Investment needed for HSE run mental health services

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Investment in HSE-run inpatient mental health services is needed to ensure that people of all financial means have access to a similar level of mental health care, according to a report.

The latest annual report from the Mental Health Commission (MHC) found that independent private mental health centers generally provide a better standard of care than facilities run by health service officials, enabling a “restricted number of people” to have health insurance or financial means. , to be able to access high-performance centers in the country.

Only two-thirds of individual care plans for inpatients at HSE Mental Health Centers are of an acceptable standard, according to Dr Susan Finnerty, Inspector of Mental Health Services for the Mental Health Commission.

She told RTÉ’s Drivetime: “Everyone has a right under mental health law to their own care plan. This sets out their needs, recovery goals and the therapies needed to achieve them.

“There is poor compliance in this area, and it has been slow to improve over the past five years.

“We continue to see a lack of appropriate targets and a lack of resources.”

The Mental Health Commission’s 2021 annual report found that more than a third (36%) of approved centers failed to comply with regulations on individual care plans.

Looking to the future, Dr Finnerty said there was no silver bullet, but that 10% of the total health budget should be allocated to mental health – at present the ireland only allocates 6% of resources to mental health.

Mental Health Commission chief executive John Farrelly said the report showed “clear evidence that private and independent mental health service providers generally provide care in higher quality facilities than the public system. “.

The only HSE area that scored higher than private facilities last year in commission inspections was CHO 5, which covers south Tipperary, Carlow/Kilkenny, Waterford and Wexford.

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MHC has asked the HSE for an updated action plan addressing issues around accommodation, individual care plans and risk management practices in its mental health services.

Over the past five years, the quality of premises has remained the commission’s main cause for concern, according to the report.

The 2021 annual report highlighted that accommodation concerns at HSE Approved Centers centered on inadequate resources and poor governance arrangements.

Speaking on RTÉ’s Morning Ireland, Mr Farrelly said the MHC considered five HSE premises in Cork to be “inadequate”.

“People who don’t have private health insurance will go to these premises in Cork, which are also weak in terms of individualized patient care,” Mr Farrelly said.

“Meanwhile, someone who lives in the Dublin area – where the majority of private, independent centers are – who has private health insurance, has much better choice and access.

He said it was “not fair and not fair”.

Mr Farrelly added that the HSE has invested in new buildings with special teams to “keep it running” in counties Tipperary, Wexford, Carlow and Kilkenny.

“You should ask the question then, if it can happen in one area, why can’t it happen in the other?” he said.

The Inspector of Mental Health Services, Dr Susan Finnerty, acknowledged that several new centers had been built in recent years. However, she said there remained a significant number of outdated and unsuitable buildings within the HSE park which had suffered from years of environmental neglect.

Dr Finnerty said service providers need to act before the annual inspection identifies them and enforcement action is taken.

The only HSE area that scored higher than private facilities last year in commission inspections was CHO 5.

“Such a knee-jerk response to adverse inspection results does not indicate good governance. The comparatively better compliance rates in CHO 5 show that HSE has the ability to adequately address premises challenges,” he said. she declared.

Dr Finnerty called for “strengthened leadership and governance across the health service” if the far-reaching and innovative actions set out in the “Sharing the Vision” mental health policy are to be achieved.

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Care plans

Dr Finnerty criticized the “persistently poor compliance” with regulations relating to individual care plans.

36% of approved centers did not comply with these regulations, although the HSE said that care planning and the individual care plan document were essential to person-centred recovery care in community hospitals and residential settings.

“Despite this, the HSE has failed to significantly improve care planning for service users over the past five years. This shows a lack of leadership and accountability,” she said.

Developing mental health program

The HSE said its mental health services continued to invest in premises, with €14.2 million allocated for capital development in 2022.

Responding to the MHC report, he said that over the past three years a recurrent fund of €6 million has also been made available to invest in the safety and compliance of mental health service infrastructure.

In a statement, he said a mental health capital program is currently being developed, focusing on upgrading existing facilities, replacing unsuitable community residential and non-residential facilities and continuing to expand facilities. services.

It says its policy is that each patient has an individual care plan and that individual service improvements have been made locally and a national service improvement initiative has been implemented.

The HSE said the mental health services have invested additional funds in recent years to increase the number of consultant psychiatrists in training, assistant psychologists leading to more clinical psychologists and psychiatric nurses in training at lower and lower levels. superior.

He added that he would continue to invest in mental health services, improving existing services and developing new ones to meet the growing and emerging needs of the population.

Child and adolescent mental health service

In 2021, there were 32 child admissions to 11 adult units compared to 27 admissions to 9 adult units in 2020 and 54 admissions to 15 adult units in 2019.

In percentage terms, 6.3% of children admitted were in adult units.

This figure is slightly higher than in 2020, when admissions to adult units accounted for 5.6% of all child admissions, the lowest number since records began.

The report says the decline in admissions of children to adult units in 2021 and 2020 may be linked to changing admission and segregation practices in response to the Covid-19 pandemic.

However, he added that based on the available data, “it is not possible to determine a direct causal relationship.”

Last year, 78% of children admitted to an adult unit posed an immediate risk to themselves, while 16% were admitted because of an immediate risk to themselves and others.

31% of admissions of children to approved adult centers in 2021 also occurred when there was no bed available in a CAMHS unit.

The report says this is “part of a trend” in recent years where the number of admissions of children to adult units “has dropped dramatically”.

He pointed out that in 2009 there were more children admitted to adult units than to CAMHS units.

Involuntary detention

The report shows that requests for the involuntary detention of people by the gardaí continued to increase over the past year.

There were 1,971 involuntary detention admission orders from the community in 2021 (compared to 1,919 in 2020). 35% of them initiated by An Garda Síochána (compared to 32% in 2020).

In its report last year, the commission was particularly critical of this approach to detention – pointing out that the only person to sign off on applications for involuntary admission to an inpatient facility should be an authorized health service officer.

The commission says the gardaí claims cannot be allowed to proceed.

Although there was a reduction in restrictive physical and mechanical restraint practices, episodes of seclusion were similar to the level reported in 2020.

To increase the protections provided to people who experience restrictive practices, the Mental Health Commission said it intends to release updated rules and codes of practice governing such practices this year.

The report showed that there was also very high compliance with the rules on electroconvulsive therapy, reflecting the move to centers of excellence over several years.

“Endemic” two-tier system in health services

Roisin Clarke, acting chief executive of mental health reform, said today’s report highlights a two-tier system that is endemic to all health services.

Speaking on RTÉ’s News at One, Ms Clarke said this was causing ‘serious inequalities’ among people with mental health issues, and while funding was part and parcel of the problem, it was not the only one. problem.

“In addition to investment, we also need stronger leadership and governance across health services,” she said.

“Mental Health Reform called for the reinstatement of a National Mental Health Officer in the HSE. This role ceased in 2016 but is now to be reinstated.”

Ms Clarke also expressed concern about the increase in the admission of children to adult inpatient units, calling it “unacceptable”.

“In 2021, 32 children were admitted to adult inpatient units.”

She said this was partly due to the closure of a CAMS unit in Dublin.

“The admission of a child to an adult hospital unit is a violation of his human rights and contradicts the government’s commitments under the United Nations conventions on the rights of the child,” she said. declared.

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