Nurses at St Mary's say they are limited by staff shortages and so have no choice but to restrain aggressive patients, writes Joe Humphreys
The entrance to one of St Mary's 28 residential units gives clues to the sort of environment in which the nurses have to work.
A four-foot barrier, which can only be opened by staff, greets visitors inside the hall door. The windows are covered in Perspex, which, like the ceiling, bears attack marks. Dislodged roof tiles and broken plaster can be seen all around.
The "clients", explains Tom Cryan, nurse manager for the unit, have a habit of taking off their shoes and hurling them upwards.
"They're very conscious of any change in the environment, and they tend to express themselves physically, by using their fists or shouting," he says.
As if to prove the point, one of the residents runs from his seat when The Irish Times arrives, and attacks some furniture and a male nurse in the neighbouring room. The nurse sounds his personal alarm, prompting two colleagues to rush to the scene from a neighbouring shelter.
The three bundle the young man into a locked room where he is observed at intervals through a window in the door.
"If you come back in 12 months that room would be gone," says Mr Cryan, a Co Roscommon native who is 12 years at Drumcar.
He means, of course, "if St Mary's gets the staff it needs", for, he says, the absence of such personnel makes the use of locked rooms and other restraint mechanisms necessary.
"Staff are extremely motivated and would aspire to change things but because numbers are so low we can't use the re-direction techniques we would like to use. We have no choice at times but to use exclusion and restraint."
Like all staff, he says, these occur only under strict guidelines which decree, among other things, that milder forms of restraint like a belt or brace be used ahead of what they call the "last resort" - a strait-jacket.
More staff would also mean more attention for residents, more interaction and fewer opportunities for clients to act up.
"Your biggest aspiration during each day is to keep everyone safe, and it takes all our current staff to do just that," Mr Cryan adds.
Three nurses are on duty at the unit during the day but only one at night. It houses eight men; some autistic, others aggressive. All are categorised as having "severe challenging behaviour", to such an extent they are a danger to themselves and others.
Because of the staff shortages one resident, whose behaviour is too erratic for a single nurse to deal with safely, is locked in his bedroom each night.
A similar story applies in a neighbouring unit, where one nurse is assigned at night to two chalets 30 feet apart, holding 19 residents. Most of them are elderly and have Alzheimer's or Parkinson's Disease.
"If you have someone who is unwell, or has a seizure, there is a dilemma for the person on duty," notes Anna Plunkett, director of nursing. Attending to someone in one chalet means leaving the other unattended.
"Those sorts of choices are being made throughout the night, throughout the campus," she says.
Such strains on the system aren't immediately visible on arrival at the Drumcar site, which covers 365 acres of rolling hillside, and includes a stately home once owned by the McClintock family and now used by the St John of Gods Order for administration.
Brothers from the order bought the site for £5,000 in 1946 and converted it for use as a residential care centre. Some of the children who were initially referred there remain residents - among them a 72-year-old man who yesterday could be found in the medical centre celebrating a fellow patient's 40th birthday.
"His joy in life is to swim," says nurse manager Geraldine O'Reilly of the latter. "We have a pool here but we haven't enough staff to let him use it because it needs three people at once."
Some of the patients might not step out of doors all week. "We'd love to give them more individual attention, or just take them for a walk, but it's impossible at present," admits Ms O'Reilly.
Her frustration is shared by Ms Plunkett, who has nothing but praise for her staff and, despite the problems, speaks with hope of the centre's plans to expand its community care programme.
"The bottom line is intellectual disability is not sexy," she says. "It's not accident and emergencies. It's very much a hidden service and taken for granted, and the very same applies to the staff who work in this area."