A damning report into governance and policies at Canberra's secure mental health unit has listed assaults on staff and confusion about the facility's purpose among a number of issues that need urgent action.
Located in Symonston, in Canberra's south-east, the Dhulwa Mental Health Unit can house up to 25 adult patients in need of both acute mental health treatment and secure surroundings.
But in May this year, the ACT government launched an independent inquiry into the facility after nurses working at the unit reported more than 100 physical assaults by patients over a six-month period.
The final report, tabled in the ACT Legislative Assembly today, noted there were "consistently raised themes" among its findings, including "unsupportive leadership; poorly managed change; fractured workforce relationships; poor communication and a lack of transparency; and workforce cliques".
Confusion rife about unit's purpose
Key among the 25 recommendations, was the need to clarify the "model of care" at the facility and that its primary purpose "was the provision of forensic mental health services".
The facility was declared a secure mental health unit and began receiving patients in 2016.
According to the unit's model of care at the time, there was no requirement that a patient at Dhulwa be the subject of a mental health order issued by the courts, and some people were admitted on a voluntary basis as it was not a corrections facility.
But the inquiry report found the model of care appeared to be non-compliant with the Mental Health Act and created "confusion about the purpose of the unit".
"The lack of clarity regarding the services Dhulwa offers and to whom, and how care is to be delivered, creates uncertainty about therapeutic and recovery-oriented practice,” the report noted.
"This is being expressed in restrictive intervention practices, extended length of stay and discharge challenges, consumer frustration, and workforce confusion and frustration."
Report finds 'restrictive' rules partly stoking aggression
The report also stated there was a lack of a framework or model for understanding inpatient aggression at the facility.
The report found, as a result, any aggression was attributed to the patient themselves, "with little regard of other contributing contextual factors, such as overly restrictive unit rules, authoritarian limit-setting styles, and limited treatments for violence reduction".
The inquiry found there was an extremely high use of security cameras at the facility and clinical staff were "overly reliant on the intervention of security staff in managing consumers".
"An examination of the Dhulwa staff incident reports indicates that security staff were frequently involved in use of force incidents involving consumers, and that in 2019 and 2020 security staff involved in restraint and seclusion incidents experienced more serious injuries than clinical staff involved in the same incidents," the report said.
"The workforce culture at Dhulwa is fractured and there appears to be no common goal for delivering quality patient care."
Another recommendation of the inquiry was that the unit work towards improved information for patients about their ability to undertake activities outside the confines of the secure facility.
"On the evidence gathered by the inquiry, the matter of the granting and cancellation of leave for consumers has been a direct cause of some consumer aggression," the report noted.
"The cancellation of leave for punitive purposes is counter-intuitive in circumstances where cancellation is likely to increase feelings of frustration and aggression in an affected consumer."
Government promises 'honest conversation'
Mental Health Minister Emma Davidson said work was already underway to implement improvements at Dhulwa.
"This is a really hard report to read," she said.
"But that's why it's so important that we take the time to read this and understand the recommendations that are being made in this report.
"It's really important that we have a really honest conversation about any problems that have occurred and any lessons that we've learned along the way and have a really good conversation — a really constructive conversation – about what the solutions might be."
The final report had been due 18 weeks after the launch of the inquiry, but it was not made public until it was tabled by Chief Minister Andrew Barr in the Legislative Assembly today.
Ms Davidson denied the government had dragged its feet on releasing it.
"Because this independently chaired inquiry was being run under the Inquiries Act – that's run through the Chief Minister's office," Ms Davidson said.
"The report is being tabled in accordance with the Inquiries Act.
"We have, in fact, been listening to staff and taking action since these [assaults] started to be reported."
Ms Davidson said the government would release its formal response to the report in the first half of next year.
Despite the grim picture of the facility painted by the inquiry's report, Australian Nursing and Midwifery Federation ACT Secretary Matthew Daniel said he was optimistic that Dhulwa could be turned around.
"For a long time, our members have been saying they don't know what the model of care is," Mr Daniel said.
"Staffing remains difficult – we're still seeing unregulated workforce still filling the gap where registered nurses aren't available – that's a problem.
"That's a bit of a stop-gap measure and we need to make sure full staffing is maintained at all times.
"We believe that with the report, and certainly the time frame for implementation for change, all those issues that we see at the moment can still be addressed."
