THE 2009 Draft Report of the Inspectorate of Mental Health Services has given cause for serious concern among County Clare psychiatric patients and their families.

Cappahard Lodge, Ennis and the acute psychiatric unit at the Mid-Western Regional Hospital, Ennis are two of the mental health facilities identified as having deficiencies that need to be addressed. Also of concern to people in this county is the report in respect of the acute psychiatric unit at the Mid-Western Regional Hospital in Limerick.
Reports were published in the past week on the State’s 63 psychiatric hospitals and mental health facilities and the findings are highly critical of the standard of accommodation, the appropriateness of treatment and the management systems in many centres.
Cappahard Lodge, a former public nursing home, now a 35-bed centre for psychiatric care of older people under the control of the Clare Mental Health Services for Older People, was one of the facilities that came in for strong rebuke.
There were a number of dysfunctional systems evident in the approved centre on the day of inspection, according to the report. “There was a lack of managerial and clinical leadership. This resulted in policies not being signed, residents not receiving active and timely reviews and a complete lack of clarity on who was to perform physical examinations. Local systems for management and review of risks were absent,” the report stated.
In fact, the inspectors found so many problems on their announced visit on June 3 that a copy of the draft report was sent as a matter of priority to the acting CEO of the Mental Health Commission. The commission subsequently requested that the inspectorate undertake an unannounced visit and on re-inspection in September, a significant improvement in the practices and procedures in Cappahard Lodge had been implemented. Systems had been implemented to ensure regular physical, psychiatric and nursing reviews.
A worrying element of the report on the 39-bed acute psychiatric unit at Ennis hospital was the finding that the seclusion unit had a significant problem with illicit drugs and alcohol being brought in. As a consequence, the front door had been continually locked and this was highlighted as a significant issue by the Irish Advocacy Network representative, who pointed out that this practice limited residents’ liberty.
It is extremely serious and dangerous that illegal drugs should find their way into any hospital and any visitors detected aiding and abetting in this practice should face the full rigors of the law.
During the announced visit on June 3, Venetian blinds on the windows of bedroom areas were identified by the inspectorate as a hazard that compromised the safety of residents but it was acknowledged that programme of replacement had commenced.
On a more positive note, the report said the facility, which included a mother-and-baby unit, a five-bed high observation area and a five-bed psychiatry of later life unit appeared to be well run and it was easy to locate and retrieve records and clinical charts.
Following an unannounced inspection on June 11 at the 50-bed unit in Limerick hospital, the inspectorate expressed concern that children continued to be admitted to the adult unit. Twelve children had been admitted since January 2009 and one 15-year-old child was resident on the day of inspection. A 13-year-old child had been admitted in March.
Most of the admissions were of very short duration, from one to three days and the teenagers were accommodated in a single bedroom with en-suite facilities and assigned a designated staff member who remained with them at all times.
These vulnerable youngsters ended up in the unit simply because all requests for admission to St Anne’s Child and Adolescent Unit in Galway were refused due to lack of vacancies there.
Also, with reference to the Limerick unit, the inspectors were disappointed to find that none of the proposed renovation works, including the development of a high observation area, had begun. In view of the fact that the physical layout of the unit was not conducive to adequate observation of at-risk residents, the restructuring works were necessary, the report noted.
Just like mental health units all over the country, these three facilities have been issued with a list of things to do to reach best practice standards.  There have been commentaries from all quarters about the problems and suggestions about solutions but since they operate under the remit of the Health Service Executive, the health authority must be at the front line to ensure that all that needs to be done is done. 

A tough year ahead

WITH predictions that the Irish economy could begin to show a recovery mid-year, dare we hope that this would have a positive impact in County Clare and the Mid-West, which has suffered so badly in 2009?
The year just ended will be recalled as one when Dell in Limerick, Shannon Airport and several blue chip firms in the Shannon Free Zone took quite a battering. The economic stability of the region was rocked when companies that were looked upon as bankers in terms of good employers began to creak and crack. This has had a serious knock-on effect on smaller manufacturing and service providers and has filtered down to retailers in many towns and villages.
In post Christmas analysis of seasonal spending, some retailers, while putting a brave face on the situation, are privately admitting that further closures are inevitable.
The full impact of job losses as a result of closures or rationalisation plans may not be felt until several months from now when workers actually cease their employment.
People in general, who have been cutting back spending on food, household necessities and clothing as well as on socialising and discretionary purchases, are likely to become even more frugal in 2010.  
There has been a relentless campaign by the job creation agencies, local authorities, business organisations and, of course, political figures to kick-start a recovery in the region. Specific attention is being directed at companies that could make a significant dent in the job loss numbers of the past year.
Meanwhile, as ordinary consumers, one way to help make the best of a bad lot is to buy Irish goods whenever possible and even more importantly, to support local shops and firms. In the best tradition of community effort, we must look out for each other.