When healing becomes hazardous: Inside Australia's hospital violence crisis

The emergency department doors slide open at Sydney's Blacktown Hospital, and tucked away in a security locker sits a chilling reminder of just how dangerous seeking medical care has become.

Among the collection of confiscated weapons is a homemade shotgun, complete with ammunition—brought in by someone who came seeking treatment, not to provide it.

This isn't an isolated incident. The Australian Institute of Criminology ranked the health industry as the most violent workplace in the country in a report last year, and the evidence is mounting that Australia's hospitals have become unexpected battlegrounds where those dedicated to healing face unprecedented danger.

A crisis that's escalating rapidly

The statistics paint a sobering picture of what healthcare workers across Australia are facing daily. Occupational violence and aggression is estimated to affect 95 per cent of Australian healthcare workers, while in-hospital assaults in Australia have increased by 60 per cent in Victoria, 48 per cent in Queensland, and 44 per cent in New South Wales from 2015 to 2018.

But it's not just the frequency that's concerning—it's the severity. From 2017-18 to 2021-22p, there was a distinct 56 per cent increase in the number of serious workers' compensation claims (involving at least one week away from work) for workplace violence and assault.

Recent data from Queensland tells an even more alarming story. According to the Courier Mail, there were 9298 incidents between January and June—the equivalent of 51 per day, up from the 42 per day recorded in 2023.

Understanding the perpetrators and causes

Research has provided crucial insights into who's behind this violence and why it's happening. Perpetrators of violence were predominantly young and middle-aged males and almost always patients, with most presenting with mental and behavioral disorders, or psychoactive substance use.

The contributing factors extend beyond individual patient circumstances. Understaffing and overcrowding in the triage area of the EDs, which results in longer wait times and communication barriers, also contribute to the volatile environment.

What this means for you as a patient or visitor

For older Australians, this crisis has particular implications. As the demographic group most likely to need regular medical care, seniors are more frequently exposed to these dangerous hospital environments.

The violence isn't limited to staff-patient interactions—workplace violence also negatively impacts patients, who are at risk of physical and psychological harm because of the violent incidents they may experience and/or witness.

The psychological toll on patients, particularly vulnerable older adults, can be significant. Being present during or witnessing violent incidents can exacerbate existing health conditions, increase anxiety, and create lasting trauma that affects future healthcare seeking behaviour.

Government response: A comprehensive approach

Recognising the severity of the crisis, the NSW Government has established significant initiatives to address hospital violence. The Working Group will develop strategies, priorities and initiatives to address work-related violence in NSW hospitals. View the Action Against Violence in NSW Hospitals Working Group Work Plan for 2024.

SafeWork NSW has also launched broader reforms, including the SafeWork NSW Psychological Health and Safety Strategy builds on the success of the previous strategy and outlines how we will continue our work to reduce work-related psychological injuries.

We will do this by providing programs and resources to support businesses, as well as ensuring compliance with standards.

The high-level hospital safety taskforce mentioned in recent news represents just one part of a comprehensive approach that includes enhanced security measures, better staff training, and improved incident reporting systems.

Promising security measures

One of the most encouraging developments has been the trial of body-worn cameras for hospital security guards. Early results suggest these devices could decrease violence in hospitals by between five and 15 percent—a significant improvement that could make real differences in patient and staff safety.

Hospital security has also been enhanced with better screening procedures, though the discovery of weapons like the shotgun at Blacktown Hospital and credit card gun at Lismore demonstrates the ongoing challenges facilities face.

Rural and remote challenges

The crisis isn't limited to major city hospitals. Rural/remote health services are vulnerable to occupational violence and aggression due to factors such as weapon accessibility, poor network coverage and distance to backup.

Police responded within 30 minutes 84 per cent of the time in rural settings but only 48 per cent of the time in remote settings.

This geographic isolation creates additional risks for patients and staff in regional areas, where backup support may be limited and response times extended.

The path forward

Healthcare unions continue pushing for enhanced protections, including new laws giving hospital security guards more power to move on dangerous individuals before violence erupts. There's also ongoing discussion about providing personal protective equipment for staff, including capsicum spray and stab-proof vests.

The AMA is calling for governments and hospitals to lead change, including the implementation of risk-management systems to reduce the impact and instance of workplace violence, investment in reporting, monitoring and evaluation mechanisms.

The challenge ahead involves balancing security measures with maintaining the welcoming, accessible environment that hospitals must provide for all patients, including those experiencing mental health crises or substance abuse issues.

A shared responsibility

While the government and hospital administrators work on systemic solutions, the responsibility for creating safer healthcare environments extends to everyone. Patients and visitors can contribute by following security protocols, reporting concerning behaviour, and treating healthcare workers with the respect they deserve.

The weapons discovered in Sydney hospitals serve as a stark reminder that behind every statistic is a real person—a nurse, doctor, security guard, or patient—whose safety hangs in the balance. The comprehensive response now underway offers hope that Australia's hospitals can return to being places of healing rather than scenes of violence.