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Meet Matthew Armstrong, an Emergency Mental Health Registered Nurse now working for Barwon Health. Specifically, he works as a PACER nurse alongside Victoria Police. He also tells us about his time working at Australia’s detention centre on Nauru. Outside of nursing Matthew has the unique hobby and side hustle of designing a publishing tabletop board games under a hobby company name – Manticore Entertainment. He is even an amateur novelist!
PACER Nurse
What is a PACER nurse and how do you become one?
PACER stands for Police and Clinician Early Response, it is a police and hospital combined initiative that sees a Senior Mental Health Clinician ride in a police car, one up with a uniformed police officer, responding to jobs dispatched by the police Radio Dispatcher, providing immediate assessments and referrals in the community on a daily basis.
Assessments comprise of Mental State Examination, Risk Assessment and advice to police, clients and families. Most of the assessments would be conducted at clients houses, or sometimes, at GP clinics, private hospitals, out in the streets or any other place, where the police have received a 000 call from a “complainant” (the person who called 000) and I deem that a mental health assessment is appropriate.
Whilst PACER is designed to provide timely assessments to patients in the community and to provide advice and guidance to police – it also contributes in a large way to avoid police bringing all those patients to the Emergency Department for an assessment which can be overly time-consuming for police, needlessly expensive for hospitals and a misdirected method of getting treatment for patients.
There are many traits beneficial to PACER but the foremost traits required would be the ability to think quickly on one’s feet, the ability to manage extremely dynamic and risky workloads, confidence and leadership.
The skills required can only be developed over years of experience working in acute mental health, usually on a CAT team (Crisis Assessment and Treatment), Psychiatric Phone Triage or ECAT (Enhanced Crisis Assessment Team) in an Emergency Department. PACER is essentially the next step up from those services and your usual PACER clinician will be working in all those roles, or has spent years working in those roles.
The specific skills required are those of acute Mental State Examination, Risk Assessment and safe decision making without being risk adverse. The reason I say it is a next step up, is because you’re one up as a mental health clinician, and often advising groups of other emergency services on what steps they need to take at most jobs. On occasions I’ve had to lead a team of many police members (on rare occasions this has included CIRT, the polices Critical Incidence Response Team) and Paramedics. Often I’m giving advice to GP’s and other health professionals at the end of an assessment.
Qualifications for me, as a Nurse, include an undergraduate degree in Nursing and a post Graduate Diploma in Nursing (Mental Health) as a bare minimum, but at least 5 years experience following ones Post Grad would be advisable before thinking about applying for PACER.
What types of patient presentations do you see as a PACER nurse?
Most presentations involve some type of Mental Health Risk, and often other types of Medical risks which have to be appropriately managed. Some of the most common are:
- Suicidal Ideation (often with a suicide attempt having occurred)
- Deliberate Self Harm
- Patients presenting with psychosis, often presenting to the police in a manner which to the police appears nonsensical and bizarre.
- Drug and Alcohol intoxication – often patients presenting in a bizarre manner can be alcohol and drug effected and police may require professional advice on how to act.
- Personality Disorders are the most common presentation for PACER and can include all of the above as part of the presentation.
Common misconceptions about a PACER nurse or mental health nursing do you want to bust?
I think most people (even in the profession) don’t know what PACER does. I’ve met a lot of people over the years who have expressed interest in the role I’m performing and want to know what it actually does. So rather than a misconception, it’s more so the fact that PACER is a bit of an unknown for most people.
As far as misconceptions about Mental Health Nursing, most non-mental health clinicians tend to “thank” me for doing a role they could “never do!” but I feel it’s the best kept secret (which is not a good thing as we need more staff!). It (mental health nursing in general) is not a role that is any more difficult than other nursing roles, it’s just very different and once people learn that the role revolves around Mental State Examinations and Risk Assessments they quickly learn that anyone can do it once they know how to.
Is the role dangerous? What is the relationship between PACER nurse and police officer?
Yes, any role that involves working with the police has to be undertaken with the understanding that you’re placing your life/safety at risk every day when you go to work. Just like the police and other emergency services do. PACER responds once a first responder unit (a divvy van with 2 uniformed members in it) has already made contact at the scene of the 000 call. That’s not to say that things don’t still happen.
I’ve seen police pull fire arms on a patient who was armed with a bow and arrow, I’ve had a patient throw a machete at a group of myself and 3 police members, and a lot of the environments that the assessments occur in would never normally pass the Home Visit Risk Assessment required for regular community mental health staff.
The relationship between the police member and the clinician is as partners on the job. We work together and make decisions together, whilst police will endeavour to keep the clinician safe at all times by not letting them enter a dangerous scene and not leaving the clinician by themselves if the patient is deemed to be dangerous.
All the police doing PACER are generally regularly rostered onto the job, and the more they do it, the better their understanding of Mental Illness becomes, and the better they get at the job themselves.
Why is being a PACER nurse a highlight of your career and what is the Chris Allen Model?
I feel really lucky to get to work with the Victorian police. They are constantly living up to the values attributed to the Victorian Police Force, Respect, Leadership, Professionalism, Support, Integrity, Safety and Flexibilty. The PACER clinician really has to exemplify all those values themselves if it (the partnership) is going to work well.
Over the time that I’ve worked on PACER I have been fortunate enough to work with Chris Allen (currently at the time of writing this blog, he is a commissioned Police officer holding the rank of Inspector). Chris devised a model for PACER that is more proactive, rides around in the car for the duration of the shift, allowing PACER to respond more quickly to jobs, effectively turning more police away from the Emergency Department and bringing assessments and referrals to more patients in the community instead.
Under this model we respond to any jobs that the clinician and police member on the team think that we can help with, not just the obvious Mental Health ones. The amount of times we’ve helped out police at a scene where Mental Health was not the primary reason for the 000 call is so numerous that this in itself supports the need for running this particular model.
Chris’ foresight sees the workload of PACER increase dramatically, but with it comes more flexibility and leadership as the role provides a more holistic coverage of advice to emergency services across the board.
Whilst Chris didn’t give this title to the model himself, or probably even think of it as a model, I have since taken this model to a second Mental Health Service and worked closely with his equivalent down here in Geelong, and we have not only successfully implemented the same model here but we continue to build upon it and perfect it, on a daily basis. The decision has seen amazing success and a huge decrease in the workload coming to the Emergency Department.
Whilst I’ve worked in many areas across my time doing nursing, PACER is the highlight because it’s such a specialised service and we get to do a lot of things that most nurses would never think of. Some of the exciting jobs I’ve been on remain strong in my memory, even years later.
What do you wish you knew before you started in mental health nursing?
I wish I knew how highly intelligent and experienced most of the consultant psychiatrists I work with were! I highly underestimated them, and some of the consultants I’ve had the pleasure of working with have been an amazing source of leadership and guidance.
What is great about working at Barwon Health and why should others consider a career within this large health service?
Baron health strives to hire the best staff to fill their mental health positions, and is led by an amazing team of Psychiatrists, Nurses and Allied Health staff who all really work together to bring the best possible care for our patients.
The staff are particularly all highly educated these days, and they continue to strive for excellance by also involving the Centre for Innovation in Mental Health and Clinical treatment in order to find new evidence for mental health treatment and bring it to our patients sooner meaning that they don’t just follow evidenced based treatments but also strive to innovate and introduce new ones of their own. Working in such as service gives us as nurses amazing opportunities to be a part of this.
Nauru
Can you tell us about your time on Detention centre on Nauru?
I had to do a previous 3 month deployment to an extremely remote centre in the outback of WA first in order to prepare myself for Nauru and once I’d completed that the company then started me on a fly in, fly out trip to Nauru, which is a tiny Republic in Micronesia to the southeast of Australia. The country is actually a member of both the Commonwealth and the United Nations.
There is an Australian Operated “Processing Centre” there for people who attempt to come to Australia without a Visa, by sea. They are deemed to be Illegal Maritime Arrivals (IMA) and there has been a law passed in Australia in 2013 by the federal govt to make attempts to turn back boats where possible and to deny refugee status for those who are reasonably believed to have deliberately discarded or destroyed their identity documentation.
Due to these changes, there ended up being a really high number of detainees who ended up in Detention Centres all around Australia and also in Nauru and Manus. I was interested, as a nurse, to find out how being stuck in these holding areas affected people from a mental health level and what was really happening behind the scenes.
My role there was very much revolving around the government’s requirements to provide medical and mental health treatment to those people who had come to our country in that manner, as such, I provided a standard mental health assessment to people who had not had one within a certain time frame.
From those assessments, we would usually identify those that required more frequent contact, and we were able to then involve them in group activities, therapy sessions, referrals to more specialised services on the island such as the Torture and Trauma team and I was also regularly bought in to consult on, and in many cases oversee mental health crisis’ occurring in the centre.
The most positive thing I took to the island was creating a “Tabletop Board Game Group” which I ran on a daily basis when I was on shift, where I would travel down to one of the camps and in a private air conditioned room I had quite a number of board games that were donated by GUF (a private company in Australia specialising in board and card games).
The games were enjoyed by the people in detention there are were a great distraction for them from the long days on the island which dragged on, for some of them, for years. I then started holding board game sessions for some of the teenagers on the island, as well as some families in other parts of the centre, to give them a semblance of respite at least. I introduced other clinicians to the group, with hopes that it would run long after I’d left the island.
I often made bedside calls to the tents where individuals slept, in order to bring the mental health treatment direct to them, for those that were not keen to catch the buses up to the main medical centre for mental health appointments. Sometimes the outreach was the first step in people seeking help for their ongoing depressive issues which they experienced whilst in detention.
Of the things I wished I knew before, such as, the political nature of the detention exercise, and the legitimacy of peoples claims of asylum and the very nature of why humans seek out this life, or this personal journey – these things of course I had always wish that I could know; but I am very confident that only people who have worked in these locations would actually be able to answer these very personal questions for themselves, and depending on ones outlook on such things, each individual clinician may find very differing opinions or answers.
One thing that was apparent, was that having APHRA registered mental health staff on the Island is a great benefit to those detained there. It’s certainly something I have promoted to many of my colleagues, and the skills I learnt there, such as doing assessments with an interpreter, were something that I took back to Australia in my work on a public mental health CAT team in the west of Melbourne, where they also have to often use interpreters for assessments.
Tell us about the board games!
One of the reasons I took board games over there is that because it’s something I use for my own personal distraction, I love playing board games and always have even as a young child. I have also developed my own board game called “Voyage Home: An Odyssey” which I self published under a company name of Manticore Entertainment, and you can have a look at it on my website, just search any of the aforementioned names.
I believe that board games help people connect, socialise, are good for mental health and great for educating children in critical thinking and problem solving and above all else, they are an amazing distraction technique to exercise your mind and keep it busy on positive thoughts!
Having a hobby like creating and publishing my own board game has been a great personal achievement that I’ve done in my spare time when im not on shift at the hospital and as a Mental Health Nurse im always advocating to patients to maintain a high amount of positive hobbies in their lives to keep their mind busy.
Other
Advice for nurses curious about a mental health nursing career?
Do it, it’s not for everyone but you won’t know unless you try it. Entry level for Nurses would be on a Mental Health Acute inpatient ward, which there are plenty of jobs in and from there you can branch out to many, many areas of mental health, including the private sector.
Why are you still so passionate about mental health nursing?
As long as things don’t get boring, im always passionate. And acute mental health work is very rarely boring, there’s always challenges on every shift, and always plenty of assessments and work to do.
If I’ve ever found myself growing stagnant in a role, I’ve then moved to something else, but in general I love the acute crisis work, I love problem solving in a crisis and helping a team to come to a conclusion and bring referrals and guidance to people in crisis so that they know there’s help out here.
I don’t envision myself ever stopping this work, although since I’ve had kids I’ve cut back my hours in order to raise my kids and when they’re older I’ll probably pick up hours again.
Nursing at Barwon Health and studying an MBA?
Innovation and Compassion are the two of Barwon Health values I can resonate with the most. Although all of the values are relevant. I particularly find that I can be compassionate with all the patients I work with, try to see things they way they see things and let them know that I am listening, and then try to find a way to help them the best way that I can.
I always do my best to meet their needs where possible and make sure they have some type of follow up planned so they know there’s something on the horizon. People without a vision of hope for their future will be more likely to not recover from whatever crisis and state of mind they’re in when you see them, so compassion is really important.
Innovation is my favourite thing. I have studied an MBA at Melbourne Business School which teaches innovation through mathematics and in particular Data Analytics, and I have done my best since learning this through MBS (at University of Melb) to use Data Analysis to be innovative in my field. And in particular try to analyse and improve PACER by delving deep into data that other people generally don’t have accsss to. As a clinician working in PACER and having an in depth understanding of it, I can find ways to make that Data useful and bring change to the PACER service and make improvements to help patients and the hospital at the same time.
Where empty values can create cynical and dispirited employees in companies, values that are full of meaning and able to be employed on every shift are ones that create a rallying point for staff and helps nurses to clarify their identity in the workplace.
By harnessing Barwon Health’s values I can bring clarity to my work, passion to the workplace and instill the same positivity to colleagues, making it a more pleasant place to work in. If we can instill values as a cultural cornerstone of the hospital, we can impart these across to the patients and bring to them a more positive treatment outcome.
To find more information about the roles in the mental health service I’d check here:
https://www.barwonhealth.org.au/services-departments/mental-health
This site lists all of the different departments in the mental health service and by looking through them you can find out what all the different roles in the service might be. The best way to really find out more is to ring the Manager that is advertising a role, and ask as many questions as you can think of, and really challenge that Manager to sell the job to you.
If people ask me about EMH (ECAT and PACER) I’m all too happy to talk their ears off about the job and try to sell it to them, but the best people to talk to are the ones advertising the jobs on Seek, Barwon Health Mercury and other advertising locations online.
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