Instances of physical restraint almost tripled in a year at Cork mental health centre, according to report

Instances of physical restraint have almost tripled in a year in a Cork mental health centre for children and adolescents, a new report by the Mental Health Commission (MHC) has confirmed.

Nationally, the majority of centres saw their episodes of restraint decrease between 2022 and 2023. However, in Cork, physical restraint increased by 30%, according to the report.

Physical restraint is “the use of physical force (by one or more persons) for the purpose of preventing the free movement of a person’s body, when the person poses an immediate threat of serious harm to self or others.”

The report notes: “The use of seclusion, mechanical, and physical restraints are considered to be at odds with contemporary evidence-informed approaches to mental health care, which should be based on a recovery orientated ethos and principles of ensuring human rights. 

Research has highlighted that the use of restrictive practices increases the risk of trauma.”

There was a reduction in restraint in the acute mental health unit in Cork University Hospital (CUH) from 112 episodes in 2022 to 65 in 2023.

However, this was offset by increases elsewhere.

Eist Linn child and adolescent mental health inpatient unit saw restraint almost triple in a year, with 14 episodes in 2022 and 37 in 2023, representing a 164% increase.

The report clarifies: “The number of episodes of physical restraint and residents restrained varied across approved centres. In some centres, the rate was skewed by frequent use as an intervention in relation to a small number of residents due to the clinical needs and risks posed.”

In Eist Linn, fewer than five residents were restrained over the year despite the large amount of episodes.

St Michael’s unit in Mercy University Hospital saw restraint increase by 85% year-on-year, with 34 in 2022 rising to 63; while there was a 70% increase in the Carraig Mór Centre in Shanakiel, from 31 to 53 episodes; and a 31% increase from 19 to 25 in St Stephen’s Hospital, Glanmire.

There was a rise in Cois Dalua, a privately operated approved centre run by Nua Healthcare in Meelin. There were no episodes of restraint there in 2022, but 29 in 2023.

There were no instances of restraint in 2022 or 2023 in the Owenacurra Centre or in St Catherine’s ward in St Finbarr’s Hospital. 

There was a reduction from 13 incidents in 2022 to less than five in 2023 in the Centre for Mental Health Care and Recovery, Bantry, but the centre was closed for over half the year so the data is not comparable.

The overall increase in Cork, with 272 episodes of restraint in 2023 compared to 210 in 2022, goes against the national trend. 

It comes despite new rules regarding restraint which came into effect in January 2023. The report also notes episodes of seclusion — there were 28 episodes of seclusion in the Carraig Mór centre in 2023 compared to 17 in 2022, a 65% increase.

Though the number of residents secluded also rose from nine to 11, there was a decrease in the average duration for period of seclusion from five hours 30 minutes to four hours 36 minutes year-on-year. No other Cork centres used seclusion in either year.

The rate of restraint in Eist Linn was among the highest in Ireland in 2023, with 9.3 episodes per resident physically restrained compared to 2.8 in 2022. Rates of restraint increased in some centres, from 3.4 to 4.4 in Carraig Mór and from 1.8 to 1.9 in the Mercy, while it remained steady in St Stephen’s at 1.9 and decreased from 2.3 to 1.8 in CUH.