SUMMARY OF FINDINGS

Issued by: Department of Health

SUMMARY OF THE FINDINGS OF THE MENTAL HEALTH COMMITTEE'S INVESTIGATION INTO PSYCHIATRIC FACILITIES.

The findings can be classified into a number of broad categories:

1. UNACCEPTABLE HEALTH STANDARDS:

Several facilities were found to be unsuitable for patient care delivery.

2. MANAGEMENT ISSUES

a) General Management:

Inefficiencies in managing staff and patients at some facilities include a lack of:

• Standardized staff/patient and patient/ward ratios.
• Management culture: Discriminatory practices including racial discrimination.
• Grievance procedure for patients and staff.
• Basic accommodation requirements eg nutritious food, privacy, heating.
• Standards of hygiene.
• Standardized record-keeping protocols.
• Staff discipline and training.

b) Patient management:

• Lack of treatment protocols/guidelines.
• Variable or absent admission and discharge policies.
• Lack of measures to monitor/discipline staff.
• Lack of mechanisms to investigate and report on adverse patient incidents including deaths.

c) Safety measures:

• Lack of patient safety guidelines

d) Building maintenance:

• Failure to maintain physical integrity of buildings eg minimal privacy in toilets, intermittent lack of heating in winter, crumbling walls etc.

3. ALLEGATIONS OF HUMAN RIGHTS VIOLATIONS:

• Abuse of patients, including physical and secual abuse.
• Discriminatory practices including racial discrimination.
• ECT use/overuse without sedation and/or guidelines.
• Use of restraints without medical directives or recordkeeping.
• Punitive measures against patients eg seclusion, withholding food etc.
• Patient labour.
• Indefinite institutionalisation without regular medical review.
• Loss of personal property.

Note: An allegation of drug trials/experimentation without patient consent or an ethics committee's or an equivalent body's oversight, was received after the committee's investigation was concluded.

4. GOVERNANCE:

• Lack of or ineffective hospital boards for oversight purposes.

5. RESOURCE ALLOCATION

• Diverentiation among hospitals and inequality in resource allocation result in overcrowding, staff shortages, structural failures etc.

6. CONTRACT WITH A PRIVATE PROVIDER

• Failure to maintain facilities and patient care at acceptable health standards.

7. LEGISLATION/REGULATION

• Protective legislation facilities potential "cover-ups" of inefficiencies and human rights violations at mental health facilities.
• Current legislation governing mental health matters inadequately address and enforces norms and standards, standards for licensing and inspection of mental health facilities, management guidelines etc.