Critical Safety issues at Waypoint Centre for Mental Health Care
Waypoint Centre for Mental Health Care: A brief overview
OPSEU Local 329 represents more than 1,200 workers at Waypoint Centre for Mental Health Care, 40 per cent of whom are part-time. The local president is Peter Sheehan.
Waypoint is a unique mental health treatment facility. The $474.1-million facility opened in May of 2014. It replaced the old Oak Ridge building which had existed since 1933.
Key issue: Structural impact on worker safety
Since the move to the newer facility, staff have experienced an increase in the severity and frequency of physical assaults by patients. The numerous structural and technological problems within the building are also posing new health and safety risks that are contributing to the rise in incidents.
Worker concerns about the infrastructure went unheeded when the Atrium opened in 2014. The Atrium is the building that houses the forensic unit at Waypoint. That is where offenders who are found to be unfit to stand trial, or not criminally responsible, reside. Within three months of the move to the Atrium, all the locks had to be changed. Staff members have no confidence whatsoever that the doors (or walls) can provide security from a breach by patient action. The builder states that the doors were not intended to be used in the manner for which they are presently used.
The facility was built as a hospital, not as a maximum security facility, which it is. The institution may have moved to a new building, but the patients have not changed. They still need to be in a secure environment and workers still need to be adequately protected from them. The patient rooms should have been built using cement blocks and steel. Instead, they were built with drywall. Just this month a patient kicked a hole in a wall, destroyed an electrical box, and removed screws from the box. This is unacceptable. These patients come to Waypoint because they cannot be managed at other facilities, yet workers are not even given the most basic consideration of an appropriate building that would allow them to work in a safe environment.
Key issue: Cuts to staff affect safety, hurt patients
The deficiencies in the structure of the building are one factor in the rise in violence against workers; cuts to staff are another. With fewer staff, there is more opportunity for violence. The staffing problems are compounded by the fact that part-time workers are replacing full-time workers, who have more of an opportunity to build a therapeutic relationship with the patients. That connection between staff and patients can actually lead to a decrease in violent incidents.
There is no excuse for cutting staff, especially given that Waypoint has steadily increased its layers of management. A scan of the facility’s organizational chart found at least 73 management positions.
Key issue: Violent incidents on the rise
For some time, OPSEU has been demanding immediate action to make Waypoint Centre for Mental Health Care a safer place to work.
As recently as May 12, 2016 three workers were injured in a violent incident in the forensic unit. One suffered a knee injury and cuts and bruises to his face; the other two were bitten so hard their skin was punctured. The Ministry of Labour has been notified and an investigation is ongoing.
This is the third significant violent incident involving staff injured by patients in just over one month. On April 5, 2016, a worker was stabbed in the back with a screwdriver taken from the Vocational Services area of the unit. A nurse manager who intervened was also stabbed and two other workers were injured. The next day, three more were hurt in another attack.
On April 14, the Ministry of Labour issued four orders for compliance in relation to the April 5 attack. Two of the issues are resolved and by June 3 and June 30 respectively, the employer must:
- re-assess the risk of workplace violence, with specific emphasis on the existence and effectiveness of measures and procedures in place to control and monitor access to tools and other items that could be used as weapons against workers; and
- review and revise (and put in writing, as required) all measures and procedures for the health and safety of workers associated with the operation of the Vocational Services area. When the union asked that the worker Joint Health and Safety Committee members receive copies of the employer’s proposed compliance in advance of the compliance date of June 30, the employer declined, saying that they would be working on it up until the compliance date. This is an unacceptable response and is contrary to the Regulation for Health Care and Residential Facilities.
Waypoint operates under a general hospital model of care. OPSEU believes the model is inappropriate for the types of offenders the facility houses and does not emphasize the safety of staff and patients – which should be paramount.
To improve the health and safety of the workers and patients at Waypoint, OPSEU recommends the following:
1. Security personnel on all wards who can intervene preventatively and in situations of workplace violence to reduce the severity of worker injuries sustained from workplace violence. Prior to divestment in 2008, attendants handled security; these were registered practical nurses (RPNs) with specialized training. Now, registered nurses (RNs) are in charge of security.
Asking nurses to do double duty as security personnel contradicts the goal of fostering a therapeutic relationship with patients. If the nurse has to apply force, the therapeutic relationship is broken and can trigger violence.
2. A dedicated extraction team with enhanced training that should include personal protective equipment use, care and storage in addition to extraction planning and strategy. Again, this team should not include nurses whose role should be focused on building the therapeutic relationship.
3. Walk-through metal detectors for all wards and program areas, including the vocational and hairdressing areas.
4. Safe staffing levels that would allow for:
- working in pairs in a buddy system in hallways and during care; and
- sufficient regular staffing to operate full programming for patients such as use of the pool, tennis courts and the vocational area.
Access to programming options and interaction with regular staff enhances the therapeutic relationship, improves patients’ quality of life, and reduces tension that causes or contributes to violent incidents.
5. Training for frontline staff developed in consultation with the JHSC and delivered by a qualified training provider mutually agreed to by the employer and union. Training should consist of:
- specialized defense from sharp edged weapons, advanced break free and self-defense techniques, and specialized training on pinel restraints;
- specialized take-down procedures (lowering a patient to the floor from a variety of positions);
- specific floor techniques that have been proven to be safe and effective;
- interventions to raise the patient up from a floor or face-down position and transport them safely, and any other additional specialized interventions;
- practice, assessment, and evaluation of skills in intensive practice demonstrations; and
- specifically designed interventions and risk management strategies that address the risks the patients pose to the staff in the context of their environment.
6. Mandatory electronic and visual flagging for patients with a history of violence that includes recording behaviours, triggers, and interventions. Recording these items improves patient-centred care and protects those who interact with the patient. We recommend that patients be individually assessed upon admission and prior to being authorized to move unescorted through the hallways or attending vocational programs.
7. The immediate full-time release of the OPSEU health and safety committee chairperson/designee to:
- address ongoing issues; monitor and report on the progress of the employer’s adherence to MOL orders;
- build the internal responsibility system for compliance with all aspects of the Ontario Health and Safety Act; and
- provide counsel and advice on health and safety training and all matters coming to the Joint Health and Safety Committee until all matters are fully addressed and Waypoint is a safe workplace.
Further, the employer must provide release time for the union health and safety members to attend union health and safety training and any joint training that the parties undertake to deliver.
8. A commitment that the dangers existing as a result of the P3 build and design, including all necessary retrofits to ensure a safe physical build, will be addressed and will be communicated and enforced in future builds at similar facilities across the province.
It is imperative that action to address the health and safety issues be taken immediately before more injuries occur – or worse yet, someone is killed.