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22/10/2021

Dept of Psychiatry at St Luke's Hospital in Kilkenny ‘not fit for purpose’

The Department of Psychiatry at St Luke’s Hospital is ‘not fit for purpose’ and requires a huge investment in staff and facilities according to Deputy John McGuinness.
The Fianna Fáil TD made his comments in the wake of the publication of The Council of Europe’s anti-torture committee (CPT) report on a visit to Ireland in 2019 when a delegation viewed three psychiatric facilities, including the Department of Psychiatry (DOP) at St Luke’s Hospital.
Investment needed
“The DOP at St Luke’s Hospital is not fit for purpose and requires a huge investment in staff and in particular its facilities,” said Deputy McGuinness adding that the government needs to ‘invest heavily in the physical structure’ adding that the present building ‘doesn’t lend itself to easy care of those most in need’.
The Dáil Deputy said the current location is ‘not appropriate’ and that the department needs to be moved within the campus and added that there should be a park around the facility.
“We need a brand new building and to modernise the facilities. The DOP at St Luke’s is cited too often in reports for all the wrong reasons. Mental health issues will be with us to a far greater degree after Covid-19,” he added.
recommendations
The CPT committee recommends that the management of the Department of Psychiatry (DOP) at St Luke’s Hospital reiterate to staff that no more force than is strictly necessary and proportionate should be used to bring an agitated patient under control. Due regard should be had to gender-specific concerns. Where staff act inappropriately, management must act to sanction them accordingly, the report states.
In the psychiatric facilities visited by the CPT, patients generally spoke highly of staff who displayed a caring attitude.
Living conditions
Regarding living conditions, all three psychiatric units visited were clean and generally in a state of repair, with the wards at St Luke’s having been recently renovated.
However the report also found that patients’ rooms in all the units were impersonal and equipped with minimal furniture reflecting a clinical environment, rather than a therapeutic setting. The report went on to state that the four and six-bedded rooms of the establishments visited were cramped, stuffy and, at times, noisy, providing hardly any personal space or privacy. The CPT recommends that the four-bed and six-bedded rooms be divided into smaller units and that steps be taken to personalise the rooms.
Activities
At the DOP at St Luke’s in addition to occupational therapy, the range of therapeutic activities consisted of recovery groups, discharge planning, relaxation, art therapy and walking groups.
While patients on the sub-acute ward were generally engaging in the various activities on offer, patients on the acute ward appeared to spend their time lying on their beds or wandering aimlessly along the corridors. Some patients told the delegation that they were not aware of the activities on offer.

Electro-convulsive therapy
The report also stated that the only unit visited that carried out ECT on site and had a dedicated ECT suite was the DOP at St Luke’s. The administrations of ECT is surrounded by an appropriate range of safeguards, which are fully in line with CPT standards. Use of ECT was relatively rare, with four patients undergoing the treatment voluntarily between April and October 2019.
Seclusion
Generally, no excessive recourse to seclusion in terms of the number of episodes was noted in any of the three units visited. However at the DOP in St Luke’s one patient was secluded for 573 almost consecutive hours, while another was secluded for 108 hours at the DOP at St Luke’s.
In all cases where episodes of seclusion lasted for more than 72 hours (or seven orders in seven days), these were notified to the Mental Health Commission, according to normal practice. However, the CPT has serious doubts as to whether the seclusion of patients for such lengthy periods is justifiable.
In relation to staff the report found that at the DOP at St Luke’s there was 13 psychiatrists shared with other regions in the catchment area (Carlow, Kilkenny, South Tipperary, Waterford and Wexford). For full report see www.coe.int/en/web/cpt
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