Meet Jackie Ashmore, ermha365 Chief Operating Officer and former Nurse Unit Manager at Thomas Embling – a high-security forensic mental health hospital in Victoria.

Read on to learn all about nursing security and forensic patients in one of the most unique and under talked about areas of nursing!

We want to thank Forensicare and ermha365 for giving us approval for this interview.

From Corrections Officer to Nurse Unit Manager at Thomas Embling Hospital

Before becoming a nurse, I was a corrections officer in Victorian prisons. I always really liked working with the nurses so, my experience working in a forensic/corrections setting was an influence while studying nursing. As part of my studies, I did a placement at Thomas Embling Hospital, operated by Forensicare.

Thomas Embling Hospital is a secure mental health hospital providing care and treatment for Victorians living with serious mental illness. Patients are admitted to the hospital from the criminal justice system but may also be admitted from the general mental health system.  During this time, I worked with some of the most vulnerable people in our community, with many patients having experienced significant trauma and ongoing stigma.

Working as a forensic mental health nurse isn’t for everybody. It can be confronting, but it’s rewarding and where I wanted to be. I knew I wanted to work with people who struggled with being accepted by our society and who others may turn away or didn’t have the expertise to help. I’m driven to provide the highest level of care and treat people as humans, especially those marginalised in society.  I believe in second chances, maybe even third or fourth, with the proper support.

‘Day in the life’ look like for a nurse in a prison or secure mental health facility?

I’ll describe your first entry point on a workday in prison or a secure mental health facility because it’s not like any other workplace.

It’s important to know that you need to be there earlier than you usually would for any other workplace. There are security protocols to go through before you start your day. This could look like anything from walking through a metal detector, a body scanner, being patted down by a prison officer. The items you bring with you to work are scanned through an x-ray machine, and you are required to produce identification on arrival every day.  

You also can’t have all the things you’d usually have on the outside if you were working in a general health setting. For example, you can’t bring Vegemite into these facilities because the yeast can be used to make alcohol. The security dogs are trained to detect things like this. You will enter with a clear bag, so everything you take in is shown for everybody to see.

It sounds a bit daunting, but once you’ve been working in these security settings for a while, it can sometimes feel like the safest place in the world. You have a solid team surrounding you, a very connected team, because to work here, you need to be connected to your people. And there’s a lot of peer support in these environments.

You will always have your formal handover as you come in. This could involve working with your multidisciplinary team. There’s a strong nurse leader within these facilities and a strong work ethic.

A day in life could be anything from giving medications to playing a game of cards with somebody who’s actively in a state of psychosis. It could be consoling somebody through their psychosis or de-escalating a person in an acute phase.

You will have an allocation of patients, and you might do anything from cooking a meal spending time understanding and getting to know what is going on with that person at that time—coordinating their care, connecting them back to their people and family, supporting them through doctor’s consultation or interventions and trying to reassure clients that they will be okay. There’s always the usual, standard nursing care, but situations can change quickly, so you need to be prepared.

Difference between forensic and security patients.

Thomas Embling Hospital provides care for men and women aged above 18 and typically up to 65. It’s not a physical needs hospital. But there are times when you’d do that type of work. There are generally two types of consumers at Thomas Embling Hospital. 

Forensic patients: Patients who have been found not guilty by reason of mental impairment or unfit to stand trial.  Forensicare patients are held at Thomas Embling Hospital under a custodial supervision order assigned to them by the courts. This will be issued with a nominal term; and the date can change depending on their recovery journey. If their recovery is going well, they can apply to have their orders changed through court. The average stay for forensic patients is approximately 7 – 8 years.

Security patients: patients who are currently serving a prison sentence who require hospital treatment for their mental ill-health.  To be admitted to Thomas Embling Hospital, security patients must be assessed by a forensic psychiatrist, certified under Mental Health Act 2014 and placed on a secure treatment order.  Security patients generally stay at the hospital for 6-8 weeks before returning to prison to serve out their remaining sentence.  While in prison, prison patients will receive treatment and support from Forensicare prison-based services.

What are common misconceptions about forensic mental health nursing?

People think working in forensic mental health is dangerous and that from the minute you walk through the door to the minute you leave, consumers are not friendly and will hurt you, which is simply not true. For the most part, consumers are often victims of crime themselves.

They are targeted in the prison system because they are different; on the streets, they are often homeless; and there is often an extensive history of trauma, particularly in the female population. People don’t plan to become drug addicts; this is often a symptom of the real problem, escaping one’s mind to cope with trauma, the past, the present or the fear of the future. There is so much stigma in this space.

It’s very much a misconception that consumers are either mad or bad. You’ll find, for most of it, they are misunderstood. And so, if we can get back down to the basis of why people have done what they’ve done, what is happening for them, we may be able to work a little closer on how to prevent it from happening again.

It’s about looking at alternate treatment options as well. Treatment doesn’t just come in a pill, and boom, everything is fixed. We need to address underlying trauma, and if we can manage that, we can prevent things like long-term addiction, which can lead to people ending up with drug-induced psychosis.

How can someone prepare themselves to get a nursing job in this area?

You’ve got to walk in with an open mindset and have no judgment for what you will see and who you will work with. This can be difficult because sometimes, what you hear or read is disturbing. Your role isn’t as a judge and/or jury. You’re there to provide the highest mental health care that you can.

We need more people in this space. It’s daunting, even for me moving from a maximum-security prison into nursing in this space. But at the end of the day, they’re just people.

You will have an excellent knowledge base around you, and the teams are pretty damn impressive. They are the closest teams I’ve ever worked in, which is pretty special.

Lastly, you need to be honest with yourself and your colleagues.  Different things may affect you at other times; clinical supervision is vital.

Please give it a go!

Stigma and mental health conditions / those who are incarcerated?

If we want to look at the future and reduce recidivism in these spaces, we need to treat people as people and understand what took them down that path before we can help. People often say, “lock them up forever,” but the reality is most people get out of prison.

Isn’t it better that we treat people humanistically whilst in prison, show them that there are better options when they get back into the community and support their mental health? In that case, we can lessen the opportunity or propensity for further offending in the community.

No judgement is probably the critical component of that. People in prisons have already been judged. That’s already happened in the court. They are not their crimes. So, if we genuinely want to help people and make the community safer, this is the only way to do that.

As a Nurse Manager in this area, what skills/traits were you looking for in your nursing staff?

It helps to have diversity within the team because you want to be able to reflect the diversity in your client group. It’s essential for staff to be empathetic but not sympathetic. It’s very easy to fall into a space of sympathy, and that’s not helpful in this environment. Professional boundaries are essential but not so restrictive, where people don’t connect with the clients. When working in mental health, there needs to be a connection component.

In prisons, in particular, there’s always the concern with over-familiarising yourself with people in custody. So, staff must be aware of this so as to develop emotional intelligence from day one. Nurses are, by nature, very compassionate, and in general nursing settings, you can be more demonstrative with patients and families. Within the forensic mental health setting, you have to be mindful of perceptions, so it’s a different compassionate approach that you have to have.

Education is essential for all staff in that space – what is okay and what isn’t okay.  As a general nurse, grabbing somebody an extra cup of coffee for a patient because you’ve got a spare five minutes is okay – you wouldn’t even think twice about it.  In, a prison setting, doing something like this can be seen as special treatment. 

So, just as much as choosing the right people is essential, educating them on the system and their requirements are vital because it’s such a different environment.

What attracted you to your current workplace, ermha365?

I’ve been working in secure settings for my whole nursing career seven years prior, around 15 years. I wanted to have experience outside of an acute setting and more focus on preventative work in this space. There’s no better place to do this than the community and not for profit sector.

I’d dealt with ermha365 on several occasions through Thomas Embling Hospital with some complex clients. I thought they were a place that was going to have, what I could foresee, support for the forensic population, and they knew how to work with people in the community. So, I could learn as much as I could from them, and they could learn from my secure settings experience.

Our population group at ermha365 does sit in that complexity with co-occurring conditions. So often, there’ll be an intellectual disability or an acquired brain injury coinciding with a mental health diagnosis, which is the standard clientele we will have in our setting. We’re working with those one-percenters that don’t necessarily get everything they need from a generalised public mental health system.

What has it been like, moving into management and strategic roles?

I didn’t think I’d ever come into the management side. But what I did see is that through every step of my career, I could influence or impact more people. Initially, I thought it was the one-to-one stuff I needed to do on the ground. And I loved that. And I still keep my registration current by actively participating in that space. I’d happily walk back out onto the floor again tomorrow, but I felt I needed to move further along the chain to influence things differently.

I’m seeing changes now at that larger-scale policy level from Government, and I’m involved in several focus groups with the Department of Health about mental health reform. I have the opportunity to influence in those spaces on how nursing will evolve in the mental health system in Victoria. That means that we will have, at some point, a better plan, and I’m just contributing differently. One is not more important than the other.

We need people at all levels to influence policy and change things for a better system. I love chatting with any nurse working on the ground, and I often get enthralled and live vicariously through them.

More about Jackie

How long have you been nursing?

I started my undergraduate degree in Nursing as a mature age student at 29.

My career path has been varied. I grew up in a regional town, left school at 16, and worked in a supermarket butcher shop; I managed a Cash Converters store and then trained to be a prison officer. The role I liked the most in the prison service was as a Health Services Officer; I received training in level three first aid and emergency defibrillation and oxygen.

My nursing journey started because nurses surrounded me daily, and they were always encouraging me to do nursing. With their support/encouragement, I applied and was accepted to Federation University in Ballarat, Victoria and graduated in 2013.

I moved into the mental area of nursing after a student placement at Thomas Embling Hospital in Melbourne. I loved it so much it changed my nursing pathway to mental health, and subsequently, I did my graduate and post-graduate program with Forensicare commencing in 2014.

This area of nursing isn’t for everybody; you are working with a highly vulnerable population often portrayed as disliked or “scary”. I wanted to help the people that others avoided. So, Forensicare was the obvious choice for me.

Initially, I wanted to be a paramedic after completing my nursing; I liked the adrenaline; to go and save lives. But that changed for me during my undergraduate degree with the placements I did and the amazing nurse mentors I had.

I stayed with Forensicare for six years and was lucky enough to have numerous opportunities. I completed my grad year and continued to do a post-grad year, completing a postgraduate diploma in mental health supported by Forensicare.

I soon became an Associate Nurse Unit Manager and then a Nurse Unit Manager not long after. During my time as a NUM, I managed an Acute Male inpatient unit, but the prison was calling me back; an opportunity came up to open the expanded female Marrmak unit for mental health inpatients at Dame Phyllis Frost Centre (Victoria’s maximum-security women’s prison). During that time, I commenced my Masters of Health Services Management with Monash University.

That took me to my next job -General Manager of Forensic Intervention Services at the Department of Justice and Community Safety; this area completes interventions for offending behaviour for violent and sexual offenders in the Victorian criminal justice system. I spent just over two years in that role with the primary purpose to combine two clinical services.

I worked in a multidisciplinary setting that sat across mostly psychologists and social workers. So as a nurse, it was a little bit different. There was only one other nurse there when I started who worked in direct interventions, but I had the forensic background, and it sat nicely in that space.

In mid-2021, I started at ermha365, a complex mental health and disability service provider in Victoria and the Northern Territory. I’m the Chief Operating Officer for Mental Health, Forensic and Community Services, and I lead in a clinical capacity. My nursing career has taken me in many different directions, but its heart has always been focused on forensic and mental health.

What are two fun facts about yourself, or two things you would like to add?
  1. Well, I guess I have had an unconventional path to nursing. I left school at 16 and worked in a supermarket butcher shop, managed a Cash Converters shop and then trained to be a corrections officer.
  2. I think I’m a builder/maker at heart. I spend most of my weekends outside in the garden, either pottering around or making things out of leftover pieces of wood. And that’s my downtime. That’s my space.