By the time Alyce Gumley got to Essendon Private Clinic in June, she'd been wanting to take her own life for 10 days.
WARNING: This story contains details some readers will find distressing.
She'd been in and out of the voluntary psychiatric facility in Melbourne's north-west multiple times since 2017 for treatment of bipolar one disorder.
This time around, her mother was terrified and exhausted from trying to keep Alyce safe.
"Part of going into hospital is everyone has this kind of peace of mind that you're going to be OK," Alyce said.
"And everyone can just take a breather, because you're gonna be in a place where you're safe. But I wasn't, no-one was."
She is one of several former patients and staff who've accused Essendon Private Clinic's operator of running an unsafe psychiatric facility with inexperienced staff, and of putting profits ahead of patients.
They allege there was a toxic culture at the hospital, fuelled by a focus on the bottom line.
Patients say while some staff were highly skilled, others avoided interacting with patients, who at times ended up caring for each other.
Two former workers have told the ABC some members of the therapy team were underqualified, leading to increased thoughts of self-harm among patients.
One psychiatrist said he had greatly reduced the number of patients he sent to the hospital because of his concerns.
Alyce, and several other patients, say they came out sicker than when they went in.
She discharged herself from the 32-bed facility after one week because she felt unsafe.
"I went in there suicidal. I came out suicidal, I think that's a pretty good indication," she said.
"I felt abandoned, not just by EPC, but by the entire mental healthcare system."
Macquarie Health Corporation, which runs EPC and 10 other private hospitals, has defended the skills of its staff and strongly rejected the broader claims in a statement, saying "high quality patient care and standards are at the core of our business".
Alyce felt 'dismissed' at mental health clinic
Alyce describes the care she received at EPC in the late 2010s as "top tier," and the mental health knowledge as excellent.
But when she arrived this time, intent on self-harm, she alleges she was left alone in her room for two days with barely any checks from nursing staff.
A former staff member said she believed Alyce would have been put on at least hourly checks by her psychiatrist, due to her risk level.
However Alyce said she had five checks at most over 48 hours, with hardly any interaction.
"[It] made you feel super lonely and abandoned, because you go to this place to feel cared for and when you're dismissed by the people that are supposed to care for you, it feels horrible," Alyce said.
A former staff member said another patient spent her first two days of COVID isolation in April without any food being brought to her or proper engagement from the nurses — even though she was in deep mental distress and ill with coronavirus.
She believes that workers had forgotten the patient was isolating.
Macquarie Health said this would have been a breach of its policy, and meals were delivered to patients' rooms when they were isolating.
Without commenting on Alyce's case, the company said patients were visually observed and assessed for risk and concerns by staff every hour.
However, several patients insisted even this didn't happen.
Victoria's guidelines for mental health checks in public hospitals emphasise the observations shouldn't just be visual and should involve meaningful interaction with the patient.
At a later point in her stay, Alyce asked if one of the nurses could look at her self-harm wounds which she had inflicted before admission.
A nurse proceeded to place sticky adhesive medical tape directly over the open wounds, with no form of padding.
"I guess I was just stunned," she said.
"They obviously didn't know what they were doing. I was also scared, like, how am I going to get this off?"
Alyce later ripped it off like a bandaid.
Shed full of fishing line and gas bottles left unlocked
A former worker has told the ABC in one instance, nurses didn't know how to administer an epipen when a patient went into anaphylactic shock, so the patient did it herself.
Several patients said nurses were often unaware of common terms or illnesses in psychiatric settings, like "dissociation" or "serotonin syndrome".
Increasingly worried about safety at the hospital, Alyce went into the shared outdoor space and opened the door of an unused office in the facility.
It had become a shed, full of fishing line, a barbecue and gas bottles.
"So, a myriad of things that you could obviously hurt yourself with," she said.
"Anyone could [open it]. Anyone would if they were having an episode."
She said it took two days of her nagging for a staff member to lock it.
Alyce and other patients said it was also easy for people to smuggle things in to harm themselves, and proper bag checks didn't always occur.
One told the ABC she had razor blades in her bag and used them to self harm. She said her observation checks weren't increased afterwards.
Macquarie Health said no incidents had been reported in relation to the smuggling of razors or the unused office at the hospital.
It said patient searches were done by two staff when patients were admitted or returned from leave, which is in line with National Standards for Mental Health Services.
Hardest for Alyce though was the general lack of care she alleges she saw from the majority of staff at the hospital, apart from a few nurses who went above and beyond.
One day she broke down crying outside the nurse's station in the common area, where a group of nurses had gathered.
"The nurses were just like standing there talking," she said.
"They could … see that I was sitting there."
"My friend came and sat next to me, and they asked 'What's going on?' I said 'I'm dissociating, like, I'm really scared'. And she said 'I'll get a nurse for you'."
She said the nurses then ignored her friend.
"And while this is also happening, nurses and receptionists and a unit manager are walking past me. And I'm like, bawling my eyes out," she said.
Eventually, Alyce said she screamed at the top of her lungs for help, and the nurses came.
Another time, she said many of the patients were scared and upset after another patient had an episode.
Alyce said she ended up comforting them, because the nurses on duty didn't.
Former staff express concerns about standards
Jess Anderson, a former senior mental health nurse at EPC, is blowing the whistle after she resigned from the hospital in June.
Ms Anderson, who is also vice-president of the Health and Community Services Union, has worked at three private facilities in her 17 years as a mental health nurse and said Essendon Private Clinic was like nothing she had seen.
"It's definitely, by far the worst in quality of care," she said.
"It was not a hospital, it was a business."
She started work at the hospital in March 2020, and said things deteriorated earlier this year.
"They didn't care … who came in, they didn't care what level of risk they were, they didn't care if they had a mental illness or not," she said.
"As long as there was somebody in that bed for a period of time.
"I still feel a great level of distress for the patients who are currently there at the moment."
Ms Anderson said although many nurses were doing their best, there was high turnover of staff and a reliance on agency workers with no mental health training.
She said when she left in June, just three out of a permanent nursing staff of roughly 40 had formal mental health nursing qualifications.
But one of Ms Anderson's greatest concerns was the therapy being offered at EPC.
When patients are admitted to any private psychiatric facility, they are required to attend daily group therapy.
But legally, there are no minimum standards of training that the therapists need to have or the type of therapy they need to lead.
The person currently in charge of EPC's team is registered as a provisional psychologist, which means they have just completed their university studies and need to be supervised by a psychologist before they themselves are fully qualified.
Another member of the team, who has delivered "trauma therapy" for EPC, lists no previous health qualifications on a personal website, but says she is in the process of studying a diploma in counselling online.
She advertises her services privately as a crystal healer who specialises in detecting energy imbalances and emotional blocks.
There is no evidence she was practising these techniques at EPC.
Some patients 'felt worse' after therapy sessions
Ms Anderson said there was a marked increase in people having thoughts of self-harm after going to the sessions run by some of the inexperienced therapists, something she'd never seen before.
"A lot of patients were coming out of these groups saying that they felt triggered, and that they felt that the group actually made them feel worse than actually better," she said.
"So their level of risk increased, because they just didn't feel safe. And they felt like they had to resort to things like self harm, and, you know, even had suicidal thoughts, because they just weren't ready to process the level of trauma that they received from the group program."
Another staff member who spoke to the ABC agreed, and said they knew of cases of self-harm connected to the therapy groups.
They also alleged the therapy team was strongly encouraged to get recently discharged patients to continue to attend the therapy program as an outpatient, regardless of whether they needed it, as this was how the hospital could make extra revenue.
A spokesperson for Macquarie Health denied the staff member's claims.
They did not comment on how many nurses had mental health qualifications in June, but said EPC now had eight out of 32 nurses who had post-graduate training in mental health.
"All of EPC's nurses have completed mental health training as part of their primary nursing qualification," they said in a statement.
"While post graduate experience provides nurses with additional knowledge and skills, post graduate experience is not a requirement for a nurse to work at a mental health facility.
"EPC provides an in-house continuing education program to nursing staff to enhance and support their professional development."
They said Macquarie Health used agency staff on occasion and its preference was to engage those with post-graduate mental health training.
The spokesperson said a review carried out earlier this year had improved the way issues were being handled at EPC.
"Patient and doctor satisfaction has also increased as a result of the changes that have been implemented," the spokesperson said.
Macquarie Health's spokesperson said its therapy team consisted of psychologists and mental health therapists, but didn't answer direct questions about their qualifications.
"Each member has an appropriate tertiary qualification that is relevant to their qualification and scope of practice within our therapist guidelines," the spokesperson said.
"EPC utilises a documented therapy program, which therapists are required to follow, that prescribes the content of each therapy session."
They also said the appropriate triggering of patients was an important part of mental health therapy.
"Triggering helps patients develop strategies to manage their response in a safe environment and prepare them for their return to the community," they said.
Former worker claims building issues weren't addressed
Ms Anderson said the reluctance of management to spend money at EPC could be seen everywhere.
She alleges basic medical equipment such as blood pressure and ECG machines were broken, and not replaced.
Ms Anderson said she would have to buy her own batteries to replace dead ones in medical equipment like thermometers and blood glucose monitors.
Macquarie Health said these issues should have been readily resolved at the time under hospital policy, but Ms Anderson maintains they weren't — despite her repeatedly asking.
She, and patients, said nurse errors when dispensing patient medication were common.
Ms Anderson alleges she once sent someone via ambulance to an emergency department after he showed cardiac issues and shortness of breath.
He believed he'd been given the wrong medication that day, but the cause of his health issues was never determined.
Macquarie Health said some medication errors had been identified earlier this year and it had implemented new policies to improve its systems.
"While the errors identified were not serious, they were of concern to EPC management," a spokesperson said in a statement.
"Following the commencement of this management intervention, we have noted a reduction in medication errors."
Ms Anderson said emergency call bells in patient rooms were sometimes broken, and patients would be found in crisis or collapsed on the floor when there was a scheduled check.
The sewerage system was failing, and a smell of faeces would regularly waft through some of the rooms, she claimed.
She said sometimes the system backed up and sewage came out of the patient's shower drains.
"It was had nothing to do with 'oh, we can't get quotes' or anything like that," she said.
"It had everything to do with their budget and that they just weren't willing to spend the money."
Macquarie Health said it had spent $5 million on a renovation when EPC opened in 2017, but from time to time maintenance issues arose.
"EPC does not restrict its maintenance expenditure to a budget and assesses issues as they arise," the company's spokesperson said.
"Where a maintenance issue represents a threat to the safety and well-being of patients, it is prioritised and addressed accordingly."
They said the plumbing issues affecting one room had now been resolved.
Calls for clinic to be investigated
Dr Rachel David, CEO of Private Healthcare Australia that represents the health insurers, said she was shocked by the allegations.
The organisation said private health insurers paid $7.3 million to EPC over the last year — $739 per night per patient — which is the majority of the hospital's income. The rest comes from the federal government.
Patients were often paying more than $9,500 per year for their private health insurance.
"People living with mental health conditions are among the most vulnerable in our community, and if they get to the stage where they need to seek hospital care, they need to be treated with the best quality care that we have to offer. "
"The situation that's been described to me certainly indicates that the dollar is what's driving this hospital's activities, and not actually getting patients better and back on their feet."
Psychiatrist Vinay Lakra, president of the Royal Australian and New Zealand College of Psychiatrists, said regulatory bodies and the government should investigate the hospital.
"We need to make sure that every facility which is providing [mental health] care, and treatment, provides good quality care and treatment, they meet the expected standards, not only in terms of the care provided, but also in terms of the required skills for the workforce," he said.
The clinic was most recently accredited under the federal government's National Safety and Quality Health Service (NSQHS) Standards in December.
Former patient Alyce went to another private facility after she left EPC, which she said was streets ahead in terms of care.
She said she was speaking up for those who were unable to.
"I get that psychiatric private facilities are businesses that need to make profit to keep running," she said.
"But … where does it cross the line where it's at the expense of some of our most vulnerable people?"
