Safe unit announced for Westmead Hospital

The Acute Behavioural Disturbance Unit will support patients in crisis and keep emergency department staff safe.

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Sydney’s Westmead Hospital will get a dedicated unit for patients experiencing heightened distress or aggression, the NSW government announced today.

The Acute Behavioural Disturbance Unit (ABDU) will be purpose built to house six beds for patients in severe behavioural crisis. Construction is to start in August and is expected to be completed in “early 2027”.

The western suburbs hospital has seen a 31% increase in the past five years of patients presenting to ED with mental health or behavioural-related matters, according to the NSW state government.

There has also been an increase in aggression towards frontline staff in the Western Sydney Local Health District, as well as by health sector workers generally, with a recent NSW Nurses and Midwives Association report finding that 88% of nurses, midwives and carers surveyed had experienced violence in the last year, most commonly in the public sector.

“Hard work and meticulous planning between the NSWNMA and Western Sydney Local Health District has gone into establishing this specialised unit to address the violence being experienced in the ED,” said the NSWNMA’s general secretary, Michael Whaites.

Rose Jackson, the NSW minister for mental health, said:

“Our nurses and clinicians who work at Westmead ED have told us they are seeing more and more patients who become aggressive or violent and it’s making their job harder.

“Some patients don’t deal well in the loud, busy environment of an emergency department, it can cause them to behave in a way that puts the safety of our staff and other patients at risk.

“That’s why we’re building a new, specialist unit to divert these patients away from the ED waiting room, improving outcomes for them and for our staff.”

The 2020 Anderson review into the safety of staff, patients and visitors in NSW public hospitals recommended the “provision of a safe space in emergency departments (in the best interests of both patients and staff)”, such as “Safe Assessment Rooms” or “PANDA Units (Psychiatric, Alcohol and Non-prescription Drug Assessment)”.

Nepean Hospital, also in Sydney’s west, opened a Safe Assessment Unit in June last year for patients facing mental health and substance abuse challenges and was used by 250 patients in its first three months of operation.

And the Prince of Wales Hospital, in Sydney’s east, opened its Emergency Department Assessment Unit in November 2024 for patients who are acutely intoxicated, have acute behavioural disturbance associated with substance use, psychiatric conditions, psychosocial crisis or a combination.

Both of these have brought down waiting times in emergency departments and reduced the need for sedation and restraint, the NSW health department said.

In his 2020 final report, Mr Anderson said the units that were already operating in Victoria were effective.

“I had the opportunity to visit the Behavioural Assessment Unit (BAU) located in the emergency department at the Royal Melbourne Hospital, as discussed in the Interim Report. At The Alfred Hospital, a similar unit also located in the emergency department is referred to as Behaviours of Concern (BOC),” Mr Anderson wrote.

“These models in Victoria have proven to be effective in safely managing patients who come into emergency departments with behavioural disturbances. Security staff are part of the clinical management team along with the doctors and nurses. The patient is assessed and treatment commenced in a timely manner, and the staff are not placed at risk because the patient is managed in a controlled environment.”

Westmead Hospital experienced two knife-related incidents in November last year, and three security guards and a nurse were attacked the year before by an assailant with a knife.

“With two knife-related incidents in three days, it’s clear that doctors working in the emergency department and their patients are dangerously exposed to extreme violence,” Australian Salaried Medical Officers’ Federation president Nicholas Spooner said last year.

“What has infuriated members most is that they’ve informed NSW Health of their concerns and risks over an extended period of time, and once again, nothing has been done.

“Doctors are going to work every day without even the most basic protections against violence, and that is completely unacceptable.”

The union called for a safety review of the Westmead ED “focused on protecting staff and patients from violent offenders”.

According to a report published last year by the Australasian College for Emergency Medicine, “workplace health and safety, including violence in EDs, is consistently ranked within the top 10 stressors of ACEM’s members, and recently has risen to become one of the top five issues most negatively impacting on ED physicians”.

“Violence in Australian EDs is pushing the healthcare workforce to its breaking point. Urgent action is needed by Federal and State/Territory governments, as well as hospitals. Without immediate, systemic intervention, more highly skilled doctors and health professionals will leave, worsening patient care and further destabilising an already overwhelmed healthcare system,” the report said.

Nine out of every 10 ACEM survey respondents reported that there had been one or more incidents of violence from a patient or accompanying person in their ED in the past week, 79% cent included physical violence.  Nine out of 10 said verbal violence occurred daily or one or more times a week, and 55% said physical violence occurred daily or frequently.

The college said incidents were underreported, so the numbers were actually higher.

“While this service within Westmead ED will help locally, there are many others with the same urgent need to build fit-for-purpose units that help keep staff, patients and our community safe,” said Mr Whaites.

Overcrowding in emergency departments and access blocks were the main drivers of violence in emergency departments, the ACEM report said. It also said there needed to be more security staff, who were well trained, and better ways to report violence and have it acted upon.

The NSW government noted that it had also built the “Safe Haven” drop-in services (including one at Westmead, with more to come) and Medicare Mental Health Centres to provide appropriate alternatives to emergency departments for some patients. The Westmead Integrated Mental Health Complex is currently under construction and due for completion in late 2027.