A dozen failures to meet regulations were found in Portlaoise hospital's psychiatric unit, in a new report published by the Mental Health Commission.
Rules that all patients in high observation must stay in pyjamas all day with no mobile phones are “demeaning” says Dr Susan Finnerty, Mental Health Services Inspector.
There are failures in codes of practice on using Electro-convulsive therapy and physical restraint.
The building itself remains High Risk non compliant since 2016.
There are risk areas to patients trying to commit suicide.
“Ligature points in the approved centre had not been minimised despite the fact that the ligature audit had identified a number of significant ligature risks that required removal”.
It was found not to be clean.
“External areas including the garden required attention. Internal areas were in a poor state of repair. It was not clean, hygienic, and free from offensive odours throughout,” the report found.
The unit failed in the Codeof Practice on the admission of children because there were no age appropriate facilities provided to the four children under 18 who were admitted to the unit in 2017.
The report was done following an inspection team that visited the unit and interviewed staff and patients.
It failed on privacy regulations, as it has done since 2016, over the pyjama issue and names on display.
“Not all residents were wearing clothes that respected their privacy and dignity. Residents in the high observation unit were only permitted to wear night clothing, which did not ensure that their privacy and dignity was respected at all times,” the report found
“This was demeaning as the risk of absconsion was mitigated by a locked door,” the Inspector said.
Noticeboards detailing residents’ full names, were visible from the corridor and in the male ward, and male patients in seclusion have to walk down a corridor to get to showers or toilets.
This “did not respect their privacy and dignity,” said the report.
It found that patients in the high observation area have no access to therapy, which led to another High Risk non compliance decision.
“The occupational therapist met with residents, except for those in the high observation unit, on a one to one basis. They held groups outside of the ward as facilities were limited within the ward itself. Residents in the high-observation wards could not go”. the report stated.
“There was no access to mobile phones and restricted access to therapeutic and recreational activities. There was no evidence that all residents in high-obs were individually risk assessed as to whether personal phones presented a risk or there was a risk of absconsion,” said the report.
There are almost no scheduled recreation activities in the unit, with activites decided arbitrarily by staff with not all patients informed.
“The last recorded activity in the female recreational activities book was two months prior to the inspection, and the last before that took place six months previously”.
“Apart from table tennis there were few opportunities for residents to partake in indoor and outdoor exercise and physical activity”.
However residents in the general ward could attend recovery programmes such as a breakfast club, walking club and soccer group
There was High Risk non-compliance too in the use of seclusion, used as a “last resort”.
Patients in seclusion do not have adequate toilet or washing facilities and not all the medical staff involved had signed a policy to confirm they understood it.
It was non compliant in staffing because not all staff were trained in fire safety, Basic Life Support, Therapeutic Management of Violence and Aggression and the Mental Health Act 2001.
The unit also failed in how it registers new residents. Their diagnosis was not recorded on either admission or discharge.
There was high risk of non compliance for the use of Electro Shock Therapy. “The ECT record completed after each treatment was not signed by the registered medical practitioner administering ECT”.
There was no risk manager at the unit and the Inspector questioned how risks were recorded in the register with no person responsible.
The 46 bed unit serves Laois and Offaly with 10 beds reserved for Kildare and West Wicklow.
There were positives reported. Compliance on regulations over religion, visitors and complaints procedures were all rated excellent.