‘Urgent’ action needed after Melbourne woman’s near decade in solitary confinement in mental health facility, judge says

A Victorian judge says the state's health and attorney general's departments must act urgently in the case of a woman who has spent almost a decade in solitary confinement at a forensic mental health facility.

Guardian Australia revealed in July that the Melbourne woman is being held at Thomas Embling hospital, a secure forensic mental health facility, after being found not guilty because of mental impairment on assault charges in 2015.

The woman, whose identity is suppressed, was formally placed on a custodial supervision order for charges of recklessly causing injury and common law assault. Each charge has a maximum penalty of five years in prison.

But the woman has instead spent much of the past nine years in seclusion at Thomas Embling.

Judge Nola Karapanagiotidis said in the county court on Monday that she was concerned more progress had not been made in "de-seclusioning" the woman since she heard the case three months earlier.

The court heard that there had been inadequate resources to act on a three-phase plan to end the woman's seclusion by the end of the year.

"This is an emergency situation," Karapanagiotidis told lawyers for the health and attorney-general's department.

"I must take this opportunity really to emphasise the importance of adequate resources

"It needs to be management down who are guiding and supporting, and there needs to be adequate resources, and it needs to be given urgent attention ... this needs to be a priority, it is an exceptional case."

The court has previously heard that the woman had been violent towards staff and other patients, which had led to her seclusion, but that the circumstances of her confinement had also made her behaviour worse.

Dr Edith Chau, a consultant psychiatrist at the hospital who has been working with the woman, told the court on Monday that she had asked for five staff to form a support team tasked with acting on the "de-seclusion plan" she provided to the court in August.

But she said that she was instead told that four staff would be allocated, and had not heard back from management about whether the updated business case would be accepted, nor knew when that may occur.

"I suppose I'm not privy to all the managerial decisions around rostering and acquisition of staff, I was told at one point there was no funding, then I was told it would commence, then I raised it at a higher level," she said.

"Where it stood as of last week was that a more robust business case has been put forward to management about what we require."

Chau said that in the meantime she had been "dynamic" about how to work towards "de-seclusioning" the woman, including by using "mechanical restraints" known as soft handcuffs.

This had allowed the woman to spend more time out of seclusion, including in half hourly meetings with other patients housed in the unit in which she will be based.

Chau said that a sticker incentive chart had also been used to encourage the woman to not be violent with staff, but that its success had plateaued.

Chau agreed with Karapanagiotidis when she asked if it was accepted that the woman's violence was "inextricably linked" to the fact she has now been held in seclusion for "what is approaching a decade".

She also said that while there had been some conjecture in the past over the woman's diagnosis, she was instead focusing on understanding the reasons for her aggressive behaviour.

The woman has been diagnosed by various mental health experts as having borderline personality disorder, post-traumatic stress disorder, treatment resistant schizophrenia, and a mood disorder.

Karapanagiotidis said she expected lawyers for the department to ensure her calls for action regarding the woman were "communicated to those who instruct you" and that progress must be made before the matter is heard again in December.

"I'm certainly not expecting this situation upon a return," she said.