Investigation Underway After Patient Death at Geelong Mental Health Ward Amidst Long-Standing Safety Concerns

A 31-year-old patient died in the acute mental health ward of the Swanston Centre, University Hospital Geelong, on February 22. The incident, which occurred overnight, is currently under investigation by the Homicide Squad. Another patient was reportedly present in the deceased's room and is now under police guard.

This death has brought renewed attention to long-standing safety concerns regarding the facility's design, particularly its shared "Jack and Jill" style bathrooms, which mental health professionals and staff have identified as a significant risk.

Incident Details and Investigation

Emergency services were called to the Swanston Centre around 2:00 AM on February 22, where police officers located a deceased male patient inside a room. The identity of the 31-year-old man has not been formally confirmed. Another patient, from an adjacent room, was found in the deceased man's room with broken glass nearby. Authorities have stated that the two men were known to each other.

The Homicide Squad is leading the investigation into the death. Affiliate Professor Ajai Verma, Barwon Health's chief medical officer, confirmed the "unexpected death of an inpatient" and noted the matter was referred to police. WorkSafe is also investigating the circumstances.

No charges have been filed, and the patient from the neighboring room has been relocated to a secure psychiatric unit in Melbourne, as they are reportedly too unwell to be interviewed by police. The coroner has been informed of the death.

Facility Design: A Central Concern

A central focus of the investigation is patient access between rooms, specifically related to the "Jack and Jill"-style rooms on the 26-bed acute ward. These rooms feature shared bathrooms accessible from both patient rooms via non-locking doors.

Such shared bathroom configurations are considered a safety risk, are prohibited in new psychiatric centers, and are in the process of being phased out in existing facilities across Victoria.

Sources close to the investigations indicate that patient access between rooms is a key area of inquiry.

A Decade of Unheeded Warnings

Concerns about shared bathrooms and poorly lit corridors at the Swanston Centre have been raised by staff for over a decade. They have reportedly been a "constant 'flashpoint' for patient and staff danger."

In June 2022, psychiatrist Dr. Helen Schultz reported unsafe practices at the Swanston Centre to WorkSafe after an alleged assault by a patient. WorkSafe subsequently ordered Barwon Health, the facility's operator, to improve processes. Dr. Schultz has since ceased clinical practice in psychiatric hospitals and advocates for the centre's closure, citing a lack of change since her initial reports.

During her time as a locum in 2022, Dr. Schultz encountered a patient admitted under the Mental Health Act who had reportedly been without a risk assessment or treatment for several days. She described an incident where the patient, in psychosis, allegedly assaulted her by throwing coffee and then briefly escaped into a public area before being apprehended by police and security.

A survey conducted by the Health and Community Services Union after the recent death revealed that over 70 percent of more than 45 responding staff were not confident in providing a unit free from violence or aggression. Nine out of ten staff were unaware of changes or improvements since the death, with many citing shared bathrooms as the greatest danger. Workers also noted that this marks the fifth adverse outcome for a patient admitted to the unit since December 2025.

The Swanston Centre's acute ward was not included in recent state government funding allocated for upgrades to older wards. The Victorian Health Building Authority had reconfigured 16 mental health acute inpatient units to ensure all bedrooms have private en suites under a $61.1 million safety overhaul, but Swanston Centre was omitted from these works.

Official Responses and Systemic Issues

Barwon Health has extended condolences to the family of the deceased patient and has provided support to its staff members. Affiliate Professor Ajai Verma, Barwon Health’s chief medical officer, stated that patient and staff safety is a top priority, units are appropriately staffed, and patients receive timely access to psychiatrists. He affirmed the organization's commitment to continuous improvement and addressing recommendations from internal and external reviews. Barwon Health also stated that its mental health inpatient units are accredited against National Safety and Quality Health Service Standards.

The Mental Health and Wellbeing Commission endorsed ongoing facility upgrades statewide. A Victorian government spokesperson offered condolences but declined to comment on the ongoing police investigation.

Victorian Public Advocate Dan Stubbs has highlighted systemic issues within the mental health system for six years, warning that risks to patients and staff will persist without increased funding and planned implementation of royal commission recommendations.

He noted that many inpatient units operate in environments not designed to meet contemporary safety and therapeutic standards.

Call for Information

Individuals possessing information pertinent to the investigation are encouraged to contact Crime Stoppers.