Behind prison walls


What makes a young nurse take up the challenge of forensic mental health nursing at Sydney’s Long Bay jail?

Built to confine and control, the maximum security walls of Sydney’s Long Bay jail are hardly enticing.

Many have dreamed of escape, a daring few have tried and even fewer have succeeded.

Shona MacLeod is a young Scottish nurse who quit her job and travelled half way around the world to pursue a career inside this formidable complex.

Seeking work while backpacking round Australia, Shona, a qualified mental health RN, was offered a casual position at the prison hospital, where she received additional risk management training including management of aggressive and violent patients.

‘I found I enjoyed the challenge,’ she said. ‘It was a very different use of my skills, trying to be therapeutic with patients involved in the justice system. It’s about being sympathetic and non judgemental and treating them as patients and individuals.’

After returning to Scotland Shona successfully applied for a permanent position at Long Bay and made the big move to Sydney four and a half years ago.

On a typical working day, Shona arrives at the prison, a half-hour drive south of the CBD, at 7am. She walks through a metal detector while her bag goes through an x-ray machine. She then undergoes a biometric data check in the form of an iris or fingerprint scan.

Once identified, she collects a set of keys to access all areas within the 40-bed mental health unit, and a duress alarm.

Based in the high dependency female ward (there are two male wards), she’s one of two nurses each assigned to two or three patients.

Forensic patients may have been found not guilty – or ruled unfit to plead – because of mental illness. Some may be on remand, awaiting trial or sentence. Others may have become mentally ill while serving a sentence.

After a handover from the night shift, Shona liaises with prison officers to plan the day’s activities.

‘We talk about issues or incidents concerning particular patients and how we are going to manage them. It’s also our role to help educate the officers on mental health symptoms and behaviours. We work together to achieve the best environment for the patients.

‘When patients’ rooms are unlocked, we help ensure they are out of bed and showered before breakfast in the dining room when we give them their medicine.’

Nurses join with activity officers – prison staff and allied health workers – to run therapy and education groups such as cooking, music, sports and yoga. These are similar to programs in standard mental health services but with an added overlay of security.

Under a ‘sight and sound’ policy prison officers must keep nurses and pa-tients in sight and within hearing range.

Shona says while not all patients require such high security, it’s compul-sory in the prison environment and nurses must fit within that framework.

‘There is very thorough risk assessment and management of patients. Staff are trained to identify these risks very quickly and are able to put strategies into place to minimise them.’

Shona’s daily routine includes close liaison with family and carers, as many female forensic patients have children in institutional care or with family members.

There’s also liaison with non-mental health nurses and doctors about patients referred for outside treatment. ‘We have to explain risks and ways of managing patients while they are outside the prison hospital.’

Under Department of Corrective Services rules, patients are locked in their cells from 3.45pm. During the night nurses make visual observations of patients on a regular basis, according to their acuity.

‘There’s a call button in every room so if any patient needs us we go down and talk to them. We’re also there for any crisis intervention.

‘Evening shift is a great opportunity to do care planning and risk assessments, write Mental Health Review Tribunal reports and other paperwork.’

Shona has chosen to transfer to the new 135-bed high-security forensic hospital, next to the prison complex, when it opens later this year. Many of the forensic hospital patients will have complex and challenging needs, and the new hospital environment will allow nurses to bring their highly developed skills of risk assessment and management into full play.

Unlike the prison hospital, the forensic hospital will be operated and staffed by Justice Health with no prison officers employed. A contract security company will monitor hospital entry and exit points. Internal security will be provided by multidisciplinary staff who will form emergency response teams to react to any incidents of duress.

‘Along with our multidisciplinary colleagues, nurses will be fully responsible for assessing and monitoring risk and we will be able to be more therapeutic in our approach to patients,’ Shona says.

‘The aim is to engage with patients and establish trust and rapport. We are trained to minimise escalation, identify warning signs and act proactively rather than wait for an incident to occur.

‘The new forensic hospital represents a major step forward in our ability to provide safe, humane and appropriate care for forensic patients. I’m very excited about working there.’