Ivan Dean, Speeches Index

Tuesday 15 April 2008

WARD 1E TASK FORCE RECOMMENDATIONS

Mr DEAN (Windermere - Motion) - Mr President, I move -

That the Audit and Review of the Ward 1E Taskforce Recommendations 9 July to 2 August 2007, prepared by Mr Peter Santangelo, be considered and noted.

To understand and appreciate this matter, Mr President, it is necessary to go back into some of the history and some of the reasons for the Santangelo Report, and much further than this year and last year when that report was prepared.

This issue involves a group of people who, I believe, are probably the most vulnerable in our midst, other than perhaps young children. We are talking about people with psychiatric problems and disabilities. I have put together a report for the minister responsible for the Department of Health and Human Services in relation to this matter and my concerns with issues and complaints that have emanated. I seek leave of the Council to table that report.

Leave granted.

Mr Parkinson - Is that dated 8 April 2008?

Mr DEAN - Yes, it is dated 8 April 2008.

Mr Parkinson - So that is your letter to the minister?

Mr DEAN - That is my letter to the minister that is marked -

Mr Parkinson - It has 'provided in confidence' written on top of it.

Mr DEAN - That is right. It was tabled about a week ago.

Mr Parkinson - You sent it to the minister's office, and have tabled it today.

Mr Aird - Can I say that normally the system is that before you seek to table a document it is at least described and presented so that we know what we are actually agreeing to. There have been other occasions when, with the support of other members, this has been somewhat diabolical in the methodology. I think that we need to address the Standing Orders to make sure that this does not happen again, Mr President, because things that are tabled could be potentially slanderous. This document could contain a whole range of things and you have now given protection to this document. That is what you have done; that is why you have tabled it, isn't it?

Mr DEAN - I have tabled it.

Mr Aird - What was the purpose of tabling it?

Mr DEAN - The purpose of tabling it was for the benefit of all members, all people.

Mr Aird - You could have distributed it to members rather than tabling it.

Mr DEAN - I could have done that but I believed that I should table it.

Mr Aird - Is there potentially defamatory information in that document?

Mr DEAN - I do not believe that there is any defamatory information in that document at all.

Mr Aird - Can you say that categorically?

Mr DEAN - I cannot say it categorically, but I am confident that there is no defamatory information contained within that document.

Mr Aird - Well, what was the purpose of tabling it then?

Mr PRESIDENT - Order. The document has been tendered and there has been sufficient discussion on that. The Council has voted to agree to that document being tabled. That was the time for debate on this matter.

Mr Aird - The fact is that we were not made aware of the actual tabling of the document.

Mr PRESIDENT - Order, order. There was every opportunity for every honourable member who wished to do so, to ask about that at the time. That was not done and this is not the appropriate time to be debating that aspect of the matter. I would ask the honourable member to proceed with the motion.

Mr DEAN - Thank you, Mr President. From the outset I must say that I am appalled at the lack of action by the Government and the mental health department to resolve those issues that were made abundantly clear to all back in about 2003-04, and again in March 2005 by way of the Office of the Health Complaints Commissioner. I will be further referring to that report in a moment.

The Government's releasing of this report by the then responsible minister, Mr Llewellyn, is well remembered. He demonstrated very emotionally a position on the contents of that report. However, since then there has been no obvious change, in my view, to the way in which Ward 1E at the Launceston General Hospital has continued to operate other than some cosmetic and other small changes. I am not aware of any major changes that have improved the current operations. At the end of the day, it is my strong view that the responsible minister must accept responsibility for what is happening there and for the action in the Health Complaints Commissioner's report.

A number of issues have arisen to bring me to this stage. First, I want to refer briefly to the whistleblowers. As I said earlier, the state of Ward 1E was made very evident back in 2003-04 when a number of extremely brave and resolute - and that is how I have described them - 1E staff came forward and actually put their careers on the line to bring forth a number of issues that they witnessed, were subjected to and were involved in during their activities at Ward 1E . Many of those allegations made by these people were found to be correct - some were not proven, as I understand it.

You would also be aware that the whistleblowers came to me and another politician in frustration because they were unable to break through the cultural barriers operating amongst management and some other staff in Ward 1E at the time. They had reached a stage where they had tried everything possible to bring it out but were unable to do so. They were blocked at every opportunity. The cultural barriers that existed then still remain to some extent. Those cultural barriers were able to block the information coming forward and complaints being actioned.

In some instances it was alleged and suggested that there had been some cover-ups. As I said, four to five years later, some of those cultural traits that are really damaging to that organisation remain in situ. Mr Santangelo, in the policing of his report in 2007-08, identifies with that - he says that himself.

I am not going to go into any great detail on the whistleblowers other than to say we know that their careers, in most instances, were absolutely ruined. In one instance, a person who provided information had to leave her home area and move to another part of this State, and in handling that, she had personal problems as well. Whilst all of this was going on, her 26-year-old son died - he contracted cancer. It was a horrendous time for these people.

These people believed at the time that they would be supported, would be given protection and the Public Interest Disclosures Act 2002 was, I believe, set up to provide support to these people and give this type of person protection. This type of person is, I believe, somebody wishing to provide information in relation to government services and areas that they have worked in.

It was interesting - and this came out in answer to some of my questioning in Estimates so it would be on record - that it was indicated that some even senior members did not fully appreciate or fully understand the ramifications of that act, the Public Interest Disclosures Act 2002.

I now want to move on to the report of the Health Complaints Commissioner dated March 2005. I can name the people who provided information in the first instance, they have no difficulty in being identified. Mesdames Ottaway and Rossiter made these details known. As a result of that, the Health Complaints Commissioner conducted an investigation into Ward 1E as directed then by the minister, Mr Llewellyn, on 11 March 2004.

The result of the investigation, Mr President, was to find favourably for the complainants in many of those instances. As I said, some of those complaints were not proven, but it certainly was not found that they were not correct either, and many of their complaints were proven. As a result of that, 26 recommendations - and those 26 recommendations can be broken down to become 49 independent recommendations - were identified for consideration for implementation. That is as a result of the Health Complaints Commissioner's review. Minister Llewellyn in releasing the contents of the report said that all recommendations would be implemented as a matter of some urgency, a statement made in early 2005 on the steps of Parliament House, I think, and he was very emotional when making that statement.

The recommendations, Mr President, were stark in many cases. Some of the main issues coming out of those recommendations were workplace conduct, workplace harassment, bullying - bullying was a big issue - complaints, grievances handling and performance management. There were 26 issues altogether.

The report and recommendations were quite unambiguous. The general populace, myself included, believed that those recommendations would be implemented and that Ward 1E would return to providing a very good service to everybody, that most of these problems would be satisfied. For once these issues had been identified publicly and we had a minister who was strongly supporting the implementation of those recommendations, so why would we not have believed that that would have been the case, that some very strong action would have been taken?

Shortly after, and I do not have the date, an associate professor, Des Graham, was brought into the Department of Health and Human Services as a consultant, in the first instance to work with the Department of Health and Human Services specifically in relation to Mental Health Services and some of the issues arising from Ward 1E . He was later appointed to the position that he held for some time and I am not quite sure what position he holds now, Mr President.

I am not sure what happened in Mental Health Services from that time on, or of the changes that were made but I do know that not enough changes were made to satisfy the concerns raised in the recommendations identified by the Health Complaints Commissioner.

I want to come now to the Peter Santangelo report, Audit and Review of the Ward 1E Taskforce Recommendations 9 July to 2 August 2007: Peter Santangelo, Australian College of Mental Health Nurses President. The reviewer is fairly strong in some of the statements he makes. He refers initially to the terms of reference set up for the investigation in 2004 noting that it encompassed complaints about specific incidents, Mr President, and allegations of misconduct and systemic issues relating to the management of Mental Health Services. He also noted that in April 2005 a task force was appointed by the Minister for Health and Human Services to oversee and implement the 26 recommendations made from the 2004 investigation.

We now know that in June 2007 similar complaints arose regarding staff conduct and behaviour, so in 2007, despite what has been put in place, despite these issues being identified as problems in that area, they are again resurfacing in 2007 - identical complaints almost, identical issues, identical concerns. The majority of these complaints again, Mr President, were brought to my attention and I must admit that when they first started coming to me I questioned the veracity of some of them because I believed that things had been rectified within the ward. I thought that if they were still being addressed people were aware of that and that things were changing. However, my position changed fairly quickly when other evidence was brought to me to identify with some of the complaints that were being made to me. I then started to realise that perhaps things had not changed, that the recommendations had not been implemented, and particularly in the areas relating to harassment, workplace issues, bullying and management practices.

In January 2008, with the release of the Santangelo report, it was made patently obvious that Mental Health Services and Ward 1E were in a similar state to what it was at the beginning of the known problems in 2003-04. A further 38 independent recommendations were made in the Santangelo report, many of which were almost identical with those emanating from the Health Complaint Commissioner's Review 2005. Perusal of those recommendations will reveal the similarities. Misconduct, bullying, mismanagement, accountability, policies and codes of conduct remained as critical issues yet to be resolved. It is those very same issues that led to the complaints coming out of this area in 2003-04. They were some of the very first issues to be raised with me and, I understand, another politician. Why these very matters have not been addressed and remain unresolved four years later really is beyond my comprehension. I cannot understand it and I had difficulty believing it. I really do not know why they would not have been addressed at the time. Here is Mr Santangelo in 2007-08 addressing these identical issues again.

Having read the Santangelo report and having regard to the comments on page 35, I cannot be satisfied that the recommendations have really gone far enough - that is, the current ones we are now dealing with. It is apparent that the attitude, personalities and style of management of senior management of Mental Health Services have been or are an area of concern. However, having said that, the reviewer has not acknowledged that position in the recommendations. He has not made a strong position on that. He has certainly discussed it, and I will refer in a moment to that. The attitude demonstrated by senior management, as alluded to by the reviewer, was integral to the original complaints made in 2003-04. Specifically I refer to the comments made in the Santangelo report, and I refer to the fourth paragraph on page 35 of that report. I will quote the paragraph:

'On another level, staff perceived that Mental Health management engaged in a bullying and intimidating culture. It was asserted that this was manifested by authoritarian and centralised decision making by Area Management which was imposed on clinical staff, often in relation to operational issues and issues where clinical decisions by clinicians were overridden for political outcomes. It is also claimed that progress towards the reform agenda, particularly in relation to implementing the Taskforce recommendations, was executed with little consultation or engagement with staff. Local management - that is, the CNM and CNS, were also perceived as colluding with this authoritarian agenda.'

Those comments are fairly clear and unambiguous, and I should say that the staff perceptions that I referred to have been corroborated by way of additional complaints made to me. There has been a lot of additional information that has been brought forward to me now, Mr President, since the release of this report, the Santangelo report.

The last paragraph of the Santangelo report, 7.5.3 on page 35, really says it all, and I will quote that paragraph as well:

'As a result of this internal conflict, morale was considered to be at an all time low. It was also considered that a remedy would require strong leadership and management and there was little faith that such leadership and management was going to be forthcoming as, to date, there was little evidence that these issues were controlled through appropriate performance management processes.'

Again, a repeat of the Health Complaints Commissioner's review; he raised some of these issues. Without changes and strong and effective leadership and management, Ward 1E's problems would continue to exist, and they will continue to exist now, Mr President, unless the appropriate and right action is taken. As I have said on many occasions, the ingrained, unacceptable culture existing in that workplace is unlikely to change without a clean sweep of senior people, leaders, administrators and those other staff who were originally identified as a significant part of the downfall.

Mr President, I can just refer here to a good example of some of the issues and problems that we do have, and how another organisation fixed their similar problem. I think most of us here would probably recall the devastating position that the police service was confronted with at Launceston in the mid-1990s, I think it was, when there were huge difficulties within the drug bureau at Launceston. A number of issues surfaced, a number of damning allegations were made and a number of those allegations were proven against the drug bureau in Launceston.

This is one occasion where I agreed 100 per cent with the Commissioner of Police of the time when he determined he would make a clean sweep of that bureau. He dismembered the bureau, moved them all out to different areas, and we know that there were some innocent people caught up in that unfortunately. He determined at the time that he needed to fix that and show the public that he was taking the most appropriate action necessary. He did that and brought in a new team, and since then that team has gone from strength to strength, and provides a wonderful service in relation to crime and drug detection in that area. I could not now give enough accolades to those people who have done a wonderful job. At times it is necessary to take very strong action to ensure that problems and issues are fixed, and fixed very quickly.

I was speaking with a psychologist, whom I will not name, the weekend before last. He was involved in psychiatry work and was asked to work in Ward 1E , but he turned the offer down. He told me that he had turned it down because he was aware of the negative culture in that area, and he was not prepared to put himself through it. He said that there is not the vertical will - I had not come across this saying before, and I will refer to it again later - he said, 'Without the vertical will to fix the problems, it will not change'. In other words, what he was saying was that it has to be the will exerted from the top right through.

Ms Thorp - I understood it.

Mr DEAN - You understood it, did you. I was just making sure that you did.

Mr Parkinson - I didn't.

Mr DEAN - When he first mentioned it I wondered what he was on about. I had to get a further explanation from him, but he answered it quite simply for me, and he had to.

Sitting suspended from 4 p.m. to 4.30 p.m.

Mr DEAN - Mr President, I think I had just raised the issue of the psychologist who had a discussion with me about being invited back to Ward 1E . Moving on from there, on 9 January 2008 - and I thank the department of Health and Human Services for arranging this - I attended a briefing with that service here in Hobart and Mr Peter Santangelo made himself available via a telephone hook-up. That discussion raised a number of issues. I was able to raise some of my concerns and in amongst that discussion, I asked a question and made a record of it. I asked him what his general attitude was, given the previous review and recommendations made by the Health Complaints Commissioner four years previously. I wanted him to explain how he felt having to review it again four to five years later. I asked this question and there were a number of witnesses there at the time -

Mr Parkinson - Of whom?

Mr DEAN - Mr Santangelo. My impression was that he was guarded in his response to that question. I do not really blame him. But amongst other things, he used words to the effect that, 'There were areas of disappointment in my heart.' That was the comment that he made in answer to that question. So one can gauge from that that he had some real concerns about some of the areas and issues that he identified during his review. In my opinion, that statement could be seen as an understatement of the circumstances we are confronted with.

I am drawing an analogy between Ward 1E and Ashley last year. Last year you will recall - and the member for Rowallan is not here but the member for Mersey is -

Mrs Jamieson - In fact, I was going to make the same mention.

Mr DEAN - You can expand on this because I will not go into too much detail on it. Suffice to say that last year during that inquiry the committee made 32 recommendations on Ashley that we saw were very important in remedying some of the problems in relation to that centre.

In nine months nothing really has changed. The minister agrees with that to some extent. Will there be another select committee into Ashley in another three to four years' time? If we look at Ward 1E and what has happened there, when important issues were pointed out to the Government they were not addressed. Will we see another situation arising with Ashley? I just draw a parallel between the two.

Mr Parkinson - I wondered what you were doing. I thought you had changed the subject.

Mr DEAN - No, I have not changed the subject at all, I am just drawing a parallel. I thought I made that clear when I first spoke.

Since the Santangelo report surfaced and has been given publicity, complaints started coming in to me again from a number of people working in the organisation. Some senior people within DHHS have seen fit to talk with me, most of course wanting to ensure that their identities are protected for very obvious reasons. I am going to refer to some of them, because they directly relate to some of the issues that Mr Santangelo again identifies with.

I would hope that there is no intention of anybody within the Government or any of the government departments to try to identify any of those people who have spoken with me, because you could do that. Looking at some of the issues that I raise and that were raised in that report, I have done so in good faith and I would hope that there is no move to identify any of those people. They put their jobs on the line. They know very well that they will not get the protection that they are entitled to and that their careers will be damaged.

Mr Parkinson - It's very hard to resolve anonymous complaints because you don't know if they are repeat complaints or anything else.

Mr DEAN - Mr Leader, I have agreed with the minister's office that I will talk to them and, provided there is some legal protection and support provided to both myself and to those people, I am able to provide some names in some circumstances. But there must be an absolute watertight guarantee of support and protection of those people. Without that I am not prepared to do it.

Most of these complaints that I received refer to the period between the Health Complaints Commissioner's review and the Santangelo review. So they relate to that period of time, and not before the 2003-04 period. In coming to me these complainants have indicated in each instance that they have seen fit to do that because of the protection that they need for themselves. They have made complaints previously and nothing or little has occurred in relation to the complaints that they have made, Mr President. I will share some of those complaints with you.

One complainant left a message on my mobile phone, identifying that she was a current employee and wanted absolute protection but she needed to tell me her version of what was happening. I have been very careful in my report not to interfere with any coronial inquiry here. One complainant raised a number of issues with me, but it is a coroner's matter and it is currently before a coroner, Mr President, and because of that I will not be taking that any further. Suffice to say that a number of issues have been raised with me by the family. They will come out and be addressed, I would think, in the long term.

Complainant two - I am giving them a number, not necessarily in the order that they came to me - has been a registered nurse and experienced first-hand abuse by staff and been a witness to abuse of staff by staff, and of staff by patients, of patients by patients and of patients by staff.

Ms Forrest - It's a never-ending cycle, really.

Mr DEAN - It covers every area - you are right. This lady believes there is an ingrained culture in some staff to retaliate and she identified, in her opinion, there is insufficient training of people to control and react to these people. She identified that the use of more video surveillance cameras et cetera would provide a lot more protection and support to those people in that area.

If you go through the Santangelo report you will find references to many of the issues, including insufficient staffing levels leading to frustration among staff and causing excessive workloads and restrictions on down time, breaks and the like.

Complainant three, the wife of an involuntary patient of Ward 1E who suicided following absconding from the ward, made a couple of comments to me. She raised a point that during her tragedy, undertakings were given to make changes within Ward 1E that would provide improved opportunities for patients and families and a more caring environment. It would seem little, if anything, has changed and that patients and families continue to suffer at the hands of the mental health system.

Complainant four is an interesting person. He is a professional man who was admitted to the ward following some very tragic circumstances arising within his family. I think from the information I have provided he could well be identified and, as I said, I would hope that no effort is made to do that. Suffice to say that he was admitted to Ward 1E after having been first transferred to Burnie, then being told he might be transferred to Melbourne because there was no bed and no place for him to go to. Finally he was moved back into Ward 1E at Launceston. He was in great distress at the time, in fact, was quite suicidal. This is how he described Ward 1E when he arrived there. He said there were about 20 patients present, the majority were chain-smoking and drinking coffee, all or most showing signs of boredom and wanting something to do. Mr Santangelo refers to some of those very same issues in his review. He refers to smoking - some of the issues surrounding that - and some of the other issues that I am referring to here.

Ms Thorp - You're not suggesting that patients not be allowed to smoke, are you?

Mr DEAN - I am not making any comment on it at all. If you read the Santangelo report, he refers to that as an issue and this patient also refers to that as an issue. I do not think I would have any problem with saying that in a ward with other people, smoking should be contained and controlled.

Ms Thorp - I don't have a problem with it but the idea of taking that away from a patient with mental health issues - that could be a bit draconian, I would have thought.

Ms Forrest - There is comment about the anti-smoking policy in the report.

Mr DEAN - Yes, he certainly refers to it.

Going on with this gentleman, Mr Deputy President, he refers to witnessing bullying amongst patients and complainants setting about organising some activity. He said that having done so, he could see mood changes and for the better. He said one patient attempted to escape and was returned to the ward a couple of days later.

Patient meetings with the occupational therapist and her offsider were set for each morning but only five or six patients attended. Patients were meant to do activities but materials were not available - basic art material was not available - and, again, Santangelo refers to this. The complainant querying the situation was told that the budget set for materials and outings was $300 for the year and was used in the very first fortnight of the financial year. This complainant was encouraged to write two submissions, one for outings and the other for materials, as it was felt that submissions coming from a patient would be more likely receive some action. So very clearly this person can be identified.

'Ideas were put forward to senior staff to assist with the boredom and as therapy but all ideas were squashed by whoever was in charge.'

That comes out from other complainants as well.

'It was patently obvious staff were terrified of the management. From the general nurses to the occupational therapists, to doctors, they all want to complain about budgets et cetera but realise their positions would be in jeopardy if they did so. The complainant was encouraged to do something about it for them. Their hearts are in it, they care, they are professionals' -

He is talking about the staff -

'they are totally hindered by budgets and senior management.

My view of Ward 1E may be oversimplified but there is little doubt, with a change of management practices, a realistic budget and proper rotation of staff, 1E could be optimised.

The patients most want what we all want: to be cared for and loved.'

He goes on further to say that they must have activities and things to do there and they must be provided with correct budgets to do it.

As I said, this person is very astute and occupies a fairly senior position in the State. I understand he has now made a full recovery and is perhaps back in the work force, but I am not absolutely sure about that.

Another complainant supports and satisfies some of the issues raised by Mr Santangelo. She says:

'Bullying is rife amongst staff within Ward 1E . A male staff member is creating havoc in the ward through bullying.'

She goes on in more detail in relation to that. She makes the comment:

'Unfortunately the complaints made to the manager have fallen on deaf ears.'

This is exactly the same comment that was made in 2003-04 by the people who first exposed some of the difficulties in the ward. They still exist and Mr Santangelo refers to that again.

'I can't complain personally because of repercussions. It is not good.'

In frustration I think she says to me:

'I just hope that something can be done.'

This transcript was taken from a message left on my mobile phone.

Another issue raised by another complainant - and again it comes out in the report:

'No continuity of psychiatrists and patients and parents are continually relating history which is frustrating and quite traumatic.'

It refers to a number of other issues referred to in the report and that is why I tabled it. I am not going right through every part of it. It says:

'The 24-hour crisis service is not effective. The Mental Health Team is not accessible after 10 p.m.'

I have not checked on these issues; this is information I am being provided - the emergency Help Line referred to by this person is a joke.

'It is difficult to access doctors on any relevant service in times of crises. The current process is to present at Emergency Department, where you can expect to wait from three to six hours in a waiting room, with people having to witness what can sometimes be rather disturbing behaviour.'

I will continue to read this part because it is worthy of informing us, I think, of some issues they have to go through when they first present themselves:

'This is not only demeaning to the patient but also uncomfortable to the others waiting. The MHT will not see the patient before they have been medically assessed by an intern or relevant other. Sometimes the patient can't stand this pressure and ends up leaving. I have lost count of the times I have been sitting in the waiting room for up to five hours trying to prevent my son taking off. The attitude of some reception staff in this area leaves much to be desired as they treat the psychos and their carers and families as second-rate citizens who are to be either ignored or treated with disdain.'

He makes the further comment:

'The problem is not actually with Ward 1E but mainly with the management. This is where I have experienced bullying. The nursing staff are highly alert, well trained and compassionate. They know what they are doing and at all times during the last eight years I have found them to be caring and discerning people. Indeed it is thanks to one of these professionals that my son is still alive today.'

It then goes on further to explain that situation. The next comment he makes is that Ward 1E is severely short staffed as here in such a potentially volatile environment there needs to be a much smaller ratio of patient nurse contact.

It goes on to identify a number of other issues and concerns coming out of Ward 1E and I am not going to refer to those items. But he does make a good comment here in relation to Aspire:

'The establishment of Aspire in our community has been of huge benefit to our community and the workers there have been most effective in their work of rehabilitating mental health patients. However, this organisation is not for crisis situations.'

His next point is one that I am currently doing more work on. He says:

'A lack of qualified and experienced clinical psychologists in the north is another significant problem. Currently I am under the impression that there are only two.'

In his conversation to me he refers to what he sees as a huge imbalance, again, between the north and the south. He was stressing to me that he was not being parochial. He had done his homework; he seemed to know quite a lot about it because he has had quite a lot of dealings with Mental Health Services.

There is another complainant who came forward and is a fairly senior person within the organisation. Again, in reading this report, there is a chance that he might be identified and that would be tragic if it happens, but I need to attribute a couple of comments to this person. He says:

'A senior person within DHHS produces sound documents and is a stunningly good spin doctor. It would take a truly exceptional minister to see through his snow. I have personally observed two incidents when I found his behaviour disrespectful and intimidating.'

He goes into more detail in relation to that. Another comment he makes is that Santangelo's comments about the lack of respect of many staff members for patients with personality disorder, especially borderline personality disorder, is true. I referred to that previously. He recognises that patients in that area are a challenging group of people and it takes a lot of time to deal with them and to provide them with assistance and support. He recognises that they do test your patience, but he is saying that employees should be sufficiently trained to be able to work with that.

He makes this further comment:

'I believe this is a historical view that older staff have not been able to adapt to new practice.'

He expanded on that to me: to accept practices of today, how to treat people, how to handle people and ensure that they have what they need to move forward, rather than using what might have been previously used and that is a fairly heavy-handed approach. He is saying that some of the older staff have difficulties in grasping that. He goes on to say in relation to complaints, and I quote his comment:

'However, the complainant has said that if there were formal proceedings with appropriate protections there would be a willingness to provide information publicly.'

I do not intend to go through all the comments, but I spoke with the parents of a young lady who suicided in 2005 or 2006, and this is well and truly after the Health Complaint Commissioner's report and review. That was an extremely difficult time for me; I had a father there aged in his early 70s, I would think, and his wife probably a similar age. They were relating to me the story of the support their daughter had received through Mental Health Services and through the ward. Obviously identification will be quite easy in this instance. Their daughter was admitted simply through post-natal depression after the birth of a child. She received assistance and was given support through the Mental Health Services, and returned home to her loving family, her husband and her one child.

Unfortunately they made a decision about seven years later to have another child. They wanted a second child. Whilst this is being told to me, her father broke down in tears and sobbed through this whole story. His wife was more controlled and was able to talk much more freely. On the birth of the second child, she was again admitted to the ward, once again suffering post-natal depression. The parents say that the support given was not adequate. She was released from there and the parents say that, as one of the conditions of release, she was asked whether she was suicidal. She said she was not, and of course we know what happened from there. Immediately on her release she went home and her father found her hanging in a tree a short time later. I just bring these issues out to demonstrate the concerns and issues that are out there. It is just a horrible and horrendous experience.

Another person I was talking to said - and this has recently come out, there has been publicity on this - that a member of his family was released from Ward 1E into backpackers' accommodation. He said when he found out what had gone on he was horrified to think that should be the case. It is now identified that they are released into backpackers accommodation, boarding houses and caravan parks, places that in my opinion are just not right for a person suffering from a mental problem. I do not see those areas as the right places for these people to go into. I know it is a dilemma for Mental Health Services to find suitable places for them, but in my view a lot more needs to be done.

Mr Parkinson - Often backpackers' accommodation is quite good standard accommodation.

Mr DEAN - I am not running down the accommodation itself, but these people have no idea what is going on, so they cannot provide any extra support or assistance to these people. They do not have people coming in to give them support. What the father is saying is that the person was placed there to fend for themselves. I do not know if that is suitable or not. I do not think it is. I am far from satisfied that that is the way that we should be going.

There are numerous other complaints from people in relation to bullying and the other issues raised by Mr Santangelo. Another complainant says there has been a massive turnover of staff within Medical Health Services, including Ward 1E , brought about in the main by poor leadership and management at several levels. Complaints are still being ignored and no proper system introduced to ensure efficacy in this area. Positions have been left vacant for long periods simply for the purpose of saving money.

[5.00 p.m.]
The other comment I wanted to make in relation to accommodation is that it was always realised that deinstitutionalisation was going to have some inherent problems, Mr Deputy President. One of those problems was always going to be suitable accommodation for these people; where they would go, how they would be looked after and how they would be cared for. In fact, at the time of deinstitutionalisation, I was an inspector of police in Hobart and I was asked to do a report for the police service in relation to deinstitutionalisation giving my view on what I thought the problems might be for police. That report would probably still be available and I identified in that the issue of accommodation and police being confronted by much more contact with these people. They needed to be aware of that.

I do not want to take a lot more time. I think I have gone into it sufficiently. There are just one or two other comments I want to make. Interestingly, and I read this in the paper, the psychologist I was recently talking to who had been offered a job back in Ward 1E , told me that they needed to practise zero tolerance. Zero tolerance standards needed to be set to turn unacceptable behaviour around. He said that is a way, at this stage, to try to get things right. He is a man who ought to know or at least have some idea.

As I said, a number of other complaints have been made. I am confident that there is a lot of truth in many of the issues raised with me because there was corroboration of them. Most of these issues I have referred to have not only been raised by one person, but have been raised by a number of people. That indicates to me that there is a lot of truth in what is being said.

I would say too that I received another complaint containing a number of very serious allegations, but I have not seen fit to refer to it in this report other than make that identification. I will discuss that with the minister's office at some future time if they wish and I understand that they probably want to do so.

As I said at the beginning, I am strongly of the belief that until the vertical will to change the culture occurs, changes within Ward 1E will be slow and unfortunately we could see another review in another three to four years' time.

If the Santangelo recommendations are actioned and reviewed from time to time, tested and audited by independent authorities and implemented in the right way with the knowledge, the assistance and support of the people, Ward 1E could well be the benchmark for all psychiatric facilities into the future and that is the way we would like to see it happen. I know people who work there and that they are extremely professional. They do an absolutely wonderful job, but they are curtailed in their activities by some of the things that are happening in relation to cultural issues.

Will the implementation urgency follow-up occur? If the Health Complaints Commissioner's report and the Ashley inquiry report are examples that will be followed, then no, nothing will change and I and others will be the recipients of many more complaints dealing with emotional, frustrated, hurt and drained people.

In conclusion, I want to say that the engagement of Mr David Roberts as the new Secretary of DHHS gives me some heart and provides me with some relief that finally we may move forward in sorting out the mental health services side, particularly Ward 1E . You do not think so?

Mrs Jamieson - Unless there is a cultural change.

Mr DEAN - You are right. The cultural change has to occur. I identify with that and I think that the department should understand that and I hope they do. You are right, he will have some difficulties. It will not be easy for him unless he gets the support that is necessary. He has a huge job as he has also inherited a broken hospital system that we are all expecting him to straighten up, to at least move it forward in the way it is operating and to provide an efficient and good service to the sick, again a very vulnerable group.

I spoke to Mr Roberts about this. I sought a briefing with him in relation to Ward 1E and, whilst I did not have a full briefing with him, he did indicate to me by telephone - and this was about six weeks ago - that he required at least three months to start to straighten things out within Ward 1E . I indicated to him at the time that I was quite satisfied with the position that he identified to me, that I would sit back and wait to see what did happen and I would give him any support I could if he saw fit to make contact with me to move this matter forward.

We know that there have been changes in Ward 1E recently, with some senior positions being filled. I see that as a positive move provided those people take on board some of those very important issues that have now been raised on two occasions in two senior consultants' reviews, the Health Complaints Commissioner and by Mr Santangelo.

At this stage, Madam Deputy President, I appeal to the Government to address these issues and, as I said before, in compiling this report and in the discussions that I had with some of the complainants I, too, was reduced to tears. I am not embarrassed to make that statement here today. I had to console distraught people and that is not easy.

In conclusion, Madam Deputy President, I ask again that some of these issues be addressed and taken on board. I do not want to see another review in another three or four years' time and I do not think anybody else does because, as I said at the beginning, these are some of our most vulnerable people calling out and wanting help. That is what it is about and we need to give them the best possible service, support and treatment that we are able to provide in the circumstances. I would commend that report to you and look forward to any further contributions.

[5.07 p.m.]
Mrs JAMIESON (Mersey) - I will make a few comments because the member for Windermere has given a very fulsome report on the matter and I am not privy to all of the detail that they had. I certainly support the tenor of what he has been saying and thank him very much for bringing these details to our notice again. I say 'again' because it should not be necessary to have these situations continually brought to our attention.

Most of the matters that the honourable member has mentioned should have been and could have been resolved years ago. The head-in-the-sand approach certainly does not help us and we must change to one of an empathetic support, being accountable to, listening, acting on the genuine concerns expressed by staff particularly as they relate to vulnerable patients, carers and other staff.

All too often there is inertia, and just how you shift it I do not know in the hierarchal system which closes ranks on people, making the complainant feel guilty, wrong and in fact as if they are creating mischief for their own benefit. Staff who are harassed and bullied by the system cannot give of their best in discharging their duties towards patients, carers and other staff and including themselves. Ultimately, it is the system that suffers and compassion is lost, people lose faith and become very cynical.

As we know, Mr President, whistleblowers seldom are flavour of the month, however when you the whistleblower know that you are right and hang in there long enough, eventually you may be listened to. I understand that the recommendations from the health complaints report in 2005 resulted in 26 recommendations being identified, with the then Minister for Health, David Llewellyn, saying that all recommendations would be implemented as a matter of urgency. Some of these recommendations need reiterating, such as workplace conduct, bullying, harassment, complaints and grievance mediation policies and performance management. These five recommendations are certainly not rocket science and form the basis of any healthy workplace and management. So, why, I ask, has it been necessary to have this motion before us again today - or the situation again today? Because two years later nothing has changed, that is why. It is a travesty, Mr President, and it also is a disgraceful waste of public money, with a community left in limbo, lacking confidence and filled with angst towards the system, and dare I say, the same situation has occurred on so many occasions with other expensive public inquiries done and not even dusted.

Peter Santangelo's 2007 review should have taken maybe only one or two days if nothing had changed and the audit maybe a little longer. He made 38 independent recommendations. No wonder people have so little faith in our system, a system which perpetuates known ills and inefficiencies.

I know from my own recent experiences in the Devonport area just how difficult it is to deal with the department, particularly when it comes to mental health issues, to get action from the public service - not from individuals but from the service itself - because what we end up with is a system that is inactive.

My concluding comments, Mr President, are that there is so much in common with the Ward 1E situation and the Ashley detention centre. For example, both have been the subject of repeated inquiries which have had delayed responses to recommendations, both have long-term effects upon individuals, families, general and professional communities and both are very costly entities to the Government and the Treasury, and we still have no resolutions.

Mr President, dare I suggest that we are supposed to have this whole-of-government approach to these issues and yet we still ignore them.

I do wish the new generation of staff at Ward 1E every success and support the noting of the report that has been brought to our attention by the honourable member for Windermere.

[5.12 p.m.]
Ms FORREST (Murchison) - Mr President, I would like to acknowledge the member for Windermere for bringing this motion forward. It is a shame that we have to consider an issue that has been the subject of reviews in the past and, when you read through the report, it seems that a lot of the issues, whilst there has been some action and some progress, mostly of a superficial nature when you try to get a broad overview picture of it, it has not really made that fundamental cultural change that I believe is needed to meet the needs of both patients of Ward 1E and the staff.

I wanted to start by talking about mental illness as a whole and the enormous challenge and frustration experienced when dealing with mental health issues and providing care to people with mental health illnesses.

When I was a student nurse, going back probably about 25 years, we all did our rotation in the psychiatric ward and it was a bit of an eye-opener for someone who was just 17 at the time to see the diversity of people in those wards. As a young student nurse, I felt completely powerless and could not see that these people would ever get better.

When I was there the ward had a lot of alcoholics and a few psychotic people and others with illnesses that I probably did not have a good grasp of at the time, Mr President. Often you did the ward rotation before you did the theory on it so it was interesting training. That is why I think university training has a lot to be said for it, that you get that theoretical component before you are out there amongst the patients.

It is sad that, from the report the member for Windermere tabled and from his contribution, things do not seem to have changed that much, and that is over a long time. Unless you have been in that place - have a medical background or worked in those areas - you really do not appreciate how difficult it is. The other point the member for Windermere made was that people suffering from mental illness are some of the most vulnerable people in our community, and that is absolutely right. But, Mr President, I would also say that they are also some of the most inspiring and productive members of our society when their illness is well controlled and managed. I have some very dear friends who have significant mental health illnesses who are fantastic people - creative, caring, holding down really important jobs - doctors and the like. The Leader thought that was a little bit amusing.

Mr Parkinson - The thought crossed my mind that I hope they're not surgeons.

Ms FORREST - If their illness is well controlled they can do absolutely anything, depending on the nature of their illness of course. Some of these friends of mine are very productive members of our community on a number of levels. I think the challenge is to have people with mental health disorders ideally operating at that level. The challenge is to treat them and provide a service and a system that enables them to get well, to stay well and to have a functional life. Unfortunately that is not always the case and some mental illnesses are such complex and diverse problems that it just does not seem to be possible, but there are a lot of cases where it is possible. I think unless we have a really well established and well supported health system it is not going to happen in a lot of cases.

Generally people without some sort of knowledge or background in mental health disorders often do not know how to react or respond to people with a mental health disorder. They often do not understand or appreciate that people with certain mental health disorders react to situations in ways that we think are not normal. For example, people with bipolar disorder can become really loud and aggressive when they are just trying to make a point and unless you know that is what is happening you think, 'What's wrong with you? Just settle down. Calm down', but it is just them. They are not likely to come across the table and hit you, they are just loud and seemingly aggressive. Sometimes they do not manage to behave in ways that we think are responsible. They go on spending sprees and spend hundreds of thousands of dollars or thousands of dollars, depending on what their capacity is, but they will max out their credit cards.

Mr Parkinson - You don't have to be bipolar to do that.

Ms FORREST - No, you don't. They just have no control when their illness is such that they do these things that we would think were irresponsible. It is not that they choose to do that, it is the way their illness manifests. I think a lot of us do not really understand what it is like and we perhaps make judgments about people based on our lack of understanding, and unfortunately I think that is the case in some areas. Sometimes we might see people and say they are out of control but they are not out of control, it is just that the way they express themselves appears out of control to us, who most of the time can stay in control - and we all have trouble at times with that, I am sure.

I get a high percentage of constituents through my office with issues related to mental health. In fact, my assistant has been recently commenting on the number that we seem to get. They do not just come from my electorate, they come from across the border sometimes as well. I think it is because of my background; they know that I understand a bit more about some of their issues and they do not have to go through the whole story again. It is a challenge, it is very wearing and time-consuming, particularly when you have a lot of other things on. These people take up a lot of time, but that is the nature of the beast, I guess. I certainly would not want them not to come. If they have things I can possibly help them with, that is fine by me. One of the reasons I ensured that my personal assistant undertook the mental health first aid course was the high level of activity we have in the office regarding constituents who have mental health illnesses. She found that very useful but it was still an ongoing challenge.

I noticed that last Friday night - not this one but the one just gone - Andrew Denton presented a documentary, which I unfortunately did not see - I would like to get a copy of it and read it - but I noticed that there was a bit of an overview of the documentary in the TV guide in the Advocate. I thought it just helps to look at the size of the challenge. I would like to quote a couple of sections out of here - this is just an overview of his documentary. It says:

'It takes an insightful look at mental illness, eschewing the usual experts to get straight to the heart of the matter by speaking with people who struggle daily with various psychological conditions.

In attending the Annual Mental Health Services Conference in Melbourne and speaking with people like Sandy Jeffs (whose business card reads "poet, lunatic and insanity consultant") and songwriter Heidi Everett, Denton says he conducted some of the most extraordinary interviews in his career.'

Further it goes on to say:

'The approach we decided to take in the end was going off most people's reaction to mental illness, which is one of blind fear. And understandably so - it is so seemingly unknowable.'

Mr President, this is the point I was making. People often shy away and do not want to talk about it because it is all too hard. We don't understand it. Denton goes on to say,

'The interviews I did, particularly with Heidi and Sandy, were amongst the most astonishing I have ever done because here were two people who have been undeniably mad and still struggle with the balance between reality and unreality. But they are able in a very clear way to take us inside what it is to be mad and show us the human being.'

The reason that I read that little bit out was that I thought it was interesting they used the word 'mad'. For me, that should have gone out ages ago, but I guess Andrew Denton is making his point. But I think to call someone mad is quite a derogatory term and I was surprised to read it there.

Mr Parkinson - It fits in with the program. If you watch it you will see what he means.

Ms FORREST - I am sure it does, but it just seems an interesting way to put it into print promoting the program for people to watch. I just wondered if it sets up a barrier almost - these mad people. One other comment that I will quote is:

'If someone has a heart attack, we have even a vague idea what to do. But if someone has a mental breakdown, it's almost impossible to know what to do. It's very hard to call an ambulance and say "My friend thinks love is the colour of the sky - come quickly!"

What I was hoping that this documentary would do is show people that in the middle of all of that is a human being, someone who needs help and shouldn't be run away from.'

Obviously it is a program that addresses a lot of those issues. But I think that summary of the documentary highlighted the challenge and the difficulty for the wider community in accepting mental illness and for people to be treated appropriately when they are suffering from some illness. I agree for most people in the community mental illness is unknowable and a real challenge. Comments contained in the Santangelo report also demonstrate that dealing with complex mental health issues can be a challenge even for experienced staff. I just wanted to read one section of the report here. These comments highlight the challenges that even the staff feel. These are staff who are experienced and skilled in dealing with mental health disorders. It is under the section 'Interpretation and evaluation':

'Ward 1E has been the subject of intense review and external criticism over a period of three years, with substantial media and political intervention. Staff claimed that allegations made that were subject to the HCC investigation were not proven. This has not been acknowledged publicly and staff have established the cynical view about the level of support that will be afforded to them given further allegations. As a result, a "siege" mentality has emerged manifested by staff who are both risk and complaint "shy", fearing that acknowledgment of complaints and incidents will induce undue criticism escalating an already poor image and reputation as well as potential negative personal disciplinary consequences.

Another attitudinal factor operating in the unit seems to be a prejudicial view of the "undeserving" clients. This client group is typically "Personality Disordered" and by reputation, according to staff prejudice, unreliable, manipulative and self-serving. One stakeholder asserted there was a "pecking order" of psychiatric illnesses in the Ward with "Personality Disorders" at the bottom. This client group is also typically frequent users of the mental health services and extremely sensitive to the emotional environment of the ward. They are typically long-stayers in the ward as medical staff, in particular, are reluctant to discharge them for fear of a negative outcome, most commonly the client self harming bringing further criticism about the clinical decisions made. This scenario of a "Mexican standoff" between staff and clients has the cumulative affect of an unhealthy outcome for both client and staff.'

That just shows this is a minefield of challenges even for the staff. They are worried about making a complaint for fear of further scrutiny and adverse publicity and so it goes on. They are talking about this pecking order of disorders. It made me realise how difficult it is to get to the bottom of what is really going on here. The member for Windermere has given a fairly comprehensive overview of the findings of this report, so I do not want to go into those again. But I want to make a few brief comments about the report. The executive summary summarises the reasons behind the report, and the events leading up to its review. The member for Windermere went over that. I want to quote from page 7, the general comments by Mr Santangelo. He said:

'In general, the reviewer found that the stated claims about the implementation status and progress of the recommendations as at November 2006 were correct. In fact, a number of additional actions had been initiated over and above the recommendations made.'

He further said:

'While the initial effort in implementing the recommendations has had the positive impact of pushing through the inertia of the organisation in order to progress a reform and change agenda, principles of more sustained change management need to be applied in order to ensure that the reform and culture change agenda does not lose its momentum.'

In 2007 he made those comments, based on the recommendations from November 2006. If we listen to what the member for Windermere has had to say, Mr President, you ask whether that is right. It seems the problems are still ongoing; the cultural change has not occurred. He mentioned all the bullying and harassment, and it is well documented in Mr Santangelo's report, so I wonder whether the report truly reflects the current situation even now. I certainly hope we are not back here in a year or so's time having the same discussion.

I thought it was interesting to look at the methodology used in the review. They had stakeholder consultations, with 82 individuals participating in formal interviews and forums over three weeks of the review. The stakeholders included community and inpatient staff members, official visitors and non-government agencies such as the Richmond Fellowship, Mission Australia, Laurel House Sexual Assault Service, TasCAG, Aspire and ARAFMI - that is the support group for mental illness. That number of 82 does not include the staff and consumers seen informally or staff attending formal meetings.

The individual interviews were all conducted with professionals, with staff members both at the nursing staff level as well as management. They had informal staff discussions, again with the professionals. They had the non-government organisation stakeholder forum which is for those organisations out there providing services in the community.

An informal discussion with consumers was carried out, but no formal consumer consultation. I wondered why they did not extend the review to the family members of the patients of ward 1E , particularly as the member for Windermere's submission detailed families' comments about their loved ones who had suicided or struggled. The family members are the ones who are there for that person when they are discharged, and there for them at other times as well. It appears that they did not engage that group of people and I just wonder why. It appears it was the professionals and the NGOs, but there was no formal forum for consumers as such, and families.

One other point I wanted to raise highlights some of the problems that were witnessed. This is also on page 21 of the report under the heading 'Perception of and reaction to the audit and review by stakeholders'. This is before it talks about the methodology. It says:

'Some staff of Ward 1E expressed some anxiety about the purpose of the audit and review, perceiving it as another opportunity to lay further criticism and blame on staff in the Ward. Other staff expressed the view that this was an opportunity to expose issues of concern and affect some change for the future. Certainly, the latter appeared to be the view of managers.'

It seems the managers thought it was an opportunity to air those concerns, but the staff caring for the patients thought it was just another go at them, basically that if these issues are laid out again, they were going to be the ones who copped the flak. I think it would have been a very challenging report to write; it would have been frustrating. I noticed in the paper that was tabled that Mr Santangelo said there was some disappointment in his heart, I think I read that, in relation to the findings.

[5.30 p.m.]
The recommendations he made basically broadly cover the same areas that the task force appointed by the minister in 2006 did, and I do not wish to go over those again. There were clearly some areas that really needed to be worked on. There was the issue of the role definition between the clinical nurse manager and the clinical nurse specialist. That needed to be articulated well so that there was no crossover and the boundaries were clearly defined as to who was responsible for what. There was an ongoing need to reinforce the staff boundaries in relation to inappropriate interpersonal behaviours, and the issue of bullying and harassment in the workplace. There was also a need for recruitment and retention of medical staff which is difficult in the current climate in Ward 1E . There was certainly a need for a culture of disclosure without fear of retribution by staff and patients.

There was a comment from the member for Windermere about the application of a smoking policy. I know that has been an issue in many mental health wards, because unfortunately a lot of mental health clients do smoke, often quite heavily, and to expect them to come in and stop is probably a bit unrealistic. They also tend to drink very strong coffee, as do the staff. It just goes with the territory, I think. Obviously, if there is a non-smoker in the ward they should not be exposed to passive smoking, so finding that balance is definitely a challenge. I imagine that someone who is severely addicted to nicotine would find it a challenge to have a policy imposed that means you cannot smoke in that area. I guess there needs to be some work in that area to try to meet the needs of all patients as well as staff.

There was a need for improved communication between senior management and staff; nothing new in that, Mr President. That happens in a lot of areas, not just mental health services. Also, that the professional development needs of the staff need to be identified.

Mr Parkinson - You can't smoke inside anyway.

Ms FORREST - They do.

Mr Parkinson - Well, it's against the law.

Ms FORREST - I know.

Mr Parkinson - There is no exemption.

Ms FORREST - You pop up and have a look. It is a challenge.

Mr Parkinson - You have to go outside to the courtyard.

Ms FORREST - In theory, yes. It is a challenge.

Professional development needs of staff was another area that was identified as needing further attention.

I did note recently that Ward 1E - and I cannot exactly remember the title - was proposed as a site to run a new program for contemporary mental health service delivery. This is a positive thing and may lead to some of that cultural change that is so needed. I certainly wish them well with that.

A number of other areas related to the recommendations were all listed in the report. I am sure the Government have taken them on board, but I think at the end of the day there really needs to be a significant cultural change within the ward. There needs to be very strong leadership. I do not know the staff there so I am not casting any aspersions at all on their capacity to do that, but I wish them well and I hope they can provide a service that does meet the needs of the patients and the staff because the staff definitely have needs. If you are going to get good staff and keep them, you have to have a workplace that is conducive to a happy work force and clearly in the report and in previous reports that has not been the case.

To conclude, I would like to read from the last page of the report. It states:

'Issues of most concern are those related to the negative attitude and culture, their management and their consequent impact on practice. The implementation plan, based on the recommendations made by the review in this report, is an attempt to:

" reconcile the work previously completed through the Taskforce implementation of the HCC recommendations,;

" identify those issues requiring ongoing attention;

" provide a positive way forward.

It is meant to be a working document and every effort has been made to ensure that the strategies suggested are achievable within the normal operational and strategic responsibilities of staff members charged with their implementation. The reviewer trusts that this contribution meets the goal of improved services delivered at Ward 1E .'

Mr President, I can only say I agree with those sentiments and I hope that is the outcome.

[5.34 p.m.]
Mr PARKINSON (Wellington - Leader of Government Business in the Legislative Council) - Mr President, as far as the current nursing staff on Ward 1E is concerned, there is a total of 24 nursing staff, of which 21 are nursing staff with a mental health qualification. There are 17 full-time registered nurses, of which 15 have a mental health qualification; seven part-time registered nurses, of which six have a mental health qualification. Current staffing levels on the ward compare favourably with interstate acute unit staffing levels. Base nursing staffing levels are also complemented by a casual pool of nurses for times of high acuity and unexpected staff leave.

The Santangelo report identified that the majority of the Health Complaints Commissioner's recommendations in relation to the ward had been implemented. The report provided further recommendations focused on culture change and improving client care. Mental Health Services is working with stakeholders to develop a positive and inclusive culture to promote long-lasting and sustainable change. Some of the strategies implemented to date include the following: the appointment of a strategic nurse coordinator to lead and drive cultural change; an emphasis on the provision of treatment and care, which is client-centred and includes the appropriate engagement of carers, families and significant others; developing a culture, supported by policies and procedures, which does not tolerate bullying and harassment and empowers staff, clients and families to report bullying and harassment so that appropriate action can be taken; implementation of a performance management framework which mandates appropriate professional conduct in line with legislative and ethical requirements and recognises positive staff achievements; supporting staff to engage in professional development and ongoing learning; multidisciplinary team review of all clients to ensure a comprehensive and coordinated approach to client care; the inclusion of a consumer representative of the minister's independent advisory group on mental health - TasCAG - in ward quality improvement and planning activities.

Specifically, a positive and inclusive culture is being developed by the following: a strategic nurse coordinator committed to staying until the job is done and openly stating this to staff; performance management of staff in accordance with a legislative code of conduct and ethical requirements; staff in-service training organised with HR personnel; professional behaviour role modelled by the strategic nurse coordinator, clinical nurse manager and clinical nurse specialist; mediation being facilitated at ward level by the strategic nurse coordinator and clinic nurse manager to address staff conflict; clear direction being articulated with regard to focusing on client-centred care; openly recognising and praising behaviour in staff, that is professional and caring; the strategic nurse coordinator having an open door to staff, encouraging staff to talk about issues that they are experiencing on the ward, focusing on solutions and ways to work together; promotion of an open and inclusive service in the media. This strategy is designed to improve staff morale and also make a very public statement about the intention of Mental Health Services and Ward 1E to move forward in an open and transparent manner and provide a professional and contemporary service to the community, inviting their participation in that process, by practice, development and initiative being undertaken, conducting action learning sets on the ward with one group being forward-based clinical staff and another group being for senior management within both the ward and community teams; by attendance at practice development, round-table meetings at Monash University by senior management of the ward to assist management to support staff in the development of evidence-based clinical practice at Ward 1E ; by team-building activities which are being undertaken, including four full days facilitated by 'get yes' solutions to commence in May and a team competition which has been organised to come up with a phrase that encapsulates what the service does. The employee assistance program has been well advertised and staff are encouraged and supported in accordance with these services. Performance development will be undertaken in a structured way, once clear expectations regarding professional behaviour and standards are established. All reasonable staff development activities are being supported in the interests of developing evidence-based clinical practice at Ward 1E with an ultimate focus of improving client care and client outcomes.

Staff-development activities include the clinical nurse manager attending a contemporary management course to facilitate contemporary management of staff; a clinical staff member attending the Women's Health Conference in Melbourne; a clinical staff exchange with the Alfred Hospital in Melbourne has been organised, proving to be very popular; training in responding to sexual assault allegations which is organised to commence for all staff at the end of April; clinical staff attendance at the Australian College of Mental Health Nurse Symposium and that will be in May; clinical staff attendance at the symposium organised by Forensic Mental Health; clinical staff attendance at clinical supervision workshops, organised by Mental Health Services; senior management attending nursing leadership conference; clinical staff attendance at de-escalation workshops, organised by Forensic Mental Health.

Three clinical staff have become actively involved in the Beacons Project, reducing and, where possible, eliminating the use of seclusion and restraint. These efforts have been recognised nationally and Ward 1E has recently been selected as a pilot site for implementation of the national practice standards for the mental health work force.

ARAFMI official visitors and family members have recently reported an improvement in their engagement with Ward 1E .

Just by way of background, in 2005 a health complaints commission report was released which made 26 recommendations for improvements within Ward 1E and Mental Health Services in Tasmania. The instigators of this report were former nursing staff at Ward 1E and they became known as the whistleblowers. At the release of this report a task force was set up by the Minister for Health and Human Services to oversee the recommendations. The task force was in place for six months. Significant changes were made against all 26 recommendations. During this time, any publicity Ward 1E received was mainly negative. There were also a number of allegations made about particular staff who were working on the ward at that time. These staff had been identified by the whistleblowers in the complaint that they made to the Health Complaints Commissioner. These staff were subsequently investigated and returned to work on the ward at the completion of these investigations. In 2007 a report was commissioned to review the progress made against the 26 recommendations. This is known as Santangelo report.

Mr Dean - That was one of the problems, wasn't it, the staff being returned to work in the ward?

Mr PARKINSON - In this report it acknowledged that, while significant improvements had been undertaken and that most of the recommendations had been well addressed, it identified a number of recommendations for ongoing improvement. Among these recommendations identified was the need to address the culture of bullying and harassment within the ward. It is felt that the issue of harassment and bullying alludes to the staff numbers that were the focus of the investigations following the Health Complaints Commission Report in 2005. Following the release of this report there has been more negative media with claims that nothing has changed. Complaints have been channelled through opposition and independent members of parliament.

There have been a number of complaints made by family members regarding what they believe was unprofessional and poor care given to them and their family members while at Ward 1E . A more robust complaint procedure has been introduced in Mental Health Services in the last few months. Most recently there was a very public complaint made against the service and through the media networks by the honourable member for Windermere. This followed some positive publicity that the ward has attracted since the appointment of the strategic nurse coordinator. Following this, an 11-page letter was sent to the minister by the honourable member for Windermere which is the letter he has tabled in the House today.

All of these complaints, at this time, are anonymous. A response to the honourable member for Windermere's letter is being finalised and he will be offered the opportunity to meet the new CEO of Mental Health Services, Dr John Crawshaw, and the strategic nurse coordinator, Ms Catherine Schofield.

I think it is appropriate, given the criticism by the honourable member for Windermere, Mr President, that I place on the record this letter to the honourable member from the minister which was faxed on 3 April 2008. I quote:

'I am writing as I am concerned that on 11 January 2008 you raised on ABC Radio that you had received further complaints and allegations in relation to Ward 1E . You repeated this in the briefing provided to you in relation to the release of the Santangello report where upon you were asked to provide details so that they could be appropriately investigated.

In subsequent conversations with my office, you were again requested to provide details as early as possible to allow appropriate investigation and followup to occur. I am yet to receive any such documentation from you. It is of significant concern to me that months have elapsed between me being made aware of allegations and complaints in your possession and you forwarding them for appropriate investigation.

I am concerned that you are placing Mental Health Services management, the Department of Health and Human Services and myself in an untenable and unacceptable position, as we are unable to determine if these are new complaints and allegations, which need urgent action or whether they have previously been brought to the attention of Mental Health Services or the Health Complaints Commissioner and acted on. Therefore, we are unable to determine the nature of conduct that is the subject of the allegations and whether it includes staff or patients or management. This is of significant concern as we are unable to ascertain whether the safety of patients and staff is still at risk. Furthermore, delays can make proper investigation more difficult and resolution more problematic.

I want to assure you that I and the Department of Health and Human Services do take these matters very seriously and will take appropriate action. Therefore, I ask you, as a matter of urgent priority, to provide me with details related to complaints and allegations that you received.

Yours sincerely

Lara Giddings, MP
Minister for Health and Human Services'

Mr Dean - Are you going to read my answer to that?

Mr PARKINSON - I could, but I do not believe there is much quality in it and I would rather leave it off the record for the honourable member's sake.

Then we have tabled today, Mr President, the document that is headed 'Provided in Confidence' to the minister, the 11 pages or thereabouts - in fact it goes on to page 12 - containing a range of anonymous complaints which are almost impossible to act upon. But apparently the honourable member - or someone if it was not the honourable member - has, at the same time, released this to the media, which is of particular concern, Mr President, given that complaint number nine, which the honourable member spent some time referring to, involves a coronial inquest where the coroner, himself, has requested that matters not be made public at this time, so not only has the honourable member apparently breached Standing Orders by the manner in which this document was tabled, but he has apparently by doing so made public information -

Mr PRESIDENT - Order. I do not believe that is correct. Would the honourable Leader give his reasons for saying that there is a breach of Standing Orders because it is reflecting on a vote of the Council.

Mr PARKINSON - It is my understanding that there was a breach of Standing Orders. If I am incorrect then I will withdraw it. However, as I say, there is particular concern that in some way the document has been made public in the face of a call by the coroner to try to ensure that that particular complaint, number 9 in that document, was not made public. That is of considerable concern and it is very strange that when a document like that is provided in confidence to a minister, the member would then seek to table it so that it becomes a public document in this House. That is the response on behalf of the Government, and I will end it there.

[5.51 p.m.]
Mr DEAN (Windermere) - I would like to provide an answer to some of the issues raised. First of all I thank the members for their contributions. I have some difficulty in thanking the Leader for the attack upon me, and I would have thought that if the Government were to attack the problem with the same sort of vigour we would not be in the position that we are in today. It really does cause me some concern to think that is the way they have seen fit to go in this instance. To me it was fairly ordinary, because I was simply highlighting issues that had been brought to my attention by a number of members of the public who are, and have been, involved in a number of issues with Ward 1E . They are not issues that I have simply dragged out of nowhere and seen fit to raise, that is not the case.

Perhaps it might also be an appropriate time for me to answer the letter and the reasons for the delay. I had contact with the department on many occasions, so the letter was simply a follow-up to some of that contact. I indicated to them that I was still receiving complaints and, in fact, on the day that I sent the report I received another complaint. I was trying to get all the complaints together rather than send a report off piecemeal.

As I said to the minister in my response to that letter, it has only taken me a few weeks in which to get a response to them containing some of the issues that were raised with me. As I pointed out to the minister, it has not taken me four years to start to address some of these issues and still not address them all.

Mr PARKINSON - The way that the complaints have been -

Mr DEAN - The minister did not answer me on that. If I had a copy of the letter I wrote in response to that I would table it, but I do not have it with me today, unfortunately.

Mr Parkinson - It seems to me that the way that the complaints have come in, it is almost impossible to act on them because there is no way of following them up.

Mr DEAN - It is not impossible to act on them. If that is the way that the Government sees it, then we are not going to see this matter move on in any way and we will see these problems still there in another 10 years' time with another review being done in three or four years' time. I have identified to the minister, very clearly in my report, I am quite prepared to talk with the minister in a briefing situation, person to person, and provided that I am legally protected I will provide the names of some people against whom complaints have been made. I have said that. If I am legally protected I have no problems in doing that. If that happens I would have thought that these complaints could be followed up and I would not have thought that there was any difficulty with that. If that is the way that the Government see it, then I would certainly need to be careful about what I say here.

Mr Parkinson - You were not too worried about protection when you tabled the document which was in confidence, and allowed it to be released to the media.

Mr DEAN - I wanted to speak on the document so I thought it was proper that I table the document for everybody to see.

Mr Aird - Well, you could have just circulated it.

Mr DEAN - I saw fit to do it this way, table it in the Parliament. There is nothing really secretive in the document.

Mr Aird - It was less than open.

Mr DEAN - What do you mean?

Mr Aird - The ideal would be to circulate a document so people can see what they are voting on. But anyhow I think that the Standing Orders Committee ought to address this very issue.

Mr DEAN - The President has provided -

Mr Aird - I will be arguing very strongly for that to occur as a matter of urgency.

Mr DEAN - That is a matter for you, Mr Treasurer, to follow up. I do not see that I have done anything wrong at all.

Mr Aird - Can you see the potential of that situation?

Mr DEAN - I do not really see the real difficulties with it. It is a report that I was speaking to.

Mr Aird - Just the principle. You are asking members who haven't seen the document before to vote to support it to come here without understanding its content, its nature or the reasoning. You just said 'I want to table it', bang.

Mr DEAN - I identified the fact that I had the report, the report that I had submitted and that I wanted to table it.

Mr Aird - You said it was a report, you did not say it was a letter.

Mr DEAN - I said it was a report that I had provided - and I used the word 'report', 'letter' or whatever it was, it does not make any difference. There is very little difference between -

Mr Aird - The issue is that this has emerged before and we have managed to put in other actions to make sure that it doesn't happen again. Anyhow, we will deal with that.

Mr DEAN - The position I was going to take there was the fact that a report, a letter - it is one and the same as far as I am concerned in this instance. I identified very clearly it was a report that I had provided to the minister and that I had replied and I think I said about six days previously - Monday week ago I think it was - in relation to this matter and I would be speaking on that report.

Mr Wilkinson - And there was no opposition to it when you -

Mr DEAN - There was no opposition, you are right. There was no opposition to it whatsoever at the time.

Mr Aird - But the fact is you have done it now and we have to change Standing Orders so that it can't be done again.

Mr DEAN - That might be your position, Mr Treasurer, and no doubt you will argue that.

Mr Aird - Yes, that is right and that is what I will be arguing.

Mr DEPUTY PRESIDENT - If we could move on, honourable member.

Mr DEAN - Yes, thank you, Mr Deputy President.

As I said, this is a very serious matter and I think that that has been made very clear by all speakers. Very clearly it is serious because of the Government's attack on me.

I have done this for no reason other than to try to improve the services, to try to improve the conditions that currently prevail in the area of mental health. That is what this is all about. This is not about attacking people for the purposes of some personal vendetta or for some other issue that will personally satisfy me. That is not what it is about. It is about giving some protection and support to the most vulnerable people in our midst. That is exactly what it is about.

When you talk to parents, brothers and sisters who have people with them who are impacted on by psychiatric illnesses you see it is a very difficult issue for them to deal with.

Ms Thorp - I just hope some of the people with family members in the institution at the moment aren't distressed by the adverse publicity.

Mr DEAN - You talk about adverse publicity; these issues are arising and people out there are giving publicity to this issue. It is not just me, it has been raised by many other people. I am not the only one to raise this and how else do you do something about it?

Ms Thorp - That's just my concern.

Mr DEAN - Yes.

Mr Wilkinson - But your concern as well would be for the people who are in the institution themselves if what is said is correct. That is a real concern as well and those people are probably the major concern.

Mr DEAN - That is right.

I was going to go on to say that this is not good. You are right, it is not good. I would have preferred to have stood up here today and said that the Health Complaints Commissioner's recommendations were either put into place or were being put into place and that there had been marked differences, that bullying had now finished and there was no further bullying. And, once again, I am being bullied to finish this off very quickly.

Members laughing.

Mr DEAN - I am not going to accept that position.

Mr Parkinson - You're not being bullied from this side.

Ms Thorp - I just pointed out the time.

Mr DEAN - It is not a matter that I get glee out of raising here today and it certainly does not do the organisation any good. You are right, it does not. It does not do the people any good who are working there any good either. I agree that it does nothing to stabilise the area of Ward 1E .

Mr Parkinson - If there is bullying, for example, someone has to be prepared to hold their head up on bullying allegations.

Mr DEAN - You are right.

Mr Parkinson - And report it and be prepared to substantiate it without being frightened of losing their job.

Mr DEAN - Mr Leader, I have obviously failed this Chamber today in trying to stress that there are good reasons these people will not come forward. One of the problems currently in the system is the lack of proper protection of these people.

Ms Thorp - How can you act on an unsubstantiated claim?

Mr DEAN - We have examples out there, good examples of where people's careers have been ruined. You obviously do not understand that - with the greatest respect to you.

Ms Thorp - But if I rang the police and said someone over the road is doing something, but I cannot give you their name or address or events because I am scared, what are the police going to do? Act on it? No.

Mr DEAN - That is not right; you are wrong.

Ms Thorp - You have to substantiate it.

Mr Wilkinson - If you say that they're doing this and they're doing it at 17 Mawhera Avenue -

Ms Thorp - I don't recall asking you.

Mr Wilkinson - I know, but it's an obvious answer. I'm sure they'd go. If they're killing somebody at Mawhera Avenue, of course they'd go there.

Mr Parkinson - No, no, 'They're hooning outside my house, but I can't tell you where I live because I'm frightened they'll come at me later'.

Mr Wilkinson - That's a different argument.

Mr DEPUTY PRESIDENT - Order.

Mr DEAN - Thank you, Mr Deputy President. To answer your question, depending on the information provided to the police, anonymous or whatever, the police would act on it if there was a good reason to act on it. Of course they would act on it, depending on the circumstances and everything else. Police have a policy in relation to how they police and what they do where anonymous information is provided. How they handle it, how it is recorded, what their response will be is very clearly identifiable in police standing orders - or it was and I suspect that it still is.

Because it is anonymous does not mean they would ignore it, not at all. If that is the attitude some people take, then they ought to start looking at their organisations very closely. Because much information comes in anonymously, very correct information comes in anonymously. That is why you have the crime stoppers numbers and so on, for that very purpose of receiving anonymous information and information in confidence.

Here the Leader makes the comment that these people should be coming forward and making complaints about bullying and so on. They will not do it until they can be assured that their careers, their positions, will not be placed in jeopardy. Again, it seems that it is falling on deaf ears. It does not seem to be getting through.

You have to have processes in place to handle these situations and there are other organisations -

Mr Parkinson - My advice is that there is a pretty comprehensive complaints and grievance process in place.

Mr DEAN - It has not been working then, has it? The other comment I was going to make was it is all very well to make change, but change will not fix everything unless it is the right change and unless that change is audited and is policed, for want of a better word. You cannot just make change and think that is going to fix it, because that does not work in reality. There is a lot more to it than that.

Somebody sitting in an office and saying that this is what we are now going to do does not necessarily fix the problem. Those who have read the Santangelo report will see that there are good comments in there. So it is not all doom and gloom in that report. He says good things about the ward. He says good things about many of the things within mental health services. So it is not all negative.

But it is unfortunate that the negative issues that really impact on the people at the coal face, in the work force, unfortunately do not seem to have been implemented in the right way, if they have been implemented, and have not been followed up. That is the difficulty we have. Otherwise we would not have this further review coming out identifying these problems.

Having said that, I am not going to say again the reasons I brought this forward. It is very obviously to try to get things right, to improve things in that area and get a position where staff are working well. Most of them are, but the difficulties seems to be higher than that, and there has to be that vertical will to want to fix this problem. If that vertical will is applied, and perhaps a zero tolerance, then I think that we could probably move forward in the right direction. Nobody wants to see another review in another three or four years' time.

If that happened, with the same things arising again, then I think that we would see some drastic measures having to be taken. Nobody wants that. We want to see a good service operating well and these people being supported and able to live as good a life as they possibly can in all of their unfortunate circumstances. I thank members for their contributions.

Report noted.

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