Mom: Give my daughter help

From the August 30th edition of the Halifax Chronicle Herald:

Official admits mental health facility may need more staff

By JOHN GILLIS Health Reporter

Sheila Morrison’s daughter has been confined in a psychiatric hospital room with only a mattress since Sunday.

She says her 33-year-old daughter would not be there now and may not have had the outburst that led to her isolation if there were enough staff members to deliver the kind of care she needs.

Her daughter attacked a nurse on Saturday after days of mounting agitation.

Ms. Morrison, who didn’t want to give her daughter’s name, hasn’t been able to speak to her daughter at the Abbie J. Lane Memorial Building of the Queen Elizabeth II Health Sciences Centre since then.

She said nurses have told her her daughter could rejoin other patients if there were more staff.

"The only reason she’s in there right now is that they don’t have enough staff to deal with her," she said.

But Ms. Morrison said the violent outburst might have been avoided altogether if nurses weren’t so overburdened.

Her daughter was first admitted from the emergency department to an acute-care unit on the seventh floor on May 11.

After about a month she was well enough to move to the sixth-floor community-focused living unit with a rehabilitation and recreation therapy program geared to getting people ready to move back into the community.

But recently, acutely ill patients are being admitted to the sixth floor, leaving the staff unable to focus on rehab, she said.

"They’re spending their days doing Band-Aid treatment, trying to get people stable," Ms. Morrison said.

The result is that staff may not notice when a patient like her daughter is growing agitated over a period of days.

"What is noticed is when she finally blows up and has an outburst and sometimes becomes aggressive and injures nurses," Ms. Morrison said.

At least five nurses have been injured by patients in distress since July, prompting the Nova Scotia Government and General Employees Union to call for solutions to the overcrowding and lack of security.

Prior to her recent outburst, her daughter had been growing more paranoid for two or three days.

There are clear signs, from her language to her breathing, that show she’s agitated and most often it can be managed before it progresses, Ms. Morrison said.

Instead, nurses are forced to call security codes when they feel they’re in danger, she said.

And although staff and security are specially trained to restrain agitated patients without injuring them, her daughter has been left with bruises all over her body when she’s been brought to the floor with her arms behind her back.

"The nurses would rather the patients be properly assessed and monitored and treated, but to do that they have to have more resources and more staffing," Ms. Morrison said.

Ms. Morrison learned Wednesday afternoon her daughter would be transferred to an acute-care room in the Nova Scotia Hospital when one becomes available.

Peter Croxall, director of Capital district health authority’s mental health program, praised Ms. Morrison’s advocacy for her daughter and other people with mental illness and agreed the facilities at the Abbie J. Lane are inadequate for modern mental health care.

He said there are regularly 26 or 27 patients on the 25-bed seventh floor and most tend to be very sick at admission.

"If somebody’s thinking is disordered and they come on that unit, it’s almost bound to make it worse," Mr. Croxall said.

"It’s not nicely designed; it doesn’t have nice colours; it doesn’t have a calm, home-like environment."

During the day, there are usually five registered nurses and three licensed practical nurses on that unit, plus occupational and recreational therapists and a social worker.

At night, there may be as few as three nursing staff, though the charge nurse is able to call on extra staff as needed.

Mr. Croxall said the small night staff wouldn’t be problematic if seriously ill and stable patients weren’t mixed together.

He said a proper psychiatric in-patient unit should have an intensive-care unit where the most critically ill could be cared for in private rooms away from other patients until they stabilize.

At present, the therapeutic quiet rooms are serving that purpose.

Mental health managers have met with staff several times in recent weeks.

They’ve instituted new criteria for admission, though Mr. Croxall noted patients needing emergency care must be admitted somewhere.

He said they’re also looking at changing staffing levels in the units.

"It’s often very difficult to get an extra staff person on short notice," he said. "We just don’t have a big enough pool of part-time or casual staff."

A longer-term solution being discussed is to expand the role of licensed practical nurses so they could shoulder more of the case load.

Photograph of Sheila Morrison in front of the Abbie J. Lane Memorial Building is by Darren Pittman.

For a related story published in the August 30th edition of the Halifax Daily News, click here.