Maire Devine (Sinn Fein) | Oireachtas source

I thank Mr. Bergin for his presentation. I want to focus on the major areas of non-compliance found in the HIQA report. I have several questions. The discussion on control and restraint, as it was called in the past, is reminiscent of lots of discussions of psychiatric institutions and other jails and what is now accredited. Mr. Bergin referred to the management of actual or potential aggression, MAPA, model. The management of difficult behaviour is difficult. The HIQA report states that the MAPA model of managing behaviour did not fully meet the needs of children or staff but it also states that not all staff adhere to the behaviour management policies. Is MAPA sufficient in meeting the needs of children and staff? Is it the only show in town? Are staff not implementing MAPA? It is quite traumatic for the individual and the staff to have to hold someone down and stay with them. We know from the fatalities that have been caused due to obstruction of airways and interference with cardiac functions that many front-line staff have come across this and we need to reform it. However, there is a contradiction in the two statements in the report in that it is not meeting needs yet the staff are not adhering to it. Will Mr. Bergin comment on the training model and whether he believes it is the right one?

There is an insurance issue for staff if they do not use the MAPA model and are seen to be outside it. As a practitioner, my insurance cover was compromised if I did not use the prescribed accredited method. In situations of extreme violence, trauma or emotion, not everything can be followed to the tee. This needs to be understood.

On children being at the centre of their own care, are they involved from the outset? Do they understand and agree to a treatment model? Is this by way of signature? This way there would be ownership on the part of the child, as much as it can possibly be understood. They will not adhere to it all the time but it gives them a strength of ownership in following a treatment model and an understanding that it is best for them and not necessarily just there to continually punish.

The other quite concerning area of major non-compliance is the administration of medication. There are three nursing staff. Is it just the nursing staff who administer and dispense medication and sign off on the prescriptions or is it the general workers in the facility also? The report notes incidents of treatment being delayed when this was recommended by nursing staff. Will the witness comment on that statement? I know there has been something akin to a Mexican stand-off in our prisons when nursing staff have told prison officers that someone needs treatment. There is a sort of Mexican stand-off as to who has the authority. That is another issue.

The report stated that the measures in place to ensure a robust chain of custody for medicines requiring additional controls were not adequate. This refers to the Misuse of Drugs Act and the Dangerous Drugs Act, which have specific provisions on how drugs are stored, ordered, counted and how one double-signs and makes sure the chain of events can be followed. Drugs are to be returned to the pharmacy or, if there is one, the pharmacy facility on-site. Drugs are always accounted for and two professional people are responsible and account for them.

Mr. Bergin has said that he had addressed the matter with written assurance to the inspectors. Can we have an explanation and copy of that?

Mentally ill people are increasingly incarcerated in prisons because of the closure of our big institutions and the lack of beds. The same applies to children. We know of the closure of Linn Dara and of other facilities for children that are not functional or at full capacity. I gather there are 47 beds in the entire country. Can the Oberstown representatives comment on whether child mental well-being or mental ill-health is becoming part of the criminal justice system? Is Oberstown getting more people who would be more appropriately housed in secure child units?