Makeshift beds at the Department of Psychiatry
Overcrowding, dangerous ligature points and dirty conditions along with non compliance in a number of other key areas were highlighted in a recent report by the Mental Health Commission on the Department of Psychiatry at St Luke’s Hospital, Kilkenny.
The unit has been in the limelight in recent months with protests and threatened strikes amid growing staff frustration and concerns over patient safety.The Inspector of Mental Health Services, Dr Susan Finnerty outlined a summary of the inspection findings which included that bed capacity was highlighted as a risk on the risk register, however, this risk had not been reviewed in the register since January 2017.
The report also stated a number of ligature points were identified in the report which were not removed or effectively mitigated. Numerous ligature points were observed in the approved centre and there were works ongoing to minimise ligature points.
The report highlighted how the Department of Psychiatry at St Luke’s Hospital was non-compliant with eight elements of the code of practice on physical restraint.
The approved centre admitted children in 2017 but age-appropriate facilities and a programme of activities appropriate to age and ability were not provided.
No staff had received training in support of the principles and guidance in the Code of Practice Guidance for Persons working in Mental Health Services with People with Intellectual Disabilities. The approved centre was non-compliant with his code of practice.
There was non compliance with 18 elements of the code of practice on admission, transfer and discharge.
Inspectors also found that the approved centre frequently exceeded bed capacity, which led to residents using sitting rooms as bedrooms. Residents slept on mattresses on the floor which is ‘unacceptable’ according to the findings.
The report also found that the centre provided a dedicated tribunal room. However, the door to the room was fitted with a clear glass panel and the patient and everyone else in the room could be seen from the corridor. As a result, it was not possible for tribunal sittings to be held in private, as required by the Mental Health Act.
According to the findings of the report the approved centre was dirty and badly maintained.
A broken paper towel dispenser in the seclusion room bathroom was a potential hazard to residents.
Toilet floors and bedroom floors were dirty, badly stained, damaged and required replacing.
There was also broken tiles, dirty, stained and chipped skirting boards, stained and blocked air vents, a dirty and malodorous visitors’ toilet in the reception area and a pile of rubbish on the ground in the cleaners’ room.
There were no laundry facilities, and residents were air-drying wet towels through the windows and on bushes outside.
On the date of the inspection there were 47 residents in the centre, which is licensed for 44 beds. This is a recurrent issue a the Department of Psychiatry and there is currently threatened industrial action by members of the trade union, SIPTU who state that due to the constant overcrowding there are serious fears surrounding patient safety.
The inspectors found that the management team at the hospital had identified that overcrowding was a serious operational and health and safety risk.
According to the report this risk had been escalated to a national level within the HSE and the centre had developed communication meetings with the local gardaí and the staff in the emergency department to improve the processes around referral to the approved centre.
Despite these measures, there was continued overcrowding in the approved centre.
The findings of the inspection, which took place on dates last September found that the centre was non compliant in the following areas: individual care plans; general health; privacy; premises; ordering, prescribing, storing and administration of medicines; staffing; maintenance of records; register of residents; operating policies and procedures; certificate of registration; rules governing the use of electroconvulsive therapy; rules governing the use of seclusion; code of practice on the use of physical restraint in approved centres; code of practice relating to admission of children under the Mental Health Act 2001; code of practice for mental health services on notification of deaths and incident reporting; code of practice guidance for persons working in mental health services with people with intellectual disabilities; code of practice for the use of electroconvulsive therapy for voluntary patients and code of practice on admission, transfer and discharge to and from an approved centre.
Deputy John McGuiness has raised the ongoing concerns with the Minister for Health, Simon Harris earlier this month.
“There are ongoing issues which have not been addressed and this is having a terrible, negative impact are patients and their families.
“A number of people have contacted me with serious concerns and at the moment when the numbers go over the allowed amount, there is nowhere for them to be referred on to. There is now not enough chairs to admit patients to the DOP and when number over the allowed quota there is security there. The problem is that there are simply not enough beds.
“Patients and staff are under pressure and the community services are feeling the pressure as well,” he said, adding that he is aware of patients left waiting for admission walking away.
“Placements are inappropriate, community services breaking down and long stay patient numbers growing as there is no where to refer them to,” he added.