This patient lives in seclusion, while completed hospital expansion sits empty

One of Victoria’s most violent, mentally unwell women is living shackled and in solitary confinement despite a safer and more humane forensic hospital unit sitting ready, waiting on government directions to open.

The County Court on Thursday heard harrowing details of the woman’s seclusion and the ongoing attempts to safely reintroduce her into the presence of others so that she can recover, which is in part hampered by conditions in Thomas Embling Hospital in Melbourne’s inner north.

The Victorian government is spending $515.7 million expanding the Fairfield hospital – run by Forensicare for mentally unwell people in the criminal justice system – to progress a key recommendation of the Royal Commission into Victoria’s Mental Health System.

But despite the inclusion of a secure specialist space for the woman in that expanded site, the County Court heard the government had not provided operational funding nor given certainty on when and how the extra beds can be filled.

Judge Nola Karapanagiotidis has been monitoring the woman’s custody conditions since 2022 and increased efforts to transition her out of seclusion.

The court on Thursday heard her reintegration remained a challenge, particularly in her existing unit.

Forensicare executive director of clinical services Tobias Mackinnon told the court the Thomas Embling expansion reached “practical completion” in early September.

“That’s when the building is deemed to have been completed by the builders and the responsibility for the building is handed over to the owner,” he said.

“We don’t have any clear indication when the funding to operate the hospital will be delivered.”

Thomas Embling, which already struggles with staff shortages, has blamed the Victorian budget for recent redundancies, with further jobs proposed to go.

Mackinnon told the court the expansion included a specialised unit that would allow the woman to have greater independence and better address her needs, as well dedicated spaces to separate high, medium and low-security patients.

The woman was found not guilty on the grounds of mental impairment of two assault charges in 2015, which each carried a maximum penalty of five years in prison.

In the decade since, she has lived in almost total solitary confinement in the hospital, prompting Karapanagiotidis to label her case an “emergency” earlier this year.

Under her “deseclusion” plan, Thomas Embling has created a safe room away from other patients where the woman can progressively spend more time, though she must be accompanied by staff and have her ankles and her wrists shackled.

The safe space has access to a three-metre by 10-metre courtyard which allows partial views of the sky, but is surrounded by walls with no view of nature or the outside world.

After starting with two-minute periods out of seclusion, the woman has progressed to spending up to 25 minutes in the safe space a handful of times a day, though the court heard her recent sessions had been cut short due to aggression.

The woman has dancing therapy once a week and music therapy once a fortnight, alone. During those sessions, her ankle restraints are removed to allow her to dance, however her wrist restraints are kept on.

She appeared in court by video link on Thursday with her wrists shackled to her waist, despite being alone in a locked room at Thomas Embling, prompting Karapanagiotidis to halt proceedings and ask the hospital to investigate why restraints were necessary.

When the hearing resumed an hour later, the woman was unshackled. A Forensicare psychiatrist told the court the safety measure was required to allow the woman to pass through a corridor to access the interview room.

The doctor said that restraints had been used whenever the woman was out of her seclusion room since May, during which time the number of aggressive incidents against staff had dropped from an average of 12 a month to 5.3.

“The risk is always there when [the woman] is around other people,” the psychiatrist said.

“The restraints don’t stop the aggression, but they decrease the opportunity and they decrease the serious consequences.

“Without them there, the consequences are too high with the team getting injured, burning out, and we would not be able to continue.”

The court heard that in April the woman punched two staff members in the head after a communication error meant they entered a corridor while she was present, while other attacks led to staff requiring surgery or time off work.

The royal commission recommended eliminating the use of seclusion and restraint by 2029.

While Forensicare fails to meet its targets to reduce its reliance on seclusion and restraint, its annual report said the Department of Health had accepted this “due to its unique issues”.

The woman’s treating psychiatrist told the court she was yet to tour the Thomas Embling expansion to determine how it would affect her care, and that she remained optimistic progress may be made toward reintegrating her into a unit with other patients before the move.

Karapanagiotidis decided to continue the woman’s custodial supervision order, with another major review hearing scheduled for March 2026 to assess her progress.

The woman told the hearing she was happy with that outcome. “Everything you said is perfect,” she said.

The main works of the Thomas Embling Hospital expansion were originally supposed to be finished by 2024. Asked by The Age whether the expansion was completed, and when operational funding would be provided to open, a Victorian government spokeswoman insisted construction was continuing.

She said minor defects needed to be fixed, the construction perimeter needed to be removed and a multi-deck carpark built.

“The Department of Health is continuing to work closely with Forensicare to plan for the next phase of the project, including the operationalisation,” the spokeswoman said in a statement.

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