Not fair | 

People get better care from private mental health providers than HSE, report says

“The HSE has failed to significantly improve care planning for service users over the past five years. This shows poor leadership and accountability”

PICTURE POSED BY MODEL A man showing signs of depression.© PA

Neil FetherstonhaughSunday World

A new report claims that people accessing private mental health care are provided with a better service than those in the public system in Ireland.

This allows for a "select number of people" with health insurance or financial means to access the country's high-performing centres, the latest annual report by the Mental Health Commission (MHC) has found.

Mental Health Commission Chief Executive John Farrelly said the report showed "clear evidence that the independent, private mental health service providers are generally providing care in superior standard premises than those within the public system".

The 2021 annual report highlighted that premises-related concerns in HSE approved centres centred around inadequate resourcing and poor governance arrangements.

The MHC is demanding an updated action plan from the HSE to address issues relating to premises, individual care plans, and risk management practices in its mental health services.

Speaking on RTÉ's Morning Ireland, Mr Farrelly said that MHC deems five HSE premises in Cork to be "unsuitable".

"People who don't have private health insurance will be going into those premises in Cork, which are also low in terms of individualised patient care," Mr Farrelly said.

"Meanwhile someone who lives in the Dublin area - where the majority of private and independent centres are - who has private health insurance, has much better choice and access.

He said that is "not equitable and not fair."

Mr Farrelly added that the HSE has invested in new buildings with special teams to "make it work" in counties Tipperary, Wexford, Carlow and Kilkenny.

"You would have to beg the question then, if it can happen in one area why can't it happen in the other?" he said.

Inspector of Mental Health Services Dr Susan Finnerty acknowledged that several new centres had been built in recent years but that a significant number of outdated, unsuitable buildings within the HSE stock had suffered years of environmental neglect.

The one HSE area that scored higher than the privately operated facilities last year in commission inspections was CHO 5, which covers south Tipperary, Carlow/Kilkenny, Waterford and Wexford.

"Such knee-jerk response to adverse findings of an inspection does not indicate good governance. The comparatively better compliance rates in CHO 5 shows that the capacity is in the HSE to adequately address the premises challenges," she said.

Dr Finnerty called for "enhanced leadership and governance across the health service" if the wide ranging and innovative actions set out in the mental health policy 'Sharing the Vision' are to be achieved.

She said the HSE had stated that care planning and the individual care plan document were essential to person-centred recovery care within in-patient and community residential settings.

"Despite this, the HSE has failed to significantly improve care planning for service users over the past five years. This shows poor leadership and accountability," she said.

In 2021, there were 32 admissions involving children to 11 adult units compared with 27 admissions to nine adult units in 2020 and 54 admissions to 15 adult units in 2019.

In percentage terms, 6.3% of child admissions were to adult units.

This figure is slightly higher than in 2020, when admissions to adult units accounted for 5.6% of all child admissions, the lowest number since records began.

Last year, 78% of children admitted to an adult unit were an immediate risk to themselves, while 16% were admitted due to an immediate risk to themselves and others.

While there was a reduction in restrictive practices of both physical and mechanical restraint, episodes of seclusion were similar to the level reported in 2020.

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