# Mentally unwell woman in solitary confinement for almost a decade ‘an emergency situation’, Victorian judge warns

Psychiatrist says woman detained at Thomas Embling hospital is one of the most unwell patients in the state

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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