Psychiatric Unit shortcomings pinpointed by inspection

The Mental Health Commission has identified shortcomings at the Psychiatric Unit of University Hospital Galway.

The problems, which were identified following an unannounced inspection late last year, include issues in relation to patients’ privacy and dignity, use of restraints, as well as criticisms of the physical environment of the unit.

The report, issuing a list of corrective action to be undertaken, was published by the commission last week.

The unit received a ‘non-compliant, poor’ rating in relation to ensuring residents’ privacy and dignity is appropriately respected at all times.

“Male residents were required to walk through the female side to access the male toilets and showers. There was one shower and one bath on the female side and two showers on the male side of the approved centre. All showers and bathrooms were lockable but could be opened by staff in an emergency. One resident reported sharing two toilets with 18 female residents,” the report noted. It also said that a corridor beside the male bedrooms was visible from the road outside and the car park.

In response, the hospital said it has expanded the hours of opening for the High Observational Area, which provides gender neutral areas and so increases toilet and shower facilities. It said it plans to take action to obscure visibility to the unit from the outside.

The unit also scored a ‘non-compliant, poor’ for the state of the building, which was a redesigned medical ward in use since the 1970s.

“The physical environment of the approved centre did not enable the residents to engage in meaningful occupations. There was a lack of space for the residents and the environment was very busy and noisy. The approved centre was non-compliant in this regulation as it was not in a good state of repair with worn paint, malodourous toilets, furniture stored on the corridors and urinals in a poor state of repair. There was no clinical space for general health reviews,” the report said.

In response, UHG said a new purpose built Acute Mental Health Unit is currently being built and is due to be opened in the last quarter of this year.

The hospital added: “We have minor capital funding identified for painting, refurbishment and ventilation in areas identified in the report.” These minor renovations were due to be completed by the end of March, 2016.

The inspectors found fault in relation to consent and treatment where it again scored a ‘non compliant, poor’ rating. There were 11 patients involuntarily detained within the approved unit and only two of these patients were detained for longer than three months. Both patients had signed a consent form to state that they understood and agreed to take medication.

However, there was no indication in the consent as to the specific medication the patient had consented to take. This is a requirement of Section 60 of the Mental Health Act 2001. As the consent process for two patients was not in accordance with Section 60 of the Mental Health Act 2001, the approved centre was in breach of consent to treatment,” the report stated.

The centre was also found to be non-compliant in relation to the physical restraint of patients.

The report said: “The approved centre was non-compliant as the forms for episodes of physical restraint were incomplete; security staff were assisting with restraint when other staff members were present; next of kin were not informed on one episode and there was no evidence of a medical review completed within three hours as per the code of practice guidelines.”

Despite the shortcomings, the unit complied with its obligations under the vast majority of areas inspected.

The inspection of the 45-bed unit took place over four days last November. The previous inspection took place in March 2014, and identified a number of shortcomings, including care plans for residents.

The latest report pointed out the hospital had made several improvements since the previous visit.

It said: “Since the 2014 inspection, there had been a significant improvement in individual care planning. All 44 residents had an individual care plan on inspection and a standardised format was being used. Each resident had needs, goals, interventions and resources identified. Monthly audits had been sent to the Mental Health Commission as per the condition on their registration.

“It was evident that the activity programme was tailored to residents’ needs and changed when it was appropriate. There was positive feedback from residents and there was good attendance at these groups. It was recognised that the approved centre was in the process of recruiting new staff. The approved centre had removed ligature points that were identified in an audit.”