THE Lakeview psychiatrict unit at Naas General Hospital is “not suitable for the care and treatment of people with a mental illness” according to a new report published by the Mental Health Commission (MHC) last week.
The unit, one of three approved centres inspected, had seven high-risk non-compliances at the time of inspection (and 15 areas of excellence) in areas including privacy and staffing.
According to the findings, there were insufficient internal and external spaces for residents to move about. There was just one sitting room downstairs as the upstairs area closed from 8pm, and it couldn’t accommodate all residents at full capacity as there were only 11 chairs available.
Overcrowding within the premises, it was noted, necessitated the use of the seclusion room as a bedroom on six occasions since the last inspection. There was a small garden that was also a smoking area, while a garden upstairs was only open when two members of staff were available to supervise.
“Considerable” work had been completed on the upgrade of the toilets, sinks and furniture in the bedrooms and new furniture had been purchased for the sitting room. While the centre didn’t have a dedicated Mental Health Tribunals room, structural building works have been planned to develop one.
However, the centre was also described as “not clean and hygienic”, including external windows observed to be dirty and the enclosed gardens upstairs and downstairs were littered with “numerous” cigarette butts.
“The deficiencies identified on inspection were remedied through additional cleaning resources and maintenance support during the inspection,” it was explained. “Maintenance evidenced that they were in the process of obtaining various costings, e.g. weeding gardens, power hosing of garden, fixing garden furniture, deep cleaning of light fittings, new linoleum in the dining room and unit painting.”
But best practice initiatives were also highlighted in the inspection report – Lakeview Unit has introduced a de-escalation area, created to “minimise episodes of aggression and the need for seclusion”.
The unit was opened in 1988 and is registered for 29 beds – two six-bed dormitories, three four-bed dormitories, and five single rooms. The unit was full at the time of the inspection which took place earlier this year.
Lakeview caters for all acute mental health admissions from the region from 18 years and up, and serves a population of more than 241,538 in Kildare and West Wicklow. The “increased burden” on the service was noted, as was the fact that the bed capacity doesn’t reflect the needs of the community population. To cope with this, the centre had a service level agreement with the Department of Psychiatry, Portlaoise, around 30km away. This arrangement, it was said, provided for the admission of up to ten residents who required higher levels of observation. On inspection, there were five residents in Portlaoise.
According to John Farrelly, MHC Chief Executive, the contrast between a centre with 97% compliance in Galway and “less than satisfactory” findings in Kildare (and Louth) is stark. “The Commission’s evidence is that the mental health service is inconsistent across the country despite being run by [the] same provider,” he said. “This indicates a deficit in the governance and management of our mental health services.”
In response to the report HSE Dublin South, Kildare & West Wicklow Community Healthcare said it had accepted the inspection report and has taken action to address its findings.
“A number of the findings in the report are due to the confines of the physical infrastructure which we accept. It is anticipated that the proposed build will go to tender by the end of the year,” the statement said.
“ HSE Dublin South, Kildare & West Wicklow Community Healthcare Mental Health Services is aware of the limitation in the design of the current Lakeview unit and is working with HSE Estates on a new build project for Lakeview. This new state of the art facility will accommodate 21 additional beds and will have improved clinical and social spaces.”