The Mental Health Commission has found what it calls "critical and high risk" shortcomings in seven approved treatment centres here.
The watchdog says many patients cannot access much-needed therapeutic programmes and services.
It has underlined the seriousness of issues involving pressure sores at Saint Otteran's Hospital in Waterford.
These latest Mental Health Commission Inspection reports highlight overcrowding, lack of access to therapeutic services, pressure sores and staffing issues.
In the Grangemore Ward and St Aidan's Ward at St Otteran's Hospital in Waterford two serious reportable events involving Grade 4 pressure sores were reported to the Commission since its previous inspection in 2016, and the Inspector found a further 14 lower-grade pressure sores during the inspection which is reported on today.
The Inspector, Dr Susan Finnerty, said that in the Carraig Mór centre in Cork there were 10-bed dormitories that are not acceptable by modern standards.
Having one toilet and shower for ten residents is not enough, her report continues.
She says that the Department of Psychiatry at Kilkenny's St Luke's Hospital frequently exceeded bed capacity, which led to residents using sitting rooms as bedrooms and residents sleeping on mattresses on the floor.
She says the centre was dirty and badly maintained and there was a dirty and malodorous visitors' toilet in the reception area.
Overall the inspections reviewed the care of 213 residents on the day of inspections:
- 47 at the Department of Psychiatry, in St Luke's Hospital, Kilkenny
- 33 at the Grangemore Ward and St Aidan's Ward in St Otteran's Hospital, Waterford
- 34 at Deer Lodge, Kerry
- 19 at Wood View, Galway
- 35 at St Michael's Unit, at Cork's Mercy University Hospital
- 14 at Carraig Mór, Cork
- 31 at the Adult Mental Health Unit, Mayo University Hospital, Castlebar
The report on the Waterford facility says that staff could only access a tissue viability nurse over the phone and that only five nurses working in St Aidan's had been trained in the management of pressure sores.
The inspector says adequate arrangements were not in place for access by residents in St Aidan's Ward to a GP service and a tissue viability nurse.
It recalls that in the Grangemore Ward, nursing staff levels were one below what the centre itself stated in its registration information was required.
Continuing her Waterford report, the Inspector says not all health care professionals were trained in the requisite four areas.
"The skill mix of nursing staff in St. Aidan's Ward was not appropriate to the needs of the residents in relation to contemporary dementia care and the management of pressure sores," the reports states. "In addition, a qualified occupational therapist was not available to meet the needs of residents..."
In the Department of Psychiatry at St Luke's Hospital in Kilkenny, neither the numbers nor the skill mix of staff matched the assessed needs of residents.
There was a shortage of nursing staff and psychologists in that service.
Before the inspection, the department's management team had identified overcrowding as "a serious operational and health and safety risk", the report continues. The risk had been escalated to a national level within the HSE.
Representatives of the centre had regularly met the local gardaí and the staff in St Luke's emergency department to improve the processes around referral to the centre.
And a recurring delayed discharge meeting was also established to expedite discharges where appropriate. But the report states that, despite these measures, overcrowding continued.
The Health Service Executive has welcomed the publication of the inspection reports.
In a statement, the HSE, which runs the centres, said the Mental Health Commission's findings assist it in what it calls "the ongoing commitment to developing better mental health services".
The HSE said it will review the specifics of the reports in the coming days.
