Tall eucalypts tower in the distance, grey upper branches cradling blue sky.
A grey wall, several metres high with a steep overhang, marks the perimeter.
The overhang, which makes climbing impossible, is to stop anyone absconding over the perimeter wall.
This is Thomas Embling Hospital, a high-security forensic mental health hospital in Melbourne’s inner north-east.
If someone in Victoria commits a very serious crime, but is found to be so mentally ill that they didn’t understand what they were doing, rather than being sent to prison, they are sent here.
Along with the high wall, there are less-visible security measures.
“There is a secure zone, which is called a sterile zone, and that has motion sensors within the perimeter wall,” the hospital’s Executive Director of Clinical Services Danny Sullivan tells RN’s Law Report.
“Anyone who enters that will set off an alarm.”
‘My head wasn’t good’
The hospital is currently home to 136 patients. James* is one of them.
He currently resides in the Jardine ward, a locked facility across the road from the main hospital.
It’s the final step before release into the community.
Many years ago, James committed a homicide and other serious violent offences after he went off his daily medication for two months.
“I was just hearing voices and the voices were commanding me to do things,” he says.
He was also having delusional visual hallucinations.
“My head wasn’t good,” he says.
Over time, James responded to treatment and gradually reached a point where he was allowed to live in the community.
“I got out about three years ago and then I had a bit of a bump in the road,” he says.
A urine drug test detected ice, and he was returned to the secure psychiatric hospital.
“I’ve been in ever since,” he says.
Precautions and restrictions
On the morning we visit, the campus feels empty – birdsong from nearby Yarra Bend Park rings out across a road that circles around the interior’s low-rise buildings.
The security system is a complex mix of cameras, x-ray machines, iris recognition scanners, keys and electronics.
Movement within the campus is restricted depending on the patient’s risk profile.
Some are in assisted living accommodation with access to kitchens and cutlery. Some, like James, hold down jobs outside the perimeter walls.
Others can’t go much further than the next room. There’s good reason for the precautions.
“Most of the people here will have either killed someone or seriously harmed them,” Mr Sullivan says.
“You don’t get in here if it’s simply that you were taking drugs at the time, you get in here because you have a serious mental illness and it’s so serious that when you go to trial it’s seen that you weren’t criminally responsible for what you did.
“You’re seen as deserving treatment rather than punishment.”
The average patient spends around seven years living at Thomas Embling Hospital on what’s called a “custodial supervision order” before being allowed to live out on the community on a “non-custodial supervision order”.
A small number of patients who pose an ongoing risk to community safety are never released.
Patients can only have a supervision order revoked by returning to the court that sentenced them.
This happens on average 16 years after the offence was committed.
Professor James Ogloff, Executive Director of Psychological Services and Research at Forensicare, says no one who has had their order revoked has then committed a serious violent crime.
“If we look at the total sample, it’s more than 200 people who have been absolutely discharged over time,” he says.
“Of that group no one has gone on to commit a serious offence.”
The level of lower-level re-offending for those living in or visiting the community on a supervision order is higher — “about one out of every five or six people,” he says.
Only one person in this group has committed a serious violent offence.
These figures are dramatically lower than for offenders who go to jail.
“In the general prison population, at least half of the people are returning to some form of corrections or custody,” Professor Ogloff says.
“We’re seeing far less than half the rate of offending among the patient group”.
‘I didn’t think it was going to happen to me’
Former patient Greg* spent seven years at Thomas Embling Hospital after being charged with homicide. He’s now living in the community on a non-custodial supervision order, which he’s hopeful will end in April.
“I was hearing voices leading up to the offence, it was pretty bad,” he says.
“I don’t feel good about what I did but coming to Thomas Embling really taught me a lot.”
Despite describing his stay as a “shock to the system”, Greg says his stay at Thomas Embling was a period of consistency he desperately needed.
His first year included a 10 month stint in an acute unit.
“If I didn’t come into Thomas Embling, I don’t know where I’d be right now — still going around the revolving door of public hospitals or dead,” he says.
Greg spent his time at the hospital hitting the gym and undertaking further study.
“People think about Thomas Embling, they think we’re all in straitjackets, we’re all nut jobs,” he says.
“It can happen to anyone, I didn’t think it was going to happen to me.”
Insight and remorse
James says he believes “the whole Thomas Embling Hospital is set up for you to succeed.”
He points to the hospital’s therapeutic group sessions, the gym and educational facilities on campus, as evidence of how the system focusses on the whole patient.
But he says ultimately it comes down to the individual.
“It’s up to yourself, if you’re motivated, if you want to get out of here, you have to get up off your ass, get to those therapeutic groups and do the work.”
In Jardine, patients are encouraged to begin their transition to the community, attend therapy groups outside the hospital and gain employment.
James is now allowed out of Jardine seven days a week, 14 hours a day.
When we speak to him, he’s just returned home from his part-time job in the cleaning industry.
Over the years, he says, he’s gained an insight into his mental health and his actions.
In one therapy group, he remembers patients had to sit together and recite their offences aloud.
“It was pretty confronting for some people,” he says.
“A few patients cried while they said their offence, a few patients didn’t like the therapeutic group so they took off and left… but I stayed [and] I said my offence.”
‘We can’t detain everyone forever’
Thomas Embling Hospital is made up of acute units, sub-acute units, units for rehabilitation and an intensive rehabilitation and independent living unit.
Patients have their own private rooms and en suite.
Some of the spaces feel like a retirement home: Long white hallways adorned with patient artwork, a thriving vegetable garden, comfortable seats and nearby nurses’ stations.
Then you enter the ‘seclusion room’ – a stark white room without furniture or sharp corners – or try to pick up a weighted piece of furniture, and reality reasserts itself.
All applications for off-ground leave by patients on custodial supervision orders must be approved by the independent Forensic Leave Panel.
The panel includes a judge, a psychiatrist and a community member, and its primary focus is ensuring community safety.
One patient who shows us his room says he’s looking forward to going to a shopping centre on unescorted leave on the weekend.
It has taken him three years to gain that liberty.
Another patient protests his innocence, saying he’s the victim of a set-up.
This patient is only allowed out on escorted leave.
Mr Sullivan says people will have varying degrees of acceptance of responsibility for their actions, but that “if there is any link between a lack of insight and a risk to the community, leave would not be proceeding.”
“We can’t detain everyone forever,” he says.
He says in order to return people to the community, they have to gradually and incrementally provide more and more opportunities for people to interact “better and better” with others, as their mental health becomes more stable.
“It will involve, for instance, eating with knives and forks, cooking in a kitchen that has sharp implements and accessing the community where you can access drugs,” Mr Sullivan says.
“All of this is the sort of risk that has to be taken to return a person to the community.”
The hospital’s focus on treatment, therapy, and rehabilitation, not punishment, can be difficult for the friends and family of people who patients have killed.
Hear more about that, and the distress patients can feel when they realise what they’ve done, in this episode of The Law Report.
*Names have been changed
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