Name

Address

Occupation

Special Commission of Inquiry into the Drug 'Ice'

STATEMENT OF WADE NORRIE

13 May 2019

Wade Norrie

Mental Health Administration, Shellharbour Hospital 15-17 Madigan Blvd., Mt Warrigal 2529

Director of Nursing, Mental Health

On 13 May 2019, I, Wade Norrie, state:

1. This statement made by me accurately sets out the evidence that I would be prepared,

if necessary, to give in court as a witness. The statement is true to the best of my

knowledge and belief and I make it knowing that, if it is tendered in evidence, I will

be liable to prosecution if I have wilfully stated in it anything that I know to be false,

or do not believe to be true.

Background

2. I have been working in the NSW Mental Health, Drug and Alcohol, and Forensic Mental

Health since 2009, primarily as a Nursing Unit Manager. I am currently the Director of

Nursing, Mental Health at the Illawarra Shoalhaven Local Health District (ISLHD).

3. I have worked in the ISLHD for 4 years. I have worked as the Director of Nursing for

around 3 months.

4. I understand amphetamine-type-stimulants (ATS) to refer to all forms of psycho­

stimulants that have "amphetamine like" properties. This group includes all

amphetamines, including methamphetamine, cocaine, MDMA (Ecstasy), cathinone

derivatives (mephedrone) and other stimulant-like "novel/new psychoactive

substances" (NPS).

5. The ISLHD Mental Health Service provides mental health assessment and treatment

to patients who may have current or prior substance use or misuse as a comorbidity.

6. As a Clinical Nurse Consultant working in The Wollongong Hospital (TWH) Emergency

Department, I have had to assess and formulate treatment plans for persons affected

by ATS.

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7. As the Nurse Unit Manager for Community Mental Health, I co-ordinate Acute Care and

Continuing Care to patients of the service, a percentage of whom have been affected

by ATS use.

8. The categories of ATS users that we have contact with are those who have a significant

mental health and/or behavioural response to the ATS use.

9. ATS patients primarily report using Methamphetamine. They also report using Ecstasy

and Cocaine. In my experience, ATS users report using Duromine, Ritalin and other

prescribed medications less frequently.

10. I have not had any reports of the use of diverted stimulants in my current recent roles.

That is more commonly associated with community-based treatment and we have little

way of monitoring this, unless a patient was to become acutely unwell as a result of

taking a diverted substance. Often this is not brought to our attention as the patient

will avoid this disclosure.

11. In my experience, ATS users most commonly smoke ATS and less commonly they

inject. The ISLHD Mental Health Service does not collect specific data in relation to the

incidence of ATS-related presentations, types of ATS used, patterns/occasions of use

or demographics of ATS users.

12. In relation to trends, my impression is that there is a greater reliance on the Mental

Health Services to treat ATS related presentations. My experience is that behavioural

disturbance and mental health illness can be difficult to assess in the acute phase of a

patient's response to ATS use.

Harms/ process

13. In my experience, we see ATS related presentations which include:

a. substance induced psychosis;

b. acute behavioural disturbance related to substance use or misuse.

14. Acute ATS related presentations seen by Mental Health are often accompanied by

Police and Ambulance personnel.

15. Our current coding and data collection do not reliably report the proportion of ATS

related presentations to ED that result in admission. Referrals may be primarily for

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Mental Health and the substance type may not be captured until the patient is fully

assessed.

16. ATS presentations are most often referred to Mental Health services via the ED. We

are unable to separate ATS use with our current data collection processes.

17. In my view, the positive relationship between the Mental Health and ED services is

essential for the timely and appropriate pathways for ATS presentations. Both ED and

Mental Health protocols require the patients to be provided with both medical and

mental health review and support.

18. In relation to screening, we undertake routine admission protocols to assess for

substance use.

19. Patient presentation related to ATS use is recorded in a patient's electronic medical

record (eMR). There is not a specific data collection process for extracting this data.

20. In my opinion ATS related presentations impact on KPis within the ED. No specific data

is available to separate ATS use. However, substance use and specifically acute

intoxication will delay medical clearance and appropriate mental health assessment.

21. I have direct experience of ATS affected patients re-presenting to ED on more than

one occasion. There are management principles in both Mental Health and in Alcohol

and Other Drugs (AOD) Units which acknowledge relapsing substance abuse.

Continuing use of substances will increase the need to present for acute care services.

22. In my opinion, available data at this time would not provide an accurate picture of the

contribution of ATS use without significant time spent mining the Minimum Data Set

database and electronic Medical Record ( eMR).

Comorbidities

23. I am aware up to 80% of Mental Health patients can have a comorbidity of substance

use/misuse disorder, this is inclusive of nicotine. Removing nicotine approximately

40% of people will have used other substance (Guidelines for the management of co­

occurring alcohol and other drug and mental health conditions - 2nd Edition 2016).

24. Comorbidities impact on time required to safely, accurately and appropriately plan care

during an acute presentation. Providing care remains the ISLHD's core business.

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25. The nature of our interventions will vary dependent on patient acuity, safety and

available resources to accommodate the patient's clinical needs.

26. Our access to services for acute intoxication and related behavioural disturbances is

limited to our inpatient mental health facilities. If a multi-specialty model of care was

adopted, such as the Psychiatric, Alcohol and Non-prescription Drug Assessment

(PANDA) model at St Vincent's Hospital or the Behavioural Assessment Unit (BAU) in

Melbourne1, this would assist in managing ATS patients' co-morbidities in our ISLHD.

Referrals and interventions

27. Our Mental Health services have protocols including the "Red Book' (Mental Health for

Emergency Departments - NSW Health 2015) to meet the clinical presentation of ATS

users as required. However, these are not specific to ATS.

28. We have inpatient Drug and Alcohol Consultation Liaison (CL) services available at our

hospital. They provide assessment, consultation and care planning input.

29. The following services are available in our Local Health District:

a. Illawarra Drug and Alcohol Services.

b. Counselling.

c. Stimulant intervention.

d. Opiate Treatment Services.

e. The Watershed (NGO) - withdrawal services and a rehabilitation program

supported by ISLHD clinical staff for withdrawal management.

f. Private counselling/psychology.

30. There are no dedicated comorbidity supports as this is a team function. However, there

are social workers and other allied health professionals available.

31. I have experienced instances where ATS users have been unable to access AOD

services. Patients are considered to be high risk for withdrawal complications or past

histories of aggression and violence. Assessment and referral from Mental Health

1 Co-located with the ED at the Royal Melbourne Hospital.

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Services has not been a seamless pathway historically, as this requires AOD

Consultation Liaison intervention, which is not available outside business hours.

Families

32. Families of patients who have problematic substance use concerns are often negatively

impacted. The social determinants and opportunities for healthy development and

relationships are often impaired by substance use.

33. Our comprehensive mental assessment requires the assessment of substance use and

patterns.

34. Referral to ISLHD Drug and Alcohol Services is also available, where appropriate. Our

State Wide Mental Health Access Line will also provide information on other support

services, including General Practitioners, Alcoholics Anonymous, Narcotics Anonymous,

and other support groups.

35. In my experience, I have seen presentations to the ED related to domestic and family

violence that appear to have been attributable to ATS use.

36. ED Presentations are often complex by nature. Social supports and domestic violence

screening are mandatory for females who present. All patients of Mental Health

Inpatient Units receive this same assessment.

Custodial

37. I am aware there is a correctional centre in Nowra.

38. Issues relating to the custodial system are outside the scope of my expertise. I am

aware though that Mental Health Services provide both acute care and continuing care

access for any person being released from custody who requires mental health

assessment and ongoing care.

Workplace issues

39. As a clinician working in TWH ED, I have had personal experience with ATS users who

have been intoxicated.

40. Many patients acutely affected by ATS have behavioural disturbances that can make

assessment, care and safety challenging. Agitation, aggression and physical health

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emergencies are all difficult presentations. Safety for both patients and staff is certainly

a priority.

41. I have been involved with patients who have required medical intervention to be

sedated and or restrained, including with Police or Security involvement. This has been

varied in escalation points but has included restraint, rapid sedation and emergency

airway intervention.

42. Inpatient services have policy and procedures in place to support the clinical need for

seclusion and restraint such as the Policy Directive PD2012_035: Aggression,

Seclusion & Restraint in Mental Health Facilities in NSW. This policy is

available at:

https: //www 1. health. nsw .gov .au/pds/ActivePDSDocuments/PD2012 03 5. pdf

43. Staff are trained in Violence Prevention Management (VPM) practices and there are

appropriate response guidelines for response teams, when required. In the past there

have been concerns with acutely disturbed patients who have required assessment for

transfer to a more appropriate service, such as a Mental Health Intensive Care Unit.

44. All specific information and education I have received in relation to ATS use comes

from my previous experience working in Drug and Alcohol services for 15 years.

45. I have undertaken Violence Prevention Management (VPM) training, which has been

useful for safety and de-escalation. However, I have not attended training specific to

ATS use within mental health.

46. Standalone or silo approaches to workforce and service development will not meet this

population's needs. An interdisciplinary and interdepartmental response to enhance

our collaborative responses to ATS patients is required. This would be best activated

with a dedicated service model as described earlier (BAU or PANDA models) which

would allow for the appropriate pathways for ATS patients to be formulated.

47. In my opinion, current ED environments are not conducive to safe containment of

these complex patients who require thorough assessment and management. We

historically have inappropriate areas within the ED to manage these patients with an

expected length of stay commonly in excess of 4 hours.

48. In my view, we need a comorbidity treatment framework and speciality. This would be

for patients who are highly disturbed, often requiring sedation for many hours.

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However, I also understand there is evidence which suggests that 50% of patients are

able to be discharged within 24 hours and thereafter need to access community

resources. These services are not achievable within the existing mental health footprint

and financial resources. In my opinion these services will require additional resourcing.

49. I believe the efficiencies to be gained by introduction of a dedicated service model

would be likely to result in pressure reduction on Emergency Departments and single

point comorbidity treatment reducing redundancy and intervention replication.

Signatr of Wade Norrie - -

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Date

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CURRICULUM VITAE

OF

Wade Norrie

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1

CURRICULUM VITAE PERSONAL DETAILS

Name: Wade Norrie

Address:

Telephone: Mobile:

Email:

ACADEMIC HISTORY

Tertiary Studies

Current Master Health Leadership and Management

University of Wollongong

2011- Sept/Oct Certificate III TESOL

TEFL International

Ho Chi Minh City Vietnam

1996 – 2003 Bachelor of Business – Queensland University of

Technology (Health Administration Major)

Queensland - Australia

1991 – 1993 Bachelor of Science (Psychology)

University of Southern Queensland

(Completed 6 units)

Toowoomba - Australia

1990 -1991 Student Nurse Royal Brisbane Hospital

Brisbane, Queensland, Australia

1985 – 1988 Registered Nurse Baillie Henderson Hospital

Toowoomba, Queensland Australia

WORKING HISTORY

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2

Current

Director of Nursing Mental Health

Illawarra Shoalhaven Local Health District

May 2015-January 2017

Clinical Nurse Consultant

Community Mental Health – Wollongong

May 2014 – May 2015

Team Leader – St George Community Mental Health

“Connections” and “Outlook” Teams

May 2013 –May 2014

Nurse Unit Manager – Mental Health - ISHLHD

Jan 2012 – March 2013

Lecturer

James Cook University (Cairns/Mount Isa)

Jan 2012 – Sept 2012

Clinical Nurse (Part Time)

Community Mental Health Cairns – Acute Care Team

May 2010 – Jan 2012

Nurse Unit Manager (Lv3)

Forensic Hospital

NSW Justice Health

April 2009- Jan 2012

University of Technology, Sydney

University of Western Sydney

Lecturer and Marker

December 2008 – May 2010

Nurse Unit Manager (Lv2)

Fairfield Drug Health

Sydney South West Area Health Service

January 2006 – November 2008

Senior Nurse Manager/Practice Manager

Department of Defence

January 2003 – December 2006

Assistant Director of Nursing – Alcohol and Drug Program/Corrections Health

ACT Community Health

1998 – 2002 Nurse Practice Coordinator

Royal Brisbane Hospital

Hospital Alcohol and Drug Service

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3

1997 – 1998

Clinical Nurse

Royal Brisbane Hospital

Hospital Alcohol and Drug Service

OTHER PROFESSIONAL DEVELOPMENT

September 2017 Root Cause

Analysis

July 2017 Mangers Series ISLHD

October 2015 Supervision –

Conversations for Clinical

Supervision

October 2014 Disaster Management

SESLHD ( 1 day)

Sept 2014 Strengths Model Training

St George CMH (2 Days)

Nov 2013 MIMMS Course – NSW

Health (1 day)

Nov 2013 Disaster Management _ St

John Ambulance (2 days)

Feb 2013 Toastmasters Professional

Communication – Mount Isa (1 day)

Dec 2012 Simulation – NHET-SIM

Workshop - Wollongong (2 days)

Oct 2012 Emergency Nursing –

Trauma Course – Mount Isa (2 days)

May 2011 HARE Psychopathy

Training – HCLR-20 (2 Days)

Feb 2011 The Choice Partnerships

Approach – CAPA (1 Day course)

Aug 2009 Adolescent Psychiatry –

Forensics (3 Days)

2009 -2010 Take The Lead – NSW

Health

22-23 July 2009 Essentials Of Care

Facilitator Training – NSW Health

March 2009 Cert III Life Coaching

16-17 Feb 2008 – Facilitating Drug

and Alcohol Nurses of Australasia

Business Planning

18 Feb 2008 – Psychostimulant

Workshop – NSW Health

2-3 Oct 2007 - Early Management of

trauma and advanced life support

training – RACGP

25-27 Sept 2007 – Critical Incident

Mental Health Support Training –

Dept of Defence

17-18 Apr 2007 - Management

Systems Auditing (ISO) – Grays

Management Systems

17 Oct 2006 – Enabling Risk

Management – ACT Health

Nov 2005 – Occupational Health and

Safety for Managers – NSCA

Jan 2003 – Root Cause Analysis –

ACT Health

Nov 2002 – Safety Improvement

(Root Cause Analysis) – NSW

Health

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1

Apr 2002 – Managing Multiple

Projects – SkillPath

COMMUNITY INVOLVEMENT

Member St John Ambulance – Nursing Officer – Peer

Support Officer

COMPUTER SKILLS

Microsoft Word

Microsoft Excel

Microsoft Access

Microsoft Publisher

Microsoft PowerPoint

SPSS

IIMS

ESP

RiskWare

MEMBERSHIPS Associate Fellow Australian College Health service

Executives

College of Mental Health Nurses

Member of the Knowledge Panel Review Committee –

ACHSM

INTERESTS

Fitness

Travel

Health Service Delivery

Disaster management

REFEREES

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