As patients approach the psychiatry unit at University Hospital Waterford, the ceiling gets lower and the room gets tighter.
“It is daunting when you walk in,” psychiatric nurse Leish Caulfield explains. “It’s a slope and you know you’re on ground zero. You can touch the ceiling, it’s that low.”
A new entrance to the unit will be available through the newly built Dunmore wing but, for now, the staff make do with surroundings which frighten some patients. “We have heard patients say, ‘I’m not going in here’ when they’re coming in. It’s not an easy place.”
The unit was at the centre of public controversy on Friday as pictures emerged of patients sleeping on the floor surrounded by screens as overcrowding problems continue.
Chief officer for HSE South East Community Healthcare Kate Killeen-White said it acknowledged the situation “is not ideal and is not acceptable, and for that I wish to apologise sincerely to any patient or family member, or indeed any staff member at the department of psychiatry in Waterford who is impacted”.
There were currently 47 patients at the 44-bed unit, an indication of how “demand often exceeds supply”, she added.
“We are required to deliver services and manage in those circumstances and I have to acknowledge that the staff in Waterford do that and do it exceptionally well and at all times try to maintain the privacy and dignity and safety and well being of patients.”
Last weekend four staff were assaulted at the unit by patients. Each took place during the day time and the hospital panic button was used on each occasion.
Ms Caulfield said “last year I was assaulted just as I was going to stop one patient. I got a kick as a patient was going at another with a two litre bottle of juice... “I couldn’t count the number of times I’ve been assaulted over the years.”
Ms Caulfield said one reason for the assaults was the overcrowding within the unit. “It’s hit a new level,” she said.
Last July, the unit was overcrowded 22 days out of 31. Across last weekend the total number of patients admitted to the unit did not drop below 50.
“Our members believe the overcrowding leads to the increased instances of assault,” said Ms Caulfield who is the Psychiatric Nursing Association’s (PNA) branch chair in Waterford.
“As a union we went into industrial action 22 month ago on the issue of overcrowding. We thought it would have resolved issues but we hit an all-time high last weekend.
“There are no beds, no personal space, no personal dignity really. It increases the volatility within the unit.
“Patients are left with a choice of either come into us or go home, and sometimes home isn’t safe so they come into us, in a place in deplorable conditions.
“We show them to where to sleep and it might only be two chairs pushed together or a duvet for the floor. That’s their bed a it’s embarrassing.”
According to PNA general secretary Peter Hughes, a recently published report by the Mental Health Commission “lifted the lid” on the problems in the unit. The report had strong criticism for many aspects of the unit, from beds to its hygiene.
Ms Caulfield said that while staff were hurt by the report, they also feel that the conditions they have tolerated have become “normalised”.
Staff recruitment has become a major problem, and there have been retirements and resignations over working conditions.
Within the Waterford mental health service, across the department of psychiatry, the daycare centres and community mental health nurses, there are now around 47 to 50 vacancies. With around 110 currently working in the service, it means the service is lacking almost a third of its desired staff.
“That has a huge impact on operating our community service,” Ms Caulfield said.
“It’s like we’ve been left behind. There’s no vision for Waterford.”
In a statement, the HSE said: “We acknowledge that there can, at times, be instances of overcapacity in the Department of Psychiatry and we apologise to any patient affected by these issues.
“This was particularly the case over the last week where the unit had to deal with an unusually high number of involuntary referrals.”
According to figures recorded by the PNA, recent months have seen the department over subscribed for more than 20 days each month.
“Psychiatric departments are obliged to admit such patients in the interests of their own safety, notwithstanding capacity to do so,” continued the HSE statement.
“Where overcapacity does occur additional measures, including increased staffing and alternative external placement, are applied. We have deployed these measures to the fullest extent possible in recent days.”
However, said Ms Caulfield, Friday saw staff unable to begin work for up to half an hour as staff had to be redeployed from other areas.
“They are stripping one area in the community resources to redeploy to the acute unit and then putting pressure on the community resources. It’s robbing Peter to pay Paul.”
On Friday morning there were three patients who went without beds in the unit.
Regarding assaults on staff, the HSE said the number “experienced in Waterford are in line with what might be expected in a psychiatric unit of this size”.
The executive also said that funding has been approved to develop a 24/7 day hospital which will be located at the Brook House Day Centre in Waterford City. Recruitment for these posts has commenced and the service will start once the recruitment process has been finalised, according to the HSE.
It added that it has a crisis house among its community resources located in New Ross.
