Weaknesses exposed in mental health services Covid-19 strategy

Process for mass Covid-19 testing of staff and residents lacks coordination and oversight

An inconsistent and untimely testing strategy for Covid-19, and weaknesses around dormitory-style accommodation in residential mental health services during the critical period from March to July this year, are among key observations highlighted in a review paper published today by the Mental Health Commission (MHC).

The paper includes data and preliminary observations from the supervision, monitoring and support of Irish residential mental health services gathered during a three-month monitoring period this year.

John Farrelly, Chief Executive of the MHC is urging all bodies responsible for protecting the most vulnerable members of society from Covid-19 to work together to strengthen a ‘fragile’ health service and help shield residents of mental health facilities against a second wave of the virus.

One of the Commission’s key concerns during the critical period earlier this year was around staff testing in mental health services.

“We highlighted the significant inconsistencies in the process for staff testing, including the extent of planning, testing that was underway, and delays in results. The review paper identified confusion among some services as to which health guidance they should be following on testing,” Farrelly said.

The MHC observed significant geographic disparities in the ability to commence and complete the mass testing of staff and residents.

It also said that, at times, the process for mass testing of staff and residents lacked coordination and oversight, plus appeared to arbitrarily exclude certain services without explanation.

The Commission considered that staff testing should not be a once-off process, and that a strategy for service-wide or sampling of staff testing should have been embedded into health policy and repeated regularly.

There were also issues with public health guidance for residential mental health services, and confusion among services, particularly approved centres that took acute admissions, as to which guidance they should be following.

The use of dormitory-style accommodation had been a factor in disease progression in a number of the services worst affected by Covid-19, and the paper stressed a more robust regulatory framework would help protect service users and staff against winter flu, and any Covid-19 case surges.

“It is important to recognise that the management and staff of mental health services worked hard to mitigate the issues identified in this paper, and it is only fair and proper that we note that their thoroughness, compassion and, indeed, bravery, ultimately saved many lives,” Farrelly added. “As we have acknowledged many times over recent months, our society owes our health staff and management a huge debt of gratitude.”

The MHC implemented a relationship-based approach to Covid-19 monitoring, establishing a supportive framework, which lead to services contacting the Commission regularly and proactively as issues arose.

From April 4 to July 10, there were 181 services monitored by the Commission, comprising 67 inpatient units, and 114 (unregulated) community residences, caring for almost 4,000 residents.

Confirmed resident cases of Covid-19 were reported to the Commission by 28 of 181 services during the monitoring period, while 47 services reported confirmed staff cases of Covid-19.

In total, 31 per cent (56) of all mental health services monitored had reported confirmed resident and/or staff cases.

There had been a total of 17 Covid-19-related deaths across three approved centres.


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