Nurses working in Canberra's Dhulwa Mental Health unit say violent incidents have escalated so much over the past six months, a "catastrophic event" is imminent.
The mental health unit in Symonston, in Canberra's south-east, can house up to 25 adult patients in need of both acute mental health treatment and secure surroundings.
The $43 million facility opened in 2016, with a focus on rehabilitation for patients who have come into contact with the criminal justice system, with 24-hour clinical support and security.
But those who work within the facility have reported an increase in physical assaults by patients across a six-month period to February, and say the work environment is untenable.
"Nurses don't feel safe at all going to work," a Dhulwa nurse, who agreed to speak to the ABC on condition of anonymity, said.
"It's palpable on the ward that something is going on, something is going to happen.
"The thing that most concerns me is my colleagues' mental health."
The secretary of the ACT's Australian Nursery and Midwifery Federation (ANMF) branch, Matthew Daniel, said nurses were reporting "significant injuries, including a broken arm, broken nose and broken fingers".
"Nurses working at Dhulwa Mental Health Unit reported over 100 physical assaults by patients over a six-month period to February," Mr Daniel said.
"The ANMF is equally concerned about the level of distress, with Dhulwa nurses recently telling the government about the detrimental effects that working at the facility is having on their mental health and their relationships with family.
"The situation at Dhulwa represents a particularly serious example of the government's failure to respond where there is an imminent risk of a catastrophic event."
Broken bones, significant distress
Executive director of Nursing Midwifery at Canberra Health Services (CHS) Karen Grace said the increase in assaults was "very concerning" but puts the figure lower than 100, at 83.
"We've seen certainly in the last month or so, an escalation of incidents," Ms Grace said.
"Our figure over the six months from September is 83, and that's taken from the staff-reported incidents system."
But the Dhulwa nurse said that management had tried to minimise the increase in violence with some incidents not being recorded by senior staff.
They also said nurses felt they could not take any of their concerns to management.
"You just wouldn't have a job," the nurse said.
Mr Daniel said the nurses were "fed up".
"Dhulwa nurses report being directed not to disengage or withdraw from unsafe situations involving violent and aggressive patients, and [given] instructions to allowing patients to vandalise public property," he said.
"The culture at Dhulwa, which pits patient rights against the rights of nurses to work in a safe environment, is completely rotten.
"Most worryingly, the government appears to be blaming nurses for the level of occupational violence at Dhulwa."
Staff sent to 'understand the increase in incidents'
Ms Grace said CHS were unsure why there has been an escalation in physical assaults at Dhulwa, and that every situation is "complex and different".
"What we need to do in this environment is to work really hard with nursing teams to ensure that they're really well trained and supported so that when these incidents kick-off, they're able to deal with individual triggers, and behaviours and hopefully prevent escalation in behaviour," she said.
Ms Grace said finding the right balance between staff safety and patient support was delicate.
"What we understand in the mental health space is that we're constantly striving to achieve a balance between the safety of our staff and the wellbeing of our consumers, and it's our daily challenge, given the nature of the work that we do," she said.
"Certainly, whenever there is an escalation such as we've witnessed over the past month or so, we take that very seriously."
Ms Grace said that once CHS noticed the increase in incidents, they sent more staff to the unit to assess the situation.
"We … spent time in the unit, meeting with the staff, spent time on the floor with the consumers to understand what was driving the increase in the incidents," she said.
But Mr Daniel said staff turnover was "high" at Dhulwa, and that the senior staff brought in to address problems had not stayed.
Indeed, despite a deep feeling of responsibility for the patients at Dhulwa, the nurse the ABC spoke with said they too were looking for other jobs, adding: "This isn't why I became a nurse."
Union calls for an urgent inquiry
The average stay time at Dhulwa is estimated to be two years, with a focus on rehabilitation.
"It's a really important part of the spectrum of mental health services in the ACT, particularly in the space between justice and corrections," then-Mental Health and Corrections Minister Shane Rattenbury said at the time of Dhulwa's opening.
"We need a secure facility for people with acute mental health problems that really shouldn't be at the jail, but do need to be in a secure environment."
But nurse safety concerns have plagued the facility almost since its inception.
In 2018, several nurses reported being punched in the face and kicked in the head during multiple assaults by a patient, which ACT Policing investigated.
In one attack, a nurse who spoke to the ABC claimed help did not come for more than a minute.
"In evidence provided to the ACT Legislative Assembly Standing Committee on Health and Community Wellbeing on February 21, 2022, the government demonstrated a poor understanding of the safety systems and policies purportedly in place to keep nurses safe at Dhulwa, adding to the ANMF's call for an urgent inquiry into the operation of the facility."
Minister for Mental Health Emma Davidson said the government recognised the particular strain on mental health nurses, and said she was committed to listening to their experiences.
"Nurses have a really really hard job, especially mental health nurses, there's a lot of complexity in the work that they're doing," she said.
"This is why I invited a group of nurses from that workplace into the office about a week ago … so that I could hear directly from them what their experience has been like in that workplace, and to understand what it feels like when they're going to work every day."
Ms Grace said CHS had also "already undertaken several external reviews" of the situation at Dhulwa.
"There's a lot of external oversight of the facility. We operate under two pieces of legislation ... and we've also had reviews initiated over time, as happens in mental health facilities quite regularly," she said.
"We can always do more, but I am absolutely confident that we are committed and taking proactive action to seek to improve the situation, and we have actually seen a reduction in incidents over the past two weeks."
