THE overall compliance rate with national standards in the Ennis Psychiatric Unit fell by 10% over a 12 months period, a new report has revealed.
A report published by the Mental Health Commission (MHC) rated the overall compliance rate of the unit at 64% last year compared to 74% in 2019, 66% in 2018, 76% in 2017 and 57% in 2016.
The approved centre is located on the ground of Ennis General Hospital and provides in-patient mental health care to residents of North Tipperary and Clare. It had a total of 39 beds. Five beds were designated to psychiatry of later life (POLL).
Nine teams admitted residents into the approved centre including the POLL, and rehabilitation teams.
Responding to the report, the HSE stated Mid-West Mental Health Services are committed to the delivery of quality and safe mental health services.
HSE Mental Health Services welcomed the report of the MHC and has been working since the visit in November on the areas that have been highlighted. Since then the HSE have worked closely with the MHC to develop quality improvement plans on the two main risks outlined and they have accepted plans for same.
“The immediate action notice has been responded to and the corrective and preventative action plans have been submitted to the Mental Health Commission, which have been accepted. Mid West Mental Health Services continues to work to provide a safe and high quality service for our community.”
The report found there was suitable and sufficient catering equipment in the approved centre, as well as proper facilities for the refrigeration, storage, preparation, cooking, and serving of food. Kitchen areas were clean.
The numbers and skill mix of staffing were sufficient to meet resident needs and an appropriately qualified staff member was on duty and in charge at all times.
Medication was ordered, prescribed and administered in a safe manner.
However, in the garden attached to the high observation unit, there was a broken drain cover exposing sharp metal edges and a large hole on the lawn.
There were ligature anchor points evident in the approved centre.
The report outlined medication was not stored securely in a locked storage unit as the fridge in the pharmacy was unlocked on inspection.
Individual risk assessments were not completed prior to and during admission as there was no formal risk assessment tool being used.
There were blind spots in the seclusion room which hampered direct observation of the resident.
Therapeutic services and programmes included dialectical behaviour therapy (DBT); an informed skills group twice weekly; a well-being group, a health promotion group and a mindful meditation group. The activation team also worked with “Aries”, which was a peer-led education service. The occupational therapist undertook groups such as arts and crafts, newspaper, and baking.
For residents on antipsychotic medication, an annual assessment included glucose regulation, blood lipids, and an electrocardiogram.
However, one individual care plan was not developed within seven days of admission to the approved centre.
One did not identify the resources required to provide the care and treatment identified and two were not reviewed by relevant members of the multi-disciplinary team.
The report outlined the six-monthly general health assessment was inadequately completed in three cases. Family and personal history, waist circumference, and dental check were not completed and documented in all cases.
The approved centre was clean, hygienic, and free from offensive odours.
Physical restraint was in compliance with the Code of Practice on the Use of Physical Restraint.
However, on review of the account log for one resident, it was noted that there were four discrepancies in the accounting. The inspectors requested that a formal investigation be undertaken.
The centre created a Covid-19 activity pack with puzzles, crosswords, word search, and brain teasers for residents when in isolation. It provided access to recreational activities on weekdays and during the weekend.

by Dan Danaher