DRC OPEN LETTER – RMH ED

  • Open Letter:

    Unethical and Unlawful Use of Restrictive Interventions in The Royal Melbourne Hospital’s Emergecy Department

    Lauren Walsh-Buckley,

    Wurundjeri Country

    • Daniel Andrews, Premier of Victoria
    • Mary-Anne Thomas, Victoria’s Minister for Public Health
    • Gabrielle Williams, Victoria’s Minister for Mental Health
    • Colin Brooks, Victoria’s Minister for Disability, Ageing and Carers  
    • Neil Coventry, Victoria’s Chief Psychiatrist
    • Anna Love, Victoria’s Chief Mental Health Nurse
    • Deborah Glass, The Victorian Ombudsman
    • The Emergency Department Mental Health Clinicians of the Royal Melbourne Hospital
    • Alexandra Smith, Manager of Emergency Mental Health at The Royal Melbourne Hospital
    • Susan Harding, Senior Nurse Unit Manager of The Royal Melbourne Hospital’s Emergency Department

    Dear Premier, Ministers, Public Service Workers, Practitioners and the people of Victoria,

    The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability advised they would publish submissions of people who requested such. To date, there have been no individual submissions published on the DRC site. Consequently, I have elected to publicly share my submission following International Human Rights Week of 2022.

    As a former Lived Experience Peer Worker of The Royal Melbourne Hospital’s Emergency Department located on Wurundjeri Country, I write to express deep horror, dismay and disgust surrounding the discriminatory, traumatising chronic rights and law breaching practices that I have come to learn are so regularly perpetrated by RMH ED Clinicians – violations committed against people experiencing distress, pain, mental health challenges and/or disabled people.

    As a designated Lived Experienced Peer Worker in the Emergency Department who shared time with individuals experiencing distress and mental health challenges, I learned of such breaches whilst with individuals, from individuals as they told me their experiences – “they treat you like animals here” – and through the Department’s documentation and data keeping system – a system that details unlawful means of restraining and detaining individuals in the department.

    The practices I refer to; the grossly bigoted, immoral, and commonly unlawful, sanctioning and utilization of what are known as, restrictive interventions – interventions that restrict the rights or freedom of movement of a person including psychological, chemical, physical and mechanical restraints. The damages to personhood that such interventions cause is why the Victorian Royal Commission’s final report into Victoria’s Mental Health System has called for them to be swiftly reduced, and within the next 10 years, abolished – recommendation 54.

    People experiencing mental health challenges and/or disabled people must be afforded the right to equal recognition as a person before the law and have the right to protection from abuse, degrading treatment and torture. These are rights under both the Mental Health Act 2014 (Vic) and the Charter of Human Rights and Responsibilities Act 2006 (Vic). It is my assertion that numerous Clinical Mental Health Practitioners at The RMH ED have knowingly and routinely disregarded these laws, engaging in highly unethical and unlawful practice – cherry picking who and who is not afforded respect, rights and dignity.

    Psychological restraint can be defined as the use of intimidation, command, threats and emotional pressure to coerce and control a person. In The RMH Emergency Department, this can look like clinicians informing a person experiencing mental health challenges that they are what is known as a ‘voluntary patient’ and can leave the department when they choose, but advising that if they do try to exercise this right, they will be forcibly detained in the ED under ‘duty of care’ – this is a gross misuse of the law.

    Chemical restraint can be defined as the use of medication or chemical substance for the primary purpose of influencing a person’s behaviour. In The RMH Emergency Department, this can look like an individual, unbeknownst to them, having a sedative medication dissolved into their coffee whilst going to the bathroom or being coerced into taking a pill following staff threats of bodily restraints usage, or being pinned down by security staff and injected with a sedative medication after declining to take an oral medication and requesting time to be informed about the medication and why it is considered necessary that they take it i.e. informed valid consent.

    Physical restraint can be defined as the action of physical force to prevent, restrict or subdue movement of a person’s body, or part of their body. In The RMH Emergency Department, this can look like a person in distress being grabbed and dragged by 2-6 conventionally masculine security staff members – use of physical restraint to “remove” someone from the department in this very way is common and unlawful.

    Mechanical restraint can be defined as the application of devices, including belts, harnesses, sheets and straps, to restrict a person’s movement. In the RMH Emergency Department, this can look like shackles tied to a person’s ankles or wrists, often both, which are latched to a bed restricting basic movement for hours on end. Mental Health Law stipulates that people mechanically restrained must be released from these restraints as soon as possible – a rarity in The RMH ED.

    Physical restraint near always precedes use of mechanical restraints and commonly, both physical and mechanical restraints precede enforcement of chemical restraint. Although multiple restraints can be used in one incident against one person, I have observed that it is normal for not all forms of restraints used to be necessarily recorded. Restraints usage to be entirely undocumented is also, not uncommon.

    Whilst use of psychological and chemical restraint are traumatising, counter-therapeutic, unethical, unnecessary and currently inexcusably unregulated, physical restraint and mechanical restraint, known as bodily restraints, must be performed within a legal framework. The use of such force – which is widely regarded as inherently violent and may breach international human rights law (the Convention on the Rights of Persons with Disabilities) – is only permitted use against people in limited circumstances. These circumstances require both the person to be a patient under the Mental Health Act 2014 (Vic) and for the use of these restraints to be ‘a last resort’ following the attempted or considered use of all reasonable and less restrictive options.

    If an individual is not being “treated” under the Act, the use of such force must only be carried out for the sincere and considered belief that it is in the name of prevention of serious imminent harm to the person being restrained, or another person – the harm inflicted must be less than the harm sought to be avoided. This means the use of these bodily restraints in this setting and acute mental health settings alike, must be of absolute and unwavering necessity.

    In the absence of legitimate necessity and the subsequent backing of a legal framework, the use of physical and mechanical restraints is by definition, assault.

    It is my assertion that at The Royal Melbourne Hospital’s Emergency Department, these very assaults and false imprisonments/detainments occur frequently throughout the week. It is my assertion that clinical staff at The Royal Melbourne Hospital infrequently consider and/or attempt less restrictive interventions before issuing use of bodily restraints against people both being treated under the Mental Health Act 2014 (Vic) and individuals not being treated under the Act – otherwise known as voluntary patients. It is my assertion that Senior Mental Health Practitioners in the RMH ED often carry out these acts under a false ‘duty of care’ concept as opposed to a ‘principle of necessity’ (Lamont, Stewart, Chiarella, 2020). It is my assertion that Senior Mental Health Practitioners and management in the Emergency Department have been ongoingly informed that they are misusing the law and are acutely aware that they are practicing unethically and unlawfully (Jonathan Knott et al, 2020) – In fact, this is evidenced in their restrictive interventions documentation system which lists unlawful means of restraining and detaining people – in fact, this is also evidenced by the countless Mental Health incidents of concern previously sent through to emergency department management each fortnight by a designated Mental Health Educator in the Department.

    In the RMH ED, the discriminatory chronic rights and law violations occur in the context of; toxic emergency departmental culture and norms, management’s unwillingness to address cultural and practice issues, senior mental health clinicians intentionally misinforming junior nursing staff on mental health law and consumer rights, staff burnout, staff desensitisation and fear, absence of lived experience workers and educators, absence of on the ground advocates in the Emergency Department and systemwide, lack of internal accountability measures, lack of external oversight and responsive regulation that enforces consequences for unlawful practice and human rights violations.

    Abusive acts that occur in the RMH ED are also rooted in contempt for people living with mental health challenges and/or disabled people.

    In response to learning of unethical and unlawful practice, I expressed concern to senior members of staff in the ED and externally approached individuals and peak bodies with my concerns including The Mental Health Complaints Commissioner (MHCC) and APHRA. As a result of raising concerns and tactfully supporting people to have their rights upheld, I was internally subject to relentless disability discrimination and consumer worker discrimination, intimidation, bullying and harassment from Emergency Mental Health management and staff. Concerted efforts to have me removed from the Emergency Department occurred despite me only working 2 days per week. These efforts included seeking to fire me one week before my probationary period elapsed for supporting a young person to exercise their right to access legal representation prior to being transferred to a secure Mental Health facility against their will. These efforts also included seeking to fire me once again for supporting a young person to understand how staff could forcibly make them take medication – informed consent and supported decision making. In this circumstance, staff intended to physically restrain and then chemically restrain the young person within 10 minutes of instructing them to take a medication unknown to them. These types of responses are not uncommon, but they are unlawful.

    The persecution I experienced was unrelenting cowardly retaliation.

    What gross abuse and misuse of the law that transpires in The Royal Melbourne Hospital’s Emergency Department likely does not occur in isolation. This begs the questions; what conduct takes place in our Emergency Departments across the country? What happens to vulnerable people in distress in other Emergency Departments across this country? Survivors of the system hold this knowledge and their voices must be platformed, their stories told and appropriate compensation afforded for the traumatising law breaching practices that they have endured in healthcare settings.

    The abusive acts I speak of in this letter are a public health concern.

    These abusive acts are a community safety issue.

    These abusive acts must be made known to the public.

    These abusive acts are the worst kind of violence – trauma under the guise of care, perpetrated by those in paid positions of power.

    What happens in our Emergency Departments could happen to anyone and as such, I call on the people to whom this letter is addressed, government and law makers to;

    • Investigate and issue an external audit on the use of code greys and restrictive interventions by The Royal Melbourne Hospital’s Emergency Department during the 2020-2022 period and publicly publish these findings
    • Investigate the conduct of RMH Emergency Department Clinical Mental Health Practitioners during this same 2020-2022 period
    • Seek to compensate the mental health consumer-survivors who have been unlawfully restrained and detained in the RMH Emergency Department
    • Create a standardised state-wide comprehensive restrictive interventions documentation tool for Victorian Emergency Departments, with intent to collaborate with other states and scale this nationally
    • Establish a Victorian public health restrictive interventions regulatory body with enforceable powers
    • Fund and imbed on the ground independent advocates in Victorian Emergency Departments and acute mental health settings
    • Bring forward the review of the newly passed Victorian Mental Health and Wellbeing Act from 5 years time, to 1 years time
    • Bring forward the Victorian deadline for the abolition of bodily restraint and seclusion from 10 years time to 4 years time
    • Develop and mandate Lived Experience Mental Health units and Mental Health Law units in nursing courses across the state

    I implore you to act and thank you for your consideration.

    With sincerity,

    Lauren Walsh-Buckley

    References

    Scott Lamont, Cameron Stewart and Mary Chiarella, ‘The Misuse of “Duty of Care” as Justification for Non-Consensual Coercive Treatment’ (2020) 71 International journal of law and psychiatry 101598.

    For evidence of similar practices, see: Jonathan Knott et al, ‘Restrictive Interventions in Victorian Emergency Departments: A Study of Current Clinical Practice’ (2020) 32(3) Emergency Medicine Australasia 393.

    Susan Ainsworth et al, Leading the Change: Co-Producing Safe, Inclusive Workplaces for Consumer Mental Health Workers (VMIAC & University of Melbourne, 2020) <https://socialequity.unimelb.edu.au/__data/assets/pdf_file/0005/3532820/Leading-the-Change-Report-2020.pdf&gt;.

    Simon Katterl, ‘Multifaceted Strategy Required to Ensure the Consumer Workforce Feel Safe at Work’, Croakey Health Media (22 June 2022) <https://www.croakey.org/multifaceted-strategy-required-to-ensure-the-consumer-workforce-feel-safe-at-work/&gt;.