Mental health needs are being overlooked

Nursing staff are refusing to move into CUH’s new acute mental health unit as its agenda is being driven by politics and economics, not patient need, writes Des McSweeney

The only reason I exist today is because the public health care system in Ireland saved my life from cancer when I was young.

In retrospect, I believe it was the main motivation behind my decision to train as a mental health nurse — I wanted to pay back a debt by helping others in their personal battles to achieve health and recovery in their lives.

However, a situation has unfolded in my workplace that weighs heavily on my conscience and that of my nursing colleagues. Our refusal to move from the GF acute mental health unit in Cork University Hospital (CUH) to a new unit on the campus means we are inadvertently preventing the construction of a desperately needed new oncology unit. The space GF currently occupies has been earmarked for the development of this unit.

GF is an acute admissions unit that caters for people with acute mental health problems at a time of crisis in their lives. However, it no longer meets the requirements of a modern acute unit.

It was expected that the new unit would do so, with its two acute wards (male/female) and a high observation ward on the ground floor and a specialist over-65s ward on the first floor. The HSE flagged that they intended to open the unit last January.

So why aren’t we, as a group of mental health nurses, moving to the new completed unit? Our argument is that it is not clinically fit for purpose and will ultimately endanger the lives of people using the service. For over a year, I have been part of a negotiation team that has tried to engage with management on issues that remain a concern to staff.

There are three core issues, one of which is the introduction of healthcare assistants (HCA) as an alternative to mental health nurses. It is proposed to introduce five HCAs initially, with “more to follow”.

However, the reality is that while HCAs provide a very valuable service in the right environment, where their skills and knowledge can be fully utilised to provide best care, they cannot be regarded as an alternative to mental health nurses, who have a very different skillset.

Secondly, there is an issue with spreading management responsibilities over two floors. Both of the acute wards on the ground floor have their own delegated ward-based nursing manager who co-ordinates the team of nurses. However, HSE management expects that one of these ward managers will simultaneously manage the specialist over-65 ward upstairs.

In our view, this dilutes the service available to the over-65s and is discriminatory. Every person using the service has rights and is entitled to the same degree of service, so why are the elderly expected to share a manager with patients on a separate floor? We are completely perplexed.

Thirdly, the unit was to include a high observation ward, but that has been put on hold because of inadequate staffing. This ward was to care for people in a severe crisis, namely people that are suicidal who cannot be cared for in the acute ward due to the high level of risk they present to themselves or others.

When I questioned at a meeting why the plan for a high-obs ward was not being implemented, I was informed that the decision was taken at a higher level due to budget constraints. The high observation ward was designed as a key component of the new unit to keep people safe by providing extra care and attention to their needs, which would hopefully facilitate their recovery.

It is my contention that the agenda behind the new unit is driven by politics and economics, not people’s mental health needs. HSE management has continually refused requests to have the clinical issues reviewed by a third party with the expertise and knowledge required. Our concern is that the new unit will be used as a benchmarking tool for other units that are in the process of being built or opening around the country and that, as a result, similar concerns will arise and we will be left with unsafe clinical environments nationally.

It seems to me that the needs of the people who use the service I work in are being overlooked, and this evokes bad memories of failures in the mental health services, which have led to people being neglected, abused and denied the opportunity to live a full life.

When I reflect on the last 10 years in GF, I have fond memories of the people who used the service and recovered, but I also remember those who didn’t.

Some shared with me their dreams, hopes and fears; they mattered to me and they also mattered to others in their lives.

It is concern for the wellbeing of the people I look after that motivated me to write this, in the hope that I will not be a witness to another disaster that will cost someone their mother, their father, their brother, their sister, their child.

• Des McSweeney is a mental health nurse GF, Cork University Hospital.