"Care and safety concerns."

I was recently an inpatient in Tobernaveen upper in Hollywell Hospital Antrim.  It saddens me to write this because I've previously had 2 inpatient stays there where the care was excellent but in my most recent stay the care was practically non existent, the atmosphere has changed, staff morale seemed very low, and honestly its not appropriate for any mental health patients at the moment. 

I was transferred from Ross Thompson Unit to Tobernaveen Upper near the end of my stay as an inpatient for an eating disorder (Anorexia Nervosa). I noticed immediately that my bed was not a profiling bed an honestly I was very sore for the entirety of my stay.  This was raised multiple times with the nursing staff  by me and with the ward manager via my community ED team.  I couldn't sleep, and every morning my hips were red an sore from lying on the hard mattress. Given my low BMI, this is quite frankly unacceptable. The ward manager never once came to ask me if there was anything else we could do to make things more comfortable despite promising to do so with the ED team.  

I was to follow a very strict meal plan and to limit my exercise, and staff should have been supporting me with this.  However nobody seemed to have read my meal plan ( it took a week to print out my latest dietician approved one and put it in the kitchen). There seemed to be a real lack of training in regards to Eating disorder patients (on one day a staff member was trying to offer me cake that they'd brought in, on another day a nurse walked into the room whilst I was doing a wall sit, said they were just doing the checks, and walked out not even commenting on my exercise.

At lunch and dinner I'd regularly have huge portions dumped on my plate, eg I was to have one slice of ham at lunch, but they'd dump all the ham that came up (like 6 slices) on my plate, which caused me unnecessary anxiety. I was aware of another patient who was taking meal shakes but regularly dumping them in the bins. I'd pace round the dining room unchallenged and I'd scrape dinner portions into the food waste, with no one supporting me to finish. This was a stark contrast to the structured and supportive approach I had previously experienced in Upper.

A significant issue seemed to be staffing pressures, often with nobody available on the floor.  What struck me most this time, is that the nursing staff seemed to be spending all their time cleaning, feeding and changing dementia patients. Often when I went looking for someone to speak to, there'd be nobody on the desk or anyone free. For two days I had no idea who my named nurse was as it was never written on the board, and as for the daily chats that they're meant to do, these were pretty much non existent. I felt like I was being left to look after myself, whilst the nursing staff are run ragged dealing with personal care of dementia patients. The ward to me seemed understaffed at all times, and honestly staff morale seemed very low. I want to be absolutely clear that the nurses are doing their upmost to care for everyone, but they do not have sufficient numbers, time or the support to do so.

There were a number of safety concerns that I had whilst in Tobernaveen Upper.  Firstly the canteen to me seemed under supervised at times.  Given the nature of many of the patients in there, I was surprised that at times there was no one watching over the room, whilst patients finished their meals.  

I regularly witnessed patients going behind the nurses desk and letting themselves out to smoke, often because the desk was empty, but on occasion they'd do it unchallenged with staff in the office watching. I also regularly witnessed a patient sitting in the nurses office, or lying on the nurses station.  I'll admit this was a challenging patient but surely they should not be permitted into the nurses office on to lie across the nurses desk.  It could be intimidating for other service users, and I'm sure also to some of the nursing staff. There were a number of environment  checks whilst I was there, but honestly these just seemed like a tick box exercise without anyone really checking patient cupboards or around the beds. It would be incredibly easy to hide dangerous items.  As an example I had a long lead charger in my cupboard for about a week which went unnoticed.. I was in for 2 weeks but there wasn't one patient feedback meeting whilst I was there.  These used to be a weekly occurrence. 

I was advised to use AI as a form of support by the psychiatrist. The psychiatrist did know that I'm pretty capable using AI, given my day job, but this is not an appropriate or safe recommendation given the vulnerable nature of patients.  My eating disorder therapist was not informed of, or invited to, my discharge meeting, despite their key role in my care.

I would like to finish on a positive note. 

There are some absolute gems working in Upper. One nurse in particular was an exceptional mental health nurse who makes time for every patient, they were kind, listened empathetically, gently challenges you, is vigilant with safety, and quite frankly should be running the place. Another one of the staff members is also fantastic, lovely to chat too, caring ,empathetic, and really tries to make time for everyone.  I've experienced some of the other staff during previous admission and they were exceptional but it is evident that current working conditions are placing staff under significant strain, which risks impacting both patient safety and staff wellbeing.

Overall, I feel that improvements are urgently needed to ensure safe, consistent, and therapeutic care is delivered..