Aggression and violence at Canberra's adult mental health unit may be related to drug use, especially the drug ice, and alcohol as well as smoking bans.
Australian Nursing and Midwifery Federation ACT branch secretary Jenny Miragaya said she had heard from her members that the higher incidence of violence and aggression at the unit was related to the increased use of prohibited substances.
Ms Miragaya said there was a shortage of mental health nurses combined with an increasing demand for services.
"We're dealing with acutely unwell patients, they have a mental illness. We've now got an increasing demand for mental health services and we've got the other issues related to drug and alcohol abuse, particularly an increasing incidence of people who are affected by methamphetamine," she said.
Katrina Bracher, executive director of ACT Mental Health, Justice Health and Alcohol and Drug Services, said there was no easy answer as to what was behind the aggression and violence at the unit.
"Mental illness in its extreme, people can really have quite distressed, disturbed behaviour. It's part of their illness ... that's just how it is for some people," she said.
"But we also see a large number of people where the co-morbidity of alcohol and drug use is a complicating factor.
"Anecdotally we are hearing reports from the nursing staff indicating that the aggression and the violence that's associated with ice is actually impacting on some of the people that are admitted to the unit.
"That makes it really challenging from the medical perspective in terms of diagnostics – is it a mental illness? Is it a mental illness with an addiction? It's challenging from a nursing perspective where people have these very complex, complicated behaviours to manage and it's also complicated from a psychologist's and social worker's perspective where they have complicated therapeutic programming to support people while they're in the unit."
Ms Bracher said when smoke-free environments "were well implemented and staff are on board and followed the operating procedures well", there was evidence to suggest there was less aggression and violence.
"The caveat on that is that they're tough environments to consistently have all staff implement and be rigorous about how we support consumers in the unit to not smoke," she said.
"The public health aspects of people smoking in a health facility just cannot be ignored any longer."
The impact of smoking bans at the unit is also a concern for ACT Mental Health Consumer Network executive officer Dalane Drexler.
"Consumers are reporting to us that it's a significant concern for them," she said.
"Not only do we have people in there who are saying that there are violent incidents surrounding smoking and it's not always the smokers who are becoming aggressive, we also have reports from consumers who won't admit for voluntary treatment because they're a smoker and they don't want to be forced not to smoke when they're already in a very distressed state.
"When somebody is mentally unwell and they lack capacity to make decisions, they're a risk to possibly others and certainly themselves, that is not the time to be forcing somebody to stop smoking."
She said it was important to remember people were in the unit because they need "that kind of medical intervention".
"They're there because they have a mental health issue and because they need that level of support," she said.
A provisional improvement notice relating to aggression and violence at the unit is in place until October.
ACT Health has been working with staff and health and safety officers to develop an action plan to improve staff safety.
Aspects of the plan include early recognition of psychological distress by staff, reducing the acuity of people in the unit and supporting staff with rosters and training.