Westmead Hospital emergency department will get a new unit for patients presenting with acute behavioural disturbances following advocacy by the NSWNMA.
The state government has agreed to fund an Acute Behavioural Disturbance Unit (ABDU) in the emergency department of Westmead Hospital to improve staff and patient safety and clinical outcomes.
This follows almost two years of sustained action by NSWNMA Health and Safety Representatives (HSRs) in the workplace and advocacy by Cumberland Hospital branch officials to government.
Construction of the multimillion-dollar fit-out is due to begin in August, with the ABDU expected to open in January 2027.
NSWNMA worked closely with Western Sydney Local Health District on the design of the unit, which will receive patients with complex needs related to mental health, substance abuse and intellectual disability.
Cumberland – the state’s biggest mental health facility – and nearby Westmead tertiary hospital have historically operated as separate facilities but are moving toward closer integration under the broader Westmead Health Precinct redevelopment, scheduled for completion in 2027.
Cumberland branch secretary and HSR Fran Cavallaro said that before the government committed to the ABDU, Cumberland mental health nurses were allocated to a mental health assessment area in Westmead ED.
No consultation at first
“That area was established rapidly, without consultation, in a space not fit for purpose,” she said.
“Cumberland branch consistently raised serious safety concerns from 2022 but these did not lead to meaningful improvements.
“In 2024, our concerns were reinforced when a patient stabbed a security guard and injured nurses after cornering staff in a corridor.”
Fran, a workplace health and safety representative, issued three provisional improvement notices under the Work Health and Safety Act six days after the incident, that required improvements to safety systems and facilities to prevent violence in the ED.
Branch executive members and NSWNMA officials subsequently met several times with Minister for Mental Health Rose Jackson to voice member’s need for urgent safety improvements.
“The Minister was very supportive and took the time to listen carefully to the issues being presented,” Fran said.
“As a result, she visited Westmead ED to see first-hand the safety concerns that the branch had been highlighting.”
These discussions led to the establishment of a Safety Improvement reference group chaired by NSW Health Secretary Susan Pearce with representatives from Western Sydney Local Health District, NSWNMA and Cumberland branch HSRs and officials.
The group included a work health and safety officer from the Association, who supported Fran and other branch representatives through the consultation and planning process.
HSRs improved collaboration
Fran said collaboration with WSLHD and NSW Health Officials improved as the project progressed and a shared view emerged that the ED would significantly benefit from the new unit.
“We conducted site visits to Nepean and Prince of Wales hospitals before determining that the Nepean model was best suited to managing our patient cohort,” she said.
“The ABDU is designed for patients presenting in acute behavioural crisis – including those who are highly agitated, distressed or affected by drugs or alcohol.
“They require close monitoring and de-escalation before clinicians can safely assess and determine the most appropriate care pathway.
“The ABDU is intended to provide dignified care while improving safety for staff, patients and visitors.
“Clinical Nurse Consultants and Nurse Practitioners have been identified as critical to the success of the unit. It is expected that these experienced nurses will bring backgrounds in emergency, mental health, or drug and alcohol nursing.
“The ABDU project would not have been possible without the strong support and collaboration of the ED medical and nursing staff.”
Underlying causes
Fran, who has worked in mental health for 38 years, said that while the ABDU is a significant step forward, it is not a stand-alone solution.
“An ABDU plays an important role in managing immediate risk, but it does not address the underlying causes of increasing aggression in emergency departments,” she said.
“Aggression in emergency settings has been linked to systemic pressures, including long wait times and overcrowding, limited access to inpatient mental health beds, and gaps in community-based services and early intervention.
“Mental health services have been in crisis for years.
“Population numbers have exploded in parts of western Sydney over the last 10 years, but our bed numbers have declined.”