheny).Informationonthedurationofillnesswasnotsoughtduringtheinspections,anditwasthereforenotpossibletoassessthechronicityofillness.

summary

During2009,theinspectoratecarriedoutanumberofinspectionsofdayhospitalsincatchmentareasthroughoutthecountry.Thenumberofplacesprovidedrangedgreatlybetweenservicesandsomedayhospitalshadverylargenumbersofserviceusersonitsbooks.Avarietyofserviceswereprovidedinthedayhospitalsandanumberofcentresoffereddomiciliaryvisits.Themostcommonpresentationswereofaffectiveandpsychoticdisorders,butinformationondurationofillnesswasnotsoughtduringtheinspection.Mostdayhospitalshadasubstantialsectorpresenceinthatteammembersspentaconsiderableamountoftimeinthedayhospitals,andinmostcases,peoplereferredforassessmentwerediscussedbythemultidisciplinaryteam.

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Conclusion

ThereportontheuseofdayhospitalcareintwoHealthBoardareas,“Psychiatric Day Care – An Underused Option?”(2003)recommendsthat11dayhospitalplacesper35,000populationshouldbeprovided.Usingthisfigure,someofthedayhospitalsinspectedin2009haveinsufficientplaceswhereasothershaveanexcessivenumberofplaces.Itwassurprising,insomeofthedayhospitals,toseelittleactivitybeingconductedinviewoftherecommendationthatdayhospitalsshouldprovideanalternativetohospitaladmissionforacutelyillpatients.Intheirstudyontheuseofdayhospitalsintwohealthboardareas,theauthorsofthereport“Day Care – An Underused Option?”(2003)foundthatmostattendeeshadrelativelyminorillnesses,asubstantialnumberwerechronicallyillandonly6%ofattendeesweresufferingfromanacuteillness.In1998,astudyoftendayhospitalsintheU.K.(MybaP.,Creed,F.&Tomenson,B.)foundthatonly13%ofdayhospitalswereusedasanalternativetoin-patientadmission.Thesefindingswouldsuggestthatdayhospitalsarenotbeingfullyutilisedasarealalternativetohospitaladmission.

Manyoftheservicesavailableweregenericinnatureandgroupmeetingswerenotavailableinalldayhospitals.Theinclusionofserviceuserswithadiagnosisofaddictiondisordersinthreedayhospitalswassurprising,giventherecommendationinA Vision for Change(2006)that“the major responsibility for care of people with addiction lies outside the mental health system”(p.146),andtheavailabilityofservicesforaddictioninsomeareasinlocaldrugstaskforces.

Despitetheseshortcomings,itwasencouragingtoseethatinmanyofthedayhospitals,assessmentswereconductedbythemultidisciplinaryteamsandindividualcareplansforserviceusersweredrawnupandreviewed.However,itwasdisappointingtonotethat,despiteallserviceshavingapolicyonthedischargeofpatients,manyserviceusersremained‘onthebooks’forarelativelylongperiodoftime,therebyreducingtheeffectivenessofadayhospitalservice.

Recommendations

1. Greater use should be made of day hospitals to divert acute admissions from acute psychiatric units.

2. Services should carry out regular reviews of their attendees to ensure service users move to more suitable facilities when the initial acute phase of their illness has abated.

3. Sector headquarters should be located in day hospitals.

References:

A Vision for Change,(2006),GovernmentPublicationsOffice,Dublin.

HickeyT.,MoranR.,Walsh.D.Psychiatric Day Care-An Underused Option?2003,HealthResearchBoard.

MybaP.,CreedF.,Tomenson,B.The different uses of day hospitals.ActaPsychiatricaScandinavica1998:98:283-287.

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appendix 6: individual inspection Reports – Day Hospitals


Mental Health services 2009 inspection of Mental Health services in Day Hospitals

DayHospitalInspected St.FrancisDayHospitalHSEArea HSENorthDublinExecutiveCatchmentArea NorthDublinCatchmentPopulation 80,000Location RahenyTotalNumberofPlaces 30Dateofinspection 2July2009

Details

service Description

St.Francisdayhospital,openedin1978,waslocatedinanoldfriarybuilding.Thebuildingconsistedoftwofloors.Thereweretwolargegrouproomsonthegroundfloorandanumberofsmallofficesonthefirstfloor.

Twosectorteamshadaccesstothedayhospitalanditwasafive-dayserviceduringofficehours.Thebuildingwaslocatedclosetolocalpublictransport.TheHSEwascurrentlyrentingthepremisesbuttheleasewasnotduetoberenewedafter2011.Therewasalsoaclubhouselocatedinthesector.Theservicedidnotprovideadaycentreservice.

premises

Checkpoint ResponseIsthepremisespartofapsychiatrichospital? NoIsthepremisesanindependentbuilding? YesIsthepremisespurposebuilt? NoIsthepremisesaccessiblebypublictransport? YesIsthepremisesthesectorHQ? YesHowmanyactivityroomsarethereforserviceusers? 3Howmanyserviceusersareattending? 30Isthereafacilityforprovidinghotmeals? Yes

Referral procedure

Allreferralshadtobeprocessedthroughthemultidisciplinaryteamweeklyteammeeting.Referralsweremainlyfromtheoutpatientclinic.Anumberofserviceuserswerereferredduringtheirin-patientstay.Referralscouldbeassessedwithinoneworkingday.

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Onarrivalatthedayhospital,eachserviceuserwasorientatedtothebuildingandstaff,andtothegroupprogramme.Theclinicfilefollowedtheserviceuserfromtheoutpatientclinic.Anassessmentwascompletedbymedicalandnursingstaff.Therewasacentralisedcomputerdatabaseandclinicalnotessysteminplace.

Referralstootherdisciplinesandtherapieswerediscussedattheteammeetings.

staffing levels

post number Wte sessions per weekConsultantpsychiatrist 2 15hourseachNursingstaff 4 FulltimeNCHD 3 AsrequiredOccupationaltherapist 2 4Psychologist 1.7 2Socialworker 1 AsrequiredArttherapist 1 1Psychotherapist 2 2Artteacher 1 1

Range of services provided

Thedayhospitalprovidedagroupprogrammeandindividualsessionsinpsychotherapy.Thegroupprogrammewasfacilitatedbythenursingstaffandhadawiderangeofgroups,fromstressmanagementtocookerytopsycho-education.Anumberofothergroupswereprovidedbysessionalstaff.Attendancewasbasedonclinicalneed.Therewasnohomecareteambutdomiciliaryvisitswereprovidedbythecommunitymentalhealthnurses.

Anewcentralisedpsychotherapyservicehadcommencedusingthefacilitiesupstairs.Aclinicalnursespecialistcoordinatedallreferrals.Anumberofroomsupstairshadbeenpaintedandrefurnishedtofacilitatetheservice.Anumberofthedisciplineshadadditionaltraininginvariouscognitivetherapyandpsychotherapyapproaches.

Careplanningwasdisciplinebased.Thenursingstaffdocumentacareplanforeachserviceuser.Alldisciplinesrecordinasinglecasefileinthecomputerdatabase.Therewasnoindividualmultidisciplinarycareplanbuttheteammetweekly.

service user input

TheIrishAdvocacyNetwork(IAN)representativeattendedthedayhospitaltwiceamonth.Thiswasanewinitiative.Theservicehadusedaquestionnairetoobtainfeedbackonthegroupprogramme.

Acarersgrouphadbeenestablishedrecently.Itwastobefacilitatedbyanurseandasocialworkeranditwasplannedtohavemonthlymeetings.

Anumberofvoluntaryagencieshadlinkswiththeservice.TheyincludedGROW,citizensinformation,andKLEAR(anadultliteracyprogramme).

Quality initiatives in 2009

Thepsychotherapyservicehadcommenced.}}

Aquestionnairewasusedtoimproveserviceuserfeedbacktostaff.}}

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TheMentalHealthInformationSystem(MHIS)computersystemhadbeenmodifiedandupdated.There}}

wereplanstoextendittotheacuteunit.

Diagnoses (all attendees in past Month)

Diagnosis and Duration numberAffectivedisorders 13Psychoticillness 5Anxietydisorders 0Addictiondisorders 0Personalitydisorders 1Other 0Averagelengthofstay(numberofdays) 3monthsto2.5years

operational policies

Therewerenosetcriteriaforreferraltothedayhospitalordischargetootheragenciesfollowingtreatmentorintervention.Therewasnowaitinglistinoperation.Itwasreportedthateachserviceuserhadariskassessmentcompletedbeforeattendingthedayhospital.Themajorityofserviceusersremainedinthedayhospitalforamaximumofthreemonths.Twoserviceusershadbeenthereforovertwoyears.Itwasreportedthattheywereawaitinganappointmentwiththerehabilitationteam.

Therewasasysteminplaceforrecordingrisksandincidents.Staffreportedthatthenumberofincidentsreportedwasverylow.

Staffhadaccesstogeneralin-houseandHSEtraining.Localrecordsweremaintainedbyeachdiscipline.

planning

Amanagementteammeetinghadrecentlybeenrecommended.Itsobjectivewasforthemultidisciplinaryteamtoreviewstrategicplansandoperatingpolicies.Theexacttermsofreferencewerenotinplace.

Theservicemustvacatethebuildingin2011.Itwasplannedthatthenewprimarycarecentrewouldincorporateamentalhealthcentre,includingadayhospital.Adesignbriefhadbeendevelopedandwasunderdiscussion.AbuildinghadbeenidentifiedinBaldoyleandwastobeprogressedusingthepublicprivatepartnershipfundingmodel.

Conclusions

Theservicehadbeenestablishedforover30yearsinitscurrentlocation.Thebuildingwasnolongerfitforpurpose,manyoftheroomsweresmall,andthebuildingwasnotaccessible.Thesitehadbeenmadesmallerovertheyearsandtherewasnowahighwallsurroundingit.Itwasencouragingtoheartheplanswerewelladvancedtomovetoanewprimarycaresite.

Clinicallytheteamhadworkedatdevelopingagroupprogrammeandprovidingarangeofcognitivetherapies.Manyofthestaffhadacquiredadditionaltraininginspecialistareas.Thiswasanassetforserviceusersinthearea.

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1. The day hospital relocation plan should continue.

2. The team should document its criteria for referral to the day hospital.

3. Each service user should have an individualised care plan developed with the team.

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DayHospitalInspected AthloneHSEArea HSEDublinMidLeinsterExecutiveCatchmentArea Kildare/WestWicklow,Laois/Offaly,Longford/

WestmeathCatchmentPopulation 27,000Location AthloneTotalNumberofPlaces 10full-timeplacesDateofinspection 28May2009

Details

service Description

TheAthloneDayHospitalservedtheAthlonesectoroftheLongford/Westmeathcatchmentarea.Itprovidedacuteinterventionsforserviceusers,alternativetreatmentstoadmissiontohospitalandactedasastep-downfacilityforresidentsintheacutehospitalsetting.

ThehospitalwassituatedinthecentreofAthloneinthegroundsofSt.Vincent’sHospital,whichprovidedcontinuingcaretotheelderlyandhospicecare.

ThedayhospitalwasopenMondaytoFriday,from0900hto1700h.Ithad10places,butasmostserviceusersdidnotattendonafull-timebasis,itcouldaccommodatemanymorepeople.Onthedayofinspection,30serviceuserswereavailingofthefacilityonaweeklybasis.Whiletheaveragelengthofstaywasthreetosixmonths,oneserviceuserhadbeenattendingformorethantwoyears.Thedayhospitalhadgoodlinkswiththedaycentrewhichwaslocatedacrosstown.

Premises

Checkpoint ResponseIsthepremisespartofapsychiatrichospital? NoIsthepremisesanindependentbuilding? YesIsthepremisespurposebuilt? NoIsthepremisesaccessiblebypublictransport? YesIsthepremisesthesectorHQ? YesHowmanyactivityroomsarethereforserviceusers? 2Howmanyserviceusersareattending? 30Isthereafacilityforprovidinghotmeals? NoIsarecordofattendancekept? Yes

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Referral procedure

AthlonedayhospitalacceptedreferralsonlyfromtheAthlonesectorandreferralsweremadebymembersofthemultidisciplinaryteam.Referralswerediscussedattheweeklymultidisciplinaryteammeeting,andminuteswerekeptofthesemeetings.Therewasnospecificreferralform,andtherewasvirtuallynowaitinglistforadmissiontothedayhospital.

Staffing Levels

post number Wte sessions per weekConsultantpsychiatrist 1 6Nursingstaff 1 Full-timeNCHD 1 4Occupationaltherapist 1 5Psychologist 1 AccessasrequiredSocialworker 1 AccessasrequiredActivitiestherapist 0

Nursetherapist 2 Accessasrequired


TheAthlonesectorhadafullmultidisciplinaryteamwhichmetweekly.Individualmultidisciplinarycareplanswerebeingintroducedonaphasedbasistoallserviceusers.Therewereanumberofnurse-ledgroups,includinggroupsforgoal-setting,anxietymanagement,relaxationandmedicationconcordance.ASolutionforWellnessgroupprovidedgymandswimmingpassesforserviceusers.Individualsessionswerealsoprovidedbythenurseandoccupationaltherapist.

Theoccupationaltherapisthadrecentlybeeninvolvedinanumberofsession-planninggroupsandhadplannedtobeginfourregulargroupsessionsaweekinthedayhospital,whichweretoincludearelapsepreventiongroup.Inaddition,theoccupationaltherapistconductedhomevisits.

Thesocialworkerhadrecentlyconductedasix-weekparentalgroupinthedayhospital.

service user input

Therewasaweeklyserviceusersupportgroupmeeting.Themanagementteamincludedauserconsultativememberinitsgroupandthemanagementteammettheuserconsultativegroupregularly.

Serviceuserswereinvolvedintheirowncareplanningandserviceusersfacilitatedsomegroups.


Theoccupationaltherapisthadconductedasurveyofserviceusersandplannedtousetheinformation}}

gatheredtodevelopspecificgroups.

AnumberofstaffhadMentalHealthandDeafnesstrainingandwerenowabletoconduct}}

consultationswithdeafserviceusersusingsignlanguage.

Individualmultidisciplinarycareplanningwasbeinggraduallyintroducedtotheservice.}}

ThestaffhadbeenrunningacollaborativeprojectwithlocalGPsforanumberofyears.}}

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Diagnoses (All Attendees in Past Month)

Diagnosis or duration numberAffectivedisorders 11Psychoticillness 13Anxietydisorders IncludedinaffectivegroupAddictiondisorders 0Personalitydisorders 3Forobservation 1Averagelengthofstay(numberofdays) 3–6months


ThedayhospitaloperatedaccordingtoLongford/WestmeathMentalHealthServices’policies.ItoperatedthecomplaintsprocedureoftheHSE.Localpoliciesincludedareferralpolicy.StaffwereawareofthepolicyoftheMentalHealthCommissiononincidentreportingandstatedthatnodeathsorincidentshadbeenrecorded.

planning

Theplanforthedayhospitalincludedaschemetodevelopanoutreachserviceinthesector.TheInspectoratewasinformedthattherewasaplantorelocatethedayhospitaltoapurpose-builtbuildingnearbywhichwastoincorporateafullPrimaryCommunityandContinuingCare(PCCC)facilityandwhichwillallocatespaceforadayhospitalandsectorheadquarters.

Conclusions

ThedayhospitalinAthloneprovidedaserviceforthepopulationoftheAthlonesector.Itwascentrallylocatedinthetownandcouldaccommodateupto30serviceusers.Thesectorhadafullmultidisciplinaryteamandprovidedarangeofprimarilynurse-ledgroupandindividualsessionsforserviceusers.Theoccupationaltherapistalsoprovidedsomeindividualsessionsanddomiciliaryvisitsandtherewasaccesstoapsychologistandsocialworkerasrequired.Asthesectorheadquarterswaslocatedinthedayhospital,staffreportedreadyaccesstomembersoftheteamonadailybasis.


1. All members of the multidisciplinary team should be involved in providing therapeutic sessions for service users in the day hospital.

2. All service users should have an individual multidisciplinary care plan.

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DayHospitalInspected ClondalkinDayHospitalHSEArea HSEDublinMidLeinsterExecutiveCatchmentArea DublinWest/DublinSouthWest,DublinSouthCityCatchmentPopulation 55,000Location ClondalkinVillageTotalNumberofPlaces 8DateofInspection 11August2009

Details

service Description

Clondalkindayhospitalwasopened20yearsagoandservedanurbanpopulationof55,000.Itwasopenfrom0900hto1700h,MondaytoFriday.Ithadeightplacesandthedurationofstayaveragedaboutthreeweeks.Thedayhospitalwaslocatedupstairsinasmallshoppingarcade.Itwasverycrampedandconsistedoftwosmallrooms(akitchenandasittingroom)andanumberofofficesandwaitingarea.Thedaycentrewaslocatednearbyandahomecareteamandasectorteamoccupiedthesamepremisesasthedayhospital.Therewasaseamlessservicebetweenthein-patientservice,thehomecareteam,thedayhospital,thedaycentreandtheoutpatients.

Premises

Checkpoint ResponseIsthepremisespartofapsychiatrichospital? NoIsthepremisesanindependentbuilding? NoIsthepremisespurposebuilt? NoIsthepremisesaccessiblebypublictransport? YesIsthepremisesthesectorHQ? YesHowmanyactivityroomsarethereforserviceusers? 2Howmanyserviceusersareattending? 8Isthereafacilityforprovidinghotmeals? Yes

Referral procedure

ExternalreferralsfromGPsandtheEmergencyDepartmentweretothemultidisciplinaryteamandtherewasaweeklynewpatientclinic.Internalreferralstothedayhospitalwerethroughthemultidisciplinaryteammeeting,whichwasheldtwiceaweek.

Occasionallypatientsattendedthedayhospitalpriortodischargeaspartoftheirdischargeplan.

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Staffing Levels

post number Wte sessions per weekConsultantpsychiatrist 1 NotprovidedNursingstaff 2 NotprovidedNCHD 1 NotprovidedOccupationaltherapist 1 NotprovidedPsychologist 1 NotprovidedSocialworker 1 NotprovidedActivitiestherapist 0 NotprovidedArtinstructor 0 NotprovidedPsychologytrainee 1 Notprovided


Thereweremultidisciplinaryteammeetingstwiceaweek.Anursingcareplanandamultidisciplinarycareplanwasinoperation.Thehomecareteamcarriedoutdomiciliaryvisits.Althoughitwasnotstructured,anumberofactivity-orientatedandeducationalgroupswerehelddependingontheneedsoftheserviceusersandindividualsessionswerefacilitatedbythenursingstaff.Therewerealsoindividualsessionswiththemultidisciplinaryteammembersasrequired.

service user input

Serviceuserstookpartintheformationoftheirindividualcareplan,signedtheircareplansandreceivedacopyoftheircareplaniftheywished.


Anumberofgroupswereheld,includingawalkinggroup,acarersgroup,aStayWellgroupthatwas}}

rehabilitationbased,andagroupforchildrenofserviceusers.

Liaisonbetweentheserviceandvariousvoluntarybodiessuchasaddictionservices,suicideprevention}}

organisationsandfamilysupportgroupshadbeenenhanced.

Allmultidisciplinaryteammemberscarriedoutnewpatientassessments.}}

Educationalprogrammessuchascognitivebehaviouraltherapy,in-housetrainingandexternaltraining}}

andseminarscontinued.

AcasesummaryforGPsondischargeofserviceusersandforoutpatientreviewshadbeendeveloped.}}

Aworkinggrouphadbeensetuptoconsideratriagesystemforqueriesandreferralstotheteam.}}

AnopendayforGPsandvoluntarybodieswasheldannually.}}


Diagnosis and duration numberAffectivedisorders 3Psychoticillness 5Anxietydisorders 1Addictiondisorders 2Personalitydisorders 1Averagelengthofstay(numberofdays) 19.7

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Theservicehadpoliciesrelatingtoadmissionanddischarge,riskmanagement,incidentreporting.Inadditiontherewerenumerousotherrelevantpoliciesthatreflectedlocalpractice.

planning

Areportwaspreparedannually.

Amovetoanewhealthpremiseswithprimarycareteamswasplannedwithinthenexttwoyears.

Itwasplannedtoexpandtheworkingrelationshipwiththerehabilitationteamandtoobtainaccommodationforindividualswithenduringmentalillness.

Conclusions

Clondalkindayhospitalwaspartofacohesivecommunityservice.Thiswasawell-establishedseamlessserviceincorporatinghomecare,dayhospital,daycentreandoutpatients.Thedayhospitalitselfwasverysmallandcramped,andthislimitedthescaleoftherapeuticactivitiesthatcouldtakeplace.Eachserviceuserhadacareplanandtherewasgoodmultidisciplinaryteamworking.Thedayhospitalservicewasengagedwithlocalvoluntaryagenciesandthishadallowedeaseofreferralandeducationalopportunities.


1. The new purpose-built premises for the day hospital should be advanced as quickly as possible.

2. To reduce duplication, the multidisciplinary care plan should be a summary of team goals and interventions rather than a detailed replication of the nursing care plan.

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Hse south


DayHospitalInspected BallincolligResourceCentre,Co.CorkHSEArea HSESouthExecutiveCatchmentArea SouthLee/WestCork/KerryCatchmentPopulation 40,110Location BallincolligTotalNumberofPlaces 25Dateofinspection 5October2009

Details

service Description

ThedayhospitalinBallincolligwassituatedattheentrancetoaretailandtechnologyparkontheoutskirtsofBallincollig.Thebuilding,whichopenedin2001,wasasingle-storeypurpose-builtbuildingadjacenttoamedicalclinic.Itwasinagoodstateofrepairandwasbrightandquitespacious.

Thedayhospitalservedtwosectors,BishopstownandBallincollig,withacombinedpopulationof43,000.Itwasopenfrom0900hto1700h,MondaytoFriday.Thereweretwolargeactivityroomsandthreeinterviewrooms.Theservicehadafull-timeadministrationofficerinthecentre.

Eachsectorheldreviewclinicsonceaweekandonenew-patientclinicwasheldweeklyatthedayhospital.

Between20and25serviceuserswereseendaily.Medicationwasnotadministeredatthedayhospital.

Thedayhospitalhadestablishedgoodlinkswithanear-bycentrewhichranaSocialFocusProgramme,whichwasanationaltrainingprogrammeforpersonswithamentalhealthdifficulty.Anumberofclientsfromthedayhospitalhadattendedtheprogrammethere.

Premises

Checkpoint ResponseIsthepremisespartofapsychiatrichospital? NoIsthepremisesanindependentbuilding? YesIsthepremisespurposebuilt? YesIsthepremisesaccessiblebypublictransport? YesIsthepremisesthesectorHQ? YesHowmanyactivityroomsarethereforserviceusers? 2Howmanyserviceusersareattending? 380Isthereafacilityforprovidinghotmeals? No

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Referral procedure

Thedayhospitalservedtwosectors.ReferralswereprimarilyfromGPs,andinvolvedmostlynewreferrals.Urgentreferralswereusuallyseenwithinoneortwodays,andthewaitingtimefornon-urgentreferralswasuptosixweeks.OtherreferralscamefromtheliaisonserviceinCorkUniversityHospitalandsomeserviceuserswerereferredfollowingdischargefromtheacuteunit.

Followingreferral,eachcasewasdiscussedbythemultidisciplinaryteamandanindividualmultidisciplinarycareplanwasdrawnupfortheperson.Acopyofthecareplanwasgiventotheserviceuser.TheTidalmodelofassessmentwascarriedoutbythedesignatednurse.

staffing levels

post number Wte sessions per weekConsultantpsychiatrist 1.3 6Seniorregistrar 1.2 9NCHD 0.8 2Nursingstaff 1CNM2

2staffnursesFull-time

Communitymentalhealthnurse 2 Full-timeOccupationaltherapist 0 –Psychologist 0.7 8Socialworker Access –Arttherapist 0.2 2


Multidisciplinaryteamreviewswerecarriedoutonaregularbasis,andasrequired.Individualprogrammesweredesignedforeachserviceuserincollaborationwiththeindividual.Theservicewasintheprocessofcompilingamultidisciplinarycareplanforeachindividualattendingthedayhospital.

Theserviceofferedarangeoftherapeuticinterventions.Mostinterventionswereonaone-to-onebasisandserviceusersweregivenappointmentsthatgenerallylasted1to1.5hours.Thepsychologistssawclientsforcognitivebehaviouraltherapyandhadrunprogrammesinsocialanxietyandselfacceptance.

Grouptherapiesindepressionmanagement,anxietymanagementandrelaxationwereconductedfromtimetotimewhendemandexists.Asixweekrelaxationrrogrammewasalsooffered.Awellnessprogrammeandawalkinggroupwerealsoaccessible.

Throughcollaborationbetweennursingstaffandthepsychologists,educationalprogrammesindepression,psychosisandbipolardisorderwereheldfromtimetotime.Thefamilyeducationalgroupalsoranaten-weekcourseforfamiliesofserviceusers.

YogaandarttherapistsfromthelocalVECprovidedclassesuntilrecently,whenfundingproblemscausedthisservicetobediscontinued.

service user input

Serviceuserswereinvolvedinthedevelopmentoftheircareplan.Familymemberswerealsoincludedinmultidisciplinaryteamreviews,withtheindividuals’consent.

OnlyoneserviceuserwasseenbytheInspectorateintheunitduringthevisit,whichtookplaceintheafternoon.

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Anauditoftheindividualcareplansdonetodatewascarriedout.}}

Aserviceuserquestionnairewasconducted.}}

Anoutpatientsatisfactionsurveywasconducted,withgenerallyfavourableresultsfortheservice.}}

Aliaisonservicewiththelocalprimarycareunitwasestablishedtoaffordbetterlinkswithprimary}}

care.Asaresultofthisliaison,onememberofthedayhospitalstaffwascarryingamobilephonetofacilitateaccessbetweentheservices.


Diagnosis and duration numberAffectivedisorders 55%Psychoticillness 35%Anxietydisordersandpersonalitydisorders 10%Addictiondisorders 0Averagelengthofstay(numberofdays) Varies

Althoughtheservicewasconsciousofnotretainingserviceusersbeyondatimeoftherapeuticbenefit–80to90clientshadbeenattendingforlessthanoneyear–someserviceusershadbeenattendingsincetheopeningoftheservicein2001.


TheoperationalpoliciesinplacewerethoseoftheSouthLeecatchmentarea.Thesewereintheprocessofbeingreviewed.Theservicehadapolicyondischargeofserviceusersfromthedayhospital,aspartoftheircareplan.

Therewasnotrainingatthepresenttime.AllstaffnurseshadcompletedtheHigherDiplomainAcuteandEnduringMentalIllness,andoneCPNhadrecentlycompletedamaster’sprogrammeinnursing.

planning

Currentplansincludedaplantoextendtheopeninghoursto1900h.TherewasalsoaplantodevelopphlebotomyservicesatthedayhospitaltofacilitateaClozarilclinicthere.Thepsychologyservicewereplanningtorungroupsinemotionalskillstrainingandtoconductresearchworkshops.

Inthelongerterm,itwashopedtofurtherdeveloplinkswiththeprimarycareserviceinthearea.

Conclusions

ThedayhospitalatBallincolligprovideddayservicestotwosectorsintheSouthLeecatchmentarea.Theservicewasintheprocessofdevelopingindividualmultidisciplinarycareplansforallserviceusers,awelcomefeatureintheprovisionofdaycareforserviceusers.Avarietyoftherapieswereavailablefrommedical,nursingandpsychologystaff.Itappearedthatthemajorityoftherapiesweredeliveredonanindividualbasis.Therewasevidenceofaninterestinauditingandasurveyofserviceusersthatwillbeusefulininformingtheservicewhenconsideringfutureplans.

181



1. The multidisciplinary team should be fully staffed and should include an occupational therapist.

2. The review of operational policies should continue and specific policies in relation to the operation of the day hospital should be developed.

182



DayHospitalInspected CaherinaHouseDayHospitalHSEArea SouthLee/WestCork/KerryExecutiveCatchmentArea KerryCatchmentPopulation 139,835Location TraleeTotalNumberofPlaces 25Dateofinspection 15June2009

Details

service Description

TheoriginalCaherinaHousedayhospitalwasfirstestablishedin1978bythethenSouthernHealthBoard.ThepresentCaherinaHouseDayHospital,situatedaroundthecorner,wasopenedinMarch2002bytheincumbentMinisterforHealth.Itwasared-brickedpurpose-builtbungalow-stylebuildingsituatedonthewestsideofthetownonasitethatwasphysicallywellintegratedinthecommunity.

Theservice’sopeninghourswerefrom0900hto1700h,MondaytoThursday,and0900hto1600honFridays.

Premises

Checkpoint ResponseIsthepremisespartofapsychiatrichospital? NoIsthepremisesanindependentbuilding? YesIsthepremisespurposebuilt? YesIsthepremisesaccessiblebypublictransport? YesIsthepremisesthesectorHQ? NoHowmanyactivityroomsarethereforserviceusers? 7Howmanyserviceusersareattending? 80-120Isthereafacilityforprovidinghotmeals? Yes

Referral procedure

TheTraleeWestsectorformallyadmittedreferralstothedayhospitalbutreferralswereconsideredfromtheTraleeEastsector.Astandardreferralformwascompletedbytheconsultantpsychiatristwhomayreceivereferralsfromgeneralpractitioners,in-patientservices,outpatients,andtheEmergencydepartmentinemergencysituations.Emergencyreferralswerereportedtoberare.AllreferralswerediscussedatthemultidisciplinaryteammeetingsthatoccurredeachTuesday.

183


Staffing Levels

post number Wte sessions per weekConsultantpsychiatrist 1 TwiceNursingstaff 2 Full-timeNCHD 1 2–3Occupationaltherapist 0.8 FourPsychologist 0 –Socialworker 0.5 –Activitiestherapist 0 –Artinstructor 1 Once(academicyear)Psychologytrainee 1 –


Therapiesprovidedwereacombinationofgroupandindividual.Groupssuchastheyoungpersons’activitygroup,schizophreniagroup,socialskillsgroup,artgroup,therapygroupandthewellnessgroupwereallpartoftheweeklyprogramme.Pastoralcarealsooccuredaswellasone-to-onetherapiesandovercominganxietyandovercomingdepressionsessions.Therewasalsoaregulargroupforyoungpeoplewhohadbeennewlydiagnosed.

Themultidisciplinaryteamconsistedoftheconsultantpsychiatrist,psychiatricregistrar,CNM2/CNS,occupationaltherapistandsocialworker.Therewasnopsychologistattachedtotheteam,althoughatraineepsychologistcarriedoutsessionalworkatthedayhospital.ThemultidisciplinaryteammeteachTuesday.Eachmemberofthemultidisciplinaryteamactedasakeyworkerforaspecificgroupofserviceusers.Anindividualcareplanwasworkedoutbetweentheserviceuserandthekeyworkeralthoughitwasreportedthatdocumentationofthiscareplanwaspoor,theweeklymeetingsbetweenserviceuserandkeyworkerresolvedthis.Itwasreportedthatregularchronologicalprogressnotesweremaintainedcollaborativelybythekeyworkerwitheachserviceuser.

Familymeetingswerealsoheldwiththekeyworkerandserviceusertodiscusssuchitemsaspreventativemeasures,triggerstoavoidandcareplanning.

Homevisitswerecarriedoutinformallybythesocialworkerorcommunitymentalhealthnurse.

Anumberofserviceusersattendedthedayhospitalonadailybasisformedicationadministrationandfordepotmedication.

TheCNM2/CNS,whowasaqualifiedpsychotherapist,alsoacceptedindividualreferrals.

Individualsattendingthedayservicewerereferredonwardsto:theNationalLearningNetwork,whichhadayear-longrehabilitationprogrammecalledtheFocusProgrammeandgaveguidanceonpersonaldevelopmentandcareerchoiceandcoursesincludingcarpentryandcatering;RehabCarewhichofferedashelteredworkshop;andFÁS,whichhadadisabilityadvisorandapathwaytotheadulteducationcentre.

service user input

Nopeeradvocateattendedalthoughpertinentinformationregardingadvocacyandmanyrelevantvoluntaryorganisationswasreadilyavailable.Therewasalsoaninformationbookletaboutthedayhospitalandtheservicesitprovided.

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Asupportgroupforindividualsexperiencingtheaffectsofschizophreniahadprovenverysuccessful.}}

Thestaffnurseatthedayhospitalhadcompletedanurseprescribingcoursewhichwasexpectedtobe}}

usedbytheservice.

Theservicehadagoal-directedpolicy,wherethefocuswasontreatmentratherthanonpassingtime,}}

andthiswasreportedtobeworkingwell.


Diagnosis and duration numberAffectivedisorders unavailablePsychoticillness unavailableAnxietydisorders unavailableAddictiondisorders unavailablePersonalitydisorders unavailableAveragelengthofstay(numberofdays) unavailable


WrittenoperationalpoliciesfromKerryMentalHealthServiceswereavailableinthedayhospital.

Thedayhospitalhadwrittenanoperationalpolicydocumentoutliningtheadmissionanddischargepolicies,thehistoryoftheservice,themissionstatement,theroleandfunctionofthedayhospital,theserviceusergroup,themultidisciplinaryteamandthedifferentfunctionswithinit,teammeetings,qualitycontrol,incidentreportingandthecomplaintsprocedure.

planning

Theservice’sproposaltodevelopcommunitymentalhealthservicescalledVisionintoActiondescribedthepilotingofanewreferralandassessmentsystembyCaherinaHousedayhospitalwhichhadshownpromisingearlyresultsandwhichhadthepotentialtoofferamorecommunityorientatedservicetoavoidtheneedforhospitalisation.TherecommendationsofVisionintoActionwere:

BuildonworkdonebyCaherinaDayHospitalin2007inconjunctionwiththecommunitymental}}

healthteam.

Theoperatinghours,staffingandfunctionofdayhospitalstoberevisitedinlightofchangestoservice}}

deliverywiththedevelopmentofthecommunitymentalhealthteams.

Conclusions

TheoriginalCaherinaHousedayhospitalwasopenedin1978andanewbuildinghadbeeninoperationsinceMarch2002.Overthepastthreedecadestheservicehadtransformedfromoneprovidingadaycentreforindividualswithenduringmentalillnesswhoweremeaningfullyoccupiedbyindustrialtherapytoonethatnowfocusedontreatmentandsupportforindividualswithacuteandenduringmentalhealthproblems.Theserviceembracedamultidisciplinaryapproachandstrovetoofferpeopleanalternativetoin-patientcareandtreatment.

185



1. Consideration should be given to using formal multidisciplinary care plans.

186



DayHospitalInspected CarlowHSEArea HSESouthExecutiveCatchmentArea Carlow/Kilkenny/SouthTipperaryCatchmentPopulation 52,500Location St.Dympna’sHospitalTotalNumberofPlaces OndemandDateofinspection 10September2009

Details

service Description

ThedayhospitalwaslocatedinSt.Dympna’sHospital,inwhatwasformerlyawardofthehospital.Itwasabrightareawithtworoomsfordoctors’interviews,akitchen,apleasantwaitingroom,nurses’officeandonegeneralinterviewroom.Therewerenoactivityrooms.

Thedayhospital,whichservedserviceusersfromtheCarlowNorthandCarlowSouthsectors,openedin2003,andwasopenfrom0830hto2000h,sevendaysaweek.Onenurseoperatedthedayhospitalattheweekends.

Themainfunctionsofthedayhospitalweretooffermedicationmanagementandprovideaccesstoassessmentofnewpatientsfrombothsectors.Thenumberofdailyattendeesvariedfromabout25to43,dependingonwhatclinics,includingClozarilclinics,werebeingheld.Some561serviceusershadbeenattendingthedayhospitalin2008,andtheservicewasworkingtoreducethisnumber.Serviceusersattendedformedicationwhichwasdispensedbythenurses.

Premises

Checkpoint ResponseIsthepremisespartofapsychiatrichospital? YesIsthepremisesanindependentbuilding? NoIsthepremisespurposebuilt? NoIsthepremisesaccessiblebypublictransport? YesIsthepremisesthesectorHQ? NoHowmanyactivityroomsarethereforserviceusers? NoneHowmanyserviceusersareattending? 561Isthereafacilityforprovidinghotmeals? No

Referral procedure

Allnewpatientreferralstothetwosectorswereseenandassessedinthedayhospitalbythecommunitymentalhealthteams.Anewpatientclinicwasheldonceaweek.ReferralsweremadebyletterfromtheGPs,buttelephonereferralswerealsoacceptableforpatientsrequiringurgentassessment.Referralswerediscussedatmultidisciplinaryteammeetingsandallocatedanappointmentintheclinic.Occasionally,self-referralswerealsoseen.Therewasnoreferralform.

187


Otherreferralscamefromtheoutpatientclinics,communitynurses,andfromtheDepartmentofPsychiatryinKilkenny,followingdischargeofresidents.Inaddition,referralsweremadebytheteamsasanalternativetohospitaladmission.

Staffing Levels

post number Wte sessions per weekConsultantpsychiatrist 2 4-6Nursingstaff 2CNM2

2staffnursesFull-time

NCHD 2 Full-time,sharedwiththein-patientservice

Occupationaltherapist Accesswhenrequired –Psychologist Accesswhenrequired –Socialworker Accesswhenrequired –Activitiestherapist 0 –


Theprimaryserviceofferedwasmedicationmanagement,andnewpatientassessments.Therewerenogroupactivities.Serviceuserswerereferredtotheskills-basedcentrewhichwaslocatedinthegroundsofSt.Dympna’sHospitalforactivitiesandtraining.Thiscentreprovidedactivitiesincomputerskills,horticulture,activitiesofdailyliving,artandotheractivities.OtherserviceusershadbeenreferredtoSteer,whichhadlinkswithFÁS.

Therewerenomultidisciplinarycareplansinplace,buttheservicewasworkingonadaptingthemultidisciplinarycareplanthatwascurrentlyinoperationintheapprovedcentrestosuitdayhospitalusers.Thenursescarriedoutariskassessmentandhadnursingcareplansforattendees.

Whilethedayhospitalteamdidnotincludeanoccupationaltherapist,psychologistorsocialworker,serviceusershadaccesstotheseservices.

service user input

ServiceusersinthewaitingroomwereinvitedtospeakwiththeInspectorate.Oneserviceuserspokeveryhighlyoftheserviceandstaff,sayingthedayhospitalofferedanexcellentsupportservice.


TwoCNM2swerecurrentlyparticipatinginacourseonself-harm,andwereplanningtosetupa}}

specificprogrammeforserviceusers.

TwoCNM2scompletedacourseonClozarilmanagement,andweretrainingotherstaffmembersin}}

thismanagement.

Thesocialworkerandsystemictherapistinthefamilyeducationgroupwasabouttosetupacarers}}

groupinthedayhospital.

Staffwerebeingtrainedinvenepuncture.}}

Twonurseswerecurrentlybeingtrainedincognitivebehaviouraltherapy,withaviewtoprovidingitto}}

serviceusersofthedayhospital.

Usefulinformationleafletaboutthedayhospitalhadbeenproducedforserviceusers.}}

188


TheservicewasworkingtointroducetheOrchidprogrammewhichprovidedinformationtoservice}}

users.

Diagnoses (all attendees in past Month)

Norecordofdiagnosesofattendeeswaskept,althoughtheimpressionofstaffwasthatthepredominantillnesswasaffectivedisorder.

Diagnosis and duration numberAffectivedisorders NotprovidedPsychoticillness NotprovidedAnxietydisorders NotprovidedAddictiondisorders NotprovidedPersonalitydisorders NotprovidedOther NotprovidedAveragelengthofstay(numberofdays) Notprovided


Therewasapolicygroupontheimplementationofthemultidisciplinarycareplans,whichwaslookingatthesuitabilityofthisformofplanforthedayhospital.Riskassessmentswerecarriedoutbythenursesbutinaninformalway.ItwasexpectedthatriskassessmentLevel1ofthemodifiedSainsburyCentreforMentalHealthriskassessmentwastobeintroducedaspartofthemultidisciplinarycareplans.

Incidentswerereportedtothehospitalmanager,althoughitwasstatedthatincidentsoccurredinfrequently.Althoughtheservicedidnothaveanadmissionpolicy,ithadareferralanddischargepolicy.Theservicewasintheprocessofreducingitscaseload.

planning

Theservicewasmovingawayfromthemedicationmanagementmodelofoperationinitsdayhospital,andwasplanningtointroducegroupactivities.

Therewasatentativeplantorelocatethedayhospitaltoaprimarycarebuildinginthecentreofthetown,buttheseplanswereataveryearlystageofdiscussionasyet.Adatabaseofserviceuserswasestablished,andasteeringgrouphadbeensetuptoestablishwaysofintroducingmoretherapeuticservicesandgroupactivities.

Conclusions

ThedayhospitalinCarlowwaslocatedinSt.Dympna’sHospitalandwasopensevendaysaweek.Therewasaverylargenumberofattendeesonitsbooksbutitgenerallycateredforbetween25and45serviceusersdaily.Theprimaryactivitywastoprovidemedicationmanagementandsomeserviceusersattendeddailyformedication.Referralswereassessedbythemultidisciplinaryteam,andnewpatientclinicswereheldweekly.ThereseemedtobeagoodworkingrelationshipwiththelocalGPs,andthedayhospitalalsoprovidedaserviceforserviceusersrecentlydischargedfromtheDepartmentofPsychiatryinKilkenny.Therewerenogroupactivitiesandnodesignatedsessionsbyassociatedhealthcareprofessionals.

189



1. There should be designated sessions in the day hospital for the psychology, social work and occupational therapy professionals.

2. The role of the day hospital should be expanded to provide therapeutic services, and group activities should be considered.

3. A record of diagnoses should be kept.

4. The service should continue its policy of reducing the number of attendees on its list.

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DayHospitalInspected CarnHouse,NorthWexfordHSEArea HSESouthExecutiveCatchmentArea Waterford/WexfordCatchmentPopulation 61,583Location St.John’sHospital,EnniscorthyTotalNumberofPlaces 6to9Dateofinspection 21May2009

Details

service Description

CarnHouse,theNorthWexforddayhospital,waslocatedinthegroundsofSt.John’sCommunityHospitalnearthecentreofEnniscorthy.Itwasaconvertedconventandassuchtheroomsweresmallandclinicalspacewaslimited.Thedayhospitalwasnowopensevendaysaweekfrom0900hto1700h.Itwasthesectorheadquartersandalsohousedthepsychiatryoflaterlifeteam.Outpatientclinicswererunfourdaysaweekfromthedayhospital.Serviceusersattendforsessionsonly.Thedayhospitalservedaradiusofapproximately30kmandapopulationof61,000.ThedayhospitalwasownedbytheHSE.

Premises

Checkpoint ResponseIsthepremisespartofapsychiatrichospital? NoIsthepremisesanindependentbuilding? YesIsthepremisespurposebuilt? NoIsthepremisesaccessiblebypublictransport? NoIsthepremisesthesectorHQ? YesHowmanyactivityroomsarethereforserviceusers? 3Howmanyserviceusersareattending? 8to9Isthereafacilityforprovidinghotmeals? No

Referral procedure

Onesector,NorthWexford,admittedtothedayhospital.Referralswerebymembersofthesectorteam,bythein-patientservicesandbyself-referral.Areferralletterorreferralformaccompaniedallreferralstothedayhospital.

ReferralstothesectorteamwerefromGPs,theliaisonservice,fromthementalhealthserviceandfromthegeneralhospitalservices.

Allreferralswerediscussedattheteammeetingwheremanagementoptionswereagreed.

Emergencyreferralswereseenimmediately.

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Staffing Levels

post number Wte sessions per weekConsultantpsychiatrist 2 FulltimeNursingstaff 2CNM2

2staffnurse2CMHN

FulltimeFulltimeFulltime

NCHD 1 FulltimeOccupationaltherapist 1 Sessionalgroupand

individualPsychologist 1 SessionalindividualSocialworker 1 SessionalindividualActivitiestherapist 0 0Other 0 0


Themultidisciplinaryteammetweeklyandallreferralsandissuesconcerningserviceuserswerebroughttothismeeting.Therewasanursingcareplanbutnomultidisciplinarycareplan.Howeverthepsychiatryoflaterlifeservice,whichwasbasedinthedayhospital,usedamultidisciplinarycareplan.Anumberofgroupsessionswereavailableincludinganxietymanagementandrelaxationgroups.Aswellasanoutpatientclinictherewerealsohomevisitsbymostmembersofthemultidisciplinaryteam.

Familyeducationgroupswerealsoprovided.

service user input

Regularcarersgroupsandfamilyeducationgroupswereheld.Apeeradvocatedidnotcomeregularlytotheunitbutaccesstoadvocacywasclearlydisplayedandappointmentscouldbemadeifrequired.

Therewasanexcellentinformationbookletavailableaswellasinformationaboutothercommunityservices.

VoluntaryorganisationssuchasAwareandGROWheldregularmeetingsinthedayhospital.


Familyeducationgroupswereheldregularly.}}

Concordanceprogrammeswereheldwithserviceusers.}}

StaffcontributedtothementalhealthmoduleinsocialcarestudiesinWexfordEducationCentre.}}

StaffalsocontributedtotheHealthPromotionUnit.}}

ThedayhospitalhadfacilitatedanopendayforlocalGPs.}}

Staffprovidedacrisisresponsetothecommunityfollowingseriousincidentssuchassuicide.}}

Fullclozapinemonitoringwasprovidedatthedayhospitalwhichallowedserviceuserstobemore}}

involvedintheirtreatment.

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Diagnosis and duration numberAffectivedisorders NotavailablePsychoticillness NotavailableAnxietydisorders NotavailableAddictiondisorders NotavailablePersonalitydisorders NotavailableOther NotavailableAveragelengthofstay(numberofdays) Notavailable


Therewerepoliciesandproceduresonreferraladmissionanddischargeaswellasonnon-attendances.Therewereproceduresintheeventoffire.

Therewasanexcellentwrittenunitprofilewhichoutlineddifferentprocedures.

planning

Therewasnowrittenplanavailableinthedayhospital.Althoughtherewereplanstoupdatethecurrentbuildingand,inthelongterm,toprovideapurpose-builtunittheseplanswerenotactiveduetofundingdifficulties.

Conclusions

CarnHousedayhospitaliswasawell-runservicethatprovidedacomprehensiverangeofservices,includingoutpatientservices,individualtherapy,grouptherapy,mentalhealtheducationandcrisisintervention.Theservicewassomewhatlimitedbytheconstraintsofthebuildingbutgoodusewasmadeoftheexistingspace.Thestaffwereenthusiasticandjustifiablyproudoftheservicetheyoffered.


1. Should funding become available a purpose-built day hospital should be provided.

2. The service should use multidisciplinary care plans.

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Hse West


DayHospitalInspected LáNuaDayHospital,GalwayHSEArea HSEWestExecutiveCatchmentArea Galway,MayoandRoscommonCatchmentPopulation 121,567Location BallybaneNeighbourhoodVillage,Ballybane,

GalwayTotalNumberofPlaces 114Dateofinspection 29September2009

Details

service Description

LáNuadayhospitalwasapurpose-builtdayhospitalsituatedonthefirstfloorofatwo-storeybuildingthatwascompletedin2005.Thedayhospital’sfloorplanwaslimitedonlybythegroundfloorplanofthepubliclibrarysituatedbelow.ThedayhospitalwaslocatedofftheBallybaneRoadwhichwasasuburbanresidentialareaintheeastofthecity.Thedayhospitalcouldbeaccessedbythreebusrouteswhichstoppedoutsidetheentrance.

Theserviceaimedtoprovideanalternativetothein-patientserviceofferingshort-termadmissionwithinasupportiveandeducationalenvironment.

FoursectorteamsfromwithintheWestGalwayCatchmentadmittedtothedayhospital.Serviceuserswerereferredfromin-patientservicesandoutpatientservices.Theopeninghourswerefrom0900hto1700h,MondaytoFriday.

Premises

Checkpoint ResponseIsthepremisespartofapsychiatrichospital? NoIsthepremisesanindependentbuilding? YesIsthepremisespurposebuilt? YesIsthepremisesaccessiblebypublictransport? YesIsthepremisesthesectorHQ? NoHowmanyactivityroomsarethereforserviceusers? 7Howmanyserviceusersareattending? 114(averageweeklyattendance)Isthereafacilityforprovidinghotmeals? No

Referral procedure

TheservicehadaclosedreferralpolicywhichhadbeenrevisedinJuly2009.ServiceusersfromallfoursectorsoftheWestGalwayMentalHealthServicesassessedassuitableforreferraltothedayhospitalwereofferedanappointmentwithinoneweekforroutinereferralsandwithinoneworkingdayforurgentreferrals.Referralsweremadefromin-patientunitsandoutpatientclinics.Allurgentreferrals

194


mustbediscussedwiththeCNM2/seniorregistrarpriortoadmissionbeingoffered,inordertoprioritisethelevelofurgency.Thereferralformincorporatedamandatoryriskassessment.Ifserviceusersdidnotattendadmissionoranappointment,anoutpatientsdepartmentappointmentwasrequested,therelevantconsultantteamwasnotifiedandalsothecommunitymentalhealthnurseifnecessary.

Allclinicaldocumentationwasmaintainedintheserviceuser’sclinicalfile,whichfollowedtheindividualthroughoutthedifferentmentalhealthservices.

Liaisonwithotheragencieswasmaintainedinpreparationfordischarge,includingFÁS,theNationalLearningNetwork,adulteducationcentre,VEC,GalwayMayoInstituteofTechnology,daycentres,communityemployment,learningschemes,college,workandhome.

staffing levels

Itwasreportedthattheservicewasdowna0.5whole-time-equivalentnursingpost.Theholderofthe0.6occupationaltherapypostwasleavingtheservicepermanentlyonthedayaftertheinspection.Staffexpectedthisposttobefilled.

post number Wte sessions per weekConsultantpsychiatrist 4.5 Eachconsultant:onesession

everythreeweeksNursingstaff 3.36

(Incl0.75CNM2)Fulltime

NCHD 1.5 FulltimeOccupationaltherapist 0.6 –Psychologist 0.5 –Socialworker – Average0.5orasneededActivitiestherapist – 4perweek


Onadmissiontothedayhospital,acoreassessmentwascarriedoutbyanymemberofthemultidisciplinaryteam.Akeyworkerwasthenallocatedwhichwasusuallyfromthedisciplinesofnursing,occupationaltherapyandpsychology.AllserviceuserswereriskassessedusingaBriefRiskAssessmenttool;ifthisindicatedafurtherrisk,aFunctionalAnalysisofCareEnvironment(FACE)assessmentwascompletedanddiscussedwiththemultidisciplinaryteam.

AllserviceuserswereseenbytheNCHDatleastonceaweek.Eachmultidisciplinaryteammetonceeverythreeweeks.Allserviceusershadanindividualcareplanthatwascompletedateachmultidisciplinaryteammeetingandsignedbythekeyworkerandserviceuser.

Individualandgroupactivitiesoccurredincludingone-to-onesessionsandtargetedclosedgroups,includingstressandcoping,mooddisorder,anxietymanagementandpsychosiseducation.

TheprovisionofhotmealstoattendingserviceusershadceasedsinceOctober2008duetobudgetaryconstraints.

Homevisitswereundertakenwhennecessary.Therehadbeeneighthomevisitsin2008.

Therewasasupervisedgymonsite.

Allserviceusersself-medicated.Anemergencysupplyofanticholinergicmedicationwasmaintained.InitiationofcertainmedicationssuchasClozarilandAntabusewassupervisedbynursingstaff.

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service user input

Three-monthlymeetingswithserviceuserswerefacilitatedtoreviewtheprogrammeandtoensuretheprogrammewasbenefitingthem.Appropriatechangestotheprogrammethatweresuggestedbytheserviceuserswereimplemented.Minutesofthesemeetingswerepostedonthenoticeboardforserviceuserstoread.

ArepresentativefromAWAREcalledweekly.ArepresentativefromtheIrishAdvocacyNetwork(IAN),whousedtocallregularly,nowcalledonlywhenrequested;itwasreportedthatthisservicehadbeenrestrictedbybudgetaryconstraints.

Aninformationbookletonthedayhospitalandtheservicesitprovidedwasgiventoallattendingserviceusers.

InformationonIANandacontacttelephonenumberwaspostedthroughoutthedayhospital.

InformationonotherservicessuchasShine,GROWandAwarewasalsoavailable.


AllattendingserviceuserswereundergoingacoreassessmentthatwasintroducedinAugust2009.}}

Thegroupprogrammeshadbeenchangedtoincorporatemoreindividualwork.}}

Serviceusersatisfactionsurveypre-andpost-changestotheseprogrammeswereinprogress.}}


Diagnosis and duration numberAffectivedisorders 61Psychoticillness 25Anxietydisorders 17Addictiondisorders 18Personalitydisorders 8Intellectualdisability/psychosocialstressors 6Averagelengthofstay(numberofdays) 8–14weeks


ThedayhospitalhadadetailedadmissionpolicythathadbeenrevisedinJuly2009,andwhichdeclaredthattheservice’saimwastorespondtoserviceneedsandarrangeapromptandbriefassessmentforadmissiontoallsuitablereferralsfromWestGalwayMentalHealthServices.

TheservicehadadischargepolicythathadbeenrevisedinJuly2009whichincluded:serviceuserandfamilyinvolvement,dischargeplanning,liaisingwithcommunityagencies,thearrangementofanoutpatientsappointment,notifyingthecommunitymentalhealthnurseandadischargelettertotheserviceuser’sGP.

Theservicehada“DidNotAttend”policy–intheeventthattheserviceuserfailedtokeepanappointment,thereferringteamwasnotified,anoutpatientsappointmentwasrequestedandwheretherewereconcernsaboutanindividualserviceuser,thestaffatthedayhospitalcarriedoutahomevisit,oracommunitymentalhealthnursewasaskedtocarryoutsuchavisitiftherewerestaffingissuesatthedayhospital.Ifserviceusersdidnotattendregularappointmentstheyweredischargedfollowingconsultationwiththemultidisciplinaryteamorseniorregistrar.TherelevantGPandconsultant

196


teamwerenotifiedandthecommunitymentalhealthnursewasalsoinformedifthiswasdeemedappropriate.

planning

Abusinessmeetingheldbystaffoccuredonceeverytwoorthreemonthstoironoutoperationalandclinicalissues.Minuteswerekeptofthesemeetings.

Three-monthlymeetingswithserviceuserswereheldtointroducechangestoandreviewoftheprogramme.Minuteswerekeptofthesemeetings.

Thedayhospital’sserviceplanwasincorporatedintotheserviceplanfortheWestGalwayMentalhealthServices.

Conclusions

LáNuadayhospitalwastheonlydayhospitalinWestGalwayMentalHealthServices.Itservedfoursectors,whichwastheentireareaofWestGalway,includingtheAranIslands.ThedayhospitalwassituatedontheeastsideofGalwaycity.Thepurposeofthedayhospitalwastooffershort-termadmissioninasupportiveandeducationalenvironmentasanalternativetoacutein-patientadmission.


1. The 0.6 WTE occupational therapy post should be filled.

2. The service should have its own written service plan and operational framework.

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DayHospitalInspected MarkiecviczHouse,Sligo

HSEArea HSEWest

ExecutiveCatchmentArea Donegal,Sligo,LeitrimandWestCavan

CatchmentPopulation 99,875

Location Sligo

TotalNumberofPlaces Notsupplied

Dateofinspection 20August2009

Details

service Description

Thiswasafive-dayservicewhichopensfrom0900hto1700hMondaytoThursday,andfrom0900hto1700honFridays.Italsosometimesopenedforspecificgroupsintheevenings.Itwassituatedinamodernpurpose-builtbuilding,theotherhalfofwhichisusedbyPrimaryCommunityandContinuingCare(PCCC)wheregeneralhealthclinicswereheldandtherewasacanteenavailableforusebymentalhealthserviceuserswithavouchersysteminuse.Stafffelttheintegratedbuildingmodelfacilitatedconfidentialityandreducedstigma.

Mostreferralsweremadebytwoofthefiveconsultantteams.Mentalhealthreviewclinicswereheldtwiceweeklybythesetwoteams.Staffidentifiedaproblemwithfeedbacktoandfromotherconsultantteamswhorefertotheservice.Astherewerenodedicatedcommunitymentalhealthnurses,staffofthedaycentrealsoprovidedanoutreachserviceforpeoplewhodidnotattend.Stafffeltthisnegativelyimpactedontheservicetheycouldprovideinthedaycentre.Afamilytherapyandcognitivebehaviouraltherapyservicewasprovided,withdirectreferralfromGPsattachedtothecentre.Therewasa12-weekwaitinglistforthefamilytherapyservice.

Atleastfivepeopleattendedtheservicedaily.Staffnotedthatthenatureoftheservicehadchangedwiththeintroductionofthecognitivebehaviouraltherapyservice.Mostserviceusersoptedforthisratherthanattendinggroups.Peopleattendedforatime-limitedspecificpurposeanddidnottendtostayinthedaycentreallday.

Staffwereaccommodatedinalargeopenplanofficeonthedayofinspection.Therewasaconcernforstaffsafetyastherewasonlyoneentranceandoneexitfromthisoffice.Therewereplansforstaffgroups,e.g.familytherapists,tomovetotheirownofficeswithinthebuilding.Atthetimeoftheinspection,thecognitivebehaviouraltherapyteam,whichhadbeenhousedelsewhere,wasduetomoveintothebuildingwithinamatterofweeks.

Atthetimeofinspection,clericalstaffwereonleaveandcouldnotbereplacedbecauseoftheHSEstaffingmoratorium.Asaresult,essentialtypingwasnotbeingdoneandthisposedarisktopatientsafety.

198


Premises

Checkpoint ResponseIsthepremisespartofapsychiatrichospital? NoIsthepremisesanindependentbuilding? YesIsthepremisespurposebuilt? YesIsthepremisesaccessiblebypublictransport? YesIsthepremisesthesectorHQ? Yes(for2of5sectorteams)Howmanyactivityroomsarethereforserviceusers? 2Howmanyserviceusersareattending? 135Isthereafacilityforprovidinghotmeals? Yes

Referral procedure

ReferralsweremadeeitherbyGPsorconsultantpsychiatrists.ItwasreportedtotheInspectoratethattheywereawareoftheperceptionbysomepsychiatriststhatreferralwasnotopentoeveryone.TheInspectoratewastoldthatthiswasnotthecase,andtherewasconfusionamongthestaffastowhythisimpressionhadarisen.

Referralformswereavailable.Allpatientsdischargedfromthein-patientservicewerereferredtothedaycentrefromthetwoconsultantteamsand,asrequired,fromtheoutpatientclinics.

staffing levels

post number Wte sessions per weekConsultantpsychiatrist Sectorconsultants 4.25sessionsperweekNursingstaff 6.4(5inpost)

NCHD 1

Occupationaltherapist 1 ProvidesserviceforSligotownanddayhospital

Psychologist 1 Notassignedtodaycentre,hadaservicewideremit

Socialworker Aspersectorteams Limitedavailabilitytodaycentreclients

Activitiestherapist 0

Other:-CNSfamilytherapy-CNScognitivetherapy

2.43

Basedindayhospital,withservicewideremit

Pharmacist 1 Pharmacistwasavailabletothedayhospital


Thereweretwomultidisciplinaryteammeetingsaweek,heldbythetwoprincipalteamsthatusedtheservice.Thesewereattendedbytheconsultant,NCHD,nursingstaff,occupationaltherapist,socialworkerandpsychologist(asrequired).Allmadeentriesinthecasenotes.

Amultidisciplinarycareplanwasinuse,inlinewiththepracticeinthein-patientservice.

AddictioncounsellorsattendedonWednesdaymornings.RelaxationgroupswereheldonWednesdaysandFridays.Aleisuregroupwasduetostartonthedayoftheinspection,whileavocationalgroupwasduetostartshortly,toberunbyoccupationaltherapyandnursingstaff.

199


Anoutreachservicewasprovidedforrefugeesandhomelesspeople.Staffhadaccesstoaninterpreterservicebyarrangement.Theyfounddiagnosesofpost-traumaticstressdisorderwerecommonandtheycouldrefertoSpiritanAsylumServicesInitiative(SPIRASI)asrequired.

service user input

Therewasnoconsumerinputintotheservice.Therewillbeconsumerinputintotheplannedreview.ThenoticeboardadvertisedtheavailabilityofarepresentativeofIrishAdvocacyNetworkbuttherepresentativehadnotasyetvisitedtheservice.

Theconsumerpanelwasdiscontinuedasitwasfelttohavecompleteditsremit.

Therewerenoserviceusersinthecentreatthetimeofinspection.TheInspectoratewereinformedthatthiswasnotunusualasservicesweredividedbetweenthoseconductedin-house,anddomiciliaryvisits.


Areviewoftheoperationoftheservicewasplannedandtermsofreferencewerebeingfinalised.}}

Adedicatedpsychologypostformentalhealthserviceshadbeenfilled.}}

Avacantoccupationaltherapyposthadbeenfilled.}}

Twonurseswereattendinganurseprescribingcourse,tobecompletedlaterintheyear.}}


Diagnosis and duration numberAffectivedisorders 56Psychoticillness 48Anxietydisorders 10Addictiondisorders 8Personalitydisorders 7Other:-Anorexianervosa-Acquiredbraininjury

33

Averagelengthofstay(numberofdays) NotavailableTotalcaseload 135


Policieswereinoperationinlinewiththein-patientservice.Operationalpolicieswereinplaceforadmissionanddischarge,riskmanagement,incidentreportingandstafftraining.Allpoliciesneededtobeappropriatelyreviewed.

Theservicewasinspectedannuallyforfiresafety.

planning

Thiswillbesubjecttotheforthcomingreview.

200


Conclusions

ThisdayservicewasprovidedinaPrimaryCommunityandContinuingCare(PCCC)setting.Whiletherewereadvantagesintermsofstigmaandconfidentiality,therewereproblemsinrelationtohowitrelatedtothementalhealthserviceasawhole.Issuesofaccess,communicationandgovernancehadarisenandneededtobeaddressed.Thetermsofreferenceofaservicereviewwerebeingfinalised.Thisshouldaddressthefuturevisionfortheserviceandwhethertheprovisionofacommunitymentalhealthnurseatthecentrewouldfacilitateitsdevelopment.

Theenhancementofthemultidisciplinaryteamduringtheyearwastobewelcomed,butthereremainsaprobleminrelationtosocialworkservices.TheInspectoratewasinformedthatthiswasconductedthroughthesectorteams.However,notallteamshadadedicatedsocialworker.


1. The service review should be conducted as soon as possible with a view to clarifying issues that have arisen about referral, governance and access.

2. The review should address the issue of the deployment of staff in the centre and whether a dedicated community mental health nurse is needed to facilitate centre staff further developing the service there.

3. Services should reflect the mental health need of the population at least at a secondary level.

4. Access to social work staff should be addressed.

5. Policies should be reviewed and dated appropriately.

6. The service should have access to a dedicated risk manager.

7. Safety issues in regard to the office accommodation should be addressed.

8. Service user input should be enhanced.

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DayHospitalInspected DromminHouseCommunityMentalHealthCentre,Nenagh

HSEArea HSEWest

ExecutiveCatchmentArea Limerick,NorthTipperaryandClare

CatchmentPopulation 66,023

Location Nenagh

TotalNumberofPlaces 500

Dateofinspection 23July2009

Details

service Description

DromminHouseCommunityMentalHealthCentrewassituatedonDromminRoadinaresidentialareaontheoutskirtsofNenaghandassuch,wasphysicallyintegratedintothecommunity.Itcommencedofficialoperationsin2005followingthepurchaseofthepremises,formerlyfamilyresidence,andfollowingamajorextensiontotherearofthepremisesmakingitfitforpurpose.Thewaitingareaconsistedofapurpose-builtatriumwithofficesandactivityroomsoffit.Thiswaitingareawasbrightandingooddecorativeorderandhadadequateseating.Twocopiesofadailynewspaperwereavailable.Therewasfreshfiltereddrinkingwaterandaccesstotoiletareasthatwerecleanandingoodorder.Itwasreportedthattheservicehaddevelopedstronglinkswithprimarycare.

Theservice’shoursofopeningwerefrom0900hto1700h,MondaytoThursday,andfrom0900hto1600honFriday.

Serviceusersattendedforspecificclinicappointments,individualone-to-onetherapieswithmembersofthemultidisciplinaryteam,anxietygroups,sessionalwork,supervisionofdailymedicationsandadministrationofdepotmedications.

Althoughnewreferralsweretrackedfornon-attendance,therewerenostatisticsonnon-attendees.

Itwasreportedthatadjoiningneighbourswereverysupportiveoftheservice.

WorldMentalHealthWeekeachOctoberwasusedasanopportunitytotargetthegeneralpublicandspecificgroupssuchasGardamemberstocomeandviewtheworkingsoftheservice.

Premises

Checkpoint ResponseIsthepremisespartofapsychiatrichospital? NoIsthepremisesanindependentbuilding? YesIsthepremisespurposebuilt? YesIsthepremisesaccessiblebypublictransport? YesIsthepremisesthesectorHQ? YesHowmanyactivityroomsarethereforserviceusers? 12Howmanyserviceusersareattending? 500Isthereafacilityforprovidinghotmeals? No

202


Referral procedure

TheNenaghsectorteamadmittedindividualstotheservice.ReferralsweremadebyaGPtoanymemberofthemultidisciplinaryteamandsubsequentlydiscussedbytheteam.Theserviceusersthenautomaticallycameunderthecareofthesectorconsultantpsychiatrist.

Outofatotalof323referralstotheservicein2008,84werenewreferrals.

PatientswhoweredischargedfromSt.Luke’sHospital,Clonmel,orSt.Michael’sAcuteAdmissionsUnit,Clonmel,andwhowereresidentintheNenaghsector,wereautomaticallyreferredtotheserviceandwereseenwithinaweekoftheirdischarge.

AcommunitymentalhealthnurseattachedtotheserviceattendedteammeetingsofNenaghsectorserviceuserswhowereresidentinSt.Luke’sHospitalandSt.Michael’sUnit,sotheservicewasawareofimpendingdischargesbacktotheNenaghsector.TherewasnosocialworkerandpsychologyinputintotheNenaghsectorserviceuserswhowereresidentinSt.Luke’sHospitalorinSt.Michael’sAcuteUnit.

Staffing Levels

post number Wte sessions per weekConsultantpsychiatrist 1 FulltimeNursingstaff 4 FulltimeNCHD 2 FulltimeOccupationaltherapist 0 -Psychologist 2 FulltimeSocialworker 1 FulltimeActivitiestherapist 0 -AddictionCounsellor 1 Fulltime


Anewassessmentandindividualcareplanhadbeenintroducedbytheservice.Theplanwasthatallnewreferralswouldbeginwiththisdocumentation.Itwasenvisagedthatregularattendeeswouldbetransferredtothenewdocumentationintime.Theserviceusercollaboratedwiththecareplanandsignedit.

Therewasaweeklyteammeetingattendedbyallmembersofthemultidisciplinaryteam.

Homevisitswerecarriedoutbythecommunitymentalhealthnurse,andalsobyallmembersofthemultidisciplinaryteam.

Caseconferenceswereheldandwereattendedbytheserviceuserconcerned.

Aliaisonnurselinkedtheservicewiththehospitaltofacilitatefollow-upforpeoplewhodeliberatelyselfharm.

service user input

TheIrishAdvocacyNetwork(IAN)representativehadestablishedfirmlinkswiththeservice.InformationregardingIANandothervoluntaryorganisationswasdisplayedprominentlyonthenoticeboardinthewaitingroom.

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Theserviceuserreportindicatedthatstaffwerehelpfulandapproachable.However,serviceusersalsobelievedtherewastoomuchemphasisonmedicationandsomeclientshadlittleawarenessoftheircareplans.

Thesocialworkerhadfacilitatedthedevelopmentofauser-ledsupportandinformationserviceatÁrasFolláin.

Noneoftheserviceusersattendingtheserviceonthedayofinspection,askedtospeaktotheInspectorate.


Anewcommunitymentalhealthserviceassessmentandrecoverycareplanhadbeenintroducedby}}

theservice.

AnauditonnursingdocumentationbasedonAnBordAltranaisstandardshadbeenundertakenbythe}}

serviceandwastobefollowedbyasix-monthevaluationandreview.

Allmembersofthemultidisciplinaryteamhadreceivedtraininginpreventionandmanagementof}}

aggressionandviolence(PMAV).


Diagnosis numberAffectivedisorders 3Psychoticillness 4Anxietydisorders 16Addictiondisorders 3Personalitydisorders 0Other 3Averagelengthofstay(numberofdays) Notavailable


Apolicyworkinggrouphadbeenestablishedbytheservicetointroducepoliciesandprocedurespertinenttotheserviceprovided.

Theservicehadanadmissionanddischargepolicy.

Riskassessmenthadbeenincorporatedintothenewassessmenttooltobeusedforallattendeesoftheservice.

AllincidentswerenowfedintotheSTARSWebtrackingsystem.

AnumberofstafffromtheNorthTipperarycatchmenthadreceivedPMAVtrainingintheDundalkInstituteofTechnology.They,inturn,hadprovidedin-servicetrainingtoallstaffoftheserviceinOctober2008.Afollow-uptrainingprogrammewasscheduledforOctober2009.

Allstaffoftheservicehadreceivedtrainingincardio-pulmonaryresuscitation(CPR).Anautomaticemergencydefibrillatorwaslocatedonthepremises.

Allstafftraininghadnowstoppedbecauseofcutbacks.

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planning

TheplanforseparatingNorthTipperaryandSouthTipperarymentalhealthserviceswascompleteandwasmadeavailabletotheInspectorate.Thisdidnotdealwiththeclosureofin-patientservicesinSouthTipperary.Anewcommitteewasnowlookingatthisandthedevelopmentofalternatein-patientfacilitiesforNorthTipperary.ItwasreportedthatadecisionhadbeenmadethatnopatientsfromNorthTipperarywouldbeadmittedtoClonmelafter31December2010.Althoughitwasreportedthattheplanwastoextendopeninghourspossiblytoaseven-dayserviceandtofurtherdevelopthealreadyestablishedlinkswithprimarycare,DromminHouseCommunityMentalHealthCentrehadnospecificwrittenserviceplanoroperationalframework.

Conclusions

DromminHouseCommunityMentalHealthCentrewasthesectorheadquartersfortheNenaghsector,oneoftwosectorsintheNorthTipperarycatchmentthatwaspartofHSEWest.ThecatchmentwasuniqueinIrelandinthatithadnoresidentialbeds.Anyindividualwhorequiredin-patientcareandtreatmentwasreferredtoSt.Michael’sAcuteAdmissionsUnitinSouthTipperarycatchment,whichwaspartofHSESouth.

DromminHouse,setdiscreetlyinaresidentialarea,providedaservicetoapproximately500serviceusers.Ithadestablishedstronglinkswithprimarycareandhadreceivedgreatsupportfromthelocalcommunity.

Serviceusersattendedforclinicappointments,individualone-to-onetherapieswithmembersofthemultidisciplinaryteam,specificgroups,sessionalwork,supervisionofdailymedicationsandadministrationofdepotmedications.

Thefocusofcareandtreatmentwasamultidisciplinaryapproach,incollaborationwiththeserviceuser.


1. Consideration should be given to extending the service to seven days a week.

2. The service should have its own written strategic plan and operational framework to include the provision of in-patient beds and community residences for which it is responsible.

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appendix 7: service users and Carers involvement in Mental Health services 2009Maeve Kenny, assistant inspector of Mental Health services

introduction

In2009,theInspectoratewasinterestedintheviewsofserviceusersandcarersaboutthequalityofmentalhealthservices,theavailabilityofpeersupportandadvocacy,andtheirlevelofinvolvementatalllevelsinmentalhealthservices.Serviceusersandcarershaveuniqueandvaluableperspectivesontheservicetheyreceiveandconsequentlytheirviewshadbeenincorporatedintotheinspectionprocess.A Vision for Change(2006,p.9)recommendsthatthe“involvement of service users and their carers should be a feature of every aspect of service development and delivery”.

Methodology

approved Centre inspections

TheInspectoratemetwithresidentsduringinspectionsofapprovedcentresandincludedtheircommentsinindividualapprovedcentreinspectionreports.ResidentsrepresentedtheirownpersonalissuesandconcernstotheInspectorate.

Mental Health service inspections

Inspectionsofmentalhealthserviceswereconductedthroughlocalmeetingswithrelevantpersonnelwhoprovidedtheirperspectivesaboutthequalityoflocalmentalhealthservices.Generally,servicesinvitedthelocalorregionalIrishAdvocacyNetwork(IAN)orSTEERpeeradvocateandsomeservicesalsoinvitedserviceuserandcarerrepresentatives.

self-assessment

Thisyear,aspartoftheinspectionofmentalhealthservices,theInspectoraterequestedlocalmanagementtocompleteaself-assessment.Thisincludedanevaluationoftheextentofpeersupportandadvocacy,andthelevelofserviceuserinvolvementinthelocalmentalhealthservices.Thirty-onecatchmentsandSt.Joseph’sI.D.servicewererequestedtoreturnself-assessmentstotheInspectorate.Thirty-oneself-assessmentswereanalysed.Alloftheservices,withtheexceptionofDublinSouthEast,returnedaself-assessment.

Theinformationrequestedrelatedtotheme3fromtheQuality Framework(MHC,2007).Theme3statesthat“an empowering approach to mental health services delivery is beneficial to both people using the service and those providing it”(MHC,2007,p.29).Thespecificinformationsoughtrelatedtotwostandardsundertheme3,whichstatethat”peer support/advocacy is available to service users”and“that a clear accessible mechanism for participation in the delivery of mental health services is available to service users”(MHC,2007,p32).Eachofthesestandardshad5criterionagainstwhichserviceswereaskedtoassessthemselves.Thecriterionarereportedlaterinthisreport.

Theinformationreceivedfromserviceswasdifficulttocollateduetoinconsistenciesinreportinginformationanddifferentinterpretationsoftheinformationbeingsought.ThemainissuesandconcernsfromApprovedCentreandCatchmentreportsarepresentedbelow.Examplesofgoodorinnovativepracticearehighlightedfromtheself-assessmentscompletedbyservices.Thisisnotanexhaustivelistofgoodpracticesanddoesnotimplythatotherserviceswerenotdeliveringsimilarorothergoodpractices.

206


service users’ Views from approved Centre inspection Reports

Arangeofissuesandconcernsemergedinmeetingswithresidentsduringinspectionsofapprovedcentres.TheInspectorateintervenedwhereappropriate.Importantly,theInspectoratenotedthatmostresidentsstatedtheywerehappywiththeircareandtreatment.Itwasencouragingtonotethatanumberofresidentsspokeaboutthehighlevelofinvolvementtheyhadintheircareplanandtreatment.However,highlightinginconsistenciesacrossservices,otherresidentsreportedthattheywerenotawareoftheircareplanandreportednothavingenoughinformationabouttheirtreatment.Residentsweregenerallypositiveaboutimprovementsintheirenvironmentwhenfacilitieshadbeenupgradedordecorated.Mostresidentscommentedonthehelpfulness,warmthanddedicationofmoststaffontheunits,inparticular,recentlyqualifiednursingstaffwhotheyfoundtobecaringandsupportive.Thepracticeofprotectednursingtimetospendwithresidentswasseenasvaluable.

Someoftheconcernsraisedbyresidentsincludednothavingenoughchoiceoffoodandlackofprivacyinsomeapprovedcentres.Residentsalsocommentedthattherewerelimitedrecreationalactivitiesprovidedintheeveningsandatweekends.

service user Representatives’ Views from Catchment inspection Reports

TheIANandSTEERpeeradvocatesreportedthattheywerewelcomedbylocalmentalhealthservicesandsupportedbystafftocarryouttheirwork.Insomeareaspeeradvocatesattendedmentalhealthtribunalsattherequestofresidentsandthiswasvaluedbyserviceusers.Thereweremixedreportsfrompeeradvocatesabouthowsatisfiedresidentswereabouttheirlevelofinvolvementintheircareandtreatmentandthelevelofinformationthathadbeenmadeavailabletotheminrelationtotheirdiagnosisandmedication.Thisindicatedthatinsomeservicesmoreworkisrequiredinthisarea.

Peeradvocatesreportedthatinanumberofservicestheyhadbeeninvitedontotheseniormanagementteamandthustheywerepartofdecisionmakingprocesseswithintheseservices.Whilenotallserviceshadexpandedtheirmanagementstructureinthisway,peeradvocateshadbeenaskedtoparticipateinarangeoflocalgroupsfacilitatingtheinclusionofserviceuserviews,forexample,localVision for Changeimplementationgroups,healthandsafety,riskmanagementandpolicydevelopmentcommittees.

TheInspectoratenotedthatthesedevelopments,whilewelcome,hadbeengatheringpaceoverthepastfewyearsandraisedanumberofissues.Someserviceswererelyingonpeeradvocateinvolvementratherthanserviceuserandcarerinvolvement.Peeradvocates,serviceusers,carersandservicesalsohighlightedthattherewerealimitednumberofserviceusersandcarersavailabletotakeuproleswithintheservices.Thereisanongoingneedforfurthertrainingandbuildingofcapacityamongserviceusersandcarerstofacilitatethedevelopmentoftheirrolesandtheirongoingparticipationinmentalhealthservices.

IANrepresentativesreportedthatinmostareas,fundingforpeeradvocacytrainingwaslimited.Thelimitedresourcesintermsofnumbersofadvocatesmadeitimpossibleforallmentalhealthfacilitiestobevisitedonaregularbasis.Ataminimum,mosttriedtoprovidearegularvisitingservicetotheadmissionunits,butwerenotabletoprovidethesamelevelofservicetootherunitsorcommunitybasedfacilities.

Advocatesreportedthatinsomeservicesresidentsinapprovedcentreswereexpectedtoattendteammeetings,inotherservicesthisoptionwasnotprovided,whileinotherservicestheresidentcouldchoosewhetherornottoattend.Whiletherearelogisticalissuesforsomeservices,itisanexampleofhowservicescouldbereconfiguredtofacilitatethepreferencesandchoicesofresidents,therebyenhancingautonomy.

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Otherissues,highlightedinthe2008Inspector’sreport,continuedtobeofconcern,includingaperceivedover-relianceonmedication,andalackofattentiontoandinformationaboutthesideeffectsofmedications.Thelimitedtimethatserviceusershadtodiscussmatterswithaconsultantpsychiatristwascriticised.Inaddition,thelimitedaccesstoclinicalpsychologists,socialworkers,occupationaltherapistsandalternativestothemedicalmodelcontinuedtobehighlightedasaconcern.

SomeserviceshadformalandregularmeetingsbetweenmanagementandIANorSTEERpeeradvocatesandthesewerereportedgenerallytobeeffectiveinresolvingissues.Specificliaisonarrangementswithadesignatedstaffmemberonaunitorinanapprovedcentrealsohelpedcommunicationandpromptresolutionofspecificissues.

services’ perspectives on service user participation

MentalHealthServiceswereaskedtoassessthemselvesonanumberofquestionsdesignedtoexaminethelevelofpeersupportandadvocacyprovidedandthelevelofparticipationofserviceusersinthedeliveryofmentalhealthservices.Belowisasummaryoftheinformationprovidedandsomeexamplesofgoodorinnovativepracticesfromtheself-assessmentscompletedbyservices.

availability of peer advocacy services to service users

Peer-advocacywasavailableinallservices.However,thelimitednumberoftrainedpeeradvocatesresultedinlimitedaccessinsomeservices.Forexample,insomeareasadvocateswereonlyabletovisitapprovedcentresanddidnothavethecapacitytovisitcommunitybasedfacilities,orinthecaseofsomeapprovedcentreswereunabletoprovideaservicetoalltheunits,forexampleSt.Senan’swheretherewasnoprovisiontocontinuingcareunits.

availability of peer-provided services to service users

Peer-providedserviceswereavailableinallareas.TypicallytheseincludedShine,Grow,Aware,A.A.,Al-Anon,andNarcoticsAnonymous.Insomeareas,thesevoluntaryorganisationsdeliveredservicesintheapprovedcentresaswellasinthecommunity.

Hse Dublin Mid-leinster

Laois/Offaly:Therewasacommunitybased‘FindingYourWaytoRecoveryGroup’,whichwasajointinitiativebetweenShineandmentalhealthandprimarycaresocialwork.Itwasledbyaserviceuser.TherewasalsoaLighthouseClub,whichwasanout-of-hourssocialnetworkingservicerunbyserviceusersinpartnershipwithIAN.

South County Dublin:AuserresourceandinformationcentrehadbeenestablishedatBurtonHallandwasstaffedbytheServiceUserResourceCommittee(SOURCE)andvolunteers.


Cavan/Monaghan:TheSolasdrop-incentreprovidedalinkservicebetweenstatutoryandvoluntarygroups.

Louth/Meath:Clientfocusgroupswerefacilitatedbydevelopmentofficersfromlocalvoluntarygroups.

St. Joseph’s I.D. service:PeeradvocacywasnotavailablebutSocialInclusionIrelandprovidedanadvocacyserviceandtraininginself-advocacy.

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Hse West

North Tipperary:PeerprovidedserviceswereavailablethroughÁrasFalloin,acommunitybasedprojectinNenagh.

West Galway:Apeersupportcentrewasbeingestablished.

Quality Framework Mental Health services in ireland – standard 3.3

3.3.1(a): adherence to Regulation 20 (provision of information to residents)

TherewasastatutoryrequirementforcompliancewithArticle20oftheMental Health Act, 2001, (Approved Centre) Regulations.Seventy-threepercent(47)ofapprovedcentreswerecompliant.St.Finan’swastheonlyapprovedcentrethatwasnon-compliant,whileotherapprovedcentreshadeitherinitiatedcomplianceorweresubstantiallycompliant.

3.3.1(b): provision of Clear Written information on Mental Health peer advocacy services and How to access them

Mostservicesprovidedwrittenleafletsandnoticesaboutpeeradvocacyservices.Itwasnotalwaysclearfromtheself-assessmentsifthisinformationwasavailableinallmentalhealthfacilitiesintheareaoronlyapprovedcentres.St.Joseph’sI.D.servicesprovidedplainEnglishbookletsincorporatingimagery.Ninety-fourpercent(61)ofapprovedcentreswerecompliantwithArticle20(1)(d)oftheregulationswhichrequiresthatdetailsofrelevantadvocacyandvoluntaryagenciesbeprovidedtoeachresident.Allotherapprovedcentreshadeitherinitiatedcomplianceorweresubstantiallycomplaint.

3.3.2: provision of access to advocacy training for service users

Twentytwoservicesreportedaccesstoadvocacytrainingforserviceusers.


Dublin South City and Dublin West/South West:Serviceusers,carersandstaffweresponsoredtoparticipateintheCo-operativeLearningLeadershipProgramme,apartnershipbetweentheSchoolofNursing,DublinCityUniversity(DCU),theHSE,IANandtheNationalServiceUserExecutive(NSUE).


North Dublin: Advocacytrainingcouldbeaccessedthroughareferralprocessfromaconsultantpsychiatrist.

St. Joseph’s I.D. service:Trainingwasprovidedinself-advocacyandtheservicewasworkingwiththeSchoolofNursing,DCU,tosupportpeoplewithanintellectualdisabilitytodevelopleadershipandadvocacyskills.

Hse south

West Cork:Serviceusers,carersandstaffweresponsoredtoparticipateintheCo-operativeLearningLeadershipProgramme,apartnershipbetweentheSchoolofNursing,DCU,theHSE,IANandNSUE.

Hse West

Donegal:Serviceusers,carersandstaffweresponsoredtoparticipateintheCo-operativeLearningLeadershipProgramme,apartnershipbetweentheSchoolofNursing,DCU,theHSE,IANandNSUE.

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Limerick:Tenpeopletrainedinadvocacy.

North Tipperary:ArasFollainandtheCitizen’sInformationBoardprovidedself-advocacycoursesandserviceusershadbeensupportedtoattendpeeradvocacytrainingwithIAN.

Sligo/Leitrim:Trainingwasprovidedforcarers.

3.3.3: policy about availability of peer support and advocacy to service users


Dublin South City:Reportedtherewasapolicyinplace.


St. Joseph’s I.D. service:Asteeringcommitteehadbeenestablishedtodevelopastrategytosupportthedevelopmentofpeerandself-advocacy.

Hse south

West Cork and North Cork:Reportedtherewasapolicyinplace.

Hse West

Sligo/Leitrim:Reportedtherewasapolicyinplace.

3.3.4: ongoing arrangements to Monitor peer support and advocacy

Inallareas,thelocalorregionalpeeradvocatepresentedareportatanannualmeetingwiththeInspectorate.Apartfromthatforum,16servicesreportedadditionalongoingarrangementstomonitoraccesstopeeradvocacy.Mostoftenthisinvolvedregularmeetingswithpeeradvocates.Threeservicesreportedongoingspecificarrangementsformonitoringotherformsofpeersupports.


South County Dublin:ServiceuserrepresentativeswereontheelectedcommitteeinVenegasHouseMembersClub.


Louth/Meath:Thereweredesignatedgroupswithresponsibilitytomonitortheprogressofclientfocusedgroups,relativesandcarers’supportgroupsandconsumerparticipationinservices.

St. Joseph’s I.D. service:Asteeringcommitteehadbeenestablishedandmonitoringpeersupportandadvocacywaspartofitsbrief.

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Quality Framework Mental Health services ireland – standard 3.4

participation in the Delivery of Mental Health services

extent of service user involvement in the planning and Development of Research within the service

Nineservicesreportedthattheyincludedserviceusersintheplanninganddevelopmentofresearch.Someoftherepliestothisquestionhighlightedconfusionbetweenviewingserviceusersasparticipantsinresearch,ratherthanasbeinginvolvedintheplanninganddevelopmentofitandafurtherconfusionbetweenpeeradvocatesandserviceuserrepresentatives.


Dublin West/South West and Dublin South City:EngagedinresearchprojectsthroughinvolvementwiththeDCUCooperativeLearningLeadershipprogramme.Thisrequiredthecollaborationofserviceusers,carersandstafftodevelopandimplementresearchprojects.

South County Dublin:Twoserviceusersweremembersoftheadultmentalhealthresearchboard,whichreviewedallproposedresearchintheservice.

Wicklow:Theserviceuserrepresentativewasamemberoftheethicscommittee.


Dublin North Central:Serviceusershadrequestedaresearchtopiconstigma.

Hse south

West Cork:ResearchprojectswereestablishedthroughinvolvementwiththeDCUCooperativeLearningLeadershipprogramme.Thisrequiredthecollaborationofserviceusers,carersandstafftodevelopandimplementresearchprojects.

Wexford:ThepeeradvocatewasinvolvedinthesteeringgroupoftheSCANproject,whichcontainedanelementofresearchwiththeSuicideResearchFoundation.

Hse West

Donegal:ResearchprojectswereestablishedthroughinvolvementwiththeDCUCooperativeLearningLeadershipprogramme.Thisrequiredthecollaborationofserviceusers,carersandstafftodevelopandimplementresearchprojects.

West Galway:ServiceusersdevelopedtheEmploymentandSocialSupportReport,asurveyofmentalhealthserviceusersinGalway.

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service user involvement in staff training and education

Thirteenservicesreportedserviceuserorcarerinvolvementinstafftrainingandeducation.

Hse Mid-leinster

Longford/Westmeath:TherewasinvolvementinNCHDinductiontraining.

South County Dublin:TheSOURCEgrouppresentedatconferencesandthirdlevelcourses.TherewasabuddysysteminplacewithserviceusersandnursingstudentsfromUCD.ServiceuserrepresentativesattendedweeklyjointlecturesinUCD.GrowwereinvolvedinpresentationstoNCHDsatinduction.

Wicklow:Serviceuserswereinvolvedincaseconferences.


Louth/Meath:Serviceuserswereinvolvedinanassertiveoutreachinductionprogramme.Theywereinvolvedinan11dayrecoveryworkshop.TheyhadinputtothetrainingofstudentnursesinDundalkInstituteoftechnologyandlinkedwithstudentnursesonplacementintheservice.

North Dublin:StaffaccessedtraininginDCU,whereserviceuserswereinvolvedintrainingandeducation.

St. Joseph’s I.D. service:Serviceusershadongoinginvolvementintheeducationandtrainingofpre-registrationstudents.

Hse south

South Lee:TherewasinvolvementininductionprogrammesforNCHDsandstudentnurses.

Waterford:Serviceuserswereinvolvedincaseconferences.

Wexford:TherewasinvolvementinNCHDtraining.

West Cork:ParticipantsintheDCUCooperativeLearningLeadershipprojecthadpresentedthebackgroundtotheircourseandtheirresearchprojecttoallstaff.

Kerry:Thepeeradvocatewasinvolvedinundergraduatenursetrainingandactedinanadvisoryroleindesigningcommunitymentalhealthteamtrainingandstaffdevelopment.

Hse West

Mayo:Serviceuserswereinvolvedinrehabilitationandrecoverytraining.

North Tipperary:ServiceusershadpresentedtostaffonWRAP,recoveryandself-advocacy.

3.4.1: the Ways service users are active participants in the planning, implementation, evaluation and Review of their own Care and treatment

Mostservicesindicatedthatcareplanswereusedforthispurpose.Theinformationsubmitteddidnotindicatehowwidespreadtheuseofindividualcareplanswasacrossthementalhealthservicesinanygivencatchment.Itwasevidentfromtheapprovedcentreinspectionreportsthatonly31.3%werefullycompliantwiththisrequirement(20).Inspectionreportsonasampleofdayhospitalsand24-hourstaffedcommunityresidencescompletedthisyear,andself-assessmentscommentingoncommunitybasedfacilities,indicatedthatindividualcareplanswerenotconsistentlyusedthroughoutthemental

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healthservices,therebylimitingserviceuserinvolvementintheirowncareandtreatment.Apartfromcareplans,therewereanumberofotherwaysthatservicesfacilitatedinvolvementofserviceusersintheircareandtreatment.


Dublin West/South West:Aplanningandadvisorygrouphadbeenestablishedoncarerandserviceuserparticipation.

Laois/Offaly:Thepsychiatryoflaterlifeteamhadestablishedacarers’supportgroup.


Dublin North Central:Aculturalclinichaddevelopedaculturaladvisorypanelthatincludedserviceusersinordertohelpdevelopserviceswithappropriateawarenessofculturalissues.

Louth/Meath:ApilotprojectonhelpingserviceuserstomanagefuturecrisisusingcrisiscardswasdevelopedthroughaclientinterestgroupinconjunctionwithAWARE.

North West Dublin:Focusgroupsforserviceusersandcarershadbeeninitiatedtoenhanceinvolvement.

Hse south

West Cork:TheWestCorkHealthForumwasaninformalnetworkofstakeholdersintheareathatincludedcommunityorganisations,voluntarysectorsandindividuals.Itprovidedachannelforserviceusersandcarers,identifiedsupportforfamilies,engagedwiththelocalcommunityandchallengedthestigmaofmentalhealth.

Hse West

East Galway:Therewasaconsumerforumandconsumerpanels.

North Tipperary:Therewasafamilysupportgroup.

Roscommon:MentalHealthIrelandhadestablishedausergroupandtherewasalsoarelatives’supportgroup.

3.4.2: Mechanisms in place for obtaining Feedback at service and Multidisciplinary team (MDt) level from service users

Allservicesreportedthattheyhadmechanismsinplaceforobtainingfeedbackfromserviceusers.ManyservicesdidnotdistinguishbetweenfeedbackatMDTlevelandfeedbackatservicelevel.MostservicesreportedthatcareplansfacilitatedfeedbackatMDTlevel.However,asdescribedabove,notallserviceusershadcareplansanditwasnotclearwhattypeoffeedbackresidentsgavethroughtheircareplans.


Longford/Westmeath:TheAthloneserviceusers’grouphaddesignatedfeedbackmeetingswiththeclinicaldirector.


St. Joseph’s I.D. service:Non-verbalfeedbackwasmonitored.

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Hse West

North Tipperary:TherewereregularmeetingswithserviceusersinÁrasFalloin.

Roscommon:FocusgroupswereheldinRoscrea.

Atservicelevel,allcatchmentsoperatedacomplaintspolicyandmanyalsoproactivelysoughttheviewsofserviceusersthroughsatisfactionquestionnaires.Itwasnotclearfromtheinformationsubmittedwhetherornotsatisfactionquestionnaireswereusedthroughoutallaspectsoftheserviceorinspecificareassuchasapprovedcentresordayhospitals.


Dublin West/South West:Acarers’councilhadbeenestablished.

South County Dublin:Satisfactionquestionnaireshadbeencompletedbytheserviceuserresearchcommittee(SOURCE)andacateringreviewgroupplanningsurveyhadbeencompletedacrosstheservicebyserviceusers.


North Dublin:Focusgroupswereheld.

Louth/Meath:Theconsumergroupfed-backtomanagement.Thepsychiatryoflaterlifefamilysupportgroupincludedafeedbackmechanismtotheteam.

St. Joseph’s I.D. service:Therewereregularfocusgroupsbetweenserviceusersandmanagement,aswellasinformalsessionsofserviceuserfeedback.

Hse south

West Cork:TheCooperativeLearningLeadershipprojecthaddevelopedaquestionnaireseekingfeedbackaboutallaspectsoftheservicefromallthosewhouseorworkintheservices.

Wexford:Aconsumerpanelwasdevelopingmechanismsforfeedback.

Hse West

Sligo/Leitrim:MentalHealthIrelandhadinitiatedaformalsurveyoftheconsumerpanel.

3.4.3: involvement of service users in the Development and planning of the Mental Health service including inclusion on MDt Catchment Management teams

Therewassignificantvariationacrosscatchmentsintermsoftheextentofserviceuserandcarerinvolvementonvariousplanninganddevelopmentcommittees.Mostserviceshadinvolvedpeeradvocateswhilesomealsoinvolvedserviceuserandcarerrepresentatives,onthelocalVision for Changeimplementationgroups.


Dublin South City:Thepeeradvocateattendedtheheadsofdepartmentgroup.

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Dublin West/South West:Theclinicalgovernancegrouphadbeenexpandedtoincludeserviceusersandcarerrepresentativesandtheyhadbeeninvolvedinthedesignofalocalbuildingproject.

South County Dublin:Therewasserviceuserparticipationonallplanningcommittees.


Dublin North Central:Thepeeradvocateattendedtheheadsofdisciplinemanagementmeetings.

Louth/Meath:TheregionalpeeradvocatewasinvolvedinmeetingsabouttheplanninganddevelopmentforanewacuteunitinLouth,areplacementfacilityforadaycentreinMeathandamalgamationofunitsinSt.Brigid’sandserviceusershadbeeninvolvedinaserviceplanningsessionwiththemanagementteam.Serviceuserswereinvolvedinthequalityandbestpracticegroup.

Hse south

South Tipperary:Aserviceuserrepresentativewasinvolvedingovernancestructures,capitalprojectsdevelopmentsandstrategicgroups.

West Cork:Serviceuserswererepresentedonthepolicycommittee,themultidisciplinaryintegratednotes/medicalrecordscommittee,theresidentialreviewcommittee,theriskmanagementgroup,andserviceusersandcarersweremembersofthelocal Vision for Changeimplementationgroup.

Wexford:ThepeeradvocatewasamemberofthesteeringgroupforthepilotSuicideCrisisAssessmentNurse(SCAN)project.

Hse West

Clare:Thepeeradvocatewasonthemanagementsteeringgroup,thepolicygroupandthemultidisciplinaryteamcareplandevelopmentcommittee.

East Galway:Therewasinvolvementintheauditcommittee.

Limerick:Theconsumergroupfacilitatednominationsforreviewingmultidisciplinaryteamdocumentationandthecateringstandardscommittee.

Mayo:Thepeeradvocateattendedtheheadsofdepartmentmeetings,whichreportedtothemanagementteam.

West Galway:Thepeeradvocateattendedseniorstaffmeetings,quality/accreditationmeetingsandallpoliciesweresentforconsultationtoserviceuserrepresentativespriortoimplementation.

Relativelyfewserviceshadadaptedtoincludeserviceusersandcarersonthemanagementteam.Whileinallservicestherewassomelevelofinvolvementofpeeradvocatesinthedevelopmentandplanningofservices,mainlythroughinclusiononlocalVision for Changeimplementationgroups,significantlyfewerserviceshadformallyinvolvedserviceusersandcarers.


Longford/Westmeath:Thepeeradvocatejoinedthecatchmentmanagementmeetingeverythreemonths.

Wicklow:TherewasaserviceuserontheNewcastleHospitalmanagementteam.

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North Dublin:Thepeeradvocatewasamemberofthemanagementteam.

Hse south

North Cork:Thepeeradvocateattendedmanagementmeetingsalthoughthisarrangementhasnotbeenformalisedandthepeeradvocatewasamemberofpolicyandproceduregroup.

Hse West

Donegal:Thepeeradvocatewasonthementalhealthservicesmanagementteamandchairedthepolicyreviewgroup.

3.4.4: policy about service user involvement at all levels within the Mental Health service

Fourservicesreportedhavingapolicyaboutserviceuserinvolvement.


Dublin West/South West:Thepolicywastoincreaserepresentationatalllevelsoftheservice.

South County Dublin:Thepolicywastoencourageallstakeholderstoparticipateintheplanninganddeliveryofservices.

Wicklow:Therewasapolicyaboutserviceuserinvolvementonmanagementteam.

Hse south

West Cork:Thepolicywastohaveserviceusersinvolvedatalllevelsoftheservice.

3.4.5: ongoing arrangements to Monitor performance with Regard to service user involvement at all levels within the Mental Health service

Onlytwoservicesreportedongoingarrangementstomonitoritsperformancewithregardtoserviceuserinvolvement.


St. Joseph’s I.D. service:Asteeringgrouphaddesignatedresponsibilityformonitoringperformanceinrelationtoserviceuserinvolvement.

Hse south

West Cork:TimewassetasideattheendofeachVision for Changeimplementationgrouptoreviewprogressinrelationtoserviceuserinvolvement.

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summary

Thisreporthighlightedawiderangeofvariationacrossmentalhealthservicesintermsofwhatresidents,peeradvocatesandservicesreportedabouttheextentandtypeofserviceuserandcarerinvolvementatalllevelswithinthementalhealthservicesandtheavailabilityofpeersupportandadvocacy.

Residents in approved centres generally reported concerns about:

limitedchoiceoffood}}

lackofprivacy}}

limitedrecreationalactivitiesintheeveningsandatweekends}}

Residents in approved centres were generally satisfied with:

thecareandtreatmenttheyreceivedwhileinhospital}}

thepositiveeffectsofhelpfulandwarmrelationshipswithstaff}}

recentlyqualifiednursingstaff}}

protectedtimeforkeynursestospendwithresidents}}

improvementsinthephysicalenvironmentinapprovedcentres}}

Peer advocates highlighted positive issues including:

thewelcomeandsupporttheyreceivedfromstaffwhencarryingouttheirwork}}

theusefulnessofhavingregularmeetingswithstaffinapprovedcentres}}

someserviceshadadesignatedseniorstaffmemberwhotheadvocatecouldliaisewithtoaddress}}

concernspromptly

theywereincreasinglyrequestedtosupportdetainedpatientsattheirMHCtribunal}}

theexpansionofmanagementstructurestoincludeserviceuserrepresentatives}}

Peer advocates highlighted issues for improvement including:

limitedtimeserviceuserswereaffordedtospendwithconsultantpsychiatrists}}

restrictedornoaccessforserviceuserstoalternateapproachestotheirrecoveryapartfromthe}}

medicalmodel

lackofinformationmadeavailabletoserviceusersabouttheirdiagnosisandmedication,particularly}}

abouttheside-effectsofmedications

limitedinvolvementofserviceusersintheirowncareplans}}

individualcareplanswerenotusedthroughouttheentireserviceandmayonlyhavebeenusedin}}

approvedcentresorcommunityfacilities,butnotinboth

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restrictedresourcesandcapacityforpeeradvocatesandserviceuser/carerinvolvement}}

Self-assessments completed by services indicated:

significantvariationacrossservicesinrelationtoserviceuserandcarerinvolvement}}

pocketsofserviceswhereasignificantamountofworkhadbeenundertakenintheareaofservice}}

userandcarerparticipationatalllevels

WestCork,DublinWest/SouthWest,DublinSouthCity,SouthCountyDublinandSt.Joseph’sI.D.}}

servicesallstoodoutintermsoftheircollaborativeandinclusiveapproachtoserviceusersandcarerinvolvementintherespectiveservices

Conclusion

Overall,thereissignificantscopeforfurtherinvolvementofserviceusersandcarersatalllevelswithinthementalhealthservices.Manyofthegoodandinnovativepracticesdescribedinthisreportcouldbeincorporatedintoservicedeliverywithoutsignificantexpenditureandindeedsomeofthepracticesarecostneutral.

Recommendations

1. Funding,trainingandpersonnelresourcesneedtobemadeavailableasservicesstrivetoincreasethelevelofparticipationofserviceusersandcarersinallaspectsofdeliveryanddevelopmentofmentalhealthservices.

2. Formallinksbetweenmentalhealthservicesandthirdlevelinstitutionsshouldcontinuetobeforgedtodevelopcapacityforserviceuserandcarerinvolvement.

3. Servicesshoulddevelopapolicyabouttheavailabilityofpeersupportandadvocacytoallserviceusers.

4. Servicesshoulddevelopapolicyaboutserviceuserandcarerinvolvementatalllevelswithinthementalhealthservice.

5. Serviceusersshouldhaveanindividualcareplanregardlessofwhataspectsofthementalhealthservicetheyuse.

6. Formalmechanismsshouldbeimplementedinmentalhealthservicestoobtainfeedbackfromserviceusersandcarersaboutallaspectsofthementalhealthservice,includingtheperson’sMDT.

References

DepartmentofHealthandChildren(2001)Mental Health Act, 2001, (Approved Centre) Regulations.Dublin:Stationeryoffice.

DepartmentofHealthandChildren(2006)A Vision for Change – Report of the Expert Group on Mental Health Policy.Dublin:StationeryOffice.

MentalHealthCommission(2007)Quality Framework: Mental Health Services in Ireland.

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appendix 8: Child and adolescent Mental Health services 2009Dr. susan Finnerty, assistant inspector of Mental Health services

Informationforthisreportwascollectedthroughaself-assessmentquestionnairesenttoeachserviceandfromanoverviewmeetingheldwithalltheservicesinNovember2009.

Thequalityoftheinformationreceivedthroughtheself-assessmentwasvariable.Themajorityofservicesprovideddetailedinformationabouttheirservicewhileasmallnumberofservicesgaveminimalinformation,leavingsomequestionsunanswered.

Description of services

linn Dara Mental Health services (south West Dublin, south inner City, north West Dublin and Kildare)

ThepopulationservedbyLinnDarawas1.55million.Ithadeightcommunitychildandadolescentmentalhealthservice(CAMHS)teamsandprovidedaliaisonservicetoTheNationalChildren’sHospitalinTallaght.Childrenwereseentotheageof16.Ithadasix-bedin-patientunit,WarrenstownHouse,whichwasanapprovedcentre.TheplansfortheserviceincludeddevelopinganewbaseatCherryOrchardforadayhospitalandcommunityteams,anddevelopingtheserviceinWarrenstown.Developmentsincludedtheappointmentofachildpsychiatristandapprovalforfivenewstaffmembers.Therewereanumberofongoingprogrammesincludingaprojecttargetingchildrenatriskofearlyschoolleaving,parentpsycho-educationmeetings,psychotherapyforadolescentgirlsandtheDinosaurchildren’sgroup.TherewerededicatedADHDclinics.

Waterford/south Kilkenny Child and adolescent Mental Health services

Waterford/SouthKilkennyhadacatchmentpopulationof120,017andhadonecommunitymentalhealthteam.TheteamwasbasedinWaterfordRegionalHospitalforwhichitprovidedaliaisonservice.Childrenwereseenuptotheageof18.Therewereplanstorecruittwonewcommunityteams.DevelopmentsincludedtherecruitmentofaspeechandlanguagetherapistandanoccupationaltherapistandtheNCHDallocationhadbeenchangedfromregistrartoseniorregistrar.TherewasadedicatedADHDclinic.

north lee and north Cork Child and adolescent Mental Health services

TheNorthLeecatchmentareahadapopulationof178,692andNorthCorkhadapopulationof80,795.TherewerethreecommunityCAMHSteams.Theserviceassessedandtreatedchildrenuptotheageof16.Activecaseswereseentoage18.Therewasaninterimin-patientunitinSt.Stephen’sHospitalwithsixbeds.Constructionhadcommencedona20-bedunitinBessboroinCorkwhichwillbearegionalin-patientservice.Developmentsincludedcompletionofthein-patientunit.OngoingprogrammesincludedIncredibleYearsProgrammeforparents,initiationoftheJigsawProject,Parent’sPlusGroups,socialskillstraining,adolescentparentsgroupandspeechandlanguageandoccupationaltherapygroups.ChildrenwithADHDwereseenbothatadedicatedclinicandpartofroutinereferralsdependingonsector.

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Carlow Kilkenny Child and adolescent Mental Health services

CarlowKilkennyservedacatchmentareaof120,671.IthadonecommunityCAMHSteamandprovidedaliaisonservicetotheSt.Luke’sGeneralHospital,Kilkenny.Theserviceseeschildrentotheageof18.Twoconsultantpsychiatristshavebeenappointed.AwaitinglistinitiativeandanITdatamanagementsystemhadbeensetup.ParentingcoursetraininghadbeencompletedandtherewasanADHDparentinggroup.TherewasanADHDdedicatedclinic.

Kerry Child and adolescent Mental Health services

Kerryhadapopulationof139,565andonecommunityCAMHSteam.TheservicewasdeliveredbytheBrothersofCharityfortheHSE.Referralswereaccepteduptotheageof16.Theservicealsoprovidedaservicetochildrenwithintellectualdisabilitywhohadco-morbidmentalhealthproblems.TheservicewasbasedinTralee.Recruitmentofaconsultantpsychiatristhadbeencompletedalthoughtherewasnoteam.Therewasalsoanewoccupationaltherapypost.AnumberofgroupswereheldincludingADHDparentinggroups,CBTdepressiongroupsandtherewasparticipationintheJigsawProject.TherewasadedicatedADHDclinic.

Donegal Child and adolescent services

ThepopulationofDonegalwas145,000andthereweretwocommunityCAMHS.Referralswereacceptedtotheageof18.TherewereplanstointegratetheDonegalandSligoservicesatmanagementlevel.Aseniorregistrarandapsychologistwererecruitedin2009andapprovalhadbeengrantedforacommunityteam.Programmesavailableincludedgrouptherapy,afamilyclinic,parentinggroups,behaviouraltherapyandanattachmentclinic.Formallinkshavebeenestablishedwiththeadultmentalhealthservice.TherewerededicatedADHDclinics.

sligo/leitrim/West Cavan Child and adolescent Mental Health services

Thepopulationofthisareawas91,053.TherewasonecommunityCAMHSteam.Referralswereacceptedtoage18.Apermanentconsultantpsychiatristhadbeenrecruited(previouslyfilledonatemporarybasis).TherewereplanstointegrateserviceswiththeDonegalteam.Fivemultidisciplinarypostshavebeenapprovedaswellasasecondconsultantpsychiatristpost.Theservicerangrouptherapy,cognitivebehaviouraltherapyandfamilytherapy.OutreachclinicshadcommencedandtherewasadedicatedADHDclinic.Theserviceprovidedahalfdayinputtotheautismservice.

Galway, Mayo, Roscommon Child and adolescent Mental Health services

Thetotalpopulationofthisareawas463,383.TherewerefivecommunityCAMHSteams.Therewasa10-bedin-patientunitinSt.Anne’sChildren’sCentreinGalway,whichwasanapprovedcentre.Buildingwasunderwayforanew20-bedunitinMerlinParkinGalwaywhichwillbecompletedin2010.TherewereplanstoredefineboundariestomatchPrimaryCareNetworks.Aconsultantpsychiatristforthein-patientservicehadbeenappointed.TherehadbeenfiveadditionalpostsrecruitedforateaminMayo.Thereweregroupsforyoungpeoplewitheatingdisorders,communityteamsliaisewithJigsaw(currentlybeingextended)andnewinformationleafletswereinuse.TherewerededicatedADHDclinics.TherewasaChildandAdolescentMentalHealthCourseatNUIGfornursingstaff.

limerick, Clare and north tipperary Child and adolescent Mental Health services

Thepopulationintheservicewas361,028.TherewerefourcommunityCAMHSteams.Referralsweretotheageof16years,althoughthereweresomelimitedprovisionstoseechildrenuptotheageof18inLimerickCity.TherewasaccesstoadultpsychiatricbedsintheMid-WesternRegionalHospitalinLimerick.Aconsultantpsychiatristandfivemultidisciplinarystaffhadbeenrecruited.Planswereinplacetoestablishaconsumerpanel.TherewerededicatedservicesforchildrenwithADHD.

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north Dublin, Dublin north Central and part of north West Dublin Child and adolescent Mental Health services

Thepopulationofthisareawas380,856.TherewerefivecommunityCAMHSteamsbasedintheMaterHospital,anin-patientunitteamandadayhospitalteam.Therewasanewlyopenedsixbedunitfor16-18yearoldsinSt.Vincent’sHospital,whichwasanapprovedcentre,andadayhospitalfor13to17yearolds.AconsultantpsychiatristwasappointedinFebruary2009,aswellasaseniorpsychologist,seniorsocialworkerandaseniorspeechandlanguagetherapistintheMatercommunityservice.Therewerenonursesonthecommunityteams.Apsychologistandsocialworkerwereappointedtothedayhospitalteam,alsotherewasanincreaseinmedicalinput.Serviceusersprovidedformalfeedback.Therewasanupdateddatacollectionsysteminuse.Thereweregrouptherapies,parenttraining,familytherapyandartpsychotherapy.EachCAMHSteamprovidedanADHDserviceasanintegralpartoftheirgeneralwork.QualityNetworkforIn-patientCAHMS(QNIC)wasusedtoinformpracticeinthein-patientunit.TherewasaspecializedADHDteaminNationalChildren’sHospitalinTempleStreet.

louth Meath Cavan Monaghan Child and adolescent Mental Health services

Thecatchmentpopulationwas392,889andtherewerethreecommunityCAMHSteams.Referralsweretakenuptotheageof16butserviceswereextendedto18foractivecases.TherewasaregionaldayprogrammeinLouthwhichrunstwodaysaweekandaliaisonservicetoCavanGeneralHospital,OurLady’sofLourdesHospitalinDroghedaandNavanGeneralHospital.Aconsultantpsychiatristandacommunitymentalhealthnursehadbeenappointed,andaseniorpsychologistandseniorsocialworkerwerebeingrecruited.Programmesincludedfamilytherapy,cognitivebehaviouraltherapy,familysupportforADHD,psychotherapyforadolescents,earlypsychosisintervention,theKerfootprogramme,parentsupportgroups,anti-bullying,Crosslinx,groupsforadolescentswithAsperger’sSyndromeandadialecticalBehaviourTherapygroup.TherewerededicatedADHDservices.

south tipperary Child and adolescent Mental Health services

ThepopulationofSouthTipperarywas83,221.TherewasonecommunityCAMHSteam.Referralswereuptotheageof16.NonewteamswereplannedforSouthTipperary.Anewpatientclinichadbeenestablished.Nogroupsorprogrammeswereabletotakeplaceduetolackofstaff.TherewerededicatedADHDclinics.

Wexford Child and adolescent Mental Health services

ThepopulationofWexfordwas131,000.TherewasonecommunityCAMHSteam.Theservicetookreferralsupto17yearsandprovidedaliaisonservicetoWexfordGeneralHospital.Anewconsultanthadbeenappointedandtherewereplanstorecruitasocialworkerandnurse.TherewerealsoplanstoprovideclinicalplacementfortraineeGPs.Aclinicalnursespecialistliaisedwiththeschoolsofchildrenwhowereattendingtheservice.TherewerededicatedADHDclinics

laois/offaly/longford/Westmeath Child and adolescent Mental Health service

Thepopulationofthisareawas250,000andthereweretwocommunityCAMHSteams.Referralswereuptotheageof16.AliaisonservicewasprovidedtotheMidlandRegionalHospitalsinPortlaoise,TullamoreandMullingar.Asocialworkerwasappointedin2009.Abasicgradeclinicalpsychologistposthadbeenreplacedbyaseniorclinicalpsychologist;thebasicgradepostwasnowvacant.Adolescentgrouptherapieswereavailableandfocusgroupshadbeenheldwithparentsandadolescents.Therewasactiveinvolvementwithananti-obesityprogrammeforchildren.Programmesincludedparentinggroups,stressmanagementgroups,cognitivebehaviouralprogrammes,artpsychotherapy,Kerfootprogrammeforattemptedsuicide,socialskillsgroupandfamilytherapy.Therewasadedicated0.5WTEconsultantpsychiatristforADHDwithdedicatedclinics.

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south lee and West Cork Child and adolescent Mental Health service

Althoughtherewerethreeteamsinthisareaonlyinformationononeteamwassubmittedbyself-assessment.Thepopulationofthisteamwas86,921.TheservicewasrunbytheBrothersofCharityfortheHSE.Theservicealsoprovidedaservicetochildrenwithintellectualdisabilitywhohaveco-morbidmentalhealthproblems.Amindfulnessgroupforanxietydisorderhadcommenced,therewerepsycho-educationalsessionstoschools,aParentPlusgroup,alibraryserviceandanADHDserviceauditwasnearcompletion.Therewereanumberofongoingclinicalauditstakingplace.Asocialworker,part-timeoccupationaltherapistandanursewereduetocommenceworkinNovember2009.Apsychologistwasduetocommencein2010.Noconsultantposthadbeenapprovedforthisteam.TherewasadedicatedADHDservice.

lucena Child and adolescent Mental Health service

LucenaCAMHScoveredapopulationof600,000.TherewereeightcommunityCAMHSteamsandadayhospital.Therewerecloselinkstotwospecialschools.TherewasaneffectiveITsystemwhichwassharedwithSt.JohnofGodServices.Programmesincludedfamilytherapyandparentinggroups.

summary

Oneofthemoststrikingfeaturesintheinformationcollectedwastheimmenselywiderangeofservices,groupsandprogrammesofferedbythechildandadolescentmentalhealthservices.However,eachteamprovideddifferentprogrammes;someprovidingmanyprogrammeswhileothersappearedtoprovideveryfew.Whilethiswasobviouslyafactoroftheavailabilityofresources,itwasobviousthatthetypeofprogrammesonoffervariedconsiderably.Thedecisionastowhichservicewastobeofferedandhowitwastobeofferedwasmadelocally.Neighbouringcatchmentsandevenadjacentteamsoftenofferedverydifferentservices.Therewerenonationalstandardsastowhatservicesshouldbeprovidedanditwasunclearwhethertheseprogrammeshadbeenevaluated.

programmes for Children and adolescents

Therewasavarietyofgrouptherapiesavailableforchildrenandadolescents.ForexampleNorthLeeprovidedsocialskillsgroups.OtherssuchasLaois,Offaly,Longford,andWestmeathprovidedcognitivebehaviouralgroupsaswellastheKerfootproject(forchildrenwhohaveattemptedsuicide),socialskillstrainingandcommunication,andLockeprogrammeforchildrenwitheatingdisorders.LinnDaraprovidedSolutionFocusedTherapyandtheDinosaurgroupaswellastheLondubhprojectwhichtargetedchildrenatriskofearlyschoolleaving.

AnumberofareaswereeitherinpartnershiporplantobecomepartnersintheJigsawproject.ThisincludedGalway,NorthLeeandKerry.ThisprogrammewasprovidedbyHeadstronginconjunctionwiththeHSEtoprovideanearlyinterventionserviceforyoungadultsaswellasaccesstocounsellingservices.Therewascrossoverwiththeadultservicesineacharea.Itstillrequiredfullevaluationbutthemodelhadbeensuccessfullyusedinotherjurisdictions.TheJigsawprojectwasbasedoutsidethementalhealthservicebutprovidedinterventionbythementalhealthserviceswhenrequired.

parenting programmes

Manyservicesofferedparentinggroups.SomeservicessuchasthoseinNorthLeeinCork,Laois,Offaly,Longford,WestmeathandLinnDaraprovidedIncredibleYearsparentingprogramme.Carlow,KilkennyandSouthTipperaryandtheNorthEastprovidedaprogrammeforparentsofchildrenwithADHD.OthersprovidedaParentingPlusprogramme.LinnDaraprovidedaparentspsycho-education,crisisinterventionandsupportprogramme.

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Data Collection

Whereresourcesarescarceandservicesarestretchedtoprovideassessmentsandinterventions,thequalityofinformationforplanningwasvital.Onlythreeserviceswereabletoprovidedbreakdownofassessmentsofchildrenandadolescentsbybothageanddiagnosisfor2008forthepurposeofthisreport.InWexfordandSouthTipperaryandtheMaterservice,ADHDaccountedforthehighestpercentageofchildrenassessed.InSt.Joseph’sAdolescentandFamilyServicedepressionaccountedforthehighestpercentageofcasesseeninadolescents.NorthCorkprovidedabreakdownonageonly.SouthLee&WestCorkprovidedinformationfromoneteamonly.Otherservicesindicatedthatitwasnotpossibletoprovideanybreakdownbydiagnosisorage.Mostservicesdonothavecomputeriseddatacollectionsystems.Thisinformationisminimalinattemptingtoplan,auditandmonitorservices,andalsotoallocateresourcesanditwasincomprehensiblethattherewerenotthefacilitiestocollectthisdata.ThevastmajorityofserviceshadrespondedtotheperceivedneedforADHDservicesbyholdingdedicatedADHDclinics.Mostservicesprovidedaconsultationservicestootheragenciesforchildrenandadolescentswithautism.

TheFirstAnnualReportoftheChildandAdolescentMentalHealthServicescompiledbytheHSEwaspublishedin2009.

Waiting lists

Thereweredeclaredeffortstokeepwaitinglistsataminimumfrommostservices.However,waitinglistscontinuetobelonginmanyareas,rangingfromsixweekstotwoandhalfyearsfornonurgentcases.Emergencyandurgentreferralswereusuallyprovidedwithanassessmentquickly.Mostservicescouldgivenoinformationaboutthelengthoftimewaitingforanin-patientbed.ThiswasmainlyduetothefactthattherewereonlybedsinSt.Anne’sCentre,Galway(10beds),Warrenstown(6beds)andSt.Vincent’sHospital,Fairview(6beds)sinceMarch2009.WhereCAMHSwereseeing16-18yearoldsthishadaddedtothewaitingtimes.

Table: Waiting Times in Daysurgent non-urgent in-patient

Galway,Mayo,Roscommon

1 90 0

Donegal Noinformationgiven Noinformationgiven Noinformationgiven

Sligo,Leitrim

1 912 Noinformationgiven

Limerick,Clare,N.Tipperary

1 365 0

Kerry 1 450 Noinformationgiven

S.Tipperary 1 365 Noinformationgiven

Carlow,Kilkenny

0 630 60

Wexford 1 730 Noinformationgiven

NorthLee 1 570 Noinformationgiven

NorthCork 0 547 Noinformationgiven

Waterford 1 42 Noinformationgiven

Laois,Offaly,Longford,Westmeath


Mater 1 60 Noinformationgiven

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urgent non-urgent in-patientLouth,Meath,Cavan,Monaghan


DublinSouthWest,City,NorthWestandKildare

Noinformationgiven Noinformationgiven Noinformationgiven

*SouthLee&WestCork Noinformation 720 Noinformation

*Onlyoneteamprovidedinformation

Day services

Dayserviceswereminimalthroughoutthecountry.St.Vincent’sHospitalinFairviewprovideddayhospitalservicesthroughSt.Joseph’sadolescentunitwhichofferedacomprehensivedayprogrammedeliveredbyamultidisciplinaryteam.Louthhadaregionaldayprogrammewhichwasprovidedtwiceaweek.Mostserviceswerenotinapositiontoofferstructurededucationalservices.St.Anne’sCentreinGalway,St.Joseph’sAdolescentandFamilyServiceofferedcurriculumbasededucationprovidedbytheDepartmentofEducationforbothin-patientsanddaypatients.

team staffing

Therewereimprovementsinstaffinginmanyareaswiththeappointmentofsevenconsultantpsychiatrists.Thein-patientunitinGalwayreceivedfivenewmultidisciplinarypostswhileafurtherfivepostsweredueforappointmentinSligoin2009.InLimerick,WaterfordandDonegaltheappointmentofnewteamshadbeenapproved.AconsultantwasrecruitedfortheadolescentteamintheLinnDaraservice.A Vision For Change(2006)statedthattwoteamsshouldbeprovidedforeachsectorof100,000population.AscanbeseenfromthetablebelowtherecommendedteamresourcinginA Vision for Changehadnotbeenmet.Therewasamarkedshortageinparticularofoccupationaltherapistsandspeechandlanguagetherapists.

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Table: Staffing of Child and Adolescent Community Mental Health Teams per 100,000 Population population Consultant

psychiatristnCHDs nurses Clinical

psychologistsocial Worker

social Care

occupational therapy

speech & language

*RecommendedbyVision For Change

Per100,000

2 2 2 4 4 2 2 2

Galway,Mayo,Roscommon

463,383 1.29 2.2 2 0.43 2.15 2.4 1.29 0.86

Donegal 145,000 1.38 2 1.8 0.5 1.38 2 0 0

Sligo,Leitrim

91,053 1.1 1.1 0.7 1.1 1.97 2.6 0 0

Limerick,Clare,N.Tipperary

361,028 1.1 1.1 2.2 0.83 0.96 0.6 0 0

Kerry 139,565 1.1 0.7 0.7 1.1 1.1 0 0 0

S.Tipperary 83,221 1.2 1.2 1.2 2.4 1.2 0 0 0

Carlow,Kilkenny

120,671 1.49 0.8 0.6 0 1.4 0 0 0

Wexford 131,000 0.76 2.3 0 0 0 0 0 0

NorthLee 178,692 1.1 2 0 1.67 1.84 0 0.5 0

NorthCork 80,795 1.24 1.2 1.2 0.74 1.24 0 0.61 0

Waterford 120,017 0.83 0.8 0.8 1.7 0.5 0 0 0

Laois,Offaly,Longford,Westmeath

250,000 1.36 2 1.7 1.4 1.2 0 0.8 0.2

Mater 380,856 1.28 1.65 0.9 2.73 1.5 0 0.65 1.96

Louth,Meath,Cavan,Monaghan

392,889 1.17 2 1.1 0.68 1.45 0 0 0

DublinSouthWest,City,NorthWestandKildare

500,000 2.68 4 2.14 1.82 1.6 1.9 0 1.82

**SouthLee&WestCork(BandonTeam)

86,000 1.16 1.16 0 1.16 1.16 0 0 0

*Vision for Changerecommendationper100,000populationincorporatedwithintwoteams

** Onlyoneteamprovidedinformation

in-patient services

Progressintheopeningofnewin-patientbedshadbeenslow.Servicescomplainedabouttheamountoftimespentsearchingforafreebedforadmissions.Onehundredandninetythreechildrenwereadmittedtoadultunitsin2009.Althoughtherewere10bedsinSt.Anne’sChildren’sCentreinGalwaythisunitwasseldomfull,despitethefactthatchildrencontinuedtobeadmittedtoadultmentalhealthunitsthroughoutthecountry.Asix-bedunitforadolescentsopenedinSt.Vincent’sinFairview,Dublin.WarrenstownHousecontinuedtoprovidesixbeds.ThebuildingofthenewunitinGalwaythatwillprovide10extrabedshadcommenced.Theinterimunit(eightbeds)inSt.Stephen’sHospitalinCorkhadopenedandthenewunitinCork(20beds)hadprogressedtobuildingstageatthetimeofthereport.St.JohnofGodHospitalhad12bedswhichcanbeaccessedprivatelyandtheHSEhaveavailedofthisarrangementwherenecessary.St.Patrick’sHospitalplantoopenaprivateadolescentunit.TheHaven,aprivatefacilityinMaynoothwasnowanapprovedcentreandwillopeninearly2010withfivebeds.

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Conclusion

Therehavebeenincreasesinstaffinginchildandadolescentteamsin2009withtheappointmentofconsultantpsychiatristsandotherstaff.However,staffingofteamsstillremainedwellbelowthestaffingforchildandadolescentteamsrecommendedinA Vision for Change.Therewasaconsiderableshortageofoccupationaltherapyandspeechandlanguagetherapy.Becauseofshortageofstaff,individualandgroupworkofferedtochildrenandtheirfamilieswereverylimited.However,someservicesofferadiverserangeofprogrammesandtherapies.

Datacollectionwithintheservicesremainedverypooranditwasimpossibletocollectdataondiagnosisandagefromthemajorityofservicesforthepurposeofthisreport.

Difficultieswithaccessingin-patientbedscontinuedin2009withmostservicesspendingextendedperiodsoftimelookingforbedsforunwellchildren.Thetwonewunitswithatotalof40bedsshouldbeopenin2010bringingthenumberofbedsprovidedbytheHSEupto52.Meanwhiletherewereatotalof30HSEbedsnationally.

Waitingliststendedtovarynationally.Whilethemajorityofserviceswereabletoseechildrenandadolescentsurgentlysomewaitinglistsfornonurgentcasescouldbeuptotwoandahalfyears.Itappearsthatwheretherehavebeenwaitinglistinitiativesthewaitingtimehaddecreased.

Recommendations

1. ThenumberandstaffingofcommunitymentalhealthteamsshouldbeinlinewithA Vision for Change.

2. Thereshouldbeanationaldirectorforchildandadolescentmentalhealthservices.

3. Servicesshouldbestandardisednationallysothatatleastaminimalservicewasdeliveredineachareainlinewithbestpractice.

4. Computerbaseddatacollectionsystemsshouldbeputinplaceineachcatchmentarea.

5. Evaluationsshouldbecarriedoutonprogrammesofferedbyeachservice.

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appendix 9: Mental Health services for persons with an intellectual DisabilityDr. Fionnuala o’loughlin, assistant inspector of Mental Health services

In2009,aself-assessmentquestionnairewassenttoeachofthelocalhealthareasresponsiblefordeliveringmentalhealthservicestopersonswithanintellectualdisability.Theinformationreceivedwasusedtocompilethisreport.InformationwasalsogatheredatthenationaloverviewmeetingoftheservicesheldinDublininNovember2009.

Description of services

Hse West

Mayo

TherewasoneMentalHealthofIntellectualDisability(MHID)teaminMayo,whichprovidedaservicetoanestimatedpopulationof960personswithanintellectualdisability.Theteamcomprisedoneconsultantpsychiatrist,oneNCHD,onenursespecialist(dualdiagnosis)andoneclericalstaff.Admissions,whenrequired,weretotheapprovedcentreinCastlebarGeneralHospital.

Theservicedidnothaveadaycentre,anddidnotprovideaserviceforthosewithanautismspectrumdisorder.

Regularmeetingswereheldwiththevoluntarysectortodiscusspossibleservicedevelopments.

Galway east

TheserviceinEastGalwaywasestablishedin1990andservedapopulationof111individuals.TheMHIDteamhadaconsultantpsychiatrist,employedhalf-timeandminimalallocationoftimefromjuniordoctors.Twonursesworkedinthedaycentre,andtherewere46.6nursesbasedinthecommunitygrouphomes,withoneADON.

IndividualsrequiringadmissionwereadmittedtotheadmissionunitatSt.Brigid’sHospital,Ballinasloe.

Therewerenospecificservicesforthosewithanautismspectrumdisorder.TransferofresidentsfromSt.Brigid’shospitaltomoresuitableaccommodationwasapriorityfortheservicein2009butthiswasdependentonfundingbeingprovided.Discussionsaboutforminganalliancewiththevoluntarysectorhadcommenced.

Roscommon

TherewasnospecialistMHIDserviceintheRoscommonarea.Serviceswereprovidedbythevoluntarysector.RoscommonMentalHealthServiceprovided24-hourcaretosixresidentsintheCastlereasector.

Clare

TherewasnospecialistMHIDserviceintheClarearea.Thevoluntarysector,throughtheBrothersofCharityandDaughtersofCharity,providedaservicetoindividualswithanintellectualdisability.Thisservicehad1.8WTEConsultantPsychiatrists,withtwoNCHDs.

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ProposalsbytheHSEtoprovideadedicatedMHIDservicewereunderconsiderationin2009.Theservicewasalsosourcingsuitablealternativeaccommodationforindividualswithanintellectualdisability,currentlyresidentinpsychiatrichospitals.

limerick

TheLimerickcatchmentareahadnodedicatedMHIDservice.AservicewasprovidedbythevoluntarysectorteamintheClarearea.

ThementalhealthservicefortheMid-WestwasdevelopingaframeworkfordeliveryofanMHIDservice.

sligo/leitrim/West Cavan

TheMHIDteamforthisareaservedapopulationof864personswithanintellectualdisability.TheteamhadoneconsultantpsychiatristandoneNCHDandhadaccesstoadaycentre.AnAutismSteeringcommitteehadbeenestablishedin2009inconjunctionwiththeAutismservicesinSt.Angela’sCollege,Sligo.

IndividualsrequiringadmissiontoacutementalhealthunitswereadmittedtotheacutepsychiatricunitinSligo.

Donegal

TheMHIDservicewasestablishedinDonegalin2001andservedapopulationof652individualswithanintellectualdisability.TheteamconsistedofoneconsultantpsychiatristandoneNCHD;genericcommunitypsychologyservicesprovidedsupportwherepossible.Therewasnospeechandlanguagetherapyordedicatedoccupationaltherapyserviceavailable.Agenericdisabilitynurseprovidedcareforapproximately20individuals.

In2009formalmeetingsbetweenmentalhealthservicesandmentalhealthforintellectualdisabilityserviceswereinstigated,andtheservicewasmappingcurrentavailableservices.

Whenadmissiontoanacutepsychiatricunitwasrequired,individualswereadmittedtotheacutepsychiatricunitinLetterkenny.

AmentalhealthservicewasprovidedforadultswithAutismSpectrumDisorder.


Cavan/Monaghan

TherewasnodedicatedMHIDteaminthisarea.ServicesweredeliveredbytheDisabilityServicesto598personsregisteredontheNationalIntellectualDisabilityDatabaseinthearea.

TheHSEhadapprovedpostsforthecommencementofaspecialistservicetomeetthementalhealthneedsofpeoplewithanintellectualdisability.

Meath

MeathhadnodedicatedMHIDservice,andthedifficultyforadultsaccessingapsychiatricservicewasacknowledgedbytheHSE.

Serviceswereprovidedto637personswithanintellectualdisabilitybythelocalDisabilityService.

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PlansforrecruitingaconsultantpsychiatristtocovertheMeathandLouthareaswereatanadvancedstageanditwashopedtoappointaconsultantin2009.

louth

TherewasnoMHIDteaminLouth,whichhad1053individualsregisteredonthenationaldatabaseofintellectualdisability.AservicewasprovidedbytheDisabilityService.

Planswereunderwayin2009toappointaconsultantpsychiatristtocoverbothMeathandLouth.

st. Joseph’s intellectual Disability service

St.Joseph’sprovidedaserviceto247residentsincare;165oftheseresidentslivedonsiteinSt.Ita’sHospital,Portrane,and82livedin24-hoursupervisedcommunityresidences.Thereweretwoteams,eachwithaconsultantpsychiatristandNCHD.Theteamsweremultidisciplinaryandincludedanoccupationaltherapist,socialworker,arttherapist,speechandlanguagetherapistandhealthcareassistants.

Provisionofnewaccommodationon-siteinthegroundsofSt.Ita’sHospitalwasplannedfor2009.

Inadditiontoitsresidentialservice,St.Joseph’sprovidedadayservicetoserviceusers.

Hse south

north Cork/north lee/West Cork

TheMHIDteamconsistedofoneconsultantpsychiatristwithaspecialinterestinID,andanNCHD(0.5WTEpost).Nursingandmultidisciplinarystaffworkedinthegenericdisabilityservice.Proposalstorecruitasecondconsultantpsychiatristhavebeensubmitted.

Anew30-beddedunitinSt.Raphael’sCentrewasduetobecompletedinAugust2009,andaWorkingGrouponMentalHealth/IntellectualDisabilityfortheHSESouthwasestablishedduring2009.

TheAutismSteeringGroupforChildrenwasreconvenedtoreviewthedevelopmentofacatchmentarea-basedAutismSpectrumDisorderintheCork/Kerryregion.

south lee

MHIDservicesinthisareawereprovidedbythevoluntarysectorthroughtheBrothersofCharity.Itprovidedaservicetoadultsandchildren.

Kerry

TherewasnoMHIDteaminKerry.Aserviceforindividualswithanintellectualdisabilitywasprovidedbythevoluntarysector.Wherenecessary,theconsultantpsychiatristingeneraladultpsychiatryinKerryreferredindividualstotheMHIDconsultantinCork.

Wexford/Waterford/south tipperary

TherewasnoMHIDteaminthisareabuttheHSEworkedinpartnershipwiththevoluntarysectortoprovideaservice.Servicesinthisareawereprovidedbythreeconsultantpsychiatristswhohaveaccesstothreepsychologists.

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In2009,theHSEcontinuedtoaddresstheissueoftransferringresidentswithanintellectualdisabilitycurrentlyinpsychiatrichospitals,tomoresuitableaccommodation.AnumberofresidentsweretransferredfromSt.Luke’sHospital,Clonmeltoalternativeaccommodation.ChildrenwithAutismSpectrumDisorderwerereferredtocommunitydisabilityservicesforassessmentanddiagnosis.

Carlow/Kilkenny

TheCarlow/KilkennyareadidnothaveanMHIDteam,butserviceswereprovidedbythevoluntarysector.Thisservicehadaccesstopsychologistsandasocialworkeronrequest.

In2009,17residentsinSt.Dympna’sHospital,withanintellectualdisabilityweretransferredtofourpurpose–builtbungalowsinthegroundsofthehospitalatKelvinCourt.

north tipperary/east limerick

TherewasnoMHIDteaminthisarea.ServiceswereprovidedbythevoluntarysectorwhichhadtwoconsultantpsychiatristsandtwoNCHDs.

TheHSEwasproposingtoprogressaplantoprovideadedicatedMHIDteamin2009.


stewarts Hospital

StewartsHospitalprovidedaspecialistmentalhealthserviceforchildrenandadultswithanintellectualdisabilityandprovidedamultidisciplinaryteamapproachforitsdayserviceandclinics.Italsooperatedanapprovedcentreforindividualsrequiringin-patienttreatment.Therewere225peopleonthedatabaseofserviceusersin2009.TheMentalHealthManagementteamwasmultidisciplinaryandmeetsmonthly.

Theservicehad1.5WTEconsultantpsychiatristpostsand1.5WTENCHDposts.Inaddition,therewerethreepsychologists,andonesocialworkerintheMDTteam.

Whilsttherewasnodedicatedautismspectrumdisorderservice,childrenwiththedisorderwereprovidedwithassessment,treatmentandeducationalservicesaspartoftheoverallserviceinStewartsHospital.

longford/Westmeath/laois/offaly

ThisareaoperatedasoneareaforthepurposesofprovidinganMHIDservice.Itprovidedacommunitybasedservicewithoneconsultantpsychiatrist,twoNCHDs,withanoccupationaltherapist(0.5WTEpost)inLaois/Offaly.FundingwasprovidedthroughtheDisabilityServices,andattemptstosecurefundingfromtheMentalHealthServiceshadbeenunsuccessfultodate.Recentqualityinitiativeshaveincludedtheintroductionofstandardisedandstructuredassessmentinstrumentstoallowmoredetailedandsystematicassessmentsofindividualserviceusers.

Theserviceprovidedadiagnosticassessmentofindividualswithautismspectrumdisorderandtreatmentofconcurrentmentalhealthproblems.

Good Counsel Centre, Ballyboden, Dublin

Thisservicewasastand-alone,non-catchmentbasedMHIDserviceforresidentsoffourintellectualdisabilityservicesandwasfundedbytheDisabilityService.Theservicewasprovidedbyoneconsultantpsychiatristandapsychologist(0.6WTEpost).Anumberofqualityinitiativeswereimplemented

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in2009,includingthedevelopmentofacentrallylocatedfilingsystemspecifictomentalhealth,collaborativeworkingbetweenpsychologistsinonedisabilityserviceandtheMHIDteam,datacollectionandon-goingdevelopmentsofscreeningpacksfordementia,autismandmentalhealthproblems.

Currentmentalhealthassessmentsincludescreeningforautismspectrumdisorder.

Conclusion

TheprovisionofMHIDservicescontinuestobevariablearoundthecountry.ThereweretenMHIDteams(HSE)withtheremainderofservicesprovidedbythevoluntarysector.TheHSEteamsoperateanalmostentirelymedical/nursingmodelandtherewasasignificantlackofmultidisciplinaryinput.Fundingfortheseteamscomesfromeitherthementalhealthorthedisabilitybudgets.

Fewserviceswereabletoreportanydevelopmentsinservicesin2009,buttherewasaparticularfocusbyservicesonsourcingalternativeaccommodationforresidentsstillremaininginpsychiatrichospitals.Theopeningoffournew,purpose-builtbungalowsinCarlowforresidentsoftheformerKelvinGrovewaswelcomed,aswasthetransferofanumberofresidentstomoresuitableaccommodationfromSt.Luke’sHospital,Clonmel.

Itwasclearalsofromtheself-assessmentquestionnairesreturnedandparticipationatthenationalmeeting,thattherewasagooddealofuncertaintyamongstpractitionersastowhoholdsresponsibilityforprovidingaserviceformentalhealthforpersonswithintellectualdisability.Thepolicydocument, AVision for Change2006,pointsoutthat“while there was ring-fenced funding for intellectual disability services, the funding for mental health services within this was not clearly identified”(p.126).A Vision for Changealsomakesanumberofrecommendationsaboutprovidingamentalhealthserviceforindividualswithanintellectualdisabilitywhichinclude“specialist MHID teams that were catchment area-based and which should be distinct and separate from, but closely linked to, the multidisciplinary teams in intellectual disability services who provided a health and social care service for people with intellectual disability”(p.129).ThedocumentalsorecommendsthattwoMHIDteamsshouldbeprovidedper300,000population,whichwouldequatetoapproximately26teamsinthecountry.

Whilstmanyindividualsbenefitfromtheservicesprovidedbythevoluntarysector,implementationoftherecommendationsinVision for Changewouldensureamorestreamlinedandcohesiveapproachtotheprovisionofmentalhealthservicestopeoplewithintellectualdisability.

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appendix 10: Mental Health services for Homeless people 2009Dr. susan Finnerty, assistant inspector of Mental Health services

Manystudieshavebeencarriedabouttheratesofmentalillnessamongstthehomelesspopulation.Theresultsofthesestudiessuggestthatbetween30%-50%ofhomelesspeoplehavesomeformofmentalillness.AccordingtotheDublinSimonCommunity25%ofDublin’shomelesspopulationsufferfromseverementalillness.

A Vision for Change(2006)specificallystatesthatacommunitymentalhealthteamwithresponsibilityforthehomelesspopulationineachcatchmentareabeclearlyidentifiedandshouldbeequippedtoofferaneffectiveoutreachservice.Italsostatesthattwomultidisciplinarycommunitybasedteamsshouldbeprovided,oneinNorthDublinandoneinSouthDublin,toprovideamentalhealthservicetothehomelesspopulation.A Vision for Changealsorecommendsthattherebeacrisishouseoftenbedsforthesetwoteams,specificallyforhomelesspeoplewhoarenotseriouslypsychoticallyillanddonotrequireadmissiontoacutein-patientunits.

TheInspectoratecarriedoutasurveyofmentalillnessinhomelesspopulationsinurbanareasinIreland.ItalsolookedatthementalhealthservicesspecificallyprovidedforhomelesspeoplebytheHSE.Therelationshipbetweenthementalhealthservicesandtheservicesforhomelesspeoplewasalsoexplored.

TwentyfourseparatevoluntaryhomelessserviceswereidentifiedinDublin,Cork,Limerick,Galway,Sligo,Waterford,Tralee,NenaghandAthlone.Aself-assessmentquestionnairewassenttoeachservice.Informationsoughtincluded:

Numbersofhomelesspeopleexperiencingmentalillnessandnumbersofthosewhohadreceived}}

treatmentwithinthementalhealthservice.

Accesstomentalhealthservices.}}

Waitingtimesforassessmentsinthementalhealthservices.}}

Qualityofmentalhealthservicesforhomelesspeopleinthearea.}}

Seventeenvoluntaryservices,covering765homelesspeople,completedquestionnaires.Fortythreepercentofhomelesspeoplehadmentalhealthproblems–oftheseonly43%wereaccessingmentalhealthservices.Twentysevenpercenthadanadmissiontoapsychiatrichospital,andofthese16%hadspentmorethan6monthsinhospital.

Table 2: Homelessness and mental health

number of Homeless

History of mental illness

admission to psychiatric unit

>6 months in hospital

attending outpatient visits

Totalnumber 765 329(43%) 205(27%) 33(16%) 142(43%)

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access to Mental Health services

NorthandSouthDublinhadaccesstoteamsformentalhealthservicesforhomelesspeopleaswellastolocalmentalhealthteams.InCorktherewaslimitedaccesstoasmallspecialisedteamforhomelesspeople.ItwasreportedthatwomenintheFocusIrelandserviceinCorkdonothaveaccesstothisservice.InGalwayandLimericktherewasadedicatedcommunitymentalhealthnurse.HoweverinGalwaythisposthadbeenvacantforsixmonths.TherewasnodedicatedmentalhealthserviceforhomelesspeopleinTraleeorNenagh.

Dedicated services for people with Mental illness

Cork:TherewasanadulthomelessmultidisciplinaryteaminCorkCity.Thiscoveredapopulationof323,000.TherewereadmittingrightstoSt.Michael’sunitintheMercyHospitalandCorkUniversityHospital.Theteamhadacaseloadof51people.Thereweretwoweeklyoutpatientclinics.Waitingtimeforanappointmentwas1-4weeks.TherewerecloselinkswithawiderhomelessteamconsistingofGP,publichealthnurse,registerednurse,communitywelfareofficerandaddictionservices.

Developmentsintheserviceincludedanewcomputerpackage,supportformethadoneservices,involvementinphysicalneedsassessment,andenhancedwomen’sservices.

ThereweregoodlinkswithSHINEadvocacyservice.TherewasfrequentliaisonbetweenthevoluntaryservicesandCMHN.

Staffing

post WteConsultantPsychiatrist 0.6NCHD 0ADON 0CMHN 2DayFacilityNurses 0Psychologist 0.3SocialWorker 0OccupationalTherapist 0AddictionCounsellor 0Other 0

north Dublin programme for the Homeless Mentally ill

Thisteamcoveredapopulationof534,233andhadacaseloadof101clients.ItwasbasedinUsher’sIslandwheretherewasadaycentre.Thedaycentrewasopen365daysayear.TheteamhadadmittingrightstoSt.Brendan’sHospital.Therewasoutpatientserviceonceaweekandnowaitingtimesforappointmentsoncetheclienthadbeenacceptedtotheservice.Itwasoriginallysetupin1979forpatientsofSt.Brendan’sHospital.TheservicehadgraduallyincreasedtheAssertiveOutreachcomponentandoccupationaltherapistsworkedwithinhostels.

Developmentswithintheserviceincludedtheappointmentofasocialworkerandtheavailabilityofapsychologistforconsultations.Multidisciplinarycareplansandriskassessmentswereinoperation.AseriesofmeetingshadbeenheldwiththeACCESteaminSouthDublintoenhanceco-operationandplanforthefuture.ApositionpaperfortheCollegeofPsychiatryinIrelandonmentalhealthservicesforhomelesswasbeingprepared.

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Interactivelectureswereheldwithclientsinthedaycentre.TherewasaformalreviewofActivityProfilesinthedaycentrewithclients.Budgetaryhelpwasavailableandtherewasfacilitationofwillmaking,withlawyersattendingthedaycentre.TheWellnessRecoveryActionPlan(WRAP)wasinoperation.Thereweremonthlycommunitymeetingsandclientshadtheuseofanallotment.

Staffing

post Wte ConsultantPsychiatrist 1NCHD 3(shared)ADON 0.5CMHN 1DayFacilityNurses 2Psychologist 0SocialWorker 0.6OccupationalTherapist 1AddictionCounsellor 0OutreachWorker 1

aCCes team (Dublin south City)

Thisteamcoveredapopulationof674,661andhadanactivecaseloadof78homelesspeople.Itsaw81newassessmentsin2008.ItsheadquarterswasinParkgateHall.Mostworkwasdonethroughoutreachclinicsandvisitstohostels.ReferralswereacceptedfromfrontlinestaffaswellasGPsandhospitals.Staffingremainedaproblem;atpresentthereweretwocommunitymentalhealthnurses,asocialworker,anNCHDandapsychiatrist.Asocialworkerandcommunitymentalhealthnurseposthadnotbeenfilled.Therewasnopsychologistoroccupationaltherapist.TheServiceusedFACEasanassessmentandtreatmenttool.DiscussionswerecontinuingwiththeProgrammefortheHomelessinanefforttohaveonehomelessteamforDublinCity.Emphasiswasputonmulti-agencyworkingandtherewasinvolvementinaCareandCaseManagementProgrammerunbytheHomelessAgency.Therewereweeklyteammeetingsandcareplanreviews.Therewereplanstodevelopa10-bedfacilityinWeirHousetotreatmentallyunwellhomelesspeopleincrisis.

Staffing

post WteConsultantPsychiatrist 0.7NCHD 0.7ADON 0CMHN 1.8(1vacantpost)DayFacilityNurses 0Psychologist 0SocialWorker 1(1vacantpost)OccupationalTherapist 0AddictionCounsellor 0OutreachWorker 0

234


Waiting times for Mental Health assessments

Throughoutthecountrywaitingtimesformentalhealthassessmentsvariedconsiderablyfromfivedaysforurgentappointmentstothreemonthsfornonurgentappointment.

Table 3: Waiting times for assessment

Waiting times for mental health assessments

DuBlin

Simon 7weeks

NovasWomen’sServicesMountBrown 2weeks

CoRK

GoodShepherdServices 1week-6months

FocusIreland Noinformation

Simon 3weeks

liMeRiCK

NovasBr.RussellHse 3-10days

NovasDIAL 3-10days

FocusIreland 3weeks

GalWaY

Simon 3-6months

COPE 2-3months

nenaGH

NovasInitiatives 6weeks

KeRRY

Simon 3weeks

NovasTralee 1week

Relationship between Homeless services and Mental Health services

Themajorityofhomelessservicesdescribedtheirrelationshipwiththementalhealthservicesasgood,satisfactoryorexcellent.MentalhealthservicesinLimerickweredescribedasbeingadhocandpiecemealwithlackofuniformitybetweendifferentmentalhealthteams.HomelessservicesinGalwaydescribedtheirrelationshipwiththementalhealthservicesasbeingpoorandunsupportive.Theycitedlackofcommunicationasadifficulty.InDublin8therelationshipwasdescribedaspoorandlackinginstronglinks.Lackofflexibilitywashighlightedasadifficultywithinthementalhealthservicesandpracticalproblemsincludedlackofdischargeinformationandlackofmentalhealthrepresentationatcaseconferences.

Mostservicescouldaccessmentalhealthservicesthroughcommunitymentalhealthnurseswhoalsoprovidedfollow-upservices.

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Conclusion

Therewerethreededicatedteamsforthementallyillhomelesspersons,twoinDublinandapart-timeteaminCork.ThiswasinlinewithA Vision for Changeonthenumberofteams,althoughnoteamhadadequatestaffingandtherewasnocrisishouseordayhospital.However,thevoluntaryservicesintheareasservedbytheseteamsratedtheservicesasgood.OtherareassuchasLimerickandGalwayhadadedicatedpostofCMHNforhomelesspeople.ThepostinGalwayhadbeenvacantforsometime.Othervoluntaryservicesweredependentonthelocalmentalhealthservicesandingeneralfoundthisarrangementdifficultintermsofaccess,flexibility,workingrelationshipsandlackofcommunication.Waitingtimesforappointmentsvariedandcouldtakeuptosixmonthswhichwasfarfromsatisfactory.

TherecommendationsforVision for Changewithregardtoacommunitymentalhealthteamwithresponsibilityforthehomelesspopulationineachcatchmentareabeingclearlyidentifiedandequippedtoofferaneffectiveoutreachservice,hadnotbeenmet.Thishadleadtoanadhocprovisionofserviceinmanyareas.TherecommendationinVision for Changethatthereshouldbetwomultidisciplinarycommunitybasedteams,oneinNorthDublinandoneinSouthDublin,toprovideamentalhealthservicetothehomelesspopulationhadbeenmet,buttheteamswereinadequatelyresourced.

Recommendations

1. Acommunitymentalhealthteamwithresponsibilityforthehomelesspopulationineachcatchmentareashouldbeclearlyidentifiedandequippedtoofferaneffectiveoutreachservice.

2. Inthemeantimeadedicatedcommunitymentalhealthnurseshouldbeappointedtoprovideservicesformentallyillhomelesspeople.

3. Eachhomelesspersoninreceiptofmentalhealthservicesshouldhaveregularcaseconferencesatwhichbothvoluntaryandmentalhealthpersonnelattend.

4. Theexistingmentalhealthteamsforhomelessmentallyillpeopleshouldbeadequatelystaffed.

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appendix 11: Mental Health services staffingpatricia Doherty, assistant inspector of Mental Health services

Table 1: Bed Numbers standardised per 100,000 population

Catchment area total approved centre beds per 100,000

24-hour staffed residence places per 100,000

total number of catchment beds per 100,000 pop

Hse soutHNorthCork 129 52 181WestCork 45 99 144NorthLee 54 45 99SouthLee 45 10 55Kerry 73 52 125Waterford 107 22 *128CarlowKilkenny 111 128 239SouthTipperary 159 45 *203Wexford1 77 21 98HSEWESTClare 76 81 157NorthTipperary2 0 0.00 0.00Limerick 83 60 *142Roscommon 38 143 181EastGalway 85 75 *161WestGalway 60 14 74Mayo 72 36 108Sligo/Leitrim/SthDonegal 52 70 122Donegal 36 52 *87HSEDUBLINNORTHEASTDublinNorthCentral 71 15 *87St.Joseph’sID 74 26 100St.Ita’sHospital/NthDublin 54 35 89DublinNorthWest 86 87 173Louth/Meath 30 25 *54Cavan/Monaghan 46 39 85HSEDUBLINMIDLEINSTERKildare/WestWicklow 14 14 28Newcastle 50 24 74DublinSouthWest 29 20 49DublinSouthCity 38 15 53DublinSouthEast3 35 93 128SouthCountyDublin(ChluainMhuire)4 15 12 27LaoisOffaly 54 22 76LongfordWestmeath 97 34 131*Numbers correct to two decimal places

¹ Wexford – includes staffing for pre-discharge unit.

² North Tipperary avails of beds in South Tipperary Mental Health Service.

³ Dublin South East – some services provided to a number of catchment areas.

4 South County Dublin – avails of in-patient beds in St. John of Gods Hospital.

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InFigure1below,weshowtotalfiguresforbednumberspercatchmentarea.Thesearestandardisedtopopulationsof100,000.

Figure 1: Total Beds in Catchment per 100,000 Population

300250200150100500

Nor

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87 87 107 89

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98

Table 2: IN-PT and Community Staffing Numbers per 100,000 – Specialist Teams at Regional or National Level ExcludedseRViCe nurses

based in

approved

centres

per

100,000

nursing

staff for

24-hour

residences

per

100,000

Community

mental

health

nurses per

100,000

Care

assistants

per 100,000

Medical staff occupational

therapy

psychology social

Work

Cons nCHDs

HSESOUTH

NorthCork 126 27 14 0 5 10 4 4 1

WestCork 37 56 7 0 6 9 4 2 4

NorthLee 87 18 9 0 4 7 4 3 4

SouthLee 31 4 7 0 5 8 1 3 2

Kerry 96 40 9 0 4 7 2 2 2

Waterford 88 17 6 0 6 7 1 4 4

CarlowKilkenny

65 88 12 13 6 10 3 2 3

SouthTipperary

142 25 7 0 7 8 1 1 5

Wexford1 61 19 11 0 5 6 2 3 3

HSEWEST

Clare 40 117 3 0 5 8 4 5 4

NorthTipperary2

0 0 3 0 3 5 0 5 3

Limerick 68 32 3 0 6 8 2 3 2

Roscommon 43 67 7 0 5 9 6 2 3

EastGalway 68 94 10 0 7 10 5 4 5

WestGalway 44 9 9 0 4 11 5 3 5

Mayo 94 41 9 0 6 9 4 3 5

238


seRViCe nurses

based in

approved

centres

per

100,000

nursing

staff for

24-hour

residences

per

100,000

Community

mental

health

nurses per

100,000

Care

assistants

per 100,000

Medical staff occupational

therapy

psychology social

Work

Cons nCHDs

Sligo/Leitrim/SthDonegal

84 61 12 0 7 9 7 1 5

Donegal 54 36 10 0 7 10 4 3 3

HSEDUBLINNORTHEAST

DublinNorthCentral

72 10 13 0 7 14 3 3 2

St.Joseph’sID 66 35 3 89 1 1 0 0 0

St.Ita’sHospital/NthDublin

51 11 9 28 5 11 1 1 3

DublinNorthWest

87 47 12 20 8 19 9 3 4

Louth/Meath 35 13 4 1 4 8 0 2 2

Cavan/Monaghan

51 23 55 0 5 11 3 2 4

HSEDUBLINMIDLEINSTER

Kildare/WestWicklow

18 8 9 0 4 7 2 1 3

Newcastle 33 12 5 0 4 8 0 2 1

DublinSouthWest

26 12 16 9 5 8 5 2 4

DublinSouthCity

24 7 5 0 5 9 5 4 4

DublinSouthEast3

34 63 6 0 8 5 4 3 3

SouthCountyDublin(ChluainMhuire)4

N/A 4 6 0 4 9 2 3 4

LaoisOffaly 58 15 12 0 6 7 3 3 3

LongfordWestmeath

101 32 4 0 6 9 3 3 3

1 Wexford – includes staffing for pre-discharge unit.

2 North Tipperary avails of beds in South Tipperary Mental Health Service.

3 Dublin South East – some services provided to a number of catchment areas.

4 South County Dublin – avails of in-patient beds in St. John of Gods Hospital.

239


Figure 2: Total Nursing per 100,00 Population

300

250

200

150

100

50

0

206

120

161

55

179

127

229244

203

33

137 145

229

84

188 202

140

116 11697

75

153

4665 80

46

126

19

110

185175

125

Nor

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ork

Wes

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orth

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eph’

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St. I

ta’s

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pita

l/Nth

Dub

linD

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Nor

th W

est

Lout

h/M

eath

Cava

n/M

onag

han

Kild

are/

Wes

t Wic

klow

New

cast

leD

ublin

Sou

th W

est

Dub

lin S

outh

City

Dub

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Eas

tSo

uth

Coun

ty D

ublin

Laoi

s O

ffal

yLo

ngfo

rd/W

estm

eath

TheinformationpresentedintheabovetablesandchartswasobtainedviaLocalHealthOfficesduringthecourseofthe2009inspectionprocess.

240


overview of Catchment Mental Health services within Hse area

Catchment Reports by Hse area

CHapteR 5

Thesereportswerepreparedonthebasisofinformationanddocumentationobtainedduringcatchmentareameetingsandreceivedfromlocalhealthofficesduringthe2009inspectionprocess.

Chapter 5 ContentsHse Dublin north east 244

MentalHealthServices2009CatchmentAreaReportCavan/Monaghan 244

MentalHealthServices2009CatchmentAreaReportDublinNorthCentral 251

MentalHealthServices2009CatchmentAreaReportLouth/Meath 260

MentalHealthServices2009CatchmentAreaReportNorthDublin 268

MentalHealthServices2009CatchmentAreaReportNorthWestDublin 276

MentalHealthServices2009CatchmentAreaReportSt.Joseph’sIntellectualDisabilityService 288

Hse DuBlin MiD leinsteR 293

MentalHealthServices2009CatchmentAreaReportDublinSouthCity 293

MentalHealthServices2009CatchmentAreaReportDublinSouthEast 299

MentalHealthServices2009CatchmentAreaReportDublinWest/SouthWestMentalHealthService 305

MentalHealthServices2009CatchmentAreaReportWicklow 311

MentalHealthServices2009CatchmentAreaReportKildareWestWicklow 317

MentalHealthServices2009CatchmentAreaReportLaois/Offaly 324

MentalHealthServices2009CatchmentAreaReportLongfordWestmeath 330

MentalHealthServices2009CatchmentAreaReportSouthCountyDublin 338

Hse south 344

MentalHealthServices2009CatchmentAreaReportCarlow/Kilkenny 344

MentalHealthServices2009CatchmentAreaReportKerry 352

MentalHealthServices2009CatchmentAreaReportNorthCork 358

MentalHealthServices2009CatchmentAreaReportNorthLee 364

MentalHealthServices2009CatchmentAreaReportSouthLee 370

MentalHealthServices2009CatchmentAreaReportSouthTipperary 376

MentalHealthServices2009CatchmentAreaReportWaterford 382

MentalHealthServices2009CatchmentAreaReportWestCork 389

MentalHealthServices2009CatchmentAreaReportWexford 395

Hse West 402

MentalHealthServices2009CatchmentAreaReportClare 402

MentalHealthServices2009CatchmentAreaReportDonegal 410

MentalHealthServices2009CatchmentAreaReportEastGalway 418

MentalHealthServices2009CatchmentAreaReportLimerick 426

MentalHealthServices2009CatchmentAreaReportMayo 433

MentalHealthServices2009CatchmentAreaReportNorthTipperary 439

MentalHealthServices2009CatchmentAreaReportRoscommon 444

MentalHealthServices2009CatchmentAreaReportSligo/LeitrimMentalHealthServices 450

MentalHealthServices2009CatchmentAreaReportWestGalway 456

244



Mental Health services 2009 Catchment area Report Cavan/Monaghan

HSEArea HSEDublinNorthEastCatchment Cavan/MonaghanMentalHealthService Cavan/MonaghanMentalHealthServicesPopulation 118,791NumberofSectors 2NumberofApprovedCentres 2SpecialistTeams Psychiatryoflaterlife

RehabilitationPerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 7May2009

service 2009

Description of service (including Distinct Features)

TheCavan/Monaghanservicewasprimarilyahome-basedcommunity-deliveredservice.Thismodelofservicedeliveryhadbeendevelopedoverthelast15years.Thelastfiveyearshadseenashiftintheprofileofthepopulationwithinthecatchment.Therehadbeenapopulationexpansion,especiallyinCavan,andthishadresultedina60percentincreaseinthenumberofreferralstotheteam.ManypeoplemovedfromDublintoCavanduringthepropertyboom.Historicallythecatchmenthadhadahigherthanthenationalaveragenumberofelderlypeople,manyofthemlivingalone.Therewasalsoacentreforasylumseekersinthearea.

Atthetimeofreportingtheservicewasundergoingasignificantchangeprocessthatwasduetoimpactdirectlyonthefuturedeliveryofservices.Adecisiononthelocationoftheacutein-patientservicewasduebytheendof2009.Amoreimmediateproblemwastheexpectedrateofretirementsfromthenursingprofessionoverthefollowingyear.Travelrestrictionswereposingproblemsfortheteamsinvisitingserviceusers.

Therewasalackofhealthandsocialcareprofessionalsontheteams;nonewstaffhadbeenappointedin2009todate.

progress on Recommendations from the 2008 Report

1. Challenges in the forthcoming months include the validation of in-patient staff, given the emphasis to date on service provision in the community.

Outcome:Therehadbeennoprogress.

2. Enhancement of the quality of in-patient facilities should continue despite the changes in the delivery of services in the future. Expansion of the multidisciplinary care approach, introduced within the last year should continue.

245


Outcome:ThepremisesinSt.Davnet’sHospitalremainedunchangedsincelastyear.Theyarereportedonindetailintheapprovedcentrereport.

3. The staffing resource in the community mental health teams should be increased to ensure each team has a core multidisciplinary team.

Outcome:Nonewappointmentshadbeenmadesincethelastinspection.

outline of local Health service plan 2008–2009

Therewasalocalserviceplanfor2009.

Developments 2008–2009

Aconsumerpanelwasbeingdeveloped.ApilotprojectwasduetocommenceinJune.Serviceusers’}}

opinionswerebeensoughtthroughtheSolasCentreinMonaghan.

Hospital Closure plans

St.Davnet’sHospitalhadbeenreconfiguredovertheyearsandwasnowacomplexwithmanyhealthservicesonsite.Mentalhealthcareandtreatmentwasstillprovidedinthreewards,anacutewardandtwoelderlycontinuingcarewards.Thefutureprovisionofacuteserviceswasbeingdecidedandadecisionwasexpectedlaterin2009.

TheInspectorateteamhavebeenverycriticaloftheenvironmentintheelderlycarewardsforthelastnumberofyearsandreportsreceivedfromthemanagementteamthatworkswouldbecompletedweregiventotheInspectorateyearafteryear,butagainin2009therewasnoprogresstoreport(detailedindividualreportsareavailableontheMHCwebsite).

Atthismeeting,confirmationthatfundswerebeingring-fencedfortheupgradingworkwasgivenbutnostartdatewasavailable.TheInspectoratewasmonitoringtheprogressonthisobjectiveinlate2009.

service user involvement

peer support/advocacy

PeeradvocacysupportwasprovidedbytheIrishAdvocacyNetwork(IAN).TheIANrepresentativeattendedtwoapprovedcentresandanumberofcommunityfacilities.Itwasreportedthatthestaffintheservicehadwelcomedtheadvocacyserviceandthattheadvocatewasinvitedtojoinanumberoflocalandregionalcommittees.Discussionsonattendanceatthemanagementteamwereatanearlystage.

Theadvocatehighlightedanumberofresidentrestrictionsthatoperatedwithintwoapprovedcentres:lockedentrancedoors,lockedbathrooms,lackofoutdoorspace,andrestricteduseofmobilephones.

Theworkoftheadvocatehadhighlightedanunmetneedforacarersgroupinthecatchment.ThereweremanycallsfromfamilymembersconcerningtheMentalHealthAct2001andtheneedforongoingsupportforthemselves.Theservicewasplanningtoestablishaconsumerpanel.

246


service user participation

ServiceuserswereinvolvedinthedeliveryofmentalhealthservicesthroughrepresentationonlocalandregionalVision for Changegroups.TheIANrepresentativehadbeeninvitedtojointhelocalgrouplookingattheprovisionofacuteservicesinthearea.

Theservicehadcommencedplanstoestablishacarer’scouncil.Serviceuseropinionswerebeingsought.

Governance

Quality improvements (audits and Reviews)

Sincethe2008inspection,theservicemanagementteamhadbeenwidenedtoincludehealthandsocialcareprofessionals.Allhadappropriatelinemanagementstructureswithinmentalhealth.Itwastooearlytoreportontheimpactofthischangeontheservice.Termsofreferencehadbeenagreedandtherewasafullagendatobeimplemented.

staffing Dedicated to specialist Mental Health services

Medical Staff

post Wte in post Consultantpsychiatrist 6NCHD 9Specialistregistrar 4

Nursing Staff

post Wte in postDON 1ADON 3Nursesbasedinin-patientservices 60.12Nursesbasedincommunityresidences 27.37Communitymentalhealthnurse 64.75

(allgrades)Nursesbasedindayhospitals 4Nursesbasedindaycentre 12.07Other–temporarystaffpanel 0

Nursing Specialist Posts

speciality Wte in postLiaison 2Clinicalplacementcoordinators 0Nursepracticedevelopmentcoordinator 0Counsellors 7.82Advancednursepractitioner 0

247


Health and Social Care Professionals

post Wte in postClinicalpsychologist 2Socialwork 4.94Occupationaltherapist 3.84Arttherapist 0

specialist teams (excluding primary Care teams)

Community Mental Health Team (CMHT) staffing numbers by sector are available on the Mental Health Commission website www.mhcirl.ie

Community Rehabilitation Team Report

TeamDescription CommunityRehabilitationTeamPopulation 118,791

staffing 2008 Wte in post 2009 Wte in postConsultantpsychiatrist 1 1NCHD(includingspecialistregistrar) 2 2Dedicatedteamcoordinator 1 1ADON 0 0CMHN 65 62.95Clinicalpsychologist 0 0Socialworker 0.8 0.8Occupationaltherapist O 0.4Dedicatedaddictioncounsellor 0 0Dayfacilitynursestaffing 0 0Healthcareassistant 0 0

Facilities 2008 2009

Dayhospital Notapplicable Notapplicable

Daycentre 1 1

248


Psychiatry of Later Life Team Report

TeamDescription PsychiatryofLaterLifePopulation 118,791

staffing 2008 Wte in post 2009 Wte in post

Consultantpsychiatrist 1 1

NCHD(includingspecialistregistrar) 2 2

Dedicatedteamcoordinator 1 1

ADON 0 0

CMHN 13 13

Clinicalpsychologist 0 0

Socialworker 0.91 0.91

Occupationaltherapist 0.69 0.69

Dedicatedaddictioncounsellor 0 0

Dayfacilitynursestaffing 0 0

Healthcareassistant 0 0

Facilities 2008 2009

Dayhospital 1 1

Daycentre 0 0

in-patient Facilities

Thereweretwoapprovedcentresoneineachcounty.Monaghanhad11acutebedsand27elderlycarebedsonthesiteofSt.Davnet’sHospital.InCavanacutein-patientserviceswerelocatedinCavanGeneralHospital.IndividualapprovedcentrereportsareavailableontheMHCwebsite.Adecisiononthelocationoftheacuteserviceinthefuturewaspending.TherefurbishmentoftheelderlycareunitsinMonaghanwasseenasashort-to-mediumtermplan.Theservice’spreferredoptionwasapurpose-builtregionalunit.

Theservicehadbeenaskedtoadmitchildrenforin-patientcare.Bothunitswereunsuitableandclinicalstaffwereawareofthis.Thestaffwerefrustratedbythelackofaregionalprotocolfortheadmissionofyoungpeopleaged16to17yearsforin-patientcare.

statutory Requirements for approved Centres

Regulations (s.i. 551 of 2006)

Cavan:TheservicewasinbreachofanumberofRegulations.Thisrelatedinparttothereviewingofpolicies.Accesstoanoccupationaltherapistontheunithadimprovedsince2008butactivitieswerenotlinkedtoassessedneedidentifiedinacareplan.

Monaghan:Anumberofpolicieswereinneedofreview.

Rules (section 59.2 and section 69.2, Mental Health act 2001)

Cavan:Seclusion,ECTandMechanicalRestraintwerenotinuseintheunit.

249


Monaghan:TheservicewascompliantwithPart5oftheRulesonMechanicalRestraint.SeclusionandECTwerenotused.

Codes of practice

Cavan:TheservicewascompliantwiththeCodeofPracticeonphysicalrestraint.Astheunitwasunsuitableforthecareandtreatmentofchildrentheservicewasunabletoachievecompliancewiththecodeofpracticeontheadmissionofchildren.

Monaghan:Thecentrewascompliant.

Multidisciplinary Care planning

Eachteamhadacoremultidisciplinaryteam(MDT)inplace,withthehealthandsocialcareprofessionalinputsspiltbetweenteams.Therewasasingleindividualfilethatfollowedtheserviceuserthroughtheservicefromin-patientcaretooutpatientscare.Thefilewasdividedintosectionsforthedisciplinestorecordtheirassessmentsandinterventions.

24-Hour supervised Community Residences

Description

Therewerethreecommunityresidencesproviding24-hourcareintheservice,withatotalof46places.

Theresidenceswereunderthecareofthecommunityrehabilitationteam(CRT).ItwasreportedduringthemeetingwiththeInspectoratethatallresidentshadrecentlybeenassessedandthattherewasactiverehabilitationongoing.Itwasreportedthattheenvironmentinalltheresidenceswasofagoodstandard.

Residence number of places number of residents

team responsible Care plan type

St.Jude’s 15 15 CRT MDTLisdarnLodgeHostel 15 15 CRT MDTWoodvale 16 16 CRT MDT

Conclusion

TheCavan/MonaghanMentalHealthServiceappearstobeatacrossroads.Decisionsarepending}}

whichwillshapethefutureoftheservice;someofwhichareoutsidethecontrolofstaff.Thelocationofthenewacuteunitwillbeidentifiedbytheendof2009anditstillisnotclearwhethertheunitwillbeinMonaghanorCavan.Alocalgrouphasbeensetuptoresearchthebestavailableoption.Amoreimmediateconcernisthereplacementofnursingstaffinthecurrenteconomicandrecruitmentfreeze.Allthesefactorsareimpactingonthestaffmorale.

Awiderconcernontheadmissionofchildrentoadultin-patientunitsneedstobeaddressedata}}

regionalandnationallevel.

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Fortheserviceusersthereislimitedaccesstohealthandsocialcareprofessions.Systemstoinfluence}}

thedirectionofserviceshavecommencedbutfurtherworkisrequired.Thereisareportedneedforcarerandfamilysupportandaserviceusercouncil.Thelatteriscurrentlybeingdeveloped.

Theserviceandstaffarecommittedtotheprovisionofhomebasedcareandtreatmentwithinthe}}

community.Itwasevidentthatallstaffareworkingextremelyhardtoresolveissuesindifficulteconomictimes.


1. A decision regarding the future location of acute services must be made and human resources needs planned to implement the service.

2. The approved centres must be in compliance with all statutory requirements under the Mental Health Act 2001 and associated Regulations and Rules.

3. A carers support group and consumer council should be progressed.

4. A plan to address the deficits in human resources must be developed.

5. Community mental health teams must be resourced in line with national policy.

6. The structural deficits in the living environment in St. Davnet’s Hospital must be addressed and an action plan with a time line submitted to the Inspectorate.

251


Mental Health services 2009 Catchment area Report Dublin north Central

HSEArea HSEDublinNorthEastCatchment DublinNorthCentralMentalHealthService DublinNorthCentralMentalHealthServicesPopulation 143,333NumberofSectors 6NumberofApprovedCentres 2SpecialistTeams Rehabilitation

PsychiatryoflaterlifeLiaisonAdolescent

PerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 16September2009

service 2009


DublinNorthCentralprovidedaservicetoanareathathadanumberofchallengingfactors:highlevelsofdeprivation,aculturallydiversepopulation,andaverybusyaccidentandemergencyserviceattheMaterHospital.Acuteserviceswereprovidedattwosites,theMaterHospitalandSt.Vincent’sHospital.

Thereweresixsectorteams,allofthempoorlyresourced.Workwascontinuingtoalignthesectorsalongdistrictelectoraldivision(DED)boundariesandmovetolargersectorteams.Therewasonedayhospitalandasmallnurse-ledhomecareservice.Thesefactorsputconsiderablepressureontheuseofin-patientbeds.

Theservicehadaccessto40acutein-patientbedsacrosstwosites:MaterHospitalwith10acutebedsand5liaisonbeds,andSt.Vincent’sHospitalwith30acutebeds,9continuingcarebeds,6psychiatryoflaterlifebeds,21continuingcareoftheelderlybeds,18rehabilitationbedsand6adolescentbeds.Inaddition,therewere22highsupportcommunityresidentialplacesand71mediumorlowsupportcommunityresidentialplaces.Therewereplansinplacetoreducethenumberofacutebedsbytenin2009.

Theservicehadanumberofspecialityservices,rehabilitation,liaison,psychiatryoflaterlife,andanewlyestablishedin-patientserviceforyoungpeopleaged16–17years.

Thedevelopmentofasinglecohesiveservicecontinued.


1. Every effort should be made to have a fully operational mental health service with the appointment of core mental health teams.

Outcome:Fourconsultantpsychiatrists,includingthechildandadolescentconsultantpsychiatrist,werepermanentlyappointedtopostsinthelastyear.Therewerenoadditionalpostsassignedtoanyofthesectorteams.Thesectorteamswereacutelyshortofhealthandsocialcareprofessionals,especiallyinsocialwork.

252



AcopyoftheLevelIIBusinessplanforDublinNorthCentralPCCCLocalHealthOfficewasreceivedbytheInspectorateteaminadvanceofthemeeting.TheareaactionplanformentalhealthwaslinkedtotheNationalImplementationPlanforA Vision for Change2009–2013.

Thekeygoalsforthisareain2009wereidentifiedastheclosureof10acutebedsinSt.Vincent’sHospital,relocationofidentifiedresidentsfromSt.Vincent’sHospitaltomoreappropriatesettings,andthedevelopmentofcommunityservices.


Theopeningofa6-bedunitforadolescentsaged16–17yearsinMarch2009.}}

AclinicalpsychologistpostwasassignedtotheliaisonteambytheMaterHospital.}}

Plansforthedevelopmentofacutein-patientservicesattheMaterHospitalwereadvanced.Workwas}}

continuingwithestatesmanagementonthecapitalbudget,timeframesandprioritylistingwithintheoverallMaterproject.

AculturaladvisorypanelwasestablishedaspartoftheculturalclinicbasedintheMatersector.}}

Itincludedserviceusersanditsaimwastoassistthedevelopmentofserviceswithappropriateawarenessofculturalissues.

ECTserviceshavebeendiscontinuedatSt.Vincent’sHospitalandtransferredtotheMaterHospital.The}}

newservicecommencedinJuly.Theservicewasaimingtodevelopthisasaregionalcentre.

Areviewgroupwasestablishedtolookatthefunctioningandpurposeofthedayhospitalinthe}}

service.Implementationofthereview’sfindingswereduetobecompletedinthefollowingmonths.

Followingreconfiguration,anewsectorwascreatedservingtheMarino/Tolkaarea.Itwasputinto}}

operationthisyearwithconsiderableinputfromallstaff.

RiskmanagementpoliciesandprocedureswereadvancedbothinSt.Vincent’sHospitalandthe}}

community.ThecatchmentisapilotsitefortheHSEQualityIntegratedSafetyandQualityCommittee(ISQC)project.

CareplanningprocesswasfurtheradvancedattheMaterHospital.}}

AneweveningsocialclubwasestablishedintheMatersectorforserviceusers.}}

Serviceusers’informationcontinuedtobedevelopedontheSt.VincentHospitalwebsite.}}

TheGraceParkHouse24-hourcommunityresidencewasupgradedandthenumberofbedsreduced}}

from16to6inthelastyear.Therewereplanstoreducethelevelofstaffingsupportprovided.

Hospital Closure plans (Where applicable)

TherewerenoplanstocloseSt.Vincent’sHospital,rathertodevelopcertainspecialistservicesonsite.

A6-bedadolescentunitopenedinMarchforelectiveadmissions.ItwasaregionalunitforDublinNorthEast.Ithasalsoacceptedreferralfromotherregions.Datawasbeingcollected.Therewereplanstolookatextendingthenumberofadolescentbedsinthefuture.

253


The100-bedcommunitynursingunitbuildingprojecthadcommencedsincethelastmeetingwiththeInspectorate.ItwasexpectedtoopeninApril2010.AnumberofresidentsfromSt.Clare’sWardwhohadbeenassessedasrequiringnursinghomeaccommodationwereduetobedischargedtothisunit.Itwasreportedthattheassessmentshadbeencompletedandthatfamilieshadbeeninvolvedintheprocess.



ApeeradvocacyservicewasprovidedbytheIrishAdvocacyNetwork(IAN)intheapprovedcentres,thedayhospitalanddaycentre.Theadvocatereportedthattheadvocacyservicewaswidelysupportedacrosstheservice.

Intheapprovedcentres,serviceuserswerepositiveintheirsupportofstaff,developmentofinformationsitesonmedication,accesstopsychiatristsandtherangeofrecreationalactivitiesprovided.OnSt.Aloysiuswardserviceuserscommentedpositivelyonthesupportprovidedbythesocialworkerregardingaccommodationandtheoccupationaltherapyprogramme.

OfconcerntoserviceusersattheMaterwasthelackofoutdoorspaceandlimitedaccesstooccupationaltherapy(onesessionaweek).InSt.Vincent’sHospital,serviceuserscontinuedtohighlightyearafteryearthelackofaccesstosocialworkersduringacuteadmissionsandthelackofoccupationaltherapy.

Itwasreportedthatlong-stayresidentsofthehospitalfeltthattheywere“lostcauses”or“hopelesscases”.Theywereuncertainastowhereserviceswouldbeprovidedfortheminthefuture.


ServiceuserswererepresentedbytheIANonvariousinternalworkinggroups.Theyalsoattendedthemonthlyheadsofdisciplinegroupmeeting.

Governance


Management structure: Therewasatwo-tiermanagementstructureinplace.Anexecutivemanagementteamwasestablishedanumberofyearsagotodevelopamorecohesiveworkingrelationshipbetweenthethreeserviceproviders.Therewasnorepresentativefromthehealthandsocialcareprofessionalsonthisgroup.Therewasamonthlyheadsofdisciplinemeeting,attendedbyalldisciplinesandbytheadvocate.

Research/Audit:Ongoingresearchandauditswerecompletedwithindisciplines.TherewereactivelinkswiththemedicalschoolinUCD.

Incidents:Anewsystemforreviewingandmanagingriskhadbeendeveloped.Amultidisciplinarygrouphadbeenestablishedtoreviewincidentsandrecommendchangesinpolicyandpractice.

254



Medical Staff


Nursing Staff

post Wte in postDON 1ADON 6Nursesbasedinin-patientservices 103.25Nursesbasedincommunityresidences 13.79Communitymentalhealthnurse 18.5Nursesbasedindayhospitals 14.63Nursesbasedindaycentre 3.5


speciality Wte in postLiaison 0Clinicalplacementcoordinators 0Nursepracticedevelopmentcoordinator 0Counsellors 0Advancednursepractitioner 0Substanceabuse 2Familytherapy 2Behaviourtherapy 1Careoftheelderly 1


post Wte in postClinicalpsychologist 4.5Socialwork 2.82Occupationaltherapist 4Arttherapist 0

255




Rehabilitation Team Report

TeamDescription RehabilitationPopulation 143,333





ADON 0 0

CMHN 0 0


Socialworker 1 1





Facilities 2008 shared or owned 2009 shared or owned

Dayhospital None None

Daycentre Shared Shared


TeamDescription Psychiatryoflaterlife(POLL)Population 32,500(over65years)


Consultantpsychiatrist 3.5 4



DON 1 1

CMHN 4 4


Socialworker 0 0

Occupationaltherapist 1 1


Dayfacilitynursestaffing 6 6(includingEcclesStdayHospital)



Dayhospital Two Two

Daycentre Notapplicable Notapplicable

256


Liaison Team Report

TeamDescription LiaisonPopulation Notprovided





ADON 0 0

CMHN 0 0


Socialworker 0 0



Dayfacilitynursestaffing Notapplicable Notapplicable

Healthcareassistant o o




Adolescent In-Patient Team Report

TeamDescription AdolescentPopulation Regional



NCHD(includingspecialistregistrar) 0 Notprovided

Dedicatedteamcoordinator 0 Notprovided

ADON 0 Notprovided

CMHN 0 Notprovided

Clinicalpsychologist 0 Notprovided

Socialworker 0 Notprovided

Occupationaltherapist 0 Notprovided

Dedicatedaddictioncounsellor 0 Notprovided

Dayfacilitynursestaffing 0 Notprovided

Healthcareassistant 0 Notprovided




257



Therewerethreeapprovedcentresinthecatchmentarea,locatedattwosites:theMaterHospitalandSt.Vincent’sHospital,Fairview.BothadultcentreshadunannouncedinspectionsinAprilandJuneof2009.TheAdolescentUnitopenedinMarchinSt.Vincent’sHospital.ItwasinspectedinJuly2009.

Thebednumberswereconfiguredasfollows,51acutebeds(includingelderlycare),21continuingcare,21rehabilitation,and9privatelyfundedbeds.Theacutebedswerebasedacrosstwosites,MaterHospitalandSt.Vincent’sHospitalFairview.


ThethreeregisteredapprovedcentreswereSt.AloysiusWard,AcutePsychiatricUnit,MaterHospital,St.Vincent’sHospital,Fairview,andSt.Joseph’sAdolescentIn-patientUnit,St.Vincent’sHospital,Fairview.


St. Aloysius Ward, Acute Psychiatric Unit, Mater Hospital:Theservicewascompliantwith25ofthe30Regulations.Someimprovementwasnotedinthephysicalenvironmentandtheprovisionofinformation.Theimplementationofindividualcareplansforallresidentshadnotbeenachieved.Servicesusershadlimitedaccesstoatherapeuticprogrammeduringin-patientadmissionsduetopoorskillmix.

St. Vincent’s Hospital, Fairview:Thisservicewasalsocompliantwith25ofthe30Regulations.Theimplementationofcareplanningandtherapeuticprogrammeshadimprovedsincethelastinspection.Therewasstillconsiderableskillmixshortageonthecommunitymentalhealthteams.

St. Joseph’s Adolescent In-patient Unit, St. Vincent’s Hospital, Fairview:Thiscentreachievedcompliancewith25oftheRegulations.Itwasreportedthattheservicehadworkedhardinashortperiodtoachievethislevelofcompliance.Therewasnooccupationaltherapistavailabletoserviceusers.


St. Aloysius Ward, Acute Psychiatric Unit, Mater Hospital:TheservicewasnotcompliantwiththeRulesonseclusion,ECTandMechanicalRestraint(Part5).

St. Vincent’s Hospital, Fairview:TheservicewasnotcompliantwiththeRulesonseclusion.ECTwasnolongerprovidedonsite.

St. Joseph’s Adolescent In-patient Unit, St. Vincent’s Hospital, Fairview:Theservicehadseclusionfacilities.Noresidenthadbeensecludedatthetimeoftheinspection.Mechanicalrestrainthadnotbeenused.

Codes of practice

St. Aloysius Ward, Acute Psychiatric Unit, Mater Hospital:TheservicewascompliantwiththeCodeofPracticeonnotificationofdeathsandincidents.ItwasunabletomeetalltherequirementsforECT,physicalrestraintandtheadmissionofchildren.

St. Vincent’s Hospital, Fairview:TheservicewasfullycompliantwiththeCodesofPracticeonnotificationofdeathsandincidentsandonphysicalrestraint.ItdidnotprovideECT.Itwasunsuitablefortheadmissionofchildren.

258


St. Joseph’s Adolescent In-patient Unit, St. Vincent’s Hospital, Fairview:TwoCodesofPracticewereapplicable,theadmissionofchildrenandnotificationofdeathsandincidents.Theservicewasunabletomeettherequirementsofthelattercode.Attemptshadbeenmadetoinitiatecompliance.


Approved centres:Careplanninghadcommencedinthein-patientunits.Itwasatvariousstagesofimplementation.Therewasevidenceofplanstoaddressdeficitsfoundduringtheinspections.

Community:Itwasreportedthattherehabilitationteamhadmultidisciplinarycareplansinthecommunity.Therewerenoplanscurrentlytoextendthistothesectorteams.


Description

Thereweretworesidenceswith24-hournursingsupportprovided.SincethelastmeetingwiththeInspectorate,GraceParkHousehadbeenupgradedandthenumberofbedsreducedbyten.Theresidentsweremainlytransferredtonursinghomeaccommodation.Itwasplannedtoreducethelevelofnursingsupportprovidedinthecomingmonths.

Therewasawaitinglistfor24-hourcommunityplacementinthearea.Itwasmanagedbytherehabilitationteam.Itwasreportedthatthereisanunmetneedfortenhighsupportplaces.

Theservicehas71medium/lowsupportplaces.



GraceParkHouse 6 6 Generaladult NursingGallenHouse 16 16 Rehabilitation MDT

Conclusion

Theservicecontinuestomakeprogressonredirectingtheservicestoprovideasinglecohesiveserviceforallserviceusers.Anumberofthechangesrequirednowarestructuralandwillrequireadditionalcapitalmonies;otherswillrequiretherealignmentofsectorboundariesandtheprovisionofacceptablecommunityfacilitiesforserviceusersandstaff.Thereisacommitmentbyallstaffandadvocatestoachievingthis.Thishasbeenreflectedintheachievementstodate.

Intandemwiththereductioninacutebeds,thereisarealandimmediateneedtobuilduptheskillmixandcapacityonthecommunitymentalhealthteams.Serviceusersmusthaveequalaccesstoalldisciplinesandthefullrangeofinterventions.Anyresourcesreleasedfollowingtheclosureofbedsmustbeusedforthis.Alternativestoin-patientcaremustbefurtherdeveloped.

Theservicehasdevelopedaregionalin-patientfacilityforadolescents,recentlyestablishedarehabilitationserviceandhasawell-establishedpsychiatryoflaterlifeservice.

259



1. The staffing levels and skill mix on each team must be in line with national policy recommendations.

2. Plans to progress the development of the Mater site for the provision of an acute service must continue.

3. Alternatives to in-patient care must be developed.

260


Mental Health services 2009 Catchment area Report louth/Meath

HSEArea HSEDublinNorthEastCatchment Louth/MeathMentalHealthService Louth/MeathMentalHealthServicePopulation 271,845NumberofSectors 12including2MHSOPNumberofApprovedCentres 2SpecialistTeams 2MHSOPPerCapitaExpenditure2008[>18Years] 96.02euroDateofMeeting 13May2009

service 2009

Description

TheLouth/Meathcatchmentareahad12sectorteams,includingoneMentalHealthServiceforOlderPersons(MHSOP)teamineachcounty.Itwasprimarilyahome-basedcommunitymentalhealthservice.Therewasahome-basedtreatmentteamineachcounty.Theservicehadnodayhospitalbutthereweresixdaycentres:threeinLouthandthreeinMeath.Thecatchmentareahadtwoapprovedcentres:theDepartmentofPsychiatryinOurLady’sHospital,NavanandSt.Brigid’sHospital,Ardee.Therewerefive24-hoursupervisedresidences,twomediumandonelowsupportresidences.Therewasonenurse-ledassertiveoutreachteam.


1. Increased resourcing of multidisciplinary teams should be made available, particularly in the area of occupational therapy.

Outcome:AnauditofeachcommunitymentalhealthteamcompositionhadbeencompletedandmatchedtoA Vision for Changerequirementswithaviewtoreconfigurationofexistingresourcestomeetrequirements.

2. The service needs a rehabilitation team particularly in light of ongoing continuing care.

Outcome:Anurse-ledassertiveoutreachteamhadbeenestablishedinLouth,followingtheamalgamationofSt.Ita’sUnitandOurLady’sUnitinSt.Brigid’sHospitalinArdee.AlongwiththeMeathassertiveoutreachteam,linksweremaintainedwithcommunitymentalhealthteams,communityresidences,localauthoritiesandcommunityagencies.

3. Improvement should take place in the provision of therapeutic activities for residents in both approved centres.

Outcome:TherewasnooccupationaltherapyserviceinMeath.TheoccupationaltherapyserviceforSt.Brigid’sHospitalwasinsufficienttomeettheneedsofresidents.

261



ThenumberofbedsatSt.Brigid’sHospitalhadbeenreducedto50.Therewere25in-patientbedsattheDepartmentofPsychiatryinNavanGeneralHospital.

ToreconfigureexistingcommunitymentalhealthteamsinlinewithA Vision for Changerecommendations.

Torecruitcurrentvacantpoststoachievefullcompliancewithapprovedcentrerecommendations.


Theamalgamationoftwocontinuingcareunitsintoonewiththetotalreductionoffourbeds.}}

AcquisitionofasectorheadquartersfortheTrimsector.}}

Developmentofanurse-ledassertiveoutreachteamforCo.Louth.}}

Developmentofacarer’ssupportgroupinCo.Louth.}}

ReorganisationofoutpatientservicesinDroghedasectorstoacentralisedlocationinHaymarket}}

communitypremises.

EstablishmentofinfectioncontrolandhygienecommitteesinbothLouthandMeath.}}

Introductionofintegratedindividualcareplanning.}}

Completionofqualityandriskself-assessmentforbothLouthandMeathmentalhealthservices.}}

DevelopmentofaLouthmentalhealthserviceriskregister.}}

CommencementofthebuildingofareplacementdaycentrefortheNavanarea.}}


TherewerenoconcreteplanstocloseSt.Brigid’sHospital,Ardee.TheamalgamationofSt.Ita’sWardandOurLady’sWardwasapositivedevelopment.TheissueofthefutureoftheacuteunitatSt.Brigid’sHospitalremaineduncertain.Afeasibilitypaperhadbeeninitiated–drawingonA Vision for Change–thatanacuteunitshouldbepartofalargerLouthCountyHospitalattheDundalksite.ItwasstatedintheHSE’sBusinessPlan2009forNorthLouththata“localVision for ChangegroupwasintheprocessofdevelopingaplantofacilitatetherelocationoftheacuteinpatientunitinSt.Brigid’sHospital,Ardee,andtodevelopastrategyforthefuturefunctionofthecomplex”.


TheregionaladvocatehadbeeninvitedtojoinmanypanelsandgroupswithinLouth/Meathandhadbeenconsultedonnumerouspoliciesandinitiatives,e.g.hostelreferralcommittee,hostelstrategycommittee,consumerpanel.ItwasreportedthatstaffhadreadilyfacilitatedtheadvocateinaccessingpatientsdetainedundertheMentalHealthAct2001,thusenablingtheadvocatetofulfiltheirremitofprovidinginformationandsupporttoanyonewhowasinvoluntarilydetained.Thishelpedtobuildtheclient-advocaterelationshipthatinmanycasesextendedfromin-patienthospitalcaretothecommunityfollowingdischarge.

262


WhiletheDepartmentofPsychiatryinNavanGeneralHospitalhadanopendoorpolicythatappearedtobeworkingwell,theimplementationoftheopendoorpolicyintheacuteunitinSt.Brigid’shadbeendelayedbyayear.


ItwasreportedbytheregionaladvocatethattheLouth/Meathmentalhealthserviceshadembracedtheconceptofserviceuserinvolvementwiththementalhealthservices.

TheregionalpeeradvocatefromtheIrishAdvocacyNetwork(IAN)attendedtheLouthandMeathserviceseveryWednesdayandThursday.Theregionaladvocatewasalsoavailablebyphonefrom0900hto1700honaweeklybasis.

Arecentadvocacycourse,attendedbysomelong-termresidentswasalsoattendedbyamemberofnursingstaffandanoccupationaltherapistfromSt.Brigid’sHospital,Ardee.

ApeeradvocacytrainingprogrammewasheldinJuly2008byIANandfundedbytheHSE.

Serviceuserinvolvementinthequalityandbestpracticegroupandconsumerinvolvementgrouppresentfeedbackfromserviceuserswhichwasthenfedbacktomanagementteammeetings.

Theregionaladvocatewasinvolvedinmeetingsrelatingtoplanninganddevelopmentoffutureservices,e.g.designanddevelopmentofanewacuteunitforLouth,adaycentrereplacementfacilityforMeath,andanamalgamationofunitsinSt.Brigid’sHospital,Ardee.

TheregionaladvocateteamhadbeeninvolvedinpresentationstoundergraduatenursingstudentsinDundalkInstituteofTechnologyandinvolvedstudentnursesonplacementintheworkoftheadvocate.

Governance


Theseniormanagementteamcomprisedofmembersofthemultidisciplinaryteam.PlanstoincludetheIANrepresentativewereatanadvancedstage.

Theservicehadconductedanumberofauditsduringthepreviousyear,includinganauditonseclusion,physicalrestraint,recordkeeping,medicationmanagementandhygiene.

Aqualityandriskassessmentsurveywascarriedout.

Occupationaltherapistshadconductedaresearchprojectassessingtheimpactoftheintroductionofanoccupationaltherapyservicetoaunitandexaminedtheserviceuser’sandstaffperspectives.

SomestaffmembershadbeentrainedasinstructorsincoursessuchasPreventionandManagementofViolence(PAMV),manualhandling,andbasiclifesupport.

263



Medical Staff


Nursing Staff

post Wte in postDON 1ADON 5.8CNM3 2Nursesbasedinin-patientservices 91.94Nursesbasedincommunityresidences 36.32Communitymentalhealthnurse 9.9Nursesbasedindayhospitals 0Nursesbasedindaycentre 15.5


speciality Wte in postLiaison 1.86Clinicalplacementcoordinators 1.5Nursepracticedevelopmentcoordinator 0.5Counsellors 4Advancednursepractitioner 0Affectivedisorder 2Communitysupportteam 2Familytherapy 2Cognitivetherapy 1.42Clozarilnurse 1.51Home-based 12.5Assertiveoutreach 7MHSOP 3.8


post Wte in postClinicalpsychologist 6.61Socialworker 6.23Occupationaltherapist 0Arttherapist 0

264




MHSOP Team Report

TeamDescription LouthMentalHealthServiceforOlderPersonsPopulation Notprovided





ADON 0 0

CMHN(1CNM2,1Staff) 2 2


Socialworker 1 1






Dayhospital 0 0

Daycentre 0 0

MHSOP Team Report

TeamDescription MeathMentalHealthServiceforOlderPersonsPopulation Notprovided





ADON 0 0

CMHN(1CNM2,1Staff) 2 2


Socialworker 1 1






Dayhospital 0 0

Daycentre 0 0

265



Thereweretwoin-patientfacilitiesattachedtotheservice.

TheDepartmentofPsychiatryatOurLady’sHospital,Navan,wasabrightspaciousandwell-maintainedunitwithanenclosedgardentoproviderelaxationforresidents.AroompreviouslyusedforECThadbeenconvertedtoanactivitiesareaandtherewereplanstofurtherdevelopthis.

StBrigid’sHospital,Ardee,wasalargetwo-storeyred-brickedbuildingwhichprovidedcareandtreatmentforacuteadmissionsandelderlycontinuingcarefromtheLoutharea.OurLady’sWardandSt.Ita’sWardwerepreparingtoamalgamateandmovetoapurpose-builtunit,whichwasreadyforoccupation,andwhichwassituatedinthemainbuilding.



BothapprovedcentreswereeitherfullyorsubstantiallycompliantwithalltheRegulations.ThelackofanoccupationaltherapistintheDepartmentofPsychiatryinNavanaffectedcompliancewiththeRegulationsrelatingtotherapeuticservicesandstaffinglevels.AsimilarsituationappliedinSt.Brigid’sHospital,althoughanoccupationaltherapistwasemployedthere.


ECTwasnotusedineitherapprovedcentre.

Mechanicalrestraintwasonlyusedforenduringself-harmingbehaviourinSt.Brigid’sHospital,whichwassubstantiallycompliantwiththeRulesgoverningitsuse.Mechanicalrestraintwasnotusedinothersituationsineitherapprovedcentre.

TheDepartmentofPsychiatryinNavanwasfullycompliantwiththeRulesinrelationtotheuseofseclusionbutthefacilitiesinSt.Brigid’swerenotcompliant.

Codes of practice

BothcentreswereeitherfullyorsubstantiallycompliantwiththeCodeofPracticerelatingtotheuseofphysicalrestraint.

BothwerefullycompliantwiththeCodeofPracticeonthenotificationofdeathsorincidents.

ChildrenwerenotadmittedtoSt.Brigid’sHospitalandtherewasapolicytothiseffect.InNavan,althoughchildrenwereadmitted,itwasanadultunitandnotsuitablefortheadmissionofchildren.


IntegratedindividualcareplanswereinoperationattheDepartmentofPsychiatryinNavan.Therapeuticactivitieswerelinkedtothesecareplans.Thecareplanswerereviewedregularly,withinputfromtheserviceuser.

IntegratedindividualcareplanshadbeenintroducedtoallunitswithinSt.Brigid’sHospitalArdee.OnOurLady’sWard,theInspectoratefoundthattherewasalackofmultidisciplinaryteamcareplanning.

266


Nursingcareplanswereinoperationandregularreviewofresidentsbymedicalstafftendedtobeofaphysicalnaturewithalackofmentalhealthreviewsdocumentedintheclinicalfilesexamined.

Thepsychiatryoflaterlifeteamhadnoaccesstoclinicalpsychologyservices.

TheDunshaughlinsectorhadnoaccesstoclinicalpsychologyservices,whichwasacorebasicservicetoapopulationofover46,000people.

Therewasalackofoccupationaltherapyservicesinthecatchmentarea.

TheArdeeandLouthDroghedasectorshadnosocialworkservices.


Description

Theageprofileoftheresidentsineachofthe24-hoursupervisedcommunityresidenceswasdescribedbytheserviceasachallenge.Inordertoadapttotherisingageprofileofresidents,appropriateandadequatefixturesandfittingswouldneedtobeputinplaceintheseresidences.Eachresidentwillrequireappropriatemonitoringandassessmentonanongoingbasis.

Thedevelopmentofthereferralprocesshadopenedupvacanciesacrosstheservice.Therewasacentralreferralgroup.IndividualswithmentalhealthdifficultiesunderwenttheCamberwellAssessmentofNeed(CAN)andanappropriateplacementwasofferedtotheindividual.



RathnaRiogh,Navan

122respite

10 Referringteam Nursing

DeLaSalle,Ardee

141respite


AnSolasan,Dundalk

142respite


Moorings,Dundalk

132respite


St.Mary’s,Drogheda

141respite


Conclusion

Theservicehadlimitedaccesstoadequatehealthandsocialcareprofessionssuchasclinicalpsychology,socialworkandparticularlyoccupationaltherapy.

Itwasveryapparentthatallmembersofthemultidisciplinaryteamwerestriving,insomecaseswithgreatdifficulty,toprovideaqualityserviceinthesedifficulteconomictimes.

Theoutstandingvacanciesinclinicalpsychology,socialworkandoccupationaltherapyneedtobefilled.

267



1. The psychiatry of later life service should have access to clinical psychology services in line with national policy.

2. The Dunshaughlin sector should have access to clinical psychology services in line with national policy.

3. The lack of an occupational therapy service needs to be immediately addressed in line with national policy.

4. The elderly residents in continuing care in St. Brigid’s Hospital, Ardee, should come under the clinical direction of the psychiatry of later life team.

5. The newly refurbished unit for continuing care residents should be opened without delay.

268


Mental Health services 2009 Catchment area Report north Dublin

HSEArea HSEDublinNorthEastCatchment NorthDublinMentalHealthService NorthDublinMentalHealthServicePopulation 225,145NumberofSectors 6NumberofApprovedCentres 1SpecialistTeams Rehabilitation

MHSOPPerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 26August2009

service 2009


Theservicecoveredalargepopulation,andhadsixsectorteamsandlong-establishedspecialityteamsinrehabilitationandmentalhealthservicesforolderpersons(MHSOP).Therewasoneapprovedcentreattachedtothecatchmentarea,St.Ita’sHospitalinPortrane.Thiswasalarge,sprawlingred-brickedVictorianbuildingsituatedinextensivegrounds.Therewasaparticularshortfallinpsychologyandoccupationaltherapypoststhroughoutthesectorteams.ItwasreportedthatsincetheMHSOPadmissionsunit,Unit8,closedinOctober2008duetobudgetaryconstraintsandnursingstaffshortages,admissionsofolderpeoplewerenowmadetounitsunsuitablefortheneedsofthatpatientgroup.


1. The conditions in the hospital must be of a standard that is acceptable and in compliance with the Regulations as long as the hospital remains open.

Outcome:Conditionsinthehospitalremainedextremelypoor.ThishadbeenhighlightedinpreviousInspectoratereports.

2. The future location of acute services for adults and elderly service users must be delivered in line with national policy.

Outcome:FortheprevioustwentyyearstherehadbeennumerousplanstorelocatetheadmissionservicetoBeaumontHospitalbutthishadneverbeenachieved.TheneedfornewadmissionaccommodationinBeaumontHospitalremained,butlittlehadbeendonetoachievethistodate.

3. The multidisciplinary teams must be adequately staffed with an appropriate skill mix to meet the needs of the population.

Outcome:Thishadnotyetoccurred.


Itwasreportedbytheseniormanagementteamthatthisplanhadyettobefinalised.

269



TheservicehadbeenawardedaplaceonatrainingcourseinpalliativecareindementiabytheIrish}}

HospiceFoundation.AstaffdevelopmentprogrammeindementiacarewasscheduledtobegininOctober2009.

AdutysocialworkerwasnowavailabletoresidentsontheAdmissionUnittwomorningsaweek.}}

AsupportgroupforwomenusingthementalhealthservicesinRahenyandArtanehadcommenced.}}

Acarers’supportgrouphadbeenintroducedinRaheny.}}

AbereavementgrouphadbeguninArtane.}}

AdialecticalbehaviourtherapygroupforindividualsatriskofselfharmhadbegunintheSwords}}

sector.

Apsychologygrouphadcommencedforpeoplewithsevereobsessionalthoughtsacrossanumberof}}

sectors.

ApsychologygroupwasdevelopedintheSwordssectorforpeoplepresentingwithdepressionand/or}}

anxiety.

CompletionoftheinitialstagesofthedevelopmentofoccupationaltherapyservicefacilitiesinKilrock}}

House.

Theestablishmentanddevelopmentofanevidence-basedtherapeuticprogrammecommencingwith}}

occupationaltherapygroupsinWillowbrookandWoodview.


StIta’sHospitalwasalargeVictorian-erapsychiatrichospital,situatedinnorthCountyDublininextensivegrounds.Thereweresevenwardsinthehospitalcomplex,with125residents,77ofwhomwerelong-stay.Anyhospitalclosureplanswereunclear.Thefutureofthelongstayresidentswasunclear.Thecatchmentareahadapopulationof225,145insixsectors.

Conditionsinthehospitalwereextremelypoor.ForthepasttwentyyearstherehadbeenanumberofplanstorelocatetheadmissionservicetoBeaumontHospital.Nonehadbeenachieved.Theservicewasindireneedofanewadmissionunitasthepresentadmissionunitswereunfitforpurpose.Butanysuchplanswerenotconcreteandwereunclear.

Anyplansregardingthesaleorfutureuseofthehospitalandthedevelopmentofcommunityfacilitiesfortheremainingin-patientpopulationhadnotcometofruition.

Inthemeantime,125peoplewerelivinginsubstandardaccommodationthatwasnotfitforpurpose.

270




ThepeeradvocatefromtheIrishAdvocacyNetwork(IAN)visitedtheapprovedcentreonceaweek,totheadmissionunitseitheronTuesdaysorThursdayswithpriornoticegiven,andtoallremainingunitsuponrequest.Contactdetailswerealsopostedprominentlythroughouttheapprovedcentre.AnadhocservicewasalsoprovidedtoArtanedaycentreandtoSt.Francisdayhospital.

Itwasreportedthatthepeeradvocacyservicehadbeenwidelyacceptedandaccommodatedinallfacilities.

Itwasreportedthatstaffwerehelpfulandapproachableregardingissuesofconcerntoserviceusers.

Residentshadnoticedapositivechangeinstaff-patientrelations.Theyhadpraisedtheintroductionofprotectedtimeandstatedthatingeneral,staffonthewardsmadethemselvesavailablewhentheyneededsomeonetolistentothem.

Theactivityunitwasenjoyable.

Acommonthemewithresidentswasthattheystillfeltthattheyhadlittleornovoiceregardingissuespertainingtomedication.Boredomduringweekendswasanissue.

Residentssaidthattheywouldliketohavemoretimewiththeirconsultantpsychiatrist.

ResidentsreportedtheconditionsatSt.Ita’sHospitaltobeinadequate.


IANhadbeeninvitedtojoinmanypanelsandgroupsandhadbeenconsultedonsomepoliciesandinitiatives.Examplesincludedatherapiesdevelopmentgroupmeetings,integratedcareplanmeetings,managementteammeetings,andaVision for Changelocalimplementationgroup.

Anauditofresidents’viewsandopinionsoftheservices/programmesprovidedintheAdmissionUnitwascompletedinJune2009.

Governance


AudittoolsandprocesseswereinplacetosupportcompliancewiththeRegulations.}}

Ahygieneauditandanenvironmentalaudithadbeenundertakenrecentlyanditwasreportedthat}}

theresultingrecommendationswereintheprocessofbeingimplemented.

Aninfectioncontrolcommitteehadbeenestablishedwhosechiefremitwastoauditandensurethat}}

goodinfectioncontrolpracticeswereinplace.

Adrugsandtherapeuticcommitteewasestablishedtosupportprescribingpractices,includingthe}}

nurseprescribingproject.

271


Aclinicalriskmanagementcommitteehadbeenestablishedtofacilitateclinicaldiscussiongroupson}}

theunits.

Anauditofresidents’viewsandopinionsoftheservices/programmesprovidedintheAdmissionUnit}}

wascompletedinJune2009.


Medical Staff


Nursing Staff

post Wte in postDON 1(Acting)ADON 8(including1

ActingNursesbasedinin-patientservices 108Nursesbasedincommunityresidences 30Communitymentalhealthnurse 16Nursesbasedindayhospitals 10Nursesbasedindaycentre 5.5Homecare 11


speciality Wte in postLiaison 1(vacantpost)CNS(MHSOPandDementia) 2Familypsychotherapy 1Clinicalplacementcoordinators 6.5(3assigned

toSt.Brendan’sHospital)

Nursepracticedevelopmentcoordinator 2(1assignedtoSt.Brendan’sHospital)

Counsellors 0Advancednursepractitioner 0Other(lecturers) 5


post Wte in postClinicalpsychologist 3.85Socialwork 8Occupationaltherapist 3Arttherapist 1Other 0

272




MHSOP Team Report

TeamDescription MentalHealthServicesforOlderPersonsPopulation 221,000





ADON 1 1

CMHN 2 2

CNS(dementiacare) 0 1.5


Socialworker 0 0






Dayhospital No No

Daycentre No No







ADON 1 1

CMHN 0 5*


Socialworker 1 1




Healthcareassistant 0 0* There were five RPNs assigned to the community outreach rehabilitation team (one CNM3, one CNM2 and three staff nurses).

273



Dayhospital No No

Daycentre Artanedaycarecentre Artanedaycarecentre

Liaison Team Report

TeamDescription LiaisonpsychiatryPopulation Notprovided





ADON 0 0

CNS 1 1(vacant)

CMHN 0 0


Socialworker 0 0






Dayhospital – –

Daycentre – –


ItisdifficulttoconveytheextentofdilapidationoftheSt.Ita’sHospitalbuilding.Longcorridorsinpoorconditions,toiletswithnoprivacy,paintpeeling,mouldinshowers,brokenfurniture,ill-fittingdoors,crampeddormitories,thesmellofurine,poorventilationandabaredrabenvironmentwereclearlyevident.Itappearedthattherewasnofundingtorectifythepoorsanitaryconditionsinsomewards.Itshouldbeacknowledgedthatpeopleliveintheseappallingconditionsandthattherewerelittleornoplansevidenttorectifythesituation.

Itwasalsoreportedbytheservicethatafacilityforhomelessyouthshadopenedinearlyspringinsidetheentrancetotheapprovedcentre.Itwasreportedthatasmallnumberofincidentshadbeendocumentedandreported,involvinganumberoftheseyouths.Theseincidentsincludedintimidationofresidentsoftheapprovedcentre;inoneinstance,oneresidentoftheapprovedcentrehadbeenaccostedbytwoyouthswhohaddemandedmoney.Residentshadreportedtostaffthattheywerenowafraidtowalkdowntothelocalshopsandbeach.Itwasreportedthatmeetingstoresolvethisissuehadbeeninstigated.

274



St.Ita’sHospital,Portrane,wasinreceiptofanannouncedinspectionon25August2009.


Individualcareplanswereimplementedinallareasoftheapprovedcentre,exceptfortheKilbarrackEastsector.IndividualcareplanswererequiredundertheRegulationsforApprovedCentres.TheservicewasnotcompliantwithArticle21(Privacy)andArticle22(Premises).Seesectiononin-patientfacilitiesabove.


Therewasnorecordastowhethertheresident’snextofkinwasinformedoftheepisodeofseclusionnorhadthereasonfornotinformingthembeendocumentedintheresident’sindividualcareplan.Therewasnoevidenceintheclinicalfilethattheresidenthadbeenaffordedanopportunitytodiscusstheseclusionepisodewithamemberofthemultidisciplinaryteam.

Codes of practice

Theapprovedcentrewasnotsuitablefortheadmissionofchildren.


IndividualcareplanswereimplementedinallbuttheKilbarrackEastsector.CareplanswererequiredunderArticle15oftheRegulationsforApprovedCentres.ThecareplansthatwereinoperationinallotherareaswereexcellentandlinkedwellwiththestatutoryrequirementunderArticle16.




KilrockHouse,Howth

12 12 Rehabilitation Nursingcareplan

CarltonHouse,Lispopple


InchHouse,Balrothery


Conclusion

Therehadbeenanumberofsignificantareasofgoodpracticethroughouttheserviceashighlightedabove.

TherehadbeensignificantprogresswiththeintroductionofindividualcareplansforresidentsofSt.Ita’sPortrane,fromallsectorsbarKilbarrackEast.Thestaffaretobecommendedfortheobviousamountofpreparationandworkthatwentintothisproject.Despitetheextremelypoorqualityphysicalenvironmentforresidents,staffandvisitors,therewasevidencethroughouttheapprovedcentrethatclinicalstaffmaintainedahighlevelofclinicalcareandtreatmentofresidents.

275


However,ithastobestatedthatthephysicalconditionsinSt.Ita’sHospitalareextremelypoorinwhatisadilapidated,desolateanddepressingenvironmentforallwholivethere,forallwhoworkthereandforallwhovisitthere.

Inthemeantimethereare165peopleresidinginthisappallingenvironmentwithnoplanstoremovethemtoenvironmentsthataremoresuitablyfitforpurpose.


1. St. Ita’s Hospital is not fit for purpose and should close.

2. The in-patient admission of older persons under the care and treatment of the MHSOP team should be into a suitable and appropriate area.

3. The shortfall in psychology, social work and occupational therapy posts in the sector teams should be filled.

4. The accommodation in the rehabilitation unit at Willowbrook is unsuitable and should be replaced to enable a more comprehensive rehabilitation programme to be provided for a different case mix of residents.

276


Mental Health services 2009 Catchment area Report north West Dublin

HSEArea HSEDublinNorthEastCatchment NorthWestDublinMentalHealthService NorthWestDublinMentalHealthServicesPopulation 165,755NumberofSectors 4NumberofApprovedCentres 3SpecialistTeams Rehabilitation

LiaisonPsychiatryoflaterlifeProgrammeforhomelessmentallyillLowsecureteam

PerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 8September2009

service 2009


NorthWestDublinservedapopulationof165,755withthreeapprovedcentres:St.Brendan’sHospital,theDepartmentofPsychiatryinConnollyHospitalandSycamoreUnitinConnollyHospital.Therewerefoursectors,withtwoofthem,BlanchardstownEastandBlanchardstownWest,admittingtoConnollyHospitalwiththeothers,FinglasandCabra,admittingmainlytoSt.Brendan’sHospital,butwiththeuseoffivebedsintheDepartmentofPsychiatryinConnollyHospital.AdmissionstoSt.Brendan’sHospitalwillceasewhenanewwingintheDepartmentofPsychiatryisopened.ConditionsinSt.Brendan’sHospitalwereextremelypoorandtherewereplansforanewhospitalstructureonsiteinthenearfuture.SycamoreUnitwasadedicatedunitforpsychiatryoflaterlife.Thereweretworehabilitationteams,whichwerecurrentlybeingmerged,andaliaisonteamforConnollyHospital.Therewasalsoapsychiatryoflaterlifeteamandateamforhomelesspeoplewithmentalillness.


1. The mix of patients on Unit 3A and Unit 3B was untenable and all admissions to these units should cease immediately.

Outcome:AsPineUnitintheDepartmentofPsychiatryinConnollyHospitalhadnotyetopenedadmissionstoUnit3AandUnit3Bcontinued.Advertisingforstaffhadcommenced.

2. The mix of patients on Unit O was untenable and gaps in current secure services for women should be addressed nationally by the HSE.

Outcome:TherehadbeenongoingdevelopmentswhichhadimprovedtheconditionsinUnitO.Therehadbeenprogressregardingtheclientmix.

3. To facilitate the cessation of admissions to St. Brendan’s Hospital there was an urgent need for the remaining beds at Connolly Hospital to be opened. The plan for Pine Unit to be handed over to the Mental Health Service early in 2009 should proceed promptly and without delay. Funding should be made available for the recruitment of all additional staff required to run the unit.

277


Outcome:PineUnithasbeenreturnedtotheMentalHealthService.Decorationoftheunithadcommenced.Advertisingforstaffinghadcommenced.HoweverasPineUnithadnotyetopened,admissionstoSt.Brendan’sHospitalcontinued.

4. St. Brendan’s Hospital should identify clearly and agree with the HSE the nature of the service it will provide. Policies and procedures should reflect this service provision. In particular admission and discharge policies should be clear.

Outcome:Thishadbeenachieved.

5. Funding and approval should be made available to populate the teams with the full complement of health and social care professionals. This was particularly critical for the teams providing low secure beds at St. Brendan’s Hospital and the Finglas team working in areas of high deprivation.

Outcome:Thishadnotbeenachieved.

6. Remaining areas of non-compliance on Rules, Regulations and Codes of Practice should be addressed without delay.

Outcome:Theserviceremainednon-compliantonanumberofRegulations,RulesandCodesofPractice.

7. While refurbishment had taken place on some units at St. Brendan’s Hospital, the premises were old and unsuited to the purpose for which they were being used. They should be replaced at the earliest opportunity, as was advocated in the Grangegorman Development Agency.

Outcome:FullplanningpermissionhadbeenreceivedforthereplacementmentalhealthfacilitiesontheGrangegormansite.


ThebusinessplanincludedclosureofSt.Brendan’sHospitalanditsreplacementwithnewbuildings,theopeningofPineunit,refurbishmentofthefacilitiesintheFinglassector,themergingofbothrehabilitationteamsandthereconfiguringofsupervisedresidences.


AbasicgradepsychologisthadbeenappointedtoSt.Brendan’sHospital.}}

CognitivebehaviouralpsychotherapyandmindfulnessgrouptherapywasavailableintheDepartment}}

ofPsychiatry.

Anincreaseinthenumberofpsychologistsintrainingwasfacilitatinggreateraccessforserviceusers}}

intheFinglassectortopsychologicalinterventions.

Extraeveningprogrammesinalcoholserviceoffersaftercaretothoseinfulltimeemployment.}}

Psychiatry of Later Life

TheservicehadbeeninvolvedwiththeNationalImplementationGroupindevelopingtheassessment}}

formsfornursinghomessothatmentalhealthneedswereincluded.

Atemporaryconsultantpsychiatristposthadbeenfilled.}}

Theservicecaregrouphadnominatedamembertobecomeanadvocateforserviceusers.}}

278



TheconditionsinSt.Brendan’sHospitalwereextremelypoorandunsuitedtoprovidingamentalhealthservice.TheGrangegormandevelopmentplanhadincorporatedaplantoprovidereplacementmentalhealthaccommodationonthesiteofthehospital.Thiswasduetoconsistofa30-bedintensivecareunit,a20-bedcontinuingcareunitanda16-bedrehabilitationunit.Theplanwasnowatplanningpermissionstage.Theservicewasawaitingconfirmationthatfundingwouldbemadeavailabletoallowimplementationoftheplan.

Inthemeantime,admissionscontinuedtoSt.Brendan’sHospitalbecausePineunitintheDepartmentofPsychiatry,ConnollyHospitalhadnotyetopened.Theservicehadadvertisedfornursingstafftostafftheunit(aswellasfillvacancieselsewhereintheservice).Theunitwascurrentlyvacantandminorrefurbishmentwastakingplace.

ResidentsinSt.Brendan’sHospitalhadbeenassessedwithregardtotheirneedforaccommodation.



AdvocacywasprovidedweeklyintheDepartmentofPsychiatryandinUnit3A,Unit3B,UnitOinSt.Brendan’sHospitalandonrequestinUnit8AandUnit8B.ItishopedthatadvocacyserviceswillbeextendedtoUnit8AandUnit8B.

Serviceuserswereverypositiveabouttheserviceandthecareandtreatmenttheyreceived.TheypraisedtherefurbishedgardenareaandtheoccupationaltherapydepartmentinConnollyHospital,andalsothequalityoftheinformationleafletsavailable.ThestaffinSt.Brendan’sHospitalwerereportedtobehelpfulandapproachable.Theoccupationaltherapydepartmentandsocialworkersweredescribedasbeinghelpful,andtherenovationsinUnit3A,Unit3B,andUnitOwerepraised.ThequalityoftheinformationavailableinSt.Brendan’sHospitalwasalsopraised.

Someresidentscomplainedaboutthequantityandside-effectsofmedicationtheywerereceiving.Therewerealsodifficultiesinobtainingsuitableaccommodationfollowingdischarge.InSt.Brendan’sHospitalthelackofavisitingroominUnitOwashighlightedandserviceusersinUnit3Bcomplainedthatnursingstaffwerenotalwaysavailabletothem.ServiceusersintheDepartmentofPsychiatrywantedacommunalroomwithoutaTVset.


Theadvocateparticipatedinanumberpanelsandworkinggroups.Examplesincludedinvolvementinpatientinformationleaflets,serviceuserquestionnaires,specialcaretherapymeetingsandthepatientresourcepack.Therewereregularmeetingsbetweenmanagers,staffandadvocates.TheIrishAdvocacyNetworkhadrepresentedserviceuserinterestintheGrangegormandevelopmentprojectandattendedmonthlymanagementmeetingsinSt.Brendan’sHospital.

279


Governance


Themanagementteamwasmultidisciplinary.InSt.Brendan’sHospitaltherewereongoingauditsonhygieneandseclusion,abimonthlyauditontheRegulations,andanauditofmultidisciplinarycareplanning.InNorthWestDublin,therewasamedicationreviewgroup,asafetyandqualitycommitteeandaqualityandriskmanagementcommittee.Therewasaclinicaldatabasethatfacilitatedreviewofthepsychologyservice.AmedicationmanagementstandardhadbeenintroducedwithcorrespondingaudittoolandauditteaminNorthWestDublin.Educationrelatingtothisstandardhadalsobeendonewithwardstaff.

AcorecareplanforseclusionhadbeenintroducedinSt.Brendan’sHospitalwitheducationsessionsonseclusionandphysicalrestraint.

IntheDepartmentofPsychiatry,auditsincludedcareplanning,documentation,policiesandproceduresandpatientsatisfaction.Amedicationmanagementaudittoolhadbeendeveloped.Therewasanursingdocumentationstandardandanauditoftheclinicallearningenvironmentforstudentnurses.


Medical Staff


Nursing Staff

post Wte in postDON 2ADON 12Nursesbasedinin-patientservices 139Nursesbasedincommunityresidences 78Communitymentalhealthnurse 20Nursesbasedindayhospitals 6Nursesbasedindaycentre 8Other–temporarystaffpanel 7.5

280



speciality Wte in postLiaison 1Clinicalplacementcoordinators 3Nursepracticedevelopmentcoordinator 0.75Counsellors 1behaviour

therapist2bereavement

therapists3familytherapists6nursetherapists

Advancednursepractitioner 0Other 1CNM3Alcohol

service


post Wte in postClinicalpsychologist 5Socialwork 7Occupationaltherapist 15+3assistantsArtteacher 1Other 8alcohol

counsellors1outreachworker

281




Rehabilitation team Report

Untilrecentlythereweretwoseparaterehabilitationteamsinthecatchmentarea.Thesetwoteamswerebeingmergedandweredevelopingcommonpoliciesandassessmenttools.Careplanningwasbeingreviewed.




NCHD(includingspecialistregistrar) 3 2.75


ADON 1 1.5

CMHN 3 1.75


Socialworker 1 1






Dayhospital 0 0

Daycentre 0 0

282


Liaison Team Report

TeamDescription LiaisonPsychiatryPopulation 300,000(catchmentareaofConnollyHospital)





ADON 0 0

Liaisonnurse 1 1


Socialworker 0.5 0


Dedicatedaddictioncounsellor 0.5 0.5

Dayfacilitynursestaffing Notapplicable Notapplicable

Healthcareassistant Notapplicable Notapplicable




programme for the Homeless Mentally ill Report

ThisservicewasbasedatUsher’sIslandwheretherewasadaycentre.ItservedthementallyillhomelesspeopleinDublinCityCentre.

TeamDescription ProgrammeforthehomelessmentallyillPopulation Caseloadof110





ADON 1 0.5

CMHN 1 1


Socialworker 0 0.75

Occupationaltherapist 2+1assistant 1+1assistant


Dayfacilitynursestaffing 4+1outreachworker 4+1outreachworker



Dayhospital 0 0

Daycentre 1 1

283


low secure team Report

ThisservicewaslocatedinSt.Brendan’sHospitalandcoveredUnit8A,Unit8BandUnitO.Itwasdividedintomaleandfemale.ItwasaregionaltertiaryserviceandacceptedadmissionsfromtheGreaterDublinareaanddischargesfromtheCentralMentalHospital.

TeamDescription Lowsecureteam(maleandfemale)Population 36beds(regionalin-patientservice)





ADON 2 2

CMHN Notapplicable 1

Clinicalpsychologist 0 0.5

Socialworker 0 1








Community Services and Nursing Homes Report

TeamDescription CommunityServicesandNursingHomesPopulation TheserviceconsistedofWeirHome,threenursing

homesinBray,Co.Wicklow,andonenursinghomeinTheWard,Co.Dublin.

staffing 2008 Wte in post* 2009 Wte in post




ADON 0 0

CMHN 0.5 0.25


Socialworker 0 0.25






Dayhospital 0 0

Daycentre 0 0

284


psychiatry of later life Report

ThisservicecoveredNorthDublinandincludedaservicebaseintheMaterHospital,adayhospitalinEcclesStreet,adayhospitalinConnollyHospital,sixacutebedsinSt.Vincent’sHospitalFairview,and40long-staybedsinSycamoreUnitinConnollyHospital.Therewerealso67nursinghomebedsintheservice.AliaisonservicetotheMaterHospitalandConnollyHospital,St.Mary’sPark,anursinghomeinCastleknockanda50-bedunitinGlasnevinwerealsoprovided.

TeamDescription PsychiatryoflaterlifePopulation 32,500over65



NCHD(includingspecialistregistrar) 4 Noinformation


ADON 1 1

CMHN 4 4


Socialworker 0 0



Dayfacilitynursestaffing 6 6(includingEcclesSt.DayHospital)



Dayhospital 1 2(includingMater)

Daycentre 0 0


Therewerethreein-patientfacilitiesinthecatchmentarea,allapprovedcentres.

St.Brendan’sHospitalwasalargeVictorianpsychiatrichospital,inextensivegrounds,whichwasnotsuitableforprovidinginpatientpsychiatriccare.Ithas82beds.Therearethreelowsecureunits(Unit8A,Unit8B,Unit0)andtwoacuteandcontinuingcarewards(Unit3AandUnit3B).Therewasaseparateoccupationaltherapydepartmentandaspecialcaretherapyunit.Conditionsinthehospitalhadbeenthesubjectofcriticismoverthepastnumberofyears.Inthepast18months,anumberofrenovationshavetakenplaceinUnit3A,Unit3BandUnitObutthefacilitiesremainedinadequate.Planningpermissionhadbeenreceivedfornewreplacementunits.AdmissionscontinuedtoSt.Brendan’sHospitalbutwereduetotransfertotheDepartmentofPsychiatryinConnollyHospitalontheopeningofPineUnit.

TheDepartmentofPsychiatrywaslocatedinConnollyHospital.Itwasonalowergroundfloorandhad27beds.Therewasahighdependencyunitwithfivebeds.Theunitwasmodernandtherewasacentralenclosedcourtyard.

SycamoreUnitwasinConnollyHospitalandwasunderthecareofthepsychiatryoflaterlifeteam.Ithad34bedsforcontinuingcareresidents.AdmissionswerefromDublinNorthWestandDublinNorthCentral.

285




St Brendan’s Hospital:St.Brendan’sHospitalwasnon-compliantwith14Regulations.Itwasnon-compliantinfoodsafety,visits,communication,searches,individualcareplan,therapeuticactivities,generalhealth,provisionofinformation,privacy,premises,useofCCTV,staffing,maintenanceofrecordsandoperatingpoliciesandprocedures.

Department of Psychiatry:TheDepartmentofPsychiatrywasnon-compliantwithindividualcareplan,therapeuticactivitiesandgeneralhealth.

Sycamore Unit:SycamoreUnitwasnon-compliantwiththerapeuticactivities,premisesandstaffing.


St. Brendan’s Hospital:St.Brendan’sHospitalwasnon-compliantwiththeRulesgoverningtheuseofseclusion.

Department of Psychiatry:Seclusion,ECTandmechanicalrestraintwerenotusedintheunit.

Sycamore Unit:Seclusion,ECTandmechanicalrestraintwerenotusedintheunit.

Codes of practice

St. Brendan’s Hospital:St.Brendan’sHospitalwasnon-compliantwiththeCodeofPracticeonphysicalrestraint.

Department of Psychiatry:TheDepartmentofPsychiatrywasnon-compliantwiththeCodeofPracticeforphysicalrestraint.

Sycamore Unit:Sycamoreunitwasnon-compliantwiththeCodesofPracticerelatingtonotificationofdeathsandincidentreporting.


ConsiderableefforthadbeenmadebySt.Brendan’sHospitaltohaveindividualcareplanning.Allresidentshadanindividualcareplan.Therewereongoingauditsofcareplanning.Therewereregularteammeetingsoneachunit.

TheDepartmentofPsychiatryhadintroducedcareplanninginonesectoronapilotbasis.

InSycamoreUnit,careplanningwasinoperation.

286



Description

Thereareten24-hoursupervisedcommunityresidencesinthecatchmentarea,with144beds.Theywereallunderthecareoftherehabilitationteam.Manyresidentswereelderlyandhadbeensettledintheresidencesformanyyears.Communityintegrationwasgood.Atpresent,therewasanongoingreviewofallcommunityresidencesandanassessmentoftheresidents’needs.



AdelphiHouse 15 14 Rehabilitation/GeneralAdult

Nursing

ArdnaGréine 10 10 Rehabilitation/GeneralAdult

Nursing

DaneswoodHouse 14 14 Rehabilitation/GeneralAdult

Nursing

St.ElizabethCourt 26 26 Rehabilitation/GeneralAdult

Nursing

175NavanRd. 9 9 Rehabilitation ISP/FaceSanRemo 10 10 Rehabilitation ISP266NorthCircularRd. 15 15 Rehabilitation ISPAvondale 10 9 Rehabilitation MDTcareplanWeirHome 23 22 Rehabilitation MDTcareplanMaysylLodge 12 12 Rehabilitation ISP

Conclusion

Itappearsthatanumberofdevelopmentswilltakeplaceintheservicein2009and2010.Itislikely,afteralongperiodofwaiting,thatPineUnitwillopenintheDepartmentofPsychiatryassoonasstaffarerecruited.ThiswillallowacuteadmissionstoSt.Brendan’sHospitaltocease.Theplanforreplacementunitsfortheremainingresidentsinthehospitalhadreceivedplanningpermission.ItisvitallyimportantthatthisplangoaheadasconditionsinSt.Brendan’sHospitalarenotsuitableforprovidinganin-patientservice.Thefrustrationofstaffatthecontinueddelaysintheprogressoftheclosureofthehospitalisunderstandableasitbecomesincreasinglydifficulttoprovideanadequateservice.HoweverthelackofcomplianceinSt.Brendan’sHospitalwithmanyoftheRegulationsforapprovedcentrescannotbeexcusedbylackofresourcesorconditionsinthehospital.

Therehasbeenlittledevelopmentofthecommunityservicesandthespecialistteams.InparticulartheFinglassectorisdeficientinbothstaffingandfacilities,anditappearsthatfundingforimprovementoffacilitiesmaynotbeforthcoming.Thereisalackofpsychologyandsocialworkinput,whichcurrentlyhasnomanagementstructure.Themergingofthetworehabilitationteamsandthereviewoftheaccommodationandtheneedsofresidentsinthesupervisedaccommodationsectorwillresultinamorestreamlinedservice.

Thereisevidencethatserviceusersarepleasedwiththequalityofcareprovidedbytheservice.Itisalsoevidentthatconsiderableefforthasbeenmadetoincreaseserviceuserparticipationintheservice.

Asawholetheserviceoffersanextensiveandvariedmentalhealthservice:acommunityservice,acuteinpatientcare,rehabilitation,regionallowsecurecare,psychiatryoflaterlife,aprogrammeforthe

287


homelessmentallyill,aliaisonservice,rehabilitation,andcontinuingcare.Alleffortshouldbeputintocontinuingtodeveloptheseserviceswiththeprovisionofadequatestaffingandappropriatefacilities.


1. The plan to provide the replacement units for St. Brendan’s Hospital must proceed.

2. Funding should be provided to fill vacant posts on community and specialist teams.

3. Progress on the provision of facilities for the Finglas sector should continue.

288


Mental Health services 2009 Catchment area Report st. Joseph’s intellectual Disability service

HSEArea HSEDublinNorthEastCatchment St.Joseph’sIntellectualDisabilityServiceMentalHealthService St.Joseph’sIntellectualDisabilityServicePopulation 222,049NumberofSectors 1TeamNumberofApprovedCentres 1PerCapitaExpenditure2008[>18Years] 23.948euroDateofMeeting 13May2009

service 2009

Description of service

St.Joseph’sIntellectualDisabilityServicewasbasedinSt.Ita’sHospitalinPortrane.Therewere247residentsreceivingcarefromitsservices:165residentsresidingonthecampusatSt.Ita’sinPortraneand82residentsresidinginavarietyofsupportedlivingenvironmentsinthecommunity.Therewasalsoadayserviceonthecampus.Anewdevelopmentwasduetoopenin2009for60residentsonthecampus.Amultidisciplinaryteamhadrecentlybeenappointed.


1. There should be a dedicated admission unit as part of the new streetscape development.

Outcome:Whileanadmissionunithadnotbeenidentifiedtherewereplansinthemediumtermtore-configureoneunittobecomeanadmissionunit.

2. The health and social care professionals should become part of the management team following appointment.

Outcome:Astheteammembershadonlyrecentlybeenappointedthishadnotyethappened.Therewereplanstoincludealldisciplinesintheseniormanagementteam.Theservicehadrecruitedadietician,occupationaltherapist,speechandlanguagetherapistandphysiotherapist,allatseniorgrade.Theservicehadbeenunabletorecruitapsychologist.

3. The appointment of an additional community team should be considered.

Outcome:Anewcommunityteamhadnotbeenappointed.


Thelocalhealthserviceplanwassubmitted.Itincludedtheprovisionofsuitableaccommodation,enhancingqualityandsafety,enhancingtheestateandfacilities,participationincollaborativerelationships,developmentofleadership,managementandgovernancecapacityanddevelopmentoftheworkforce.Currentstatusandcompletiondateswereoutlined.

289



Thenewdevelopmentofaccommodationfor60residentsinastreetscapelayoutwasnearing}}

completionandwasexpectedtobereadyinSeptember2009.

Anewcommunity-basedresidencefor9residents,BardenLodge,wasscheduledforcommissioningin}}

January2010.

Anewmultidisciplinaryteamconsistingofaseniorsocialworker,asenioroccupationaltherapist,}}

aseniordietician,aseniorspeechandlanguagetherapistandaseniorphysiotherapisthadbeenappointed.

Anewpermanentappointmentofaconsultantpsychiatristhadbeenmade.}}

Twonurseshadcommencedtraininginanurseprescribingprogramme.}}

Acomprehensivereviewofdayserviceshadbeencompleted.}}

Aservicenewsletter,issuedeverysixweeks,hadcommenced.}}


Theplanforclosureofthehospitalwascontinuingwiththenewdevelopmentofthe10bungalowsandthenewcommunityresidence.Thiswouldenable69bedsintheolderpartofthehospitaltoclose.


advocacy

Since2006InclusionIrelandhadprovidedanadvocacyservicethroughtheHSE.Itwasavailabletwodaysaweek.Theadvocatewasbasedinthehospitalandinthecommunity.TherewereplanstodevelopselfadvocacyandtrainingwastocommenceinJune2009.Itwasalsoplannedtohaveadedicatedphonelinewhereserviceusersorstaffontheirbehalfcouldaccessadvocacyservices.

Therewasanadvocacysteeringgroupwhichmetmonthly.


Therewasaserviceuserforumwhichwaschairedbyserviceusersandattendedbyrepresentativesoftheservices.Serviceusershadhadinputintothedevelopmentoftheinformationbooklet.Thiswasanexcellentbookletwritteninappropriatelanguagespecificallyforserviceusers.

Therewasafamilyandfriendsofserviceusersgroupthatmetregularlyandhadinputintothedevelopmentoftheservice.

AsharedlearningexperienceinmentalhealthwasscheduledforSeptember2009inDublinCityUniversityforaserviceuser,acarerandakeyworker.

290


Governance

Themanagementteamwastripartitebuttherewereplanstohaveamultidisciplinaryseniormanagementteaminthenearfuture.

Therewasarisk,qualityandsafetycommitteeanddedicatedresourcestoanalyseincidents.

Therewereanumberofongoingauditssuchasdiagnosticsystems,casenotes,infectioncontrolandhygiene.Anauditonseclusionhadclearlyshownthattherateofseclusionwasdecreasing.

ApilotofCOREinformationtechnologysystemwascurrentlytakingplaceforhumanresourcesdata.


Medical Staff


Nursing Staff

post Wte in postDON 1ADON 5Nursesbasedinin-patientservices 146Nursesbasedincommunityresidences 78Communitymentalhealthnurse 6Nursesbasedindayhospitals 0Nursesbasedindaycentre 16Other–temporarystaffpanel 0


speciality Wte in postLiaison 0Clinicalplacementcoordinators 3Nursepracticedevelopmentcoordinator 1Counsellors 0Advancednursepractitioner 0Other 1

291



post Wte in postClinicalpsychologist 0Socialwork 1Occupationaltherapist 1Arttherapist 1Speechandlanguagetherapist 1Dietician 1Physiotherapist 1Dayservicesmanager 1Montessoriteachers 3.5Healthcareassistants 197Instructors(gym,woodwork,physicaleducation) 3.5


Currentlyallin-patientfacilitieswereinthegroundsofSt.Ita’sHospitalinPortrane.Manyoftheunitswereold,inpoorconditionandwereunsuitablefortheresidents.Anewstreetscapedevelopmentof10bungalowsfor60residentswastoprovidevastlyimprovedconditionsforaccommodationandalsofordayservices.



ThemajorityofRegulationshadbeenmetbytheservice.Therecontinuedtobearequirementforcareplanningthroughouttheapprovedcentre.ThecurrentpremisesandthelackofprivacyinsomeunitswereinbreachofRegulations.


TheservicewascompliantwithallRules.

Codes of practice

TheservicewaseithersubstantiallycompliantorfullycompliantwithallCodesofPractice.


Upuntilnowtherewasnomultidisciplinarystaffapartfrommedicalandnursingstaff.Despitethistheservicewaswellonthewaytoprovidingamultidisciplinarycareplanforresidents.Thecareplanwascurrentlybeingpilotedinasmallnumberofareaswithaviewtorollingitouttoallunitsinthenearfuture.Clinicalfileswerebeingintegrated.Therewereweeklyclinicalmeetingsandmonthlyteammeetingsintheunit.

292



Description

Therewerefive24-hoursupervisedresidenceswith58places.Theprocessofrollingoutanewsystemofcareplanningwasunderwayanditwasreporteditwouldbecompletedby31August2009.


team responsible Care plan type*

ClonmethanLodge(5houses)

30 30 AdultIDS NursingcareplanwithphasedintroductionofMDTcareplans

GlebeHouse 6 6 AdultIDS NursingcareplanwithphasedintroductionofMDTcareplans

HilltopHouse 7 7 AdultIDS NursingcareplanwithphasedintroductionofMDTcareplans

Woodlawn 8(3respite)

8 AultIDS NursingcareplanwithphasedintroductionofMDTcareplans

Avoca 7 7 AdultIDS NursingcareplanwithphasedintroductionofMDTcareplans

Conclusion

StJoseph’sIntellectualDisabilityServicecontinuestoimprovethequalityofthecaregiventoresidents.Thereisobviousenthusiasminallstaffdespitethechangesthatarecurrentlygoingonwithintheservice.Thefactthatthenewdevelopmentof60placesandthenewcommunityresidenceisnearcompletionisparticularlywelcomeanditisobviousthatanenormousamountofworkhasbeendonebystaffintheassessmentandpreparationforthismove.Thecontinuousdevelopmentoftheadvocacyserviceisalsowelcomeandtheinformationbookletsforresidentsareexcellent.Inall,theservicedemonstratesthatitisserviceuserorientatedandcommittedtoserviceimprovement.


1. Efforts should continue to recruit a senior clinical psychologist.

2. Care plans should be rolled out for all service users as soon as the pilot care planning is completed.

293


Hse DuBlin MiD leinsteR

Mental Health services 2009 Catchment area Report Dublin south City

HSEArea HSEDublinMidLeinsterCatchment DublinSouthCityMentalHealthService DublinSouthCityMentalHealthServicesPopulation 133,095NumberofSectors 3NumberofApprovedCentres 1SpecialistTeams PsychiatryoflaterlifePerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 23June2009

service 2009


DublinSouthCityMentalHealthServiceshadapopulationof133,095,dividedintothreesectors:Camac,DrimnaghandOwendoher.Thereweretwodayhospitals,oneinSt.Martha’sHouseinKilmainhamandtheotherlocatedinJonathanSwiftClinic.Bothprovidedoutpatientservices.Therewasmultidisciplinaryaccessoneachsectorteamalthoughstaffinglevelswerestilllow.ThetransferofcommunityservicesfromSt.Patrick’sHospitalwasongoing.

TheapprovedcentrewastheJonathanSwiftClinicinSt.James’sHospital,whichhad51beds,with26acutebeds,16continuingcarebedsand9bedsforpsychiatryoflaterlife.Therewasnorehabilitationteambuttherewasapsychiatryoflaterlifeteam.

TheservicewasprovidedunderadualmanagementarrangementinvolvingtheHSEandSt.James’sHospital.


1. There should be a written plan to direct and guide the provision of service.

Outcome:Aserviceplanwasnowavailable.

2. There is an urgent need for a fully staffed multidisciplinary rehabilitation team for this service.

Outcome:Therehadbeennoprogressontherecommendation.

3. All teams should be fully staffed and have community services.

Outcome:Therehadbeennoprogressontherecommendation.

294



Aserviceplanwasprovided.Itincludedthefollowingwhichwereallfundingdependent:

Thedevelopmentofarehabilitationteam.}}

Catchmentareateamenhancements.}}

Minorcapitaldevelopments.}}

Sectorheadquarters,dayhospitalandoutpatientdepartmentsforallthreesectors.}}

Developmentofdayhospitalandheadquartersforthepsychiatryoflaterlifeteam.}}

TransferofcommunityservicesfromSt.Patrick’sHospital.}}

Realignmentofcatchmentareaandsectorboundaries.}}


ThedualmanagementsystemwasnowinplacewiththeHSEandSt.James’sHospital.}}

Afoundationcourseinpsychotherapyformultidisciplinaryteammemberswasinprogress.}}

ThetherapeuticgardeninSt.Martha’sDayHospitalhadbeencompleted.}}



Aserviceusersurveywhichhadbeencompletedlookedataccesstotheservice.

TherehadbeenregularmeetingsbetweentheIrishAdvocacyNetwork(IAN)representativesandclinicalnursemanagers.ThesemeetingshadbeenexpandedtoincludeotherinteresteddisciplinesandhadbeenformallynamedtheSt.James’sAdvocacySteeringGroup.Thegrouphopedtodevelopapatientresourcewelcomepackandasuggestionboxsystem.

ThroughIAN,residentsinJonathanSwiftClinicsaidtheyfoundthestafffriendly,approachableandaccommodating.Theycomplainedthatthesmokingroomwastoocrampedandpoorlyventilated,theinformationstandwasnotalwaysadequatelyfilledwithinformationpamphletsandthemenuwasnotvariedenough.Theyalsosaidthattheywerenotgettingenoughqualitytimewithstaffmembersandthattheyfeltuncomfortableandanxiousduringteammeetingswhenmeetingtheentireteam.


Therewasaserviceuserrepresentativeandaservicecarerrepresentativeincludedintheheadsofdisciplinegroup.TheDCUCooperativeLearningLeadershipcoursesupportedthisinitiative.

Anannualresearchprojectwascarriedoutincollaborationwiththeserviceprovider,serviceuserandcarerrepresentativethroughDCU.Thisprojectwasdesignedtoassistinimplementingchange.

295


Governance


Thegovernancestructureconsistedofacorporategovernancegroup,anexecutivemanagementgroup,aheadsofdepartmentgroup,themultidisciplinaryteams,andthedepartmentmeetings.

Anumberofaudits,bothclinicalandnon-clinicalhadbeencarriedout.Theseincludedcareplanningandadmissionaudits(bothcarriedoutmonthly),abenzodiazepineaudit,anauditofmedicalreviewofoutpatients,auditsofwaitingtimes,andreferralstopsychologyandhygiene.Duetotimeandresourceconstraintstheservicehadfounditdifficulttoprioritiseresearch.


Medical Staff

post Wte in post Consultantpsychiatrist 7NCHD 10Specialistregistrar 1.5

Nursing Staff

post Wte in postDON 1ADON 2Nursesbasedinin-patientservices 32Nursesbasedincommunityresidences 9Communitymentalhealthnurse 7Nursesbasedindayhospitals 5Nursesbasedindaycentre 1Other–temporarystaffpanel 3




post Wte in postClinicalpsychologist 5Socialwork 5.5Occupationaltherapist 7Arttherapist 0Other 0

296



Community mental health team (CMHT) staffing numbers by sector are available on the Mental Health Commission website www.mhcirl.ie


TeamDescription PsychiatryoflaterlifePopulation 18,012





ADON 2 2

CMHN 1 1

Clinicalpsychologist 1.5 1

Socialworker 1 1


Dedicatedaddictioncounsellor 0.2 0.2




Dayhospital own own

Daycentre 0 0


Therewasoneapprovedcentre,JonathanSwiftClinic,inthecatchmentarea.Ithad51bedsandprovidedacutecare,psychiatryoflaterlifeandcontinuingcare.ItwaslocatedinSt.James’sHospitalandwasontwolevels.Therewasalsoadayhospitalintheunit.Therewereanumberofresidentsintheunitwhohadbeeninhospitalformorethansixmonthsandthelackofarehabilitationteamhadmeantthatprogressinmovingthemtomoreappropriateaccommodationhadbeenslow.



TheservicehadsomedifficultiesinmeetingRegulationsatthetimeofinspectionassomepolicieswerenotuptodate,theinsurancecertificateandfoodandfiresafetyreportswerenotmadeavailable,careplanswerenotfullycompletedandnotallresidentsreceivedappropriateinformationabouttheirclinicalteam.ThisappearedtodemonstratealackofattentiontodetailasallRegulationscouldbemetwithoutresourceimplications.(TheinsurancecertificateandfoodandsafetyreportswerelatersubmittedtotheInspectorateonfurtherrequest).

297



DocumentationonECTwasinadequatebuttheservicewascompliantinallotheraspectsontheRulesforECT.Seclusionandmechanicalrestraintwerenotusedintheapprovedcentre.

Codes of practice

TheapprovedcentrewascompliantwithallCodesofPractice.


Theservicehadputconsiderableworkintodevelopingandimplementingacareplan.However,careplanswerenotfullycompleted.Careplanningwasauditedmonthly.

Therewereweeklyteammeetingsandtheresidentattendedtheteammeetingswherethecareplanwasdecided.Residentsdidnotalwaysreceiveacopyoftheircareplan.


Description

Thereweretwo24-hourcommunityresidences,eachwith10beds.Anewcareplanhadbeendevelopedfortheresidents.Therewasnorehabilitationteamavailable.



Quilca 10 9 CMHT MDTAshdaleHouse 10 10 CMHT MDT

Conclusion

DublinSouthCityMentalHealthServicesdemonstratedagrowingserviceuserandcarerinvolvement.Theinclusionofaserviceuserandcarerontheheadsofdisciplinegroupwaswelcome.

Theabsenceofarehabilitationteamwasaseriousdeficiency,especiallyinviewofthepresenceoflongstayresidentsinthecontinuingcarewardandthesupportedaccommodationinthecommunity.Acommunityrehabilitationteamwouldbeinapositiontoprogressmovementofresidentsintomoreindependentaccommodationandultimatelycloselongstaybeds.

Thelackoffundinghadresultedinlackofdevelopmentofthecommunitymentalhealthteams,bothinstaffingandinfacilities,despiteplanstoimproveboth.

ThesuccessfultransferofundertakingsfromSt.Patrick’sHospitalwithretentionofstaffingnumberswascommendable.TheserviceswerenowunderdualmanagementbetweentheHSEandSt.James’sHospital.

298



1. A rehabilitation team is essential to facilitate the transfer of residents in residential settings to more independent living.

2. All multidisciplinary teams should be fully staffed.

3. The service should ensure that it is compliant with all Regulations for approved centres.

299


Mental Health services 2009 Catchment area Report Dublin south east

HSEArea HSEDublinMidLeinsterCatchment DublinSouthEast(Generaladult)

DublinSouthEastandCluainMhuireCatchment(Psychiatryoflaterlife)DublinMid-Leinster(Eatingdisorders)

MentalHealthService DublinSouthEastMentalHealthServicesPopulation 110,000(GeneralAdult)

285,000(Psychiatryoflaterlife)1.5million(Eatingdisorder)

NumberofSectors 3.5NumberofApprovedCentres 1SpecialistTeams Psychiatryoflaterlife

EatingdisorderPerCapitaExpenditure2008[>18Years] ServicefundingcomesfromtheHSEand

St.Vincent’sHospitalDateofMeeting 29September2009

service 2009


Geographically,thecatchmentareawassmall,8kmby3km,andspannedtheDublin2,4,8and14postalcodes.Ithadthelargestelderlypopulationinthecountry.

TheservicehadoneapprovedcentrebasedinElmMount,St.Vincent’sUniversityHospital,Dublin.OutpatientservicesforthreesectorswereprovidedinBaggotStreetHospital.Theconditionstherewereinadequateandrequiredrefurbishment.Onesector,D4,operateditsoutpatientservicesintheprimarycareunitinIrishtown.Therewasonedayhospital,whichwasforpsychiatryoflaterlife.


1. There should be a fully staffed rehabilitation team.

Outcome:Therehadbeennoprogressonthisrecommendation.

2. All multidisciplinary teams should be fully staffed.

Outcome:Nonewadditionalpostswereappointed.

3. Further development of community mental health facilities was required.

Outcome:OnesectorhadaccesstoofficespaceinthenewprimarycarebuildinginIrishtown.TheservicehadnosectorheadquartersandtheBaggotStreetclinicwasinneedofcapitalimprovement.

300



Thebusinessplanpresentedwasanupdatedversionofthe2008plan.Thisplandescribedproposalstoamalgamatesectors,developafullliaisonserviceandadditionalpsychiatryoflaterlifeservices,restructuretheeatingdisorderserviceandcontinuecommunitydevelopments.Therehadbeenlittleprogresswiththeseproposalsduringtheyear,anditwasreportedthatthemainpriorityatpresentwastomaintainservicedelivery.Previousserviceplansproposedthereorganisationofsectorsandtheservicecontinuedtolookatdevelopingthisplan.


AnewhomecareteamcalledRemishe,commencedoperationinMarch2009.Thisserviceenabled}}

theteamstoprovidecareforserviceusersintheirownhomes,andhasreducedtherateofadmissiontotheacuteunit.StaffintheOutreachteamhadundertakenaweek’strainingcourseintheprovisionofthisservice.

Medicationbookletswereintroducedtothecommunityresidences.}}

IntegratedcareplanningwasintroducedintothecommunityresidencefortheelderlyinCarewHouse.}}

Anewintegratedfileforusewithintheentirehospitalwasintroducedafterconsultationwithstaffin}}

themedicalandsurgicalareasofthehospital.

TheserviceranacourseinECTandincludedparticipantsfromotherhospitals.}}

16householdstaffmembershadcompletedaCleanPasscoursewhichisrequiredtomeetthe}}

standardsofHIQA.

Anout-of-hourscourseincognitivebehaviouraltherapyforanxietymanagementcommencedinthe}}

GlenmalureDayCentre.



Theadvocatevisitedtheacuteunitweekly.InreportingtothemeetingwiththeInspectorate,theadvocatedescribedhavingagoodrelationshipwithstaff.Areaswheretheadvocatewasinvolvedincludedattendanceassupportforpatientsattribunals,involvementintheECTandgeneraltrainingprogrammesfornurses,andparticipationinthegroupinvolvedinimplementingtheintegratedcareplanningforresidents.Inconjunctionwithmanagement,theadvocatehadbeeninvolvedinthedevelopmentofanaudiocassetteofthepatientinformationleaflet.

AttherequestoftheIrishAdvocacyNetwork(IAN),staffwerecurrentlyimplementingtheServiceUserRatingofEffectiveness(SURE)surveyforms,aspartofanationwidesurvey.

Areasinneedofattention,asdescribedbysomeresidents,includedover-relianceonmedication,insufficienttimewithconsultants,poorventilation,andinaccessibilityofcallbellsforresidentsinwheelchairs.Boredomandlackofactivityattheweek-endswerealsocitedasdifficulties.


Theadvocateattendedthemeetingsonintegratedcareplanning.

301


Governance


Management:Theexecutivemanagementteamcontinuedtobetripartite,butotherdisciplineswereinvolvedinthebroadermanagementteam.However,thisteamhadnotmetinthepreviousfourmonths.

Research/Audits:Anauditofthefirstsixmonths’workofthenewoutreachhomecareteamhadbeencompletedinAugust2009.

ReviewsofthepilotprogrammesinmedicationmanagementandIntegratedcareplanningwerecarriedoutin2009.


Medical Staff


Nursing Staff

post Wte in postDON 1ADON 6Nursesbasedinin-patientservices 37Nursesbasedincommunityresidences 69.5Communitymentalhealthnurse 7Nursesbasedindayhospitals 2Nursesbasedindaycentre 6


speciality Wte in postLiaison 2Familytherapy 2Biofeedback 1Counsellors 1Advancednursepractitioner 1Elderlytheraputicintervention 1ECTnurse 0.5CBTnurse 1Nursepracticedevelopmentcoordinator 1


post Wte in postClinicalpsychologist 4.8Socialwork 3Occupationaltherapist 4Arttherapist 0

302





TeamDescription PsychiatryoflaterlifePopulation 28,000-32,000





ADON

CMHN 6 6

Clinicalpsychologist 1.8 1.8

Socialworker 2 2



Dayhospital Owned Owned

Daycentre Accessgenericdaycentres

Accessgenericdaycentres


Therewasonein-patientfacility,ElmMount,atSt.Vincent’sUniversityHospital.Anunannouncedinspectionwasconductedon15April2009.Bednumbershadbeenreducedandresourcesdeployedtoapilothomecareassertivecommunitytreatment.



TheservicewaslargelycompliantwiththeRegulations.Therewasasysteminplaceforcareplanningandtherapeuticactivities.Onthedayofinspection,theyhadnotbeencompletedforallresidents.


Theservicedidnotuseseclusionormechanicalrestraint.ECTwasinorderapartfromtheprovisionofinformationtoonedetainedpatientonthedayoftheinspection.

Codes of practice

Theservicewascompliantwiththerelevantcodesforadults.Itwasanunsuitableenvironmentforchildrenandwasnon-compliantwiththecodeforchildren.

303



Approvedcentres:Therewasasysteminplaceforcareplanning.However,careplanshadnotbeencompletedforallresidents.

Community:Therewereplansinplacetoextendthehospital-basedsystemtothecommunity.Ithadbeguninonearea.


Description

Theservicehadaccesstothree24-hourcommunityresidencesandthreecontinuingcareunitsfortheelderly.Apartfromresidencesattachedtothepsychiatryoflaterlifeteam,therewasnorehabilitationteam.Theotherresidenceswereundertheclinicalresponsibilityofthesectorteams.Multidisciplinarycareplanswereplannedfor2010.

ThehouseonGrosvenorRoadrequiredthekitchentobeupgraded.Thiswillrequirecapitalmoney.Initialplanshavebeendrawnup.



MorehamptonRoad

10 10 Sector Nursing

GrosvenorRoad 14 14 Sector NursingCoisCéim 26 26 Psychiatryoflater

lifeNursing

UnitD 26 26 Psychiatryoflaterlife

Nursing

UnitE 26 26 Psychiatryoflaterlife

Nursing

Conclusion

TheDublinSouthEastcatchmentareawasanactiveonethatwascontinuingtodevelopitscommunityprogrammes.InMarch2009,theservicecommenceditsoutreachservicetodelivercaretoserviceusersintheirhomes,withgoodresults.Oneoftheeffectsofthisnewservicewastoreducetherateofadmissionstotheapprovedcentre.Theserviceengagedintrainingprogrammesforitsstaff,andhadestablishedagoodrelationshipwiththeIANrepresentative.

TheapprovedcentrewaslargelycompliantwiththeRegulationsandRulespertainingtotheimplementationontheMentalHealthAct2001.

Despiteitsproposalstoamalgamateandrestructureitssectors,thereseemedtobelittleprogressinthisregard.Similarily,therewaslittleprogressinestablishingafullliaisonserviceforthebusygeneralhospitalwheretheapprovedcentreislocated.Althoughrecognisingthesizeofitselderlypopulation,theservicecontinuestooperateonlytwopsychiatryoflaterlifeteamsforanelderlypopulationof33,000.Recentstaffshortagesinthedayhospitalforolderpersonshaveraisedconcernsamongststafffortheeffectivedeliveryofservicestoitsusers.

304


Thelackofarehabilitationteamcontinuestobedisappointinginaservicewithanumberofhighandmediumsupporthostels.


1. There should be a fully staffed rehabilitation team.

2. Plans to amalgamate sectors should continue.

3. There should be a full liaison team within the general hospital.

4. The service for older persons should be expanded to provide for a third psychiatry of later life team.

5. Alternative community facilities should be sought to allow a more community-focused service to develop.

305


Mental Health services 2009 Catchment area Report Dublin West/south West Mental Health service

HSEArea HSEDublinMidLeinsterCatchment DublinWest/SouthWestMentalHealthService DublinWest/SouthWestMentalHealthServicesPopulation 256,566NumberofSectors 4NumberofApprovedCentres 2SpecialistTeams Psychiatryoflaterlife

RehabilitationPerCapitaExpenditure2008[>18Years] Totalexpenditure31,984,000euroDateofMeeting 22April2009

Description


TheDublinWest/SouthWestmentalhealthservicewaslargelycommunitybased,withtwoapprovedcentreslocatedatAMNCHTallaghtandatSt.Loman’s,Palmerstown.TheunitatTallaghtwasanacuteadmissionunitandSt.Loman’sprovidedforrehabilitationandcontinuingcareoflong-stayresidents.Therewerefoursectorsinthecatchmentareawithtwoadditionalspecialistteams:psychiatryoflaterlifeandrehabilitation.Theserviceoperatedfivedayhospitals,oneineachareaandanadditionaloneforpsychiatryoflaterlife.AliaisonpsychiatryservicewasalsoprovidedinconjunctionwithAMNCH.


1. The approved centres must ensure compliance with the relevant Regulations, Rules, Codes of Practice and with Section 60, Mental Health Act 2001.

Outcome:Theapprovedcentrescontinuedtobenon-compliantwithanumberofRegulations,RulesandCodesofPractice.

2. The Service should develop the management team to include heads of clinical psychology, social work and occupational therapy.

Outcome:Themanagementteamcontinuedtooperateunderthetripartitesystemofgovernanceandtherewerenoplanstoalterthemanagementsystem.Itwassuggestedtherewerebarrierstotheexpansionofthemanagementsystem,despitethefactthattheheadsoftheotherdisciplineswerekeentobeinvolved.

3. Funding should be made available to ensure multidisciplinary teams are fully resourced and staffed with a mix of professionals to address the needs of the population served and in line with mental health policy.

Outcome:Notallteamswereresourcedtoprovidefullmultidisciplinaryteams.

306



Theservicecouldnotofferalocalhealthserviceplan,apartfromindicatingthatitwasattemptingtomaintainexistingserviceprovision,asitwasawaitinginformationonfundingbeforedevelopingaserviceplan.


Anoccupationaltherapydayrehabilitationprogrammehadbeenintroducedintherehabilitationunitat}}

St.Loman’s.

Eightnurseshadcompletedthenurseprescribingcourse,andthreenurseswereregisteredto}}

prescribe.

Asecondconsultantpsychiatristinpsychiatryoflaterlifehadbeenappointed,butwasasyetwithout}}

teammembers.

TheservicehadengagedincollaborativediscussionswithstaffinpsychiatryoflaterlifeinSt.James’s}}

HospitalandBloomfieldregardingthepossibilityofestablishingacommunityaspecttoservicedelivery.

Theservicewasintheprocessofstandardisingaprogrammeforanxietymanagementgroups}}

throughouttheservice.

Theservicesupportedtwoserviceusers,twocarersandtwostaffmemberstoundertakethe}}

CooperativeLearningLeadershipprogrammeinDCUandhadcommencedworkestablishingaserviceusersandcarerscouncil.


TherewasabuildingprogrammeplantodevelopnewaccommodationfortheresidentsofSt.Loman’sandtheserviceexpressedawishtoreplacethecurrentwardsettingwithmoresuitableaccommodation.Inaddition,planningpermissionhadbeensoughttoprovidetwomorecommunityresidences.ItwasreportedthattheultimateaimwastoclosetheunitatSt.Loman’sHospitalandtobuildcommunityfacilitiesinclusiveofahealthcentreandcommunityresidencesinvariouspartsofthecatchmentarea.


advocacy

Therewasastrongpeersupportandadvocacygroupintheservice,particularlyintheunitinAMNCH.Advocatesvisitedthewardsregularlyandasrequired.Theyfacilitatedapeersupportgroupandwereinvolvedintheintegratedcareplanninggroupandthedevelopmentofintegratedcareplans.Theyalsoparticipatedintheclinicalgovernancegroup.

Theadvocatestatedthedesiretoexpandtheservicetothe24-hoursupervisedresidencesinthenearfuture,butstatedthataccessingfundingforpeeradvocacytrainingwasadifficulty.

TheIrishAdvocacyNetworkalsovisitedtheapprovedcentreatSt.Loman’sHospital.

307


Governance


Qualityauditswereconductedregularly.

AnewmultidisciplinarycareplanhadbeendevelopedandwasduetobeintroducedacrossallsectionsoftheserviceinMay2009.


Medical Staff


Nursing Staff

post Wte in postDON 1ADON 8Nursesbasedinin-patientservices 66Nursesbasedincommunityresidences 32Communitymentalhealthnurse 12.87Nursesbasedindayhospitals 16Nursesbasedindaycentre 6Nursesbasedinhomecare 24.74Assertiveoutreach 3Other–temporarystaffpanel 2


speciality Wte in postClinicalplacementcoordinators 4Nursepracticedevelopmentcoordinator 1,sharedCounsellors 0Advancednursepractitioner 0CNS 5.5


post Wte in postClinicalpsychologist 6Socialwork 10Occupationaltherapist 13Arttherapist 0Other 3

308










ADON 1 1

CMHN 2 2


Socialworker 2 2




Homecareteam 4 4



Dayhospital Notprovided Owned

Daycentre Notprovided None


TeamDescription RehabilitationteamPopulation 256,566





ADON 1 1

CMHN 1 1





AssertiveOutreachTeam 3 3

Nursesbasedincommunityresidences 30 30

Healthcareassistants 22.25 22.25


Dayhospital Owned

Daycentre Owned

309



Theserviceoperatedtwoapprovedcentres,oneatAMNCH,TallaghtandoneatSt.Loman’s,Palmerstown.St.Loman’sprovidedcontinuingcaretotheresidents.Onthedayofinspection,therewere13residents,although22bedsremainedincommission.Residentshadcareplansandhadtherapeuticprogrammesbasedonthecareplans.Therewasnoaccesstoapsychologistandthegroundsinfrontoftheunitwereinaderelictstateasaresultofbuildingworks.

TheacuteunitattheAMNCHinTallaghthad52beds.Policiesneededtobeupdatedandtherewasevidencethatphysicalreviewswerenotdoneonresidentswhohadbeenresidentforlongerthansixmonths.

In-patientpoliciesatAMNCHhadbeenreviewedandamendedforafurtherthree-yearperiodin2009.

Compliance with statutory Requirements for approved Centres

IntheacuteunitinAMNCH,individualmultidisciplinarycareplanshadnotbeenintroduced,althoughanewsystemofcareplanningwasduetobeintroducedinMay2009.

Alargenumberofpoliciesneededtobeupdated.

CareplanswereinoperationinSt.Loman’s.


CareplansforresidentswerenotinoperationintheacuteunitinAMNCH.

Therewasevidencethatphysicalhealthreviewshadnotbeencarriedoutonresidentswhohadbeenintheacuteunitforlongerthansixmonths.

Theacuteunitwasunsuitablefortheadmissionofchildren.CompliancewiththeCodeofPracticerelatingtoECTwascompromisedbythelayoutoftheECTsuite.


TheservicewasnotcompliantwiththerulesinrelationtoECT,mainlyinlayoutoftheECTsuite.However,thepracticeoftheapprovedcentrewastotakethepatientstraightfromthewardandintotheECTsuitethereforeeliminatingtheneedtowaitoutsidetheECTsuite.TherewassubstantialcompliancewithregardtotheRulesregardingtheuseofseclusion.

Codes of practice

Therewassubstantialcompliancewithregardtotheuseofphysicalrestraint.CompliancewiththeCodeofPracticerelatingtoECTwascompromisedbythelayoutoftheECTsuite.

310



MultidisciplinarycareplanswereinoperationinSt.Loman’s.TherewerepoorcareplansintheacuteunitinAMNCH,howevertheInspectoratewasinformedthatnewcareplanswouldbeintroducedinMay2009.


Description

Theserviceoperatedfoursupervisedresidences,allunderthecareoftherehabilitationteam.



TeachBán 10 8(and2respitebeds)

Rehabilitation MDT

GroveHouse 14 14 Rehabilitation NursingBeaufortHouse 10 10 Rehabilitation/

SectorNursing

St.Columba’s 18 18 Rehabilitation/Sector

Nursing

Conclusion

Theserviceprovidedacuteandcontinuingcareforresidentsinitstwoapprovedcentres.TheintroductionofanoccupationaltherapyrehabilitationprogrammeinSt.Loman’sunitwaswelcomed,aswasthedevelopmentofasecondconsultantpsychiatristpostinpsychiatryoflaterlife.CompliancewiththeRegulationsandRuleswassubstantialforthemostpart,buttheabsenceofphysicalhealthreviewsonresidentsadmittedforlongerthansixmonthsneedstobeaddressedquickly.Itwasdisappointingtonotetheabsenceofindividualmultidisciplinarycareplansintheacuteunit.Itwasapparentatthecatchmentareameetingthatthecurrentsystemoftripartitemanagement,withtheexclusionofheadsofotherdisciplines,needstobeaddressedagain.


1. Physical health reviews must be carried out on residents admitted for longer than six months.

2. Individual multidisciplinary care plans as outlined in the Regulations must be introduced in the acute unit.

3. All teams should be resourced to provide full multidisciplinary care for residents.

4. The future of the unit at St. Loman’s Hospital should be examined in light of the sustained reduction in resident numbers.

5. The service should continue to develop the management teams to include heads of clinical psychology, social work and occupational therapy.

311


Mental Health services 2009 Catchment area Report Wicklow

HSEArea HSEDublinMidLeinsterCatchment WicklowMentalHealthService WicklowMentalHealthServicesPopulation 109,472NumberofSectors 2NumberofApprovedCentres 1SpecialistTeams IntellectualDisabilityPerCapitaExpenditure2008[>18Years] 12.254euro[sic]DateofMeeting 11June2009

service 2009


TheWicklowcatchmentareawasdividedintotwolargesectors.Eachsectorhadadistinctpopulationwithvaryinglevelsofdeprivationandconcentrationofnursinghomes.Thecatchmenthadanumberofhigh-densityurbancentresandlargeruralareas.Theruralpartsofthecatchmentwerepoorlyservedbypublictransport.Thisimpactedonserviceusers’abilitytoaccessstructureddayservices.

Theteamwashighlymotivatedandcommittedtodevelopinganddeliveringaquality-basedservice.ThishadbeenachievedwithminimalresourcesandwithfundingfromthevoluntarysupportgroupFriendsofNewcastleHospital.

Theserviceskillmixwaspoorwhenmeasuredagainstnationalpolicystandards.Serviceusershadnoaccesstospecialistmentalhealthteams.


1. Specialist teams should be set up to provide rehabilitation and psychiatry of later life.

Outcome:Therewasnoincreaseinstaffingsincethelastmeeting.

2. Provision of occupational therapy services and augmentation of psychology and social work staffing should be a priority within the service.

Outcome:Therehadbeennoappointmentofanoccupationaltherapisttotheservice.Onesocialworkerretiredandthepostwasnotfilled.Psychologystaffinglevelshadremainedconstant.

3. The implementation of multidisciplinary care plans should be extended to all residents in the approved centre.

Outcome:Careplanshadbeenextendedtobothwards.Thereremainedanunmetneedforvariousdisciplinesinthecommunitymentalhealthteams.

312



Therewasawrittenclinicaldevelopmentplanfortheserviceacrossallaspectsofserviceprovision.Theserviceasateamwascommittedtoachievingrealmeasurabletargets.


TheappointmentofaconsultantpsychiatristandCMHNtotheintellectualdisabilityservice.Thisteam}}

waspartofthecatchmentarea.

Twofull-timepermanentconsultantpsychiatristshadbeenappointed.Theywereduetocommence}}

workintheNorthsectorinthecomingmonths.

Systemshadbeendevelopedtoimprovepatientsafetyandqualityintheapprovedcentre.They}}

includedauditsandreviewsofincidents.Allstaffwereinvolved.

ThemanagementteamhadbeenexpandedtoincludearepresentativefromWicklowMentalHealth}}

Association.

KeypostsremainunfilledduetotheHSEemploymentfreezethatwasannouncedon27March2009.}}

Psychologyserviceshadbeenrationalisedandreorganisedtomaximisestaffresourceseffectively.It}}

wasreportedthattheprojecthadbeensuccessful.Anevaluationwascurrentlyunderway.

Theservicebudgethadbeencutfrom12.254millioneuroin2008to11millioneuroinJune2009.}}

Provisionhadbeenmadetoaccommodateacommunitymentalhealthteaminthenewprimarycare}}

centreinGreystones.AsimilarwasplannedforWicklowTown.


Therewerenoclosureplansatthetimeofthemeeting.Discussiononintegratingtheserviceintoalargercatchmentareahadcommenced.Anexecutiveclinicaldirectorwasappointedon1June2009.TheareaofthenewcatchmentwastoincludeSt.Vincent’sHospital,ElmPark,andtheCluainMhuireservices.Theprojectwasduetoberolledoutusingtheclinicaldirectorateframeworkagreednationally.Baselinedatawillbecollectedinyearone.



Apeeradvocacyservicewasprovidedweeklytotheacutein-patientunitbytheIrishAdvocacyNetwork(IAN).Theadvocatehadalsobeguntovisitthecommunityresidencesonthegroundsofthehospital.

Theadvocatereportedanumberofpositiveaspectstotheorganisationanddeliveryofservices.Theyincludedawarenessofrights,friendlinessofstaff,andthequalityofthefood.Anumberofserviceusershadexpressedaninterestincompletingtrainingintheareaofadvocacy.

Anumberofserviceuserscommentedonthelackofactivitiesontheward,limitedaccesstosocialworkservicesandtheneedforadditionalsupportsinthecommunity.

313


Theadvocatewasplanningtofacilitateanumberoftrainingsessionsontheroleofpeeradvocacytoallnewstaff.ItwasagreedthataformallinkwithanADONshouldbeestablishedtoimproveresolutionofissuesinatimelymannerforallinvolved.


Inadditiontoapeeradvocateservice,theWicklowMentalHealthAssociationhadarepresentativeonthemanagementteam.Thiswasaverynewdevelopment.

Governance

ThemanagementteamconsistedofaMentalHealthAssociationrepresentative,clinicaldirector,seniorclinicalpsychologist,directorofnursingandareamanager.Theotherdisciplineswerenotcurrentlyemployedintheservice.

TherehadbeenasignificantdrivetoimproveclinicalauditsystemstoensurecompliancewiththeMentalHealthAct2001.Theteammetregularlyandreviewedprogress.Theteamhadworkedveryhardtoensurethatqualitysystemsbecomeembeddedinthesystemandimproveservicesforserviceusers.

InadditiontheservicehadaverystronglinkwiththeFriendsofNewcastleHospitalgroup.Todatethisgrouphadfundedmanyinitiativesandprojectstoimprovepatientcare.


Medical Staff

post Wte in post Consultantpsychiatrist 4.3NCHD 9Specialistregistrar 0

Nursing Staff

post Wte in postDON 1ADON 3Nursesbasedinin-patientservices 36.5Nursesbasedincommunityresidences 13Communitymentalhealthnurse 5Nursesbasedindayhospitals 2Nursesbasedindaycentre 6Temporarystaffpanel 5



314



post Wte in postClinicalpsychologist 2.4Socialwork 1Occupationaltherapist 0Arttherapist 0Physiotherapist 0.5



Intellectual Disability Team Report

TeamDescription IntellectualDisabilityPopulation 109,472


Consultantpsychiatrist 0 0.6



ADON 0 0

CMHN 0 1


Socialworker 0 0






Dayhospital 0 0

Daycentre 0 0


Therewasoneapprovedcentre.Ithadtwowardsprovidingacutecareandelderlycontinuingcare.



TheNewcastleHospitalcentrewascompliantwiththemajorityofRegulations.Theoneareaofnon-compliancewasinrelationtoskillmix.SincetheapprovedcentreinspectioninApril2009,theservicehadputinanewwetfloorshowerroomandaddedachoiceonthefoodmenu.

315



ThecentrehadECTfacilitiesandwasfullycompliantonthedayoftheinspection.Seclusionfacilitieswererecordedassubstantiallycompliant.Alldocumentationandsystemstoensurecompliancewereofaveryhighstandard.

Mechanicalrestraint(Part5)wasrecordedinfull.

Codes of practice

Thecentrewasfullycompliantwithallthecodesexceptwiththeprovisionofappropriatefacilitiesforchildren.


Careplanningwasacoreobjectiveoftheservice.Ithadbeensuccessfullyintroducedintheapprovedcentre.Therewerenowplanstoextenditouttoserviceusersattendingdaycentresinthearea.Therewasverylimitedavailabilitytosocialworkandclinicalpsychology.Therewasnoaccesstooccupationaltherapy.Thesefactorslimitedtheinterventionoptionsforserviceusers.


Description

Thereweretwo24-hoursupervisedresidencesinthearea.Onewasinspectedindetailanditisreportedseparately.Therewasnorehabilitationteaminplace.Serviceusersremainedattachedtothegeneraladultcommunityteams.Theservicehadaccessto41bedsinlowsupport.



FitzwilliamHouse 12 11 Generaladult MDTEllerslie 14 10 Generaladult MDT

Conclusion

Theservicehadusedthecollectivecommitmentofallstaffsuccessfullytoachievealmostfullcomplianceinitsapprovedcentre.Remainingissuesaredependentonadditionalresourcesandimprovedstaffingskillmix.Thesedeficitswerereflectedintheserviceuserscommentsonlackoftalkingtherapiesandthelackofmeaningfulactivities.Thebudgetcutsandrecruitmentembargoisaffectingthedevelopmentofservicebeyondminimalrequirements.

Howevertheserviceisaheadinanumberofareas.Ithascommenceddiscussionsonthefutureconfigurationofalargercatchmentarea.Careplanningandqualityimprovementinitiativesarebecomingthenormintheservice.

316



1. All services users must have access to rehabilitation and other specialty teams.

2. All service users must have access to a range of disciplines and interventions, especially occupational therapy and social work.

3. All service users must have a care plan based on a needs assessment.

4. The advocate and a member of the clinical staff should meet on a quarterly basis to review services and share information.

317


Mental Health services 2009 Catchment area Report Kildare West Wicklow

HSEArea HSEDublinMid-LeinsterCatchment Kildare/WestWicklowMentalHealthService Kildare/WestWicklowMentalHealthServicesPopulation 205,175NumberofSectors 5NumberofApprovedCentres 1SpecialistTeams(E.G.POLL,REHAB) Rehabilitation

HomecarePerCapitaExpenditure2008[>18Years] NotsuppliedDateofMeeting 2September2009

service 2009


EachofthefiveKildare/WestWicklowsectorshadasectorheadquarterseitherownedorsharedbuttheseserviceshadnotreceivedthenecessaryfundingtodevelopandhadtorelyonanalreadystretchedin-patientservicebarelyabletocopewiththedemandforcareandtreatment.Inadditiontothefivesectorteams,therewasarehabilitationteamandahomecareteam.Therewasnopsychiatryoflaterlifeteamandnoliaisonteaminthiscatchment.In-patientserviceswereprovidedatLakeviewUnitinNaasGeneralHospital,wheretherewere29acuteadmissionbeds.


1. The new community residence, Clonree House, should be opened.

Outcome:Duetolackofstaffthishadnotoccurred.

2. The rehabilitation team should be resourced in order to provide an adequate service.

Outcome:Thishadnotoccurred.

3. There should be adequate staffing and resourcing of community mental health teams. This would decrease the pressure on in-patient beds by providing community-based services.



ThecatchmentserviceforwardedacopyoftheNationalServicePlan2009fortheHSEtotheInspectorate.Nolocalmentalhealthserviceplanwassubmitted.


TwostaffmembershadbeeninvolvedwiththedevelopmentoftheWellnessRecoveryActionPlan}}

(WRAP)programme.

318


Adialecticalbehaviourtherapy(DBT)grouphadbeenstartedinNorthKildare.Fourstaffmembers}}

weretoreceivespecialisttrainingintheUK.

TherehabilitationservicehadbeenrelocatedtonewheadquartersatSt.Mary’sHospital.}}

Itwasreportedthattheopeningofacommunitydayfacilitytocaterforeighttotenserviceuserswas}}

imminent.

Theroofgardenattheapprovedcentrewasdevelopedandopenedtoresidentsuntil2000heach}}

evening.

Thecoremanagementteamhadbeenexpandedtobecomemultidisciplinary.}}


Notapplicable.



AweeklyservicewasprovidedbytheIrishAdvocacyNetwork(IAN)toLakeviewUnitinNaasGeneralHospital.ServiceuserswerealsoseenbyanadvocateonanindividualbasisatCelbridge,KilcockandAthydayservices.IANfacilitatedpresentationsregardingtheroleoftheadvocateindayhospitals,daycentresandwithinthecommunityatlarge.

ItwasreportedthatserviceusersfoundstaffatLakeviewUnitfriendlyandapproachable.

ItwasreportedthattheIAN’sattendanceaspatient’ssupportatmentalhealthtribunalshadbeenwelcomedandaccommodatedbythenursingandmedicalstaffandtheclericalofficerassignedtotheunit.

ItwasreportedthatanumberofresidentsofLakeviewUnitindicatedtotheIANrepresentativethattheyhadnotbeensuppliedwithsufficientinformationregardingmedication.Theyalsostatedthattheywerenotsufficientlywellinformedabouttheircareplanandwereunclearastothetreatmentoptionsavailabletothem.


Therewasnoserviceuserrepresentationonthemultidisciplinaryseniormanagementteam.ItwasreportedbythemanagementteamandtheIANrepresentativethatsuchamovehadbeensoughtbytheseniormanagementteambutnoserviceuserinteresthadbeenexpressed.

ItwasreportedbyIANthatasaresultoftheinvolvementofLakeviewUnitstaffandmanagementandtheIANintheRefocusingProject,thepartnershipbetweenIANandthestaffandmanagementhadbecomeincreasinglyopenandprogressive.

StaffandmanagementwerecurrentlyimplementingtheServiceUserRatingofEffectiveness(SURE)surveyformsincollaborationwiththeIAN.

319


Governance


AclinicalriskassessmenttooladaptedfromtheFunctionalAnalysisofCareEnvironment(FACE)hadbeenpiloted.Thiswasduetobeauditedsoon.


Medical Staff


Nursing Staff

post Wte in postDON 1ADON 5Nursesbasedinin-patientservices 36Nursesbasedincommunityresidences 16Communitymentalhealthnurse 18Nursesbasedindayhospitals 6Nursesbasedindaycentre 4Other 0


speciality Wte in postLiaison 0Clinicalplacementcoordinators Notsuppliedby

serviceNursepracticedevelopmentcoordinator Notsuppliedby

serviceCounsellors 0Advancednursepractitioner 0CNS 8



320







Consultantpsychiatrist 0.36 0.36



ADON 1session 1session

CMHN 1 1


Socialworker 1principalpost–sessional

1principalpost–sessional






Dayhospital 0 0

Daycentre 0 0

321


Home Care Team Report

TeamDescription HomecarePopulation 64,149





ADON 0 0

CMHN 5 5


Socialworker 0 0






Dayhospital 0 0

Daycentre 0 0


LakeviewUnitinNaasGeneralHospitalwassituatedontwofloors.Theentrancewasontheupperfloorwhichwasbrightandwelcoming.Theactivitiesandthediningarea,ECTsuiteandsomeofficeswereonthisfloor.

Thein-patientwardwasonthelowerlevel.Residentstherehadaccesstoanenclosedgardenspacewhichwasusedforsmokingandrelaxation.

Thespacewithinthewardwaslimited.Onthedayofinspection,theunitwasfullyoccupied.Itappearedbusyandcrowdedtotheextentthatitwasnottherapeuticforpeoplewithseverepsychoticordepressiveconditions.Theactivitiesareaoftheunitwasinuseupto2000handthisfreedspacefromthelowertieroftheunit.Thespaceavailablehadbeenextendedwiththedevelopmentofaroofgardenontheupperfloor.Muchworkhadbeenputintothisgardenandstaffandresidentsmustbecommendedfordevelopingit.


LakeviewUnitreceivedanunannouncedinspectionon30April2009.


TheunitwasinbreachoffiveRegulations:Article7(Clothing),Article15(IndividualCarePlan),Article16(TherapeuticServicesandActivities),Article17(Children’sEducation),Article20(ProvisionofInformationtoResidents)andArticle22(Premises).

322



Therewasnorecordoftheresident’snextofkinbeinginformedoftheresident’sseclusion[Sections2.4and2.10(a)(b)].Therewasnorecordintheclinicalfilesthattheresidentwasreviewedeveryfourhoursbyamedicalpractitioner.Theresident’sindividualcareplandidnotaddresstheassessedneedsoftheresidentinseclusion[Sections4.4and4.6].

Therewasnorecordintheclinicalfilethattheresidentwasaffordedtheopportunitytodiscusstheseclusionepisode[Section6.3].Theseclusionregisterwasonlypartiallycompletedfortheseclusionepisode[Section8.2].Theapprovedcentredidnotprovideinformationtoresidentsregardingseclusion[Section9.1(a)].

Therewasnowrittenrecordindicatingthatallstaffinvolvedinseclusionhadreadandunderstoodthepolicy[Section9.1(b)],northattheapprovedcentrerevieweditspolicyonseclusiononanannualbasis[Section9.1(d)].

Therewasnoevidencethatthemultidisciplinaryteaminvolvedintheresident’scarereviewedtheepisodeofseclusion[Section9.2].Therewasnoevidencethattheapprovedcentrecompiledanannualreportontheuseofseclusion[Section9.3].

TheinformationonstafftrainingonthedayofinspectionwaslimitedanddidnotcomplyfullywiththeRegulations.

Codes of practice

Intheclinicalfilesreviewedforphysicalrestraint,itwasnotevidentthattheregisteredmedicalpractitionerwasnotifiedoftheepisodeofphysicalrestraint[Section2.6].Theclinicalpracticeformforphysicalrestraintwasonlypartiallycompleted[Section2.8].

Therewasnorecordintheclinicalnotesthattheresident’snextofkinwasinformedofthephysicalrestraintepisode[Section2.10(a)(b)].Theuseofphysicalrestraintwasnotclearlyrecordedintheclinicalnotesreviewed[Section5.1].Theclinicalpracticeformforphysicalrestraintwasincompleteonthedayofinspection[Section5.2].

Therewaslimitedevidencethatstaffinvolvedinphysicalrestrainthadreadandunderstoodthepolicy[Section6.1(b)].Theapprovedcentredidnotreviewitspolicyonanannualbasis[Section6.1(d)].Therewasnorecordofdiscussionwiththemultidisciplinaryteam[Section6.2].Therewasnorecordoftheapprovedcentrecompilinganannualreport[Section6.3].Therecordofattendanceattrainingwaslimitedandwasnotrepresentativeofthestaffingnumbers[Section7.2].

Theapprovedcentrewasunsuitableforthecareandtreatmentofchildren.Theriskmanagementpolicywasindraftform.


Multidisciplinarycareplanshadnotyetbeendeveloped.ItwasreportedthatpreliminaryworkhadtakenplaceinadaptingacareplanfromFACE.Thishadyettobeimplemented.

323





BrambleLodge 14 14 RehabilitationTeam MDTLarineHouse 14 14 RehabilitationTeam MDT

Conclusion

Despiteanexpandingpopulationinrecentyears,thecatchmentofKildare/WestWicklowreportedthatitremainedoneofthelowestfundedcatchmentareasinthecountryonapercapitabasis.Eachofthefivesectorshadasectorheadquarterseitherownedorsharedanddespitestaffcommitmenttothedevelopmentofcommunityservices,theseserviceshavenotreceivedthenecessaryfundingtosufficientlydevelop;theservicereliedonanalreadystretchedin-patientservicebarelyabletocopewiththedemandforcareandtreatment.

Staffexpressedfrustrationatthelackofresourcestoenablethemtoprovideadequateservices,yetdemonstratedcommitmentanddedication–despitetheselimitedresources–tostrivewherepossibletobringaboutrealchangethatmatteredtoserviceusers.Thedevelopmentoftheroof-topgardenwasonlyoneexampleofthiscommitment,thegardenbeingfundedbyvoluntarysources.


1. The new community residence, Clonree House, should be opened.

2. The rehabilitation team should be fully resourced so that it can provide a comprehensive service to all users.

3. A psychiatry of later life team and a liaison team should be appointed.

4. The community day facility which is to cater for between 8 and 10 service users a day and which had been scheduled to open in mid-June should be opened immediately.

324


Mental Health services 2009 Catchment area Report laois/offaly

HSEArea HSEDublinMidLeinsterCatchment Laois/OffalyMentalHealthService Laois/OffalyMentalHealthServicesPopulation 137,927NumberofSectors 3NumberofApprovedCentres St.Fintan’sHospital,Portlaoise

DepartmentofPsychiatry,MidlandRegionalHospital,Portlaoise

SpecialistTeams RehabilitationPsychiatryoflaterlife

PerCapitaExpenditure2008[>18Years] Totalexpenditure23,948,000euroDateofMeeting 8April2009

service 2009


LaoisOffalyMentalHealthServicesprovidedacutecareintheDepartmentofPsychiatry,Portlaoise,communitymentalhealthservicesthroughthreesectorteams,andcontinuingcareandrehabilitationinSt.Fintan’sHospitalinPortlaoise,whichhadtwowardsremaining.Therewasarehabilitationteamandapsychiatryoflaterlifeteaminplace.


1. Any refurbishment work should be completed.

Outcome:Therewereanumberofrefurbishmentsoutstandingforwhichfundingwasawaited.

2. The approved centre at the Department of Psychiatry, Portlaoise, should develop multidisciplinary care plans as described in the Regulations.


3. The occupational therapy input to the Department of Psychiatry should be restored.

Outcome:TherewasnowanoccupationaltherapistintheDepartmentofPsychiatry.

4. Documentation regarding ECT for voluntary patients should be reviewed.

Outcome:ThestandardofECT,includingdocumentation,wasexcellent.


Thelocalhealthserviceplanstatedthattheexistinglevelofserviceshouldbemaintained.

325



AnupgradeofBirrCommunityMentalHealthCentrewasinprogress.}}

AdaycentreinRathdowneywasduetoopeninSeptember2009.}}

Arehabilitation/recoveryunitcalledLinkCentrewasopenedinMarch2009.}}


IntheabsenceofanyfundingfortheclosureofSt.Fintan’sHospital,therehadbeennofurtherprogress.



TheamountofinformationprovidedtoserviceuserswithrespecttoArticle20oftheRegulationsforapprovedcentreswasgood.AmemberoftheIrishAdvocacyNetwork(IAN)attendedbothapprovedcentresweeklyandnoticesaboutadvocacyservicesweredisplayedonnoticeboards.VoluntarygroupssuchasGrowandSHINEheldmeetingsintheapprovedcentresregularly.Accesstoadvocacytrainingforserviceuserswasnotavailable.Theprovisionofadvocacyserviceswasnotunderpinnedbypolicy.Theadvocacyteamprovidedanannualreport.Anadvocacyserviceforpsychiatryoflaterlifewasbeingdeveloped.

Servicesusers,throughIAN,reportedthatstaffwerefriendlyandhelpfulalthoughitwasfeltbyresidentsthattheydidnothaveenoughtimewiththeirconsultants.Staffwerereportedtobepositivetowardstheadvocacyservice.Femaleserviceuserssaidthattheywerekeptintheirnightclothesfortoolongfollowingadmission.Serviceusersreportedinsufficientactivitiesandlimitedaccesstotalkingtherapies.


Astherewasnocareplaninoperation,residentswerenotformallyinvolvedintheplanning,implementation,evaluationandreviewoftheirowncareandtreatment.Serviceuserswerenotinvolvedinthedevelopmentandplanningofthelocalmentalhealthservice,research,trainingoreducation.Therewasnopolicyonserviceuserinvolvementintheservice.Therewerenoongoingarrangementstomonitorperformancewithregardtoserviceuserinvolvementwithinthementalhealthservice.

Thepsychiatryoflaterlifeteamhadestablishedamultidisciplinarycarerssupportgroup.TheLighthouseClubwasanout-of-hourssocialnetworkingunitrunbyserviceusersinconjunctionwithIAN.TherewasalsotheFindingYourWaytoRecoverygroup,whichwasajointinitiativebetweenmentalhealthsocialwork,primarycaresocialwork,andSHINE.Thiswasdeliveredinacommunitysettingandwasledbyaserviceuser.

Governance

Themanagementteamremainedtripartiteandwasnotmultidisciplinary.Therewasamultidisciplinarycatchmentteamthathadmetonceinthelast12months.

Mentalhealthassessmenttoolshadbeenintroducedtosupportclinicalpracticeandtoprovidestandardisedassessments.Therewasanongoingpatientsatisfactionsurvey.SeclusionandECTauditswereplanned.

326



Medical Staff


Nursing Staff

post Wte in postDON 1ADON 4.75Nursesbasedinin-patientservices 79.62Nursesbasedincommunityresidences 20.58Communitymentalhealthnurse 16.21Nursesbasedindayhospitals 8.43Nursesbasedindaycentre 10.46


speciality Wte in postLiaison 3.9Clinicalplacementcoordinators 1Nursepracticedevelopmentcoordinator 0.5Counsellors 4.5Advancednursepractitioner 1Other 0


post Wte in postClinicalpsychologist 3.66Socialwork 3.5Occupationaltherapist 4Arttherapist 1Other 0

327





TeamDescription RehabilitationandcontinuingcarePopulation 137,927





ADON 1 1

CMHN 2 2


Socialworker 0 0




Communityresidencestaff 20.58 20.58


Dayhospital No No

Daycentre Yes Yes

328








ADON 0.75 0.75

CMHN 4.57 4.57


Socialworker 1 1


Dayfacilitynursestaffing 1.82 1.82


Dayhospital Yes Yes

Daycentre No No


AcuteserviceswereprovidedintheMidlandRegionalHospitalinanewunit.Thisunitwasingoodcondition.

ThecontinuingcareandrehabilitationserviceswereprovidedinSt.Fintan’sHospital.Somestructuralanddecorativeworkwasrequiredintheunitsinthishospital.



TheservicecontinuedtobeinbreachoftheArticlesgoverningcareplanningandtherapeuticactivitiesandconsiderableeffortwasrequiredtoachievecompliance.

St.Fintan’sHospitalrequireddecorationandstructuralwork.Therewerenohealthandsocialcareprofessionalsintheunits(inparticularoccupationaltherapists)toprovidetherapeuticactivities.


TheservicewasincompliancewithallRules.

Codes of practice

TheservicewascompliantwithallCodesofPractice.

329



Itwasdisappointingtonotethattherehadbeenlittleprogressinintroducingcareplanningtotheservicealthoughtherewereexcellentnursingcareplans.Thehealthandsocialcareprofessionalshadnotbeeninvolvedindevelopingatemplateforcareplanning.Thereappearedtobenocoherentreasonforthedelayandtheservicewasstillsomeconsiderabledistancefromachievingevenbasiccareplanning.Whilecontinuingcareandrehabilitationresidentshadcareplans,somewerenotcompleted.Teammeetingswereheldregularlyineachunit.


Description

Therearetwo24-hoursupervisedcommunityresidences,bothofwhichhadalargenumberofbeds.



ErkinaHouse,Rathdowney

17 16 RehabilitationContinuingcare

MDTcareplan

BirchwoodHouse,Tullamore

14 13 RehabilitationContinuingcare

MDTcareplan

Conclusion

Laois/OffalyMentalHealthServiceshadanumberofpositiveaspects.Therewasstrongcommitmenttoprovidingacommunityserviceaswellasarehabilitationservice.Anumberofcommunityfacilitieswerebeingupgraded.ItwasthereforedisappointingthattherehadbeenlittleprogressincareplanningintheDepartmentofPsychiatry.


1. The Department of Psychiatry must introduce care planning as a matter of urgency.

2 . Refurbishments in St. Fintan’s Hospital should be completed.

330


Mental Health services 2009 Catchment area Report longford Westmeath

HSEArea HSEDublinMidLeinsterCatchment Longford/WestmeathMentalHealthService Longford/WestmeathMentalHealthServicesPopulation 116,000NumberofSectors 3NumberofApprovedCentres 1SpecialistTeams Psychiatryoflaterlife

CommunityalcoholanddrugservicePsychiatricliaison

PerCapitaExpenditure2008[>18Years] 116.00euroDateofMeeting 28May2009

service 2009


TheLongford/WestmeathcatchmentareahadoneapprovedcentreinSt.Loman’sHospital,Mullingar,consistingofsixwardsspreadoverthreebuildings.Ithad25bedsforenduringmentalillness,46bedsforelderlycare,and44bedsforacutepsychiatry.Theservicecoveredthreecatchmentareas:Longford,Athlone,MullingarandpartsoftheMeathareawithatotalpopulationof116,000.Therewerethreespecialistteams:psychiatryoflaterlife,communityalcoholanddrugsservice,andpsychiatricliaison.


1. Each resident must have a care plan as defined in the Regulations.

Outcome:Theservicewasatanadvancedstageoffinalisationoftheindividualcareplan.

2. Therapeutic services and programmes must be linked to the individual care plan.


3. The unsuitable conditions on the wards in St. Brigid’s block, St. Anne’s Ward and St. Edna’s Ward must be addressed. Funding should be made available to refurbish or replace these wards.

Outcome:St.Claire’sWardhadclosed.ResidentsremainedlivinginunsuitableconditionsonSt.Edna’sWard,St.Anne’sWard,St.Brigid’sWardandSt.MarieGorettiWard.

4. Each resident must have equal access to health and social care professionals based on assessed needs and funding should be made available to facilitate this. There must be an appropriate skill mix in place to meet these needs. Residents under the care of the psychiatry of later life team should have access to the team’s occupational therapist on the units.


5. Increased coordination of the household functions in the approved centre would be of benefit in addressing the challenge presented by the age and layout of the premises.

331


Outcome:Thechallengepresentedbytheageandlayoutofthepremiseswassizeable.


Theservicehadacapitaldevelopmentplan,whichwasexaminedbytheInspectorate.Itwastobefinancedbythesaleofhospitallands.However,theservicereportedthatfundsraisedbythesaleof6.75hectares(16.75acres)ofhospitallandwerenotputbackintothelocalmentalhealthservice,undermininganyhopetheservicehadofcommencingitscapitaldevelopmentplan.

ItcontinuedtobeofconcerntotheInspectoratethatresidentsremainedaccommodated,caredforandtreatedinsuchunsuitablepremisesandthatthissituationwaslikelytocontinueasnofundinghadbeenmadeavailablebytheHSEtorectifythesituation.


Thepsychiatryoflaterlifeteamhadintroducedalaterlifedatabase.Theadditionofa0.5whole-}}

time-equivalentconsultantinpsychiatryoflaterlifehadreducedthewaitinglisttoanaverageoftwoweeks.

Longfordsectorwaspilotingapersonalitydisordertherapeuticservicewhichinvolvedassessmentof}}

potentialserviceuserswithborderlinepersonalitydisorders.Theoverallaimoftheprogrammewastoprovideatheoreticaloutlineofpersonalitydisordersandtreatmentissues,andwhereappropriate,toteachspecificskillsandencouragetheimprovementofclinicalpractice.

TheclosureofSt.Claire’sWard.}}

Reductioninbednumbersfrom120to115.}}

Intheabsenceofarehabilitationteam,atemporaryhalf-timeconsultantpsychiatristandahalf-time}}

CNM3posthadbeenassignedtooverseetheplacementofresidents.Fundingforthispost,whichhadnotbeenapproved,hadbeenwithdrawn.

Careplanninghadbeenintroducedtoallsectors.}}


Theservicehaddevelopedacapitaldevelopmentplan,whichwasexaminedbytheInspectorateandwastobefinancedbythesaleofhospitallands.Asindicatedabove,theproceedsofsellinghospitallandshadbeendivertedfromthementalhealthservice,undermininganyhopetheservicehadofcommencingitscapitaldevelopmentplan.



Thepeeradvocaterepresentativereportedthatpeeradvocacywaswelcomedandencouragedbystaff.

TherewasapositiveattitudefromstaffinSt.Loman’sHospital,Mullingar,inpromotingA Vision for Change.

Residentswhoattendedtheactivationunitfounditagreathelpwiththeirrecovery.

Residentsintheacuteunitsthoughtanopenairoutsidegardenwouldbeawelcomeaddition.

332



Thelocaladvocacyrepresentativejoinedthecatchmentmanagementteamfourtimesayear.Itwasplannedtooffertheadvocacyrepresentativeapermanentplaceontheteam.

Governance


TheliaisonpsychiatryteamhadcompletedcollaborativeresearchwiththeMaterHospitalliaisongroup.}}

AnauditonincompleteadmissionorderswaspresentedattheRoyalCollegeofPsychiatristsmeeting.}}

Thecommunityalcoholanddrugservicehadupdateditsunder-18protocol.}}

ThecommunityalcoholanddrugservicepresentedapostertotheRoyalCollegeofPsychiatrists,}}

Amsterdam,onthefollowupofsubstancemisusesreferredfromliaisonpsychiatry.

NursingandmedicalparticipationatGPawarenessevenings,whichinvolvedthesharingof}}

informationbetweenprimaryandsecondarycareintheMullingarsector.

TurasProgramme,atripartiteinitiativeintheMullingarsector,wassetupinvolvingMullingar}}

communityhealthteam,theNationalLearningNetwork,andthetrainingorganisationAontachtPhobailTeoranta(APT)inTullamore.

AquarterlyclientreviewofdaycentreprogrammeoccurredintheLongfordsector.}}

Therehadbeenconcordanceskillstrainingforstaff,outliningapragmaticwayformentalhealth}}

professionalstotalktoserviceusersabouttheirmedication,promotingtheirinvolvementindecision-makingandseekingtodeveloptheirskillsindealingwiththeirownillness.

Themultidisciplinarymanagementteamweremeetingonamonthlybasis.}}

Adrugsandtherapeuticcommitteehadbeenestablished.}}

333



Medical Staff


Nursing Staff

post Wte in postDON 1ADON 5Nursesbasedinin-patientservices 116.79Nursesbasedincommunityresidences 37Communitymentalhealthnurse 5Nursesbasedindayhospitals 8Nursesbasedindaycentre 7.93Rosteredstudentnurses 15


speciality Wte in postLiaison 2Clinicalplacementcoordinators 1Nursepracticedevelopmentcoordinator 0.5Counsellors 5.82Advancednursepractitioner 0Other 9.95


post Wte in postClinicalpsychologist 4Socialwork 3.6Occupationaltherapist 3Arttherapist 0Psychotherapist 0.57

334










ADON 0.2 0.2

CMHN 4.8 4.95


Socialworker 0 0






Daycentre Owned Owned

Liaison Team Report

TeamDescription PsychiatricconsultationliaisonservicePopulation 113,737



NCHD(includingspecialistregistrar) 0.3 0.3


CMHN 2 2


Socialworker 0 0





335


Community Alcohol and Drug Team Report

TeamDescription CommunityalcoholanddrugservicePopulation 113,737





ADON 0.2 0.2

CMHN 4.82 4.82


Socialworker 0 0









StLoman’sHospital,Mullingar,consistedofsixwardsspreadoverthreebuildings.Themaleandfemaleadmissionwards,locatedwithinastand-alonestructurebuiltinthe1940sonthehospitalcampus,hadbeenrefurbishedafewyearsbeforeandwereingooddecorativecondition.St.Brigid’sWardandSt.MarieGorettiWardwerelocatedinanolderbuildingopenedin1938andwereinneedofimmediaterefurbishment.Themainbuilding,agranite-greysprawlingedificeopenedin1847,retainedtwowards:St.Edna’sWardandSt.Anne’sWard,whichcontinuedtoaccommodateresidents.TheInspectorateremainedconcernedatthecontinueduseofthesewards,whichweredilapidated,desolateanddepressing,andunsuitableforaccommodationandtheprovisionofcareandtreatmentofresidents.Thecostofrefurbishmentofthebuildingswascomplicatedbythepresenceofasbestosonsomeofthewardswhichincurredasignificantfinancialcosttoremoveitsafely.Thephysicallayoutandconditionofthelattertwobuildingsprovidedanongoingchallengeforhouseholdandmaintenancepersonnelandrequiredawellcoordinatedresponse.

Despitethepoorphysicalenvironmentforresidents,visitorsandstaff,theInspectoratenotedtheconsiderableprogressmadesincethelastinspectioninrelationtoclinicalpracticethroughincreasedcompliancewiththeRegulations,RulesandCodesofPractice.Itwasevidentfrommeetingswithmanagement,staffandresidentsthattheservicewasstrivingtoimprovethecareandtreatmentprovidedtoresidents,inthecontextofhavingnoadditionalfundingtorectifydeficitsorplanforthefuture,andstafflossesarisingfromHSErecruitmentembargo.TheInspectoratewasinformedthatnursingstaffshortagesinparticularhaveledtoasignificantovertimebudgetandassociatedimpactoncontinuityofcaredespiteacoregroupofstaffbeingallocatedtospecificwards,andsignificantdifficultiesreleasingstafffortraining,someofwhichismandatorytrainingundertheMentalHealthAct2001.

336




St.Loman’sHospital,Mullingarwasfullycompliantwith24oftheRegulationsforapprovedcentresandsubstantiallycompliantwithfour,whilecompliancehadbeeninitiatedwithone.However,theapprovedcentrewasnotcompliantwithtwoArticles:PremisesandStaffing.

Rules (section 59.2 and section 69.2, Mental Health Act 2001)

IntheRulesgoverningtheuseofseclusion,theapprovedcentrewasnotcompliantwithsections2.10,6.3,10.1,and10.2.

Intheclinicalfileofoneresidenttherewasnodocumentaryevidencethattheresident’snextofkinhadbeeninformedoftheresident’sseclusionandthereasonfornotinformingthemwasnotdocumented.

Therewasnodocumentaryevidenceintheclinicalfile,followingtheendingofseclusion,thattheresidenthadbeenaffordedtheopportunitytodiscusstheepisodeofseclusion.

Theapprovedcentrehadnopolicyandproceduresforstafftraininginrelationtoseclusion.

ThemandatorytrainingfortheRulesandCodesofPracticeformedicalstaffwasbeingfulfilledandaregisterofattendancewasmaintained.

Codes of practice

IntheCodeofPracticeregardingtheuseofphysicalrestraint,theapprovedcentrewasnotcompliantwithsections7.1and7.2.

Theapprovedcentrehadnopolicyandproceduresforstafftraininginrelationtophysicalrestraint.

Arecordofattendanceattrainingwasnotmaintainedasnostaffhadreceivedtraininginphysicalrestraint.

TheservicewasalsonotcompliantwiththeCodeofPracticerelatingtotheadmissionofchildreninsections2.5(b),2.5(e),and2.5(g).


Therewerethreesectorteamsandthreespecialistteams:aPsychiatryofLaterLifeteam,aCommunityAlcoholandDrugServiceteamandaPsychiatricLiaisonteam.Therewasaneedforafully-resourcedRehabilitationteam.Amultidisciplinarycareplanningapproachhadbeenintroducedtothethreesectorsandspecialistteams,howeverasystemfordesignationofkeyworkerswasprovingdifficulttoimplement.

337



Description

Therewerethree24-hourstaffedcommunityresidences,oneineachsector.AllthreewereunderthedirectionoftheirrespectiveGeneralAdultteams.



AshfordHouse,Longford

14(including1respitebed)

15 Generaladult MDT

Edgewater,Mullingar

13(including1respitebed)

13 Generaladult MDT

Glenavon,Athlone 12(including2respitebeds)

12 Generaladult MDT

Conclusion

TheLongford/Westmeathmentalhealthserviceswereprovidedthroughthreesectorteamsandthreespecialistteams.Acareplanningapproachhadbeenintroducedbutneededtobefollowedthroughbyusingmultidisciplinarykeyworkers.

ThemajorityofmentalhealthservicesatSt.Loman’sHospital,Mullingar,wereprovidedinareasthatremainofconcerntotheInspectorate.Thesewards,whichweredilapidated,desolateanddepressing,wereunsuitablefortheaccommodationandtheprovisionofcareandtreatmentofresidents.

Theservicehaddevelopedacapitaldevelopmentplanthatwastobefinancedbythesaleofhospitallands.However,theservicereportedthatfundsraisedbythesaleofhospitallandwerenotring-fencedforreturntothelocalmentalhealthservice,thusscupperinganyhopetheservicehadofcommencingitscapitaldevelopmentplan.

Despitethepoorphysicalenvironmentforresidents,visitorsandstaff,theInspectoratenotedtheconsiderableprogressmadesincethelastinspectioninrelationtoclinicalpracticethroughincreasedcompliancewiththeRegulations,RulesandCodesofPractice.Itwasevidentfrommeetingswithmanagement,staffandresidentsthattheservicewasstrivingtoimprovethecareandtreatmentprovidedtoresidents,inthecontextofnoadditionalfundingtorectifydeficitsorplanforthefuture,andstafflossesarisingfromtheHSErecruitmentembargo.


1. St Brigid’s, St. Edna’s, St. Marie Goretti and St. Anne’s wards were in poor condition and should be decommissioned as a matter of urgency.

2. The psychiatry of later life team should have access to clinical psychology services.

3. The multidisciplinary care planning approach introduced to the sector teams and specialist teams needs to be fronted by a designated multidisciplinary key worker.

4. There is an urgent need for an occupational therapy service for St. Loman’s Hospital, to provide assessments and facilitate therapeutic activities for residents.

338


Mental Health services 2009 Catchment area Report south County Dublin

HSEArea HSEDublinMidLeinsterCatchment SouthCountyDublinMentalHealthService CluainMhuireServicePopulation 175,000NumberofSectors 3multidisciplinaryteams(notsectorised)NumberofApprovedCentres ContractforbedsinSt.JohnofGodHospitalSpecialistTeams Liaison

Earlyinterventionforpsychosis(DETECT)PerCapitaExpenditure2008[>18Years] 14.7meuro[sic]DateofMeeting 29October2009

service 2009


TheCluainMhuireservicehadapopulationof175,000andwasinSouthCountyDublin.IthadnoapprovedcentrebuthadacontractforservicewithSt.JohnofGodHospitalforalladmissionsthatweremanagedbytheCluainMhuiresectorteams.TherewasaliaisonteamservingawiderpopulationandanearlyinterventionforpsychosisteambothofwhichservethewiderpopulationofWicklowandElmMountmentalhealthservicesinadditiontotheCluainMhuireservices.Therewasnorehabilitationteam.ThepsychiatryoflaterlifeservicewasdeliveredfromSt.Vincent’sUniversityHospital.Therewasone24-hoursupervisedresidence.Thecatchmentareawasnotsectorisedduetothesmallgeographicalsizebuttherewerethreemultidisciplinarycommunityteams.Thereweretwoconsultantsoneachteam.


1. There should be an occupational therapist on each team.

Outcome:Therecruitmentoftwooccupationaltherapisthadgonesomewaytoprogressingthisbuttherewasstillnooccupationaltherapistoneachteam.

2. There should be a specialty team appointed for rehabilitation.


3. The core management team should be inclusive of all disciplines.



Thelocalhealthserviceplanincluded:

Increasedoccupationaltherapystaffingandhavinganoccupationaltherapistoneachteam.}}

Developingarehabilitationandassertiveoutreachteam.}}

339


Acquiringadequatefundingtosecurethelong-termviabilityoftheregionalearlyinterventionservice}}

inpsychosis.

Developmentofanacutedayhospitalteamfor2010.}}


AnewdayhospitalhadopenedintheCentreforLivinginBlackrock.Itincludedanacutepsychosis}}

stream.Twenty-eightpeopleattendedeachdayfortargetedinterventions.

Thecommunitynursesnowoperatefrom0900hto2000hsevendaysaweek.Thisservicewasdueto}}

bereducedduetoresourceproblems.

TheSuicideCrisisAssessmentNurse(SCAN)pilotprojecthadbeenextendedtothethree}}

multidisciplinaryteams.

TherewasareductioninbedscontractedfromSt.JohnofGodHospital.}}

ElviraGateontheBurtonHallcampuswasanewdevelopmentthatofferedimprovedrecovery}}

programmes.ThisincludedaREFRESHrehabilitationprogrammeandalocalteambaseforcommunitymentalhealthnurses.Italsoincludedathriftshopandaninformationandresourcecentre,bothofwhichwererunbyserviceusers.

Thesocialworkdepartmentrunthefollowingprogrammes:aWellnessRecoveryActionPlan(WRAP)}}

group;awellnesssupportgroupformothersatriskofpost-nataldepressionemotionallyunstablepersonalitydisorder;afamilyinformationandskillsgroup;asupportgroupforchildrenofparentswithmentalillness;aparentingskillsgroup,afamilyandcarerspsycho-educationandskillsgroup;arecoveryworkshop;andaManagingYourRelationshipsworkshopaspartoftheCentreforLivingandREACHprogrammes.

Thepsychologydepartmentofferedthefollowingprogrammes:DealingwithDepression(coping}}

withdepression),firstepisodepsychosis,cognitivebehaviouralprogrammeforobsessivecompulsivedisorder,dialecticalbehaviourtherapyskillsgroup,emotionsgroupandmindfulness-basedstressmanagementgroup.

REACHwasa21-weekpsychosocialprogrammefundedbyFÁSwithaFETACLevel3qualification.Fifty}}

percentofattendeesmovedtomainstreamemploymentandfiftypercentcontinuedtoLevel4.Fortypercentofthoseattendingthisservicewerefromoutsidethecatchmentarea.



TheIrishAdvocacyNetwork(IAN)visitedSt.JohnofGodHospitalweekly.Itwashopedtoextendthisservicetothecommunityservicesinthenearfuture.Theserviceusersindicatedthattheyfoundthestaffinthehospitaleasytotalkto,thequalityofthefoodwasgoodandtherenovationsinthehospitalwerewelcomed.Serviceusersspokehighlyofoccupationaltherapy.Someserviceuserscomplainedofboredomintheeveningsandatweekends.Theyalsofeltthattheydidnothaveenoughinformationaboutmedication.Theyalsocomplainedaboutlackoftimespentwiththeirconsultantpsychiatrists.

340



TheServiceUserResearchCommittee(SOURCE)scrutinisedresearchprojectsfromaserviceuser’spointofview.AnewserviceuserresourceandinformationcentrehadbeenopenedatBurtonHallandwasstaffedbyserviceusersandvolunteers.SOURCEhadreviewedtheDETECTprogrammeandwrittenmaterialavailableforserviceusers.

TheservicehadbeenundertakingregularsatisfactionsurveysandthesewerenowundertakenbySOURCE.

Therewasserviceuserparticipationinallplanningcommittees.Theywereencouragedandsupportedintheirparticipationineducationprogrammes.

Governance


Theseniormanagementteamwasnotmultidisciplinary.Therewereregularquarterlymeetingswithheadsofdiscipline.Itwasproposedtosetupaformalclinicalgovernancecommitteebytheendof2009.Themultidisciplinaryclinicalauditcommitteemetbi-monthlyandauditswerepresentedfromthemultidisciplinaryteams.Auditshadincludedpsychotropicmedicationandmonitoringside-effects,accesstoservice,physicaltestsandmonitoring,andGPsatisfaction.


Medical Staff

post Wte in post Consultantpsychiatrist 7.5NCHD 11including3DETECT

and1researchSpecialistregistrar 5

Nursing Staff

post Wte in postDON 1ADON 0Nursesbasedinin-patientservices 0Nursesbasedincommunityresidences 7Communitymentalhealthnurse 10.53Nursesbasedindayhospitals 5.25Nursesbasedindaycentre 5Temporarystaffpanel 2

341



speciality Wte in postLiaison 1Clinicalplacementcoordinators 0Nursepracticedevelopmentcoordinator 0Counsellors 0Advancednursepractitioner 0Other 1.5


post Wte in postClinicalpsychologist 5.9Socialwork 7.3Occupationaltherapist 4Arttherapist SessionalDramatherapist Sessional



DETECT Team Report

TeamDescription EarlyinterventionforpsychosisPopulation 350,000





ADON 0 0

CMHN 1.5 1.5








Headquarters AvilaHouse AvilaHouse

Daycentre 0 0

342


Liaison Team Report

TeamDescription LiaisonteamcoveringSt.Michael’sHospital,DunLaoghaire,andSt.Colmcille’sHospital,Loughlinstown

Population





ADON 0 0

CMHN 1 1


Socialworker 1 1




CluainMhuireservicesdidnothaveanapprovedcentre.Allin-patientcarewasaccessedasrequiredfromSt.JohnofGodHospitalwhereCluainMhuireteamscontinuedtoprovidein-patienttreatment.


TherewasatemplateforcareplanningcurrentlyinuseontheMentalHealthInformationSystem(MHIS).Therewerededicatedcareplanningmeetings.Careplanningwasdonewiththeserviceuser.Therewasadetailedformalresidentialcareplaninthe24-hoursupervisedresidence.


Description

Therewasone24-hoursupervisedresidenceinStillorgan.Ithad21beds.Eachresidenthadacareplan.Therewassomemovementthroughtheunitinthataboutfiveplaceswereavailableeachyear.Therewerenomediumsupportresidencesanddischargesweretolowsupportandindependentliving.



Oropesa 21 21 Communitymentalhealthteams

MDT

343


Conclusion

TheCluainMhuireservicesareastronglycommunity-basedserviceandhaverecentlyopenedanewdayhospital.Theyarealsoorientatedtoserviceuserinvolvementandserviceuserparticipationisevidentinmanyprogrammesandincareplanning.TheDETECTprogrammeremainsanimportantserviceforearlyinterventioninpsychosis.Theirinformationsystemisexcellentandtheservicehasmovedfromapaperbasetoacomputerisedservice.Therearecontinuousauditsandthesocialworkandpsychologydepartmentsofferawiderangeofservices.


1. There should be an occupational therapist on each community team.

2. The senior management team should be multidisciplinary.

344


Hse south

Mental Health services 2009 Catchment area Report Carlow/Kilkenny

HSEArea HSESouthCatchment Carlow/KilkennyMentalHealthService Carlow/KilkennyMentalHealthServicesPopulation 120,671NumberofSectors 5NumberofApprovedCentres 3SpecialistTeams Psychiatryoflaterlife

RehabilitationPerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 12November2009

service 2009


TheCarlow/Kilkennycatchmentareahadaccesstoatotalof151hospitalbedscomprising44acute,24inpsychiatryoflaterlife,66rehabilitationand17learningdisabilitybeds.Theservicesweresituatedinthreeapprovedcentresacrossthetwocounties.Anewpurpose-builtunithousedpeoplewithlearningdisability.Inaddition,theservicehad155placesin24-hourstaffedcommunityresidences.


1. The rehabilitation team should be fully resourced with an appropriate skill mix of staff to ensure that it can provide more than assessment.

Outcome:Thishadnotbeendone.

2. The community mental health teams must be resourced in line within national mental health policy.

Outcome:Thishadnotbeendone.Aprojectgrouphadbeensetuptoformulateamanpowergroupwitha2–3yeartimeframe.


SeventeenresidentsinSt.Anne’sWardinSt.Dympna’sHospitalweretransferredtoKelvinCourt,anewpurpose-builtdevelopmentforpeoplewithlearningdisability.ThishadfacilitatedtheclosureofSt.Anne’sWard.

Planstorelocate17residentsfromSt.MarysWardinSt.Dympna’sHospitalweredelayedduetostaffonleavenotbeingreplaced.Familieshadbeencontactedandtheproposedmovehadbeendiscussedwiththem.

345


StaffplannedtocarryoutassessmentsoftheresidentsofSt.Patrick’sWardinSt.Dympna’sHospital,withtheintentionofmovingpeoplewhowouldbenefittotherehabilitationunit.Similarlyassessmentsweretobecarriedoutforthe16residentsofSt.Luke’sWardinSt.Canice’sHospital.

Anew8-place24-hourstaffedresidencewasopenedon10November2008inCarlowtofacilitateresidentsdischargedfromrehabilitativecare.


Staffwerecontributingtoamulti-agencydomesticabuseprogramme.}}

MultidisciplinarycareplansincorporatingtheSainsburyCentreforMentalHealthriskassessment}}

toolhadbeenpilotedandweredueforfurtherevaluation.Traininghadbeenconductedintheiruseandtheywerebeingimplemented,albeitunevenly,throughouttheservice.TheacuteunitandSt.Dympna’sHospitalweremoresuccessfulinthisregardthanSt.Canice’sHospitalwas.

TheexcellentORCHIDinformationprojecthadbeenfurtherdevelopedtoincludeSt.Canice’sHospital.A}}

newinformationofficerhadbeenappointed.Aserviceuserhadbeeninvolvedintheproject.

Therapeuticgroupshadbeendevelopedinthedayhospitaltoincludemindfulness,assertiveness}}

training,andanxietymanagement.

Post-dischargegroups,includingawomen’ssupportgroup,hadbeeninitiatedinacommunitysetting.}}

Amultidisciplinaryeatingdisorderprogrammehadbeeninitiated.Staffreportedthatserviceusers}}

wereadverselyeffectedbythewithdrawalofthedieteticservice.

TheGreenbankscrisishousehadreducedadmissionsfromtheCarlowarea.}}


StaffreportedthatSt.Canice’sHospitalwasduetocloseattheendof2010,withtheexceptionofpsychiatryoflaterlifeservices,whichwouldremainforCarlowandKilkenny.Multidisciplinaryassessmentswiththehelpofsocialcareprofessionalsfromotherteamswereinprogresstofacilitatethis.Assessmentsofresidentsinthelastremainingward,St.Luke’s,areunderway.ItwasexpectedthatSt.Mary’sWardwouldcloseearlyin2010.

PlanswereinplacetocloseSt.Dympna’sHospital.St.Anne’sWardclosedinFebruary2009.ItwasexpectedthatSt.Mary’sWardwouldclosetowardstheendof2009andresidentswouldbeaccommodatedinnursinghomes.Oneward,St.Patrick’s,wouldremain.



ArepresentativefromtheIrishAdvocacyNetwork(IAN)providedsupportonaregularbasis,orbyrequest,totheapprovedcentres,dayhospitalsandhostelswithinthecatchmentarea.Theadvocatereportedthatamonthlyserviceusermeetingwithstaffhadbeenwellreceived.

However,clientshadreportedtotheadvocatethattheydonotknowwhotheirprimarynurseorkeyworkeris.Theyreportedthattheywerefrightenedonadmissionandwouldlikemoretimetobeintroducedtostaffandresidents.

346


RepresentativesfromSHINEwereinterestedindevelopinganinductionpackforresidents.

Afocusgrouphadbeenconductedwithserviceuserswhohadattendedtheserviceforanumberofyears.Mostdiscussionconcernedthein-patientunitandtraumaticeventsthathadoccurredontheward,e.g.dealingwithoutburstsbyotherresidents.Staffidentifiedaneedtodevelopprotocolsforhandlingsuchevents.

AserviceuserandcarerwereinvolvedonthesteeringgroupoftheORCHIDInformationprogramme.

Asocialworkteamleaderwhowasamemberofthemultidisciplinarymanagementteamhadbeendesignatedtoactasasupporttotheadvocatewhoseconcernswerethenfedbacktotheteammeeting.


Serviceuserswereencouragedtoparticipateintheformulationofmultidisciplinarycareplansandthereviewofsuchplans.

ArepresentativeoftheIANattendedtheclinicalgovernancegroupbutnotthemultidisciplinarymanagementmeeting.ContacthadbeenmadewiththeIANtoaddressthis.

Governance


Aclinicalgovernancecommitteeisinexistenceandreportstoamultidisciplinarymanagementgroupthatmeetsfortnightly.Anumberofgroupshadbeenestablishedtosupportthisstructureincludingaclinicalincidentreviewgroup,riskmanagementgroup,policiesdevelopmentgroup,multidisciplinarycareplanninggroupandasteeringgroupforthedevelopmentofplansforlong-staywards.


Medical Staff

post Wte in post Consultantpsychiatrist 7NCHD(includingspecialistregistrar) 11.5

Nursing Staff

post Wte in postDON 2ADON 4Nursesbasedinin-patientservices 78Nursesbasedincommunityresidences 104Communitymentalhealthnurse 15Nursesbasedindayhospitals 6Nursesbasedindaycentre 9Other–TemporaryStaffPanel 40

347



speciality Wte in postLiaison 1Clinicalplacementcoordinators 2Nursepracticedevelopmentcoordinator 1Counsellors 4Advancednursepractitioner 0SystemicFamilyTherapy 4Other 5


post Wte in postClinicalpsychologist 3Socialwork 3.8Occupationaltherapist 4Artinstructor NotprovidedOther –



Specialist Team Report

TeamDescription RehabiliationServicePopulation 120,726





ADON 1 2

CMHN 1 1


Socialworker 0 0



Dayfacilitynursestaffing 5.75 6



Dayhospital St.Canice’sHospital Owned

Daycentre ClannNua Shared

348



TheacuteunitinSt.Luke’sHospital,Kilkenny,wasamodernbrightunit,withwellmaintainedgardensandfacilities.Thestaffwereenthusiasticandhadworkedhardoverrecentyearstobringaboutchangestoimproveservices,e.g.serviceinformationresourcesandmultidisciplinarycareplans.Fivesectorteams,alongwiththerehabilitationteamandthepsychiatryoflaterlifeteam,admittothe44beds.

TherewereplansinplacetocloseSt.Dympna’sHospital,Carlow,andmovetheremainingresidentstomoreappropriateaccommodation.Seventeenresidentswithlearningdisabilityhadbeenmovedtoapurpose-builtfacilityatKelvinCourt,reducingthein-patientbedsto36.

St.Canice’sHospitalprovidedcontinuingcare.Multidisciplinaryplanswerenotoperatingevenlyandstaffreportedthattheabsenceoftherehabilitationconsultantwasaffectingtheoperationoftheplans.Thenursingstaffworkedhardtoprovidegoodqualitycaretoamainlyelderlypopulation.Itwasplannedtocloseonewardinthishospitalandretainonewardunderthecareofpsychiatryoflaterlifeteam.


TherewasgenerallyahighlevelofcompliancewiththeRegulations,RulesandCodesofPractice.Theexceptionstofullcomplianceareoutlinedbelow.


st. Canice’s Hospital

Compliance initiated:Article15(CarePlanning)–MultidisciplinarycareplanshadnotbeenintroducedtoSt.Luke’sWard.

Compliance initiated:Article26(Staffing)–Therewereinsufficienthealthandsocialcarestaffintheservice.

Substantial compliance:Article16(TherapeuticActivities).

Substantial compliance:Article22(Premises).

Department of psychiatry, Kilkenny

Substantial compliance:Article26(Staffing).

st. Dympna’s Hospital

Substantial Compliance:Article6(FoodSafety)–Afoodsafetyreportfrom2009indicatedsomeareasthatneededattention.

Substantial Compliance:Article22(Premises)–Althoughgenerallywellmaintainedthereweresomeareasofdampnessandcondensation.

Substantial Compliance:Article27(MaintenanceofRecords)–onefileexaminedwasnotinkeepingwiththeregulations.

Substantial Compliance:Article32(RiskManagement)–Thepolicywasundated.

349


Compliance initiated:Article26(Staffing)–Therewereinsufficienthealthandsocialcareprofessionals.


st. Canice’s Hospital

Mechanical Restraint:TheservicewasnoncompliantwithSection21asthedurationofrestraintwasnotrecordedinthenotes.

Codes of practice

Department of psychiatry, Kilkenny

Admission of Children:TheservicewasnotcompliantwiththeCodeofPracticeinrelationtotheadmissionofchildren.


Amultidisciplinarycareplanninggroupfacilitatedthedevelopmentofpilotplansandtheirevaluationintheapprovedcentres.Staffweretrainedintheiruseandanauditshowedtheywerebeingimplemented.TheexceptionwasSt.LukesWardinSt.Canice’sHospital,whichsufferedbecausetheconsultantwasonleaveandwasnotreplaced.Inspiteofthis,however,theserviceuseradvocatepointedoutthatresidentscomplainedofconfusionastotheidentityoftheirtreatingteam.

350



Description

Theserviceoperated14supervisedresidences,fourofwhichwereforpeoplewithanintellectualdisability.Oneofthehousesfunctionedasacrisishouse.Inall,therewere155placesintheseresidences.TheservicehadestablishedagrouptoexaminetheresidenceswithaviewtoimplementingtherecommendationsofA Vision for Change.



AltamontHostel 13 13 RehabilitationKilkennyNorthKilkennyWestKilkennyEast

Nursingcareplan

Lismore 10 9 Rehabilitation NursingcareplanKincoraHostel 14 13 Rehabilitation NursingcareplanMountLackenHostel


MilleniumCourtHostel


Caomhnú 21 18 Rehabilitation NursingcareplanAlcantra 9 9 NursingcareplanParkLodge 9 9 Rehabilitation NursingcareplanCourtViewHostel 8 7 Rehabilitation Nursingcareplan65BeechwoodDrive


SacredHeart 8 8 CarlowNorth Nursingcareplan75ElmParkDrive 8 6 Rehabilitation NursingcareplanGreenbanks 12 6 North/Southand

RehabilitationNursingcareplan

KelvinCourt 17 17 GeneralAdult Nursingcareplan

Conclusion

TheserviceintheCarlow/Kilkennycatchmentareacontinuestoimprovefacilitiesandcareforitsserviceusers.ClosureplansforSt.Dympna’sHospitalareprogressingandafurtherwardwasclosedin2009.TherewereanumberofdevelopmentsinserviceprovisionwiththeintroductionoftheraputicgroupsandtheORCHIDProjectinthecommunity.TheLocalHealthServicePlanhadfocusedonassessingresidentsandidentifyingmoresuitableresidencesforeachindividual.

Allthreeapprovedcentresperformedwelloninspectionduring2009.TheInspectoratealsoinspectedthedayhospitalatSt.Dympna’sHospitalandmadeanumberofrecommendationstoimproveitsuse.AninspectionofthenewaccommodationunitofKelvinCourtwasalsocarriedout.Althoughtheresidenceprovidesanexcellentfacilityfortheresidents,thelackofanintellectualdisabilityspecialistteamlimitstheeffectivenessofthegoodaccommodation.

ClosureplansforSt.Dympna’sareadvanced,andplansforSt.Canice’sprovidefortheretentionofonewardthere.

351



1. All teams should be fully staffed in terms of multidisciplinary members.

2. Closure plans for St. Dympna’s Hospital should continue to be implemented.

3. In view of the reported unavailability of services from the local voluntary service for intellectual disability, consideration should be given to providing an intellectual disability specialist team for the catchment area.

352


Mental Health services 2009 Catchment area Report Kerry

HSEArea HSESouthCatchment KerryMentalHealthService KerryMentalHealthServicesPopulation 139,835NumberofSectors 5NumberofApprovedCentres 2SpecialistTeams RehabilitationPerCapitaExpenditure2008[>18Years] 240,984euro[sic]DateofMeeting 17June2009

service 2009


ThementalhealthservicesinKerryservedapopulationof139,835andforthepurposesofservicedeliverythecountywasdividedintofivesectors.Theservicewasdeliveredinacombinationofcommunity-basedfacilitieslocatedineachsector,includingoutpatientsclinicsandcommunitydayservices,withsharedin-patientfacilitiesintheformof44acuteadmissionbedsatKerryGeneralHospitaland58continuingcarebedsatSt.Finan’sHospitalinKillarney.


1. Community mental health services should be implemented.

Outcome: Asteeringgroupandthreesub-groupshadbeendevelopedfortheimplementationofVisionintoAction,theKerryLocalHealthOfficestrategicplanfortheimplementationofA Vision for Change.

2. St. Finan’s Hospital should close.

Outcome:DesignbriefsforthefacilitiesidentifiedfortheclosureofSt.Finan’sHospitalhadbeensubmittedandwereawaitingapprovalforfunding.

3. A psychiatry of later life team should be developed.



ThatfutureservicedeliveryinKerrywillbeorientatedthroughaplannedprocessfrominstitutionalcaretoalternativecommunitymentalhealthservicesthataredeliveredsafelyandeffectively,asoutlinedintheVisionintoActionstrategy.

TheservicehadsubmittedplansfortheclosureofSt.Finan’sHospital,thebuildingofa25-bedcontinuingcareandchallengingbehaviourunitforolderpersonswithmentaldisorders,a15-bedintensivecarerehabilitationunit,anda10-bedcommunityresidencefortheremainingresidents.Theplanwasdependantoncapitalfunding.

353



ThelocalmentalhealthstrategyVisionintoActionhadbeensignedoff.}}

Thestrategysubgroupswereintheprocessofaddressinghumanresources,trainingandorganisational}}

change.

Mentalhealthsectorboundarieswerealignedwithprimarycare.}}

Thenumberofpersonnelintherehabilitationteamhadbeenexpanded.}}

Twopermanentconsultantpsychiatristshadbeenappointedtosectorteams.}}

Apurpose-built24-hourcommunityresidencewasabouttobehandedovertotheservicetoreplace}}

Cherryfield.


St.Finan’sHospitalwasamid-nineteenthcenturyVictorianhospitalwhichstillaccommodatedthreewardswithinit,withtwoothersremainingoncampus.TheservicehadsubmittedplansfortheclosureofSt.Finan’sHospital,thebuildingofa25-bedcontinuingcareandchallengingbehaviourunitforolderpersonswithmentaldisorders,a15-bedintensivecarerehabilitationunit,anda10-bedcommunityresidencefortheremainingresidents.Theplanwasdependentoncapitalfunding.

St.Paul’sWard,St.Peter’sWardandSt.Martin’sWardwereinneedofcompleterefurbishmentandwerenotsuitableforhabitationbyresidents,norfortheprovisionofcareandtreatmenttothoseresidents.

ThenumberofbedsintheDepartmentofPsychiatry,KerryGeneralHospital,hadbeenreducedfrom50to44.Theplanstoreassignappropriatestafftothecommunityfollowingthereductioninbedshadbeencaughtupinindustrialrelationsissues.



Department of Psychiatry, Kerry General Hospital:TheserviceuseradvocatedescribedasapositivedevelopmenttherefurbishmentanddecoratingoftheDepartmentofPsychiatryinKerryGeneralHospital.Thedevelopmentofthecomputerroomwasalsoapositivesign.Thesensorygardenhadbeenopenedandhadbeenawelcomeadditiontotheunit.Increasedone-to-onenursinginterventionshadprovedanotherpositivedevelopment.ThecontinuingtransferofresidentsfromKerryGeneralHospitaltoSt.Finan’sHospitalwasofconcerntoserviceusers.

St. Finan’s Hospital, Killarney:Thisapprovedcentrewasviewedasunsuitableforresidents.Anoccupationaltherapyposthadbeenlostandnotreplaced.Itwasreportedthatdormitorieswerelockedduringcertainhourstoencourageresidentstoattendtherapies.Itwasreportedthatsomeresidentswhowereexperiencingtheeffectsofmedicationwerepreventedfromlyingontheirbedsforthisreason.


Therewasnoserviceuserrepresentationonthemultidisciplinaryteamcatchmentareameeting.TherewasserviceuserparticipationonVisionintoActionsub-groups.Aserviceuserrepresentativeonthelocalclinicalgovernancecommitteehadbeenproposedandaccepted.

354


Governance


RevisedarrangementsforclinicalgovernancehadbeenproposedasanintegralpartoftheVisionintoActionmentalhealthstrategy.ThetermsofreferenceforthiswereconsistentwiththeHSEQualityandRiskagendaandtheMentalHealthCommission’sQualityFramework.Thisgroupwilltaketheleadindevelopingauditandinternalqualityimprovementandestablishlinkstocollateresultsacrosstheregion.

Localauditshadbeencarriedoutbyindividualdisciplines.Examplesincluded:specialing,assistedadmissions,educationalandclinicalplacementauditsandclinicalriskintheacuteunit.

Itwasenvisagedthattheclinicalgovernancegroupwouldofferanopportunitytoundertaketheseauditsmoresystematicallyandonamultidisciplinaryteambasis.


Medical Staff


Nursing Staff

post Wte in postDON 1ADON 5Nursesbasedinin-patientservices 134Nursesbasedincommunityresidences 56.5Communitymentalhealthnurse 12Nursesbasedindayhospitals 6Nursesbasedindaycentre 10.5Temporarystaffpanel 20


speciality Wte in postLiaison 0Clinicalplacementcoordinators 2Nursepracticedevelopmentcoordinator 1Counsellors 0Advancednursepractitioner 0Enduringmentalillnessandtherapeuticrogrammes 2



355


specialist Mental Health teams

CommunityMentalHealthTeam(CMHT)staffingnumbersbysectorareavailableontheMentalHealthCommissionwebsitewww.mhcirl.ie







ADON Shared Shared

CMHN 0 2








Dayhospital No No

Daycentre No No


TheacuteadultmentalhealthunitlocatedinKerryGeneralHospitalcomprisedtwowards,ReaskWardandValentiaWard.GenerallyReaskWardadmittedserviceusersfromtwoofthecommunitymentalhealthteams(CMHTs)andValentiaadmittedfromtheotherthreeCMHTs.Onthedayofinspection,thedoorintoandoutoftheunitwaslocked.Thetotalnumberofbedshadbeenreducedfrom50to44.

St.Finan’sHospital,Killarney,wasbuiltinVictoriantimesin1849andwassituatedonanelevatedprominenceoverlookingthetown.Fivewardscontinuedtoprovidecareandtreatmenttoresidents.Ofthese,St.Paul’sWard,St.Peter’sWardandSt.Martin’sWardwereinneedofcompleterefurbishmentandwerenotsuitableforhabitationbyresidents,norfortheprovisionofcareandtreatmenttothoseresidents.Theothertwowards,EastWingandWestWing,wereseparatefromthemainbuilding,butoncampus,andwereundergoingcompleterefurbishment,theWestWinghavingbeencompletedpriortotheinspection.Althoughacutein-patientserviceswereprovidedbytheDepartmentofPsychiatryinKerryGeneralHospitalinTralee,St.Finan’sHospitalcontinuedtoreceivetransfersofresidentsinacutedistresswhorequiredmoreintensivecareandtreatmentinamoresecureandsafesetting.

356




Department of Psychiatry, Kerry General Hospital:ThepolicyinrelationtotransferofresidentsasrequiredbyArticle18(2)referredonlytotransferstoandfromthesecureunitsinSt.Finan’sHospital.Apolicyontransferstoandfromtheacuteunitwasrequired.TheInspectoratewasinformedthatresidentsweretransferredfromtheacuteunitonlytooneofthetwosecurewardsinSt.Finan’s.Howeveronthedayofinspection,theInspectorateteamnotedthatatleasttwotransfershadtakenplacetoO’ConnorEastandWestwithinthepreviousmonth.

St. Finan’s Hospital, Killarney:TheapprovedcentrewasinbreachofArticle20(ProvisionofInformationtoResidents),Article21(Privacy)andArticle22(Premises).


Department of Psychiatry, Kerry General Hospital:PoliciesinrelationtoRulesmustbereviewedannually.

St. Finan’s Hospital, Killarney:Onthedayoftheinspection,itwasreportedthattheseclusionroominSt.Peter’sWardwasbeingusedasabedroom.

PoliciesinrelationtoRulesmustbereviewedannually.

AnumberofresidentsrequiredtheuseoflapbeltsandbedrailsunderPart5:useofmechanicalmeansofbodilyrestraintforenduringself-harmingbehaviour.Intheprescriptionordersexamined,thedurationofusagewasnotdocumented.Intheapprovedcentre’sowndocumentationforthisuse,thesectionforthedateofreviewhadnotbeencompleted.

Codes of practice

Policiesinrelationtophysicalrestraintinbothcentresmustbereviewedannually.

TheapprovedcentresriskmanagementpolicymustbeamendedtobecompliantwiththeCodeofPracticeonnotificationofdeathsandincidentreporting.


Multidisciplinarycareplanningwasoperationalintherehabilitationteamnetwork.Thisinvolvedserviceuserinputinpre-careplanningwiththekeyworkerandintheplanningmeeting.Acareplanwasreviewedeverysixmonthsbyasmanymultidisciplinaryteammembersaspossible.

MultidisciplinarycareplanningattheDepartmentofPsychiatrywasoperational.

TheCMHTtraininganddevelopmentprogramme–whichwasdevelopedbytheWorldHealthOrganisationandincludedprovisiontoaddressareassuchascasemanagement–wasdesignedtoallowsystemsofcarethatwouldfacilitateaCMHTcarecoordinatortodevelopandberesponsibleforreviewofcareplans.Thiswouldalsofacilitatesharedcarewithprimarycareinmanagingindividualswithsevereandenduringmentalillness.

Multidisciplinarycareplanninginareasresponsibleforcareofolderpersonswasinneedofdevelopment.

357



Description

Therewerefivecommunityresidencesproviding24-hourcareintheKerrycatchmentarea,withatotalof73places.Fourresidenceswereunderthecareoftherehabilitationteamwhileone,Writer’sGroveinListowel,wasunderthecareoftheNorthKerryCMHT.Cherryfieldwasduetotransfertoanewpurpose-builtresidence.



Writer’sGrove,Listowel

14 14 NorthKerryCMHT Nursing

IslandView,Caherciveen

13 23 SouthKerryCMHT MDT

TeachanChúraim,Rathmore

12 12 Rehabilitation MDT

KillardenHouse 18 18 Rehabilitation MDTCherryfield 16 16 Rehabilitation MDT

Conclusion

St.Finan’sHospitalwasamid-nineteenthcenturyVictorianhospitalwhichstillaccommodatedthreewardswithin,withtwoothersremainingoncampus.TheservicehadsubmittedplansfortheclosureofSt.Finan’sHospital,thebuildingofa25-bedcontinuingcareandchallengingbehaviourunitforolderpersonswithmentaldisorders,a15-bedintensivecarerehabilitationunit,anda10-bedcommunityresidencefortheremainingresidents.Theplanwasdependentoncapitalfunding.

St.Paul’sWard,St.Peter’sWardandSt.Martin’sWardwereinneedofcompleterefurbishmentandwerenotsuitableforhabitationbyresidents,norfortheprovisionofcareandtreatmenttothoseresidents.


1. St. Finan’s Hospital should close.

2. Funding should be made available for the development of the 4-bed high observation unit at the Department of Psychiatry, Kerry General Hospital.

3. The service is in need of a psychiatry of later life team.

4. Remaining multidisciplinary team vacancies on sector teams need to be filled.

358


Mental Health services 2009 Catchment area Report north Cork

HSEArea HSESouthCatchment NorthCorkMentalHealthService NorthCorkMentalHealthServicePopulation 80,795NumberofSectors 3NumberofApprovedCentres 1SpecialistTeams RehabilitationPerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 15April2009

Description

service Description

St.Stephen’sHospitalwascurrentlytheheadquartersfortheNorthCorkmentalhealthservices,whichservedapopulationof80,795andwasdividedintothreesectors.Thereweretwoacuteunits(maleandfemale)onsite,withfourlongstayunits.Therewasalsoanincompleterehabilitationteamandanumberofcommunityfacilities.Therewasnoteamforpsychiatryoflaterlife.AsignificantnumberoflongstayresidentswerefromoutsidetheNorthCorkcatchmentarea.

IthadbeentheplanforsometimethattheNorthLeeandNorthCorkcatchmentareaswouldamalgamate.Howeveranyprogressonthishadbeenslow.


1. Each team should be fully staffed as a multidisciplinary team as recommended in A Vision for Change.

Outcome:Asocialworkerhadrecentlybeenappointed.Apartfromthisnofurtheradditionshadbeenmadetothemultidisciplinaryteams,whichremainunder-resourced.TherewasnopsychiatryoflaterlifeteaminNorthCork.

2. Consideration should be given to maximising resources in the HSE South by amalgamating some of the catchment areas in line with A Vision for Change recommendations.

Outcome:AsteeringgrouphadbeenformedintheHSESouthtoprogresstheamalgamationofNorthLeeandNorthCork.

3. Training needs for health and social care professionals should be addressed.

Outcome:Thetrainingneedsofstaffwerenowbeingaddressedonanongoingbasisandtrainingwasrecorded.

4. Efforts should continue to facilitate the provision of alternative accommodation based on assessed need, either in specialised rehabilitative care or in nursing homes.

359


Outcome:Thiswasongoing.Forexample,theCarrigabrickhousingprojectinFermoyhadopenedwithdischargedresidentsfromSt.Stephen’sHospital,andotherresidentshadbeenmovedtonursinghomes.

5. Each unit should be self-staffing.

Outcome:ThishadbeenreferredtotheHRdepartmentandmightbereviewedinthecontextoftheintroductionofa35-hourweekfornursingstaff.


Theserviceplanincludedthefollowing:progresstheimplementationofA Vision for Change,toshiftmentalhealthservicestocommunity-basedsettingsinlinewiththePCCCtransformationandreconfigurationprogramme,andtobasicallyimproveservicesforserviceusers.

Developments 2008-2009

TheCarrigabrickhousingprojectopenedinJuly2009.Thishad14bedsandallowedclosureofbedsin}}

St.Stephen’sHospital.

AsectorHQopenedinFermoy,consistingofoffices,clinicalspaceandakitchen.}}

AnewdaycarecentreinCharleville(TurasNua)openedinOctober2008.}}

ACNSinbehaviourtherapybeganworkinginMallowsectorinJanuary2009.}}

ACNSinbehaviourtherapybeganworkinginKanturksectorinDecember2008.}}

ACNM2wasappointedtoCharlevilledaycarecentreinJanuary2009.}}

Aseven-daycommunitymentalhealthservicecommencedin2009withtwocommunitymental}}

healthnursesondutyeachweekend.

Theestablishmentoftwoadvancednursepractitionerpostswasatdiscussionstage.}}


Theadvocatewasinvolvedinthepolicyandproceduregroupofthementalhealthserviceandwasinvitedtomanagementmeetings.


Theadvocateattendedbothacuteunitsandlongstayunitsaswellastherecreationcentre.Theadvocatealsooccasionallyattendedthecommunityresidencesandday-centres.Howevertherewerenoformalmeetingsbetweenmanagementandtheadvocatetofeedbackserviceuserconcerns.Thishadresultedinsomeissuesnotbeingpassedontomanagement.Theserviceundertooktorectifythis.

MostserviceusersreportedthattheywerepleasedwiththeirtreatmentinSt.Stephen’sHospital.Theypraisedthefood,theoccupationaltherapydepartmentandtheinformationavailabletothem.Therewassomeconcernexpressedthatserviceuserswerenotconsultedaboutthereconfigurationofthetherapeuticactivityservice.Theyfeelthepremiseswastoosmallcomparedtowhathadbeenavailablepreviouslyandtheyhadlesstimethere.Therewasspecialpraiseofthemusicsessionswhichtakeplaceindifferentunits.

360



Theadvocatehadattendedmanagementmeetingsonoccasion.Theadvocatehadalsobeenpartofthepolicyandprocedurecommittee.

Therehabilitationconsultant,theadvocate,andserviceusershadintroducedaserviceuserfeedbackformforuseatmultidisciplinaryteammeetings.

Governance

Therewasamultidisciplinarymanagementteamthatmetmonthly.Allpoliciesweredevelopedwithmultidisciplinaryinput.

Therewereanumberofauditstakingplace.Theseincludedanauditofcommunitykeyworking,anauditofdrugprescribing,andanauditoftheliaisonservice.


Medical Staff

post Wte in post Consultantpsychiatrist 4NCHD 8Specialistregistrar Notapplicable

Nursing Staff

post Wte in postDON 1ADON 3.79Nightsuperintendant 2Nursesbasedinin-patientservices 101.78Nursesbasedincommunityresidences 21.44Communitymentalhealthnurse 11Nursesbasedindaycentre 17.96Other Clozapinenurse(1)

CNM3training(0.85)Behaviourtherapynurseincommunity(2.5)–1vacant

CNS Posts

speciality Wte in postLiaison 0Clinicalplacementcoordinators 0Nursepracticedevelopmentcoordinator 0Counsellors 2.79Advancednursepractitioner 0Other 0

361



post Wte in postClinicalpsychologist 3.4Socialwork 1Occupationaltherapist 3.36Arttherapist 0.56Other 0









CMHN 3 3

Psychologist 0 0

SocialWorker 0 0


Dayfacilitynursestaffing Sharedwithsectorteams

Sharedwithsectorteams

ADON 1 1


Dayhospital DayhospitalongroundsofSt.Stephen’sHospital

–sharedbetween3sectorsandrehab

OwnedbyHSE

Dayhospitalceasedoperatingin2009–see

DayCentrebelowOwnedbyHSE

Daycentre 4Kanturk–HSEownedMallow–HSEowned

Fermoy–LeasedMitchelstown–ownedbySeniorCitizensassoc

androomsrented

6Kanturk–HSEownedMallow–HSEowned

Fermoy–leasedMitchelstown–owned

byseniorcitizensassociationandrooms

rentedCharleville–leased

DayCentre–HSEowned

362



NorthCorkin-patientfacilitieswereprovidedinSt.Stephen’sHospitalinGlanmire.Thehospitalwaslocatedabout8kmfromCorkCityinaruralsetting.Ithadextensivegroundsandthecomplexmainlyconsistsofindividualunits.Therewasaunitforindividualswithchallengingbehaviour,twoadmissionunits(maleandfemale)andcontinuingcareunits.TherewasalsoanAlzheimer’sunitthatwasnotpartoftheapprovedcentre.

Theconditionofthebuildingswasrelativelygoodandtherewasaregularprogrammeofmaintenance.Allareaswereverycleanandprivacywasmaintainedasfaraswaspossible.

Whilethereappearedtobeacommitmenttoreducebeds,aclosureplanforthehospitalwasdifficulttoascertain.Closurehadbeencomplicatedbythefactthatalargeproportionofthelongstaypopulationoriginatedfromothercatchmentsandtherewasanexpectationthattheseothercatchmentswouldtakeresponsibilityforre-housingtheirresidents.ThisappearedtobehighlyunlikelyasNorthLeeinparticularhadfewavailableresourcestodothis.AsteeringgrouphadbeensetupwithNorthLeetolookatfutureprovisionofaccommodation.

Theadmissionunitswereonthegroundsofthehospital.DuetotheuncertainfutureoftheMercyHospitalinCorknoplansfortherelocationoftheacuteunitstoageneralhospitalsitewereavailable.

Compliance with approved Centre statutory Requirements

Regulations (s.i no.551 of 2006)

TheapprovedcentreofSt.Stephen’sHospitalwasfullycompliantwithallRegulations.


TheapprovedcentreofSt.Stephen’sHospitalwasfullycompliantwithallRules.

Codes of practice

TheapprovedcentreofSt.Stephen’sHospitalwasfullycompliantwithallCodesofPractice.


Multidisciplinarycareplanningwasinplacethroughoutthehospital.Therewasanexcellentcarepathwayinoperationforrehabilitationresidents.Multidisciplinarycareplanswerealsoinplaceinthesupervisedresidences.

363





SolasNuaHousingProject,SpaGlen,Mallow


CoisAllaHousingProject,Kanturk


CarrigabrickHousingProject,Fermoy


Conclusion

NorthCorkMentalHealthServicesaretobecommendedforbeingincomplianceofallRegulations,RulesandCodesofPracticeforapprovedcentres.Itwasevidentthatstaffhadworkedhardtoimproveservices.Therewasagoodsystemofcareplanninginoperation.Therapeuticactivitieshadbeenreconfiguredandnowextendedtodifferentunits.WhiletherewerenodirectcomplaintstotheinspectoratebyserviceusersthereweresomeissuesraisedbyserviceusersthroughtheIrishAdvocacyNetworkthatrequiredaddressingandaforumforraisingserviceuserissueswasnotinplace.

Althoughtheconditionofthehospitalwasadequateitwasstillaninstitutionthathoused76longstayresidentswithdifferingneeds,whorequirealternativecommunityaccommodation.Fromtheinformationreceiveditseemedunlikelythatthisrequirementwouldbemetinthenearfuture.Therehadbeensomereductioninthenumberoflongstayresidentsin2009withtheopeningofasupervisedresidence.

TheamalgamationofNorthCorkandNorthLeedoesnotappeartohaveprogressedinanymeaningfulwayandtherewasuncertaintyaroundthefutureofSt.Stephen’sHospitalandtheserviceasawhole.


1. Management and the Irish Advocacy Network representative should meet regularly on a formal basis.

2. A clear plan for the amalgamation of North Lee and North Cork catchment areas should be completed. This should include plans for the future accommodation of long stay residents in St. Stephen’s Hospital and the future location of the acute unit.

364


Mental Health services 2009 Catchment area Report north lee

HSEArea HSESouthCatchment NorthLeeMentalHealthService NorthLeeMentalHealthServicesPopulation 167,536NumberofSectors 5NumberofApprovedCentres 2SpecialistTeams(e.g.POLL,REHAB) 1PerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 6November2009

service 2009


TheNorthLeecatchmentareaprovidedamentalhealthservicetoanareaofCorkwithahighlevelofsocialdeprivation,particularlyinthenorthofthecity.Geographically,itspreadfrominnercitytothesuburbsofCork.Ithadtwoapprovedcentres:St.Michael’sUnit,MercyHospital,andCarraigMórinShanakiel.St.Michael’sUnitwastheacuteadmissionunit,andCarraigMórprovidedcontinuingcaretothe22residentsonthefirstfloorandfunctionedasaPICUonthegroundfloorwith18beds.

Thecatchmentwasservedbyfoursectorteams,whichincludedahome-basedtreatmentteam.Therewerenospecialistteamsforrehabilitationorpsychiatryoflaterlife.Theservicehaddevelopedanoutreachservicewhichwasworkingwellandwhichprovidedanafter-hoursservice.

Upto10patientsremainedinSt.Michael‘sUnitbecauseoflackofappropriateaccommodationtomoveonto.Onepersonhadbeeninacutecarefor4to5yearsforthisreason.Communitynursingunitsinthecitycouldnotaddressthisdifficulty.TheInspectoratewasinformedthattraditionallytherehadnotbeengoodaccesstolong-termcommunitybedsinthecatchmentarea.


1 The lack of specialist teams should be addressed. Provision for a rehabilitation team, an enhanced liaison team and a psychiatry of later life team should be progressed.

Outcome:Nospecialistteamshadbeenappointed.

2. Breaches in the statutory Rules and Regulations for approved centres should be immediately addressed as should breaches of Codes of Practice.

Outcome:ThetwoapprovedcentresfailedtomeetfullcompliancewiththeRegulationsandCodesofPractice.

3. Multidisciplinary teams should be fully resourced.

Outcome:Teamswerenotfullystaffedwithmultidisciplinarymembers.Therewasnopsychologistsinthepsychiatricintensivecareunit(PICU)inCarraigMórandtherewasaninadequatenumberofoccupationaltherapistsandsocialworkers.

365


4. The development of a full regional forensic service should be advanced as quickly as possible.



TheInspectoratewasnotprovidedwithaserviceplanfor2009.Managementindicatedinaself-assessmentformthatitsfocuswouldbeoncommunity-deliveredservices.


AmultidisciplinarydaytherapyprogrammehadbeenimplementedinMay2009.Itprovidedforupto}}

12serviceuserstoattendgroupsandworkshops.

AnacutedayhospitalopenedinApril2009toprovidedayservicesforresidentsintheCityNorth}}

sector.

AnoutreachprogrammehadbegunoperatinginCityNorthfromanewlyrefurbishedfacilityat}}

Erinville/InniscarrigCentre.

Thehome-basedtreatmentteamhadrelocatedtoamorecentrallocationprovidingeasieraccessto}}

assessmentsforitsserviceusers.

Amultidisciplinarypsychologicaltherapiesprogrammehadbeenintroducedtoenablequickeraccess}}

forserviceusersreferreddirectlybyGPs.Twosessionsaweekwereallocatedforassessmentbythemembersofthepsychologicaltherapiesteam.

Psycho-educationalfocusgroupstookplaceinthedayprogramme,ontopicssuchashearingvoices,}}

bipolardisorderandanxiety.Someofthesewereconductedoutofhours.


Therewasnohospitalclosureplan.ThefutureoftheadmissionunitatSt.Michael’sUnitwasdiscussedinpreviousyears,withaviewtopossibleamalgamationwithCorkUniversityHospital.

NoplanshadbeenputforwardregardingresidentsinthecontinuingcaresectionofCarraigMór.



TheadvocatewhovisitedallthefacilitiesintheNorthLeecatchmentareapresentedareportontheworkoftheadvocate.TheadvocatereportedthatanumberofissuesinSt.Michael’sUnithadbeenresolved.ThedirectorofnursingundertooktofollowupissuesbroughttotheattentionoftheadvocateinCarraigMór,includingthefailureofseniorstafftomeetquarterlywiththeadvocate,lackofprivacywhenmakingphonecalls,andtheperceivedfailuretoholdcommunitymeetingsforresidents.

Residentsintheservice’shostelshadexpressedsurpriseattheincreaseof66percentintheirrentcontribution.ThisfollowedfromtherecentnewchargeintroducedbytheHSE.

Administrativeproblemshadresultedinsomepatientsnotgettingadequatenoticeofmentalhealthtribunaldates,independentreviewappointmentsandsolicitors’visits.Staffagreedthiswouldbeaddressed.

366



Theadvocatemetmonthlywiththemultidisciplinarymembersofthecommunitymentalhealthteams.OneoftheadvocatespresentstothenursesintraininginUCContheroleoftheadvocateinthementalhealthservice.Individualserviceusersmetwiththeirmultidisciplinaryteamweeklyandhadaninputinthedevelopmentoftheircareplan.Theyarealsoinvolvedinthedesignofacourseonboat-buildingwhichleadstoaFETACqualificationuptoLevel5.

Governance


ThemultidisciplinarymanagementteaminSt.Michael’sUnitmetweekly,andmettheLocalHealthManagerquarterly.Duetosomeconfusionabouttheroleoftheexecutivecclinicaldirector,thismeetingdidnottakeplaceforsomemonthsduringtheyear.Thematterhadnowbeenresolvedandmeetingsweretakingplaceagain.

InCarraigMór,thereweremanagementmeetingseverysixweeks,buttheydidnotincludeoccupationaltherapyorsocialworkmanagers.Theserviceuseradvocatewasnotcurrentlyinvolvedinthemanagementteam,butmanagementagreedtoreviewthissituation.

TwoauditsontheindividualcareplansinSt.Michael’sUnitwereconducted,andtheheadsofdisciplinecarriedoutasafetyauditoftheservice,includingoutsideunits,duringthepastyear.Thehome-basedtreatmentteamadministeredasatisfactionscaletoeachclientattheendoftheirintervention.Positivefeedbackhadbeenreported.

Ariskmanagementgroupcoordinatedtheresponsetohigh-riskissueswhileminorincidentsweretriagedandreportedeverysixmonthstotheMentalHealthCommission.



Medical Staff


Nursing Staff

post Wte in postDON 1ADON 5Nursesbasedinin-patientservices 145Nursesbasedincommunityresidences 30Communitymentalhealthnurse 15Nursesbasedindayhospitalsanddaycentres 18Other–Temporarystaffpanel 52

367



speciality Wte in postLiaison/Part-timeGP 0.5Clinicalplacementcoordinators 0Nursepracticedevelopmentcoordinator 0Counsellors(including2substancemisuse) 3Advancednursepractitioner 0


post Wte in postClinicalpsychologist 4.5Socialwork 7Occupationaltherapist 5.6Arttherapist 1


In-patientfacilitieswereprovidedatSt.Michael’sUnitandatCarraigMór.AnunannouncedinspectionwascarriedoutinCarraigMórin2009.Betweenthem,theapprovedcentresprovidedanacuteadmissionunit,acontinuingcareunitandaregionalPICU.ClinicalresponsibilityfortheresidentsinthecontinuingcaresectionofCarraigMórwassharedbetweenconsultantpsychiatristsandmanyoftheresidentsdidnotcomefromtheNorthLeecatchmentarea.


TheInspectoratecarriedoutinspectionsineachapprovedcentreduring2009.


StMichael’sUnitwascompliantwiththemajorityoftheregulations.TheservicehadinitiatedcomplianceonlyinregardtoArticle15,provisionofindividualcareplansforresidents.ItwassubstantiallycompliantwithArticle16(therapeuticservices)andArticle26(staffing).

TheapprovedcentreatCarraigMórfailedtomeetfullcomplianceinaconsiderablenumberofRegulations.ItwassubstantiallycompliantwithArticle5,Article19,Article25,andArticle31,buthadonlyinitiatedcomplianceinArticle15,Article16,Article26,andArticle27.


SeclusionwasnotusedinSt.Michael’sUnitandnoresidenthadbeenmechanicallyrestrainedintheunitwithinthepreviousyear.TheservicewassubstantiallycompliantwiththeRulesinrelationtoprovisionofinformationonECT,andwasfullycompliantwiththeremainderoftherulesonECT.

MechanicalrestraintandECTwerenotusedinCarraigMór.Inrelationtotheuseofseclusion,theservicewassubstantiallycompliantwiththesectiononfacilitiesandhadonlyinitiatedcomplianceonstafftraining.

368


Codes of practice

ThecentreatCarraigMórdidnotadmitchildren,hencetheCodeofPracticeonadmissionofchildrenwasnotapplicable.ItwasfullycompliantwiththeCodeofPracticeonnotificationofdeathsandincidents.BothSt.Michael’sUnitandCarraigMórwerefullycompliantwithallsectionsoftheCodeofPracticegoverningtheuseofphysicalrestraintexceptinrelationtostafftrainingonphysicalrestraint.

St.Michael’sUnitwasfullycompliantwiththeCodeofPracticeonnotificationofdeathsandincidents.ItwasonlysubstantiallycompliantwiththeCodeofPracticeonadmissionofchildrenastheunitwasnotsuitablefortheadmissionofchildren.


TherewerenoindividualcareplansasdescribedintheRegulationsonthefirstfloorofCarraigMór.ThePICUinCarraigMórhadgoodcareplans.InSt.Michael’sUnit,comprehensivecareplanshadbeenintroduced,butinalimitedwayowingtolackofmultidisciplinaryteammembers.TheIANrepresentativereportedthatpatientsdidnothavecopiesoftheircareplansandthatinsomeinstancesstaffwerecompletingthem.


Description

TheNorthLeecatchmentareahadfour24-hoursupervisedresidences,threeinCorkcityandoneinMidleton.



GouganeBarraHouse

15 15 Generaladult Nursing

MillfieldHouse 16 16 Generaladult NursingSt.Colman’sHouse 12 12 Generaladult NursingOwenacurra 32 32 Generaladult Nursing

Conclusion

TheNorthLeecatchmentareaserviceprovidedamentalhealthservicetoapopulationofalmost168,000withfourcommunitymentalhealthteams.Ithadnospecialistservicetoproviderehabilitationorpsychiatryoflaterlifecaretoitsserviceusers,buthaddevelopedahome-basedserviceinoneofitssectors.Noneofthesectorteamswerefullyresourcedintermsofmultidisciplinarymembership,forexamplepsychologists,occupationaltherapistsandsocialworkers.Theinabilityoftheservicetoaccessaccommodationforsomeresidentshasresultedininefficientuseofin-patientfacilities.

ResidentsinthecontinuingcaresectionoftheapprovedcentreatCarraigMórdidnothaveindividualcareplansandalthoughcareplanshadbeenintroducedinSt.Michael’sUnit,thesehadnotbeencompletedforallresidents.

369


Theservicecontinuedtodevelopthecommunitycareaspectofitsworkduringthepreviousyear,withprovisionofmultidisciplinarydaytherapy,theopeningofadayhospitalintheCityNorthsector,andanafter-hoursservice.


1. Individual care plans should be introduced for all residents in both approved centres.

2. Specialist services in rehabilitation and psychiatry of later life should be put in place.

3. Plans should be drawn up to provide care in more suitable accommodation for the long-term residents in the continuing care ward of Carraig Mór.

4. Multidisciplinary teams should be adequately resourced to provide full multidisciplinary care.

370


Mental Health services 2009 Catchment area Report south lee

HSEArea HSESouthCatchment SouthLeeMentalHealthService SouthLeeMentalHealthServicesPopulation 179,133NumberofSectors 6NumberofApprovedCentres 2SpecialistTeams Psychiatryoflaterlife

LiaisonpsychiatryPerCapitaExpenditure2008[>18Years] 13,436,089euro[sic]DateofMeeting 21October2009

service 2009


SouthLeeMentalHealthServicehadbothurbanandruralcomponents.Itspercapitafundingwasrelativelylow(75euro).Itscommunityteamswerepoorlystaffedandtherewereminimalcommunityfacilities.TheacuteunitwasinCorkUniversityHospitalandwasnotdesignedtoprovideanacuteservice.TheservicehadtwolongstaywardsinSt.Finbarr’sHospital:St.Monica’sandSt.Catherine’s,whichhadarehabilitationfocus.Therewasnorehabilitationteam.TheservicehadadmittingrightstoCarraigMórwhichwasapsychiatricintensivecareunit.


1. A rehabilitation team should be appointed in the service as a priority.


2. Staffing of the teams should be multidisciplinary and should include an appropriate skill mix.

Outcome: Therehadbeennoprogressonthisrecommendation.

3. Work should progress on making the unit in Cork University Hospital more suitable for all residents.

Outcome: Thenewreceptionareahadbeencompleted.Furtherworkwasrequiredtomeetthisrecommendation.


TheserviceprovidedaLevel1BusinessPlanfortheHSESouth.Theplantoestablisharehabilitationteamandprovidefurthercommunitymentalhealthteamstaffingwasnotduetobeachievedin2009duetofundingrestrictions.


TherehadbeensomereconfigurationofserviceinHeatherside,wherestaffhadbeenreleasedby}}

amalgamatingwards.

371


ThenewreceptionareaintheacuteunitinCorkUniversityHospitalhadbeencompleted.}}

ThecommunityfacilityinSt.Patrick’sStreethadbeenextended.Therewerenowtwooutpatientclinics}}

aweek.

Anearlyinterventionprogrammeforyoungpeoplewithschizophreniawasinprogress.}}

Themusictherapyprogrammewascontinuingandhadbeensuccessful.}}


Therewerecurrentlynoplanstoclosethetwowards(St.Monica’sandSt.Catherine’s)inSt.Finbarr’sHospital.Thelackofarehabilitationteamandcommunityresidentialfacilitieshadmeantthatthereweredifficultiesmovingresidentstomoreappropriateaccommodation.



Therewasregularpeeradvocacythroughouttheservice.TheserviceuserspraisedsomeofthestaffandwelcomedtheactivitiesavailableintheacuteunitandSt.Catherine’sWard.TheresidentsinGlenmalureresidenceproducedaregularmagazine.Therehadbeensomeconcernsraisedabouttherubbishcollectinginthegardenintheacuteunit.Theregularmeetingsbetweennursingstaffandtheadvocatehelpedtoresolvemanyissuesthatarosebutthereportoftheadvocatesuggestedthatthisforumdidn’tfacilitateresolutionofallissues.Thiswasanissuetheserviceneededtoaddress.


Theadvocatehadbeeninvitedtoattendsomemanagementteammeetings.Serviceusershadbeeninvolvedinplanning,implementationandevaluationofcareplanninginmostpartsoftheservice.Twoservicepatientsatisfactionsurveyshadbeencarriedout.TherewasserviceuserinvolvementintheinductionprogrammeforNCHDsandstudentnurses.

Governance


Theseniormanagementteamwasmultidisciplinaryandmeteverysixweeks.Therewasapolicyreviewboardandariskmanagementgroupaswellasaclinicalauditgroup.

Therewasregularreviewofincidentreports.

Psychologystatisticalreturnswereduetobecompletedatyearendandwouldlinktodevelopmentsinpsychologyserviceprovisionearlyin2010.

372



Medical Staff


Nursing Staff

post Wte in postDON 1ADON 5Nursesbasedinin-patientservices 56Nursesbasedincommunityresidences 8Communitymentalhealthnurse 12.42Nursesbasedindayhospitals 4Nursesbasedindaycentre 9.19Temporarystaffpanel 20.17




post Wte in postClinicalpsychologist 5.5Socialwork 3Occupationaltherapist 1Arttherapist 1.31Other 1

373




Liaison Team Report

TeamDescription TheliaisonteamwaslocatedinCorkUniversityHospital.Planneddevelopmentsofgeneralacuteservicestobelocatedinthehospitalwereexpectedtoincreasedemandforliaisonservices.

Population Notprovided





ADON 0 0

CMHN 0 0


Socialworker 0 0






Dayhospital - -

Daycentre - -







ADON 0 0

CMHN 1.82 2.82


Socialworker 0 0





374



Dayhospital 0 0

Daycentre TogherCommunityCentre-rentedand

shared2daysaweekAwbegsuite,CUH

shared

TogherCommunityCentre-rentedand

shared2daysaweekAwbegsuite,CUH

shared


Thereweretwoapprovedcentres.TheacuteunitinCorkUniversityHospitalwasunsuitableindesignasanadmissionunit.Thetwolong-stayunitswerebasedinSt.Finbarr’sHospital.Thestructureoftheseunitswasnotsuitableandmanyresidentsshouldbeaccommodatedincommunityresidences.Intheabsenceofarehabilitationteamanymovementtowardsclosureoftheseunitswasunlikely.



Acute Unit, Cork University Hospital:Theunitwasnon-compliantinindividualcareplanning,therapeuticactivities,premises,orderingprescribingstoringandadministrationofmedicationandstaffing.

St Finbarr’s Hospital:Theunitswerenon-compliantincareplanning,therapeuticactivities,generalhealth,premises,orderingprescribingstorageandadministrationofmedication,staffingandoperatingpolicies.


Acute Unit, Cork University Hospital:Theunitwasnon-compliantinECTandmechanicalrestraint.

St. Finbarr’s Hospital:ECT,seclusionandmechanicalrestraintwerenotusedintheseunits.

Codes of practice

Acute Unit, Cork University Hospital:Theunitwasnon-compliantinECT,physicalrestraint,admissionofchildren,andnotificationofdeathsandincidentreporting.

St. Finbarr’s Hospital:ECTandphysicalrestraintwerenotusedintheseunits.


Integratedcareplanningwasnotfullyinoperationthroughoutthein-patientservicethoughitwasreportedthatitwasinuseinthecommunitysectorteams.Howeverthelownumbersofmultidisciplinarystaffinghadmeantthatthemultidisciplinarycomponentwaslacking.

375



Description

Therewasonlyone24-hoursupervisedresidenceintheSouthLeeMentalHealthService.Despitethelackofarehabilitationteam,therewassocialworkinvolvementinmovingresidentstomoreappropriateaccommodation.



Glenmalure 18 18 CitySouthEastgeneraladultteam

Nursingcareplan

Conclusion

ThelackofresourcesintheSouthLeeMentalHealthServicehadseriouslyhinderedthedevelopmentoftheserviceandhadresultedinpoorinfrastructureandlackofmultidisciplinaryteaminput.Theservicehadimplementedintegratedcareplansinthein-patientservicesbutthemultidisciplinaryinputwaslimited.Thelackofarehabilitationteamhadresultedinlackofanymeaningfulrehabilitationservicealthoughtheservicehadattemptedtocoverthisdeficitasbestitcanwithlittleresources.Itisdifficulttoseeanydevelopmenthappeningwithinthisserviceinthecurrentfundingrestrictions.


1. Every effort should be made to expand the sector mental health teams in terms of staffing and resources.

2. The absence of a rehabilitation team should be addressed.

3. Occupational therapists should be recruited, especially in the acute unit and long-stay units.

4. The service should review its current arrangements for feedback from the peer advocate to ensure that issues raised are addressed appropriately.

376


Mental Health services 2009 Catchment area Report south tipperary

HSEArea HSESouthCatchment SouthTipperaryMentalHealthService SouthTipperaryMentalHealthServicePopulation 83,052NumberofSectors 3NumberofApprovedCentres 2SpecialistTeams Rehabilitation

PsychiatryoflaterlifePerCapitaExpenditure2008[>18Years] 291.69euroDateofMeeting 11November2009

service 2009


Threesectorteamswereinoperationwithinthecatchment:ClonmelEast,ClonmelWestandTipperary.Inadditionthereweretwospecialistteams:rehabilitationandpsychiatryoflaterlife.

ThereweretwoapprovedcentresattachedtoSouthTipperaryMentalHealthServices:St.Luke’sHospital,Clonmel,openedin1835,andSt.Michael’sUnit,anacuteadmissionsunitsituatedinthegroundsofSouthTipperaryGeneralHospital.

SouthTipperarycatchmentalsoprovidedbedstoNorthTipperarycatchment,whichhadnoin-patientbedsofitsown.Anumberoflong-stayresidentsfromNorthTipperarywerecontinuingtoresideinSt.Luke’sHospital.

SincelastyearthenumberofbedsinSt.Luke’sHospitalhadbeenreducedfrom106to83.St.Michael’sUnithad49beds.BothapprovedcentreshadbeensubjecttoaSection55MentalHealthAct2001inquirythereportofwhichwaspublishedinMarch2009.Conditionswereimposedontheregistrationofbothapprovedcentreson14May2009.FullcompliancemustbeobtainedbySt.Luke’sHospitalandSt.Michael’sUnitundertheRegulationsforapprovedcentresinrelationtoindividualcareplans,therapeuticservicesandprogrammes,transferofresidents,provisionofinformationtoresidents,premises,staffingandriskmanagementprocedures.Inadditiontheinquiryrecommendedthatbothapprovedcentresshouldbeinspectedonthreeoccasionsduring2009.


1. Urgent action must be taken to improve the care and treatment of residents in St. John’s Ward and St. Bridget’s Ward. This includes a complete assessment of individual residents’ needs and the provision of therapy and care to meet those needs.

Outcome: St.John’sWardhadclosed.TheaboverecommendationhadbeenachievedinregardtoSt.Bridget’sWard.

2. St. Luke’s Hospital should be closed. In the interim, the conditions in the hospital must be brought to an acceptable standard.

377


Outcome:Conditionsthroughoutthehospitalhadimproved.St.John’sWardhadclosedduringtheyear.ItwasreportedthatclosureplansforSt.Luke’sHospitalwereontrack.ItwasreportedbytheservicethatSt.Bridget’sWardwasscheduledforclosureinJanuary2010.

3. Admissions must cease to St. Luke’s Hospital, apart from appropriate admissions to the psychiatry of later life and rehabilitation services, which are located within the hospital.

Outcome:Thishadbeenachieved.

4. The issue of provision of in-patient services for North Tipperary must be resolved at both management and clinical level.

Outcome:Thisissuewasongoing.


ThelocalserviceplanwassubmittedtotheInspectorateandwasexamined.


Aseven-dayout-of-hoursserviceextendingto2030hhadbeenestablished.}}

St.John’sWardhadbeenclosed.}}

AllwardsinbothapprovedcentreswerenowusingindividualcareplansasdefinedintheRegulations.}}

Aprogrammeofbedclosuresandresettlementofclientsintoalternativeappropriateaccommodation}}

wascontinuing.

ConsumerpanelshadbeenestablishedandmetonthefourthWednesdayofeverymonth.}}

Itwasreportedthatthenewly-appointedexecutiveclinicaldirectorwas,withotherexecutiveclinical}}

directorcolleagues,lookingtowardsformulatingnationalstandardsforaclinicalgovernancestructureforconsistencythroughoutthecountry.

Itwasreportedthattherewasnowbroadagreementamongmoststafffromalldisciplinesthatthe}}

Section55inquiryhadbeenbeneficialtotheservice.


St.John’sWardhadclosedduringtheyear.ItwasreportedthatSt.Bridget’sWardwasscheduledforclosureinJanuary2010.ThenumberofbedsinSt.Luke’sHospitalhadreducedoverthelastyearfrom106to83.ItwasreportedthatthescheduleddateforfullclosureofSt.Luke’sHospitalwas2013.



Thepeeradvocacyservice,itwasreported,hadbeenwelcomedbybothresidentsandstaff.Theadvocacyrepresentativeoutlinedthepositiveaspectsoftheserviceprovidedtoresidentsincludingthatrecreationalactivitiesandtherapeuticprogrammeshadbeenwell-receivedbyresidents.Aroomwasavailabletotheadvocacyrepresentativeshouldtheneedarise.Therelocationofresidentstomoreappropriatefacilitieswaswelcomedbyresidents.Thefoodwasreportedtobeofgoodquality.Staffwere

378


generallyreportedtobefriendlyandapproachable.Theadvocatereportedthattheclinicaldirectorandthedirectorofnursing’sdoorwerealwaysopentohim.

Areasthatresidentsidentifiedcouldbeimproved:ItwasreportedthatSt.Michael’sUnitwasattimescrampedandovercrowdedandthatitlackedagardenwhereresidentscouldavailoffreshair.Residentshadinformedthepeeradvocatethatdifferentstaffondifferentshiftshaddifferentsetsofrulesandboundaries,forexample:timetogotobedandtimeforswitchingtheTVsetoff,which,itwasreported,oftenangeredandconfusedresidents.


Thepeeradvocatereportedthatthevoiceoftheserviceuserwasnowrepresentedatalllevelswithintheservice.Thepeeradvocateattendedprojectteammeetings,policydevelopmentmeetingsandmanagementmeetings.Thepeeradvocatewasnotamemberoftheseniormanagementteam.

Governance


ItwasreportedbyanumberofstaffthattheSection55MentalHealthAct2001inquiryhadbeenacatalystinimprovingstandardsacrosstheservice.AllresidentsofbothapprovedcentresnowhadindividualcareplansasdefinedintheRegulations.


Medical Staff


Nursing Staff

post Wte in postDON 1ADON 4Nursesbasedinin-patientservices 117.8Nursesbasedincommunityresidences 21Communitymentalhealthnurse 6Nursesbasedindayhospitals 10Nursesbasedindaycentre 5Temporarystaffpanel 21.8


speciality Wte in postLiaison 1Clinicalplacementcoordinators 1Nursepracticedevelopmentcoordinator 0Counsellors 5Advancednursepractitioner 0Other(CNS) 9

379



post Wte in postClinicalpsychologist 4Socialwork 3.8Occupationaltherapist 0.8Arttherapist 0Other 0









ADON 0.2 0.2

CMHN 3 3

Clinicalpsychologist 0.5 1

Socialworker 0 0






Dayhospital No No

Daycentre No No

380








ADON 0.2 0.2

CMHN 3 3


Socialworker 1 1






Dayhospital No No

Daycentre No No


ThereweretwoapprovedcentreswithintheSouthTipperaryCatchmentArea:St.Luke’sHospital,ClonmelandSt.Michael’sUnit,locatedinSouthTipperaryGeneralHospital.AnumberofareaswithinSt.Luke’sHospitalwereinneedofrefurbishmentandthiswasreportedintheindividualapprovedcentrereports.ItwasreportedthatconditionsinSt.Michael’sUnitwerecrampedandtheapprovedcentrewascontinuingtooperateabove100percentbedoccupancyrates.



BothapprovedcentreshadcomplianceissueswithArticle26oftheRegulations(staffing):therewasashortfallofhealthandsocialcareprofessionalsacrossallteamsandtherewasalsoaneedforward-basedoccupationaltherapistsinbothapprovedcentres.Article22(premises)complianceissuesrelatedtoSt.Luke’sHospital,whichwasanoldpre-Victorianbuildingopenedin1835andaprogrammeofclosureofthisapprovedcentrewasprogressing.However,therateofthisprogressionwasdependentoncapitalfunding.BothapprovedcentreswerecompliantwithremainingArticles.


St.Michael’sUnitwascontinuingtouseseclusionroomsasbedroomsimposingonthemabreachofRule7.5.

381


Codes of practice

St.Michael’sUnitwasnotsuitablefortheadmissionofchildrenandtherewerebreachesinregardtoSection2.5(b),Section2.5(e),andSection2.5(g).


Multidisciplinarycareplanningwasnowinusethroughoutallwardsinbothapprovedcentres.


Description

Therewerethreecommunityresidencesproviding24-hourcareintheSouthTipperarycatchmentareawithatotalof37places.Tworesidenceswereunderthecareoftherehabilitationteamwhileone,MountSioninTipperaryTown,wasunderthecareofageneraladultteam.



MountSion,TipperaryTown

17 15 Adult MDT

Lorica,Cashel 10 9 Rehabilitation MDTEdelQuin,Clonmel 10 10 Rehabilitation MDT

Conclusion

St.John’sWardinSt.Luke’sHospitalhadclosed.Thebedreductionthisyearhadbeenfrom106to83.ThetimeframeforSt.Bridget’sWardtoclosewasreportedtobeJanuary2010.St.Michael’sUnitwasfrequentlyoperatingatabove100percentoccupancyrateanditwasreportedthatthepracticeofusingseclusionroomsasbedroomswascontinuinginemergencysituations.Therewasalsonoenclosedgardenareawhereresidentscouldavailoffreshair.Bothapprovedcentreswereinspectedthreetimesin2009.EachsubsequentreportshowedthedegreeofincreasingcompliancebybothapprovedcentreswiththeRegulations,RulesandCodesofPractice.Thecommitmentandenergyofstafftoimprovingthequalityofcareofresidentswasobvious.InorderfortheclosureofSt.Luke’sHospitaltobeexpedited,additionalresourcesshouldbeputinplacetoenhancethestaffingofthethreesectorteams,therehabilitationteamandthepsychiatryoflaterlifeteam.

Recommendations and areas for development

1. Written agreement regarding house rules and boundaries, localised to individual wards, should be established across all shifts, day and night, in both approved centres, so that these house rules and boundaries are clearly visible in written form to both residents and staff.

2. The closure plan for St. Luke’s Hospital should be expedited.

3. Former residents of St. Luke’s Hospital should be placed in appropriate settings based on need.

4. The skill mix of staff on the three sector teams, the rehabilitation team and the psychiatry of later life team should be in accordance with A Vision for Change recommendations.

5. The issue in relation to the provision of in-patient beds for North Tipperary should be resolved.

382


Mental Health services 2009 Catchment area Report Waterford

HSEArea HSESouthCatchment WaterfordMentalHealthService WaterfordMentalHealthServicesPopulation 123,000NumberofSectors 4NumberofApprovedCentres 2SpecialistTeams Rehabilitation

PsychiatryoflaterlifeChildandadolescent

PerCapitaExpenditure2008[>18Years] NotreturnedDateofMeeting 20May2009

service 2009


WaterfordMentalHealthServicesoperatedtwoapprovedcentres:theDepartmentofPsychiatryatWaterfordRegionalHospital,with44acutebeds,andSt.Otteran’sHospital,with78bedsforrehabilitationandpsychiatryoflaterlife.

ThecatchmentincludedSouthKilkennyandhadatotalpopulationof123,844foradultservicesand120,017forchildandadolescentmentalhealthservices.Therewerefoursectorteams:EastWaterford,MidWaterford,WestWaterfordandSouthKilkenny,andthreespecialistteams:psychiatryoflaterlife,rehabilitationandchildandadolescent.


1. Each resident of the two approved centres must have an integrated individual care plan as defined in the Regulations.

Outcome:IndividualcareplanswerebeingintroducedintheDepartmentofPsychiatryandinSt.Otteran’s,individualcareplanswerebeingrolledoutoneresidentatatime.

2. Consideration should be given to amalgamating sectors in line with national health policy.

Outcome:WaterfordandWexfordwereamalgamatingcatchmentareasinlinewithA Vision for Changerecommendationsandtheappointmentofanexecutiveclinicaldirectorwasimminent.

3. Community mental health teams should be adequately staffed in order to provide a comprehensive community service.

Outcome:Areconfigurationofstaffwasinprocess.TherecruitmentoftwooccupationaltherapistswasabouttotakeplaceastheservicehadonlyjustreceivedclarificationfromtheHSEthatthesepostswereexemptfromthepresentmoratoriumonrecruitment.

383


4. Local health management should actively support the closure plans for St. Otteran’s Hospital and the rehabilitation team should be properly staffed as a measure to achieve this. A project team for closure of the hospital should be appointed from within the service.

Outcome:AgrouphadbeensetuptolookatthebroaderrecommendationsinA Vision for Change.OverthepreviousyearthenumberofbedsinSt.Otteran’sHospitalhadfallenfrom115to78.


InlinewithA Vision for Change,andwithrequirementsfrompreviousInspectoratereports,aplanwasbeingdevelopedtoprovidefortheclosureofSt.Otteran’sHospital.


St Otteran’s Hospital

Asub-committeewithaconsultantpsychiatristasleaderhadbeenestablishedtodevelopan}}

integratedfileincorporatingacollaborativecareplanforresidentsofSt.Otteran’s.

Screeningofclientsonpsychotropicmedicationwasbeingconductedwithgeneralpractitioners.}}

Pilotoutreach–onepatientinindependentlivingwasbeingmanagedbyaCNSontherehabilitation}}

team.

Department of Psychiatry, Waterford Regional Hospital

Auditsofadmissionprocedureswerebeingcarriedout.}}

Aninteractionalpsychotherapygroupwasestablished.}}


InlinewithA Vision for Change,andwithrequirementsfrompreviousInspectoratereports,aplanwasbeingdevelopedtoprovidefortheclosureofSt.Otteran’sHospital.

Twelvelong-stayresidentshadbeentransferredtonursinghomes.

Thetransferof16residentsfromSt.Claire’sWardtoapurpose-builtunitoncampus,Grangemore,wasimminent.

TheclosureofSt.Joseph’sWardforrefurbishmentwasabouttotakeplace;followingthisrefurbishmentandthebuildingofanenclosedgarden,theresidentsofSt.Aidan’sWardweretobetransferredthere.

Anew4-placelowsupportresidencewasbeingpurchasedandasecondresidencefortworesidentswastoberented.Residentsandtheirfamilieshadalreadybeencontactedregardingassessmentsfortheseplaces.

RemainingresidentswouldbelivinginSt.Monica’sWardandSt.Joseph’sWard.

Theabovedevelopmentswillenabletheoldhospitaltobevacated.

384




Residentsreportedthatthefoodwasofgoodquality.Therelaxationsessionsfacilitatedbynursingstaffwereenjoyedbyresidents.Musictherapyhadbeenfacilitatedsomemonthsagowhichwasenjoyedbyresidentsanditwashopedthatthistherapymightbearegularpartofthetherapeuticprogramme.ResidentsstatedthattheyfoundthetalksgivenbysupportorganisationssuchasGROW,AWARE,Shine,andBefriendingverybeneficial.

Residentsfeltthatdifferentstaffhaddifferentsetsofrulesthatwerequiteconfusingforthem.TheyalsofeltaneedforanopenspaceorgardenattheDepartmentofPsychiatry.

Itwasreportedbytheadvocacyrepresentativethatclientsonthe10-bedacuteunitintheDepartmentofPsychiatryhadnoaccesstoadvocacyservices.


WaterfordMentalHealthServiceshadapolicyofincludingserviceusersontheirdecision-makingbodies.

ItwasreportedatthecatchmentmeetingthataserviceusernomineehadbeenrequestedbytheexecutivemanagementteamforformalinclusionontotheexecutivemanagementteaminlinewithA Vision for Changerecommendations.Theadvocacyrepresentativeconfirmedthenameofthenominee.

Governance


Inadmissionprocedures,anewadmissionproformawasintroduced.}}

Aliaisonpsychiatryauditwasbeingcarriedout.}}

ApsychotropicusageauditwasbeingcarriedoutbytherehabilitationserviceinconjunctionwithGPs.}}

Thenursingcareplanwasauditedbythenursepracticedevelopmentco-ordinatorandclinical}}

placementcoordinator.

AnursingtrainingauditwasconductedbyAnBordAltranaisin2009.}}

Inmedicationmanagement,patientswerebeingencouragedtoself-medicate.}}

Themultidisciplinaryteampolicydevelopmentgroupwasmakinganongoingcontributionto}}

developingservicepolicies.

Aclinicalreviewgroupwasreportingintothemultidisciplinaryteampolicydevelopmentgroup.}}

Aninteragencygrouponsuicideprevention,withparticipationfromthementalhealthservice,}}

submittedareporttoacitydevelopmentboardforimplementation.

385



Medical Staff


Nursing Staff

post Wte in postDON 1ADON 4Nursesbasedinin-patientservices 108.9Nursesbasedincommunityresidences 21Communitymentalhealthnurse 7Nursesbasedindayhospitals 8.5

(4BrookHouse,4Newport,0.5Lismore)

Nursesbasedindaycentre 0Other–Temporarystaffpanel 0


speciality Wte in postLiaison 0Clinicalplacementcoordinators 1Nursepracticedevelopmentcoordinator 0Counsellors 0.5Advancednursepractitioner 0Other 6


post Wte in postClinicalpsychologist 5.5Socialwork 4.6Occupationaltherapist 1Arttherapist 0Other 0

386










ADON 0.3 0.3

CMHN 2 2








Dayhospital 0 0

Daycentre 0 0

Rehabilitation team report






ADON 0.5 0.5

CMHN 1 2


Socialworker 1 1






Dayhospital 0 0


387


CAMHS Team Report

TeamDescription ChildandAdolescentPopulation 30,249





ADON 0 0

CMHN 1 1








Dayhospital 0 0

Daycentre 0 0


WaterfordMentalHealthServicesoperatedtwoapprovedcentres:theDepartmentofPsychiatry,whichhad44acutebedsatWaterfordRegionalHospital,andSt.Otteran’sHospitalwith78bedsforrehabilitationandpsychiatryoflaterlife.

Theresident’sfromSt.Claire’sWardwereabouttobetransferredtothepurpose-builtGrangemoreunit,astand-aloneunitoncampus.



ThemajorityofRegulationshadbeenmetbytheservice,thoughinthecaseofanumberofRegulations,compliancehadonlybeeninitiated,andinafewinstancestheservicewasnotcompliant.Therecontinuedtobeaneedforcareplanningthroughoutbothapprovedcentres.ThecurrentpremisesandthelackofprivacyinsomeunitswereinbreachofRegulations.


TheservicewascompliantwithallRules.

Codes of practice

TheservicerangedfromcomplianceinitiatedtofullycompliantwithallCodesofPractice.

388



TheDepartmentofPsychiatryatWaterfordRegionalHospitalwasintroducinganintegratedcareplanonarollingbasisin2009.TheimplementationofthisnewintegratedcareplanwasSeptember2009.

InSt.Otteran’sHospital,thenewintegratedcareplanhadsofarbeenappliedonlytoalimitednumberofresidents.


Description

Theservicehadtwo24-hoursupervisedcommunityresidences,oneofwhichwasinspectedbyamemberoftheInspectorateteam.Bothwereundertheclinicaldirectionoftherehabilitationteam.



ArdnaDéise 13 13 Rehabilitation NursingSpringmountHouse 14 11 Rehabilitation Nursing

Conclusion

Therehavebeensomeimprovementsintheservicesince2008withanumberofqualityimprovements.TherehadbeensomeprogressincommencingtheclosureofSt.Otteran’sHospital.ItwasdisappointingthatdespiteareductioninresidentnumbersinSt.Otteran’stherehasbeennoincreaseinstaffingnumbersinthecommunitymentalhealthteam.TheservicehadcommencedworkontheintegratedcareplanninganditwashopedtocommencethisinSeptember2009.


1. The composition of the teams should be enhanced with the necessary multidisciplinary professionals.

2. A risk assessment should be undertaken regarding access to the garden facilities for residents at the Department of Psychiatry, Waterford Regional Hospital.

3. Individual care plans should be introduced in line with the requirements of the Regulations.

4. Training in multidisciplinary care planning should be provided for all staff.

5. The information booklet for residents should be completed and introduced for all residents and families.

6. Advocacy services should be available in the acute unit at the Department of Psychiatry, Waterford.

7. There should be a written plan for the closure of St. Otteran’s Hospital, with time frames, reduction of bed capacity, and enhancement of specialty and sector teams to ensure residents have an

adequate follow-up on discharge to the community.

389


Mental Health services 2009 Catchment area Report West Cork

HSEArea HSESouthCatchment WestCorkMentalHealthService WestCorkMentalHealthServicesPopulation 53,445NumberofSectors 1NumberofApprovedCentres 1SpecialistTeams NonePerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 25June2009

service 2009


WestCorkwasamainlyruralcatchmentareaandhadonelargesectorwiththreesub-sectors.Therewasoneteamcoordinatorwhoprocessedallreferralstothecommunityservice.TheapprovedcentrewasinBantryGeneralHospitalandhad18beds.Therewerenolong-staybedsintheservice.Therewerethree24-hoursupervisedcommunityresidences.Theservicehadalonghistoryofserviceuserinvolvementandwasactiveinmentalhealthpromotionandnetworkingwithvoluntaryorganisations.Staffingofmultidisciplinaryteamsremainedlow.


1. The approved centre must be compliant with all Regulations, Rules and Codes of Practice.

Outcome:TherehadbeensignificantimprovementinthisareaandtheapprovedcentrewasnowcompliantwiththemajorityofRegulations,RulesandCodesofPractice.

2. The sector teams should be adequately staffed with core members of the multidisciplinary team.

Outcome:Thishadnotbeenachieved.Therewerestillsignificantgapsinteamstaffing.

3. The service should continue to develop service initiatives in the current environment of financial and staffing restraints that can be sustained over time.

Outcome:Theservicehadcontinuedtodevelopserviceinitiativeswhichwereserviceuserorientated.


The2009servicebusinessplanincludedthefollowing:

ExtensionandrefurbishmenttoPerrottHouse,a24-hoursupervisedcommunityresidence.}}

PreparationasahostexchangesitefortheInternationalInitiativeforMentalHealthLeadership2010.}}

ProgressionofBantrysocialhousinginconjunctionwithCorkMentalHealthFoundation.}}

390


Developmentofthethirdsub-sectorinClonakilty.}}

ProgresswithPhase2oftheco-operativeLearningLeadershipProgramme2009/2010.}}

Developingandrecruitingafull-timeserviceuserpost.}}

Developmentofaserviceuserfocusgroup.}}

Developmentofabefriendinggroupinconjunctionwithvoluntaryorganisations.}}

Developmentofasupervisionpolicyforallstaff,includingteambuildingandtraining.}}


Anewmedicalrecordsdepartmenthadbeendeveloped.Anauditofmultidisciplinaryintegrated}}

clinicalfileshadbeencompleted.

Thesecondphaseoftheresidentialreviewhadbeencompleted.}}

Therewereanincreasednumberofactivitiessuchasmusicandartsessionsintheacuteunit.}}

Acommunitygardenprojecthadcommenced,usingcommunityallotments.}}

TheartprojectTheRoadtoRecoverywasbeingcompletedbyserviceusers,staffandvolunteers.}}

AMovingTowardsRecoverygrouphadbeendevelopedbytheoccupationalandpsychology}}

department.Thiswasaskill-basedgroupforyoungadultsandprovidedcommunitybasedactivities,peersupportandcopingskills.Examplesincludedrelaxation,cooking,kayaking,sailingandmindfulness.

Agardenhadopenedintheacuteunitandagardeninggrouphadcommenced.}}

Adrop-incentrecalled“AisEirí”hadopenedandwasmanagedbyamentalhealthsupportworker.}}

Acarerspackhadbeendeveloped.}}

TheassertiveoutreachprogrammeHomeFocushadbeenextended.}}

Anadvancednursepractitionerpostformentalhealthinaprimarycaresettingwasbeingdeveloped.}}

TheWellnessRecoveryActionPlan(WRAP)programmehadbeenimplementedinSaolNua.}}

Therewasacommunitymentalhealthforumwhichconsistedofanallianceofcommunityactivists,}}

serviceusers,carers,PrimaryCommunityandContinuingCare(PCCC)andserviceproviders.

TheWestCorkMentalHealthWeekhadbeenplannedinOctober2009.}}

391




ThroughtheIrishAdvocacyNetwork,serviceusersstatedthattheywerepleasedwiththeserviceoffered.Theyfeltthattheservicewasserviceuserorientated.Thereweresomeconcernsexpressedaboutthefactthatjuniordoctorschangedeverysixmonthsandthishadadetrimentaleffectonthecontinuityofcare.

Apatientinformationpackhadbeendevelopedandwasgiventoresidentsandcarers.


TheWestCorkCooperativeLearningLeadershiphadimplementedaquestionnaireforallpeopleinvolvedwiththeservicewithaviewtomakingchangesintheservice.

ThedropincentreAisEiríhadopened.

AserviceuserandcarerrepresentativeparticipatedontheWestCorkpolicydevelopmentgroup,themedicalrecordscommittee,theresidentialreviewcommitteeandtheriskmanagementgroup.Allchangesanddevelopmentsinservicewerediscussedwiththeserviceusersandacarerrepresentative.

TheWestCorkMentalHealthForumhadinformalmonthlymeetingstoprovideachannelforserviceuserstovoiceopinions,identifysupportsandengagethecommunitywithmentalhealthissuesandchallengethestigmaofmentalhealth.

Governance


Anauditofthemultidisciplinaryintegratednoteshadbeencompleted.

Thereviewofresidentialplaceswasinitssecondphase.

Therewasnoformalauditorreviewsysteminplace.Informationwasavailableonanumberoftopics,includingassistedadmissions,Gardaescorts,transfers,outpatientattendancesandadmissions.Therehadbeenanincreaseinreferralstotheservicein2008.

Therewereanumberofcommitteestoreviewcurrentpracticesandmakerecommendations.Theseincludeariskmanagementcommittee,hygienecommittees,policydevelopmentgroupandexternalreviewcommittee.

392



Medical Staff


Nursing Staff

post Wte in postDON 1ADON 4Nursesbasedinin-patientservices 20Nursesbasedincommunityresidences 30Communitymentalhealthnurse 4Nursesbasedindayhospitals 0Nursesbasedindaycentre 0Nursesbasedinresourcecentre 1


speciality Wte in postLiaison 0Clinicalplacementcoordinators 0Nursepracticedevelopmentcoordinator 0Counsellors 3.2Advancednursepractitioner 0Primarycarenurse 1


post Wte in postClinicalpsychologist 1Socialwork 2.2Occupationaltherapist 1.85Arttherapist 0Teamcoordinator 1


Therewerenospecialistteamsintheservice.

CommunityMentalHealthTeam(CMHT)staffingnumbersbysectorareavailableontheMentalHealthCommissionwebsitewww.mhcirl.ie


Therewasoneapprovedcentre:theacuteunitinthegroundsofBantryGeneralHospital.Ithad18beds.Itwasunsuitableasanadmissionunitasitwaslaidoutonthreelevels,hadnarrowcorridorsandwassmallandcramped.Itoperatedatapproximately50percentoccupancy.

393




TheacuteunitinBantryGeneralHospitalwascompliantwithallRegulationsapartfromArticle22(Premises).Thepremiseswasunsuitableforanadmissionunit:itwasonthreelevelsandwastoosmall.


NoECT,seclusionormechanicalrestraintwascarriedoutontheunit.

Codes of practice

TheapprovedcentrewasinbreachofArticle2.5oftheCodeofPracticerelatingtotheadmissionofchildreninthattheunitwasunsuitablefortheadmissionofchildren.

ItwascompliantintheCodeofPracticeonthenotificationofdeathsandincidentreporting.

Theapprovedcentrewasnon-compliantintheCodeofPracticeonphysicalrestraintasstafftrainingwasnotadequate.


Theservicewascurrentlypilotingasecondrevisedmultidisciplinarycareplan.Thisappearedtobeworkingwellandmettherequirementsofamultidisciplinarycareplan.Residentswereabletosigntheircareplanandcouldreceiveacopy.Teammeetingswereheldweeklyintheunit.


Description

Therewerefour24-hoursupervisedresidencesinWestCork.PerrottHousewasalargesupervisedresidenceinneedofsomerenovation.



PerrottHouse 24 24 Generaladult MDTArdRéalt 10 9 Generaladult NursingElmwoodHouse 11 11 Generaladult MDTSaolNua 8 7 Generaladult MDT

Conclusion

WestCorkmentalhealthservicecontinuestoprovideaserviceuserorientatedservicewithamultidisciplinaryfocus.Therearenowmultidisciplinarycareplansforallresidents.Therearealargenumberofinitiativesthatdirectlyinvolveserviceusersandalsousevoluntaryandcommunityagencies.Theoperationofthecatchmentasonelargesectorappearstobeworkingwell,andtheprovisionofathirdconsultantiswelcome.Thereisstilladeficiencyinmultidisciplinarystaffing.Thehomefocusteam

394


hasreceivedfundingtocontinueuntilDecember2009.Howeveritisdifficulttodevelopthisservicewithpiecemealfunding.Therearenospecialityservices.

Theproblemwiththestructureoftheacuteunitremainsanditisdifficulttoseehowthiscanberectifiedundertheconstraintsofthebuilding.Thereisnohighobservationareaintheunit.Theopeningofthenewgardenprovidesawelcomeoutdoorspaceandgardeningactivities.

Recommendations and areas for development

1. There should be an increase in multidisciplinary staffing in line with national policy.

2. An alternative to the current acute unit should be considered.

3. The Home Focus team should be provided with ongoing funding.

395


Mental Health services 2009 Catchment area Report Wexford

HSEArea HSESouthCatchment WexfordMentalHealthService WexfordMentalHealthServicesPopulation 131,615NumberofSectors 2NumberofApprovedCentres 1SpecialistTeams Rehabilitation

PsychiatryoflaterlifePerCapitaExpenditure2008[>18Years] 195euroDateofMeeting 20May2009

service 2009


WexfordMentalHealthServicesprovidedaservicetothepopulationofCountyWexford.Serviceswereprimarilydeliveredviatwolargesectorteamsandtwospecialityteams.Theservicehadembracedandsettargetstoachieveachangeprocessthatisintendedtoseeitsdevelopmentplanimplementedinfull.ThepopulationofWexfordwasamixtureofruralandurbancentres.Theservicehadaccesstooneapprovedcentreandhaddevelopedanumberofcommunityservices.


1. Sleeping out of patients in other wards must cease.

Outcome: Thiscontinuedatalowerlevel.Informationonnumberswasprovided.AnewformalagreementwasbeingprogressedwiththeDepartmentofPsychiatryinWaterfordRegionalHospitalwhichwouldallowacuteadmissionifnecessary.

2. All teams must be staffed to the required level outlined in the national policy document.

Outcome:NoadditionalpostshadbeenallocatedtotheservicesinceDecember2008.Anumberofnursingpostshadbeenredeployedfollowingtheclosureofwards.

3. All residents with an intellectual disability living in the hospital must be relocated to more suitable accommodation.

Outcome:Sincethelastinspection,St.Bridget’sWardhadclosedandtheresidentshadmovedtoanewpurpose-builthomeinanearbyvillage.Therewerestill17residentswithanintellectualdisabilitylivingininstitutionalcareatthetimeofwriting.Itwasreportedthatinordertorelocatepeopletothecommunityadditionalfundingwasrequiredbutnosuchfundingwascurrentlyavailable.

4. The hospital closure plan must be funded and resourced.

Outcome:Thestaffoftheservicehadworkedextremelyhardtoprogresstheclosureplan.Theyhadbeencreativeinworkingwithinbudgetaryconstraints.Theywerenowatthepointwhereadditionalfundingwasrequiredandadecisiontakenonthefuturelocationofacutein-patientservices.

396


5. Nursing home care must be funded for those residents for whom it is appropriate.

Outcome:Todatethefundingfornursinghomecarehadbeentakenfromthementalhealthservicesbudget.AnumberofresidentshadbeenplacedinnursinghomecareandfollowedupusingthecodeofpracticeissuedbytheMHC.Thenursinghomeresettlementprogrammewasbeingfundedfromthementalhealthrevenuebudget.

6. Any money raised from the sale of the lands must be ring-fenced for the provision of services in Wexford.

Outcome:NolandhadbeensoldsincethelastInspectoratereport.


Theservicecontinuestoworkfromits5yearplan2007-2011.AnumberofcapitalprojectshadbeensubmittedtotheHSEdevelopmentplanforconsideration.


Theclosureofthreewards,relocationofserviceuserstoappropriatecarefacilities,andthe}}

redeploymentofnursingstafftocommunityteams.

Thecontinueddevelopmentoftheliaisonandsuicidecrisisassessmentnurse(SCAN)serviceat}}

WexfordGeneralHospital.Itwastobeexpandedtoaseven-dayservicein2009.Researchandpublicationoffindingswasinprogress.

Fournurseshadbeenassignedtoanassertiveoutreachcomponentoftherehabilitationteam,twoto}}

eachsector.Initialfindingswerepositive.

AnewMentalHealthCentreforGoreyTownwasatcommissioningstage.Fundingwaspending.}}

Thedayservicesweretobereconfiguredtooptimisetheuseofhumanresourcesandprovidea}}

FurtherEducationandTrainingAwardsCouncil(FETAC)accreditatedcourseforserviceusers.

Theoccupationaltherapyservicehadbeenreconfiguredtomaximisetheuseof3.0whole-time-}}

equivalentpostsacrossthesectorsandin-patientservices.

ThepsychologyservicehadestablishedtheWexfordInformationandSelfHelp(WISH)schemeto}}

increaseaccesswithinthepublicandprimarycareservicestogoodqualityself-helpmaterialsintheareaofmentalhealthandemotionalandpsychologicalwell-being.

Formallinkshadbeenestablishedbetweentheserviceandchildcareservices.}}

Twoadditionalstaffwerebeentrainedashealthcareassistants.}}


Thehospitalhadafive-yearplanforitsclosureandfortherelocationofserviceusersandservicestoappropriateenvironments.Itwascurrentlyontargetbuttherewasnoadditionalfundingavailabletoprogresstothefinalstages.Therewasnodecisiononthelocationofacuteservicesinthefuture.

397




ApeeradvocacysupportservicewasprovidedbytheIrishAdvocacyNetwork(IAN).CurrentlytherewasaweeklyservicetotheacutewardsinSt.Senan’sHospitalandaquarterlyservicetotwodayhospitalsinthecounty.Noservicewasprovidedtothelong-staywardsduetolackofhumanresources.Itwasplannedtocommenceatrainingprogrammeforvolunteerswhocanworkwiththeadvocate.

TheadvocateinawrittenreporttotheInspectoratewaskeentohighlightthesupportandwelcomethatwasprovidedbystafftotheIAN.Serviceusersreportedsatisfactionwithnursingstaff,thequalityoffoodandtheavailabilityofopenspace.ServiceusersreportedtotheIANconcernsaboutthelackofsocialworkercoverformaternityleave,lackofstimulationontheacutewards,anddifferentrulesinoperationondifferentnursingshifts.

Therewasasysteminplacefortheadvocatetoreportanyconcernstothedirectorofnursing.Itwasplannedthatthiswouldbeformalised.


Ataclinicallevel,anumberofserviceuserswereinvolvedinsigningtheirowncareplans.Allwereinvitedtoattendreviews.

Ataplanninglevel,theIANrepresentativewasinvolvedinVision for ChangeimplementationmeetingsandintheSCANservice.TherewereplansfortheIANadvocatetobeinvolvedinmultidisciplinaryteamclinicalgovernancemeetingsandinpolicydevelopmentmeetings.

Governance

Therewasamultidisciplinaryteammanagementstructureinplace.Theoccupationaltherapistmanagerwasbasedoutsidethementalhealthservicebutdirectlysupervisedclinicalstaff.Sincelastyear’sinspectionasocialworkerteamleaderhadbeenappointedtothemultidisciplinarymanagementteam.

Anewclinicalgovernancecommitteehadbeenestablished.Itsremitincludedreviewsofallincidents,seclusionandrestraint.

Theservicewaspartofamulti-centrestudyonsuicidecrisisassessment.Researchwascontinuing.Inaddition,theservicehadactedonrecommendationsmadeintheindependentreportcommissionedfollowingin-patientsuicides.Thishadresultedinthedevelopmentofachecklistforresidentsreturningfromleave.Itwasthepolicyoftheservicetocommissionanindependentreportfollowinganin-patientsuicide.

Atthetimeofinspection,therewerefourteamswithanominatedteamleaderandpart-timeteamco-ordinatorinpost.

398



Medical Staff


Nursing Staff

post Wte in postDON 1ADON 5Nursesbasedinin-patientservices 80Nursesbasedincommunityresidences 25.5Communitymentalhealthnurse 15Nursesbasedindayhospitals 12Nursesbasedindaycentre IncludedinfigureaboveTemporarystaffpanel 20


speciality Wte in postLiaison 2Clinicalplacementcoordinators 1Nursepracticedevelopmentcoordinator 1SharedCounsellors 2Advancednursepractitioner 0Other 0



399










ADON 0.5 0.5

CMHN 3 5








Dayhospital 0 0

Daycentre 2Shared 2Shared







ADON 0.5 0.5

CMHN 4 4









Daycentre 1 1

400



In-patientfacilitieswereprovidedinSt.Senan’sHospital.Ithadthreeprimaryfunctions,theprovisionofacutecare,continuingcareandcareforpersonswithanintellectualdisability.

Thefacilitieshadbeenthesubjectofmuchcriticismovertheyears.Thebuildingwasalargeoldinstitution,unsuitablefortheprovisionofcareandtreatment.Itwasunacceptablethatpersonswithanintellectualdisabilitycontinuedtoliveininstitutionalcare.



St.Senan’sHospitalhadworkedveryhardataddressinganydeficitsfrompreviousreports.Multidisciplinarycareplanninghadbeenrolledouttoallthewards.Anumberofbarrierswereoutsidethecontrolofthelocalmanagementteamincludingthecontinueduseofalargeinstitutiontoprovidecareandtreatment.

ThedetailedindividualapprovedcentrereportisavailableontheMentalHealthCommissionwebsite.


TheservicehadECT,seclusionandmechanicalrestraint(Part5)inuseinthehospital.Theservicewaslargelycompliant.Detailsaregivenintheapprovedcentrereport.

Codes of practice

Theserviceusedphysicalrestraint,reportedincidents,providedECTandadmittedchildren.Thehospitalwasunsuitablefortheadmissionofchildren.Regionalbedsplannedfortheareawerenotyetoperational.Detailsaregivenintheapprovedcentrereport.


Multidisciplinarycareplanninghadcommencedintherehabilitationteam.Itwasbeenextendedtothegeneraladultteams.AcommonassessmenttoolwasbeendevelopedandpilotedintheSouthsector.

401



Description

Therewerethreecommunityresidencesintotal.Allwereundertheclinicaldirectionoftherehabilitationteam.Twowerededicatedtopeoplewithanintellectualdisability.

Theteamhadaccesstothreemediumsupportresidencesandsixlowsupportresidences.Allserviceuserswereregisteredashavingahousingneedwiththecountycouncilasappropriate.



Ardmine 11 11 Rehabilitation MDTWestlands 8 8 Rehabilitation MDTBallynaslaneyHouse


Conclusion

ThestaffandmanagementofWexfordMentalHealthServiceshaveagainreportedpositivedevelopmentswithintheservice.Thesehavespannedtheclosureofwards,provisionofsuitableaccommodationinthecommunityforresidents,andthedevelopmentoflinkswithotherprovidersandpartnersinthecounty.Thefive-yeardevelopmentplanwasontarget.Staffhavebeenredeployedasappropriate.

Therehasbeensignificantprogressmadeintheareaofserviceuserinvolvementintheserviceandtherewereplansforthistobeprogressedfurther.

TheremainingtargetsthatwillbringaboutcompletionoftheVision for Changeimplementationplanaredependentonadditionalresourcesandfunding.

TheHSEmustaddressimmediatelythecontinueduseofinstitutionalcareinunacceptablestandardsforthosewithanintellectualdisabilityandthosewhoremainonlong-staywardssimplybecausecommunityaccommodationhasnotbeenprovided.Theprovisionofacuteservicesinappropriateenvironmentsmustbefast-tracked.Thecurrentwardsareunacceptableandlackprivacy.


1. The hospital must close and alternative and appropriate accommodation must be provided based on assessed needs of the residents.

2. Acute in-patient services must be provided in a general hospital and an action plan put in place to achieve this.

3. Sleeping out of residents from the acute wards poses risk management issues is an unacceptable practice and must be discontinued.

4. The teams must be staffed in line with national policy agreements.

5. Multidisciplinary care plans must be extended to all areas.

402


Hse West

Mental Health services 2009 Catchment area Report Clare

HSEArea HSEWestCatchment ClareMentalHealthService ClareMentalHealthServicesPopulation 110,950NumberofSectors 4NumberofApprovedCentres 3SpecialistTeams Psychiatryoflaterlife

RehabilitationPerCapitaExpenditure2008[>18Years] Totalexpenditure24,993,450euroDateofMeeting 4June2009

service 2009


ClareMentalHealthServicescoverapopulationof110,950whichisspreadacrossalargegeographicalareawithapoorinfrastructure.Therearefourgeneraladultcommunitymentalhealthteamsandtwoestablishedspecialityteamsinpsychiatryoflaterlifeandrehabilitation.Servicedeliveryiscommunitybased.

Thecatchmenthadthreeapprovedcentres.Oneofthem,CappahardLodge,hadshownlittleevidenceofprogressinrelationtocompliancesinceitwasregisteredinOctober2008,andapproximatelyeightmonthsafterreceivingrecommendationsfromtheInspectorateinrelationtocompliance.IntheviewoftheInspectorate,therewasalackofagreementaboutthenatureoftheserviceandanabsenceofstrongleadershiptobringaboutcompliancewiththeRegulations,RulesandCodesofPractice.Thesestatutoryminimumstandardswerenotbeingappliedtothecareandtreatmentofresidents,therebyincreasingclinicalrisksandbreachingtherightsofresidents.


1. The management team should be representative of all disciplines that have knowledge of the provisions of mental health services.

Outcome:Operationalmanagementcontinuedtobeconductedalongtraditionaltripartitelines.AmanagementsteeringgroupcomprisingmultidisciplinarystafffrommentalhealthandPrimaryCommunityandContinuingCare(PCCC)andtheIrishAdvocacyNetwork(IAN)representativehadbeenestablished.

2. All teams should be fully resourced.

Outcome:CompletionofcommunitymentalhealthteamsinlinewithA Vision for Changearebeingprogressedinsofarascurrentfinancialconstraintsandacceptanceofchangingpracticewithintheserviceallows.

403


3. Each approved centre should be compliant with the Regulations.

Outcome:NoneofthethreeapprovedcentresintheClarecatchmentwerefullycompliantwiththeRegulations,RulesandCodesofPractice.CappahardLodgehadanunacceptablylowlevelofcompliance.


AcopyofthelocalmentalhealthserviceplanwasrequestedbytheInspectoratebutwasnotforwarded.


2008 Developments

Implementationof}} Vision for Change:RecommendationsfromA Vision for Changewereprogressedthroughsub-committees,e.g.careplanning,sectorreview.Alocalmultidisciplinarymentalhealthsteeringgroupwasestablished.

Generaladultpsychiatry:Thesectorreviewsub-committeeprogressedworkconcerningreconfiguration}}

ofsectorsinlinewithA Vision for Changerecommendations,alignedwithprimarycareteams.

Childandadolescentmentalhealthservices:TraininginChildrenFirstwasundertakenbyidentified}}

staffandlinkageswiththechildandadolescentmentalhealthservice(CAMHS)teamcontinuedtobeadvancedinlinewithbestpractice.

Authorisedofficers:Staffwereidentifiedin2008toundertaketraining.}}

CappahardLodge:AreviewofpoliciesandproceduresatCappahardLodgewasundertakenwhich}}

informedfutureservicedeliveryatCappahardLodge.

Reconfiguration:Anumberofnursingpostsweretransferredtocommunitysettingstomeetincreasing}}

needs.

2009 Developments

Nursinghometransfers:DuringFebruaryandMarch2009,24patientsfromthelong-stayunit}}

transferredtonursinghomeaccommodationonfootofmultidisciplinaryteamassessment.

Nursingresources:Therewereongoingdiscussionsconcerningthereconfigurationofnursingresources}}

inlinewiththestrategicpolicyobjectivesofA Vision for Change.

CappahardLodge:ChangestostaffingpracticesinlinewithQualityFrameworkforMentalHealth}}

Services(MentalHealthCommission2008)andtheResidentialStandardsforOlderPersonServices(HIQA2008).

QualityFrameworkroll-out:RolloutandimplementationofaspectsoftheQualityFrameworkwas}}

advancedthroughpilotingofindividualmultidisciplinarycareplansatsectorlevel.Individualcareplansbasedontherecoverymodelalreadyinplaceinrehabilitation.

Qualityriskstandardsandgovernance:TheClarementalhealthserviceswereintegratedintothenew}}

governancestructureinClarePCCC.ThenewstructurewasintendedtofacilitateprogressoftheMentalHealthServicequalityagenda.Forexample,sinceJanuary2009theservicehadhadaccesstothePCCCinfectioncontrolnurseandthiswashelpingtoprogressandembedacultureofqualityawarenesswithinthementalhealthservices.

404


Mentalhealthandprimarycare:Therewasaconsolidationoflinkageswithprimarycare.Thearea}}

manageranddirectorofnursingwererecentlyjoinedbyaconsultantpsychiatristonthelocalprimarycareimplementationgroup.

Authorisedofficers:ThreestaffmembersunderwenttrainingandwereavailabletoClareMentalHealth}}

ServicestofulfiltheauthorisedofficerroleinlinewithMentalHealthAct2001.


Thiswasnotapplicable.



TheIrishAdvocacyNetwork(IAN)hasbeenprovidingapeeradvocacyserviceintheClarementalhealthservicessince2006.TheIANservicewasbeingextendedthroughoutClarementalhealthservice.TheIANvisitedtheAcutePsychiatricUnitandOrchardGroveweekly,however,peeradvocacywasnotyetavailableinCappahardLodge.

RegularinformationsessionswereprovidedbytheIANtoserviceusers.

Patientinformationsheetscontinuetobeupdatedandmadeavailable.


InthecommunityrehabilitationserviceandOrchardGrove,allserviceuserswereinvolvedintheirownindividualrecoverycareplans.Residentsintheacutepsychiatricunitandoneofthesectorswereinvolvedintheirindividualcareplans.

FeedbackfromserviceuserswasbeingfacilitatedthroughthecareplanningprocessandtheHSE“Yourserviceyoursay”procedures.TheIANrepresentativewasontheClarementalhealthmanagementsteeringgroup,thepolicygroup,andthemultidisciplinarycareplandevelopmentcommittee.

Governance

TheexistingmanagementstructurehadbeenreviewedanditwasbeingreconfiguredinlinewithA Vision for Change.ThemovetoestablishtheregionalareainlinewiththeenvisagedMid-Westcatchmentareaalongwiththeappointmentofaregionaldirectorshouldbefollowedbytheestablishmentofthemultidisciplinaryareamanagementteam.

Atlocalleveltheexistingtraditionaltripartitelinemanagementstructuresremain.AlocalmultidisciplinarysteeringgroupcomprisingmentalhealthandPCCChadbeenestablishedtoassistinprovidingstrategicdirectiontolocalplans.


TheservicesofaninfectioncontrolnursehavebeingmadeavailabletoClareMentalHealthServicessinceJanuary2009.

405


Approvalhasbeengivenforthepilotingofintensivecommunity-basedtreatment(ICBT)intheWestClarecommunitymentalhealthteamandconsiderationwillbegiventotheextensiontoothersectorsdependingonthefeedbackfromthepilot.

AnumberofclientshavebeentransferredfollowingmultidisciplinaryteamassessmenttomoreappropriatecaresettingswithaconsequentreductionininpatientnumbersinOrchardGrove.


Medical Staff


Nursing Staff

post Wte in postDON 1.18ADON 8.56Nursesbasedinin-patientservices 44.23Nursesbasedincommunityresidences 130.22Communitymentalhealthnurse 3Nursesbasedindayhospitals 12.16Nursesbasedindaycentre 13.09Other–Temporarystaffpanel 1.37


speciality Wte in postLiaison 0Clinicalplacementcoordinators 0Nursepracticedevelopmentcoordinator 0Counsellors 0Advancednursepractitioner 0CNS(ECT) 1CNS(CMHN) 6CNS(Rehabilitation) 4


post Wte in postClinicalpsychologist 5Socialwork 4.6Occupationaltherapist 4.2Arttherapist SessionalcommitmentAddictioncounsellors 2.5

406










ADON 1 1

CMHN 2 2


Socialworker 0 0.6




Nursesbasedinapprovedcentre 29.74 28.74



Dayhospital 0 0

Daycentre 0 0







ADON 1 1

CMHN 0 0


Socialworker 1 1



Nursesincommunityresidences 59.32

Dayfacilitynursestaffing 0 8.37


407



Dayhospital

Daycentre OrchardDayCentre,Kilrush

EnnisDayCentre(Rented)

OrchardDayCentre,Kilrush

EnnisDayCentre(Rented)


TherewerethreeapprovedfacilitiesintheClarementalhealthservices.CappahardLodgestoodoutbecauseofitspoorlevelofcompliancewiththeRegulations,RulesandCodesofPracticeonthedayofinspection.Duetothelevelofconcerninrelationtolackofcompliance,thematterwasreporteddirectlytotheMHCandwillcontinuetobemonitored.

Detailsofapprovedcentreinspectionsareavailableintherespectiveapprovedcentrereports.



CapphardLodgewascompliantwith6articlesoftheRegulations.OrchardGrovewascompliantwith23articlesoftheRegulations.Theacutepsychiatricunitwascompliantwith21articlesoftheRegulations.



Cappahard Lodge:NeitherseclusionnorECTwereused.TheservicewasnotcompliantwithsomeaspectsofPart5ofthemechanicalrestraintRules.

Orchard Grove:Neitherseclusion,ECTnormechanicalrestraintwereused.

TheAcutePsychiatricUnitwassubstantiallycompliantwithregardtotheuseofseclusion.ThedesignatedECTnursehadnotbeentrainedinECT.Mechanicalrestraintwasnotused.


Codes of practice

physical Restraint

Cappahard Lodge:Therewasnopolicyinplace.

Orchard Grove:Theunitwassubstantiallycompliant.

APU: Theunitwasnotfullycompliant.


Cappahard Lodge:Childrenwerenotadmitted.

408


Orchard Grove:Childrenwerenotadmitted.

APU: Althoughchildrenhadbeenadmittedtotheunititwasnotfullycompliant.

notification of Deaths and incident Reporting

Cappahard Lodge:Theservicewasnotcompliant.

Orchard Grove:Theservicewascompliant.

APU:Theunitwasfullycompliant.

eCt for Voluntary patients

Cappahard Lodge:ECTwasnotused.

Orchard Grove:ECTwasnotused.

APU:ThedesignatedECTnursehadnotbeentrainedinECT.



InCappahardLodge,noneoftheresidentshadanindividualmultidisciplinaryteamcareplan.InOrchardGrove,amultidisciplinaryteamrecoverycareplanwasinplaceforeachresident.Intheacuteunitallresidentshadindividualmultidisciplinarycareplansthatclearlydocumentedtheteam’sinvolvementandresidentparticipationinthecareplanningprocess.


Description

Theservicehadsix24-hoursupervisedhostels.Twoofthehostelshadnomentalhealthteamresponsiblefortheresidents,anumberofwhomhadintellectualdisability.



OrchardLodge 21 18 Rehabilitation MDTCoisMara 16 16 None NoneAvonreehouse 11 9 None NoneDeilgnis 14 14 Rehabilitation MDTGortGlas 20 19 Rehabilitation MDTTeachnaBeithe 8 7 Rehabilitation MDT

409


Conclusion

TheAcutePsychiatricUnitandOrchardGrovecontinuedtoprogresstowardsfullcompliancewiththeRegulations,RulesandCodesofPractice.However,CappahardLodgehadapoorlevelofcomplianceonthedayofinspection.Thiswasdespitethefactthatthethreeapprovedcentresarepartofthesameserviceandknowledgeandpracticescouldeasilybesharedacrosstheapprovedcentres,particularlyintheareaofpolicies.Duringtheinspection,seniormanagersreportedthattheywereawarethatCappahardLodgehadsignificantdeficitsinrelationtocompliance,yetnoactionwastaken.ThepoorlevelofcompliancewasreportedtotheMentalHealthCommissionandwillcontinuetobemonitored.


1. Each of the three approved centres must be compliant with the Regulations, Rules and Codes of Practice and compliance with regard to Cappahard Lodge must be a priority.

2. The management team should be representative of all disciplines.

3. All of the clinical teams should be fully resourced.

410


Mental Health services 2009 Catchment area Report Donegal

HSEArea HSEWestCatchment DonegalMentalHealthService DonegalMentalHealthServicesPopulation 139,432NumberofSectors 4NumberofApprovedCentres 2SpecialistTeams Childandfamily

IntellectualdisabilityMHSOPRehabilitationandrecovery

PerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 15October2009

service 2009


DonegalMentalHealthServiceshadfoursectorteamsandfourspecialistmentalhealthteamsthatcoveredalargelyruralareaandtwourbanareas:LetterkennyandDonegalTown.St.Conal’sHospital,whichonthedayofinspectionhad19residents,13maleand6female,andtheacutepsychiatricunitatCarnamuggah,whichhad30residents,werebothapprovedcentres.Thebuildinginwhichtheacutepsychiatricunitwastemporarilyaccommodatedwaspurpose-builtforuseasanursinghome.Becauseofthis,thestaff-to-residentratiowashighandtheleaseofthebuildingbyDonegalMentalHealthServicesamountedtog300,000perannum.Thenewunithadbeenscheduledtobeginconstructioninthefirstquarterof2009butthishadnothappened.ItwasreportedthatthetenderfortheconstructionofthenewbuildinghadbeenacceptedandthattheprojectwasawaitingapprovalfromtheDepartmentofFinance.Therewerespecialistrehabilitation,olderpeople,childandfamily,andintellectualdisabilityteams.TherewasonedayhospitalusedbytheCentralSector.Allremainingsectorshaduseofadaycentre.Theolderpeopleandchildandfamilyteamshadaccesstonodaycentre.


1. All teams should be adequately resourced with the full complement of multidisciplinary team members.


2. The closure of St. Conal’s Hospital should proceed and remaining residents should be placed in suitable alternative accommodation.

Outcome:ItwasreportedthatabusinessplanfortheclosureofSt.Conal’sHospitalwasatanadvancedstage.

3. All residents should have an individual care plan as described in the Regulations, and a single composite set of notes should be kept.

411


Outcome:Allresidentsofbothapprovedcentreshadasinglecompositesetofnotes.EachresidentofSt.Conal’sHospitalhadanindividualcareplanasdefinedintheRegulations.Residentsoftheacutepsychiatricunithadnursingcareplans.


ThelocalhealthserviceplanwasexaminedbytheInspectorate.Ithighlightedtheservice’sprogressinimplementingA Vision for Change,modernisationofthementalhealthserviceanddevelopmentswithinthecatchmentarea.


Ongoingassessmentofserviceusersover65yearsinsupervisedresidentialaccommodationbythe}}

elderlyserviceregardingtheirsuitabilitytobeplacedinacommunitycaresetting.Allserviceuserswhoaremovedtocommunityfacilitiesarefollowedupbythecommunitymentalhealthnurseorconsultantpsychiatrist.

STEERAdvocacyServiceshadscheduledvisitstoapprovedcentres.}}

The“proofofconcept”phaseofaninformationsystemformentalhealthservicescalledWISDOMbeing}}

pilotedinDonegalMentalHealthServicesbegan.

Referral,transferanddischargepoliciesweredevelopedforthecommunitymentalhealthteams.}}

MeetingsbetweenLetterkennyGeneralHospitalandlocalmentalhealthservicestoproactively}}

managereferralandliaisonissueshadbeenestablished.

Anauditoftheoccupationaltherapyservicehadbeencompleted.}}

AdraftpositionpaperongovernanceofoccupationaltherapyinDonegalMentalHealthServiceshad}}

beenproduced.

AserviceuserquestionnaireforserviceusersofDonegalMentalHealthServiceshadbeendeveloped}}

andwasbeingused.

AserviceusersatisfactionsurveyhadbeendevelopedbytheserviceinpartnershipwithSTEER.}}

TheHearingVoicesgroup,runinconjunctionwiththedepartmentofoccupationaltherapy,beganin}}

thesummer2009,andmetfortnightly.

Adance,voiceandmusicgroupmetweeklyinSt.Conal’sHospital.}}

Amultidisciplinarypolicydevelopmentgrouphadbeenestablished,chairedbytheSTEER}}

representative.


TheclosureofSt.Conal’sHospitalhasbeenplannedforsometime.Itwasanticipatedthattheremainingmaleresidentswouldbeaccommodatedina24-hoursupervisedresidencewithinthefollowingsixmonths.Theservicewasatanadvancedstageofnegotiationwithavoluntarybodyregardingprovisionofalternativeaccommodationinasmallhousingunitforthefemaleresidents.

412




TheadvocatevisitedSt.Conal’sHospitalandtheacuteunitatCarnamuggaghandreportedanexcellentworkingrelationshipwiththestaffinbothunits.

Inadditiontoprovidingadvocacytoserviceusers,thepeersupportgroupSTEERwasactivelyinvolvedineducationandtrainingprogrammes.ThegrouphadparticipatedintheleadershipprogrammerunbyDCUandhadconductedanauditofserviceusers,thereportofwhichwasduetobepresentedtotheserviceoncompletion.

STEERestablishedaprimaryactiongroupwhichfunctionedasaconsumerpanelforserviceusers.Inresponsetoconcernsofserviceusers,theadvocacygroupalsoestablishedahousingassociationforitsclients.


Theserviceusersadvocacygroupwasinvolvedinanumberofactivitieswithintheservice.Theadvocatewhoco-chairedthepolicygroupwasamemberofthemanagementteamandsatonvariousothercommittees.

Governance


Themanagementteamwasreconfiguredin2008andnowincludesallheadsofdiscipline.Itmetonamonthlybasis.Arepresentativefromthisteamparticipatedinthementalhealthmanagementteamoftheservice.Amedicationmanagementaudit,includingitemssuchasprescriptionsignaturesandlegibility,hadbeencarriedoutandwascurrentlypostedonthewardsforvalidation.Amentalhealthqualityandriskmanagementforumwasestablishedandaqualityandriskmanagementframeworkself-assessmentprocesshadbeencompleted.

413



Medical Staff


Nursing Staff

post Wte in postDON 1ADON 4CNM3 2Nursesbasedinin-patientservices 75Nursesbasedincommunityresidences 50Communitymentalhealthnurse 14Nursesbasedindayhospitals 7.75Nursesbasedindaycentre 5Other–Temporarystaffpanel 19


speciality Wte in postLiaison 1Clinicalplacementcoordinators 1Nursepracticedevelopmentcoordinator 0.5Cognitivebehaviouraltherapists 5CNM2Advancednursepractitioner 0Studentallocationofficer 1Nurseaddictioncounsellor 7(3CNS,

4CNM2)Genericcounsellor 1CNSOther–Youthaddictioncounsellor 1


post Wte in postClinicalpsychologist 4Socialwork 3.5Occupationaltherapist 4.5Arttherapist 0Other 0

414









Dedicatedteamcoordinator(ADON) 1 1

CMHN 6 6


Socialworker 1 0






Dayhospital No No


MHSOP Team Report

TeamDescription MentalHealthServiceforOlderPeople(MHSOP)Population 18,000





CMHN 5 5


Socialworker 1 1






Dayhospital No No

Daycentre No No

415


Intellectual Disability Team Report

TeamDescription IntellectualDisabilityPopulation 150,000





ADON 0 0

CMHN 0 0

Communityintellectualdisabilitynurse 1 1


Socialworker 0 0






Dayhospital No No

Daycentre 2owned 2owned

Child and Family Team Report

TeamDescription ChildandFamilyMentalHealthPopulation 40,288





ADON 0 0

CMHN 2.6 2.6


Socialworker 1 1






Dayhospital No No

Daycentre No No

416



Theservicehadtwoin-patientunits.St.Conal’sHospitalprovidedcontinuingcareundertherehabilitationteamfor11maleand6femaleresidents.Closureplanswerewelladvancedanditwasexpectedthatallresidentswouldbetransferredtomoresuitableaccommodationwithinthenexttwelvemonths.

TheacuteadmissionunitwaslocatedinatemporarybuildingatCarnamuggagh,pendingtheconstructionofanewacuteunitinLetterkennyGeneralHospital.Ithadbeenatitspresentlocationforthepreviousthreeyearsandconstructionofthenewunithadnotyetcommenced.Theacuteunitaccommodated38residentsandhadafullcomplementofresidentsonthedayofinspection.


Aninspectionofbothapprovedcentreswascarriedouton14October2009.


NeitherapprovedcentrewasfullycompliantwithArticle6(FoodSafety),Article24(HealthandSafety),Article26(Staffing)andArticle29(OperationalPolicies).TheacuteunitatCarnamuggaghwasnotcompliantwiththeRegulationgoverningindividualcareplans,andwasonlysubstantiallycompliantwiththeRegulationsonprovisionoftherapeuticservices,children’seducation,foodandnutritionandpremises.


TheRulesonseclusion,mechanicalrestraintandECTfordetainedpatientswerenotapplicableasthesewerenotinuseinSt.Conal’sHospital.

Theacuteunitdidnotuseseclusionormechanicalrestraint.NopatientwasreceivingECTatthetimeofinspection.

Codes of practice

PhysicalrestraintwasnotusedinSt.Conal’sandchildrenwerenotadmittedtothatcentre.TheunitatCarnamuggaghwassubstantiallycompliantwiththeCodesofPracticerelatingtouseofphysicalrestraintandadmissionofchildren.

BothunitswerefullycompliantwiththeCodesofPracticeonreportingofdeathsandincidents,anduseofECTinvoluntaryresidents.


TherehabilitationteamhadintroducedanexcellentcareplanfortheresidentsinSt.Conal’sHospital.IndividualcareplansasdefinedintheRegulationshadnotbeenintroducedintheacuteunit,buttheservicewasintheprocessofpilotingcareplansforresidentsintheadmissionunit.

417



Description

TheDonegalserviceoperatedfour24-hoursupervisedresidences.Oneofthesewasunderthecareoftherehabilitationteamandresidentstherehadindividualcareplans.TheotherresidenceswereunderthecareoftheCMHTsandnursingcareplanswereinoperation.


team responsible Care plan type*

ClearyHouse,Letterkenny

20 12 RehabilitationandRecovery

MDTandnursing

ParkHouse,Dungloe

18 11 NorthWestCMHT Nursing

RowanfieldHouse 16 14 SouthWestCMHT NursingRadhaircnaSléibhe 18 17 NorthEastCMHT Nursing

Conclusion

ThecatchmentareaofDonegalservedapopulationofalmost140,000people.IthadfourCMHTsandprovidedaspecialistserviceinrehabilitation,psychiatryoflaterlife,intellectualdisabilityandchildandfamilypsychiatry.TheservicewasproceedingwellwithitsplanstoeffectclosureofSt.Conal’sHospitalwithintheyear.TheprocessoffixingatenderfortheconstructionofanewacuteunitinLetterkennyGeneralHospitalwastakingconsiderablylongerthananticipated,andresidentscontinuedtobeaccommodatedinaunit,whichalthoughprovidingaccommodationofaverygoodstandard,wasnonethelessunsuitableasanacutepsychiatricadmissionunit.

CMHTswerenotfullyresourcedintermsofmultidisciplinaryinputanditwasdisappointingtoseethatsometeams,includingtherehabilitationteam,functionedwithoutasocialworker.

TheInspectoratewasimpressedwiththequalityofthecareplansforresidentsinSt.Conal’s,andwouldencouragetheadaptationoftheseplansforuseintheacuteunit.


1. Individual care plans, as defined in the Regulations, should be introduced in the acute unit.

2. The closure of St. Conal’s Hospital should proceed and residents transferred to more suitable accommodation.

3. All CMHTs should be fully resourced in terms of multidisciplinary input.

418


Mental Health services 2009 Catchment area Report east Galway

HSEArea HSEWestCatchment EastGalwayMentalHealthService EastGalwayMentalHealthServicesPopulation 110,100NumberofSectors 4NumberofApprovedCentres 1SpecialistTeams Psychiatryoflaterlife

RehabilitationPerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 16July2009

service 2009


TheservicehadacatchmentareacoveringthegeographicareaofEastGalway,servingthemaintownsofBallinasloe,Mountbellew,Glenamaddy,Loughrea,Athenry,Portumna,Gort,TuamandHeadford.Acuteandcontinuingcarein-patientserviceswereprovidedinthetworemainingunitsofSt.Brigid’sHospitalinBallinasloe.Theservicehadfouradultcommunitymentalhealthteamsandspecialistteamsintheareasofrehabilitationandpsychiatryoflaterlife.Alloftheservicesprovidedacontinuumofcarerangingfrombriefintervention,tomorespecialiseddayhospitalordaycareinterventions,aswellasin-patientcare.Homecarewasencouragedandallservicesencouragedfamilyinvolvementandwereusingarecoverymodelapproach.

AddictionserviceswerecommunitybasedacrossallfoursectorsandinTuamandLoughreaworkedonasharedbasiswiththecommunityaddictionworkers.Historicallytheservicehadprovidedservicestoalargecohortofadultswithanintellectualdisability.AllwereontheNationalIntellectualDisablityDatabase(NIDD)andallbuttenclientshadbeendischargedfromthehospitaltosupportedcommunityaccommodationprovidedbytheMentalHealthService.Threetrainingcentresalsoformedapartoftheservice.Theservicehadundergonemajorchangeinrecentyearsinshiftingfromthemainlyhospitalsettingtoacommunitybasedone.


1. All Rules, Regulations and Codes of Practice should be adhered to.

Outcome:Theservicecontinueditseffortstoreachfullcompliance.

2. The training of staff in management of aggression should be addressed as a matter of urgency.

Outcome:Aprogrammeofmandatorytrainingwasunderwayoverthepastyearwith83staffhavingcompletedtraininginviolenceandaggressionmanagement.

3. Community teams and specialist teams should be fully staffed.

Outcome:Teamswerenotfullystaffed.Candidatesfortwooccupationaltherapypostshadbeenselectedandofferedposts.ThepsychiatryoflaterlifeteamwasrecruitingtofilltwoCMHNposts.

419



Reducein-patientbednumbersto80.}}

Establishapsychiatryoflaterlifeservice.}}

IntroduceSTARSWebtrackingsystemaspartofriskmanagement.}}

ImplementHSEattendancemanagementpolicy.}}

Appoint}} A Vision for ChangeimplementationgroupforGalway.

ReorganiseswitchboardoperationsatSt.Brigid’sHospital.}}

Ceasein-houselaundryserviceatSt.Brigid’sHospital.}}

RedeployCNM2positionsduetoclosureofwardsbylookingatareasfordevelopmentofCMHNposts.}}

Reviewheat,lightandpowerusage.TheservicehadinstalledwoodburningstovesinSt.Brigid’s}}

Hospital,whichresultedinsubstantialsavings.

Reductionintravel.}}


Aconsultantpsychiatristinpsychiatryoflaterlifehadbeenappointed.}}

Twoadditionaloccupationaltherapycommunitypostshadbeenapproved.}}

ClosureofWard21AandWard16.}}

Continuationofpolicytodischargeolderpeopletomoreappropriatesettings.}}

Productionofclosureplanforthe“NewBuilding”.}}

Establishmentofenhancednursemanagementstructureintheacutearea.}}

Refurbishmentofareasofthehospital.}}

Refurbishmentandre-openingofPortumnaDayCentre.}}

Establishmentofaclinicalauditgrouprepresentativeofallstaff.}}

Establishmentofariskmanagementgroup.}}

Establishmentofaclinicalpracticegroupintheacutearea,developinggenericassessmenttool,}}

enhanceddocumentation,casefiles,andcareplandocumentation.

Workcontinuedinalignmentofserviceswiththenewprimarycareteams.}}

Discussionscontinuedwithvoluntaryserviceproviderinrespectofintellectualdisabilityserviceshand}}

over.

Workcontinuedonredeploymentofstaffandservicesfromthemainhospitalbuilding.}}

420


Planningapplicationsubmittedtothelocalauthorityinrespectofrefurbishmentoftheformernurses}}

homeascatchmentheadquarters.

Introductionofanon-callseniornurseserviceforoutofhours.}}

Involvementofstaffindesignteamforthenew50-bedCNUontheSt.Brigid’scampuswhichwill}}

facilitatethedischargeofabout20olderpeopletothisfacility.

Home-basedcareteamcommencedinPortumnaarea.}}

Anumberofeducationeventswereorganisedduringtheyearintheareasofgovernance,clinical}}

practiceandserviceuserinvolvement.

EstablishmentofgrouprepresentativeofallGalwayservicestoreviewprovisionofAddictionservices.}}

TheservicesponsoredthreeparticipantsontheDCUcooperativelearningleadershipprogramme.Their}}

projectworkwasontheareaofempowermentoftheserviceuser.

Unitstaffinghadbeensuccessfullyintroducedinthein-patientunits.Thishadimpactedpositivelyon}}

servicedelivery.

SixserviceusersfromBallinasloeaccompaniedbytwostaffjoinedsixfromChaloninFranceona}}

therapeuticexchangeatalocationontheFrenchMediterraneancoast.

TheWellnessRecoveryActionPlan(WRAP)programmehadbeenintroducedacrosstheservices.}}

Theservicewasbecomingincreasinglyrecovery-orientatedintermsofitsphilosophy.}}


Thenumberofresidentscontinuedtodecline.Therewere52residentsinlong-staycareinSt.Brigid’sHospitalonthedayofinspection.Twowards,Ward16andWard21A,hadbeenclosedsincethepreviousinspection.ResidentswerenolongeraccommodatedintheoriginalVictorianbuilding.ThenextphaseofclosureisexpectedtoseetheclosureofWard17,withsuitableresidentsbeingaccommodatedinnursinghomes,giventheirageprofile.



AnadvocatevisitedSt.Brigid’sHospitalregularly.Insomewardstherewereroutinevisits;theadvocatevisitedotherwardsasrequired.Thereweregoodrelationsbetweenthestaffandtheadvocate,andtherewerenodifficultiesinreportingserviceuserconcerns.

Theadvocatedescribedsomecommonissuesraisedbyserviceusers,namelyperceivedoveruseofmedication,beingunawareoftheircareplans,lackofsupportinthecommunity,andinsufficientinformationabouttheirillness.Therewasconcernamongsomeresidentsinoneofthelong-staywardsabouttheproposedmovetoalternativeaccommodation.

421



Therewasaserviceuserontheauditgroup.AconsumerpanelwasestablishedintheGalwayregion.However,duetotheinabilityoftheLocalHealthManager’sofficetoprovidefundingtofacilitatetravelorexpensesforparticipants,themembersofthepanelwithdrew.Atthecatchmentmeeting,itwasreportedthatanarrangementcouldnowbesetuptofacilitatetravelpayments.ItwasexpectedthattheconsumerpanelwouldresumeintheAutumn.

Governance


Theservicecontinuedtooperateatripartitesystemofmanagement.Whilethemanagementteammetwiththecatchmentmanagers,itwasreportedthatnocatchmentmeetinghadbeenheldsinceDecember2008.Apartfromthismeeting,therewasnoforumforlinkswiththemanagementteam.Theoccupationaltherapyandpsychologymanagersexpressedadesireforanopportunityforgreaterinvolvementinmanagement.Similarly,therehadbeennoinvolvementinthemanagementteambytheadvocate.

AnauditcommitteehadbeeninplacesinceJanuary2009.


Medical Staff

post Wte in post Consultantpsychiatrist 7.45NCHD 11Specialistregistrar None

Nursing Staff

post Wte in postDON 1(acting)ADON 7(including3acting)Nursesbasedinin-patientservices 74.65(acuteunitand

twolongstaywards)Nursesbasedincommunityresidences 104

(including46intellectualdisabilityand11rehabilitation)

Communitymentalhealthnurse 11Nursesbasedindayhospitals 20Nursesbasedindaycentre 18Other–temporarystaffpanel 0

422



speciality Wte in postLiaison 1(nursinghomeliaison)Clinicalplacementcoordinators 1Nursepracticedevelopmentcoordinator 1Counsellors 9(addictions)Advancednursepractitioner 0Cognitivebehaviouraltherapy 3Acutecare 1


post Wte in postClinicalpsychologist 4Socialwork 6Occupationaltherapist 6Arttherapist 0Physiotherapist 1

specialist teams (excluding primary teams)





Consultantpsychiatrist 1Locum 1sinceJune2nd2009

NCHD(includingspecialistregistrar) 0.5 2


ADON 0 0

CMHN 0 0


Socialworker 0 1sinceFebruary2009






Dayhospital 0 0

Daycentre 0 0

423








ADON 0.5 0.5

CMHN 0 0


Socialworker 1 1






Dayhospital 0 0

Daycentre 0 0


St.Brigid’sHospital,Ballinasloe,wasanapprovedcentreundertheMentalHealthAct2001andwaspartofawidercommunitymentalhealthservice.Thehospitalconsistedofthreemainbuildings:themainbuildingatthefrontofthecampuswasagrey-brickedpre-Victorianedificebuiltin1833whichforthepastfewyearshadbeenusedforadministrationpurposesonly.Attherearofthecampuswasthe“NewBuilding”openedin1903,whichprovidedthreewardsconsistingof53bedsforcontinuingcareresidents.Offcampus,acrosstheroad,wasa1930sstructurethatalsocontainedthreewards,consistingof41beds,whichwerepartoftheAdmissionUnit.Foursectorteamsadmittedtotheacuteadmissionsunit.Theservicealsohadtwospecialistteams:apsychiatryoflaterlifeteamandarehabilitationteam.


AllwardsintheapprovedcentrewerevisitedduringtheinspectionandalltheRegulationswereinspectedintwowards.TheseclusionandECTfacilitieswerealsoinspected,asweretheregistersforphysicalrestraintandseclusion.


TheapprovedcentrewasfullycompliantwiththemajorityoftheRegulations.ThecentrewasnotcompliantwiththeRegulationrelatingtoprivacy,andhadinitiatedcompliancewiththeRegulationsonindividualcareplans,therapeuticservices,staffingandcomplaintsprocedures.TheInspectoratewasinformedthattheindividualcareplansasdescribedintheRegulationswouldbeintroducedinSeptember2009.

424



TheservicehadinitiatedcompliancewiththeRulesectionsonfacilitiesforseclusionS69(7),andtheuseofCCTVS69,11.2(b).TherewasfullcompliancewiththeremainderoftheRuleonseclusion.

Codes of practice

TheservicewasnotfullycompliantwiththeCodeofPracticerelatingtotheadmissionofchildren.Theapprovedcentrewasunabletoprovideage-appropriatefacilitiesfortheadmissionofchildren.Childrenshouldnotbeadmittedtoadultunits.TheapprovedcentrewascompliantwiththeCodesofPracticeonECT,physicalrestraintandnotificationofdeathsandincidents.


Thepsychiatryoflaterlifeteamwasintheprocessofintroducingrecoverycareplansforallresidentsinitscare.TheInspectoratewasinformedthatmultidisciplinarycareplanswouldbeintroducedintheacuteadmissionwardsinSeptember2009.




CallowView,Portumna

6 4+2respite Portumna/Gort Nursing

2BridgeRoad,Portumna

4 4 Portumna/Gort Nursing

EnnisRoad,Gort 5 5 Portumna/Gort NursingTullaHill,Loughrea 6 6 Loughrea/

AthenryNursing

BrookHouse,Mountbellew

8 7+1respite Ballinasloe/Mountbellew

Nursing

GroveHouse,Moher,Ballinasloe

5 4+1respite Ballinasloe/Mountbellew

Nursing

ToghermoreHouse,Tuam

25 22 Tuam/Headford Nursing

Aishling,MilltownRoad,Tuam

9 7 Tuam/Headford Nursing

RiverviewHouse,Ballinasloe

9 9 Rehabilitation Nursing

13GarballyOaks,Ballinasloe

6 6 Rehabilitation Nursing

Conclusion

TheEastGalwaycatchmentteamwasaprogressiveteamasisevidencedbytherangeofinitiativesanddevelopmentsreportedtotheInspectorate.Lackoffundsinhibitedfurtherdevelopments.TheclosureplanfortheoldersectionofSt.Brigid’sHospitalwasproceedingandresidentswerenolongeraccommodatedintheoldbuilding.Thenumberofresidentsaccommodatedinthe“NewBuilding”sectioncontinuedtodecline.Itwasencouragingtoseetheappointmentofapsychiatryoflaterlife

425


teamtotheservicebuttherehabilitationteamneedstobefullystaffedinviewofthelong-staynatureofsomeoftheresidents.TheservicecontinuedtoretainitstripartitesystemofmanagementwhichiscontrarytoA Vision for Changeandwhich,byitsnature,failstofullyutilisetheskillsofitsmultidisciplinarymanagers.ThereportthattheLocalHealthManager’sofficecannowfacilitatetravelexpensesforparticipantsoftheconsumerpanelenablingmemberstore-establishitwasencouraging.


1. Multidisciplinary care plans should be introduced to all residents in the approved centre.

2. Renovations should be carried out to improve bathroom standards in the approved centre.

3. The service should consider extending its core management system to include managers of other disciplines.

426


Mental Health services 2009 Catchment area Report limerick

HSEArea HSEWestCatchment LimerickMentalHealthService LimerickMentalHealthServicesPopulation 184,055NumberofSectors 5NumberofApprovedCentres 3SpecialistTeams Forensic

LiaisonRehabilitation

PerCapitaExpenditure2008[>18Years] NotprovidedDateofMeeting 9July2009

service 2009


LimerickMentalHealthServicesprovidesaservicetoLimerickcityandcounty.IthadthreeapprovedcentresatLimerickRegionalHospital,St.Joseph’sHospitalandinTearmanandCurragourwardsatSt.Camillus’sHospital.Thecommunitywasservedbyfivecommunitymentalhealthteamsandtherewerefourspecialistteams.Thespecialistteamsprovidedcareinliaison,forensic,rehabilitationandarecentlycreatedpostinpsychotherapy.


1. The urgent closure of St. Joseph’s Hospital should be advanced from plan to action.

Outcome:TheservicehaddrawnupacomprehensiveplanfortheclosureofSt.Joseph’sandprovisionofmoresuitableaccommodationforresidents.FromtheInspectoratereport,itwasapparentthattheplanhadnotbeenimplementedasyetandthatinfacttherecontinuedtobeadmissions.InNovember2009,Unit10wasclosedfollowingthedischargeofresidentstoappropriatecommunitycaresettings.

2. More suitable normalised accommodation should be sought for those in large 24-hour supervised residences.

Outcome:Althoughthishadnothappened,suitableplacesinnursinghomeshadbeenidentifiedforsomeoftheresidents,andconsultationhadbegunwithfamilies.Inaddition,theplancalledforthedischargeofresidentsoflongstandingfromO’ConnellHousetonursinghomecare.Therightsoftheseresidentsmustberespectedinanysuchmove.

3. The rehabilitation team should be enhanced to provide assessment and active rehabilitation for the above group of service users.

Outcome:Therehabilitationteamdoesnothaveaclinicalpsychologistorsocialworker.

427



Theservicehadproducedaserviceplan.TheserviceplanreiterateditspriorityobjectiveofrelocatingresidentsfromSt.Joseph’sHospitaltomoresuitableaccommodation.ThedevelopmentofthehighobservationareainUnit5Bwasbeingprogressedthroughtheremainingstagesofitsdevelopmentandplanningpermissionhadbeenapproved.TheplanproposedtocontinuetheprocessofintegrationofpsychiatryoflaterlifeintothementalhealthserviceswithintheLimerickarea.


Anewmultidisciplinaryindividualcareplanbasedonarecoveryapproachhadbeenpilotedandwas}}

expectedtobefullyintroducedtotheapprovedcentreatUnit5Bbytheautumn.

Aconsultantpsychiatristwithspecialinterestinpsychotherapyhadbeenappointedandwasinpost,}}

andasecondconsultantinchildandadolescentmentalhealthwasappointedinJuly.

Interviewshadbeenheldforthepostofprofessorofpsychiatry,associatedwiththeUniversityof}}

Limerick,andfundinghadbeenapprovedforalecturer’spost.

TherehabilitationandrecoverycentreatIniscarainLimerickcityhadwonanationalawardforitswork}}

indevelopingadailyprogrammeforserviceusers.

TheCMHNontheCAMHSteamparticipatedindrawingupthecareplanofanychildadmittedto}}

Unit5B.

AnexternalhygieneauditwascarriedoutinSt.Joseph’sHospitallatein2008.Thereportwasawaited.}}


TheservicehadaclosureplanforSt.Joseph’sHospital.



Theregionaladvocatepresentedareporttothecatchmentmeeting.Itwasreportedthattheadvocatehadnodifficultyaccessingresidentsandpatientsinanyofthefacilities,andstaffweregenerallyhelpfultotheadvocate.KeystotheacuteunitandtoawardinSt.Joseph’sHospitalhadbeenprovidedforeaseofaccess.

Oneofthemaincomplaintshighlightedbytheadvocatewasthealmostpermanentlockingoftheentrancedoor.Someresidentswereunawareoftheircareplans,otherscomplainedofanoveremphasisonmedication.Someresidentsrequestedmoreinformationontheirmedication;somepeopledidn’tknowwhattheyweretaking.

TheadvocatewasunawarethatTearmanandCurragourWardsinSt.CamillusHospitalwerefunctioningasanapprovedcentre.Followingthecatchmentmeeting,itwasreportedtotheInspectoratethatanadvocatenowvisitedTearmanandCurragourWardeverythreetofourweeks.


TheconsumerpanelinLimerickhadbeendisbanded,followingafailuretoresolvetheissueofexpensesforparticipants.Itwassubsequentlyreportedthatithadbeenreactivitated.

428


TheadvocatewasinvolvedinthedevelopmentofthecareplansinUnit5B.

Governance


Theservicecontinuedtoretainthetripartitesystemofgovernance.Theheadofpsychologyservicesinmentalhealthhadrequestedinclusionintheprocessandstatedthattheconsultativeprocesswasnotyetactive.ItwassubsequentlyreportedtotheInspectoratethatamultidisciplinarymanagementteamwasinplace.

Theissueofthegovernanceofpsychiatryoflaterlifeteamsposeddifficultiesfortheconsultantpsychiatrists.Thelocalhealthmanager’sofficewasoftheviewthatpsychiatryoflaterlifecameunderthegovernanceof“elderlycare”,whilethepractitionerswereclearlyoftheviewthatthespecialtylaywithinmentalhealth.AstherewasnoreferencetoSt.CamillusHospitalinthecatchmentareaself-assessmentforwardedtotheMentalHealthCommission,itwouldappearthattherewasalackofclarityregardingthisapprovedcentreanditsstaff.

StaffidentifiedadifficultyintheoperationoftheauthorisedofficersystemunderSection9oftheMentalHealthAct2001.TheseofficerswerenotfunctioninginLimerickandhadtoberecruitedfromoutsidetheareawhenrequired.Thismatterneededtoberesolvedassoonaspossible.Itwassubsequentlyreportedthatoneoftheseofficerswasoperatinginthearea.


Medical Staff


Nursing Staff

post Wte in postDON 1ADON 8Nursesbasedinin-patientservices 126Nursesbasedincommunityresidences 58Communitymentalhealthnurse 6Nursesbasedindayhospitals 27.5Nursesbasedindaycentre 9Nurses–Rehabilitation 4Nurses–Forensic 0.5Nurses–Administration 3Nurses–PracticeDevelopmentUnit 4

429



speciality Wte in postLiaison 4Clinicalplacementcoordinators 0Nursepracticedevelopmentcoordinator 1Counsellors 0Advancednursepractitioner 0


post Wte in postClinicalpsychologist 5.5Socialwork 4Occupationaltherapist 3Arttherapist 0.1Addictioncounsellors 3

specialist Mental Health teams


Forensic Team Report

TeamDescription ForensicteamPopulation 184,055



NCHD(includingspecialistregistrar) 0.5 0.5

Dedicatedteamcoordinator O 0

ADON O 0

CMHN O 0

Clinicalpsychologist O 0

Socialworker O 0

Occupationaltherapist O 0

Dedicatedaddictioncounsellor O 0





Daycentre Noinformation Noinformation

430



TeamDescription RehabilitationteamPopulation 184,055





ADON 0 0

CMHN 0 0


Socialworker 0 0






Dayhospital Noinformation Noinformation


Liaison Team Report

TeamDescription LiaisonteamPopulation 184,055





ADON 0 0

CMHN 0 0


Socialworker 0 0






TheLimerickcatchmentareahadthreeapprovedcentresattheDepartmentofPsychiatry,LimerickGeneralHospital,St.Joseph’sHospitalandTearmanandCurragourwardsinSt.Camillus’sHospital.AlthoughtherewasaclosureplaninplaceforSt.Joseph’sHospital,residentscontinuetobeadmitted.

431




TheapprovedcentreatSt.Joseph’sHospitalwasnotcompliantwithanumberofRegulations,includingtherapeuticservices,andhadinitiatedcomplianceinrelationtotheintroductionofintegratedindividualcareplans.

Unit5B,LimerickGeneralHospital,hadinitiatedcompliancewiththeintroductionofintegratedindividualcareplansandtherapeuticservices.Childrencontinuedtobeadmittedtotheunitdespiteitsunsuitability.

TheapprovedcentreinSt.Camillus’sHospitalwasunderthecareoftwopsychiatryoflaterlifeteamsandthiswasitsfirstinspectionasanapprovedcentre.Theadmissionofelderlypatientswithamedicalillnessonlytothisunitwasacauseforconcernastherewasnoclearlineofclinicalresponsibilityforthesepatients.

Followingthecatchmentmeeting,arecovery-orientatedmultidisciplinaryapproachtotherapeuticserviceshadbeendevelopedinconjunctionwithserviceadvocates.


ECTwasprovidedinUnit5B.TheunitwassubstantiallycompliantwiththeRulesinrelationtoECT.Seclusionwasnotinuseinanyoftheapprovedcentres.ThecentreswerecompliantwiththeRulesinrelationtotheuseofmechanicalrestraint.

Codes of practice

ChildrencontinuedtobeadmittedtoUnit5B,despiteitsunsuitability.TheunitwasnotcompliantwiththeCodeofPracticeonadmissionofchildren.Anewinitiativeensuredthatacommunitymentalhealthnursewaswiththechildontheacuteunitatalltimes.Staffreportthishadbeenwellreceived.AlthoughaconsultantpsychiatristhadbeenappointedforchildandadolescentmentalhealthservicessinceJuly1,nootherstaffhadbeenappointedasyet.Staffforthatunitweretobeprioritisedintermsofreplacementposts.


IndividualcareplansasdescribedintheRegulationswerenotinoperationinUnit5B,St.Joseph’sHospital,orinTearmanandCurragourwards.

432



Description

The24-hoursupervisedresidenceswerelarge;oneofthemaccommodatedupto34residents.Theservicehadaplantotransferresidentsfromsomeoftheseresidencestomoresuitableaccommodation.



NewStrandHouse 17 16 Generaladult NursingcareplansFerndale 20 18 Generaladult NursingcareplansIverniaHouse 14 14 Generaladult NursingcareplansO’ConnellHouse 25 25 Generaladult NursingcareplansInisgile 34 34 Generaladult Nursingcareplans

Conclusion

TheLimerickcatchmentareahadanumberofprojectsinhandtofacilitateitsdevelopmentintoaservicewhichwillbetterserveitscatchmentareapopulation.Theseshouldbeprogressedassoonaspossible.Thedevelopmentofapsychiatryoflaterlifeteamwasawelcomedevelopment,butpresentedchallengestotheorganisationthatneededtobeaddressed.Inprogressingplansfortheoldagepopulation,therightsofpeoplewhohavelivedinlongstayaccommodationintheserviceshouldbeprotectedasmuchaspossible.Likewisetheadmissionofchildrentotheacuteunitwasacauseforconcern,particularlywhentheywereoftenadmittedforshortperiods.EvenwhenthenewadmissionfacilitiesinGalwayarefullydeveloped,theneedforalternativecarearrangementsforthisgroupofchildrenshouldbeexamined.


1. Admissions to St. Joseph’s Hospital should cease.

2. Governance issues in St. Camillus’ Hospital should be clarified.

3. The refurbishment of Unit 5B should begin as soon as possible.

4. An analysis should be made of the length of stay of children on the acute unit with a view to assessing whether alternative care is more appropriate.

5. All teams should be fully resourced in line with the recommendations of A Vision for Change.

6. Multidisciplinary care plans should become fully operational as soon as possible

7. Issues with regard to the authorised officer system should be addressed.

433


Mental Health services 2009 Catchment area Report Mayo

HSEArea HSEWestCatchment MayoMentalHealthService MayoMentalHealthServicePopulation 123,839NumberofSectors 5NumberofApprovedCentres 4SpecialistTeams Psychiatryoflaterlife

RehabilitationandrecoveryPerCapitaExpenditure2008[>18Years] 30million[sic]DateofMeeting 23July2009

service 2009


MayoMentalHealthServiceprovidedacommunitybasedserviceacrossfivesectors.Thesectorswereintheprocessofbeingalignedwiththenewprimarycarenetworks.Inadditiontothegeneraladultteamstherewerethreespecialistteams:psychiatryoflaterlife,rehabilitationandintellectualdisability.TherewasalimitedliaisonservicetoMayoGeneralHospital.

Theservicewasalargelyruralareawithanumberofurbancentresthatwasfacinganumberofsignificantchallengesinthecomingyears.Therehadbeenasignificantnumberofseniornurseretirementsandthishadimpactedontheservice.Reconfigurationofthecurrenttotalbedcomplementof101beds,therequiredskillmix,andtheprovisionofresourcestoexpandthecommunityserviceallhadtobeconsidered.


1. All teams should be resourced with the appropriate skill mix to ensure provision of a full multidisciplinary team approach.

Outcome:Therewerenoadditionalresourcesprovidedin2009.Anumberofnursingpostsweresuppressed.

2. The current management system of tripartite management would be improved by the introduction of multidisciplinary involvement.

Outcome:Therewasnoprogressonthisrecommendation.ItwasuncleartotheInspectoratewhatthebarrierstochangewere.


Therewasawrittenbusinessplanfor2009/2010.PlansarecontingentonthecurrentfinancialsituationandtherecruitmentstrategyoftheHSE.

434



ThebednumbersinAnCoilínhadbeenreducedandintegrated.Thiswasincompliancewiththelong-}}

termobjectiveofproviding10rehabilitationbedsand15continuingcarebeds.

TheclosureofadaycentreinKiltimagh.Thishadresultedinserviceusersaccessingmoreappropriate}}

genericservicesinthecommunity.

Thecareplanningprocesshadbeenunderactivereviewanddiscussionbytheservice.Amended}}

documentationwasnowcomplete.

St.Anne’sUnitintheSacredHeartHome,Castlebar,hadbeenregisteredasanapprovedcentreunder}}

theMentalHealthAct2001.

Aconsumerpanelhadbeenestablished.}}

ElectroconvulsiveTherapyAccreditationService(ECTAS)accreditationforECTwasalmostcomplete.}}


Notapplicable.



ApeeradvocacyservicewasfacilitatedbytheIrishAdvocacyNetwork(IAN).Anadvocatevisitedalltheapprovedcentresandalsoanumberofthecommunityfacilities.Theadvocates,inawrittenreporttotheInspectorateteam,highlightedanumberofpositiveaspectswithintheserviceasreportedtothembyserviceusers.Thesepositiveaspectsincludedthefollowing:thatstaffarefriendly,thatactivitiesintheacuteunitarevalued,especiallythemusicsessions,andthattherearegoodworkingrelationships.Theareasforconcernweremainlyfocusedontheacutein-patientunit.Theyincludedthelockeddoorpolicy,thelackofmeaningfulactivities,thelackoftimewithnursingandmedicalstaff,andhavingtorepeattheirstoriestovariousdoctors.


Theconsumerpanelmetonaregularbasisandhadgoodworkingrelationshipswiththemanagementteam.ApieceofresearchwascurrentlyunderwaybytheIAN.Thequestionnairebasedontherecoveryprincipleswascurrentlybeingadministeredto25serviceusersoftherehabilitationteam.

Therewasstructuralandregularinputfromfamiliesandserviceusersintoanumberofworkinggroups.

Allserviceuserswereencouragedtobeactivelyinvolvedinthecareplanningprocess.

Governance

TherewasatraditionalmanagementstructureinplacetooverseetheprovisionanddevelopmentofMayoMentalHealthServices(directorofnursing,hospitalmanagerandclinicaldirector).ThehospitalmanagerhadformallinkswiththeLocalHealthManagerandthePrimaryCommunityandContinuing

435


Care(PCCC)managementstructure.ItwasarecommendationlastyearthatthestructurebeextendedtoincludeheadsofdisciplineinaccordancewithA Vision for Change.Thishadnothappenedanditwasdifficulttopinpointtheexactreason.Itwasreportedthatallstaffwerewidelyconsultedonissuesandthatthereweregoodworkingrelationshipsinplace.Formalmeetingswithheadsofdisciplinehadnotoccurredinrecentmonths.

Ataclinicallevel,aqualityframeworkgrouphadbeenestablishedtoensureallapprovedcentresareincompliancewiththeRegulations(S.I.551,2006oftheMentalHealthAct2001).


Medical Staff


Nursing Staff

post Wte in postDON 1ADON 6CNM3 7Nursesbasedinin-patientservices 110Nursesbasedincommunityresidences 51Communitymentalhealthnurse 11Nursesbasedindayhospitals 4Nursesbasedindaycentre 17.7Dedicatedteamcoordinator 1Temporarystaffpanel 11


speciality Wte in postLiaison 2Clinicalplacementcoordinators 2Nursepracticedevelopmentcoordinator 1Counsellors 5Advancednursepractitioner 0Cognitivebehaviouraltherapy 2Other 2


post Wte in postClinicalpsychologist 4Socialwork 6Occupationaltherapist 5Arttherapist 2.3Musictherapist 1Pharmacist 1

436










ADON 0.5 0.5

CNM3 0.5 0.5

CMHN 3 3


Socialworker 1 1





Facilities 2008 shared or own 2009 shared or own


Daycentre Sharedwithgenericservices

Sharedwithgenericservices


TeamDescription RehabilitationandrecoveryPopulation 123,839





ADON 1 1

CNM3 1 1

CMHN 0 0



Occupationaltherapist 1 0.5




437




Daycentre None 1


TherewerefourapprovedcentresinMayoprovidingatotalof101beds.Therewere32acutebeds,34continuingcarebedsand10specialisedrehabilitationbeds.Inadditiontherewere15elderlycarebeds.AllwerecentralisedinCastlebar.


Therewerefourapprovedcentres.


OveralltherewasahighlevelofcompliancewiththeRegulationsacrossthefourcentres.Theservicehaddemonstratedthatthereweresystemsinplacetoreviewpoliciesandproceduresonaregularbasis.Incidentswerereviewedanddetailedreportswereavailable.

Themainareasofnon-compliancewereinrelationtocareplanningandtherapeuticservicesandprogrammes.Sincethelastinspection,theservicehadestablishedaworkinggrouptoreviewandimprovethecareplanningdocumentation.Atthetimeofinspectionthiswasreadytogolive.

ThelackofaccesstoandinputfromhealthandsocialcareprofessionalswasmostnotableinTeachAisling.Additionalresourceswillbeneeded.


TheapplicationoftheRulesappliedmainlyintheacuteunitatMayoGeneralHospital.Theservicewasinsubstantialcompliance.Themainareasthatrequiredattentionwerethedocumentationprocessandaffordingserviceuserstherightofreview.

MechanicalrestraintwasbeingusedinTeachAisling.

Codes of practice

Theservicewasincomplianceacrossmostareas.Detailedindividualreportscanbefoundintheapprovedcentresections.


Therewasaworkinggroupinplace.Careplanshadbeenadaptedsincethelastinspection.Theyhadbeenintroducedintherehabilitationserviceandweretobeintroducedtotheapprovedcentres.Therewerenoplanscurrentlytoextendthemtotheoutpatientservices.

438



Description

Theservicehadaccessto45beds.Clinicalresponsibilityfortheresidenceswasdividedbetweenteams.Thiswasbecauseofthewidegeographicallocationofsomeoftheresidences.Itwasreportedthatallresidentshadmultidisciplinarycareplansinplace.



Fairways 23 23 Rehabilitation MDTSwinford 5 5 Generaladult MDTBallina 12 12 Generaladult MDTAshbrookHouse 5 5 Rehabilitation MDT

Conclusion

Thereisastrongcommitmentfromstaffandpolicy/planswithintheservicetoamentalhealthservicebasedanddeliveredinthecommunity.SincethelastmeetingwiththeInspectorateinDecember2008,theservicehasactivelyreviewedthecareplanningprocess,embeddedserviceuserparticipationinservicedevelopment,andreconfiguredanumberofdaycentres.

Inthefuturetheservicewillhavetodecideonthelocationandnumberofbedsandservicesthatitisproviding.TheneedsoftheserviceusersdischargedtoalternativeplacementsfollowingtheclosureofSt.Mary’sin2006havenowchanged.Staffingnumbers,skillmixandworkinghoursareallrealchallengesfortheservice.Thereisaneedtomovetowardsaseven-dayalternativetoin-patientacutecare.


1. There should be a single multidisciplinary team management structure in place in accordance with national policy.

2. All teams should be staffed in accordance with agreed numbers as per national policy.

3. The number of beds for future rehabilitation and continuing care needs to be planned.

4. Service users should have the option of a seven-day alternative service to in-patient care.

439


Mental Health services 2009 Catchment area Report north tipperary

HSEArea HSEWestCatchment NorthTipperaryMentalHealthService NorthTipperaryMentalHealthServicePopulation 66,023NumberofSectors 2NumberofApprovedCentres NoneSpecialistTeams CommunitymentalhealthsectorteamsPerCapitaExpenditure2008[>18Years] RequestedbutnotforwardedDateofMeeting 23July2009

service 2009


NorthTipperaryMentalHealthServiceswasintheuniquepositionamongcatchmentsofprovidingacommunitymentalhealthserviceonly.Theservicewasfullystaffedbytwosectorteamsbuthadnooccupationaltherapist.Servicestopeopleneedingin-patientcareandtreatmentwereprovidedbySouthTipperaryMentalHealthServicesbasedinClonmelinHSESouth.InputfromNorthTipperaryintothisservicewasseverelylimitedintermsofgeneralplanningintherunningofthein-patientserviceandintermsofitsinputintoindividualcareplans.Socialworkersandpsychologistsdidnotgenerallyvisitin-patientsbecauseofthedistanceinvolved.In-patientshadaccesstosocialworkservicesbyreferral.Liaisonbetweenthetwoserviceswasprovidedbyaconsultantpsychiatristwhohadresponsibilityforin-patientsfromtheareaandattendedteammeetingsinNorthTipperaryfortnightly.Acommunitymentalhealthnursealsoattendedalternatemeetingsinbothservices.TheInspectoratewasinformedthatallpatientsdischargedfromSouthTipperarytoitscatchmentwereseenwithinaweek.


1. A decision for the future plans for service organisation and delivery must be made as matter of urgency.

Outcome:TheestablishmentofaprojectteamtomodernisetheSouthTipperaryMentalHealthServicewasduetobeannouncedbytheHSEearlyin2009.StaffinNorthTipperarywerenotinvolvedindecisionsthatwerebeingtaken,eventhoughtheywouldeffecttheservicestheyprovided.Itwasreportedthatplanswerebeingdiscussedwhichwouldresultinthetransferofin-patientservicestoLimerick.Adecisionhadbeentakenbytheprojectteamthatnoin-patientsfromNorthTipperarywouldbeadmittedtoSouthTipperaryfrom31December2010.Theimplicationsfortheprovisionofcommunityservicestothoseresidentsdischargedtotheirareahadnotbeendiscussedwiththem.


Acopyofadocumenttitled2008NorthTipperary–SouthTipperaryPlansfortheSeparationofMentalHealthServiceswasgiventotheInspectoratealongwithacopyoftheVision for Changeimplementationplan.TheformerplandidnotincludeplansfortheclosureofClonmelandhadbeensupersededbytheprojectmanagementteamforSouthTipperary.NocopyofthisplanwasavailabletotheInspectorate.

440



Thesituationwithregardtothefutureoftheservicewasmoreuncertainsincethe2008reporthad}}

beensupersededbytheSouthTipperaryprojectteam.

Contactswiththedevelopingprimarycareteamswereongoing.Sectorareaswerealmostcompletely}}

alignedwiththeprimarycarenetworks.

Allheadsofdepartmentwereontheseniormanagementteam.Serviceuserinvolvementwasbeing}}

considered.

Threefocusgroupshadbeenestablished,focusingonorganisationaldevelopments.}}

Clinichourshadbeenextendedto1900honeeveningaweekintheThurlessector.}}

Multidisciplinaryassessmentandcareplanningformshadbeendevelopedandwerepilotedin}}

February.

Asystemofclinicalsupervisionforallnurseshadbeendeveloped.}}

Amindfulness-basedcognitivebehaviouraltherapygroupforpeoplewithdepressionwasheldtwice}}

yearly.


AdecisionhadbeentakentostopadmissionstoSt.Michael’sUnitinClonmel,forresidentsofNorthTipperaryfrom31December2010.Alternativein-patientfacilitieswerebeingexploredbytheprojectteaminSouthTipperary.



ThepeeradvocatereportedthatasarepresentativefromIrishAdvocacyNetworkhewasmadewelcomebystaffinNorthTipperary.TheadvocatevisitedthedaycentresandÁrasFolláinonaregularbasisandhadbeengivenakeytothepeersupportfacility,whichwasfoundtobehelpful.Discussionshadbegunbetweentheregionaladvocateandtheprincipalsocialworkertorestartalocaladvocacygroupthathadbeendiscontinuedthepreviousyear.

However,theadvocateidentifiedsomeissuesthatneededtobeaddressed.Therewasnorepresentativeserviceusercommittee.Someclientshadlittleawarenessoftheircareplans.Somewouldlikeanexerciseprogramme.Someworriedabouttheeffectsofmultiplemedicationandsomefelttherewastoomuchemphasisonmedication,ratherthanontalktherapies.


ThecommunitypeersupportfacilityÁrasFolláinwasintendedtoprovideanenvironmentwherepeoplehadanopportunitytodeveloptheirphysical,emotionalandspiritualwellbeing.Itwasrunbyserviceuserswithrepresentationfromtheprincipalsocialworkeronbehalfofthementalhealthservices.

Thenewcareplanningformswereexpectedtofacilitateuserparticipationintheircareplans.

441


Theregionaladvocatehadmadeapresentationtothemultidisciplinaryteamhighlightingissuesthathadariseninrelationtoserviceuserparticipationonthemanagementteam.Workwascontinuingonthedevelopmentofprotocols.

Governance


Anevaluationofthemindfulness-basedcognitivetherapyprogrammehadbeenundertakenbytheseniorpsychologist.

AnauditofpatientfileswascompletedinNenagh,focusingonMentalHealthCommissionandAnBordAltranaisstandards.

Aclinicalgovernancegroupfocusingonactivities,riskmanagementandtraininghadbeeninitiated.


Medical Staff

post Wte in post Consultantpsychiatrist 2NCHD(includingspecialistregistrar) 3

Nursing Staff

post Wte in postDON 0ADON 0Nursesbasedinin-patientservices 0Nursesbasedincommunityresidences 0Communitymentalhealthnurse 2Nursesbasedindayhospitals 0Nursesbasedindaycentre 11Temporarystaffpanel 0


speciality Wte in postLiaison 0Clinicalplacementcoordinators 0Nursepracticedevelopmentcoordinator 0Counsellors 2Advancednursepractitioner 2Liaison 4Deliberateselfharm 1

442





Astherewerenospecialistteamsthiswasnotapplicable.


TheservicehadadmittingrightstoSt.Michael’sUnitinSouthTipperaryGeneralHospitalwhere20residentswereidentifiedasbelongingtoNorthTipperary.Inaddition,21longstayresidentsinSt.Luke’sWardwerefromthecatchmentarea.Twenty-sevenresidentsofcommunityresidenceswerefromNorthTipperary.Theservicehadlittleinputintothecareprovidedinthein-patientfacilities,althoughtheSouthTipperaryservicehadbeencriticisedinareportpursuanttoSection55oftheMentalHealthAct2001publishedearlierintheyearbytheMentalHealthCommission,forthequalityofcareprovidedtoitsresidentsinSouthTipperary.

Detailsoftheinspectionofthein-patientfacilitiesarecontainedinthereportsonSouthTipperaryMentalHealthServices.


Astherewerenoapprovedcentresthesewerenotapplicable.


Amultidisciplinarycareandassessmentplanhadbeendevelopedandpilotedduringtheyear.Serviceusersweretobefacilitatedtocontributetotheircareplans.


Therewereno24-hoursupervisedcommunityresidencesinthearea.

Conclusion

Thisserviceisdevelopingwellatthelevelofthecommunitymentalhealthteams.Itisregrettablethatitstillhasnooccupationaltherapyservice.Atanotherlevelhowever,theserviceandthepopulationitservessufferfrombeingdivorcedfromitsin-patientserviceandnothavingthefullrangeoffacilitieswhicharenecessarytoprovideaservicetopeoplewithenduringmentalillness.Itcontinuestoexistina

443


climateofuncertaintyasitdoesnotknowwhereitsin-patientservicewillbebasedafter31December2010andwhatpreparationsitneedstomaketofacilitatethis.


1. This service should include plans for development of its in-patient and specialised community services as soon as possible.

2. The service should have its own development plan.

3. An occupational therapist should be included on the community teams as soon as possible.

444


Mental Health services 2009 Catchment area Report Roscommon

HSEArea HSEWestCatchment RoscommonPCCCMentalHealthService RoscommonMentalHealthServicesPopulation 63,000NumberofSectors 3NumberofApprovedCentres 1SpecialistTeams(e.g.POLL,REHAB) NonePerCapitaExpenditure2008[>18Years] NotProvidedDateofMeeting 16July2009

service 2009


RoscommonMentalHealthServiceshadacatchmentareapopulationof63,000.Therewerethreegeneralconsultantsandnospecialistteams.TheservicehadoneapprovedcentreattheDepartmentofPsychiatrylocatedonthegroundfloorwithinRoscommonCountyHospital.Therehadbeenareductioninacutebedsfrom30to22since2008.Aprivatebedroomwithen-suitefacilitiesforchildrenbetweentheagesof16and18hadbeendevelopedandcommissionedsince2008.Anew4-bedhighobservationareahadalsobeendevelopedandcommissionedsince2008.Therewasone7-daydayhospitalinoperationandthreetrainingcentreslocatedinBoyle,CastlereaandRoscommon.Theservicehadsixdaycentresinsixlocationsaroundthecatchmentarea.Seventy-threelong-staybedswereprovidedinhostelaccommodation.Thisincluded34bedsprovidedforelderlyanddementiacare.

Theservicehadseenareductioninmentalhealthfundingof6.5millioneurointhetwoyears.


1. The high observation unit should be completed and commissioned as soon as possible.

Outcome:Thehighobservationunithadbeencommissionedandcompleted.

2. Each team should be sufficiently staffed in order to provide a full multidisciplinary team approach to the care of service users.

Outcome:Noextrastaffingtoenhancemultidisciplinarycarehadbeenprovided.

3. The training centre in Castlerea should be upgraded in light of the very poor condition of the current building.

Outcome:Afullreviewofthefacilityhadbeencompleted.Nomoneyhadbeenprovidedtorefurbishthisbuilding.EmployeerelationsissueshaddelayedaplantoprovidealternativedayservicesoutsidetheHSE.

445



Theexistingtrainingcentrehadbeenreportedasunacceptabletoyoungerpatients.SincetheclosureofSt.Patrick’sUnitin2007,ithadbecomeashelteredworkshop.Therewasnowaneedforafour-yeartrainingprogrammeforyoungerpeople.

Castlereadaycentrewasfullandsignificantinvestmentwasrequired,buttherewasnoalternativeatpresent.Attendeesneededtotransfertorehabilitationservices,butemployeerelationsissueswereimpedingthisdevelopment.

Therewerenospecialistteamsanditwassuggestedthatasharedcarearrangementwithalargercatchmentareamighthelpaddressthisservicedeficit.


Thefacilityforyoungpeopleaged16-18yearshadbeenopened.}}

AreviewofCastlereatrainingcentrehadbeencompletedandaneedsassessmentofclientshadbeen}}

undertaken.

Apublic/privatepartnershipplantodevelopanewmentalhealthheadquartersanddayhospitalin}}

associationwithPrimaryCommunityandContinuingCare(PCCC)hadbeendevelopedandcontractshadbeensigned.CompletionisexpectedinNovember2012.


Thereareplanstoclosetwocommunityresidenceandmovetheresidentsintosixpurposebuilthousingunitswithnursingstaffsupport.



Thepeeradvocatevisitedtherangeofservicesinthecatchmentareaandprovidedareporttotheinspectorate.

Thepeeradvocatereportedthatstaffwereaccommodatingandwelcoming.

Serviceusersreportedthattheyfoundtheseven-daytrainingcentreatRosnaSuandayhospitalveryhelpful.

Theadvocatesuggestedthatserviceusersintheapprovedcentrewereboredespeciallyatweekends.Theyreportedthattherewasanoverrelianceonmedicationandalackoftalkingtherapiesavailableintheapprovedcentre.

ThepeeradvocatereportedthatthetrainingcentreatCastlereawasstillopenandthatserviceuserswhoutilisedtheservicefeltdemoralised.Itwasstatedthatolderandyoungerresidentsdidnotmixeasilyinthedaycentreduetotheirdifferentneeds.

ConsumerPanelswerenowinplaceandadequatetraininghadbeenprovided.SomefundingforthishadbeenprovidedbytheHSE.

446



TheadvocatefromtheIrishAdvocacyNetwork(IAN)expressedconcernthattheconsumerpanelthathadbeenplannedinlinewithAVision for Changepolicywasrefusedfundingthatwouldenableserviceuserstoattend.Asaresultitwasnotfunctioning.Agreementwasreachedwiththegeneralmanagertoexaminetheissues.

Governance


HealthoftheNationOutcomeScales(HoNOS)assessmentshadbeenundertakeninthecommunitymentalhealthteams.

Multidisciplinarycareplanshadbeenintroduced.Thesefacilitatedserviceuserinput.

Regularreviewsandplanningmeetingsweretakingplacewithresidents.



Medical Staff


Nursing Staff

post Wte in postDON 1(vacant)ADON 3(1vacant)Nursesbasedinin-patientservices 25(4vacancies)Nursesbasedincommunityresidences 39(5.5vacancies)Communitymentalhealthnurse 4(1vacancy)Nursesbasedindayhospitals 3.5Nursesbasedindaycentre 25.75(3vacancies)Other–Temporarystaffpanel 0


speciality Wte in postLiaison 0Clinicalplacementcoordinators 0.5(vacant)Nursepracticedevelopmentcoordinator 0Counsellors 3.5Advancednursepractitioner 0Other 0

447



post Wte in postClinicalpsychologist 1Socialwork 2Occupationaltherapist 3.5(2vacancies)Arttherapist 0OtherCNS(acuteunit) 1


TheDepartmentofPsychiatrywaslocatedonthegroundfloorwithinRoscommonCountyHospitalandhadthreegeneraladultteams.Therehadbeenareductioninacutebedsfrom30to22in2009with12residentsintheapprovedcentreonthedayofinspection.Aprivatebedroomwithensuitefacilitieshadbeendevelopedandcommissionedsince2008forchildrenbetweentheagesof16and18.Anew4-bedhighobservationareahadalsobeendevelopedandcommissionedsince2008.Thebathroomsandtoiletareashadbeenrenovatedtoahighstandard.Thewardwasbright,cleanandwellmaintained.Ithadahighstafftopatientratio,therewasnopressureonbedsandtimewasavailablefordirectpatientcontact.


Theapprovedcentrehadanumberofnon-complianceissueswiththeRegulationsonthedayofinspection.Issuessurroundingrecreationalactivities,careplanning,therapeuticactivitiesandprivacyrequiredfurtheraction.


Theoperatingpoliciesandproceduresneededtobeupdatedandreviewedappropriately.


TherewereanumberofbreachesoftheRulesinrelationtoseclusionandphysicalrestraintthatneededtobeaddressed.Itisimportanttoensurethatstaffhavereadandunderstoodthepolicies,oncetheyhavebeenadopted.

Codes of practice

TherewereanumberofbreachesintheCodesofPracticeinrelationtophysicalrestraintandtheseshouldbeaddressed.TherewasnopolicyavailabletotheInspectorateinrelationtophysicalrestraint.

TheservicewascompliantinrelationtotheCodeofPracticeonnotificationofdeathsandincidentreporting.

Itwasunacceptableforchildrentobeadmittedtoanadultunit.Anumberofpoliciesinrelationtotheadmissionofchildrenwerenotavailable.

448



Multidisciplinarycareplanswereinplace.Theplansfacilitatedserviceuserinputbutthiswasnotbeingachieved.Therapeuticactivitieswerenotlinkedtocareplans.Therewasnoevidenceofhealthandsocialcarecontributiontothecareplansinthefilesinspected.


Description

Theservicehadsix24-hoursupervisedcommunityresidences.



Castlerea 73 Castlerea Nursing

Boyle 9 7 Boyle NursingStrokestown 7 7 Strokestown NursingKnockroeHouse,Castlerea

15 15 Castlerea Nursing

TithenagCarad,Castlerea


RosalieUnit,Castlerea


Conclusion

Therehadbeensomeimprovementsintheservicesince2008however;itwasdisappointingthatdespiteareductioninresidentnumbersintheapprovedcentretherehadbeenlittleincreaseinstaffingnumbersinthecommunitymentalhealthteam.Anumberofresidentsintheapprovedcentreonthedayofinspectionseemedtobewithoutactivitiesandwerelyingontheirbedsorsittingaround.Whileitisacknowledgedthatanoccupationaltherapyassistantworkedintheunit,thelackofanon-siteoccupationaltherapistcontributedtothelackofaneeds-basedtherapeuticenvironment.ItwaslikelythatthelackofcompletedindividualmultidisciplinarycareplansasoutlinedintheRegulationsalsocontributedtothis.Multidisciplinarycareplanswereinplacein24-hoursupervisedresidences.

ItwasofconcerntotheInspectoratethatadolescentscontinuedtobeadmittedtothisadultunit.ItwasreportedthatallrequestsforadmissiontoSt.Anne’sChildandAdolescentUnitinGalwaywererefusedduetolackofvacanciesinthere.

Theservicehadsufferedareductioninstaffnumbersduringtheyearandthismayberelatedtothereductioninbeds.However,staffreportedthatthosewhohadlefttendedtobethemoreexperiencedstaffandtheexpectationwasthatthiswouldimpactonservicedeliveryinthefuture.


1. The composition of the teams should be enhanced with the necessary multidisciplinary professionals.

2. Each resident must have an individual care plan. The system developed must be reviewed and all disciplines must be responsible for meeting the requirements of Article 15.

449


3. The care plans should be linked to the therapeutic activity and educational programme.

4. Training in multidisciplinary care planning should be provided for all staff.

450


Mental Health services 2009 Catchment area Report sligo/leitrim Mental Health services

HSEArea HSEWestCatchment Sligo/Leitrim/SouthDonegalMentalHealthService Sligo/Leitrim/SouthDonegalMentalHealth

ServicesPopulation 99,875NumberofSectors 5NumberofApprovedCentres 1SpecialistTeams Rehabilitationandrecovery

PsychiatryoflaterlifePerCapitaExpenditure2008[>18Years] Totalexpenditure28,127,272euroDateofMeeting 3December2009

service 2009


Sligo/Leitrim/SouthDonegalhadapopulationofapproximately100,000withfivesmallsectors.Therewereplanstoreconfiguretheservicesoastohavetwolargesectors.Therewasarehabilitationandrecoveryteamandapsychiatryoflaterlifeteam.Multidisciplinarystaffingwasspreadthinlyacrossteams.Therewasoneapprovedcentrewithanadmissionunitandaspecialcareunit.ThereweretentativeplanstoopenanewadmissionunitinSligoGeneralHospital.Thereweresixcommunityresidences,onlytwoofwhichwereunderthecareoftherehabilitationandrecoveryteam.


1. Service user advocacy should be introduced.

Outcome:PeeradvocacythroughtheIrishAdvocacyNetwork(IAN)wasnowavailable.

2. All teams should be resourced with an appropriate multidisciplinary team skill mix.

Outcome:AsenioroccupationaltherapistbegananewpostinNorthLeitriminAugust2009.Apartfromthisnodevelopmentofteamshadtakenplace.

3. Provision of a new acute unit should be a priority.


4. Community residences should come under the care of the rehabilitation team as soon as possible.

Outcome:Thishadnotbeenfullyachieved,butonefurthercommunityresidencewastakenunderthecareoftherehabilitationteamin2009.

5. Consideration should be given to reorganisation of sector teams into larger population groups and redeployment of existing staff to the catchment area specialist services.

Outcome:Thisremainedatplanningstage.

451


6. The needs of people with serious mental ill-health should be prioritised by community staff funded by the mental health service.



Thebusinessplanfortheserviceincludedplanstoreconfigurethesectorstohavetwolargesectorswith60,000and39,000populationrespectively.TheLeitrimsectorwastohavetwoconsultantsandtheSligosector2.5consultants.Thiswasexpectedtobecompletedinearly2010.Therewerealsoplanstoreconfigureandupgradetheexistingfacilities.

Thenewacuteunitwasatphasethreeplanningstageandawaitedfinalapproval.


BankHousecommunityresidencehadclosedandresourceshadbeendeployedtocoverovertimeand}}

toprovidedayservicesinManorhamilton.

DayservicesinNorthLeitrimhadbeenenhanced.}}

AsenioroccupationaltherapistcommencedinAugust2009.}}

Advocacyserviceshadcommenced.}}

Athree-yeareatingdisorderprogrammewastocommencewiththreeeatingdisorderpractitionersas}}

acommunity-basedservice.

Adayhospitalreviewhadtakenplacetoassesssatisfactionandaccesstodayhospitalservices.}}

Theservicewasinvolvedinaperinatalpathwaypost-nataldepressionproject.}}

Twonursescompletedthenurseprescribingcourse.}}

Thepsychiatryoflaterlifeteamheldpublicmeetings,presentedatausergroupstudyday,andwere}}

involvedinanartproject.Theyachievedlowadmissionratesandhadnowaitinglists.Theyprovidecarersupportandcarriedoutauditsofcasenotes,benzodiazepinesandhealthandsafety.

Theoccupationaltherapydepartmenthadimplementedanewreferralpathway,aprioritysystemand}}

newelectronicassessments.ThecommunitymentalhealthoccupationaltherapyservicehadbeenextendedinSligoandintherehabilitationandrecoveryteam.



Peeradvocacyhadrecentlybeenstartedandwascurrentlybeingextendedtothecommunityfacilities.Ingeneral,theserviceusersdescribedthestaffasfriendlyandapproachableandtherewerenodifficultiesaccessingpeopledetainedundertheMentalHealthAct.Theoccupationaltherapywaspraised,aswastheaccesstothegarden.

Someserviceuserssaidtheywereboredontheunit.Theservicestatedthatithadaddressedtheissueofcompulsorypregnancytestingandhadstatedinitspolicydocumentthatitwasnotcompulsory.Some

452


femaleresidentscomplainedaboutthelackofsecurelockersandthelackofteaandcoffeeonSundays.Manyresidentswantedmoreinformationabouttheirmedication,wouldlikemoretimewiththeirdoctors,moreawarenessoftheircareplansandmoreparticipationinthedrawingupoftheirdischargeplans.


Therewasfeedbackonthepatientsatisfactionquestionnairefromtheadvocateandserviceusers.TherewasaMentalHealthIrelandrepresentativeatmeetings.

Governance


Therewasamultidisciplinarycatchmentareamanagementcommittee,aclinicalriskcommitteeandadrugsandtherapeuticscommittee.Apolicymanualwasinplace.TherewasalsoanimplementationgroupforA Vision for Change.IncidentswerereviewedweeklyandtheSTARSWebreportingsystemhadbeenintroduced.Ariskmanagerwasappointedrecently.

Therehadbeenmonthlyauditsonclinicalcharts,anauditonthedischargesystem,anauditonMentalHealthAct2001compliance,abenzodiazepineaudit,andahealthandsafetyaudit.


Medical Staff


Nursing Staff

post Wte in postDON 1ADON 5Nursesbasedinin-patientservices 84.3Nursesbasedincommunityresidences 61Communitymentalhealthnurse 12Nursesbasedindayhospitals 6Nursesbasedindaycentre 13.7


speciality Wte in postLiaison 1Clinicalplacementcoordinators 1Nursepracticedevelopmentcoordinator 0Counsellors 6Advancednursepractitioner 0Familytherapyandcognitivebehaviouraltherapy 11

453












CMHN 4 4

Clinicalpsychologist .12 .12

Socialworker 1 1






Dayhospital – 1

Daycentre 1 0

454


Rehabilitation and Recovery Team Report

TeamDescription Rehabilitationandrecovery,whichincludedanassertiveoutreachteam

Population 99,875





CMHN2 0 5

Clinicalpsychologist .12 .12

Socialworker 1 1



Dayfacilitynursestaffing 4.8 0



Dayhospital – –

Daycentre 1 1


Therewasoneapprovedcentrewhichwasatwostoreystructure.Maleadmissionunitandthespecialcareunitwerelocatedonthegroundfloorandthefemaleadmissionunitwasonthefirstfloor.



TheapprovedcentrewasnoncompliantintheRegulationswithregardtochoiceoffood,careplanning,therapeuticactivities,generalhealth,privacy,premisesandCCTV.TheservicehasinitiatedorcompletedcomplianceintheseRegulationssincethetimeofinspection.


Theservicewasnon-compliantwiththeRulesregardingtheuseofseclusion.Achecklistsystemhadsincebeenputinplacetorectifythis.

Codes of practice

Theservicewasalsonon-compliantwiththeCodeofPracticeregardingphysicalrestraint.Achecklistsystemhassincebeenputinplacetorectifythis.

455



Allserviceusersintheapprovedcentrehadmultidisciplinarycareplans.Therewasamultidisciplinarycareplanworkinggroup.Anauditofcareplanninghadbeencarriedout.


Description

Two24-hoursupervisedresidenceswereunderthecareoftherehabilitationandrecoveryteam.Bothoftheseusemultidisciplinarycareplans.BankHousehadrecentlybeenclosed.



CastlecourtHouse 10 9 RehabilitationandRecovery

MDT

AshbrookHouse 19 12 RehabilitationandRecovery

MDT

CypressLodge 18 16 AdultMentalHealth

MDT

SliabhanHouse 8 8 AdultMentalHealth

MDT

BenbulbenLodge 10 9 AdultMentalHealth

Nursing

LindenHouse 15 15 AdultMentalHealth

Nursing

Conclusion

TheSligo/LeitrimMentalHealthServiceisabusyservice.Itcurrentlyhasfivesmallsectorswiththinlyspreadmultidisciplinarystaffing.Thiswillchangeearlyin2010totwolargesectorswithbetteraccesstodifferentdisciplines.HoweverstaffingwillstillbebelowthatrecommendedbyA Vision for Change.TheprogressofthenewadmissionunitinSligoGeneralHospitalhas,toallintentsandpurposes,stalledandthereseemslittleprospectofanewunitintheimmediatefuture.Thecommencementofpeeradvocacyisparticularlywelcomedanditappearsthattheservicehasalreadyextendedintothecommunity.Thenon-complianceissueswithRegulationsandRulesforapprovedcentresarebeingaddressed.Therearesomeinterestingdevelopmentswithintheservice,especiallytheeatingdisorderprojectwhichisduetocommenceshortly.


1. The new admission unit in Sligo General Hospital should progress as quickly as possible.

2. There should be full multidisciplinary staffing of all teams.

456


Mental Health services 2009 Catchment area Report West Galway

HSEArea HSEWestCatchment WestGalwayMentalHealthService WestGalwayMentalHealthServicesPopulation 121,567(95,097over18years)NumberofSectors 4NumberofApprovedCentres 2SpecialistTeams(E.G.POLL,REHAB) PsychiatryoflaterlifePerCapitaExpenditure2008[>18Years] 14.23million[15europercapitaexpenditure][sic]DateofMeeting 16July2009

service 2009


WestGalwayMentalHealthServicesprovidedacatchmentareaserviceto121,567people(95,097over18years).Thecatchmenthadasignificantpopulationofthirdlevelstudents,asignificanttransienttouristpopulationinsummerandalsoprovidedservicestoanoffshoreislandpopulation.

Thecatchmentareawasspreadoveralargegeographicalareacoveringaruralandurbanmixwithhighlevelsofdeprivationinbothurbanandisolatedruralareas.

Thereweretwoadultapprovedcentres;theDepartmentofPsychiatry,UniversityHospitalGalway,andUnit9A,MerlinPark.Theservicehadahighnumberofbedsforthepopulation,43acutebedsand26continuingcarebeds.Therehadbeenpoordevelopmentofcommunity-basedmentalhealthservices,withallstaffbasedinandworkingfromtheacuteunit.Therewasonedayhospitalinthecity.Allserviceusershadtoattendacentralisedoutpatientclinicintheacuteunit,manytravellingupto80km.

AliaisonservicewasprovidedfromtheDepartmentofPsychiatrytoUniversityHospitalandMerlinParkHospitalwhichinturnprovidedaregionalserviceforHSEWestintheabsenceofafullyresourcedliaisonteam.


1. A full rehabilitation team should be provided.

Outcome:Therewasnoprogressreportedonthisrecommendation.

2. A liaison team should be provided.

Outcome:Therewasnoprogressreportedonthisrecommendation.

3. Tully hostel must open as a matter of urgency.

Outcome:Therewasnotimeframeavailable,althoughstaffhopedthatitwouldbeduringthecurrentyear.

457


4. Clarity should be provided as to the exact nature of the provisions to progress the merging of East and West Galway.

Outcome:Therewasnofurtherclarityavailable.

5. A multidisciplinary team senior management group should be in place by early 2009.

Outcome:Monthlymeetingsofseniorstaffandheadsofdepartmentwerescheduledwiththegeneralmanager.Thefocuswasstrategicandoperational.MinuteswerecirculatedtotheLocalHeathManagerandtheAssistantNationalDirectorofMentalHealthServices.


TherewasabusinessplanfortheGalwayMentalHealthServices.Itoutlinedtargetsfor2009.


Constructionofahighobservationareaintheacutepsychiatricunitwascompleted.Ithadnotopened}}

duetostaffshortages.

ApilotWellnessRecoveryActionPlan(WRAP)programmehadbeeninitiated.}}

Ascopingexercisefortheintroductionofsectorisationwasinprogress.}}

Dieteticserviceandpharmacyservicewereembeddedintotheservicesandexpanded.}}


ThebusinessplanreportedthatUnit9Abednumberswouldbereducedbyhalfthisyear.Anumberofresidentswouldmovetoa24-hourresidenceinTully.Thisplanhadbeendebatedforanumberofyearsnow.Progresshadbeenpainfullyslow,andintheinterimserviceuserswereinappropriatelyplacedinhospital.



TheIrishAdvocacyNetwork(IAN)providedapeeradvocateservicethroughoutthecatchmentarea.OnthedayoftheInspectoratecatchmentmeeting,theypresentedawrittenreporttotheInspectionteam.Thereporthighlightedanumberofpositiveaspects,inparticularthehelpfulnessandsupportofdomesticstafftoserviceusersduringadmission,inputfromoccupationaltherapists,availabilityofacommunityemploymentprogramme,andthattherewasanopendoorpolicy.

Ofconcerntoserviceuserswastheperceivedoveruseofmedication,reluctanceonthepartofstafftodiscussorsupportserviceuserswhowantedtodiscusstraumastheyhadsuffered,lackofstafftoaccessthegymandhavingtorepeattheirhistorytojuniordoctors.Othersreportedthattherewaslimitedtimewithnursingstaff,lackofmeaningfulactivities,rightsnotbeenfullyexplainedandbeinggivenspecialone-to-onenursinginasinglebedroomwithnobathroomfacilities.Inthecommunityservice,userscomplainedaboutthelackofacommunityserviceandpooraccesstocommunitynurses.

458



Itwasreportedthatserviceuserswereincludedandtookanactivepartinqualityinitiativesinthehospital,includingvoluntaryaccreditationprocesses.TheviewsofresidentsonthepsychiatricunitweresoughtthroughanongoingMcLeanPerceptionofCaresurveyandthroughweeklymeetingswithseniorstaff.Outpatients’viewsweresoughtthroughasatisfactionsurvey.Therewasamechanisminplacetoreceivefeedbackfromserviceusersintheacuteunit.Afamilyandcarersgroupwasintheplanningstagesforlaterintheyear.

Thepsychiatryoflaterlifeteamhadanestablishedcarersgroupinoperation.Itranfor6to8weeksandwasfacilitatedbymembersoftheteam.

ServiceusershaddevelopedanemploymentandsocialsupportreportfromasurveyofmentalhealthserviceusersinGalway.

Governance


Anewgovernancestructurehadbeendeveloped.ItwasreportedthatitwouldbeimplementedinSeptember2009.

TherewasanongoingresearchprogrammealliedtotheDepartmentofPsychiatryatNationalUniversityofIrelandGalway.

Ascopingexercisewithaviewtofacilitatingsectorisationwasinprogress.

Agrowingissueofconcernfortheservicewastheinabilitytoreleasestafffortrainingpurposes.


Medical Staff


Nursing Staff

post Wte in postDON 1ADON 3Nursesbasedinin-patientservices 52.95Nursesbasedincommunityresidences 10.5Communitymentalhealthnurse 10Nursesbasedindayhospitals 3.4Nursesbasedindaycentre 8Temporarystaffpanel 3

459



speciality Wte in postLiaison 1.2Clinicalplacementcoordinators 1Nursepracticedevelopmentcoordinator 1Addiction 3.5Advancednursepractitioner 0Clozaril 2.4Cognitivebehaviouraltherapy 0.5


post Wte in postClinicalpsychologist 3.41Socialwork 5.6Occupationaltherapist 5.91Arttherapist 0Other 0









ADON 0.2 0.2

CMHN 2 2


Socialworker 1 1





460



Thereweretwoadultapprovedcentres,thePsychiatricUnit,UniversityCollegeHospital,Galway,andUnit9A,MerlinPark.St.Anne’sChildren’sCentrewasreportedseparately.



ThePsychiatricUnitwasnotcompliantinanumberofareas,includingcareplanning,informationandhavingcurrentpoliciesinplace.Residentshadbeentransferredtoanotherhospitalforthepurposeofalleviatingbedshortages,althoughtheratewaslowerthanin2008.

ThereweredifficultiesinUnit9AwithregardtobeingcompliantwiththeRegulations.Thiswasinfluencedbythelackofarehabilitationfocus,lackofadedicatedteamandthatresidentswereinappropriatelyplacedinhospitalwhenalternativecommunityaccommodationwasavailablebutnotinuse.Bedswereusedinappropriatelytoaccommodatebedshortagesintheacuteunit.


ThePsychiatricUnitwasnon-compliantintheprovisionofinformationonECT,renewingpoliciesyearlyandcompletingthedocumentationonseclusioninaccordancewiththeRules.

Unit9AdidnotuseanyformoftreatmentthatwasgovernedbyRules.

Codes of practice

Theserviceshadanumberofbreachesintheuseofphysicalrestraintandinrelationtopoliciesforchildren.

Unit9AwasincompliancewiththeCodesofPracticethatwereapplicabletothecentre.


Multidisciplinarycareplanningwasinitsinfancyintheinpatientunits.Therewasnomultidisciplinarycareplanninginoperationinthegeneralsectorteams.

Thepsychiatryoflaterlifeteamhadamultidisciplinaryapproachtocareplanning.


Description

Thereweretworesidencesinoperation.Theserviceusersaccessedtheirsectorteam.Therewasnoaccesstoarehabilitationteam.Bothhouseswerereportedtobeingoodcondition.

TullyHouseremainedunopenedatthetimeofthereport.

461




BreadaghHouse 7 7 4generaladult NursingSycamore 10 9 2sectorteams NursingTullyHouse Vacant Vacant Unopened

Conclusion

WestGalwayisabed-richservicewith43acuteand26continuingcarebedsforanadultpopulationof120,000.Therearenodedicatedelderlycarebeds,theteamaccessgenericservicesandnursinghomeaccommodation.Acommunitymentalhealthservicehasnotbeendeveloped,despiteacatchmentthatcoversawidegeographicalarea.WhilethebusinessplanforGalwayMentalHealthServicesadvocatesacommunity-basedapproach,thereisstillsomedistancebetweentheaspirationandthepracticeontheground.Theserviceremainssignificantlybehindmostotherservicesinthecountryinthisregard.Allcliniciansarebasedinandworkfromtheacutein-patientunit.


1. Service users should have access to a community-based service in their local area in accordance with national mental health policy.

2. Residents in Unit 9A who no longer require in-patient care should be discharged to Tully residence.

3. A plan should be developed with specific outcomes stated and with a time line to put in place a community-based service, with real alternatives to in-patient care. Costing should be included.

4. The number of beds should be reduced to reflect the population level.

5. The teams should be staffed according to national policy norms.

6. The transferring of residents from the acute unit to Merlin Park due to overcrowding must cease and the high observation area should open as a matter of urgency.

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additional information

CHapteR 6

465


additional information

ContaCtinG tHe Mental HealtH CoMMission:

MentalHealthCommission/CoimisiúnMeabhair-ShláinteStMartin’sHouse,WaterlooRoad,Dublin4Tel:(+353)016362400Fax:(+353)016362440Email:[email protected]:www.mhcirl.ie

solicitors: ArthurCoxEarlsfortCentreEarlsfortTerraceDublin2Tel:(+353)016180000Fax:(+353)016180618www.arthurcox.com

accountants: CrowleysDFK16/17CollegeGreenDublin2Tel:(+353)016790800Fax:(+353)016790805www.crowleysdfk.ie

auditors: OfficeofComptrollerandAuditorGeneralTreasuryBlockDublinCastleDublin2Tel:(+353)016031000Fax:(+353)016031010www.audgen.gov.ie

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irish Websites

Government organisations

DepartmentofHealth&Children www.dohc.ieGovernmentofIreland www.gov.iePublicServiceInformation www.citizensinformation.ie.

Health service executive

HealthServiceExecutive www.hse.ieTheHealthServiceReformProgramme www.healthreform.ie

independent & state Research Bodies/organisations

TheEconomicandSocialResearchInstitute www.esri.ieHealthResearchBoard www.hrb.ieIrishResearchCouncilfortheHumanities&SocialSciences www.irchss.ieIrishSocialScienceDataArchive www.ucd.ie/issdaNationalInstituteofHealthSciences www.nihs.ieIrishCouncilforBioethics www.bioethics.ie

Mental Health professional organisations and Health professional organisations

TheCollegeofPsychiatryofIreland www.irishpsychiatry.ieAssociationofOccupationalTherapistsofIreland www.aoti.ieIrishAssociationofSocialWorkers www.iasw.ieIrishCollegeofGeneralPractitioners www.icgp.ieTheNationalCouncilfortheProfessionalDevelopmentofNursingandMidwifery www.ncnm.ieNationalServiceUsersExecutive www.nsue.ieThePsychologicalSocietyofIreland www.psihq.ieIrishAssociationofSpeechandLanguageTherapists www.iaslt.com

Mental Health organisations and advocacy organisations

TheAlzheimerSocietyofIreland www.alzheimer.ieAware www.aware.ieBodywhys www.bodywhys.ieGROW www.grow.ieHeadstrong www.headstrong.ieInclusionIreland www.inclusionireland.ieIrishAdvocacyNetwork www.irishadvocacynetwork.comIrishMentalHealthCoalition www.imhc.ieMentalHealthIreland www.mentalhealthireland.ieSamaritans www.dublinsamaritans.ieShine www.shineonline.ieSTEER www.steermentalhealth.comTheIrishAssociationofSuicidology www.ias.ie

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other

Age&Opportunity www.olderinireland.ieAmnestyInternational-IrishBranch www.amnesty.ieSimonCommunitiesofIreland www.simon.ieFocusIreland www.focusireland.ieHealthInformation&QualityAuthority www.hiqa.ieHSELibrariesOnline www.hselibrary.ieIrishHumanRightsCommission www.ihrc.ieIrishSocietyforQuality&SafetyinHealthcare www.isqsh.ieLawReformCommission www.lawreform.ieNationalFederationofVoluntaryBodies www.fedvol.ieNationalOfficeforSuicidePrevention www.nosp.ieOmbudsmanforChildren’sOffice www.oco.ie

Registration Bodies

AnBordAltranais www.nursingboard.ieMedicalCouncil www.medicalcouncil.ie

staff Representative organisations

IMPACT www.impact.ieIrishHospitalConsultantsAssociation www.ihca.ieIrishMedicalOrganisation www.imo.ieIrishNursesandMidwivesOrganisation www.inmo.iePsychiatricNursesAssociationofIreland www.pna.ieSIPTU www.siptu.ie

state Bodies

NationalDisabilityAuthority www.nda.ieOfficeoftheMinisterforChildrenandYouthAffairs www.omc.gov.ie

european, international, Reference and uK websites

european

CouncilofEurope www.coe.intHOPE www.hope.beHealth–EUPortal http://ec.europa.eu/health-eu/index_en.htm

international

UnitedNations–HumanRights www.un.org/rights/WorldHealthOrganization www.who.intWorldFederationforMentalHealth www.wfmh.org

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Reference sites

GuidelinesInternationalNetwork www.g-i-n.netTheInternationalSocietyforQualityinHealthcare www.isqua.orgNationalInstituteforHealthandClinicalExcellence www.nice.org.ukTheCochraneCollaboration www.cochrane.org

uK

DepartmentofHealthUK www.dh.gov.ukMedicalResearchCouncil www.mrc.ac.ukMentalHealthAlliance www.mentalhealthalliance.org.ukMentalHealthFoundation www.mentalhealth.org.ukMentalWelfareCommissionforScotland www.mwcscot.org.ukNHSChoices www.nhs.ukHealthInformationResources www.library.nhs.ukTheRoyalCollegeofPsychiatrists www.rcpsych.ac.ukSANE www.sane.org.ukSocialCareOnline www.scie-socialcareonline.org.ukSainsburyCentreforMentalHealth www.scmh.org.uk

2009 annual report - mhcirl.ie · the commission and their support to me and my staff since my...

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