The mental health services' watchdog has warned that State provision in the area will continue to be unsafe and substandard unless the Government and the Health Service Executive begin a process of major change.

The Mental Health Commission cited a series of shortcomings in the HSE-run services, which it says breach the fundamental rights of vulnerable service users.

The statutory commission's comments accompany its annual report for last year.

Inspector of Mental Health Services Dr Susan Finnerty said that while some good care was provided, she was greatly concerned that child and adolescent services were generally inadequate, poorly funded and unresponsive to the needs of young people and their families.

She called for urgent action to address this "unacceptable" situation.

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Dr Finnerty said compliance with rules and regulations had only improved by 2% over 12 months and she lamented that a "disturbingly high number of in-patient units were dirty and poorly maintained", with associated implications for infection control.

Dr Finnerty said this marked a deterioration since 2016.

"The physical care of patients had worsened," she reported. "Care plans were mostly paper exercises which were not collaborative and failed to address recovery."

Commission Chairperson John Saunders criticised the glaring and inconsistent pattern of standards, warning that the lack of any real progress and commitment on these matters undermines the fundamental human rights of service users.

He singled out the 82 inappropriate admissions of children to adult mental health in-patient services and the widespread use of restrictive practices, such as seclusion and physical restraint, as a normalised behaviour in inadequately staffed services.

Mr Saunders called on the Government and the HSE to begin a process of major change in the area.

He warned that the alternative is for the country to continue providing unsafe and substandard services.

Speaking on RTÉ’s Morning Ireland, Mr Saunders said the Government was not listening to its concerns and while there may be some rhetoric about the need to change and make improvements, it was not apparent on the ground.

He said there were also fundamental issues around basic hygiene and repair, with people living in places that inspectors described as "dirty".

Mr Saunders said 1,300 people with severe mental health problems or disabilities were living in unfit for purpose community based residences.

Minister of State for Mental Health Jim Daly responded to the commission's criticism by highlighting substantial increases in budget allocations to the area since Fine Gael entered government in 2011.

He told RTÉ's Morning Ireland that spending had been boosted by over €200m since 2012 and that an additional €55m had already been allocated to new initiatives planned for next year. 

Minister Daly blamed the volume of private members' bills for delaying his legislative reform programme which, he said, will include making it mandatory for the commission to inspect community residences where some 1,300 mainly highly dependent people live in the care of the HSE.

In response, the advocacy organisation Mental Health Reform said that Government spending on mental health services had declined since 2008, as had the number of people providing care and support to those with mental health problems.