Drugs, violence are rife in psychiatric prison hospital. Staff cuts will make it far worse

Victoria’s only mental health hospital for prisoners is slashing key specialist roles that care for some of the state’s highest-risk psychiatric patients, at the same time concerns grow over the danger of drug abuse within its wards.

Doctors and drug specialists are being culled from Thomas Embling Hospital even as the state government adds dozens of beds to the Fairfield facility, which already has staffing “challenges” that can’t cope with demand.

Forensicare, which runs the hospital for mentally ill patients in the criminal justice system, has blamed the Victorian budget for its redundancies.

Despite proposing to cut a drug specialist nurse position, Forensicare has privately conceded illicit drugs were circulating within the facility.

“We have confirmed today that illicit substances are present on campus,” a Forensicare manager told staff on September 19 in an email obtained by The Age.

Security measures were immediately ramped up “to manage the associated risks and ensure the safety of all staff, patients and visitors” before being reviewed. Those immediate measures included extra security checks, drug screening and room inspections.

The Age has also learned that illicit drugs were known to be on campus in July when an acute male patient in the hospital’s A Block set fire to his room while under the influence of illicit substances.

One patient went missing for two days this week while on day release. 7 News reported that the patient, who cannot be named for legal reasons, was caught by two members of the public on Tuesday.

Yet staff will be stretched further after a series of cuts. In internal correspondence, Forensicare blamed the Victorian budget for making four registrars redundant.

That email, sent last Thursday and obtained by The Age, said the job losses were “significantly impacting our staffing capacity” and that these “challenges” were further compounded by delays to two other registrars starting work.

Forensicare also foreshadowed axing five other specialists in its change impact statement – an alcohol and other drugs nurse practitioner, an autism spectrum nurse, primary care nurse, lead speech pathologist, and a senior occupational therapist – and suggested scaling back the hospital’s use of external drug and alcohol specialists.

A Forensicare spokesperson said it was consulting its workforce on the changes and was proposing to “refine the leadership structure of Thomas Embling Hospital”.

They refused to detail its drug-testing program or the number of patients breaching conditions of their day release, citing the risk of compromising security protocols.

“We have robust processes in place to mitigate the risk of contraband entering the hospital and are constantly monitoring our practices,” the spokesperson said.

Staff have described, anonymously to protect their employment, drug abuse being a recurrent issue both on site and for patients allowed to leave on day release.

“Patients have attacked staff ... completely beaten up because patients came back on hard drugs,” one Thomas Embling staff member said.

“We also have patients who have no leave who are testing positive for ice. It’s in the hospital.”

The number of occupational violence claims accepted by WorkCover for Forensicare staff has almost doubled in three years, with almost 2 per cent of employees injured each year.

The severity of injuries has also increased, with those requiring staff to have time off work almost tripling since 2021-2022.

Forensicare is well short of meeting its benchmarks because of staff shortages. According to its most recent annual report, only 12 per cent of male security patients were admitted to Thomas Embling within seven days – well below the 80 per cent target. Fewer than a third of male security patients were discharged from Thomas Embling to a correctional facility within 21 days, also well below the 80 per cent benchmark.

There is an average wait time of 371 days for patients on a custodial supervision order to gain a bed at Thomas Embling. These patients, who have been ordered by courts to be supervised in Thomas Embling after being deemed either permanently unfit to plead or not guilty because of mental impairment, are kept in prison until a bed opens up at the hospital.

While jobs have been cut, the government is expanding the site to add 82 beds to fulfil a key recommendation of the Royal Commission into Victoria’s Mental Health System.

Health and Community Services Union secretary Paul Healey said cutting critical roles jeopardised the quality and continuity of care for some of Victoria’s most vulnerable patients.

“Slashing specialist roles while pushing staff into high-risk environments like Thomas Embling Hospital is reckless and dangerous. Safe care is impossible without a safe workforce, and right now, safety is being sacrificed for savings,” Healey said.

Australian Medical Association Victoria president Dr Simon Judkins said Thomas Embling staff were already overstretched and that would-be patients were inappropriately languishing in prisons.

Judkins said it was a vital facility, and by cutting its resources, “you’re just going to have prisons filled up with people who don’t need to be there, but they haven’t got anywhere else to go”.

The royal commission said people in the criminal justice system often did not get the support they needed, and prisons had become the mental health provider of last resort.

Health services across Victoria are having to find efficiencies.

A government spokeswoman said the Department of Health worked with providers to ensure changes were in line with policies and prioritised frontline services.

“Any proposed workforce changes at Forensicare must not compromise clinical care, staff safety or the delivery of essential forensic mental health services.”

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