Mr Randolfo Obregon1, Ms Phillipa Thomas2
1Victorian Department Of Health And Human Services, Melbourne, Australia, 2Alfred Psychiatry, Melbourne, Australia
The use of restrictive interventions as a risk and consequence management strategy in mental health inpatient units is often driven by the need to communally support two important groups whose needs are incompatible with each other – those at risk to cause harm, and those vulnerable to be harmed.
While innovation has supported improvements in the prevention, management, and reporting of aggression, the same for sexual safety has been slow and remained for many services a complex and vexing proposition. Defining, addressing, and appropriately escalating early warning behaviours challenge the reflexes of staff in dynamic treatment environments; the result too often traumatic and unacceptable experiences of sexual harm, and use of restrictive interventions as a first and last response.
In Victoria, the Chief Psychiatrist is mandated to provide both clinical oversight and monitoring of incidents and allegations of sexual assault, sexual harassment, and sexual activity occurring on acute inpatient units. However, a reliable account of the scale of sexual safety breaches has historically been undermined by an inconsistent threshold for, and quality of reporting. The result, insufficient intelligence to ensure case level rigour, and intelligence to drive system improvements to deliver safety and a reduction in the use of restrictive interventions.
Recognising the dilemma, in March 2018, the Office of the Chief Psychiatrist Victoria implemented a new mandatory reporting process and intervention checklist to collect case and system level information to ensure incidents are understood by sufficient rigour, and escalated appropriately. Reporting connected services to advisors to review each incident, provide timely advice, and identify emerging high level service and system trends.
An initial 3 month pilot was evaluated to test a process for the logical collection and interrogation of information, and the utility and experience of the process for services and the OCP. During this period services were required to scrutinise and report on any incident of a sexual nature occurring on an acute inpatient unit to the OCP within 24 hours.
The product, a quantitative dataset that establishes a baseline understanding of the issue across Victoria, and the steps taken by services and OCP advisors to understand and respond to incidents, and qualitative insights into perceptions of guided reporting as a system improvement.
This presentation will consider the challenges that have belied sexual safety incident reporting to date, the issue scrutiny and data collection process, and learnings for governance, infrastructure, workforce capability, and opportunities for co-design of prevention and early intervention strategies that will support safety for all.
The following areas will be discussed regarding the pilot and recommendations:
- Profile of sexual safety incidents in Victoria for a 3 month period.
- inconsistencies in the conceptualisation and description of sexual safety incidents
- overview of risk and consequence management including use of restrictive interventions
- the role of government and services in demonstrating rigour and transparency in response to community expectations of safety, and fairness
- future considerations for addressing sexual safety in mental health service settings
Randolfo Obregon is Senior Project Officer at the Office of the Chief Mental Health Nurse.
Randolfo has ten years’ experience in public service, with a focus on workforce development policy and translation of policy into practice.
Phillipa Thomas – Manager, Business and Strategy – Alfred Health
Ms Thomas is a Social Worker and Psychiatric Clinician with an established history in quality and project management, service redesign, and implementation science. She has held a number of senior clinical roles with Alfred Psychiatry as well as having successfully led a number of system change, design and implementation projects