Lim is a highly experienced Registered Nurse working in the Psychiatric Emergency Care Centre (PECC) that is embedded with the Emergency Department at St Vincent’s Hospital, Sydney. PECC commenced operations in November 2005, it is a 6 bed specialist unit which is open 24 hours a day 365 days a year. The Emergency Psychiatry Staff work in unison with the General Emergency team and maintain strong links with Community Mental Health Teams, General Practitioners and Non-Government Agencies to deliver quality, timely and appropriate care for all people who arrive in Emergency with mental health and/ or behavioural problems.
The PECC unit sits on a service continuum that aims to avoid prolonged hospital admission and/ or premature discharge into the community. The focus of its philosophy is to provide a continuing detailed assessment and deliver therapeutic interventions over a 1-2 day period, with the aim of ensuring a rapid return to community or family care with an optimum level of functioning.
As a result of Australia adopting the PECC model, ED’s are experiencing increased presentation by patients with acute mental health and addiction needs. Little is still known about the effectiveness of the care provided or how they work on a day-to-day basis.
In a study conducted by Monash University Centre for Forensic Behavioural Science research fellow Joyce Lee in 2011, findings, which experts describe as “disgusting”, suggest nurses working on hospital psychiatric wards suffer mental illness at a rate eight times that of the general community, and almost double that of police and paramedics.
In a 2013 article for The Australian, Joel Magarey reported that the research found 43 per cent of nurses working in psychiatric wards at three general Melbourne hospitals met criteria indicative of “non-psychotic mental illness”, including 18 per cent with likely post-traumatic stress disorder. The rates were higher than those found in the city’s forensic hospital.
The scale of the distress uncovered — which was linked to patient aggression, the use of coercive practices and work stress has also alarmed the national nursing federation and prompted calls for a national inquiry.
The researchers say the study supports claims of a “cycle” of patient aggression and coercive psychiatric practices, and have backed calls to reduce the use of physical restraint and solitary confinement of patients, known as “seclusion”.
Australian Nursing and Midwifery Federation federal secretary Lee Thomas said the findings were alarming and that such high rates of “workplace related stress can negatively impact on (nurses’) ability to safely care for people with mental ill health”.
Study collaborator and CFBS head James Ogloff said too little attention was paid to “the detrimental effect experiences and work can have on them”. He said the main causes were believed to be high levels of verbal abuse, lower but still “shocking” levels of physical assault and broader work stress on the wards.
Related research had shown between 80 and 90 per cent of staff had reported verbal abuse, an event mental health nurses say happens daily — while 15 to 20 per cent had been physically assaulted.
Professor Ogloff said that despite community misconceptions, mental illness was seldom the sole cause of patient aggression. It was “interrelated” with staff stress and ward practices, including the “compounding” effect of seclusion and restrain. Professor Ogloff stated that part of the cycle occurring on wards involved nurses “switching off to consumer distress, for the purpose of self-protection” following patient aggression or violence, which could in turn contribute to patient demoralisation or frustration.
University of Melbourne professor of youth mental health Pat McGorry said inpatient care was “in a parlous state Australia wide” and called for a national inquiry.
Central Queensland University nursing professor Brenda Happell said staff perceptions of low levels of support exacerbated their stress levels. She said evidence indicated nurses were “negatively affected by involvement in coercive practices, so a vicious cycle can easily develop”.