Enhanced dialogue and co-operation between management and staff is bringing improvements to a violence-plagued mental health service.

The NSWNMA’s Illawarra Shoalhaven mental health branch says a joint management–union approach is bringing about a safer workplace and better staff representation in the district’s mental health service.

A combined committee of NSWNMA and Illawarra Shoalhaven Local Health District represent-atives has overseen the introduction of capital improvements, better equipment and more training this year.

In 2019, after several serious assaults by patients on other patients and staff, SafeWork NSW found the LHD had breached the Work Health and Safety Act and issued it with an improvement notice.

SafeWork said staff were “at risk of psychological injury” due to the way misconduct allegations were handled, which included “potentially intimidating correspondence” sent to workers.

SafeWork directed the LHD to develop, “in consultation with workers, a system to control the risk of psychological injury arising from the process of investigating allegations of misconduct.”

Also in 2019, the NSWNMA launched its own health and safety inspection of the service’s Eloura East Acute unit, Eloura West high Dependency Unit and Mirrabook Acute Unit.

The inspection found the LHD had failed to take reasonable steps to protect nurses from exposure to violence from patients and management bullying.

Sixty-two per cent of members in the service said they had been bullied at work in the previous 12 months, mostly by “management or a supervisor”.

NSWNMA assistant general secretary, Judith Kiejda, said the inspection found “multiple safety issues that put nurses at significant risk of serious injury”.

Physical environment not fit for purpose

The inspection report said the physical environment of all three units was not fit for purpose, with poor lines of sight and an inability to separate patients.

CCTV cameras were inadequate, units lacked spaces for de-escalation and separation, windows were made of breakable glass and back-up power supplies were insufficient.

Nurses worked in isolation yet there was a shortage of personal duress alarms.

Regarding patient care, there was a shortage of doctors, poor medical management and a lack of continuity of care.

Understaffing was rife and low rates of anti-violence training were “extremely concerning”.

Management had failed to address serious issues raised by nurses through consultative mechanisms, including assaults on staff resulting in injury, sexual harassment of female staff, high levels of fatigue and low morale.

In a letter to The Illawarra Mercury newspaper titled “Help”, published in November 2019, staff members said “urgent action is critical to instil professional management, systems and procedures” in the mental health service.

The Mercury reported there had been at least six serious assaults on staff by patients between December 2018 and November 2019.

In November, NSWNMA general secretary, Brett Holmes, told ABC News the lack of trained staff was deeply concerning.

“If they can’t recruit sufficient staff then they need to manage the level of service that they can provide otherwise they’re putting the lives of patients and their staff at risk,” Brett said.

He said a shortage of staff was very dangerous for a facility with such a history of violent incidents.

“There need to be adequate numbers of staff to intervene in critical situations and that’s a minimum of six people needed to restrain some-one who’s physically violent towards themselves or others.”

Brett said a shortage of trained staff gave rise to a high risk of nurses of being involved in a potentially violent incident and then being accused of not practising properly.

“Then staff get investigated, and suspended during that investigation, which only adds to the staffing issues.”

Catalyst for change

During 2020, there has been “a marked shift in management’s attitude and the issues are being taken seriously and being addressed,” said Chris Scott, a delegate of the NSWNMA’s Illawarra Shoalhaven mental health branch.Chris told The Lamp the union health and safety inspection was “a catalyst for significant change”.

Management agreed to close several beds, which was “a relief to staff on workload and safety grounds”, he said.“Previous workloads were unrealistic and unsuited to caring for people with challenging presentations.

“The LHD has committed to working through matters with the union including regular joint meetings to implement improvements.

“An external HR organisation was brought in to review the culture of the mental health service. That allowed staff to express their concerns without fear of repercussions.

“The union and mental health executive are implementing changes which are leading to a safer workplace.”

This year has seen improvements to patient access to medical care and staff access to, and sight of areas within units.

CCTV coverage and lighting has improved and faulty duress alarms have been replaced.

Violence prevention training has significantly improved and patients have more therapy activities and more and safer exercise equipment.

Units have been supplied with new weighted chairs and tables that cannot be thrown as weapons.

There is also more support for nurse unit managers.