albury wodonga health

Cameras are essential in a high-risk mental health unit, nurses say.

Nurses are resisting an attempt to remove security cameras from a high dependency mental health unit (HDU) on the Albury Wodonga Health campus.

Nurses say the cameras at Nolan House HDU are an essential safety measure.

The unit was upgraded with state of the art CCTV to eliminate blind spots, after a critical incident resulted in a ‘root cause analysis’ (RCA) and coroner’s recommendations in 2014.

Albury Wodonga Health campus is on the border of NSW and Victoria. Nurses are employed by NSW Health and seconded to Victorian health authorities who manage the campus.

Nolan House is a 24-bed acute unit including a seclusion room and the three-bed HDU, with bedrooms, lounge and a courtyard. As a non- gazetted unit the HDU receives lower funding and staffing numbers.

The HDU was shut down in July 2017 and reconfigured to make it more secure after nurses refused on safety grounds to be permanently stationed inside the unit (see The Lamp November 2017).

During renovations, Victoria’s chief mental health nurse Anna Love visited the unit and said CCTV did not have a role in Victorian or NSW mental health services.

She said cameras would be removed in the interests of “patient privacy and therapeutic engagement”. Ms. Love reassured nursing staff that workplace health and safety education would be provided as a matter of priority.

CCTV ensures safety

Branch secretary Gillian Rhodes said CCTV allows one staff member to see patients and other staff in all parts of the HDU other than bathrooms at all times – not only at the 15-minute intervals required under NSW Health engagement and observation policy.

“CCTV allows staff to monitor, evaluate, and provide escalation or de-escalation and early intervention,” she said.

“This ensures the safety of patients and staff and is also a great comfort to patients’ families.

“It does not replace the required physical, therapeutic engagement with staff members every 15 minutes.

“Since the introduction of CCTV our unit has had a low incidence of self-harm, disinhibited sexual behaviour, assaults and reportable incidents – and there have been no more RCAs or critical incidents.”

Gillian said branch members believe 15-minute visual observations are “inadequate to maintain the safety of our highest-risk and most vulnerable patients.”

“Members strongly believe that therapeutic relationships are not impaired by the use of CCTV, which has enhanced safety for both staff and patients.

“The CCTV does not record footage as a measure to protect patient confidentiality and privacy.”

Difficult to recruit and retain in rural areas

She said the unit’s location in a rural catchment area created difficulties in recruiting and retaining staff.

“CCTV helps to maintain the safety of patients, staff and visitors when we have such limited staff resources.

“CCTV is increasingly used to improve safety in public places such as squares, airports and shopping centres; it’s just been installed in Albury CBD, for example.

“It is therefore a backward step for CCTV to be excluded from a high-aggression and high-risk work area.”

Gillian said it was unrealistic to expect staff to view every patient every minute.

“However, technology advances such as CCTV have made this possible, making it safer for both patients and staff. Why take away an invaluable tool used to enhance visual observation and safety for both patients and staff?

“Members appreciate previous WHS and violence de-escalation training, but this does not replace the 14 minutes of visual observations, as the nurses can only be in one area at any given time.

“We are expected to accept the most dangerous patients, some of whom have forensic histories and most patients are under the influence of illicit substances.

“In the past staff have accepted this position, but only because of the added security that CCTV provided.

“If asked to do the same job without such security advances and less funding than gazetted mental health units, the members say ‘No’.”

Until recently, Nolan House staff were not permanently stationed inside the HDU because it had only a single entrance/exit door that needed a key to be opened from the inside.

Earlier this year the chief mental health nurse visited the facility and without consultation with nurses, directed that staff should stay inside the HDU at all times. If not, they were to record every episode as a seclusion.

That led to nurses deciding to close beds and refuse to admit patients on safety grounds. The NSWNMA branch passed resolutions criticising the lack of consultation with nurses and attempts to intimidate staff to comply with the directive.

An occupational health and safety review by the NSWNMA resulted in an agreement to reconfigure the HDU to make it safer.