Worker safety comes first in mental health
Mental health facilities must prioritise employee safety over measures to improve the therapeutic environment for patients, the NSW Industrial Relations Commission has ruled.
Commissioner John Murphy made the ruling when he dismissed an attempt by Sydney Local Health District (SLHD) to overturn a SafeWork NSW prohibition notice.
SafeWork had ordered SLHD not to remove a counter inside the McKay Unit of the Concord Centre for Mental Health, in the absence of consultation.
Management wanted to remove two 1.31-metre-high counters in the Intensive Psychiatric Care Unit (IPCU) and High Dependence Unit (HDU) and replace them with fixed “touch down” desks.
A WorkSafe inspector told the LHD not to remove the IPCU counter because its removal would put staff in greater danger of violence from patients.
Her notice said: “You must ensure that workers are not exposed to occupational violence, so far as is reasonably practicable, by having adequate systems of work including physical protection for workers from aggressive and violent patients that includes drug-affected patients.”
The inspector noted that staff used the counter as:
- A physical barrier to separate them from violent patients
- a space from which they can try to de-escalate a situation
- a means to safely observe what is happening in the ward in the event of an emergency
- a safe space to walk into from the nurses’ station, that permits workers to see the ward and identify risks prior before entering it (staff cannot see all of the ward from the nurses’ station).
According to minutes of a meeting with management to discuss proposed capital works, the “mass majority” of McKay staff protested against the decision to remove the counters, which had “saved their lives during many incidents involving patients”.
Commission rejects LHD’s appeal
Commissioner Murphy noted that an NSWNMA workplace health and safety officer also raised safety concerns.
The LHD applied to SafeWork for an internal review of the prohibition notice but SafeWork upheld the inspector’s decision.
The LHD then asked the Industrial Relations Commission to authorise an external review of the SafeWork decision.
In rejecting the application for an external review, Commissioner Murphy said SLHD wanted to remove the IPCU counter “to enhance the therapeutic environment for the patients.”
He added: “Whilst this motivation is commendable, it cannot override the obligation that the Workplace Health and Safety Act places on SLHD to ensure, so far as is reasonably practicable, the health and safety of the staff on the unit.”
Commissioner Murphy said subsections 19(1) and 19(2) of the WHS Act “certainly require that the safety of employees be preferred over the desire to enhance the therapeutic environment for the patients”.
He said replacement of the counter with a “touch down” desk of lower height would make it easier for patients to get over or around and behind the desk and attack staff.
Also, removal of the counter would “deprive staff, on exiting the nurses’ station, of the ability to look out and observe what is happening in the unit from a relatively safe position before proceeding further”.
Commissioner Murphy said the LHD did not assess the risk of removing the counters until after SafeWork issued the prohibition notice.
Furthermore, the risk assessment team comprised four managers, so it was “unsurprising that the risk assessment, when it was eventually conducted, concluded that the removal of the counter in the IPCU would not pose a safety risk to the staff who worked on that unit.”
Consultation has now occurred. Management and staff are now working together on a safe resolution of the issue.
Commission sets precedent for all mental health units
The Industrial Relations Commission decision on the McKay Unit sets a precedent that nurses aim to have applied at other mental health units.
For instance, nurses at Campbelltown Hospital’s Birunji youth mental health unit have asked management to reverse a decision not to replace a counter that was demolished by an aggressive patient.
NSWNMA delegate for Camp-belltown mental health services, Mark Hardacre, said the counter had been an effective barrier between aggressive patients and staff.
“It gave you an area to retreat to if there was a risk of violence,” he said.
“Now, with the counter gone, you’ve got no defence.
“It’s a safety risk and we want to use the IRC decision relating to the McKay Unit to get it fixed.”
Since the counter was demolished in August, staff have reported several incidents connected to the absence of a counter.
Some incidents have required the use of duress calls. In others, staff have had to remove aggressive patients from the main nurses’ station.
At Concord Hospital, McKay Mental Health Unit nurses say management are more inclusive and transparent in their decision making following the IRC ruling.
Management and staff are working together to come up with a mutually agreeable design for new counters for the Intensive Psychiatric Care Unit and High Dependence Unit.
There have been several meetings involving staff and management-appointed architects.
The meetings have examined 12 designs and chosen a shortlist of four.
A risk assessment of the shortlisted designs is being done by a team comprising an NSWNMA workplace health and safety officer, a health and safety representative in the McKay Unit, a nurse unit manager and representatives of hospital management and allied health staff.
Read the decision
Commissioner Murphy’s decision can be downloaded via: