BOOK 1 – PART 1 Mental HealtH CommissiOn annual RepORt 2008 inCluding tHe RepORt Of tHe inspeCtOR Of Mental HealtH seRviCes Book 1 Part 1 Mental Health Commission Annual Report 2008 1 BOOK 1 – PART 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) 2 Mental Health Commission Annual Report 2008 BOOK 1 – PART 1 Vision Working together for Quality Mental Health services Mission the Mental Health Commission is committed to ensuring the interests of those involuntarily admitted pursuant to the provisions of the Mental Health act 2001 are protected and to fostering and promoting high standards in the delivery of mental health services Mental Health Commission Annual Report 2008 3 BOOK 1 – PART 1 4 Mental Health Commission Annual Report 2008 BOOK 1 – PART 1 COntents PART 1 Chairman’s Foreword 6 Introduction – Chief Executive Officer 8 Commission Members (April 2007 – 2012) (At time of appointment) 9 CHAPTER 1 11 Mental Health Commission: Functions & Structures 13 CHAPTER 2 17 Strategic Plan 2006 - 2008 19 CHAPTER 3 21 Progressing the Strategic Plan 2006 – 2008 23 PART 2 CHAPTER 4 55 National Review of Mental Health Services 2008 56 appendiCes 69 CHAPTER 5 97 Overview of Catchment Mental Health Services within HSE Area – Catchment Reports by HSE Area 97 CHAPTER 6 283 Additional Information 285 BOOKs 2-7 Report of the Inspector of Mental Health Services is available on CD-ROM (see back of report) Mental Health Commission Annual Report 2008 5 BOOK 1 – PART 1 CHaiRMan’s Foreword The year 2008 showed again that bringing about change in Ireland’s Mental Health Services is a most challenging task. This has been the case over the past number of years when there was additional revenue available. We can expect it to be even more challenging now that we are entering a period of great economic difficulty and exchequer shortages. As 2008 came to an end, the extent of the global and national economic difficulties had become apparent. Therefore the publication in September by the Commission of a report showing the economic benefits of investment in services to deal with mental health problems was timely. The report, The Economics of Mental Health Care in Ireland, was prepared by Eamon O’Shea and Brendan Kennelly of the Irish Centre for Social Gerontology and the Department of Economics at NUI Galway. The report showed that mental health problems cost the economy over g3 billion a year. While ultimately decisions on resource allocation are grounded in societal values, the report presented sound economic reasons as to why investment in mental health services would more than repay its cost. In other words, investment in mental health services is good for our economic well-being as well as for our health. The investment the Commission wants to see is in community treatment facilities to replace the institutional care approach. This is the core of Government policy as outlined in its policy document, A Vision for Change. While there were a number of restatements of commitment to Vision for Change, I must once again record the Commission’s disappointment at the lack of progress towards its implementation. In the introduction to the 2007 Annual Report I stated: “While acknowledging that Vision for Change involves a seven to ten year programme of change and development, the Mental Health Commission was disappointed and concerned at the absence of progress in 2007.” It is with great regret that I make the same statement again in relation to 2008. The recruitment restrictions imposed by the HSE in relation to core multidisciplinary staff has affected the ability of mental health services to meet current needs and provide a comprehensive range of evidence based therapeutic interventions to service users. The new economic realities mean we must concentrate not just on the amount that is spent on mental health services, but on how it is spent. The Commission’s Quality Framework for Mental Health Services in Ireland asserts that the systematic evaluation and review of mental health services underpinned by best practice will enable providers to deliver quality services. In the context of the Quality Framework, it is disappointing to see there was poor compliance in relation to the regulations concerning the need for individualised care plans where service users were fully involved participants. While increased funding can of course help deliver quality services, a key issue is also the governance of those services. While there are some examples of excellent audits, quality improvement measures and multidisciplinary management structures, we do not have the formal structures and processes that are needed. The ambition of Government policy is to have a national network of comprehensive, community-based multidisciplinary mental health teams. This vision is far from reality. In 2008 the Inspector of Mental Health Services found that community teams often exist at very basic levels with insufficient approved posts. In some areas he also noted strong industrial relations resistance to the moving of mental health services from old hospital based settings and into the community. The inquiry team established by the Commission continued through 2008 to prepare the report into care and treatment practices in St Michael’s Unit, South Tipperary General Hospital and St Luke’s hospital, both in Clonmel. The report itself was published in 2009 and therefore not within the period covered by this annual report. 6 Mental Health Commission Annual Report 2008 BOOK 1 – PART 1 During 2008 the Commission’s own inspection process focussed on concerns about the care and treatment of residents in these units and the 2009 annual report will detail the steps taken by the Commission to have these concerns fully addressed in the best interests of patients. Central to this is the development of community treatment facilities that will allow the closure of institutions such as St Luke’s. At the core of a Vision for Change is the development of community based mental health multidisciplinary teams which will form the backbone of service delivery. Without this change, many service users will continue to be treated in unsuitable and outdated inpatient facilities at considerable cost to them as individuals, to the society in which they live and to the economy which suffers as a result of inadequate mental health services. The reports of the inspections of all the approved centres are published in this annual report (Books 2-7). For the first time, however, these inspection reports were published in the Mental Health Commission’s web site well before the annual report. In some cases in the past there was a gap of up to 15 months between an inspection being carried out and the final report being available to staff, service users and the general public. The policy of early publication arises from the fact that the earlier feedback is given, the quicker people will take any action required on foot of an inspection report. During the year the Commission also took a clear position against the relocation of the Central Mental Hospital to Thornton Hall in North Dublin. The Chief Executive and I accepted an invitation from the Oireachtas Committee on Health and Children to give evidence on the subject. We said that we fully supported the replacement of the current Central Mental Hospital with a purpose designed, modern facility which promotes patient safety and dignity. However we said that the proposal to build it beside a prison would promote isolation, exclusion and stigmatisation of the residents, and that there were other reasons such as inadequate public transport connections that made the site inappropriate. The Commission said there should be a comprehensive assessment of the State’s need for forensic mental health services undertaken as a priority. Over the past year, the Commission members have applied themselves to the mandate and responsibilities set out in the 2001 Mental Health Act. They have ensured that respecting and promoting the best interests of the service user was core to the decisions they reached and I thank them for fulfilling this responsibility. The work of this Commission would not have been possible without the knowledge, skill and dedication of its Executive to ensure the MHC operates in a highly effective manner, meeting the everyday challenges in a truly professional and responsive way. 2008 saw the appointment of a new Inspector of Mental Health Services, together with new appointments to the roles of Assistant Inspectors. Their professionalism and team work has resulted in a comprehensive report that will assist all stake holders’ focus their minds on the strengths and positives developments as well the weaknesses and challenges within the Irish mental Health service. Finally, the Commission would like to express its appreciation of the leadership of its CEO, Ms Bríd Clarke, who has effectively managed the operations of the MHC as an independent statutory body and ensured that the work plan for the Commission over 2008 was completed to the highest possible standard. dr. edmond O’dea Chairman Mental Health Commission Annual Report 2008 7 BOOK 1 – PART 1 introduCtiOn – CHief exeCutive OffiCeR I am pleased to introduce the seventh Annual Report of the Mental Health Commission including the Report of the Inspector of Mental Health Services, for the period ending 31st December, 2008, pursuant to Section 42, Mental Health Act 2001. The year 2008 was a period of consolidation, review and development, following the full commencement of the Mental Health Act 2001 in November 2006.