College President, Dr John Hillery, on concerns over restraint and seclusion of mental health patients.
College President, Dr John Hillery, spoke to Gavin Grace on ClareFM about concerns over recent report from Mental Health Commission on the use of restraint on mental health patients in mental health centres across the country, 23/10/2018.
According to recent figures from the Mental Health Commission more than 1,000 patients were physically restrained or secluded an average of 4 times each per year. These findings present what the College says is another manifestation of the under-resourcing of services for people with serious psychiatric illness. In a press statement the College noted that:
Seclusion and restraint should only be necessary in extreme circumstances as early intervention and support should prevent any individual becoming so unwell that their safety or the safety of others requires such intervention.
Unfortunately Ireland currently lacks the resources in trained personnel to ensure all people in need get the variety of evidenced based, individualised interventions they require.
In an interview with Gavin Grace on Clare FM Dr Hillery reflected on the stark figures reported and stated that recent media coverage on this will have been very frightening for people, especially for those feeling unwell mentally and thinking of seeking help. Some of the photographs that accompanied the coverage suggested that people would be tied up or handcuffed:
“It is important for people to realise that physical restraint means the holding of someone to prevent them from injuring themselves or others. The report shows that this is really only used for brief amounts of time (a minute or two) in over 50% of the cases and seclusion is very highly supervised to ensure that they are ok and in the majority of cases it isn’t used for a long amount of time.”
He reiterated however that this should be a last resort for people who are very unwell and who may be very agitated and putting themselves or others at risk.
Dr Hillery was asked if ‘mechanical restraints’ are ever used, like the ones depicted in movies, and he explained that;
“These are only used in the Central Mental Hospital where there would be people with very serious psychiatric illness and a history of violence to themselves or others. But across the country the Mental Health Commission reports that these aren’t used at all in regular psychiatric units…From the point of view of the needs of people with mental illness it does suggest once again that we don’t have early intervention and the services that people need to stop them getting to the point where they are really that distressed that they need to be held or need to be secluded in a room.”
Dr Hillery also clarified that if a person is held it is by professionals, usually nurses, who are trained in safely holding people so that the person is not at risk of injury. “The people who are trained in this are also trained in other methods of calming people down before they get to the point of having to hold them.” When asked if he thought the figures of restraint reported were appropriate he stated;
“No, it’s not appropriate and I think the inspector does point out this is probably due to resource issues, both physical resources in that we don’t have the appropriate buildings and rooms in which to manage people who are quite ill and agitated without restraining them and also we don’t have enough staff in those units to manage them otherwise….We would say early intervention is key and to do that you need personnel in the communities.”
There has also been much discussion about the figures of readmissions of people with psychiatric illness and late presentation. These are further signs that there aren’t enough staff in the community to stop people getting to a place where they need to be hospitalised, let alone seclusion or restraint.
This ties in to the broader point that has been made by many over many years; that there needs to be better investment in mental health and at community level in particular. In the last 11 years, A Vision for Change has not come anywhere near implementation across the country. The Sláintecare document backs this up especially around the budget provision for services for people with mental illness, which should be at least 10% of the health budget;
“In the recent national budget we heard large amounts being allocated to mental health services, but if you do the math it’s still a figure way lower than that of A Vision for Change, Sláintecare, or countries equivalent to Ireland who provide funding for people with psychiatric illness.”
Funding and staffing retention issues are repeated themes in many discussions regarding mental health services. When asked if progress was being made, Dr Hillery told Clare FM that progress is slow and there isn’t a long term view;
“We don’t have a group looking at what is necessary to provide the staff, and I’m not just talking about psychiatrists, I’m talking about specialist nurses, psychologists, occupational therapists and social workers..A Vision For Change does set out a plan for that but it hasn’t been implemented…You and I wouldn’t be having this conversation if 11 years ago someone had acted on that.”
Dr Hillery also highlighted the fact that there is no National Lead for Mental Health Services in the HSE.
“It is a worry that we don’t have a leadership in this even though it is seen as a key issue by most people. The needs of vulnerable people with mental health problems are something they really care about and a recent survey by Mental Health Reform also supports the fact that people on the street would like to see omney from the budget going to support people with psychiatric illness. There is money there but it’s still a small percentage of what’s recommended.”
Dr Hillery finished by noting that Vision for Change can still be implemented but if it is not one would worry that Sláintecare will meet the same fate. He noted that Minister Simon Harris recently put together an implementation council for Sláintecare but there is no representation from frontline psychiatric services which is worrying.
“We get this impression taht mental illness is not seen as an illness to be treated by the health services and that resources go elsewhere and I think the people in general don’t believe that. The people want to see investment in these services. Everyone has a friend or relation who has needed these services and I think people need to go to their public representatives and say this needs to change.”