A third of applications to have people detained against their will in mental health facilities came from gardaí last year – a situation described as "alarming" by the Mental Health Commission.
For the first time the largest proportion of applications from the community to have people involuntarily detained under the 2001 Mental Health Act came from gardaí (32 per cent), followed by a family members (29 per cent), the HSE (26 per cent) and “other” (13 per cent).
Mental health commissioner John Farrelly said the highest proportion should be coming from health professionals. The over-reliance on gardaí was "extremely concerning", he said, "and even more so given that it happened during Covid-19 when people who required treatment might have been even more vulnerable. An intervention by gardaí could have led to additional distress".
The commission’s 2020 annual report, published on Thursday, also details 151 suspected suicides among patients engaged with mental health services, dilapidated facilities, inadequate care planning and an increased use of seclusion, with one patient put in seclusion for 101 days.
Consent
In all, there were 1,919 admission orders made without the patients’ consent under the Act. A person can only be admitted and detained if he or she is suffering from a mental disorder as defined under the Act, and this admission must be reviewed at a tribunal within 21 days.
“Both the expert group that reviewed the 2001 Mental Health Act six years ago, and the current heads of Bill to amend the same Act, recommend that the only person to sign applications for involuntary admission to an inpatient centre should be an authorised officer of the health service,” Mr Farrelly said.
“The thought process behind this is that it will have the effect of lessening the burden on families and carers, while it will also reduce the involvement of gardaí in the admission process.
“Instead, in every year since 2007, the lowest number of applications to detain someone against their will have come from the HSE’s ‘authorised officers’.”
It was “abundantly clear” this part of the Act had “never been properly implemented,” he said.
While additional funding would be required, it was "imperative . . . we cannot allow applications by the gardaí to continue". Mr Farrelly said he has written to Garda Commissioner Drew Harris on the issue.
Inspector of mental health services, Dr Susan Finnerty, said compliance with the requirement that all patients have a quality individual care plan was just 59 per cent, "with little improvement over the past three years".
“There is a lack of leadership, training and attitude in this area and this must change without delay,” she said.
Neglect
She found many facilities housed in buildings “suffering from years of neglect and lack of funding, resulting in people with a mental illness living in, or receiving treatment in unsuitable, run-down centres”.
The highest number of involuntary admissions concerned people living in the north Dublin and north central Dublin area (403), followed by Kerry and north Cork area (389). The lowest numbers were from Clare, Limerick and Tipperary (160) and Wicklow, Dún Laoghaire and Dublin South-East (179).
The deaths of 586 people using mental health services were reported to the commission last year, compared with 563 deaths in 2019. Of these, 151 were suspected suicides, down from 168 in 2019.
There were 1,840 episodes of seclusion involving 643 residents in 28 centres. The shortest episode was 10 minutes, while the longest was 2,424 hours and 30 minutes (101 days). This compares with 1,719 seclusion episodes involving 653 residents in 28 centres in 2019.
