Mental health centre carried out treatment without consent – report

A mental health centre in Co Laois carried out electro-compulsive therapy (ECT) on a patient without obtaining proper consent, constituting a breach of human rights, an inspection has found.

An inspection by the Mental Health Commission rated the department of psychiatry at Midland Regional Hospital, Portlaoise, Co Laois as critically non-compliant in the use of ECT .

The inspection report states that during administration of ECT for one patient, during which small electric currents are passed through the brain, written consent was not obtained for the eighth and ninth treatment session.

The inspectors found that appropriate information on the procedure was not given by the consultant psychiatrist to enable the patient to make a decision on consent for each treatment session and that a comprehensive assessment of capacity by the consultant psychiatrist was not completed.

Are patient waiting lists shrinking for the right reasons?

---

Some 45,000 taken off waiting lists last year without seeing medical specialist

---

Could coronavirus become a Sars-like illness?

---

Free dose of vaccine offered in response to mumps outbreak

---

Information was provided on the likely adverse effects of the treatment, however, other appropriate information such as the nature, description, purpose, benefits of treatment and alternatives to ECT were not given to the patient.

Following the inspection, the Mental Health Commission issued an immediate action notice to the registered proprietor of the approved centre.

The approved centre was also found to be non-compliant with the regulation therapeutic services and programmes.

Audit

Residents in the high dependency unit were not provided with therapeutic programmes,which are directed towards restoring and maintaining optimal levels of physical and psychosocial functioning.

Ligature points had not been minimised, the mental health commission added.

A ligature audit had identified a number of significant ligature risks requiring removal, including in bathrooms, showers, and bedrooms, which had not been addressed at the time of inspection.

Nine children were admitted to the facility, and age-appropriate facilities and a programme of activities were not provided, inspectors said.

John Farrelly, chief executive of the Mental Health Commission, said admitting children to an adult acute unit is "neither suitable or acceptable in our mental health services".

“Age-appropriate facilities and a programme of activities was not provided for these children. Access to CAMHS [children adolescent mental health services] in-patient beds is a significant challenge. Waiting times for CAMHS remains unacceptably long,” Mr Farrelly said.

“There had been a lack of investment in this area which has resulted in children and young people being admitted to adult psychiatric units. This practice has to cease and is not tolerable to the Mental Health Commission.”

Dr Susan Finnerty, inspector of mental health services, said having a critical risk rating is a "very serious finding" by the inspectors.

“There are very strict rules governing the use of ECT. While ECT can be effective evidence based treatment for some severe and persistent mental illnesses, a programme of ECT shall not be administered to a patient unless the patient gives his or her consent in writing if deemed to be capable of consenting,” Dr Finnerty added.

Separate incident

In the psychiatric unit in Tallaght Hospital, a separate inspection found an overall decrease in compliance with regulations from 63 per cent compliance in 2017 to 56 per cent compliance in 2019.

The centre was rated critical non-compliant in individual care planning and received seven high risk non-compliance ratings for general health, use of CCTV, staffing, maintenance of records, policies and procedures, use of seclusion, and consent to treatment.

Inspectors found that a number of care plans were not developed by the team, did not identify appropriate goals, did not specify the care and treatment required to meet the identified goals, and did not identify specific resources required to provide the care and treatment identified.

Two individual care plans were not reviewed on a weekly basis, and there was no evidence that ten of the residents were offered a copy of their own care plans including any reviews.