NSWNMA members have won staffing and other improvements at a violence-plagued mental health centre in Newcastle.

The Waratah mental health centre’s NSWNMA branch has achieved the employment of an additional nurse on every shift in the Older Persons’ Mental Health Unit (MHUOP).

The additional nurses are rostered for a six-bed locked area within the 22-bed unit.

The unit houses elderly men diagnosed with Tier 7 BPSD (behavioural psychological symptoms of dementia) – the highest level of dementia-related behavioural problems.

Aggression in BPSD patients can be triggered by a wide range of circumstances such as fatigue, an over-stimulating environment, too many strangers, failure at simple tasks and being asked too many questions at one time.

The Waratah centre also contains a psychiatric emergency care centre (PECC), an 8-bed intensive care unit (MHICU) and two 21-bed acute wards.

Branch secretary Michelle Birkett said the Waratah centre had experienced an upsurge in patient violence since November 2019.

This included 11 serious assaults in the PECC and MHICU over 15 days in August.

Michelle said staff had suffered severe psychological and physical injuries and five experienced nurses had left the centre due to violence this year.

“One staff member has had five assaults so far this year; he is often the only male on shift and is the designated code black responder.  Another senior nurse lost teeth after being kicked in the face.

“Staff are getting injured but not recording it because they don’t want to go on restricted duties, which would put an even greater burden on their colleagues.

“Personally I’ve never felt so unsafe. I’ve had chairs cracked over my head. I say goodbye to my family every day and hope I come home in one piece.”

More staff makes a safer environment

The introduction of an additional nurse led to a dramatic fall in the number of code blacks.

However, management was now talking about reducing staffing in the MHUOP six-bed area because of the recent reduction in code blacks, Michelle said.

“They don’t seem to realise that code blacks have dropped because having extra staff has raised the level of care and safety of patients.”

This was reinforced by NSWNMA General Secretary Brett Holmes in a letter to David McLeod, Director of Mental Health Nursing in the Hunter New England Local Health District.

Brett said the increased staffing levels were the minimum required to ensure the safety of staff and patients.

“Given the frequency and severity of assaults against staff under staffing levels prior to 21 August 2020 the Association believes that the current staffing levels should remain on an ongoing basis,” he said.

The branch has also won a cap of five people in the PECC waiting room which is staffed by two nurses.

Safety inspection strengthened case

Michelle said the small area was previously packed with up to 15 people waiting for care.

She said a NSWNMA health and safety inspection of the PECC and MHUOP strengthened the branch’s case for staffing and design improvements.

Management agreed to negotiate the redesign of a small antiquated bathroom used to shower and toilet pat-ients who can be both aggressive and incontinent.

Management also agreed to support the election of work-place health and safety representatives (HSRs) and the formation of a Union Specific Consultative Committee to negotiate further improvements.

And the Waratah centre’s NSWNMA branch has grown stronger by recruiting more members.

However, access to security staff remains a problem for the centre.

The centre is attached to the Calvary Mater Hospital under a decade-old public private partnership and shares three security staff with the hospital.

“This so-called partnership is a root cause of many of our problems,” Michelle said.

“The security guards do the best they can to look after us but they have to cover the whole hospital and can take several minutes to arrive in response to a code black.

“This has caused unnecessary injuries to our nursing staff. We are trained in de-escalation and humane restraint but most of us don’t have the physical strength needed to restrain our patients.

“Management say we don’t need our own security but they are not on the floor dealing with this stuff.”

Morisset closure adds to pressure

The state government’s closure of Morisset Hospital’s Ibis Lodge Unit in 2019 put more pressure on the Waratah centre.

The Ibis unit cared for patients with severe behavioural and psychological symptoms of dementia.

In October 2019, Hunter New England LHD acknowledged that Ibis staff had provided “wonderful care” to patients but said the model of care was “no longer considered contemporary” and the building was old and hard to maintain.

Ibis unit patients would therefore be sent to the “more homely environment” of a nursing home.

But Hammond Care in Cardiff refused to accept them when it realised the difficulty of managing their behaviour.

“The Ibis patients were sent to us because they had nowhere else to go,” Michelle Birkett said.