A woman with an intellectual disability who was kept in isolation for years developed diabetes as a result of weight gain, an inquiry has been told.
A hearing of the disability royal commission has focused on the story of 'Melanie', the pseudonym given to a woman who lived in seclusion at a NSW forensic hospital after transferring from prison.
Her lawyer, Helen Seares, recounted seeing dried blood graffitied on the walls of one of the rooms Melanie was held in.
"The smell of dried blood mixed with body odour, and the sight of that graffiti, is something that will be with me until the day that I die," she told commissioners on Wednesday.
Melanie engaged in two "very serious" acts of violence as a teenager, the hearing was told on Tuesday.
One resulted in the death of a staff member at the juvenile detention centre where she was being held and saw her transferred to an adult prison, counsel assisting Janice Crawford said.
She left prison in 2011 when transferred to a forensic hospital and has now been detained for more than 20 years.
Melanie was only recently moved out of seclusion to a room on a ward after a period of about seven years.
Ms Seares said there were many missed opportunities to help her before she was sent to juvenile detention.
She was removed from her mother when she was five after signs of physical and sexual abuse, commissioners were told.
"In spite of the fact that it was considered that her mother and her mother's friends had abused Melanie, both physically and sexually, her mother continued to be given access," she said.
Commissioners were told of the difficulties for staff in managing potentially dangerous patients at the forensic hospital in evidence from NSW Nurses and Midwives' Association general secretary Brett Holmes.
"If nurses are concerned that they cannot maintain a safe place for themselves or other patients, as a result of that patient in seclusion not being able to be properly contained, then they would be reticent to transition that patient out of seclusion," he said.
He said it was possible to balance staff safety and patients' freedom with adequate resources and appropriate training, however there were shortcomings at the forensic hospital.
"What we faced at the forensic hospital over many years was a constant situation of almost 30 full-time equivalent vacancies," he said, noting the shortcoming was often overcome using causal or agency staff, or overtime.
He said there was a tendency to fill vacancies through the recruitment of new graduates at the start of their nursing careers.
An eight-day hearing of the disability royal commission will hear from 33 witnesses as it explores indefinite detention and the "cycling in and out" of prison by people with disability.
In his opening statement, commission chair Ronald Sackville cited an Australian Institute of Health and Welfare survey that found 29 per cent of prisoners reported a long-term health condition or disability that affected everyday life.