THE first time I experienced the death of a patient on a ward was as a first-year student nurse. I still remember who that person was. They had been institutionalised in an old mental health hospital for most of their life. I found it particularly upsetting that under this older system of care, they had very limited opportunities for recovery and very little freedom to actually live rather than simply exist.
Thankfully, the model of care has changed a lot since then with a distinct and ongoing move away from institutionalisation. But I do feel that at times this progress is hampered by the economic and political considerations that are brought to bear on our healthcare system. People’s needs are still not being met in our modern mental health system.
For the last eight months there has been a bitter struggle between a small group of nurses and HSE management over the opening of a new acute 50-bed state-of-the-art mental health unit in the grounds of Cork University Hospital (CUH).
There is no disputing that the new unit offers a far more pleasant environment for patients and staff than the rundown GF ward we have now left behind. But I for one still have concerns that the new unit will not be providing an optimal service for patients until such time as the six-bed high-observation unit is open. As a nurse, I consider this to be an integral part of a modern, acute service and delaying its opening because of staffing shortages is simply not good enough.
Our motivation as nurses throughout the last eight months has not been on our own conditions but on making sure we were transferring to a service that would meet people’s needs. This was my motivation for criticising the HSE in the media during the dispute. I felt we needed to get the new service right from the start. My row with management culminated in my being put temporarily off duty with pay but I felt I was justified in speaking up and bound to do so. As well as the temporary shelving of the high-obs ward , we had concerns about the introduction of healthcare assistants to the service and whether they would ultimately be used to bolster nursing numbers. We have been assured that this will not be the case.
These were the kind of issues that had me and my colleagues up in arms. After numerous attempts to resolve the impasse, with proposals from the Labour Relations Commission rejected by members of both Siptu and the Psychiatric Nurses Association, one final engagement in order to find a solution was held between senior HSE management and unions at Portlaoise on June 16. During these discussions an agreement was reached which was accepted by members. Unfortunately, the deal did not include an opening date for the high-obs ward, but there was an undertaking verbally that this was a priority and in line with national policy.
The high-obs ward is viewed as an integral part of the new unit in people’s recovery. It is designed to care for people in a severe mental health crisis, namely for people who are suicidal and who cannot be cared for in the acute wards due to the high level of risk they may present to themselves or to others. That is why it is so essential to the service.
Although we voted in favour of the move to the new unit — we were granted a number of concessions around increased staffing, as well as the regularising of nurses in acting posts and a commitment to make nurses on temporary contracts permanent — we are still unhappy with the failure to open the high obs. The HSE’s track record in this respect is not reassuring. The opening of a new €2m four-bed high-obs unit at Kerry General Hospital has been postponed a number of times.
The history of a six-bed high-obs ward in Galway is even more depressing. It was built eight years ago and has been used largely as an administrative space since then. The HSE finally agreed to open it for the purpose for which it was intended as part of the resolution of a wider dispute signed off on June 3 last. It was a key element of the resolution of that dispute. It has yet to open.
Our new acute mental health unit at CUH opened on Wednesday, August 5. When I arrived on duty that night, I couldn’t help but notice the vacant high-obs area in darkness. I wondered how much longer it would remain this way. Failure to open it is to deny people who need it the intensive care that can help them recover from acute mental illness. When services that are meant to be available are not, then how far can we truly say we have come in giving people the opportunity to recover, and as a result, the freedom to truly live?