Amnesty concerned over high levels of seclusion and restraint in mental health services

29 January 2011

A new report from the Mental Health Commission points to worryingly high levels of seclusion and restraint within mental health services in Ireland, according to Amnesty International Ireland (AI). In one centre the use of physical restraint has risen by more than 600 per cent.

The report reveals that nearly three quarters (72.3 per cent) of all approved mental health facilities recorded episodes of physical restraint and nearly half (43.9 per cent) had placed residents in seclusion during 2009. There was a 34 per cent increase in the number of episodes of physical restraint overall in 2009 (the year the report covers).

Colm O’Gorman, Executive Director of AI, said: “While we welcome the release of the Commission’s report because it shines a light on practices that have, for too long, gone unmonitored, we are seriously concerned by the figures it has uncovered.

“The practice of seclusion and the use of restraint can have very serious implications for the individual patient’s human rights to their dignity, bodily integrity and privacy.
It has the potential to breach the prohibition on inhuman or degrading treatment. It is crucial that seclusion and restraint only be resorted to where necessary and proportionate in the individual circumstances.

“Now that the scale of the use of seclusion and restraint has been identified, services must identify what steps they will take to minimise the use of such practices.”

Mr O’Gorman added: “The Commission’s report points out that the focus needs to shift towards preventative measures that eliminate or minimise the use of restrictive interventions. This underlines the need for the review of the law in this area, the Mental Health Act 2001, which is due this year, to be rigorous and comprehensive. AI is calling for this review to bring the Act in line with international human rights standards, including in particular, the UN Convention on the Rights of Persons with Disabilities.

“The staff shortages at one particular service described in the Inspector of Mental Health Service’s annual report from 2009, points towards a link between that and the increased use of restraint. This shows the desperate need for the full implementation of the Government’s mental health policy, A Vision for Change. Piecemeal implementation is not working, and people’s lives and dignity are being affected as a result. We need to see the long promised shift away from the over-reliance on a hospital based response towards community based services that include a range of supports and promote recovery. It is crucial the new government introduces legislation to ensure that mental health reform really happens.”

He added: “It is important to note that many services did reduce the number of episodes of physical restraint and seclusion. However, it’s also the case that these figures only show short-term trends in the use of seclusion and restraint as they only cover the period 2008 to 2009.

“We also welcome the amendment to the Commission’s Rules Governing the Use of Seclusion and Mechanical Means of Bodily Restraint. From 1 March 2011 a patient in seclusion must be kept under direct observation by a registered nurse for the first hour following initiation of a seclusion episode, and continuous observation thereafter for the duration of a seclusion episode.”

Mr O’Gorman concluded: “The Commission’s transparent reporting of these statistics means that the general public as well as people using services will be able to hold mental health services to account for their practice. We would welcome the Commission expanding its reporting to chemical restraint, like sedation, already flagged by the Inspector as an area of concern.

“We are hopeful that the publication of this information will assist in fostering better practice in the Irish mental health services.”


Note to editors
More information from, The Use of Seclusion, Mechanical Means of Bodily Restraint and Physical Restraint in Approved Centres: Activities Report 2009

Three approved mental health facilities accounted for more than one third (37 per cent) of all episodes of physical restraint in approved centres in 2009. These were St Joseph’s Intellectual Disability Services, Portrane, St Vincent’s Hospital, Fairview, and the Acute Psychiatric Unit at the Midwestern Regional Hospital in Ennis. All three approved centres recorded increases in the use of physical restraint compared with 2008.

Lakeview Unit, Naas General Hospital
The report revealed that at the Lakeview Unit in Naas General Hospital there was a 657 per cent increase in the use of physical restraint. The unit continues to have a high use of restrictive interventions per bed compared to the average in Ireland.

Child and Adolescent Mental Health Services
Physical restraint was used in two child and adolescent approved centres in 2009. It was used eight times in Warrenstown Child and Adolescent Inpatient Unit and 20 times in the adolescent in-patient unit at St Vincent's Hospital. St Anne’s Child and Adolescent Unit had recorded 10 episodes of physical restraint in 2008 but did not use this intervention in 2009. 

St Vincent’s Hospital

St Vincent’s Hospital, Fairview recorded an increase in episodes of physical restraint in 2009 compared with 2008. In 2009 there was a 310 per cent increase in episodes, with 271 episodes in 2009 compared with 66 in 2008. The most recent (2009) inspection report for St Vincent’s found that the service was in an old building that was difficult to maintain, and that the teams in the hospital were ‘poorly resourced’, with access to disciplines curtailed by lack of multidisciplinary team staffing.

Acute Unit at Midwestern Regional Hospital

The Acute Unit at Midwestern Regional Hospital in Ennis reported an increase of 135 per cent from 91 episodes of physical restraint in 2008 to 214 in 2009. This is a 39-bed unit that includes a mother and baby unit, a high observation unit and a unit for psychiatry of later life.

St Joseph’s, Portrane
Episodes of both seclusion and physical restraint at St Joseph’s Intellectual Disability Service in Portrane increased with 557 episodes of physical restraint (a 122 per cent increase over 2008) and 692 episodes of seclusion (a 28 per cent increase). However, it is important to note that in October 2010, the new residential development Knockamann was opened in Portrane that will enable transfer of residents from the Victorian intellectual disability service at St Ita’s facility to modern residences.

Time length of seclusion
The length of time the seclusion lasted varied considerably. Eight per cent of episodes of seclusion lasted more than 16 hours and only one per cent more than 72 hours. In the Central Mental Hospital 69.7 per cent of episodes in this service lasted for longer than 16 hours. It also had a relatively high percentage of seclusion episodes (17.2 per cent) lasting for more than three days or 72 hours.

Mental Health Act 2001
The Mental Health Act 2001 does not regulate the use of physical restraint or chemical restraint (i.e. the use of sedation). This is a serious shortcoming with the Act, given the potential for abuse of both forms of restraint. While the Commission has issued guidance on the use of physical restraint, there is no such guidance on the use of sedation. It is clear then that the Act must be extended to ensure the use of such measures are regulated and in line with international best practice.

Implementation of the Government’s mental health policy A Vision for Change is painfully slow