This is a guest piece by Dr. Shari McDaid from Mental Health Reform - a national coalition of organisations working to promote improved mental health services. Dr McDaid's guest contribution looks at the need for an independent complaints mechanism for mental health services in Ireland.
Nowhere is the issue of accountability more important than in services for people in mental distress. Mental Health Reform has been examining the issue of complaints about mental health services. A complaints procedure helps provide accountability for services. Under the UN’s Mental Illness Principles (1991), having a complaints procedure is a human right in itself, a position affirmed by the World Health Organisation in its guidance on Mental Health, Human Rights and Legislation.
The Mental Health Commission’s 2012 report on satisfaction with inpatient services found that 53% of respondents were not aware of the hospital’s complaints procedure. Almost a third of respondents wished to complain about the inpatient service. Of those that did complain, 52% were dissatisfied with how their complaint was dealt with, while 54% were not satisfied with the outcome.
Mental Health Reform has heard from service users and family members/carers in Ireland about their difficulties with making complaints including:
It is clear that improvements are needed to the complaints system. Mental Health Reform seeks a system that is safe and accessible for the complainant, investigates complaints in a transparent and impartial way and provides a timely response. It is important that complainants feel listened to and respected and that they have access to independent advocacy if they need support to make a complaint.
Mental Health Reform has recommended changes to the Mental Health Act, 2001, to strengthen service users’ and family members’ right to make a complaint. Currently, the Complaints Officer is often a member of staff of the relevant service. Individuals who complain to the Inspector of Mental Health Services are likely to have their complaint referred back to the local service because this is the Inspectorate’s standard procedure, aside from serious complaints. Given the lack of choice over mental health service providers within the public services, this is a highly dissatisfactory situation. In practice, it means that a person may have to submit their complaint to a staff member who could involuntarily detain and treat them or withdraw service from their family member.
The Mental Health Act, 2001, should be revised so that individuals can make a complaint directly to the Inspector of Mental Health Services and the Inspector should be empowered to investigate individual complaints. There is also a need for adequate legal protection to prohibit retribution towards or victimisation of a complainant. With these changes in legislation, the accountability for mental health service delivery could be greatly strengthened.
Some individuals made specific comments to MHR about making a complaint:
“You need a separate and independent complaints procedure; going to the person you have a problem with to make a complaint about them is ludicrous.” (Mental Health Reform Consultation Meeting)
“When you’re going through it though, you realise you are fighting a system and fighting a culture that doesn’t listen to people and you get tired out...” (Case Story from a family member )
“Over the course of the few years where I did lodge complaints, it was really tough... Emotionally it was really hard. It was characterised by the opposite to support... I felt like I was stone-walled…” (Case Story from a family member)