Significant drop in restrictive practices at residential mental health services in Cork and Kerry

Restrictive practices in residential mental health services in Cork and Kerry have almost halved in seven years, as a Cork TD says legislation currently going through the Seanad needs to be amended to ensure progress is not lost.

Physical restraint is defined as 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 themselves or others.

The Mental Health Commission (MHC) monitors both restraint and seclusion, the placing or leaving of a person in any room such that the person is prevented from leaving the room by any means.

The MHC’s annual report for last year showed there were 241 episodes of physical restraint in CHO 4, the health area made up of Cork and Kerry, in 2024.

The figures show a decline every year, except in 2021 where there was a slight increase from 2020 figures, but the low figure in 2020 may be due to the pandemic.

MHC’s themed reports on restrictive practices for the last seven years show that there were 458 instances of physical restraint in CHO 4 in 2018, with 453 in 2019, 296 in 2020, 356 in 2021, 300 in 2022, and 274 in 2023. The figures show a 47% decrease from 2018 to 2024 in Cork and Kerry in terms of physical restraint.

Seclusion also reduced from 150 episodes in 2018 to 80 in 2023, the latest date for which data is available, also a decrease of 47% — with a further decrease likely in 2024 as nationally, seclusions were down nearly 17%.

A report authored by the inspector of mental health services, Jim Lucey, highlights how steps taken by the MHC and by service providers to improve quality care through the adoption of a human rights-based approach has accelerated the downward trend in these types of practices.

Cork Social Democrats TD, and former clinical psychologist, Liam Quaide told The Echo the reduction was welcome, but it was important that progress wasn’t undone.

He said: “The significant decrease in physical restraint and seclusion recorded by the Mental Health Commission in acute units is to be welcomed.

“However, the removal of a section from the Mental Health Bill on chemical restraint means that practice will not be monitored and regulated in the same way. Re-inclusion of this section at Seanad stage is essential in upholding the human rights of service-users.”

Chemical restraint refers to the use of medication, not for treatment of a diagnosed condition, but to control a person’s behaviour, restricting their freedom of movement. Figures for this practice were not provided in MHC reports.