One of the most mentally unwell patients in Victoria will deteriorate further if she continues to be held in solitary confinement, where she has been detained for almost a decade, a court has heard.
The Victorian county court judge Nola Karapanagiotidis heard a major review on Wednesday of the detention of the woman under the Crimes (Mental Impairment and Unfitness to be Tried) Act.
Guardian Australia revealed last year that the woman, whose identity is suppressed, has been held at the Thomas Embling hospital, a secure forensic mental health facility, since 2015. Earlier that year she was found not guilty because of mental impairment of two assault charges, which each had a maximum penalty of five years in prison.
Last October Karapanagiotidis told lawyers from the state’s health and attorney general’s departments they must act urgently in the case, which she described as an emergency situation.
But the court was told on Wednesday that there had been little change in how the woman was being treated.
Dr Calum Smith, a psychiatrist who has independently assessed the woman and provided several reports on her condition to the court, described her as one of the most unwell patients in the state.
He told the court it was concerning that recommendations for her “deseclusion” were not being implemented and that instead issues were being raised when parts of this process did not go as planned.
The court heard that the woman had lashed out at other patients and staff during periods of being released from seclusion, including when she was placed in restraints known as “soft cuffs”, which restrict arm movement. On one occasion, the court was told, she had punched another patient in the head.
Smith said that in part these assaults would be unavoidable but that the hospital also had been provided plans since 2017 that clearly outlined the steps it should take towards reintegrating her. Instead, it was “hustling” to “deal with problems retrospectively”.
“She is not going to get better while she is in long-term seclusion,” he told the court.
“As long as she remains in seclusion, you’re not going to get a significant improvement in her mental state, in her behaviour, in her treatment of other people.”
Smith said Forensicare, which manages the hospital, needed to stop the “waiting for Godot” approach to the woman.
He had been asked to assess the woman’s case because of his previous experience with long-term secluded patients in New South Wales who had been reintegrated, the court heard.
“It’s not going to change. You just have to simply take her out of seclusion … and manage this very difficult situation as best as possible.”
He also said it was “incomprehensible” that people in the woman’s care team were spending as much as half their shifts doing administrative tasks.
Dr Edith Chau, a psychiatrist at the hospital who is managing the woman’s treatment, told the court that if resourcing were not an issue, she would make sure the woman’s medication was correct, have her undergo electroconvulsive therapy and have her moved to a purpose-built facility where “we can more adequately manage deseclusion while thinking about the … psychological and physical safety of my staff and the other patients”.
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She was unable to speak about the resourcing issues that may be affecting the woman’s treatment but that it was possible “deseclusion” could occur this year.
Karapanagiotidis said it was concerning that the process may stretch for several more months.
“I think we can all agree that the restrictions on her freedom and personal autonomy are extreme,” the judge said.
“It is of concern to the court to be told in March that deseclusion is something that could be achieved this year. This is an emergency situation – it should not fall upon the shoulders of one individual practitioner.”
She said she had to apply the law vigilantly and it was clear that the woman’s long-term seclusion had been harmful and injurious.
“The real concern is that we’re sitting here in several years’ time debating or traversing the same issues and that would be unacceptable,” Karapanagiotidis said.
“No one is pretending this is easy, but we have to keep this moving.”
The woman, who has made complaints about being sexually assaulted by staff in the hospital, told the court she wanted to leave the facility.
“I don’t think I should be in this hospital for too long … I just want to be in a different hospital,” she said.
“I just want to be out of here. I just want to be out of here.”
The court is expected to hear from the justice department next month about the resources available for the woman’s treatment.