Patient kept in seclusion for 111 hours in Central Mental Hospital

A patient at the Central Mental Hospital was kept in seclusion for 111 hours on a single occasion last year, according to a report that is highly critical of the use of restrictive practices in mental health units.

The Mental Health Commission, which publishes the report on Monday, says its findings demonstrate a lack of oversight and governance in the use of practices such as seclusion, physical restraint and mechanical restraint over the past decade.

"We have to acknowledge that we have a cultural issue when it comes to the use of restrictive practices in this country that we need to tackle without delay," says the commission's chief executive John Farrelly.

Seclusion is defined as 'the placing or leaving of a person in any room alone, at any time, day or night, with the exit door locked or fastened or held in such a way as to prevent the person from leaving'

There has been a 57 per cent increase in episodes of restrictive practices on inpatients in Ireland’s mental health facilities over the past 10 years, the report estimates.

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The report draws on figures for the use of seclusion, physical restraint and mechanical restraint in 2017 and 2018, and in 2009. The percentage increase is calculated relative to the wider population.

Seclusion is defined as “the placing or leaving of a person in any room alone, at any time, day or night, with the exit door locked or fastened or held in such a way as to prevent the person from leaving”.

According to the commission, there were 4,765 combined episodes of physical restraint and seclusion in 2008. This compares to 7,420 episodes of restrictive practices reported to the commission in 2017, and 7,464 in 2018.

The report says there was an 18 per cent increase in episodes of physical restraint over a 12-month period, with 5,665 episodes recorded in 2018 compared to 4,773 in 2017. Physical restraint was used in 85 per cent of centres in 2018, as opposed to 81 per cent in 2017.

Physical restraint is defined as “the use of physical force (by one or more persons) for the purpose of preventing the free movement of a resident’s body when he or she poses an immediate threat of serious harm to self or others”.

No benefits

There were 1,799 episodes of seclusion in 2018, compared to 1,392 in 2017, a 29 per cent increase. Seclusion was used in 42 per cent of centres in 2018, and there were 317 episodes in 2018 where a person was secluded for more than 24 hours, and 81 episodes where a person was secluded for more than 72 hours.

In contrast, the use of mechanical restraint was low in 2017 and 2018. Only one approved centre – the Central Mental Hospital – reported the use of mechanical restraint, with all episodes involving the use of handcuffs. No straitjackets were used.

“When one considers that there is no evidence of a therapeutic benefit associated with the use of restrictive practices, and limited evidence of restrictive practices reducing behaviours of violence and aggression, it is disappointing to note that episodes have increased by 57 per cent in just 10 years,” says Mr Farrelly.

The commission has been calling for legislation to ensure the laws governing the physical restraint of individuals are fit for purpose. It says it intends to put forward recommendations in this regard as part of its current review of the Mental Health Act 2001.

It has also written to the HSE seeking a clear strategy and implementation plan aimed at significantly reducing episodes of restrictive practices across the country’s mental health services.