Nowhere to train to be forensic psychiatrist after embattled hospital deemed too dangerous

1 month ago 16

Victoria’s only mental health hospital for prisoners has been stripped of its trainees because of violence at the facility, worsening staff shortages and leaving junior doctors without a pathway to become forensic psychiatrists.

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) last Friday took the extreme measure of immediately removing all four training posts in the acute wards of Forensicare’s Thomas Embling Hospital over repeated safety concerns.

Thomas Embling Hospital in Fairfield, pictured in 2023, is facing staff cuts despite increased need for services.

The loss of trainees will inflame staff shortages at the hospital, which is struggling to cope with patient violence and drug abuse. Four registrars were recently made redundant, blamed on the May state budget, with five other specialists also proposed to go.

The hospital is already unable to cope with demand, leaving the most severely unwell patients in prison without the appropriate treatment.

RANZCP had warned for more than a year that unsafe conditions, staff shortages and a lack of supervision risked Forensicare’s accreditation to host placements. The posts at the Barossa, Argyle, Apsley and Atherton acute wards were withdrawn last Friday.

“This decision, effective immediately, has not been made lightly and reflects a culmination of sustained concerns regarding trainee safety, clinical supervision and staffing adequacy,” the college told Forensicare last Friday in a letter obtained by The Age.

A registrar on placement was recently injured at the hospital in what the college called a “serious incident”.

Two industry sources, speaking anonymously to protect their employment, said stripping the positions effectively meant the pathway to obtain a certificate in advanced forensic psychiatry no longer existed in Victoria. The certificate requires a three-month placement in an acute inpatient forensic setting, which is no longer possible in the state.

RANZCP disputes this characterisation but ultimately hopes Forensicare can lift its standards by the time the next batch of placements begins in February. If not, the college will find alternatives on a case-by-case basis, which could include placements interstate or in acute wards that are not with forensic patients.

The two industry figures questioned whether local alternatives could expose trainees to equivalent experiences to prepare for the job.

Three trainees were pulled last week, two of whom were registrars completing the certificate of advanced forensic psychiatry. They were expected to be waved through, having finished 10 weeks of the 12-week placement, while the third trainee was placed elsewhere.

RANZCP president Dr Astha Tomar said the decision was not taken lightly.

“Safety concerns with Forensicare have been raised several times in recent years, and we have been monitoring ongoing issues relating to inadequate staffing levels and inadequate clinical handover at Thomas Embling,” Tomar said in a statement to The Age.

She said the college was dedicated to supporting affected trainees and exploring “future opportunities for safe and sustainable training at Thomas Embling Hospital”.

“The safety and wellbeing of our trainees is of paramount importance to us.”

RANZCP first questioned Thomas Embling’s suitability to host students in July 2024 after the state’s workplace safety watchdog issued improvement notices for a string of failures in late 2023.

WorkSafe Victoria had accused Forensicare of having “failed to provide a system” to manage “occupational violence and aggression”.

The college, which is responsible for training psychiatrists and establishing workforce standards, said it recognised Forensicare’s attempts to deal with the issues.

“Despite these efforts, unresolved concerns – most recently a serious incident involving a trainee – have led the [Victorian Psychiatry Training Committee] to conclude that the current environment does not support safe and effective training. We understand the gravity of this decision and the impact it may have on your service, your staff, and the broader forensic mental health system,” last Friday’s letter said.

“We acknowledge the longstanding challenges faced by Thomas Embling Hospital, particularly in relation to workforce pressures and safety risks.”

Forensicare said it was supporting affected trainees to have “a safe and smooth transition to alternative placements” and was working with the college to have its accreditation reinstated.

“The safety of all Forensicare staff is our number-one priority, and we have robust processes in place to mitigate the risk of violence and aggression,” a spokeswoman said.

Training posts in other parts of the facility, like community services, remain.

A government spokeswoman said violence towards healthcare workers was unacceptable.

“Forensicare has been clear that the delivery of care for consumers at Thomas Embling Hospital will not be impacted.”

The Department of Health and the Office of the Chief Psychiatrist were supporting the affected trainees and working with Forensicare to ensure accreditation is reinstated, she said.

Paul Healey, Victorian secretary of the Health and Community Service Union, supported the decision to keep those workers safe.

“But unfortunately for our members, that withdrawal of services and workforce is not an option because we cannot risk the safety of the service users,” Healey said.

“So it’s doubly imperative that the Victorian government and Forensicare break their silence, engage with the union and develop truly proactive safety plans to ensure that all on site are safe while using the facility or working there.”

While jobs are being 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.

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.

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