The Mental Health Commission has said that a number of practices carried out at the Central Mental Hospital (CMH) in Dundrum, Dublin infringe on patients' rights and dignity and impact on the standard of clinical care available to them.
The commission, the statutory regulatory body for mental health services, said the nature and degree of service deficiencies outlined in the report of a committee of inquiry warranted urgent reform of the hospital's forensic mental health services. The commission established the inquiry 18 months ago to examine the care provided at the hospital.
As revealed in The Irish Times yesterday, the inquiry report strongly criticises the excessive use of seclusion in some areas of the hospital, the blanket policy of locking patients in their rooms all night irrespective of level of risk, and the practice of keeping patients waiting in a locked bedroom when needing to use the toilet.
The report expresses concern regarding services for women patients. It says that women's underwear is routinely removed during seclusion and they are not allowed appropriate choice of sanitary protection.
It also states that policy allows male staff to be involved in the restraint of women patients and that this apparently is not confined to exceptional situations.
It also finds that patients continue to have their mail monitored despite legal advice that the practice is illegal.
The report says that due to security concerns there is constant monitoring of patients' private communications and it calls for reforms to this policy.
"Staff were required to open letters coming into or going from the CMH and also to sit near to patients when they were on the phone to be able to listen in on any telephone conversations," it says.
The report says that legal advice had suggested that the monitoring of mail was illegal but that a staff union had opposed any change and that the practice had continued. The report says that the evidence pointed to "an excessive use of seclusion".
It maintains that there was some evidence to support the view that it was a routine procedure for patients to be placed in seclusion upon admission. It also states that the documentation supporting the practice was variable "with at times no clear rationale for the use of seclusion detailed".
It says that all rooms, apart from those in the hostel on the site, were locked by 9.00pm.
The report commends the hospital on the ending of the practice of patients slopping out. However it says that there were complaints from patients and carers about the time it took for staff to open rooms to allow patients to go to the toilet. The commission said that it would be asking the HSE to address the concerns within specific timeframes.
Minister of State for Health Tim O'Malley said the report highlighted issues that must be addressed by the HSE. He said that an additional €2 million had been provided for the hospital this year.
The HSE said it acknowledged some of the criticisms in the report but that a significant programme of improvements was already underway. It said funding had increased by 29 per cent since 2004.
Fine Gael said that the report showed the role a strong independent inspectorate could play in ending bad practices in the health services.
Labour described the report as "deeply disturbing" while the Green Party said it was a shocking indictment of the Government's indifference to mental illness.
