Coronavirus: The forgotten patients

Despite endless promises, there’s little sign of a new psychiatric hospital

By Gina Agapiou

Nurses at Cyprus’ sole state psychiatric hospital say they are near ‘burnout’ as they struggle to deal with overcrowded, crumbling facilities which lack crucial staff and prevent them from providing patients with quality health care, all exacerbated by the coronavirus pandemic.

Over a year ago in February 2020, the Sunday Mail described appalling conditions at Athalassa’s decades-old psychiatric hospital which in recent years has been operating without key professionals such as a social worker, a pharmacist and a general practitioner.

A year later, nothing has changed those who work there say, expressing concerns that fresh announcements this week pledging the construction of new facilities in Nicosia and Limassol constitute just more broken promises.

The poor conditions at the only reference hospital for involuntary admissions have exacerbated during the pandemic with nurses claiming they cannot cope.

“We are exhausted, we are a step away from occupational burnout,” a nurse at Athalassa and a representative of Pasyno union, Dometios Skouropatis, told the Sunday Mail.

Other nurses said they feel ‘defeated and frustrated’. They say that many ended up doing double shifts during the pandemic or coming in on their day off.

A scheduled House health committee meeting this week, meant to discuss issues concerning the mental health services, was virtually pointless. Health Minister Constantinos Ioannou promised to participate, but instead had to receive his coronavirus vaccine at the time, while state health services organisation Okypy had different obligations.

“In a sense we didn’t have a discussion, and nothing happened,” Skouropatis, who participated in the committee meeting, told the Sunday Mail.

Saying she feels defeated, Georgia Michael, another mental health nurse of Pasyno union believes that “nothing will change” anytime soon.

“I think it is time to proceed to actions and resolve the issues instead of discussions and promises,” Skouropatis added.

Athalassa treats about 130 patients daily while the actual capacity of the six wards of the hospital amounts to 101, according to a recent report by the nursing service administration.

Prior to the committee, Okypy announced that works are on the cards for the construction of new facilities in Nicosia and Limassol to replace the 57-year-old building.

But promises for the construction of new buildings have been heard over the last two decades and never materialised.

The president of the state nurses’ union Pasydy Andreas Andreou told the health committee that “despite commitments of the ministers of health and transport to start planning for the construction of the new wards since last November, the so-called ‘master plan’ has not yet started.”

“Covid has aggravated our long-standing problems coupled with increased admissions, and having to abide by all the health protocols,” head of the health ministry’s Mental Health Services Anna Paradisioti told the Sunday Mail.

In an attempt to manage increased demand, following the pandemic outbreak which led many former patients back for additional treatment, the hospital was forced to once again raise the number of beds per room, pushing patients and staff ever closer together.

“It is not a solution to add extra beds in a room, in the end we do not offer the appropriate care to our patients,” Skouroupatis said.

And patients themselves are not blind to these issues as the Sunday Mail has been informed nurses often receive complaints over mouldy walls and broken toilets.

“We understand that the building is not appropriate, and this is why we included the construction of new facilities in this year’s budget. Our goal is to upgrade the [mental health] services,” the spokesman for the State Health Services (Okypy) Charalambos Charilaou told the Sunday Mail.

Limassol general hospital’s psychiatric unit is expected to get an additional eight beds for inpatient compulsory treatment by the end of the month. This will facilitate patients from different districts who must currently be treated in the capital far away from their families, Paradisioti explained.

Okypy also expects the department of public works to announce the bidding for the first phase of the new hospital in Nicosia “which involves two new wards [of 20 beds] for acute cases and a new ward for the treatment of people addicted to alcohol and legal substances”, Charilaou added.

The approved 2021 budget for the next three years includes the Nicosia-based construction amounting to €9 million, while the total cost of the hospital reaches €40 million. To cover the amount, Okypy is seeking funding from European programmes according to a health ministry official, but this leaves the deadline of its construction still unknown.

But Athalassa’s problems go way beyond its crumbling facilities. Coronavirus-related problems hit it hard, and underlying all that is the lack of coordination and help from other state services.

Some 91 patients and staff members tested positive for coronavirus during an infection outbreak at the hospital earlier this year which included 42 psychiatric patients, most of them from the male ward. One male patient with underlying health conditions died with Covid while being treated at the hospital.

A portion of the staff have blamed the incident to “bad management” arguing the board operates blindly.

In order to establish a functional coronavirus protocol, the hospital’s infection committee relocated certain wards and altered its guidelines 14 times over the last twelve months until a suitable room was assigned to isolate possible asymptomatic coronavirus cases.

“We don’t have proper management, the people in charge just gossip and take arbitrary decisions,” claimed an Athalassa nurse.

“A huge crack appeared on a column near the canteen where we used to carry out rapid tests. It has been a month and they did not bring anyone to fix it,” another mental health nurse Georgia Michael of Pasyno said.

Last November, the hospital was accused of locking a mentally ill woman in a closed room meant for temporarily monitoring aggressive patients after she contracted the coronavirus. The room did not have an operational shower or toilet and the patient was forced to use a commode wheelchair with a plastic bag during the four days she was left there.

Incidents of patients escaping the hospital and causing public damage have also been recorded in recent months.

Apart from people with mental illnesses, the hospital also treats people with special needs and illegal drug users that the court has ruled for mandatory treatment. In addition, about 20 chronic patients occupy beds permanently.

“We must treat whoever is referred to us,” explained the hospital’s chief quality officer Dr Anestis Vasiliou of Pasydy trade union.

Michael, in charge of the female ward, believes that approximately “30 per cent of patients are those with special needs and drug users” while four out of the six beds belong to chronic patients who are there for years, even decades.

“I have a patient who entered the hospital when she was 20 and now she is 65. She never left,” the nurse said, explaining the patient has both mental issues and special needs. “I also have another one whom I received when she was still underaged and now is 39 years old.”

“There is no other place for them,” she added, highlighting the great need for new infrastructure to accommodate those patients.

Paradisioti said attempts to rehabilitate those patients have failed so far as some are dangerous. She added that a possible place was found for the ones who are not a danger to themselves or others, however it needs modifications and approval by the relevant services which might not take place this year.

She said that the hospital has also requested from Okypy to hire a pharmacist, a general practitioner and a social worker as those positions have remained unfilled in recent years.

“It is unacceptable not to have a social worker,” Michael said.

A double murder in Ergates earlier this year made this crucial missing link between the social welfare and mental health services tragically clear.

A 59-year-old man who was arrested for stabbing his wife and son to death in February was later revealed to have killed his 11-year-old niece when he was 15. The suspect had spent nine years in the psychiatric hospital. However, after the double murder, the social welfare services said they had never received any report that he might pose a danger.

The department added that “matters of mental health are not within the remit of the social welfare services.”

According to Paradisioti the social welfare department has refused to assign a social worker at Athalassa for the last three years claiming understaffing. “Unfortunately, our numerous requests reached a dead end and the lack of social worker creates many issues with the rehabilitation of patients back into society.”

At times nurses might take on the responsibilities of social workers by helping patients apply for benefits and assisting the family.

“But what if I have a patient who is being beaten up at home and doesn’t tell me? How am I going to find out?” said Michael.

Since, Okypy took charge of Athalassa three more psychiatrists have been hired, raising their number to seven from four, Charilaou said.

But like social workers, the position of a general practitioner has also remained vacant since the implementation of Gesy forcing staff to accompany patients to Nicosia general hospital for any minor incidents.

“Psychiatric drugs cause many pathological problems which must be monitored by a GP,” the chief quality officer said.

The recently created quality office of the hospital, run by nurses, took the initiative to transform an old storage room into a pharmacy and bring medicines in the hospital. Based on the relevant legislation, however, all hospitals must have their own pharmacy and the board requested Okypy to hire a pharmacist.

In response to the unfilled positions, Okypy’s Charilaou said they had issued multiple announcements but “there was no interest”.

In the light of that, crumbling bricks and mortar may prove to be the least of Athalassa hospital’s problems.