A former mental health nurse claims difficult patients were put "in the too hard basket" and inappropriately transferred to Dhulwa, Canberra's most restrictive inpatient facility.
The ACT Human Rights Commission has been critical of patients not charged or convicted of crimes (known as non-forensic patients) being transferred to Dhulwa, which was primarily designed to house adults caught up in the criminal justice system.
They have raised concerns about the practice being illegal.
The former nurse, who wished to remain anonymous, worked at the Adult Mental Health Rehabilitation Unit at Canberra Hospital for 15 years. Her employment was terminated in 2021 after disciplinary issues.
She said patients moved from the hospital to Dhulwa were denied the mental health care they desperately needed.
"If a person has a mental illness [Dhulwa] mental health unit is the worst place to be. Patient care is now non-existent," the former nurse said.
"Not long before I left the [unit at Canberra Hospital], I remember seeing the list of patients that were in Dhulwa. I think three of them [out of 10] would have classified as forensic patients, because I've looked after all of them at some stage."
The nurse claimed former patients told her the Alexander Maconochie Centre - Canberra's jail - allowed inmates significantly more freedom than Dhulwa, which a 2021-2022 report by the Human Rights Commission found was the most restrictive mental health unit in Canberra.
It said transferring non-forensic patients to the facility "appears to contravene the spirit and objects of the Mental Health Act, insofar as people with a mental disorder or mental illness should receive assessment and treatment, care or support in a way that is least restrictive or intrusive to them".
A Canberra Health Services spokesperson said Dhulwa was intended to cater not only for forensic patients but also those needing higher level of inpatient care than could be offered in mainstream services.
"While patients being treated at Dhulwa may include people who are currently detained at the Alexander Maconochie Centre or have other involvement with the justice system, this is not and has never been a criteria for admission to receive care," they said.
The high security setting at Dhulwa, in Symonston, is also used to house higher risk patients found to be not guilty of crimes by reason of mental impairment.
The Adult Mental Health Rehabilitation Unit at Canberra Hospital houses inpatients with acute mental health issues requiring high and low levels of care.
Violence 'part of the job'
In September last year a 34-year-old woman died at Dhulwa after being transferred from the mental health unit at Canberra Hospital.
The Canberra Times understands the woman had been transferred from care at the hospital several months before her death. The masthead is not suggesting the woman died as a result of being transferred to Dhulwa.
The former nurse claims prior to being moved to Dhulwa the woman had been an inpatient at the adult mental health facility for four years in total with a brief period out in the community.
The nurse said the woman had an assortment of books, clothes, makeup and other personal items in her room at the hospital, which was unusual but represented the longevity of her stay.
However, she was known to be violent towards staff, punching and pulling out hair.
Canberra Health Services declined to comment on the death, citing patient privacy.
So far this year, 149 incidents of occupational violence were reported at the adult mental health unit at Canberra Hospital. This included verbal abuse and physical violence towards staff, ranging from pushing, spitting and assault.
"I've lost count of the number of times I was assaulted. It was part of the job," the former nurse said.
"I got punches in the back of the head, knocked to the floor, kicked and strangled. God knows how many times. It just happens. Another one was a fella that used me as a punching bag."
Last year a new approach was trialled across four wards at Canberra Hospital and Calvary Public Hospital. The Safewards program aimed to reduce conflict by building positive relationships between patients and staff, and identifying situations likely to lead to violence.
A review of the trial recommended it be expanded across the ACT. While the changes have yet to be implemented in the territory, they have been adopted in NSW and Victoria.
Lack of treatment
The ACT Human Rights Commission's concerns were first raised in the previous year's report. The Canberra Times understands it first became aware of non-forensic patients being transferred to Dhulwa in early 2021.
Issues raised with the commission included concerns admission into Dhulwa was the result of "a lack of appropriate community supports and/or accommodation options".
It also received complaints about staff quality of care and "negative attitudes expressed by staff towards [patients]".
The Official Visitor Scheme, an organisation which provides independent oversight of government institutions, raised "significant concerns" around services at Dhulwa in its 2021-22 annual report.
"There is a distinct lack of any therapeutic model of care and interactions appear limited to observation and supervision and lack empathy, compassion or a person-centred approach," the report said.
The previous year's report noted patient complaints about "staff use of treatment tools as punishments, restrictions of food and internet access, combined with a high turnover of management staff which has created an atmosphere of anger and distrust".
Dhulwa is currently the subject of an ACT government inquiry into legislative clinical and governance policies at the facility after nurses reported more than 100 physical assaults over a six-month period. The findings are expected to be handed down in the coming days.
ACT Council of Social Service chief executive Emma Campbell, in a written submission in August, claimed the inquiry had been framed to suggest the needs and rights of patients and staff were diametrically opposed.
"This adversarial tension has been exacerbated by the short timeframe for making submissions and the lack of dedicated and supported consultation with consumers and carers," she wrote.
"Poor consultation with consumers and carers is symptomatic of a broader and systemic lack of transparency with regard to processes, procedures and policies at Dhulwa and the mental health system in the ACT.
"Consumers, carers and advocates find it extremely difficult to navigate the system, which can add to anxiety and lead to further deterioration of relationships with staff."
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