Unit bosses fail to put mind over matter

If there was one over-riding message that HSE honchos wanted media to take from a tour of the new acute psychiatric unit at Cork University Hospital on January 20, it was that all was well.

Unit bosses fail to put mind over matter

As someone with no background in psychiatric nursing, I was inclined to agree. The unit was bright, airy, spacious. It housed seven landscaped interior gardens and had a “wander loop” for elderly patients with dementia to allow them to wander in safety.

HSE staff who took part in the tour reassured us that it was “fantastic” compared to the hospital’s existing psychiatric unit, known, uninspiringly, as “GF”. Mental Health Minister Kathleen Lynch enthused that the unit was “not just a different world, it’s a different universe”.

Evidence of the parallel universe in which the HSE appears to operate, where good news is rarer than hens’ teeth, has since emerged. On the very day the media was being courted to devote column inches in praise of the unit, unions representing staff expected to work there were sitting down at a conciliation conference under the auspices of the Labour Relations Commission (LRC) in an effort to get workers to agree to the cross-campus transfer that the new unit will entail.

The roof garden of the South Lee Mental Health Unit, CUH, Cork, which was designed

to provide a calm space for retreat and reflection. Picture: Jim Coughlan

While there is nothing unusual about resistance among staff in any organisation to changes to their work environment — and overcoming it often involves protracted talks — there was no mention of any industrial unrest on the day of the media tour, even from key nursing staff involved in the project.

There was no suggestion that a significant agenda remained to be resolved, chiefly staffing numbers.

The media was told the new unit would boast 56 whole-time-equivalent staff, 10 more than GF, and four additional beds and that it would open “in the next 10 days” — it remains closed.

What the HSE did not mention was that it had proposed 66 additional staff just last September, but that this figure was reduced by 10 in December. These revised staffing levels, the HSE said, were reflective of a revised service delivery model, because plans for a six-bed high observation unit would not now go ahead.

Staffing numbers had been reduced accordingly.

Neither the Psychiatric Nurses Association (PNA) nor Siptu, which represent GF staff, accepts this argument. As PNA general secretary Des Kavanagh points out, the overall number of beds in the €15m unit has not reduced — the figure remains at 50, and nurses will still be expected to care for the same number of patients, with or without “high-obs”. While the tag “high obs” has been removed, the six beds remain in situ.

An adult bedroom at the South Lee Mental Health Unit at CUH, which mental health

experts said was not set up to operate safely. Picture: Dan Linehan

The unions’ staffing concerns are shared by Professor of Psychiatry at University College Cork Ted Dinan who, while appreciative of the aesthetics of the new building, is extremely annoyed by its location and by HSE failure to take on board the unions’ claim that they need more staff.

“If they had asked anyone who knew anything about psychiatry about the new unit, they’d have said ‘nice design, but you will require more staff’. If management are surprised by this, then I am shocked,” he said.

Prof Dinan said he was “absolutely behind the nurses” in this regard, that the new unit with “all its nooks and crannies and space” would make it very difficult to nurse. “Anyone that asks can the new unit be run by the same number of nursing staff [as GF], the answer is an unequivocal ‘no’ if you want to run it safely,” Prof Dinan said.

He is also incensed by the new unit’s stand-alone status on campus, about a 100m-walk from the main hospital door.

Whereas the acute GF unit is integrated in the main body of the general hospital, allowing psychiatric patients to enter through CUH’s main door — thereby not signposting their psychiatric status — anyone entering the new unit can clearly be seen.

“We are going to be the loony bin at the side of the main hospital,” Prof Dinan said. “It’s going to be obvious to everyone that if you walk in there, you have mental health issues. Why should psychiatric patients not be entitled to walk in the main door the same as everyone else? It’s the only unit in the entire hospital that is not integrated.”

He said making the unit standalone ran contrary to Government policy, which favoured locating acute psychiatric units in general hospitals.

Rather than remove the stigma of mental health which Gretta Crowley, HSE operations manager for mental health services in Cork and Kerry, said was part of the reason for making it standalone — “It’s out on the campus, not trying to hide, as has been the case with mental health. We are focused on getting rid of the stigma,” she said — Prof Dinan said it would reinforce it. He described Ms Crowley’s claim as “the most naive, senseless statement I have ever heard”, that people with mental health issues had “been stigmatised from the beginning of time” and that the location of the new unit was “nothing but a recipe for stigmatisation”.

The location has raised other concerns. The unions are seeking clarification as to how patients admitted via the emergency department, especially at night, are to be transferred to the unit which, unlike GF, will no longer be down the corridor.

They want assurances that nurses on the unit will not be required to leave to assist such transfers, with 72% of assisted admissions occurring between 5pm and 9am. They want clarification on access to the hospital ‘Crash Team’ and on how they can continue the practice of accessing X-rays and other tests for patients in the new unit during quiet periods, often at night when such patients can be brought up the corridor from GF.

The unions also want clarity around availability of security staff to respond to panic alarms in the event of challenging behaviour.

Between September 2012 and May 2014, there were such 649 incidents. Security staff themselves have spoken of problems responding to the new unit, some distance from the main hospital.

The decision to locate the new unit out of the main hospital was politically motivated, said Prof Dinan. He claims the cancer department wanted the GF space.

As regards the physical structure of the new unit, Prof Dinan concedes it has “very good aspects and is a nice environment” but again, there are concerns.

Chief among them is a lack of clarity around how it is proposed to evacuate first-floor patients in the event of fire. The first floor eight-bed unit is designed for elderly patients with dementia.

There are lifts, unusable in a fire, and a staircase. The unions are also concerned about the distance between the activities area on the first floor and the office, as well as the placement of work stations — which patients can walk behind, presenting, the unions say, the threat of attempted strangling of staff, as has happened in the past.

Many of these concerns were raised as far back as August 2013. Failure to address them led to an emergency meeting of the LRC in Dublin on January 16, which was adjourned, then reconvened in Cork on January 20, the same day the media was being told the unit would open “in the next 10 days”.

Those talks broke down and HSE management made a complaint to the Haddington Road oversight body, which said the two parties should re-engage around clinical and health and safety issues and progress industrial relations issues through normal IR channels. The two parties are scheduled to meet again tomorrow under the auspices of the LRC.

In the meantime, the unit has passed muster with the Mental Health Commission — a site visit by the commission was also carried out on January 20 — and was registered on February 4.

As an approved centre, it will be subject to annual MHC inspections starting this year.

The inspections will shed light on how successfully the unit is functioning in the years ahead.

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