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10/04/09 PNA both welcome and are critical of the Mental Health Commission report by the Committee of Inquiry in relation to the Psychiatric Services in Clonmel. Welcome on the basis that this report lays the blame fairly and squarely where it belongs with the HSE.  The expectation now is that this report will force the HSE to provide the necessary resources in terms of staffing and the provision of finance to facilitate the movement of services from the hospital base to the community in an orderly fashion in accordance with the principles set out in “Vision for Change”.

The PNA has for many years criticised the lack of development of community services in Clonmel which for whatever reason got left behind.

Criticisms we ask you to note the following:
“The inquiry inevitably focused on areas where improvements were needed, rather than on areas where practice was in line with recognised standards” (26.6)
It was therefore inevitable that the report could only reflect negatively on the Clonmel Service.
The report speaks about the conditions in St.Lukes and St. Michael’s being “bleak” “cold and institutional” “bare” “run down appearance” “dull decor” “peeling plaster” “extensive exposed pipe work” “floor in need of repair” “general maintenance hard to access”
One would have thought that the inquiry team would have made recommendations to have these matters resolved.  But, no, they let the HSE off the hook again.
“The closure of St. Luke’s Hospital sets something of a dilemma for the managers of the service.  In any hospital closure programme a balance has to be struck between maintaining the fabric of old buildings, providing a fresh environment and not spending large amounts of public money on facilities that will only be in use for a short period of time” (20.6.1)
With regard to the injuries the report contains no evidence to back up the allegations that some or all of the injuries were non-accidental.  Quite the contrary.

It has now emerged that 2 Orthopaedic Surgeons were asked to review the injuries.
The first examined 5 of the patients records that the clinical risk manager “considered” could be non accidental.  His response was that:
•The features were not diagnostic.
•He commented that such fractures are common in the elderly and osteoporosis was present in several cases.
The second orthopaedic surgeon was asked to:
•“Advise whether the frequency, nature and circumstances of the injuries reported are consistent with the expected occurrence of injuries in a population of this age group and health status” (22.3.6) and

•To advise if, in his opinion, any of the injuries, in the context within which they occurred, are considered to be non-accidental. (22.3.6)

•In his report the orthopaedic specialist commented that “it was not clear to him that fractures occurred more frequently at St. Luke’s Hospital than at similar hospitals”. He reviewed the x rays of the five cases examined by the other orthopaedic surgeon and concluded that “the injuries were, most likely, caused by simple accidents” (22.3.6)

•He concluded, “There is no substantial evidence, clinical or radiological, in the data made available to me... to point to non accidental injury as a likely or probable cause of the musculo-skeletal injuries that are a feature of the Report” (22.3.6)

The inquiry team stated in its finding on this section “An orthopaedic specialist provided an independent report on these injures.  He believed there was no substantial evidence of non-accidental injury and the inquiry team accepts this opinion” (22.6.E)
With regard to seclusion
•The audit covering 2005 noted that nine per cent of seclusions took place because of staff shortages. (18.2.5)
This was 2 years prior to when the inquiry team commenced their inquiry and over a year before the Mental Health Commission introduced rules governing seclusion (Nov ’06)
They identified that there were four units where patients were secluded from time to time, St. Brigid’s, St. Kevin’s, St. John’s, St. Michael’s.

The report recorded the following:

•St. Brigid’s – “Only one episode of seclusion was recorded since the rules came into effect”. (18.3.13)

•St. Kevin’s Ward – “The seclusion room was no longer used”. (18.2.14)

•St. John’s Ward – “The seclusion room was used occasionally.  The team was told that staffing was increased in St. John’s ward at night, and this had reduced the need for the use of seclusion.  Only one residence was secluded with any frequency”. (18.2.15)

•St. Michael’s – “The inquiry team believes that there is an opportunity in St. Michael’s Unit, with clear leadership and support to staff, to greatly reduce and, perhaps, completely eliminate the use of seclusion”,

Again this gives the lie to the impression created by this inquiry team that seclusion was rampant.  They went on to comment on seclusion thus:

“Seclusion should be one of a range of alternatives for managing disturbed and dangerous behaviour”. (18.6.2)


“There was a local policy on the use of physical restraint.  Use of physical restraint appeared to be in line with Commission’s code of practice” (18.3.3)

Again where is the Problem?

Lack of activities.

The report records:  Nursing staff ran a programme of activities.  Sessions were run during part of most mornings and some afternoons.  These were provided by nursing staff and by organisations, such as advocacy, GROW A.A and Schizophrenia Ireland.  An art therapist and staff from the local VEC provided art classes.  Social work staff ran a Wellness and Recovery Action Plan group fortnightly for an 18 month period but informed the inquiry that the group was on hold due to a difficulty with accessing audiovisual equipment. (17.3.1)

Again hard to understand why the inquiry team wishes to create a very negative public image of services in Clonmel.

Impression created that Clonmel was unique however the reports records “many of the problem identified in South Tipperary are shared, to some extent, by other hospitals, as is clear from the annual reports of the Inspector of Mental Health Services”. (26.4)

Again taking this to be the case it is hard to understand why the Mental Health Commissioner targeted Clonmel.
In the Mental Health Commission press report dated Friday 3rd April the Commission Chairman Dr. Edmond O’ Dea stated “The Commission will work with all interested parties in relation to the development of quality mental health services in South Tipperary.  Government policy as set out in its document A Vision for Change is to move towards the closure of institution such as St Luke’s and to move towards a community based care and treatment model”
He went on to say:
“For this to happen, community mental health services must be provided and funded.  We acknowledge the grave difficulties faced by the Exchequer in funding existing services in the current economic climate.  However even in difficult economic times, there is a need for the continued development of mental health services to ensure people with mental illness receive appropriate care and treatment”
The PNA now calls on Dr O’Dea and the Mental Health Commission to put its money where its mouth is, to work with us as the largest professional body and to force Government to make the necessary finance available to develop the community facilities necessary.