Children admitted to dirty adult psychiatric unit - Mental Health Commission

As the unit is an adult approved centre, the commission noted that “age-appropriate facilities and a programme of activities appropriate to children were not provided”.

It did note that provisions were in place to ensure the safety of the children and respond to their “special needs as a young person in an adult setting”. And they noted that the requirements for the protection of children and vulnerable adults within the approved centre were appropriate and implemented as required.

But inspectors did also discover that “the centre’s own ligature audit indicated that ligature risks remained”.

It added that although the policy of locking bedroom doors during the day went “some way to mitigating these risks”, however the risks “remained at other times”.

The unannounced 18 – 21 June 2019 annual inspection noted: “Children did not have access to child advocacy services. The centre was non-compliant (because) age-appropriate facilities and a programme of activities were not provided by the approved centre and child residents did not have access to child advocacy services.”

Mental Health watchdog, John Farrelly, the Mental Health Commission’s CEO, said: “The placing of children in adult units remains a totally unacceptable, but common feature of mental health care practice in Ireland. The psychiatric unit at Limerick is an adult acute admission unit and, as such, is not structured or resourced to provide separate or specifically age-appropriate facilities.”

The Mental Health Commission released a total of three reports which identified 12 high-risk non-compliance ratings across three units in Limerick, Mullingar and Portlaoise.

All three approved centres had a high-risk non-compliance with staffing in relation to training.

Not all staff were up to date or had been trained in mandatory training in fire safety, basic life support, prevention and management of aggression and violence, and the Mental Health Act 2001.

Inspector of Mental Health Services, Dr Susan Finnerty said:

"The Mental Health Commission has outlined basic training requirements for staff in order to provide a safe professional service for residents of acute mental health services. Failure to provide or avail of training in fire safety, basic life support, prevention and management of aggression and violence, and the Mental Health Act 2001 puts service users and staff at risk.” 

Of the 42-bed Acute Psychiatric Unit 5B in University Hospital Limerick, the report also noted In relation to staff training - “not all staff were trained in basic life support, management of violence and aggression and fire safety”.

Regarding the high risk non-compliance in premises, the "cold" main sitting room was “bare and stark” in appearance. It was also a thoroughfare to the outdoor area where residents could smoke.

The premises, the report said, was unclean in some areas — particularly the fridge and the sink in the pantry. One outdoor area contained litter such as cigarette butts and one toilet was observed to be malodorous. The plant beds in all of the gardens were overgrown with weeds. There was graffiti on the wall of the outdoor area next to the psychiatry of later life area.

In reaction to the results of the inspection at the Limerick facility, the HSE said: "Since the inspection in June 2019 , the HSE has developed and implemented a range of corrective and preventive measures to ensure that the areas of noncompliance are addressed and the service is working to achieve compliance with the regulations on an ongoing basis.

"The HSE is fully committed to ensuring all areas of non-compliance are addressed in full and it should be noted that significant progress has been made over the past number of months in terms of improving compliance in a number of areas, with further work planned."