Patients at the Dhulwa Mental Health Unit are out of control, and staff are leaving, claiming the medium security facility is the worst they have worked at, according to the Australian Nursing and Midwifery Federation (ANMF) ACT Branch, which called yesterday for an urgent inquiry following an alleged 100 assaults over the past six months.
Matthew Daniel, the ANMF ACT branch secretary, blamed a “rotten” work culture, and claimed that Canberra Health Services management scapegoated, rather than supported, nurses, while the ACT Government failed to act.
“The government seems content to stand by while poor governance, confused patient management, inconsistent and opaque systems of work, appalling HR practices, and toxic relationships have created an environment where occupational violence has become business as usual at Dhulwa,” Mr Daniel said.
CHS, however, claimed most of the 83 (not 100) incidents happened within the last month, and that the executive responded immediately, increasing resourcing for the unit and rostering senior mental health clinicians to support staff.
“We’re doing absolutely everything we can to mitigate the likelihood of a recurrence,” said Karen Grace, CHS executive director of nursing and midwifery.
But according to Mr Daniel, management blamed nurses for the level of occupational violence at Dhulwa. ANMF members reported they were too scared to intervene when a patient’s behaviour escalated because management could take HR action against them.
“They feel paralysed … because they’ve seen some heavy-handed and unjust HR practices,” he said.
Despite CHS claims to the contrary, Mr Daniel said, members reported CCTV (which records video but not audio) was used to reprimand nurses for their claimed failures, “to haul nurses over the coals, and they’re absolutely sick of it”.
“Apparently, the Star Chamber that looks at these incidents makes decisions about the level of care that nurses have provided without the full picture; in some cases, our members say they have very little input into these assessments and review of these incidents.”
(A report on an investigation into a recent assault provided evidence of scapegoating by CHS, Mr Daniel said; specific details would too easily identify the victim.)
Policies and procedures were not consistent with evidence-based practice, he said. Management changed care plans without consulting nurses, and nurses said their efforts to create a consistent and effective therapeutic environment were actively undermined. Management directed nurses not to withdraw from unsafe situations involving violent or aggressive patients, but encouraged them to let patients vandalise public property.
“The picture painted by our members is a facility where patients in some cases are completely out of control,” Mr Daniel said.
Patient rights trumped work health safety legislation, he said; the facility focused on minimising risk to patients, but did not understand how to manage occupational risk according to the WHS legislation.
“Government don’t seem to get the issues,” Mr Daniel said. “They seem to be doing some sort of balancing act between human rights and worker safety legislation – when clearly, work health safety legislation is the primary concern of the government as an employer.”
Jennifer Harland, a CHS interim executive director, said: “In a scenario where it is safer to allow a patient to engage in behaviour that may cause damage to property than to intervene, this would be the most appropriate course of action. Staff are trained to respond to incidents as a team, and to regain safe control of the environment as swiftly as possible after an incident.
“This is modelled by senior, experienced staff on a daily basis. Behaviour Support Plans carefully articulate appropriate responses for staff to manage incidents safely. This includes using an appropriate number of staff to attend, so reducing the risk of harm to all staff. Consideration must be given to the impact of overstimulation for complex consumers in the mental health setting which can trigger unnecessary distress or escalate the situation.”
Mr Daniel claimed that Dhulwa did not meet staffing requirements: registered and enrolled nurses were substituted with workers who did not have the necessary education and training. Emma Davidson, ACT Minister for Mental Health, said she was unaware of any untrained staff being on shift.
Although Dhulwa was designed to be a low to medium security facility for people involved (or likely to become involved) with the criminal justice system, Mr Daniel said it admits high security patients, or patients requiring more restrictive practices to maintain safety.
“Patients are admitted to the facility that shouldn’t be there,” he said. “That’s the government’s own admission to us on several occasions.
“They say they don’t know where else to put them,” Mr Daniel told CW. “How on earth are [nurses] they expected to provide the right level of care for patients who actually shouldn’t be there?”
According to Mr Daniel, there was talk in the past that some patients might be transferred to NSW facilities – but NSW would not entertain that option.
“Our nurses are wearing the outcome of the failure of the government to provide the right health facility for these patients,” he said.
Ms Davidson said Dhulwa was a forensic mental health facility: “They deal with a diverse range of different conditions there, some of which require greater levels of security than others.”
But, Mr Daniel said, ANMF members were advised by email last week that Dhulwa was not a forensic mental health facility.
According to CHS, positions at Dhulwa are highly sought after, and staff turnover is only around 10 per cent; in the last year, seven out of 70 staff have left the facility.
But according to Mr Daniel, not a single person was left from when the facility opened in 2016; senior staff brought in to address problems left after they were assaulted themselves; and most nurses recruited from overseas and other states had left, claiming Dhulwa was the worst facility they had worked in.
“They say they’ve never worked in any facility in any other state of Australia that compares with how bad it is here in the ACT,” Mr Daniel said.
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