Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697803980854.pdf (Ireland)
MENTAL HEALTH COMMISSION COIMISIÚN MEABHAIR-SHLÁINTE FINANCIAL STATEMENTS For the year ended 31 December 2021 MENTAL HEALTH COMMISSION Financial Statements For the year ended 31 December 2021 Contents General Information Certificate of the Comptroller and Auditor General Page 3 4 - 5 Governance Statement and Commission Members’ Report 6 - 11 Statement on Internal Control 12 - 17 Statement of Income and Expenditure and Retained Revenue Reserves 18 Statement of Financial Position Statement of Cash Flows Notes to the Financial Statements 19 20 21 - 33 2 MENTAL HEALTH COMMISSION General Information For the year ended 31 December 2021 Senior Leadership Team Mr John Farrelly – Chief Executive Dr. Susan Finnerty – Inspector of Mental Health Services Ms Orla Keane – General Counsel for MHC (DSS) Ms Áine Flynn – Director - Decision Support Service Mr Simon Murtagh – Chief Operations Officer Mr Gary Kiernan – Director of Regulation Members of the Commission Mr John Saunders (Chair) Mr. Ned Kelly Ms. Rowena Mulcahy Dr. Michael Drumm Ms. Nicola Byrne Dr. Margo Wrigley Mr. Patrick Lynch Ms. Colette Nolan Mr. Tómas Murphy Dr. Jack Nagle Dr. John Hillery Ms. Fionn Fitzpatrick (Appointed 12/02/2021) Dr. John Cox (Appointed 12/02/2021) Head Office Waterloo Exchange Waterloo Road Dublin 4 Web Site: www.mhcirl.ie Bankers Allied Irish Bank 1 Lower Baggot Street Dublin 2 Auditors The Comptroller and Auditor General 3A Mayor Street Upper Dublin 1 Solicitor Byrne Wallace LLP 88 Harcourt Street Dublin 2 Accountants Crowleys DFK 16/17 College Green Dublin 2 3 MENTAL HEALTH COMMISSION 4 Ard Reachtaire Cuntas agus Ciste Comptroller and Auditor General Report for presentation to the Houses of the Oireachtas Mental Health Commission Qualified opinion on the financial statements I have audited the financial statements of the Mental Health Commission for the year ended 31 December 2021 as required under the provisions of section 47 of the Mental Health Act 2001.
The financial statements have been prepared in accordance with Financial Reporting Standard (FRS) 102 — The Financial Reporting Standard applicable in the UK and the Republic of Ireland and comprise the statement of income and expenditure and retained revenue reserves the statement of financial position the statement of cash flows, and the related notes, including a summary of significant accounting policies.
In my opinion, except for the non-compliance with the requirements of FRS 102 in relation to retirement benefit entitlements referred to below, the financial statements give a true and fair view of the assets, liabilities and financial position of the Mental Health Commission at 31 December 2021 and of its income and expenditure for 2021 in accordance with FRS 102.
Basis for qualified opinion on financial statements In compliance with the directions of the Minister for Health, the Mental Health Commission accounts for the costs of retirement benefit entitlements only as they become payable.

This does not comply with FRS 102 which requires that the financial statements recognise the full cost of retirement benefit entitlements earned in the period and the accrued liability at the reporting date.
The effect of the non-compliance on the Mental Health Commission’s financial statements for 2021 has not been quantified.

I conducted my audit of the financial statements in accordance with the International Standards on Auditing (ISAs) as promulgated by the International Organisation of Supreme Audit Institutions.

My responsibilities under those standards are described in the appendix to this report.
I am independent of the Mental Health Commission and have fulfilled my other ethical responsibilities in accordance with the standards.

I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion.

Report on information other than the financial statements, and on other matters The Mental Health Commission has presented certain other information together with the financial statements.
This comprises the governance statement and Commission members’ report, and the statement on internal control.

My responsibilities to report in relation to such information, and on certain other matters upon which I report by exception, are described in the appendix to this report.

I have nothing to report in that regard.
John Crean For and on behalf of the Comptroller and Auditor General 29 June 2022 MENTAL HEALTH COMMISSION 5 Responsibilities of Commission members As detailed in the governance statement and Commission members’ report, the Commission members are responsible for the preparation of annual financial statements in the form prescribed under section 47 of the Mental Health Act 2001 ensuring that the financial statements give a true and fair view in accordance with FRS 102 ensuring the regularity of transactions assessing whether the use of the going concern basis of accounting is appropriate, and such internal control as they determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.
Responsibilities of the Comptroller and Auditor General I am required under section 47 of the Mental Health Act 2001 to audit the financial statements of the Mental Health Commission and to report thereon to the Houses of the Oireachtas.

My objective in carrying out the audit is to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement due to fraud or error.
Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with the ISAs will always detect a material misstatement when it exists.

Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.
As part of an audit in accordance with the ISAs, I exercise professional judgment and maintain professional scepticism throughout the audit.

In doing so, I identify and assess the risks of material misstatement of the financial statements whether due to fraud or error; design and perform audit procedures responsive to those risks; and obtain audit evidence that is sufficient and appropriate to provide a basis for my opinion.
The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control.

I obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the internal controls.
I evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures.

I conclude on the appropriateness of the use of the going concern basis of accounting and, based on the audit evidence obtained, on whether a material uncertainty exists related to events or conditions that may cast significant doubt on the Mental Health Commission’s ability to continue as a going concern.
If I conclude that a material uncertainty exists, I am required to draw attention in my report to the related disclosures in the financial statements or, if such disclosures are inadequate, to modify my opinion.

My conclusions are based on the audit evidence obtained up to the date of my report.

However, future events or conditions may cause the Mental Health Commission to cease to continue as a going concern.
I evaluate the overall presentation, structure and content of the financial statements, including the disclosures, and whether the financial statements represent the underlying transactions and events in a manner that achieves fair presentation.

I communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that I identify during my audit.
I report by exception if, in my opinion, I have not received all the information and explanations I required for my audit, or the accounting records were not sufficient to permit the financial statements to be readily and properly audited, or the financial statements are not in agreement with the accounting records.
Information other than the financial statements My opinion on the financial statements does not cover the other information presented with those statements, and I do not express any form of assurance conclusion thereon.
In connection with my audit of the financial statements, I am required under the ISAs to read the other information presented and, in doing so, consider whether the other information is materially inconsistent with the financial statements or with knowledge obtained during the audit, or if it otherwise appears to be materially misstated.

If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact.
Reporting on other matters My audit is conducted by reference to the special considerations which attach to State bodies in relation to their management and operation.

I report if I identify material matters relating to the manner in which public business has been conducted.

I seek to obtain evidence about the regularity of financial transactions in the course of audit.
I report if I identify any material instance where public money has not been applied for the purposes intended or where transactions did not conform to the authorities govern MENTAL HEALTH COMMISSION Governance Statement and Commission Members’ Report Governance The Commission was established under the Mental Health Act 2001 (the 2001 Act).

The functions of the Commission are set out in section 33 of this Act.
The Commission is accountable to the Minister for Health and is responsible for ensuring good governance and performs this task by setting strategic objectives and targets and taking strategic decisions on all key business issues.

The regular day-to-day management, control and direction of the Mental Health Commission are the responsibility of the Chief Executive (CE) and the Senior Leadership Team (SLT).
The CE and the SLT must follow the broad strategic direction set by the Commission, and must ensure that all Commission members have a clear understanding of the key activities and decisions related to the entity, and of any significant risks likely to arise.

The Commission acts through, and its functions are performed in the name of the Commission, by the CE.
The CE mandates and controls generally the administration and business of the Commission and such other (if any) functions as may be determined by the Commission.

The Commission’s statutory functions were expanded on 30 December 2015 with the enactment of the Assisted Decision-Making (Capacity) Act 2015 (the 2015 Act).

The Commission is responsible for the establishment of the Decision Support Service and for the appointment of the Director of the Decision Support Service.
The 2015 Act provides for the establishment of the Decision Support Service (DSS) within the Mental Health Commission.

The DSS will support decision-making by and for adults with capacity difficulties and will regulate individuals who are providing support to people with capacity difficulties.

The 2015 Act reforms Ireland’s capacity legislation, which has been in place since the 19th century.

It will establish a modern statutory framework to support decision-making.
Commission Responsibilities The work and responsibilities of the Commission are set out in Mental Health Commission’s Corporate Governance manual, which also contains the matters specifically reserved for the Commission’s decisions.

Matters specifically reserved to members of the Commission are: - • To define the vision and strategic direction of the organisation.

• To ensure the organisation fulfils its statutory duties.
• To define the internal control mechanisms for the organisation to safeguard public resources.

• To monitor the overall management of the organisation.

• Adoption of the Commission’s Strategic Plan, Annual Business Plan and Annual Budget.

• Approval of significant acquisitions, disposals and retirements of assets of the organisation.

• Approval of any borrowings by the Commission, subject to the approval of the Minister for Expenditure and Public Reform (Section 41 of the 2001 Act).
• Approval of annual report and other reports requested by the Minister (Section 42 of the 2001 Act).

• Approval of the annual financial statements.

• Appointment of the Finance, Audit and Risk Committee.

• Review of the organisation’s system of internal controls.

• Appointment, remuneration and assessment of and succession planning for the Chief Executive.

• Significant amendments to the pension benefits of the Chief Executive and Staff.
6 MENTAL HEALTH COMMISSION Governance Statement and Commission Members’ Report (continued) Section 47 of the 2001 Act requires the Commission to keep, in such form as may be approved by the Minister for Health, all proper and usual accounts of money received and expended by it.
In preparing these financial statements, the Commission of the Mental Health Commission is required to: • select suitable accounting policies and apply them consistently, • make judgements and estimates that are reasonable and prudent, • prepare the financial statements on the going concern basis unless it is inappropriate to presume • that it will continue in operation, and state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the financial statements.
The Commission is responsible for keeping adequate accounting records which disclose, with reasonable accuracy at any time, its financial position and enables it to ensure that the financial statements comply with Section 47 of the Mental Health Act 2001.

The maintenance and integrity of the corporate and financial information on the Mental Health Commission’s website is the responsibility of the Commission.

The Commission is responsible for approving the annual plan and budget.
The 2021 annual plan and budget were approved on 21 January 2021 and 25 March 2021 respectively.

The Commission is also responsible for safeguarding its assets and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
The Commission considers that the financial statements of the Mental Health Commission give a true and fair view of the financial performance and the financial position of the Mental Health Commission at 31 December 2021, except for the non-compliance with the requirements of FRS 102 in relation to retirement benefit entitlements, as directed by the Minister for Health.
Commission Structure The Commission consists of a Chairperson, and 12 ordinary members, all of whom are appointed by the Minister for Health.

The members of the Commission were appointed for a period of five years and meet at least 8 times a year.
The table below details the appointment period for current members: Commission Member John Saunders Ned Kelly Rowena Mulcahy Dr. Michael Drumm Nicola Byrne Dr. Margo Wrigley Patrick Lynch Colette Nolan Tómas Murphy Dr. Jack Nagle Dr. John Hillery Fionn Fitzpatrick Dr John Cox Role Chairperson Member Member Member Member Member Member Member Member Member Member Member Member Date Appointed Reappointed 05/04/2017 Reappointed 29/09/2017 Appointed 26/09/2017 Appointed 05/04/2017 Appointed 05/04/2017 Appointed 05/04/2017 Appointed 05/04/2017 Reappointed 05/04/2017 Appointed 22/01/2019 Appointed 17/12/2019 Appointed 01/11/2020 Appointed 12/02/2021 Appointed 12/02/2021 7 MENTAL HEALTH COMMISSION Governance Statement and Commission Members’ Report (continued) The Commission undertook an internal evaluation of their own performance for the year in December 2021 as guided by the Code of Practice for the Governance of State Bodies (2016).
The Commission has established two committees, as follows: 1.

Finance, Audit and Risk Committee: comprises three Commission members and four independent members.

The role of the Finance, Audit and Risk Committee (FARC) is to support the Commission in relation to its responsibilities for issues of risk, control and governance and associated assurance.

The FARC is independent from the financial management of the organisation.
In particular, the Committee ensures that the internal control systems including audit activities are monitored actively and independently.

The FARC reports to the Commission after each meeting, and formally in writing annually.

The members of the Finance, Audit and Risk Committee are: Patrick Lynch (Chairperson), Mairead Dolan, Ciara Lynch, Kevin Roantree, Richard O’Farrell, Tómas Murphy and Nicola Byrne.

There were four meetings of the FARC in 2021.


The Chairman of the Commission is an ex officio member of the Finance, Audit and Risk Committee.

2.

Legislation Committee: comprises three Commission members and two independent members.

The members of this committee are: Rowena Mulcahy (Chairperson)(Resigned 18th February 2021), Ned Kelly, Michael Drumm (Appointed Chairperson 15th July 2021), Mary Donnelly, Teresa Blake and John Hillery (Appointed 15th July 2021).
There were 2 meetings of the Legislation Committee in 2021.
8 MENTAL HEALTH COMMISSION Governance Statement and Commission Members’ Report (continued) Schedule of Attendance, Fees and Expenses A schedule of attendance at the Commission and Committee meetings for 2021 is set out below including the fees and expenses received by each member: Commission Number of meetings 11 Finance, Audit & Risk Committee 4 John Saunders Ned Kelly Rowena Mulcahy Dr. Michael Drumm Nicola Byrne Dr. Margo Wrigley Patrick Lynch Colette Nolan Jack Nagle Tómas Murphy Ciara Lynch Kevin Roantree Richard O’Farrell Mary Donnelly Mairead Dolan Teresa Blake Dr. John Hillery Fionn Fitzpatrick Dr John Cox 11 8 11 10 10 10 10 9 11 9 - - - - - - 11 7/9 8/9 - - - - 4 - 4 - - 2 2 3 3 - 4 - - - - Legislation Committee Fees 2021 € Expenses 2021 € 2 - 1 1 2 - - - - - - - - - 2 - 1 - - - 11,970 - 7,695 - - 1,924 - 7,695 7,695 - - - - - - - 7,695 6,811 6,811 58,296 156 - - - - - - - - - - - - - - - - 156 Five of the Commission members did not receive a Commission fee under the One Person One Salary (OPOS) principle.
There was no Commission meeting and conference costs (2020: €4,471) incurred during the year.

Key Personnel Changes Fionn Fitzpatrick and Dr. John Cox were appointed to the Commission on 12 February 2021.

The Chair of the Legislation Committee, Rowena Mulcahy, resigned as of 18 February 2021.

Michael Drumm was appointed Chair of the Committee as of 15 July 2021.

John Hillery was appointed as a Member of the Committee as of 15 July 2021.
Disclosures Required by Code of Practice for the Governance of State Bodies (2016) The Commission is responsible for ensuring that the Mental Health Commission has complied with the requirements of the Code of Practice for the Governance of State Bodies (“the Code”), as published by the Department of Public Expenditure and Reform in August 2016.

The following disclosures are required by the Code.

Employee Short-Term Benefits Breakdown are disclosed in note 5 to the financial statements.
9 MENTAL HEALTH COMMISSION Governance Statement and Commission Members’ Report (continued) Consultancy Costs Consultancy costs include the cost of external advice to management and exclude outsourced ‘business- as-usual’ functions.
Legal advice Procurement CIS Support Regulatory Review Hybrid Working Review Risk Management Review Health and Safety DSS Business Analysis Project Management HR and Pension ICT Advisory Board Effectiveness Review Quality Framework Review Total consultancy costs Legal Costs and Settlements 2021 € 154,407 720 12,497 281,670 61,500 30,442 24,464 1,289,202 117,914 30,100 - 9,749 2,012,665 2020 € 101,356 - - - - - - 658,194 - 28,930 16,600 - 805,080 The table below provides a breakdown of amounts recognised as expenditure in the reporting period in relation to legal costs, settlements and conciliation and arbitration proceedings relating to contracts with third parties.
This does not include expenditure incurred in relation to general legal advice received by the Mental Health Commission which is disclosed in Consultancy costs above.
Legal fees - legal proceedings Legal fees – legal aid scheme Settlements Total Travel and Subsistence Expenditure Travel and subsistence expenditure are categorised as follows: Domestic - Commission - Employees International - Commission - Employees Total 2021 € 551,757 3,131,334 1,845 3,684,936 2020 € 467,248 2,670,321 6,193 3,143,762 2021 € 156 77,566 - 117 77,839 2020 € 3,730 75,227 - 1,724 80,681 10 MENTAL HEALTH COMMISSION Governance Statement and Commission Members’ Report (continued) Hospitality Expenditure The Statement of Income and Expenditure and Retained Revenue Reserves includes the following hospitality expenditure: Commission / Staff hospitality Total No client hospitality related expenditure was incurred in 2021 (2020: nil).
2021 € 6,076 6,076 2020 € 2,585 2,585 Statement of Compliance The Commission has adopted the Code of Practice for the Governance of State Bodies (revised 2016) and has put procedures in place to ensure compliance with the provisions of the Code.

The Commission is in full compliance with the Code for the year ended 2021.
………………………… Dr John Hillery Chairperson 27th June 2022 ………………………… John Farrelly Chief Executive 27th June 2022 11 MENTAL HEALTH COMMISSION Statement on Internal Control Scope of Responsibility As Chairperson, I acknowledge the Commission is responsible for the system of internal control.

The Commission has delegated responsibility to the Chief Executive to deal with management and operational issues and to report to the Commission regularly.
Purpose of the System of Internal Control The system can only provide reasonable and not absolute assurance that assets are safeguarded, transactions authorised and properly recorded, and that material errors or irregularities are either prevented or would be detected in a timely manner.
Control Environment The following steps have been taken to ensure an appropriate control environment: • The Commission has a regular schedule of meetings (at least eight per annum) at which it is provided with regular updated reports of expenditure.

• A Finance, Audit and Risk Committee of the Commission has been established.
The Committee’s Terms of Reference are in accordance with the Code of Practice for the Governance of State Bodies (revised 2016) to include oversight on financial reporting, external and internal audits, risk management and internal controls.

• Management responsibilities are assigned, with corresponding accountability.
Risk and Control Framework The Mental Health Commission has established processes to identify and evaluate financial and business risks by: • Identifying the nature and extent of financial risks and business risks facing the Commission.

• Assessing the likelihood of identified risks occurring.

• Assessing the Mental Health Commission’s ability to manage and mitigate the risks that do occur.
12 MENTAL HEALTH COMMISSION Statement on Internal Control (continued) Impact of COVID-19 pandemic to the Control Environment The onset of the COVID-19 pandemic in early 2020, and the resulting public health advise and safety measures, rapidly and fundamentally changed the working practices of the MHC with remote and virtual working becoming the norm for most MHC staff.
The pandemic and the public health restrictions continued throughout 2021 and the MHC continued to monitor the impact of the pandemic on the internal control environment.

MHC sought to mitigate the risks that may affect the MHC’s business operations, staff and stakeholders.

Actions taken by the Commission includes: - • Continual monitoring of MHC’s Business as Usual (BAU) model in a remote working environment where most business processes continued as normal.
• Continual assessment of significant risks pertaining to the COVID-19 pandemic and the agility of the MHC to respond effectively.

• Ensuring robust segregation of duties remains and adequate cover is in place should specific approving authorities be unavailable.

• Ensuring all existing data protection and records management policies and procedures continue to apply in the remote working environment and are monitored and reported on as normal.
• Ensuring that staff members access MHC’s network using MHC’s approved ICT equipment and that all staff members working remotely have been equipped with the necessary ICT equipment.

• Ensuring robust and secure measures to counteract the threat of cyber attacks have been put in place.

• Assessing on an ongoing basis the potential for weaknesses in internal controls resulting from COVID-19 and taking measures to monitor and update internal controls where necessary.
• Continual monitoring of the external environment and adhering to Public Health advice.

• Convening of Mental Health Tribunals by video conferencing in place of face to face.

Ongoing Monitoring and Review The system of internal control is based on a framework of regular management information, administrative procedures including segregation of duties, and a system of delegation and accountability.
In particular it includes: • Appropriate budgeting system with an annual budget, which is reviewed regularly by senior management.

• Regular review by senior management of periodic and annual financial reports, which indicate financial performance against forecasts.

• Regular senior leadership team meetings.

• Completion of an Internal Control Questionnaire (ICQ) by senior management to assess the effectiveness of the control environment in their respective areas of responsibility.
• Update of the C&AG guidance issued on “The impact of Covid-19 on your control environment (September 2020).” 13 MENTAL HEALTH COMMISSION Statement on Internal Control (continued) Mechanisms for ensuring the adequacy of the security of the Information and Communication Technology (ICT) systems that include the establishment of appropriate policies and control procedures have been established.

This also includes robust cyber security measures to protect the ICT network from unwanted threats.
The Mental Health Commission has a properly constituted internal audit function which reports to the Finance, Audit and Risk Committee.

The internal audit function operates in accordance with the Code of Practice for the Governance of State Bodies.

The Commission’s monitoring and review of effectiveness of the systems of internal control is informed by the work of the outsourced internal auditor and the Finance, Audit and Risk Committee.
The following internal audits were completed in 2021, as part of a 3-year internal audit plan:- • Review of the Health and Safety • Review of DSS Governance and Management • Review of Operational Resilience Two further internal audits were carried out during the year but not completed by 31 December 2021: • Review of Internal Financial Control • Review of the Rules, Code of Practice and Guidance.
Procurement I confirm that Mental Health Commission has procedures in place to ensure compliance with current procurement rules and guidelines.

The Finance, Audit and Risk Committee receives updates by way of a Statement of Procurement Non- Compliances prepared by management.
I can confirm that no procurement breaches occurred in 2021. Review of Effectiveness The Finance, Audit and Risk Committee have reviewed the Statement on Internal Control and the Commission to ensure it accurately reflects the control system in operation during the reporting period.

I confirm that the Commission conducted an annual review of the effectiveness of the internal controls for 2021 and this was signed off by the Commission in March 2022.
The Commission is of the opinion that reasonable assurance can be placed on the effectiveness of the system of internal controls instituted and implemented for the financial year ended 31 December 2021.

14 MENTAL HEALTH COMMISSION Internal Control Issues Internal Control Issues Mitigating actions 1. Review of the Health and Safety Process During 2021, a review of the Health and Safety processes was conducted by the Internal Auditor.
Four findings of importance were identified during the audit, as follows: 1.

Retention of Covid-19 Health Checklists 2.

Covid-19 responses to be incorporated into an MHC Business Continuity Plan 3.

MHC Accident / Near-Miss Log not utilised for Inspections 4.

Health & Safety Committee Terms of Reference In response to addressing the findings identified, the Commission took the following actions: 1.

There is a process in place if an inspector has Covid-19 symptoms before entering an approved centre.
However, under GDPR regulations the MHC does not retain the health checklists completed by them.

2.

The Business Continuity Plan has been drafted and the MHC will ensure that procedures, response emergency introduced the Covid-19 during pandemic, are incorporated into the plan.

3.

A log of all accidents and near misses is maintained and is discussed at the quarterly Health and Safety meetings.

4.

The MHC has drafted a Terms of Reference for the Health & Safety Committee.
2. Review of DSS Governance and Management During 2021, a review of DSS governance and management was conducted by the Internal Auditor.

In response to addressing the findings identified, the Commission took the following actions: Two findings of importance were identified during the audit, as follows: 1.

Enhancements to DSS Project change request process 2.

Enhancements management to DSS Project risk 1.


The Change Control Procedure document was updated include thresholds for changes that require escalation to the Change Control Board or the DSS Project Board.

to 2.

The MHC undertook a risk review and a new reporting format was implemented to align DSS and corporate risks.

Further, the DSS Project Team will consider the reallocation of ownership of risk in the RAID logs as appropriate.

Any reallocation will be addressed in reports to the Project Board.
15 MENTAL HEALTH COMMISSION 3. Review of Operational Resilience During 2021, a review of operational resilience was conducted by the Internal Auditor.

Two findings of importance were identified during the audit, as follows: 1.

Enhancements to MHC Business Continuity Plan development 2.

Data Privacy Risk Assessment In response to addressing the findings identified, the Commission took the following actions: 1.
The Business Continuity Plan has been drafted and the MHC will ensure that procedures, response emergency introduced the Covid-19 during pandemic, are incorporated into the plan.

The MHC will ensure that an additional review will take place twelve months after the DSS becomes operational.

2.

When the Working from Home Policy is line with Government launched policy, the MHC will carry out a data privacy and risk assessment of staff working hybrid working arrangement.
In line with the results of this risk assessment the MHC will take the appropriate action to address any underlying risks and will put in place new controls or enhance existing controls to mitigate the risks identified.

in in a 4. Review of the Rules, Code of Practice and Guidance During 2021, a review of the rules, codes of practice and guidance was conducted by the Internal Auditor.
In response to addressing the findings identified, the Commission took the following actions: One finding of importance was identified during the audit, as follows: 1.

Policies and Procedures 1.

The MHC will update the Standards Development policy to ensure it is fit for purpose and incorporates the matters identified during the review, including a process for policy review and revision.

5.

Data Breaches There was one data breach reported to the Data Protection Commissioner during 2021.
The breach occurred when a letter addressed to a patient was received by a member of the hospital staff with the same name.

The Mental Health Tribunals has measures in place to limit the number of data incidents occurring.

The breach was investigated and the MHC was assured that the incorrect recipient disposed of the letter and it had not been seen by any other party.

16 MENTAL HEALTH COMMISSION 6.


Update on 2020 Statement on Internal Control The 2020 Statement on Internal Control highlighted some areas that required further work by it addressed any weaknesses in its internal control environment.

These were as follows: the MHC to ensure 1. Review of Risk Management Process 2. Review of Resource Planning and Deployment 3.

Procurement Issues 4.

Internal Financial Control Issues 5.


Data Breaches Signed ………………………… Dr John Hillery Chairperson 27th June 2022 The MHC took the following steps to address these issues: in 1.

The MHC considered all three findings the Review of Risk noted Management Risk Management Review took place in 2021, and a Business Continuity Plan has been developed.

Process.

A 2.

The MHC has addressed findings noted Resource Planning and Deployment in the two the Review of 3.
Two legacy procurement issues identified in 2020 have been resolved.

4.

Two Internal Financial Control issues identified in 2020 have been resolved.

5.

The MHC has taken measures to limit the number of Data Breaches.
17 MENTAL HEALTH COMMISSION Statement of Income and Expenditure and Retained Revenue Reserves For the year ended 31 December 2021 Income Grant income Superannuation contributions Other Income Expenditure Commission Costs Staff Costs Mental Health Tribunals Upkeep and Overheads General Expenses Depreciation Surplus for the year before appropriations Transfer (to) / from capital account Notes 2021 € 2020 € 2 3 4 5 7 8 9 11 15 20,532,690 60,779 800 20,594,269 58,451 5,604,109 7,983,391 767,483 4,023,233 95,280 18,531,947 17,093,940 59,841 - 17,153,781 56,081 5,139,903 7,525,141 778,514 2,481,663 89,551 16,070,853 2,062,322 (1,156,020) 1,082,928 (837,198) Surplus for the year after appropriations 906,302 245,730 Balance brought forward 1 January Balance carried forward at 31 December 646,213 1,552,515 400,483 646,213 The Statement of Income and Expenditure and Retained Revenue Reserves includes all gains and losses recognised in the year.
The Statement of Cash Flows and notes 1-20 form part of these financial statements.
On behalf of the Commission ………………………… Dr John Hillery Chairperson 27th June 2022 ………………………… John Farrelly Chief Executive 27th June 2022 18 MENTAL HEALTH COMMISSION Statement of Financial Position As at 31 December 2021 Fixed Assets Property, Plant and Equipment Assets under development Notes 11 12 Current assets Cash and cash equivalents Receivables and prepayments 13 Current Liabilities Amounts Falling Due Within 1 Year 2021 € 2020 € 221,538 1,949,856 2,171,394 205,792 809,582 1,015,374 3,287,172 529,891 3,817,063 1,469,971 482,431 1,952,402 Payables and accruals 14 (2,264,548) (1,306,189) Net Current Assets 1,552,515 646,213 Total Assets less Current Liabilities 3,723,909 1,661,587 Net Assets Reserves 3,723,909 1,661,587 Statement of Income and Expenditure Capital Account 15 1,552,515 2,171,394 3,723,909 646,213 1,015,374 1,661,587 The Statement of Cash Flows and notes 1-20 form part of these financial statements.
On behalf of the Commission ………………………… Dr John Hillery Chairperson 27th June 2022 ………………………… John Farrelly Chief Executive 27th June 2022 19 MENTAL HEALTH COMMISSION Statement of Cash Flows For the year ended 31 December 2021 Net Cash Flow from Operating Activities Excess income over expenditure Depreciation charge (Increase) / Decrease in receivables Increase / (Decrease) in payables Loss / (Gain) on disposal of fixed assets Net Cash Inflow / (Outflow) from Operating Activities Net Cash flows from investing activities Amounted allocated to fund asset additions Disposal of assets Net Cash Flow from Investing Activities Note 2021 € 2020 € 11 15 2,062,322 95,280 (47,460) 958,359 299 3,068,800 1,082,928 89,551 (136,818) 300,884 - 1,336,545 (1,251,599) - (1,251,599) (926,749) - (929,749) Increase / (Decrease) in Cash and Cash Equivalents 1,817,201 409,796 Cash at bank 1 January Cash at bank 31 December 1,469,971 3,287,172 1,060,175 1,469,971 On behalf of the Commission ………………………… Dr John Hillery Chairperson 27th June 2022 ………………………… John Farrelly Chief Executive 27th June 2022 20 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 1.
Accounting Policies a) General The Mental Health Commission was established by the Minister for Health on 5 April 2002 under Section 32 of the Mental Health Act, 2001 with a head office at Waterloo Exchange, Waterloo Road, Dublin 4.
The principal functions of the Commission, as specified in the Act, are to promote, encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services and to take all reasonable steps to protect the interests of persons detained in approved centres.
The Commission undertakes the following activities: • Appointing persons to mental health tribunals to review the detention of involuntary service users and appointing a legal representative for each service user.

• Establishing and maintaining a Register of Approved Centres.

• Inspecting approved centres and other mental health services.
• Making rules regulating the use of specific treatments and interventions as specified in the Mental Health Act 2001; and • Developing codes of practice to guide people working in mental health services.

The Assisted Decision Making (Capacity) Act 2015 was enacted on the 30 December 2015.

When commenced in full, the legislation will confer additional statutory functions on the Mental Health Commission.
The Commission is also empowered to undertake such activities, as it deems appropriate to foster and promote these standard and practices.

b) Statement of Compliance The financial statements of the Mental Health Commission for the year ended 31 December 2021 have been prepared in accordance with FRS 102 (the financial reporting standard applicable in the UK and Ireland issued by the Financial Reporting Council) with the exception of Section 28 Employee Benefits - (See Accounting Policy H).
c) Basis of Preparation The financial statements are prepared under the historical cost convention, except as indicated below.

The following accounting policies have been applied consistently in dealing with items which are considered material in relation to the Mental Health Commission’s financial statements.

The financial statements are prepared in Euro which is the functional currency of the Commission.

d) Period of Account The financial statements relate to the year ended 31 December 2021.
21 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 Accounting Policies (continued) e) Income State Grant Income shown in the financial statements under State Grants represents the amount received, including capital grants, in the period.

Other Income Superannuation contributions from staff represents the actual receipts in the period.

f) Tangible Assets and Depreciation Tangible assets are stated at their historical cost less accumulated depreciation.
Depreciation is charged to the Statement of Income and Expenditure on a straight line basis, at the rates set out below, so as to write off the assets, adjusted for residual value, per their expected useful lives as follows: IT Equipment Office Equipment Furniture and Fittings Leasehold Improvements Straight-line over 3 years Straight-line over 5 years Straight-line over 10 years Straight-line over 8 years The residual value and useful lives of fixed assets are considered annually for indicators that these may have changed.
Where such indicators are present, a review will be carried out of the residual value, depreciation methods and useful lives, and these will be amended if necessary.

Changes in depreciation rates arising from this review are accounted for prospectively over the remaining useful lives of the assets.

Assets Under Development Assets under development relate to the implementation of an ICT system to support the establishment of the Decision Support Service by the MHC.
Development costs of the asset are capitalised as they are incurred.

Depreciation of the asset will not commence until the asset is in use.

g) Capital Account The capital account balance represents the unamortised value of funds used for the purchase of fixed assets and assets under development.
22 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 Accounting Policies (continued) h) Employee Benefits Short-term Benefits Short-term benefits such as holiday pay are recognised as an expense in the year, and benefits that are accrued at year-end are included in the Payables figure in the Statement of Financial Position.
Retirement Benefits The Commission had submitted a superannuation scheme for approval by the Department of Health regarding pension arrangements as per Section 40 of the Mental Health Act 2001.

In 2017 the scheme was approved.

The Public Service (Single Scheme and Other Provisions) Act 2012 became law on 28th July 2012 and introduced the new Single Public Service Pension Scheme (“Single Scheme”) which commenced with effect from 1st January 2013.
All new staff members to the Mental Health Commission, who are new entrants to the Public Sector, on or after 1st January 2013 are members of the Single Scheme.

In accordance with the direction of the Minister for Health, pensions are accounted for on a 'pay as-you go' basis.

The provisions of FRS 102 'Section 28: Employee Benefits' are not applied and the liability for future pension benefits accrued in the year has not been recognised in the financial statements.
i) Receivables Receivables are recognised at fair value, less a provision for doubtful debts.

The provision for doubtful debts is a specific provision and is established when there is objective evidence that the Mental Health Commission will not be able to collect all amounts owed to it.

All movements in the provision for doubtful debts are recognised in the Statement of Income and Expenditure and Retained Revenue Reserves.
j) Payables Trade creditors are measured at invoice price, unless payment is deferred beyond normal business terms or is financed at a rate of interest that is not market rate.

In this case the arrangement constitutes a financing transaction, and the financial liability is measured at the present value of future payments discounted at a market rate of interest for a similar debt instrument.
k) Contingencies Contingent liabilities, arising as a result of past events, are not recognised when (i) it is not probable that there will be an outflow of resources or that the amount cannot be reliably measured at the reporting date or (ii) when the existence will be confirmed by the occurrence or non-occurrence of uncertain future events not wholly within the Commission’s control.
Contingent liabilities are disclosed in the financial statements unless the probability of an outflow or resources is remote.

Contingent assets are not recognised.

Contingent assets are disclosed in the financial statements when an inflow of economic benefits is probable.
23 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 Accounting Policies (continued) l) Critical Accounting Judgements and Estimates The preparation of the financial statements requires management to make judgements, estimates and assumptions that affect the amounts reported for assets and liabilities as at the statement of financial position date and the amounts reported for revenues and expenses during the year.
However, the nature of estimation means that actual outcomes could differ from those estimates.

There were no judgements required that had a significant effect on amounts recognised in the financial statements for 2021. m) Operating Lease Rental expenditure under operating leases is recognised in the Statement of Income and Expenditure and Retained Revenue Reserves over the life of the lease.
Expenditure is recognised on a straight-line basis over the lease period, except where there are rental increases linked to the expected rate of inflation, in which case these increases are recognised when incurred.

Any lease incentives received are recognised over the life of the lease.

24 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 2.
State Grant Department of Health (Vote 38 Subhead E1) Department of Health – (ICT Capital Grant) Department of Justice (Vote 24 Subhead D10) Department of Children, Equality, Disability, Integration and Youth (Vote 40, Subhead D9) 2021 € 15,070,000 109,029 - 5,353,661 20,532,690 2020 € 13,800,000 33,940 1,800,000 1,460,000 17,093,940 3.
Superannuation Contributions By agreement with the funding Departments, the Commission retains superannuation contributions payable by staff who are members of the model superannuation scheme.

This is recognised as income in the financial statements.

The amounts payable in the year are recognised as income in that year.

The €60,779 brought to account in 2021 is in respect of deductions made in the accounting year.

The €59,841 brought to account in 2020 is in respect of deductions made in 2020.
Employee contributions under the Single Scheme are remitted to the Department of Public Expenditure and Reform.

The Public Service Pay and Pensions Act introduced an “additional superannuation contribution” payable by all staff.

These salary deductions are not retained but are remitted to the Department of Health as required.

4.

Commission Costs Chairperson's stipend Commission member fees Commission meetings and conference costs Travel and Subsistence 5.
Staff Costs Salaries and wages Agency Personnel Travel and Subsistence – Domestic Travel and Subsistence – Foreign Staff training and CPD Average number of employees WTE’s at 31 December 2021 € 11,970 46,325 - 156 58,451 2020 € 11,970 35,910 4,471 3,730 56,081 2021 € 4,522,402 874,417 77,566 117 129,607 2020 € 4,411,468 593,662 75,227 1,724 57,822 5,604,109 5,139,903 77 74 74 78 25 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 Additional superannuation contributions were deducted in line with statutory requirements.
€95,536 of additional superannuation contributions have been deducted in 2021 and paid over to the Department of Health (2020: €92,554).

There were no termination payments or overtime payments made in the year.

Key management personnel remuneration is disclosed in note 17 to the financial statements.
Employee benefits breakdown Employees’ short-term benefits in excess of €60,000 are categorised into the following bands: Range of total employee benefits From To Number of Employees 2021 2020 €60,000 - €69,999 €70,000 - €79,999 €80,000 - €89,999 €90,000 - €99,999 €100,000 - €109,999 €110,000 - €119,999 €120,000 - €129,999 €130,000 - €139,999 €140,000 - €149,999 €150,000 - €159,999 €160,000 - €169,999 €170,000 - €179,999 €180,000 - €189,999 €190,000 - €199,999 €200,000 - €209,999 €210,000 - €219,999 €220,000 - €229,999 €230,000 - €239,999 €240,000 - €249,999 €250,000 - €259,999 Total 12 4 1 1 1 - 2 - - 1 - - - - - - - - 1 - 23 11 4 2 - 1 1 1 - 1 - - - - - - - - - - 1 22 Note: For the purposes of this disclosure, short-term employee benefits in relation to services rendered during the reporting period include salary, overtime allowances and other payments on behalf of the employee but exclude employer’s PRSI.
26 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 6.

Chief Executive's Remuneration Chief Executive's annual basic salary: 2021 € 2020 € Chief Executive All-in cost of the Chief Executives' total remuneration (incl superannuation) 156,821 147,266 156,821 147,266 The Chief Executive’s pension entitlements do not extend beyond the standard entitlement in the model public sector defined benefit superannuation scheme.

7.
Mental Health Tribunals Fees to Panel Members Chairpersons’ Fees Lay Members’ Fees Consultant Psychiatrists’ Fees - Commission Consultant Psychiatrists’ Fees – Independent Legal Representatives’ Fees 2021 € 2020 € 1,373,013 678,505 901,395 1,515,463 3,131,334 1,317,654 656,371 869,536 1,469,749 2,664,228 Legal Representatives’ Fees - Circuit court appeals * 254,456 319,774 Other Costs Travel and subsistence Other costs Training associated with the Mental Health Act *These include fees paid to the patients’ legal representative only.
8.

Upkeep and Overheads Repairs and maintenance Rent, rates and service charges Insurance 55,423 66,737 7,065 168,682 53,527 5,620 7,983,391 7,525,141 2021 € 10,340 753,908 3,235 767,483 2020 € 12,486 764,204 1,824 778,514 27 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 9.
General Expenses Telephone Light and heat Printing, postage, stationery and storage Taxi and courier Recruitment costs Accountancy and internal audit Audit fees Bank charges IT technical support IT development costs Advertising to include recruitment Library publications and reference material Subscriptions Cleaning Pension and human resources Regulatory review Risk Management review CIS Support Procurement advice Health & safety Hybrid working review Loss on Disposal of Fixed Assets DSS Business Analysis Project Management Legal fees general High Court – Solicitor High Court - Counsel Publications expenses Conference, room hire and seminar expenses Hospitality expenses Research Projects Licenses GDPR Services Communications and media Insurance General office expenses Quality Framework Review ICT Advisory Board Effectiveness Review Covid-19 2021 € - 219,255 62,020 18,219 9,749 30,100 - - 4,023,233 2020 € 127,326 17,037 48,396 9,030 127,507 165,085 17,600 1,247 387,103 287,024 - 18,092 16,862 6,392 5,756 - - - - - - - 658,194 101,356 144,712 2,762 6,160 2,922 2,585 - 98,672 923 96,414 51,923 30,748 - 28,930 16,600 4,305 2,481,663 28 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 10.
Decision Support Service Income Department of Justice Department of Children, Equality, Disability, Integration and Youth 2021 € 2020 € - 1,800,000 5,353,661 1,460,000 5,353,661 3,260,000 Expenditure Pay Salaries and Wages Non-Pay Telephone Light and Heat Printing, postage, stationery and storage Recruitment costs Accountancy and audit Bank charges IT technical support IT development costs Cleaning Rent, rates and service charges Subscriptions and licenses Travel and subsistence Library publications and reference material Legal fees general DSS Business Analysis Project Management Staff training Insurance General office expenses Depreciation Communication & Media Licences Advertising to include recruitment Loss on Disposal of Fixed Assets Total DSS related expenditure Transfer (to) / from capital account Surplus / (Deficit) for the year 1,610,907 1,355,588 1,610,907 1,355,588 25,757 2,938 632 98,194 35,395 1,186 62,531 2,712 2,764 220,217 610 (491) 7,096 41,327 1,289,202 15,510 19,191 - 3,371 97,361 79,473 2,337 299 38,764 5,036 552 47,333 33,224 35 60,838 10,675 1,888 220,954 30,703 5,488 6,616 21,060 658,194 19,264 15,671 4,752 13,348 21,232 - - - 2,007,612 1,215,627 3,618,519 2,571,215 (845,537) (156,752) (1,139,719) 595,423 29 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 11.
Property, Plant and Equipment Furniture and Fittings Office Equipment IT Equipment Leasehold Improvements € € € 373,206 13,712 - 386,918 306,473 5,957 - 312,430 71,684 4,763 - 76,447 63,343 2,819 - 66,162 371,581 92,850 (38,558) 425,873 301,368 63,453 (38,259) 326,562 € 207,456 - - 207,456 146,951 23,051 - 170,002 Total € 1,023,927 111,325 (38,558) 1,096,694 818,135 95,280 (38,259) 875,156 Cost At 1 January 2021 Additions Disposals At 31 December 2021 Depreciation At 1 January 2021 Charge for the period Disposals At 31 December 2021 Net Book Value At 31 December 2021 74,488 10,285 99,311 37,454 221,538 At 31 December 2020 66,733 8,341 70,213 60,505 205,792 12.
Assets Under Development Cost As at 1 January Additions Disposals At 31 December 2021 € 809,582 1,140,274 (-) 1,949,856 The asset under development relates to the implementation of an ICT system to support the establishment of the Decision Support Service by the MHC.

The funding and the associated expenditure for the system has been drawn down from the income provided under note 10 above.

Development costs of the asset are capitalised as they are incurred.
Depreciation of the asset will not commence until the asset is in use.

30 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 13.

Receivables and Prepayments Prepayments Receivables 2021 € 529,891 - 529,891 2020 € 480,188 2,243 482,431 The fair value of debtors and prepayments approximate to their carrying amounts.

All debtors are due within one year.

Debtors are shown net of impairment in respect of doubtful debts.

14.
14.

Payables and Accruals Creditors PAYE/PRSI Accruals Withholding tax Other creditors VAT 2021 € 116,998 202,512 1,774,185 165,189 2,053 3,611 2,264,548 2020 € 83,733 223,217 815,801 182,269 181 988 1,306,189 Tax and social insurance are subject to the terms of the relevant legislation.

Interest accrues on late payment.

No interest was due at the financial year end.

The terms of accruals are based on the underlying contracts.
Other amounts included within creditors not covered by specific note disclosures are unsecured, interest free and repayable on demand.

31 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 15.
Capital Account As at 1st January Funds allocated to acquire fixed assets Funds allocated to development of assets Amount amortised in line with asset depreciation Amount released on disposal of assets 2021 € 2020 € 1,015,374 178,176 111,325 1,140,274 (95,280) (299) 117,167 809,582 (89,551) - Amount released from / (to) statement of income and expenditure 1,156,020 837,198 As at 31st December 2,171,394 1,015,374 In accordance with accounting policy, Government grants are recognised based on actual receipts.
The element of these grants which are for the purchase of tangible assets and to development of assets are recognised over the useful life of the assets.

There are no unfulfilled conditions or contingencies attaching to these grants.

16.

Operating Lease The Mental Health Commission has commitments in respect of a lease on office accommodation at Waterloo Exchange, Waterloo Road.

This lease is held by the Office of Public Works for a period of 25 years which commenced in 1997 and will expire in May 2022.
The annual rent payable is €636,300 and annual service charges payable are €109,197.

Lease Commitments Commitments in respect of this lease including service charges are as follows: Under 1 year Between 2 – 5 years Over 5 years As at 31 December 2021 € 263,466 - - As at 31 December 2020 € 751,289 263,466 - 263,466 1,014,755 During 2021, the OPW charged a full year of the service charges at €113,723 (2020: €114,989).
32 MENTAL HEALTH COMMISSION Notes to the financial statements For the year ended 31 December 2021 17.

Related Party Disclosures Key management personnel in the Mental Health Commission consist of the Chief Executive, senior management and members of the Commission.

Total compensation paid to key management personnel, including commission members’ fees and expenses and total CE remuneration, amounted to €1,027,695 (2020: €948,589).
The Commission has adopted procedures in accordance with the guidelines issued by the Department of Public Expenditure and Reform in relation to the disclosure of interests by Commission Members and these procedures have been adhered to in the year.

There were no transactions in the year in relation to the Commission’s activities in which a Commission Member had any beneficial interest.

18.
18.

Capital Commitments During 2020, the Commission entered a contract with a third party to provide a computerised ICT system to support the establishment of the Decision Support Service within the Commission.

The total fixed price of the contract is €3,630,960 inclusive of VAT.

At the 31 December 2021 €1,949,856 has been paid.

The remaining expenditure will be expended in 2022.

19.

Contingent Liabilities The Commission is involved in a number of legal cases at the financial year end.
The Commission is unable to reliably estimate the potential financial impact of these cases.

20.

Approval of financial statements The financial statements were approved by the Commission at its meeting on 27th June 2022.

33