1955-56

VICTORIA

REPORT

OF THE

MENTAL HYGIENE AUTHORITY

FOR THE YEAR ENDED 30TH JUNE, 1955

PRESENTED TO BOTH HOUSES OF l'AltLIAl\IENT l'VRSrANT TO ACT No. 5519, SECTION IJ

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Approximate Co.'f~ o) flt:port.. -Preparatlon, not gi\·ell_ Printing (600 oopit:d), £400.]

By Auth{)rity :

W. M. HOUSTON. GOVERNMENT PRINTER. MELBOURN~.

Nn. 34.-(3s. 3D.j-l804j56.

MENTAL HYGIENE AUTHORITY, 300 Queen-street, Melbourne, C.l, 30th September, 1955.

The H onorable the Minister of Health,

SIR,

The Mental Hygiene Authority has pleasure in submitting, in conformity with Section 11 of the Mental Hygiene Authm·ity Act 1950, the accompanying Report concerning the exercise of its functions and operation of Mental Hygiene services in this State for the period ended 30th June, 1955.

Yours faithfully,

E. CUNNINGHAM DAX, Chairman. CHARLES R. D. BROTHERS, Deputy Chairman. E. R. H. EBBS, Administrative Member.

TABLE OF CONTENTS

PAGE

PRESENTATION BY THE MENTAL HYGIENE AUTHORITY 7

STATISTICAJ. SUMMARY 17

STATISTICAL TABLES-

Patients and Voluntary Boarders- Table f.-Total Cases Under Care on 31st December, 1954 18 Table H.-Number of Cases on the Books from 1940 to 1954 19 Table III.-Voluntary Boarders 1940 to 1954 20 Table IV.-Receiving Houses-Statistics for 1954 21 Table V.-Mental Hospitals-Statistics for 1954 22 Table VI.-Mental Hospitals-Statistical Summary from 1900 to 1954 23 Table VII.-Patients Boarded Out on 31st December, 1954 24 Table VIII.---Private Mental Homes-Summary 24 Table IX.-Causes of Death-Mental Hospitals, 1954- .. 25 Table X.-Causes of Death-Receiving Houses, 1954 .. 25 Financial. Table IX.-Summary of Receipts and Expenditure 75 Table X.-Maintenance Costs of Cases in Mental Hospitals-Totals 75 Table XI.-Average Weekly Cost per Patient 76 Table XII.-M:ental Defectives-Maintenance Costs 77

REPORTS-- Secretary Mental Hygiene Authority (Financial) 72 Psychiatrist Superintendents (in following order)- Ararat, Ballarat, Beechworth, Bundoora, Kew, Larundel, Mont Park, Royal Park, Sunbury 26 Mental Defective Institutions- Janefield, Pleasant Creek, and Travancore 58 " Moorakyne " Girls' Hostel 63 Psychiatric Clinics 64

Pathologist 7l

Dentists 71

REPORT

This year's report shows progress in many ways. The psychiatrist superintendents' submissions may be compared to advantage ·with those of some years ago; it is obvious that there is a great deal more activity in the hospitals, particularly in the patients' occupations, recreations, and social activities. The patients are more adequately treated and fed and are enjoying more freedom and a better status. Admittedly costs have risen, as is the general trend, but they still remain moderate despite a large amount of new furnishings and equipment which replaced the old stock and the added expense of making considerable improvement in the diet. However, it is gratifying in return to find this policy has encouraged earlier admissions and more voluntary boarders. It has also enabled a greater number to be discharged, 288 more patients were admitted and 442 more discharged from the receiving houses last year than in 1953. The discharges compared to the admissions have, therefore, risen from 44 per cent. to 56 per cent. in the past year. From the Mental Hospitals, 285 more patients were discharged, the discharge rate having risen from 55 per cent. to 71 per cent. This figure may be rather higher than expected as more patients were discharged from trial leave. The number of voluntary boarders have been trebled in the past three years and now form 40 per cent. of all the admissions. It is hoped that this percentage will continue to rise as general practitioners encourage more of their patients to enter hospital of their own free will. Figures are now available to compare the average percentage of discharges for the past five years with the average for the previous ten years. In the past five years the discharges have averaged 52 per cent., in the previous ten years it was only 42 per cent. This increased discharge rate has occurred despite a rising number of elderly admissions whose chance of recovery is not so good as the younger patients. Last year 21· 4 per cent. of the admissions were aged 65 and over. These encouraging improvements have been obtained even when the overcrowding remains extremely acute. :More beds are very urgently needed. The overcrowding in the mental hospitals is now 37 per cent., but rather less in the training centres for the intellectually handicapped. The construction of new wards must be given the highest priority as more beds will be lost as amenities are provided, wards improved, and alterations made. Already beds are down the centres of wards, and some have to be made up on the floor, whilst day room space is occupied in many cases by further beds. ,~Vhen this state of affairs is added to the insufficient and often appalling toilet facilities, which are only slowly being improved, the urgent need of relief is all the more obvious. One of the most encouraging features of the year's work is the reduction of wards under lock and key. Particularly notable is the fact that no male patient entering Royal Park is in a closed ward any longer. Additionally, it is very satisfying to know that the padded rooms have been taken down, that. seclusion has greatly diminished, and the restraint of patients is disappearing. The staff of all the hospitals have to be congratulated on the progress that has been made in this way.

STAF:F. The present strength of medical staff engaged by the Authority on the 30th June totalled 70 as compared with 60 in the previous year and 34 in 1951. Although the number of medical officers on duty is now more than double what it was at the time the Authority took over, several hospitals are still inadequately staffed, particularly in regard to senior medical personnel. Recruitment of medical officers has been restricted on account of insufficient medical officers' residences. However, during the course of the year six new residences were made available and plans were put into operation for others to be completed by Ju:ne, 1956. Included in the number of medical officers joining the staff during the year were two juniors and one senior officer recruited from Great Britain. The medical staff move frequently, and, as the only means by which they can be recruited is to provide them with houses, a building programme for staff houses will have to go on for some years. The staff who live on the hospital estates repay this policy many times over by participation in evening duties, and teaching patients .and staff recreations and social therapy. Many of the patients' activities which are an essential part of their treatment would break down but for the resident staff's willing and loyal co-operation. 8

The number of part-time medical specialists attached to the Department on a sessional basis has been increased from four to six. They now consist of a neurologist, neuro-surgeon, consultant physician, psychiatrist, and two anaesthetists. Great difficulty has been experienced in securing the desired number of psychologists, social workers, and occupational therapists. The existing strength, (ten pyschologists, eighteen social workers, seventeen occupational therapists) is well below establishment. As there is always a reluctance on the part of these workers to accept country hospital appointments, it would appear desirable to establish scholarships whereby students about to undertake a University training could be given financial assistance in the form of a bursary, on their undertaking to serve in nominated country hospitals at the end of their academic: training. The situation regarding the shortage of nursing staff is referred to in the report from the Chief Medical Officer. As regards nursing training, plans are at present being made to introduce in the coming year preliminary training for all student nurses entering the Department. This training will be given over a period of four weeks at the Nurses' Training Units at Royal Park and Ballarat respectively. More tutors -will certainly be required in order to carry out efficiently an adequate programme of training for student nurses. 'fhe annual examinations for student nurses are held at six-monthly intervals. The number of successful candidates for 1954/55 were as follows:-

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Year. Male. Female. Total.

First ...... 41 32 73 Second ...... 43 26 69

Third ...... 50 23 73

Total .. 215 •• ! 134 81

This is an increase of twelve on last year's numbers. The appointment of an additional 134 artisans has been approved in order to cope with the expansion of services and to relieve the nursing staff of duties other than those required in the actual psychiatric nursing and care of patients. The staff throughout the Department are adjusting to the changing conditions, are keen to co-operate for the benefit of the patients and are at the same time adding to their own knowledge, interest, and professional standing. However, new uniforms are needed for all the nursing staff so they may be as well dressed as their colleagues in the general hospitals. On 1st August, 1954, the Rev. W. Graham was commissioned to Sunbury Hospital. His appointment was the first of six full-time chaplains. A Chaplains' Advisory Committee has been formed, representing all denominations and an apportionment of staff to all holilpitals has been agreed upon. The co-operation of the church and psychiatry will open up new fields of work and be of considerable assistance in the patients' treatment and welfare. It is hoped that before long chapels may be provided within the various hospitals.

CLINICS. At the four metropolitan Clinics and the Observatory Out-Patient Department, a total of 1,540 new patients were seen during the past year as against 1,425 the previous year, representing an increase of 115. As in previous years, the Clinics have played important roles in post-graduate and under-graduate teaching programmes, as well as instruction to other groups associated with mental hygiene activities. With the exception of the new day treatment section opened at the Observatory Clinic, the Authority has had to further delay its plans for extension of clinic services for the time being, mainly due to the very extensive commitments in regard to improvement and extension of the mental hospital services and the need for further medical staff. 9

MENTAL DEFECTIVES. The major development during the year, was the successful opening of a Training Centre, for adolescent boys, at Bendigo. The premises were made available by the Commonwealth Government, with accommodation for 100 boys. Although opened only in March, 1955, the unit is an unqualified success, improvement in the mental and social outlook of the boys being most noticeable.

While more detailed information is given in the report from Bendigo, the Authority desires to record its appreciation of the very keen interest taken in the Centre by the staff and many local residents. The boys are divided into groups of six, each group being supervised in particular activities, i.e., carpentering, painting, gardening, &c. Much of the work of altering the original internal partitions in the various huts has been done by the boys under supervision, while their pride and interest in individual projects has been reflected in improved behaviour and development.

There are good prospects of placing several in positions available locally, and it is intended to use two of the huts (each of which accommodates six boys) as a Hostel until they are sufficiently stabilized to obtain accommodation outside the Centre. Bendigo will afford a valuable means of training older boys, and it is anticipated that a number will be able eventually to take their place in the community.

Renovations, alterations, and additions at Kew Cottages during the year have reached the stage that conditions are such that about half the children are now housed satisfactorily. It is true that overcrowding due to lack of alternative accommodation is still a very serious problem, but tenders for the erection of two additional wards, the first units in a new section of the Cottages, were let towards the end of the financial year.

It is regretted that the long delayed opening of a Toddlers' Block at Travancore was again held up owing to staff shortages. At Pleasant Creek (Stawell) the new boys' unit (31 beds) was approaching completion, and the new Nurses' Home commenced. The second timber ward at Janefield (30 beds) was completely renovated, and subject to staff being available, will be re-occupied early in the new financial year.

Allocations from the Mental Hospitals Fund (Tattersalls) per~itted payment of increased maintenance and capital grants to various day and residential centres for mentally retarded children. Day Centres now function at Box Hill, Kew, Northcote, Ivanhoe, Oakleigh, Brighton, Cobnrg, Footscray, Frankston, South Yana, Richmond, Mildura, Ballarat, Shepparton, Traralgon, Bairnsda.le, Bendigo, Geelong, Terang, and Wonthaggi.

Maintenance grants are now paid on the basis of £720 per annum for each twelve children attending a Da.y Centre functioning full time, with pro rata grants to part-time centres. In effect, this grant covers cost of instructors' salaries which form the major operating costs. Capital grants, equivalent to four-fifths of building costs of approved works, were made available, and this generous provision encouraged several centres to erect their own buildings. All plans are examined by the Authority and the Commission of Public Health before any grant is recommended. It is the considered policy that capital grants will not be supported unless a minimum of sixteen children are in attendance, the lowest economic number.

During 1954-55, £23,703 was paid as maintenance grants, while in respect of approved capital works, £114,870 was allocated to ten centres. Of this latter amount progress payments of £55,820 were made, leaving a balance of commitments of £59,050 at the end of the year.

With the co-operation of the .Maternal and Child Hygiene Branch of the Department of Health, students were selected to undergo a short training comse of six months. Each student received £20 per month living expenses, plus a total of £9 towards travelling expenses. The course covers both academic and practical training, the students being given opportunities of instruction in training both normal and sub-normal children. On completion of the course, the students will return to the respective centres which sponsored their application. 10

The development of Day Centres throughout the State, indicated the need for regular inspection and the availability of trained personnel to afford advice to the various committees managing the Centres. The Authority is fortunate in that 1\f.r. K. M. Cathcart, formerly Senior Psychologist at the Travancore Clinic, was appointed Inspector of Mental Deficiency Training. Apart from inspectorial duties, he will visit Centres to advise regarding training, examine and test children, and generally act as liaison officer between the Committees and the Authority. With his wealth of experience, both as a teacher and a psychologist, his services will be invaluable to Centre committees and staff.

THE MENTAL HYGIENE ACTS. It is hoped that the various Mental Hygiene Acts will soon be revised. They are out of date, the Mental Deficiency Act is outdated before it is proclaimed, and they are out of keeping with modern thought, making 'ents and relatives suffer, and burdening the Chief }ledical Officer with so many nee ss office tasks that his more useful visits to supervise the hospital activities are curtailed.

THE STOLLER REPORT. In May, the Stoller report was released by the Commonwealth Government, Dr. Stoller, the Chief Clinical Officer, had been lent to make this survey throughout Australia. The report was remarkably accurate and factual after so short a time to study the conditions. It brought forward many points of interest and importance, and must make a profound impression on the future planning of the mental health services in Australia. In Victoria all the suggested alterations had already been put in hand, but the confirmation of the principles of the planning was of much use. It cannot be too often or too forcibly stated that there is an enormous amount still to be done in the mental health services and Dr. Stoller's report has very usefully brought these matters before the public again.

TEACHING AND RESEARCH. The Chief Clinical Officer has been able to arrange a number of teaching courses in which the department's staff, officers in other branches of the public service, specialists in private practice, and the occupational therapy school have participated. These courses have improved the training and added to the staff morale . • There is also more teaching taking place within the hospitals as well as at the school and staff are participating more generally in ward reports and discussions and clinical meetings. Further reference to the teaching and the research is made in the Chief Clinical Offwer's report, but it is clear that one of the basic necessities for medical and nursing recruitment is adequate training and the opportunity to engage in interesting and original work. Towards the end of the year a fund of £75,000 was sought for use in research into the causation of mental illness and its prevention. This fund was to be used to co-ordinate and sponsor the researches of the various bodies working in certain branches of social and preventive psychiatry, to gather information about social problems with a direct bearing on mental illness, to make information available on the prevention of mental and nervous illness and to finance further research within the department. Such subjects as alcoholism, marital problems, migration, educational retardation, housing, and old age are all of the greatest importance in the causation of mental disorder which is intimately concerned with these social fields. There is a very great willingness to co-operate in research studies by all the departments, agencies, and organizations concerned and there is an opportunity through such a fund to do most valuable work with far reaching effects. In the field of preventive psychiatry which could be covered from this fund the circulation of pamphlets on, for instance, the upbringing and management of ~he intellectually handicapped, on childhood and general mental hospital problems and on the psychiatric services can be of much value. Lectures, films, and courses can be used and much general education in this subject is of value amongst those whose work is in the social field. The establishment of a psychiatric information bureau would be of considerable use. 11

BUILDINGS AND WORKS. It is difficult to give an assessment year by year of the structural work and alteration~:~ that have been done. Much of the work has progressed without being finished and as one contract is completed another takes its place. It is, however, possible to give a general picture of the progress that has been made in the past three years including the major projects on hand. It has to be remembered that in time nearly every ward in every hospital has got to be remodelled and mostly completely altered. In many cases a single day-dining room has been provided for a large number of patients allowing no privacy, poor classification and no furnishings other than benches and bare wood tables. The dormitories have been large and overcrowded, there has been no wardrobe accommodation and very few bedside lockers or chairs. Clothes have, therefore, been rolled in bundles and sorted in the morning. No matter how economically the alterations are made, beds are bound to be lost in the process of reconstruction which tends to increase the overcrowding even further, although the new bed centres are no further than five feet apart giving a maximum of only two feet betwen beds. Up to date about forty of the hundred and fifty wards which must be radically altered are now in hand and fifteen of them finished. The sketch plans have been completed for some· of the remainder and, in a few cases, the working drawings as well, but only a certain number of wards can be closed at one time owing to the overcrowding and the finances are restricted, so the progress must necessarily be slower than it should be. It is impossible to give priorities to the various types of work. For instance, is it more important to relieve the overcrowding when beds are nearly touching, or to make the water supply adequate to deal with fires ? Should the nurses be given adequate accommodation so they no longer sleep on the wards, or should further facilities be made available for the newer forms of treatment? Are broken lavatories without doors or partititions to be renewed or should there be modern kitchens ? Clearly all the work must go on at the one time and as quickly as both finances permit and contracts can be arranged within the limitations of the accommodation. Thus, apart from these alterations consideration must also be given to the essential services, the staff accommodation, provision for early treatment and relief of overcrowding. The essential services were in so poor a condition, when the Authority was appointed, as to be likely to break down at any time. Almost every boiler house and kitchen, many of the laundries and much of the artisan accommodation has had to be renewed, and the farm buildings made fit to produce clean milk. Seven boiler houses have been or are being erected with renewal of the machinery and four others have yet to be done. Six kitchens have been or are being renewed and eight more must be done. Three laundries still need extensive alterations and several others have already been improved. Many artisan shops have had to be replaced by light timber construction buildings, as their condition was crude in the extreme; water reticulation, electrical supplies, and sewerage pipes have needed extensive rene"\vals and considerably more has still to be done. Ten nUTses' homes, male and female, have been built or are being constructed, three have been enlarged but four others are still needed. Three years ago, houses were available for less than a third of the total medical establishment, and for this reason in part, the numbe;r of doctors was too few to carry out much more than the bare routine care required for the general welfare of the patients. Seven houses have been added and building is now going on at most hospitals including ten houses at Kew. Medical officers will be housed in a number of these for the fourth year of their post-graduate experience in psychiatry whilst working in the out-patient services and emergency psychiatric services. Some special provisions have been made at Royal Park and Ballarat for dealing with the early in-patient treatment of mental disorders. At Royal Park a number of aluminium buildings have provided a training school with residential accommodation. A nurses' home, cafeteria, kiosk, laboratory, insulin unit, sick hospital, and social therapy centre are also being built of the same materials. The whole of the old buildings are also being remodelled. The new buildings will be opened shortly and when all the work is completed Royal Park will provide the needs of the modern psychiatric hospital and full teaching and research facilities which will be at least comparable to the new units in other countries. 12

At Ballarat " :Novar ", a private hospital, has been purchased and is being altered for use as a convalescent hospital and a unit for the treatment of the neuroses and milder cases of mental disorder. Plans have also been made to use these receiving houses for treatment by the day and their return to their homes at night. Ballarat will then have a unit for the treatment of the more acutely ill ·with new occupation facilities as well as this hospital for the milder disorders. The overcrowding will be able to be relieved as soon as the money is available. A standard concrete-veneer timber frame ward has been designed and should be easily and rapidly erected. It incorporates many interesting features but is simple and economical. The plumbing and concrete flooring is centrally situated. The washing, bathing, and toilet accommodation is generous and facilities for the proper care of clothing are generally available. Each ward holds 36 beds in six small sub-units and has an enclosed sun verandah and a modified cafeteria system for dining. It is hoped that 40 of these wards will shortly be constructed in the various hospitals giving a further 1,440 beds towards the 2,000 needed to relieve the overcrowding. The remainder of these beds will come from Bristol buildings, new sick hospital blocks and wards being constructed at Larundel and Kew Cottages. At present there are over 8,000 patients in the accommodation for 6,000. Two t.housand further beds will be needed to bring the proportion of mental hospital beds in Victoria up to the minimum required by the standards in other civilized communities. A hospital at Traralgon is being planned and will be ready to be commenced in 1956 and a further psychiatric hospital at Bendigo and a colony for the intellectually handicapped must follow. These will give the requisite minimum proportion of beds to the population. But if the population of Victoria is to increase by 50,000 per year this means that 200 extra mental hospital beds must be provided every year. For this reason an extra six hundred thousand pounds is needed each year purely for the provision of mental hospital heels for the newcomers to the State and such a provision should be borne in mind in the migration programme. Some important works were completed during the year. The new boiler house at Kew cost £48,000. The nurses' home at Sunbury was opened by the Honorable V. J. Doube on 14th April, 1955. It cost £164,000. The Honorable W. P. Barry opened the extension to the Observatory Clinic on 28th October, 1954, which provided consulting rooms, treatment clinics for adults, and play therapy units for children. £18,400 was spent on these buildings. The Melbourne Lions Club together with the funds of the Pamplin Green Estate provided in their kindness an occupational therapy unit for Kew Cottages at a cost of £21,000. This was opened by Councillor M. Nathan on the 22nd May, 1955. Collectively, the major items of expense have been a series of light timber construction buildings for occupational activities in therapy centres and artisan shops, patients' social clubs, offices and recreational activities. These have provided many of the essential features which have previously been lacking as an essential part of the patients' treatment. Furniture and fittings have had to be found as well as new buildings. Practically all the furniture throughout the hospitals has had to be replaced. Fortunately the availability of Tattersalls' funds enabled new mattresses to be provided in most of the hospitals. Previously ticking had to be stuffed with straw, \vhich was emptied and burned when dirty and produced a filthy stench throughout the wards. The laminex-topped tables and steel chairs have made for much greater cleanliness in the places where they have been provided, and stacking seats in some of the entertainment halls have allowed them to be more extensively used for a variety of activities. VOLUNTARY BODIES. There are many voluntary bodies interested in the mental health movement in Victoria, perhaps as great a number in comparison to the size of the population as are found anywhere else. Their provision of amenities, clothing, toys, gifts varying from an aviary to a scientific camera, picnics, drives, dances, and concerts have all been welcome. The management of the kiosks, visiting of the hospitals, " adoption " of patients to send those without visitors, birthday and Christmas gifts, and provision of furnishings, fabrics and flowers have all been amongst their numerous functions. The Mental Hospital Auxiliaries, Country Women's Association, Australasian Association of Relatives and Friends of the Mentally Ill, Melbourne Lions Club, Red Cross, Melbourne Rotary Club, Kew Mental Hospital vVelfare Group, Federation of Mothers' Clubs, Returned Soldiers' League, and other bodies associated with the ex-servicemen, the Victorian Optical Association and many other associations and individuals have all given very generous help. 13

During the year representatives from twenty of these g1oups together forming the :\!ental Health Federation have been prepared to give up their valmtble time to n:eet regularly as a central body to hear of the progress and to use their influence for the improvement of the mental hospital services. The librarian, Miss Lindsay Cheeseman, organized an appeal for books at the end of 1954 which yielded a magnificent response of volumes in good order and cartons are still coming in, six months after the appeal closed. Publishers and booksellers were particularly generous. The appeal was made possible by the kindness of the Press, Wireless Networks, the Commonwealth Bank, Myer's Emporium, Brown-Gouge, the Public Libraries, the Victorian Railways, the Town and Shire Clerks throughout the State, and the Victorian Transport Association. The Country \¥omen's Association collected and packed the books at the Shire Halls to put them on the Railways, the Mental Hospitals Auxiliary sorted the books and despatched them to the hospitals. A particular tribute is due to Mrs. R. R. Webb who in an honorary capacity has, in her kindness, been responsible for a great deal of the work associated with the collection, sorting, and distribution of the books in the appeal. As a result of the appeal a central library for reference purposes has been established and a nucleus of expendable books has been placed in every hospital ward. We are very grateful indeed to the Red Cross who gave their complete co-operation in the appeal, provided books, and are now setting up a fiction and lending library in each hospital. They are also providing the services of helpers to advise the patients and help run the individual libraries. The Melbourne Rotary Club has very kindly made available a central technical library which will provide the initial needs for technical instruction and rehabilitation. When the central library at Royal Park is completed before the end of the year a lending service which will include these and books on the Arts provided by the Mental Hospital Auxiliaries will be generally available. We have also to thank the Red Cross for sponsoring the Music in Hospitals Committee, appealing for gramophone records, sorting and collecting them in a central library, and organizing the despatch of records. At the same time "live ,. concerts have been organized at three hospitals and many gramophone recitals are held and there is a growing musical interest amongst the patients which, as time goes on, will produce therapeutic results. The Council for Adult Education has given an increasing service to the hospitals. For recoverable patients to learn in hospital of the many services that can be given by this body on their discharge is of real value in the preservation of their mental health. The Mter-care Hostels, run by the Mental Hospital Auxiliary at Kinkora and Trelowarren continue to be of great use to the mental health services. Their association with the Observatory Clinic, its occupational therapist and the departmental social workers has made them even more useful. Ninety-two patients were admitted to Kinkora and seventy-two to Trelowarren during the year. The 21 branches of the Mental Hospitals Auxiliaries have raised the magnificent sum of £7,000 for the benefit of the patients in the hospitals. The Authority has enjoyed close co-operation with the Central Council for Mentally Retarded Children, formed of the representatives from the branches distributed throughout the State. This magnificent voluntary movement is an outstanding success and grows in strength every year. The Official Visitors have continued their good work in the various hospitals, bringing an outside viewpoint on the activities, acting as a medium of appeal for the patients, and as representatives of the public in the hospitals. Their very useful reports and continued interest have been generally appreciated. The Advisory Committee has met regularly, one fortnight at one or other of the hospitals or clinics and the next at the office. In this way progress has been reviewed, many useful suggestions have been made, the committee has been kept aware of the department's activities and have been able from eveq point of view to give kindly, useful, and most valuable advice and help to the Authority. The thanks of the Authority are due for the willing co-operation of the Public Service Board and Public Works Department. E. CUNNINGHAM DAX, Chairman. CHARLES R. D. BROTHERS, Deputy Chairman. E. R. H. EBBS, Administrative Member. 14

CHIEF :MEDICAL OFFICER'S REPORT.

DR. H. J. c. EDMONDS.

On the whole, it can be said that the patients are well cared for. However, there is still room for considerable improvement. The two main problems which will have to be overcome before much further progress can be made in the standard of care of the patients are shortage of nursing staff and shortage of accommodation.

(a) Nursing Staff. All hospitals are short of nursing staff, particularly female nursing staff. In the country hospitals numbers are almost up to the establishment, but in metropolitan hospitals the numbers are far short of requirements. Mont Park and Sun bury are the hospitals most seriously affected. Because of the few nurses on duty each day in these hospitals, it is impossible for the patients to be adequately cared for, and the lack of rewarding work discourages the few nurses available. The position is more serious than the shortages in numbers of nurses would suggest because of the very thin veneer of trained staff. All hospitals are deficient in trained staff, but here again the metropolitan hospitals are more affected than the country hospitals. As soon as nurses qualify by passing the final nursing examination, they are promoted to fill vacancies as charge nurses. The number of student nurses is still small and does not seem to be increasing. It would seem likely that while the economic position of the community remains as it is at present, we can expect only very gradual improvement in the recruitment of female student nurses. I have no doubt that the improvement in the training scheme which has been planned will encourage more suitable young women to offer for this work. Much credit must be given to the nurses for the fact that the standard of care of patients is as high as it is in spite of the shortages in numbers and in trained nurses, and most credit must go to those older nurses who have not only had to carry the tremendous burden of responsibility caused by the fact that they have had no trained staff to assist them, but they also applied their minds to the changes which have taken place in the ward where it has been necessary for them to develop a new concept of nurse-patient relationship. Most hospitals have no shortage of male nursing staff, although in some there is a deficiency in trained staff. Mention should be made of the New Australian members of the staff. All hospitals have a percentage of them on both the male and female nursing staff rising in one hospital to as high as 50 per cent. .Most of the New Australians on the staff are very satisfactory and are most anxious to complete the course of nursing training. Some have already qualified for and been promoted to senior positions.

(b) Accommodation. The over crowding of patients in the wards has reached a very serious level, and in some hospitals each month sees a few more floor beds added. According to modern standards, the existing buildings should accommodate fewer than 6,000 patients, whereas there were 8,000 patients in the mental hospitals on 31st December, 1954. The most urgent necessity is the erection of new wards to accommodate this surplus. On the minimum basis of four beds per 1,000 of population, 10,000 beds should be available for psychiatric patients in Victoria's population of two and a half million. This overcrowding allows very limited classification of patients. Apart from its effect on the patients, it causes frustration and discouragement to the medical and nursing staffs, and has undoubtedly been responsible for many resignations, particularly from the female nursing staff. There has been a greater movement of patients from one hospital to another, due mainly to transfers to and from the neuro-surgical ward at Mont Park. During 1954 an attempt was made to eliminate the danger of typhoid carriers. Twenty-five patients were operated on at the Fairfield Infectious Diseases Hospital, thanks to the fine co-operation of the Superintendent of that hospital. Unfortunately, two patients died a few days after the operations, and this led to a somewhat intensive coronia! inquiry. }l'inally the Coroner agreed that the operations were undertaken for the welfare of the patients operated upon. Of the 23 surviving patients, all but five have shown persistently negative results since the operation. One of the most urgent needs is for a separate T .B. Ward to provide adequate isolation of infected patients. The lack of this facility is causing grave concern to all Psychiatrist Superintendents, but is particularly serious at Mont Park and Kew. The fact that Royal Park is no longer a mental hospital has meant perhaps a more rapid turnover in patients. It has emphasized the need for a big increase in the number of beds at Royal Park and an alteration of the Act to allow patients to remain at a receiving house for at least six months. There has been a steady improvement in amenities for patients, and in spite of the overcrowding, the standard of living for patients has been improved. It will necessarily be a long time before all wards have been modernized and new accommodation must be made available before this can be done satisfactorily. Ware furnishings in some hospitals could be improved and bedding is still poor in a few wards. Patients' meals in all hospitals seem to be quite satisfactory. Meal service is being improved everywhere but some hospitals still retain old enamel or aluminium utensils for disturbed wards. l5

M ental Dtifectives. Of institutions for mental defectives, the one causing most concern is the Children's Cottages at Kew. There have been marked improvements in some wards, especially the girls' wards, but there is much work to be done in modernizing the boys' wards. The Cottages are now accommodating 100 more children than they did three years ago, and the demand for beds for the lower grade defectives is growing. With the improvement in conditions the death rate is falling, thus increasing the overcrowding. At the three special schools, children are admitted only as vacancies occur, but much more accommodation is needed to give adequate service to the community. There is no accommodation for the younger mentally retarded boys who are not up to Travancore or Stawelllevel. I would recommend that wards should be erected at J anefield for this group of children. All mental defective institutions have had female staff shortages, but the position became so acute at Travancore that it was necessary to close down two wards at the end of the first school term at the beginning of 1955. In addition, one ward at .Janefield has been unable to reopen after renovations because of the staff shortage. Another difficulty is that at .Janefield some girls are reaching mature years. They will always be dependent for their care, but the only place for them at present is a mental hospital. While they remain at Janefield they prevent the admission of young girls who could benefit from the training there. Some independent accommodation is required for them. A similar position is arising at Moorakyne Hostel, but arrangements are being made to provide some accommodation for these older hostel girls. In March, 1955, a training centre for mentally retarded youths was opened at Bendigo. Numbers were quickly built up to 40 but will probably remain at that for some months to allow the centre to settle down adequately. The organization has been working very satisfactorily in these early months and the boys have settled in very well indeed. An increase in facilities for training the girls at Janefield would help fit more of them for outside occupations at the Moorakyne leveL I would like to express my appreciation of the ready co-operation of the Psychiatrist Superintendents and all members of the staffs during my inspections of the Receiving Houses, Mental Hospitals, and Mental Defective Institutions.

CHIEF CLINICAL OFFICER'S REPORT.

DR. ALAN STOLLER.

Despite the absence of the Chief Clinical Officer who was loaned to the Commonwealth Health Department for approximately four months, considerable progress has been made in the field allotted to him. The building-up of staff has been slow, but there is a difficulty in recruiting well -qualified research personneL There is activity with regard to clinical investigation and the general standard of medical interest is encouraging. Training .courses are raising the general standard and outlook of medical officers, nursing staff, chaplains, and other ancillary personnel, with a consequent improvement in the general climate of the institutions. The opening of the Chief Clinical Officer's clinical and research centre, in providing suitable accommodation and ready access to the technical library, should considerably facilitate research and training in the coming year.

Stc,.ff and Accommodation. The staff, which has so far been provided for the Chief Clinical Officer, consists of a technical librarian and female assistant, and two senior stenographers. A psychiatric biostatistical research officer and senior psychologist are being sought. No medical or social work staff has so far been allotted to him. Office accommodation has been provided at Royal Park Receiving House and a new building is in course of erection, and almost completed. Provision has been made for a technical library, conference and demonstration room, theatrette with one-way screen, and six offices.

Training Courses. (a) Medical OJ!icers.-A post-graduate course in psychiatry, comprising 80 lecture~ and demonstrations, commenced in March, 1955, and continues for five months. An induction course for newly-admitted medical officers has been introduced and is being given twice- yearly. The course is residential and lasts for one week. . (b) Nurses.-A need exists to help nursing staff adjust itself to changing patterns of psychiatry and mental hospital practice. Accordingly, a continuous programme is being arranged, designed to reorientate senior nursing staff. So far, three one-week residential courses have been arranged for principal nurses; three two-week residential courses for charge nurses ; and one residential activities course, of two weeks' duration, run by the Occupational Therapy School of Victoria. This is the first of a series of six and aims to equip charge nurses to introduce activity programmes in their own wards. (c) Theological Studenta.-A two-term course of theoretical and practical work for theological students has also been conducted. · 16

(d) Othe1·s.-The Chief Clinical Officer has been consulted on the mental health content of courses, run by Maternal and Child Hygiene Branch, for Infant Welfare Sisters and teachers in centres for the mentally retarded. The Poliomyelitis Division has requested help in arranging a course for its workers in the field. The Council of Social Service has requested an institute, on mental deficiency, for the heads of children's institutions. And, finally, a Chaplain's Course has been arranged to take place in July.

Research. (a) Mental Health Research Fund.-This fund, consisting of £4,000 from the Victorian Government and £600 from public subscription, has been allotted to four studies by University Departments. The fund was designed for University-Mental Hygiene co-operation, and both bodies are represented on the committee. The researches undertaken for the year are-- (a) Anatomy Department: (i) investigation of physical growth processes of Mongol children, (ii) temporal lobe function and its relation to behaviour ; (b) Pathology Department: atheroma and arteriosclerosis in relation to cerebrovascular disease ; (c) Physiology Department: Effect of lithium and other cerebral analeptic drugs; (d) Pharmacology Department : Investigation of pharmacology of chlorpromazine. Our resources are being mobilized and help sought for all of these studies, except pathology, where the work is entirely in the laboratory at present.

(b) Other.-Many research activities, within the Department, have depended on the interest of individuals. Papers, among others, have been produced on such topics as Mongolism, Huntington's Chorea, psychiatric effects of )1urray Valley encephalitis, and the use of Succinic Acid, Chlorpromazine, Reserpine, and Lithium treatment in psychiatry. Work proceeding at present includes radiological investigation of skulls of mental defectives at Janefield and an evaluation of our patients who have had psychosurgery.

Clinical T-reatment. Electroencephalography.-An electrophysicist has been appointed and is helping establish the E.E.G. department at Mont Park, in relation to the neurosurgical unit. Another E.E.G. machine is ordered for Royal Park. Neu-ro-radiology.-Angiography is now being carried out at the neurosurgical unit, Mont Park. Chlorpromazine and Reserpi1w.-Al1 investigation is to proceed into the use of these newer drugs within the Department. Already, useful investigations have been carried out at Royal Park, Ballarat, and Beech worth, and a controlled study is proceeding at Larundel.

General. Techm'cal Library.-This is functioning as the psychiatric library for Victoria, as part of the Central Medical Library of Victoria. It is taking 68 separate journals and a further seventeen are on order. Two lists of new books have been issued. The library now has in the region of 2,000 books, with 400 new titles added in the past twelve months. All institutions and clinics are being given a basielibrary service. Displays of psychiatric literature have been arranged for several visiting groups. A very excellent job has been done in building up the library, despite severe limitations of space. Part of the time of the librarian, during the current year, was spent in organizing a :Mental Hospitals Book Appeal for patients.

Abstracts and Information Bulletins.-The circulation of two sets of abstracts of articles from psychiatric and allied fields, prepared by members of the staff, has taken place. In addition, a number of administrative and information bulletins have been issued, including one on the " open door" in mental hospitals. A catalogue of health films, available from the State Film Centre, has been circulated, and particulars of some new films added. Training in psychiatry and neurology are relatively poorly represented in courses for the Diploma in Psychological Medicine of the Melbourne University. In view of the fact that entrants for this postgraduate medical diploma are studying part-time, worth-while changes envisaged should involve less emphasis on basic subjects such as psychology, and the incorporation of psychopathology into a general course of psychiatry. Such a course must include more individual teaching at the bedisde, and senior supervision of treatment by physical and psychological methods. To foster such training for the junior medical officers, it is necessary to arrange special teaching programmes, and this will demand recognition of the fact that man-hours must be made available for this purpose. 17

STATISTICAL SUMMARY 19ti4.

RECEIVI:-JG HousEs.

(C = CPrtijied Patients; V.B. = Voluntnry Boatiler8.) C. V.B. On Books 1st January, 1954 208 Admitted during year 1,600 1,127 2,727 Total number under care 2,935 Discharged 628 891 1 ,ii19 Died 33 9 42 Admitted to Mental Hospitals .. 963 165 1,128 2,689

Remaining on Books 31st December, 1954 246

--~-

1\IENTAI. HosPITALS. (Certified Cases nnd Voluntm·y Boarders.) On Books 1st Jmwary, 19ii4 i'l,lHJ

Admitted during year-~ Direct 674 From Receiving Houses 1,128 1,802

Total number under care 9,983 Discharged 1,289 Died 563 1,852

Remaining on Books 31st December, l95·i 8,131

FIXA"SCIAL 1954-55. Maintenance Costs-- £ Mental Hospitals, Receiving Houses, and General Expenses 3,620,945 Mental Defectives Branch . . 205,921 Public W arks Department Expenditure on repairs, renovations, and maintenance of buildings and essential services 331,706

Total 4,158,572

Re•t;enue 218,652 Average gross weekly cost per patient-£9 17s. 4id. Average net weekly cost per patient-£9 6s. 7fd.

1304/56.-2 TABLE I.--Showing the Number of Cases under the Care of the Department on the 31st December, 1954.

~- Certllled Patients Receiving House Voluntary Repatriation Special Patients on Total on .Resident. Patients. Boarders. Cases. School Cas<>s. Trial Leave, &e. Books•

~~ ~-~ Name of In•tituti on. ~--~~ -~--~·-- ~- ---- ~~·~~--·- ·- Ma.le•. ll!'emales. Total. Males. Female~. Total. Male''· Females. Total. Males. Females. Total. Males. IFemales.! Total, Males. Femalcs. Total. Males. Females. ·rotal. ------Mental Hospital, Kew .. 500 456 956 ...... 16 14 30 ...... ;)6 50 106 572 520 1,09:.! Mental Hospital, Kew Children's Cottages .. 281 214 495 ...... 2 2 ...... 41 15 56 322 231 553 Mental Hospital, Ararat . . 540 296 836 ...... 6 4 10 ...... 3 2 i) 549 302 851 Mental Hospital, Boechw rth .. 179 462 641 ...... 8 6 14 ...... 45 10 55 232 478 710 Mental Hospital, Sunbur. .. 482 688 1.170 ...... 37 18 55 ...... 190 199 389 709 905 1,614 MentaJ Hospital, Ballara . . 314 561 875 ...... 9 16 25 ...... 51 7l 122 374 048 1,022 Mental Hospital, l'toyal ark ...... Mental Hospital, Mont P •rk . . 460 810 1,270 . . .. 42 68 JlO ...... 88 128 216 590 1,()06 1,591) Mental Hospital, Larund I . . 334 ll2 446 ...... 46 21 67 ...... 39 44 83 419 177 596 Mental Hospital, .Janoficl I .. 6 63 69 ...... 15 8 23 ...... l 4 5 22 75 97 1-1- 3,096 3.662 6,758 ...... 179 157 336 ...... 514 523 1,037 3,789 4,342 8,131 Repatriation Mental Hos 1ital, llun- doora ...... 223 .. 223 ...... 40 . . 40 263 . . 26:{ J--.< !---- i 00 3,096 3,662 6,758 ...... 179 157 336 223 .. 223 ...... 554 523 1,077 4,052 4,342 8,394 H.eooiving House, Bal1ara ...... 5 5 10 4 4 8 ...... I l 9 10 ]!} Receiving Houae, ltoyal )!ll'k ...... 26 .')() 76 38 58 96 ...... I I 64 109 178 Receiving Hou'le, Plcasan t View ...... :n 33 54 ...... 21 33 M -- - !-~ ~~- 3,096 3,662 6,758 31 1)5 86 :.!42 :?52 4!'14 223 .. 223 ...... 554 525 1,079 4,146 4.494 8.640 Trava;wore Development 1 Centre ...... 28 27 55 ...... 28 27 55 StaweU Special School ...... 58 17 75 ...... 5S J7 75 Janefield Colony '...... 15 144 159 ...... 15 144 150 - ··--- ~~- i- ~--· ~-~- - Total Number on Book ' of State .. In~titutions '. .. :l,09() 3,662 6.758 31 55 86 242 252 494 :.!23 1 223 101 188 289 ;)54 525 1,07!'1 4,247 4,682 8,92!) ·---- -~- Total Number Residen in State I Institutions . . 3,096 3,662 6.758 31 55 86 242 252 494 22:l 1 . . 223 101 188 289 ...... 3,fl93 4,157 7,Sii0 1- ~~--1- :--~--· ~-~ :------~- -~~~ Private Mental Home "N .erton ~) ...... :~- ··-· ·- !--·~- Total Number umlo1· Care of Depart- ' ment .. . . 3,096 3,662 6,758 31 55 86 242 252 494 223 I 223 101 188 289 554 525 1,079 4,247 4,682 S,92ll i ----- ~--· ~--~~ ·------~ Mental Hospital, ltoyal Park, closed 7.4.54. "Merton" clooed 18.0.54. TABLE If.~Sbowittg the Number of Voluntary Boarders on the Books of the Mental Hospitals awl Receiving Houses and Private Mental Homes, the Number of Patient" (Ex Defeuee Personnel) treated under Seetions 234 to 238 (Mental Treatment) of the 11lenta.l Hygiene Act 1928, the Number of Patients in the Receiving House..", and the Number of Certified Patients ou the Books of the Mental Hospitals and the Private Mental Homes at the end of each Year from 1940 to 1954.

Voluntary Boarders. Ex I>efence Service Personnel. lteceivinM Houses. Certified Patients.

Yea1-. Mental Private Mental Total Ho•pltals. Uegist

Males. I Females.lj TotaL Total. i--1-!-!-!l-:-1--- («). 1940 1SI 50 231 + 27 2·9 230 \1 37 3,483 i 3,801 1 i,21l4 47 ' lj2

!.)() {)7 ' ' 1!141 207 24 2·() 223 i 31 3,468 1 a,872 i 7,:Ho 16 43 ;}9 1942 151 1:1 217 _,_ 10 J3 !JG 2·S 227 I -1 4 46 67 1131 3,438 ' 3,81S 1,256 25 34 59 I 7,315 84 194;{ I)!) ., ' 7ii li4 l!l .)2 71 245 -;- 28 3·1 229 4;) 58 103 10 3,412 3,840 7,25~ 18 38 56 7,308

1944 112 :HO IS 44 f) us 62 272 27 3·7 :.!34 41 64 Ill 8 3,425 3,817 7,242 15 :J2 47 7,289 I \I 194.3 134 lOS 242 23 67 !)() 332 4·1 245 11 48 66 ll4 +60 3 3,478 3,784 7,262 14 32 46 7,30S f l ~~ 1946 115 !JO 205 :!5 60 85 269 290 42 3·7 24 47 89 136 22 3,290 3,747 7,037 12 30 42 7,071} -~2H 1947 114 102 216 31 70 101 317 27 4·1 2ii 4!J 8 78 124 12 3,269 3,783 7,052 11 27 38 7,0!)0 + 11 1948 97 7;) J72 23 78 101 27:~ 44 3·5 278 42 74 ll6 8 3,307 3,813 7,120 10 21 31 7,151 + 61 1949 107 67 s:~ 174 :m 112 286 + 13 3·6 293 + lli 42 74 llti 3,304 3,899 7,203 9 18 27 7,230 l-

1950 !12 70 17 s·) .j;) 162 99 :.!(11 25 3·2 303 + 10 90 14-1:} 29 3,420 4,052 7,472 7 20 27 7,499 -t-2(JH 1951 fJ3 64 1Gi 20 S3 103 260 3·1 301 2 :)8 82 135 10 3,459 4,109 7,568 4 19 23 7,591 !1:' to.:; 1952 133 238 17 68 85 323 ! o:J 3·8 244 {)7 44 61 105 30 3,553 4,154 7,707 3 Ill 21 7,728 +t:r; 1953 186 l5ii 341 42 42 273 383 !60 4·4 29 44 6S ll2 7 3,652 4,284 7,936 13 13 7,949 -~-~j 1954 242 ;3;)2 494 494 Ill 6·7 ~!)3 10 :n f)5 86 26 3,610 4,1S!i 1,705 7,7!l5 ---l!H

(a) = Increase +, Decrease - 'l'ABI,J<: III.~Statistical Return of Voluntary Boarders since 1940. ·-·· .. - . ... !'er· Admissions. eentage of AU ,.... Admis· Discharges. Certifiecl. Died. ~ions, i.e.t Year. I State Private Total Certified Institutions. Institutions. Admissions. Pailents

and ------.... ---~·------Voluntary ~I,! leE!. Females. Tout!. Males. Females. Total. Males. J<'emales. Total. Boarders. Males. Females. Total. }Jales. i Femnks. Total. }tales. Females. Total. ------! I 1940 .. .. . 298 227 ;)25 3;)2 25!) .')6 !)1 ll HI 3H . 54 104 158 :331 mm 25·7 276 535 35 I 1941 ...... 305 261 5456 52 114 166 357 375 732 26·8 322 275 597 43 i 88 131 14 6 20 1942 .. . . 279 2454 543 51 138 189 330 402 732 27·!) 261 319 580 48 04 112 17 13 30 I 1943 303 227 530 ;)7 71 128 360 298 liiiH 2f)· 7 287 232 519 33 41 74 18 l!l 37 i 1!)44 310 287 597 57 105 162 367 302 i!)\) 27·8 302 305 607 22 :12 .).1, 31 :12 63 ! !5 1945 399 268 667 35 143 198 454 411 86.; 29·4 366 319 685 3!l i 32 71 22 27 49 I i 1946 341 185 526 !!2 140 232 433 32ii 75t> 26·ii 396 312 708 34 l!l 53 20 l!J 3!) 1947 308 229 ii37 ll5 174 289 423 I 403 H20 28·7 367 333 700 2!) 30 iifl 22 18 4() 1 1948 :154 1454 o3l8 105 14:3 248 4;")9 :107 7(16 25·1 422 259 681 4o3 40 8;) 17 27 H

1949 31ll 233 624 109 129 238 ;)00 362 862 26·4 439 310 749 28 :m .)4 17 :W 41i 1950 .. 412 259 671 Ill 151 262 523 410 H:{3 24·8 509 355 8454 24 l!l ·i3 17 34 ."il

1951 .. 300 151 451 !l7 143 240 397 I 294 mn Hl·1 370 259 629 12 13 ~)) 11 27 3S I i' 1952 .. . . 441 272 713 !)7 IilO 247 538 422 I 960 23·9 449 357 806 37 17 ;)4 15 22 a7 1953 607 488 1,095 30 87 117 637 575 1,212 27·6 559 507 1,066 27 60 9 17 20

1954 909 867 1,776 .. 7 7 909 874 1,783 :39·3 826 775 1,601 ': I 1:3 2.2 20 :l!l 4tl ------. --~ '... ------~--· ~--- ·- TABLE IV.~Showing the Admissions, Readmissions, Discharges and Deaths at Receiving Houses of Certified Patients and Voluntary Boarders during the Year Ended 31st December, 1954. --- Males. ];' ~males, Total Total Grand 1\Iales. Females. Total. Certified. Voluntary Hoarders. i --r--- - ! I11 InRtitutions 1st .January, 1954 42 fi7 58 so 125 :W3

Absent without leave 2 1 .. 2 I 3 - Total number on lst .January, 1954 .. 82 126 208 Ca::;cs Admitted--

! First admissions 665 492 702 [J52

Not first admissions 92 2!! HI 54

---- ·---- ~-~------·-- Total eases admit-ted during the year .. 1,278 1.449 2,727 t-:) 1-' CaRes discharged outright 280 401 ;)48 -WO

Cases transferred to Mental Hospitals 480 93 483 72

Died 10 2 23 7 -----!----.--~ --- Total eases d.iscltarged, tmnsferred, and died the year .. 1.266 1,423 2,689

Remaining in the Inst.itutions, 31st December, 1934 31 6:3 5:') 95

AJ,sent without leave 2 -:~ -··--· --- ..- -. "--- Total number on books, 31st December, 1!)54 .. 9-t 152 246

---~--

A nrmge number resident during the year 31 57 fJ!l 91 t\8 150 238

:Persons under care during the year f 755 462 85fl ' 522 1,217 1,377 2,594 - ---- . TABI.r; V.--Showing the Admissions, Discharges, :md Deaths at Mental Hospitals of Certitl0d P J.tienbs and Voltmbry Bo.u·d,Jr:-~ dttrillg the Ye

. ------Males. .l<'emales. ------~-- --~~ Total Males. Voluntary - Voluntary Certified. Boarders. Certifi~~-~ Boardern. I In Hospitals, lat ] 954- ...... 3,081 148 3,644 97 :3,22H 3,741 6,970

On trial leave ...... 397 .. 503 . . 3H7 [)03 900

Boarded out ...... 163 .. 134 . . 163 134 297

Absent without leave ...... 11 . . 3 .. 11 3 14 ~------. . . . 3,800 !,381 ~.181 Total number 011 hooks, lst Ja.n mry, 1954 ...... Cases Admitted-

104 295 86 I 189 Direct admissious ...... '

~'rom Receiving Houses ...... 480 93 483 72 !:.,:)

---···--~ ------!:.,:) ------Total caseR :tdmitte

Cases discharged ...... 372 339 389 ISH

DiNl ...... 254 18 279 12 ---1------'------Total cases and died :luring the year ...... 983 869 I l,852 R~·mil.iniug in the HospitalR, 3l"t. Deeemb er, 1954 ...... 3,096 179 3,662 157 3,27[) 3,81H 70!) On trial leave ...... 328 . . 381 .. 328 :JSl I J3mmled out ...... 173 . . 136 .. 17::) 136 309

Absent without leave ...... 13 . . 6 .. 1:-l 6 19 '------Total number on hooks. 31st De }ember, 1954 ...... 3,789 4,342 8,131 ---

Average number resident during the year ...... 3,227 182 3,823 132 3,409 3,955 7,364

Pf~rf

RC'rnaining 31st Decernber, Percentage of D"" ths on the Admitted. ms<·harged. Died. each Year, Average Number Ht>Hldent. Yrnr. ----, ------I Total. ~Ialrs. Total. Males. I Females., Total. M<>lrs. I Females.! Total.

Average tiguroB for the t~·n years 1!100 OlJ 41.! 7.)2 !77 1;;4 331 201 139 340 2,H12 2,4l>5 !i,097*1 2,300 i 2,140 I 4,446 I 4:J•(j 45·7 44·0 I 8·7 6·6 I 7•6

Average ligures for tlw t<·n .vears I 1!110.-19 421 I :n4 7H.1 148 ! .j.,') 2H:l 238 l7l 409 2,8i)5 2,\llll ,>,84H* 2,fl56 2,474 i 5,030 I :lii' ! i 38·8 j 36·8 I !)·3 (j•!) 8·1 I A ven>ge figureR ft•r tll<' ten years I 1920... 29 .. 43ti :l!J4 s:~o 143 [1)2 30fi 243 184 427 3,16!! 3,:~6:l ti,5:H* 2,639 2,790 5,429 I 32•8 42·2 I 36·7 I B·2 6•6 ! 7•9

,\ ~·era,ge !igru'Ps fur the t"n yetH'l! 424 441) 870 J;)() 1H4 350 198 420 3,4()() 3,776 7,226* 3,154 5,H89 :w·s 3H·7 7·8 6·3 7•3 b:) 1930--39 .. 222 2,!!3ii I 43·41 c..: Average figures for the t<'n years I 194()...49 420 476 !!96 W!l 206 374 230 252 482 3,304 :i,S99 7,203* 2,951 3,346 t\,297 40•0 43·4 41·7 7·!! 7. i) I 7•7

19;';(1 577 626 1.203 1!12 206 398 235 251 486 :1,420 4,01)2 7,472 2,9tll 3,454 6,405 :33·0 33•0 33·0 8·0 7•0 7•5

Uli'i l .'}60 05U 1,219 260 3l0 ii70 2ti9 294 563 3,459 4,10!! 7,568 2,{198 :3,519 6,ii17 46•5 47•0 47·0 ll·O 8•0 8•5

J9J2 .. 783 761 1,544 37!l 402 781 281 295 576 3,657 4,232 7,88!l 3,246 3,705 6,9iil 48·4 52•8 50·6 8·7 8•0 8•3 ' 7•7 l!Ui3 .. 1,0ltl 804 1,820 612 392 1,004 261 263 524 3,800 4,381 8,181 3,:396 3,803 7,1!l!l 60·2 48.71 55•2 6•9 7·3 1954 .. 272 291 563 il.789 4.342 8,131 3,409 3,955 7,364 n-1 69·11 71·5 8·0 7·4 7·6

• Figure• remaining at end of each Yeat of decade.

]<'or the year 1952, the percentages of patients admitted whose ages were (15 years and over were: Males 16·6, Females 26·0; Total 21·2. For the year 1953, the percentages of patients admitted whose a.ges were 65 years and over were: Males 16·4, Females 25·2; Total 20·3. !!'or the year 1954, the percentage,~ of patients admitted whose ages were 65 years Hurl over wert>: Males 18·5, Fem:1lt>~, 24·7; Total 21·4. 24

TABLE VII.-Showing Certified Patients Boarded-out on 3lllt December, 1954.

Patients Boarded-out to- Fe mal eH. Total.

After-care Hostels 7 1 8

Private Individuals 1

Ballarat Benevolent Home 34 77

Beechworth Benevolent Home 28

Bendigo Benevolent Home

Castlemaine Benevolent Home 102 92 194

Tot,al 173 136 309

TABLE VIIL-PRIVATE MENTAL HoME, MERTON. Showing the Admissions, Discharges, and Deaths during 1954, and the number remaining on 31st December, 1954. -----·--·--··---· Males. Females. Total Total Grand -- Males. ],emales. Total. Voluntary 'i Voluntary Certified. I Boarders. Certitled. Boarders. I I Resident 1st January, 1954 ...... -. . . 11 42 . . 53 53 On Trial Leave ...... 2 . - - . 2 2 i Total numbers on books 1st January, 1954 ...... ! . . . - 55 55

Received, first admissions, &c. -...... 1 7 -. 8 8 Transferred from 1\!ental Hospitals, &c...... I ...... i . . . - . . -. .. 63 63 Discharged ...... 3 39 . . 42 42 Died ...... I . . . . 10 . . 10 10 Transferred, &c...... 11 . . . . 11 11 i I Total discharged, died, &c...... i ...... I 63 63 ' 'l'otal resident 31st December, 1954 ...... ! ...... On Trial Leave ...... I Total number of patients on books 3l;;t December, 1954 ...... I

~--·-----· ·------M-·--- NoTE.-Merton closed down on 18th September, 1954. 25

TABLE IX.-Showing the Primary Causes of Death of Certified Patients and Voluntary Boarder~ in Mental Hospitals during the year ended 31st December, 1954.

-·-----~~-- Cauoe of Dm th. Female. Total. -·------~----~----~------~------:------~------1. Diseases of Nervous System- (a) Vascular lesions affecting central nervous system ;:)2 3<1 (b) Neoplasm of the brain 2 3 (c) Epilepsy 11 ;) (d) Other diseases of the central nervous system .} 3

2. Diseases of Cirenlatory System­ (a) Disease of blood Yessels 36 4H t'.2 (b) Diseases of heart 57 70 127

3. Diseases of Respiratory System­ (a) Pulmonary tuberculosis ;] :) lO (b) Pneumonia -1:") 3Cl so (c) Other disease:-\ of respiratory sy;;tem :3 ;) 6

4-. Di~eases of Digesti,·e System 8 ::l 10

5. Diseases of Genito Urinary System .. 6 9 15

6. General Diseases-· (a) Infective diseases (other than pulmonary tuberculosi!l) .. :3 ;) (b) Neoplastic (other than tumour of brain) !I t::l (c) Metabolic nutritional dise11ses 2 4 (d) Exhaustion 2 2 (e) Senility 2\J 42

7. Accidents and Violenee 16 10

8. Suicides .. 1

Total

TABLE X.-Showing the Primary Causes of Death of Certified Patients and Voluntary Boarders in Receiving Houses during the year ended 31st December, 1954.

Caude of Death.

1. Diseases of Nervous System- (a) Vascular lesions affecting central nervou;; system 3 4 (b) Neoplasm of the brain (c) Epilepsy (d) Other diseases of the central nervous system 1

2. Diseases of Circulatory System- (a) Pulmonary tuberculosis 2 :3 (b) Diseases of heart 4- 8 12

3. Diseases of Respiratory System- (a.) Pulmonary tuberculosis (b) Pneumonia 7 7 (c) Other diseases of respiratory system

4. Diseases of Digestive System 2 3

!). Diseases of Genito Urinary System ..

fi. General Diseases- (a) Infective diseases (other than pulmonary tuberculosis) .. (b) Neoplastic (other than tumour of brain) (c) Metabolic nutritional diseases 1 (d) Exhaustion 2 2 (e) Senility 4 5

7. Accidents and Violence

S. Suicides . .

9. Unknown 3 3 ------Total 12 30 42 26

STATE MENTAL HOSPITALS. E.ctmots from reports by the Psych£atri8t-Superintendents to the iliental Hygiene Authority.

:VIENTAL HOSPITAL, ARARAT.

P.TENDENT: DR. J. L. GoR.\lAN.

~[alP. l''emulc. Tu tal.

'------:-~-~------~

Xumber of Patients on Books 1st January, JH34 5[)] 307 858 Admitted- Voluntary ~ 7 15 Certified l 2 Transferred from other Hospitals 2\i 22 31 Discharged .. ll 8 HI Transferred to other Hospitals 10 13 23 On Trial Leave 3 2 5 Died 19 14 33 On Books 31st December, 1954 54\l 302 851

General Health. The general health, especially in view of the large proportion of senile patients, has been good. Heveral typhoid carriers were transferred for treatment. Satisfactory isolation of tuberculous patients still present;; a difficulty. There are no known active cases on the female side, and only two known active cases on the male side. A mass X-ray of all patients has just been completed, the reports are not yet to hand. Surgical treatment at the Mont Park Neurosurgical Unit was satisfactorily carried out on several patients. A marked improvement in the diet appears to be reflected in the improved general health.

Treatment. Despite the fact that there is no Receiving House, most modern techniques have been carried out, including electroplexy, sub-coma insulin, lithium, and abreactive techniques. A start has also been made with the latest treatrnents-largactil and serpasil. These are producing good results, even in patients of long standing. Results will be incorporated with the general research programme.

Occupational Therapy is increasing despite the lack of a trained Occupational Therapist. Two separate therapy units haYe been built, but until the rapidly progressing renovations a1·e completed, must be used for temporary hou~ing, as wards in the eourse of renovation are temporarily put out of aetion. A very good occupational therapy unit at" .J" Ward is almoRt complete, and will fulfill a long-felt need. The basket-making sections at both " .) .. Ward and tl1e Main Building are doing good work and the prodnctR are in great demand. A colourful display of baskets. fanl'y work. &c., wa~:< well received at thP Exhibition in the Melbourne Town Hall last Kovember. The social activities continue to expand, and a comprehensive rcereation programme is provided with the help of the acting Amenities Oflicer. The Annual Picnic and the Fancy Dress Ball were as usual the most popular events of the year with the patients, and much time and work was devot,ed to them by both patients and staff. Dr. Dax attended the Ball and helped with the judging of cost.unws. Jn audition to the active recreation, many entertainments were provided by the various voluntary organizations. Movies continue twice weekly, one session being deYoted to patients who before were dcenwd rather inaccrssiblc. Dunces are held fortnightly. Community singing is popular and so are record recita b . .Many patients take part in the Amrat footbalL erickct and tablt> tennis competition;;. 'fhe Dramatic Club includes both staff and patients.

Amenities. A more thorough clas::;ification has resulted in a greater measure of freedom for patient;;. The open wards on both the male and female sides are a marked success and each caters to a fair extent for its own social life. The fellow feeling amongst the patients in each of these wards is marked and is being further encouraged.

Two of the most notable improvements to he seen in this Hospital are in the clothing and diet of the patients, who show a marked appreciation. Ill-fitting hoots, " molrskins ,. , ami gala tea dresses are things of the past. The gratuity syHtem for workers continues to prodm·e ~oorl resuh~. 27

Buildings, Equipment, Artisan WoTh'. The building programme has gone ahead very well. Two new houses for :VIedical Officers have been completed and are already occupied. Four new houses for senior staff are approaching completion and will be ready for occupation within a few weeks. Four more such houses have already been commenced.

A new Concert Hall iH planned and the pretlent inadequate hall will be converted to a ehapel.

Two Occupational Therapy Units have been completed, one on the male side and Ol)e on the female side. A large L.T.C. building has been provided as a new shop for the carpenter.

Work is progressing steadily on alterations and additions to the female side of the Hospital. Temporary housing has been provided for patients, from wards taken over by the builders.

A general overall plan has been drawn up for five new wards aud a modern Hospital l3look. This plan also includes a new oval and other sporting facilities. Kitchen remodelling still awaits finalization of plans.

Equipment has been added to throughout the Hm;pital. On the medical side two new E.C.T. maehincR, an ether machine and a general anaesthetic machine have been provided, in addition to many other items such as modern resuscitation units, &c. A new dental surgery haB been fully equipped and it is proposed that the three dcnti;;ts of the town will work one day weekly in rotation. Thu" conservative dentistry will be done for the first time-~a very great advance. A staff car has been provided and is put to immmera.ble uses. Transport in general around the Hospital has been mechanized. This has produced a great improvement in the general working of the Hospital.

The work of the artisan staff has been helped by modern equipment of many and dinrse kind~. resulting in saving of labour and improvement in results. A Furphy Unit with power jets is ready for fire fighting at all times, and during very hot days is mounted on a truck in the quadrangle ready for immediate action.

There is a very competent artisan staff at thiR Hospital. The ready availability of materials OYer the past year has greatly increased their zeal and the high quality of their work is very noticeable. Additions to staff have also been a great help in this regard. The proposed enlarging of the store and addition of a technical store will greatly increase efficiency.

Fann and Gardens. Farm.-Milk production (128,620 quarts) was up to preYious Rt,amlard~. lt has not, as yet, been found necessary to buy milk from outside sources. Work has commenced on the building of the new dairy and pasteurization unit-a big forward step. Egg production was well up to standards of previous years but the proposed extension of the fowl pens would enable the Hospital to be self supporting in this regard. This would he a big monetary saving to the Department. Pig production was also well up to standard. Pork is provided four times a year for the patients besides that being cured for bacon. Pigs arc regularly sold at th£l Bal!arat market and it is of note that thRre iR keen competition amongst the Ballarat agents to obtain tlw HospitaL; custom.

Vegetable Garden.-Vegetable production (22·~J,345 lb.) showed aa increa~e ou pmYious years. However, with the growth of the Hospital and the general improvement iu pati<>nts' diet. it was found HccesRary, for the first time, to purchase a few vegetables for a o;hort period between seasons. It is hoped that this dilliculty will be overcome in the near future hy taking over portion of the existing sporting oval for garden purposes after Mw proposed new sporting area on Grano-street is completed. Flower Garden8.--With regard to landscape gardening. the appe;u·;mce of the hospital has greatly improved. This has been brought ahout by the increased intere~t of the gardening staff in general, and the addition of two temporary gardeners t.o the Htaff, which has enabled the more Henior garden ~taff to spend more time in planning and laying out.

Stajf. In :Match a third Medical Onicer wat< appointed, and this has resulted in much more personal alld individual attention for patients. Ararat is siuguhuly fortunate ill jJO::;se;;sing a fullnnrsiug ;-;t,tff. There are owr JO applicants ou the waitino list for the male staff. There is also practically a full complement on the female nursing staff, but no waiting list. :Many are married women am! efforts are being made to recruit more Billgle girls. The nurses· hostel is hy no means fully occupied. The general st.aff has been augmented

The office staff i5-l also working at top yressure. and i::< very inarkrplately hon"t'd. Tht'V are \•:ell pr,JYided for in the overall plan, but this may tah sonw tilfi(• to eomplMe. 28

Staff Training and Teaching. Lectures are being given in all three years, first year being duplicated. As lectures are also being given, for all three years, at Pleasant Creek Special School Stawell, the net result is seven series of lectures at present in progress. A 16 mm. projector and an Aldis projector have been provided as aids for teaching. The tutor from Ballarat visits this Hospital on two days per week. Various members of the medical and nursing staff have attended " refresher courses in Melbourne. The medical staff is encouraged to individually train the nurses in their wards in the course of the daily routine.

V olunta1'y Orgam:zations. The Mental Hospital Auxiliary as usual has been a tower of strength. The kiosk established by them continues to flourish. Their personal ministrations to the patients at regular intervals are very much appreciated. At the recent Annual Meeting, Mrs. Pardy complimented them on their marked and rapid progress.

The Red Cross has established a special library, and local members help in its administration. This is a definite adjunct to the individual libraries in the wards which were formed as a result of the " million books., appeal. Many other orgauizations haYe contributed to the happiness of the patients by donations, and also by organizing outings and concerts. Included are the various Country Women's Associations and Red Cross Branches, Rotary, The Inner Wheel, Ararat Ladies' Pipe Band, and the various Church organizations.

Out-Patienf.y. An out-patient clinic is conducted at the Ararat and District Hospital, and provides for both adults and <:hildren. Cases are mainly referred by the local medical practitioners. In-patients are also seen in consultation with them. Patients from Stawell and other districts are encouraged to attend this clinic .

.. J ., W({rd. This special ward for difficult patients, and those admitted under Section 66 has improved in its general outlook. Since the increase in medical staff, more personal attention can be given, with gratifying results. l\Iovies are now shown weekly and are eagerly looked forward to. The aviary donated by the Auxiliary is now completed and stocked with birds. Aspects such as occupational therapy and new buildings and renovations have been dealt with earlier in this report. Treatment is carried out here as in the main hospital. The patients appear to be happier despite the curtailment of their liberty. The gardens as usual are a picture and are almost wholly maintained by patients-several prizes were won in a recent flower show.

Geneml Comments. Building activity for many diverse purposes has greatly improved the efficiency of the Hospital.

The patients themselves are participating in more social activities. Their diet has been very much improved. Clothing has departed from the old institutional pattern. New furnishings combine with light pastel shades to lend a cheery appearance to many of the wards. An efficient and increased artisan staff has resulted in improved maintenance. A general clean up of the grounds and improved gardens has given the Hospital a " face-lift ". All this has contributed to a marked improvement in the patients and has produced a brighter and more cheerful outlook in even the oldest and most chronic. Their human dignity has increa;;;ed with these man;' impmved conditions. 29

lVlENTAL HOSl)ITAL AND RECEIVING HOUSE, BALLARAT.

P:;;vcHlATRIST-SuPERINTENDENT : DR. E. L. RoBERTS.

STATISTICS. 1954.

Mental Ho.~pital, Ballaml. On Books, 1st January, 1954--­ Voluntary 14 Certified· 1,030

Total 1,044

Admitted­ Voluntary 47 Certified· 78

Total 125

Discharged­ Voluntary 34 Certified 44

Total 78

Died 7S

On Books, 31st December, 1954- Voluntary 25 Ct>rtified 997

Total 1,022

R e.cei~·inf! House. Ballant/. On Books, 1st January. 1954-­ Voluntary 6 Certified 11

Total 17

Admitted-­ Voluntary 102 Certified 129

'l'otal 231

Discharged­ Voluntary lOO Certified 61

Total 161

Died 1

On Books, 31st December, 1954-­ Voluntary 8 Certified 11

Total 19

No voluntary boarders were certified during the year. The relative number of voluntary boa1·ders at the Receiving House remained unchanged at 44 per cent. (102), but the total number treated increased by 29 to 231 for the year. The increase in discharge rate from 63 per cent. to 70 per cent. is satisfactory comtidering 22 of those admitted were more than 65 years of age. At the )!ental Hospital the number of transfers from Melbourne institutions diminished from 38 for the previous year to four this year ; a satisfactory r·eduction. An increase of voluntary boarders admitted to 37 per cent. (47) from 18 per cent. (22) for 1953, represents improvement. The percentage of dea.ths (76) remained practically unchanged at 6 · 3 per cent. One case of suicide occurred when a woman voluntary boarder left the ReceiYing House without the knowledge of the nursing staff within a few minutes of returning from an outing with her husband. 30

Ornem.l Health.

There has been a slight change in the patient~' phpical health. Fewer have been confined to bed and the ~tandard of nursing crrre of those that ha\'e has been of high standard. The increrrsed efficiency of the Hospit;1! as a whole has bt>en marred by the development of an outbreak of typhoid (three cases) and scabies. Typhoid has appeared in epidemies in this Hospital since 1912. Several proved and suspect C"rriers are known to exist hut the latest outbreak, limited to one ward, could not be traced to any one of tht>m. TAB inoculation::; have ht>t>n carried out annually on all patients and made available for the staff also.

Ben hies has also heen endemic amongst a gronp of defectives and epileptics for several years in one of the large female wards of oyer 100 bed:;;. It spread to a ward for the af!:ed and fifteen cases developed before it was brought under control. With the provision of further diagnostic aids to assist in the care of the physical illness of the patients, it would now appear desirable that a consultant physician be appoint<'d on a regular sessional basi11 to advise the medical staff. Another complete X-ray survey is scheduled to be cowlucted in .July. No fresh cases of T.B. have been detected. Dental S<'tTices have been incrca;,e

Treatment. The resocioJiza,tion programme progresses gradually but more ad,·ance has been made in forming a community life than in additional oecupationH. The patients have gained confidence in the management of their recreation club, but they still require the assistance of a Recreation Officer and tlle young male nurses who have undertaken this work have done very well. The variety of recreations covers a wide range and now caters for almost every taste. Emphasis is being made constantly on the active participation of patients, ~uch as inter-ward competitions, team sports, and a patients' concert party ; the latter have visited other Mental Hospitals and return visits from Sun bury and Ararat have been paid here. At the annual picnic more patients were engaged in the greater variety of activities organized by all r;ections of the staff. These trends can now clearly be 8een in the graphs which are set out for everyone in the Hospital to see. A df'tailed monthly retnm from each ward ha;; provided AssistaHt Head NurseH with the figures and much work was entailed in obtaining uniform methorls of recording, hut now thi:; has been aehieved the fact of any change should be ~ignificant.. Participation in active recreation has risen from tO per cent. to 28 per cent. while attendance at passive forms ::thows a grPater increase from 31 per ceat. to iit per cent. of total number:;. The greatest percental-!e increase ha;,; been on the female side. Closely a8sociated with the recreation programme is the amount of freedom allowed the patients in the form of parole. Three grades were tried, revised, and are now considered satisfactory. Difficulties encountered initially are less freq ucnt and the patients are co-operating exceedingly well, hnt it must he expected that isolated infringements will oecur. The Illlmber having parole has increased from 22 per cent. to 36 per cent. since the inception of the aystem eigltteen months ago. It has been found t.hat more activitif's ean be enjoyed if the participants are pt>rmitterl to go to them freely.

Freedom for vatient:s to expre~A an opinion about their environment is being encouraged and further steps will be taken soon to make more upportnuitr for thi:-; as the staff'~> feeling of insecnrity diminishes and real permissivenes,q increases. All ward:i no\v have shelns of expendable hookfl, most of which came from the Departmental appeaL Recently thn Red Cross have installed a 600-hook lending library at the }fpntal Hospital and will soon have ;;maller libraries at the ReceiYing HouBes. DiYine Services continued to be conducted by thP part-time Chaplain::; who al11o gave perRonal attention to indivi,~uaJ~

Henmtl efforts at occupational Yent:tres bt n• bern ~nece~~ful but no grPat progress hal! been made. With only one Occupational Therapist the diffir-nlty of guiding the nursing staff is very considerable and the senior ;tdministrative nurfiing staff ha Ye dono r•·a;.:onahly well enn:-~idsring their inexperience. Accelerated progress i;; expected with the introduction of occup:ttional cour:::es fl)r nurses in Melbourne and the arrival of a male Occupational Therapist frum England. The t-endency for the a mount of maintenance and es:-~ential service work done bv patients to fall away is being eh< :·ked and the dangl'r of disphtein@: patients in this sphere is recognized aiHl will he clm;ely watdwd, becau~e this type of work is more important than specialized craftwork to aid the rehabilitation uf patient;;. As long as tl1i~ ~·orm of work is not allowell to hecome excessive for any one individual, and is adequately rewarded, it is of great benefit. Rosters for those engaged in 1tll the year round work of thiR nature have been introduced and although gratuities have improved they are still inadequate.

The greatPst increa~P has heen in the numher8 engaged in domestic work in the wanb: from 45 per cent. to 53 per cent. on the female side and from 29 per cent. to 37 per cent. on the male side. Craftwork in ward groups was nil and now varit>s from 3 per cent. to 16 per cent. The attendance at the female Occupational Therapy Centre continues to be low at an average of 3 per CPnt. The art school haR increa;;:ed in sizt> since it reopenrcl in the new huilding··IU1 L.T.C. which is proving very adequate. At the Receiving House social activities are not so organized but with the rapidly-changing population no rigid structuring of programme is possible. Occupational therapy is regularly conducted by the Red Cross and the new rt>creation room should ilhortly be available. 31

At" ::\oYar" t.he patiellt~

The Psychiatrist is of the, opinion that treat.uwnt generally ha~ ueen ,;atisfaeturily de;·doped but i;; still limited hy the capac:ity and numbers of thr profc~sional staff. For rxample, wit.hont a p.'ychiat.rie sr.eia.l worker there is a. very limited contact with the patient\ hrJme enYimnllH'nt. ·when such work is done hy a member of the nursing or medical staff it can only be at the expense of their own work allll by diverting their special skills from their most useful application. Thi;; i;; uneconomical in the long run. Recreational, and social work i~ largely in the hand::. of the nursing ~t.aff. Likewise the actual work uf the regi:;tered nnrsing staff still inYolves a great deal of non-technical math-rs. Howt~ver, dmiug the year tlHH'e has been an iucrea~ing clarifieation of t]Je ;·arions nursing roles with nn increa.">e in e±riciency and effeetive working C

With the medical staff now at five, and with the improved internal urganization, there has been an increasing capacity to provide a better and mcm' comprehensive treatment pl'ogrammc. There is still an insufficient time for an:v systematir attempt to pro1·id(' indi;·idnal p~ydwtlwra.py, (,J' for rmy long·term planning in this connexion.

The main emphasiR has been 011 group techniques with a wider npproach through wcial psychiatry. This hH.s provided scope for considerable improvement in many cast's. Such improvement haB, in fact, c'ccurred, as i.., seen in the reduction of Rt;Oiusion and restraint t.o 80 hotll'R, all uf which was on the ft>male sidP. The total for 1953 was 2,050 hours. Only fin of thirteeu ;v,Hd~> remain closed.

The function of the C. W.A. Cottage 11t t.he :\feu tal Hospit,ll l'tll' ll'dlllf'll r a self-management ;;oheme has hcen in operation, is proving very satisfactory.

Some progres~ has been made on the reclassification of the wul·d.:;, especially on the femal.e ;;ide. As a result of this it has been possible to develop social activities within wnrds suited to the capacity of those patients residing therein. Social activities have been started for the aged of both sexes, with considerable benefit. .Jiore can be done to develop ward communities where the number.~ make this practicable. Subdivision of the large female wards ifl urgent.ly needed in this respect, and progress is held up by thi,.; at present.

The psychological methods of treatment have been extended and ;,;cnral new trends introduced. Formal group psychotherapy has been extended, and m•m'. acti;·it,_y groups Aarted (puppets, cushion making, music, dancing, &c.). i\lore activities centred 011 the ward have begun, for those who are not able to participate in the genrral recreational cluh activities. The.se latter have been <'xteHdcd so that it i;:; no poBsibl~ to attend ey,:ry acti,·ity during the WP<'k as man:1; have t,o lw run at. the snme t.imP.

A limitc•cl ;!mount of individual pt~yclwthm·ap,v of a short·tenn Hature is done at the R:,c·Jivinu; House but ~uch patient~ will usually he treated at "Novar" iu the future, where individual and g-roup psychotherapy is carried out and the principle~ of " community therapy " 1HP being fostPred. Thi;; unit has alrea\ly been treating out·paticnts and day·patients with coBsiderable .~tH'C<'ss. The Day Ho;pital eoncevt i~ one which will develop into a most wleful p~ychiatric sen·ice. No young or middle-aged patient admitted duri11g the year has hren permitted to deteriomtc, and the progression of many chronic illnesses seems to haw been halted. To hu.ve congenital mental defective;; living among psychotic v•tients adds considerably to the difficultirs of administration, and in certain respects impairs the etTorts of the intellectnallv normal patient,~ to organize their own communal life. When the new dental equipment is installed in the dent

8rJecia1 Treatment. All accepted methods of physical treatment have been used; insulin coma therapy ha,; been continued throughout the year with success. The numbers under treatment have varied from 3 to ll. Of the 31 under treatment 13 han left. ho,pital, 9 remain in hospital improYcd, and 9 have not shown any permanent benefit. Nine patients have entercd the ho~pital to bn·e the treatnwnt llR mluntary boarders and El han shown i m pro ;·Nnent. Electro-conYnl11ive therapy baR been nsed with benefit at the .:\lental Ho;.;pital and Receiving House. At the Receiving Hou>~e 70 paticmts recf'i;~ed thi'i treatment and 58 were able to leaw. At the 2\lental HoHpit.al this treatmrut has more often been used symptonw.tically, and nwn.v have ht>cn enable to so Llo. It i" expect\.'d that this latter application of elect.ro-convnlsive therapy will dencase as the ~:>ocial psyehiatry programme i:1 furt.her developed. Electronarcosis has been u:~ed fur a small numher of patients.

Recently introduced drugs (Chlorpromal!ine, rauwolfia) ha;·e been n,;ed with cou~iderable benefit..

Other forms of physical treattm·nt have been gi;·en where indicated, and F

The u;-;c of psyehntlwn1 peutic mP.thod,; ha A already been mentimwd.

Resea,rd'. A research project was carried out nmler the direction of the Psychiatrist, Dr. JDhn LiudsH.y, into the use of Chlorpromazine in the treatment of chronic psychotic patient~ a.nd published b~- Andermann and Lindsav m the 1Vled£cal Journal of Anstralin, 16th July, 1955. · Research is in progress on the incidence of fracture of the femur amongst the aged patients. 32

A 111e11 if'irs. Aper Care.-A hostel is urgently required in the city for patients following their discharge from the :Jlental Hospital and Receiving Houses. lt should provide accommodation for the patients who are well enough to work but not able to find a suitable social environment under ordinary conditions. It is felt that when "Novar" is orJeratin!f fully, a house adaptable to use aR a hostel must be found and opened. Clothing.·-The problem of providing better clothing seems to be the most difficult one confronting us. Apparel now being purchased, though improved in appearance, is mostly below the quality necessary to withstand the rigour of large-scale laundry processing. .More pressing will have to be done to make it presentable and a dry cleaning plant should be installed in the remodelled laundry. Supplies of clothing have improved lately but moleskin trousers have not yet been entirely replaced. Galatea working dresses for women continue to be used, because no material of equal quality has been forthcoming to replace it. Once again it is suggested that unstriped galatea of hri~hter and varied colours he supplied for use where nece~.:ary for deteriorated a]l(l disturbed patientH. Toilet Requiwites.-A more liberal and adequate amount of toilet paper, sanitary pads, soap, razor blades, and cosmetics is now supplied. The men shave more frequently and bearded faces are unusual, while the women take more interest in their toilet and appearance. Diet.-]'urther refinements of diet have been proposed but little more can be dolle until facilities improve. Special diets will he prepared in the new kitchen of the female hospital ward now that the cooking staff is available. The opinion of the patients concerning the menu was recently c.ought for the first time and it is proposed to hold regular food conferences with patients and staff in future. At the instigation of the Senior Dietitian a forward move was made in taking many patients off a mince diet and they now enjoy more normal and varied food. The female nursing staff have made considerable progress in introducing a modifierl scheme of self-service for meals in spite of architectural difficulties and the results are gratifying.

Buildings, Equipment, and Artisan Work. In some respects the past year has been a significant one. The old Cornish boiler!:!, condemned years ago, were removed and replaced by steam generators. Time will tell whether these W'llPrators ar<> a better proposition than the originally propo~Pd multi-tubular boi!N:.:.

New pumpH for the sewerage plant, advoca.ted years ago, were al~o proYitled, but only one is yet in operation. That has failed on several occa.~ions. The engineer suggests t.hat tl1e pumphouse-well be made waterproof and a sump pump installed to deal with any seepage. This pump eonld be inserted into a sump made a.t the lowest point of the pumphouse ba>~emeut and float controlled. New modern equipment has been installed in the laundry and old washing machine>:> and hydros are being replaced, but waste pipes are (juite inadequate and the staff are com;tantly walling in water. One can understand reluctance to spend money rectifying this condition when a new laundry is in prospect but it is not reasonable to expect staff to tolerate present conditions. Either the new laundry should be proceeded with very soon, or conditions in the old laundry improved. The former alternative is favoured. A new kitchen is dependent on a new laundry. Conditions in the kitcheu are far from satisfactory anrl cannot be otherwise until extensions are carried out. It must be reeognized that as the Hospital grows, ancillary services must be proYided for the increased numbers. \.Yhat applies to the kitchen and laundry applies also to th!:' pharmacy, store, and offices. Years ago, request was made for improved conditions in these directions and to-day we find ourselves very embarrassed because nothing has been done. The pharmacy is a di~race to the Hospital now held in such high regard. The work of the storemen is hindered by such limited space in which to deal with all the provision items, furnishings, medical and general equipn,ent, 11ow being handled in addition to general supplies of clothing, bedding, hardware, and artisans' supplies in general use. Only by taking o\·er some of the rooms of the first-floor medical officer's fiat hasH been possible to meet the need of office accommodation. Now the problem of finding a ~uitable room for the Chaplain and for other additional professional staff has to be faced. The installation of a new fire alarm system commenced eighteen months ago has made no progress for spveral months. Delay in providing the new sub-station has been an irritation. The building was erected as a very urgent measure nearly twelve months ago. It iR ~till not equipped, nor is the cabling for the new reticulation complete. }Jeanwhile, the new nurseR' home o:tands iclle and drop in voltage has been blamed for various electrical failures. Parts of the Hospital roads are a menace at night, but the new reticulation i::; required to provide lighting in those localities and should have been po~sible many months ago. The strain on inade

It is hoped to open the new nurses' home in ~ ovember and then it will be possible to proceed with renovations of the old one so that the cha.rge nurses who spend their whole working life in a hospital can be provided with a bedroom and sitting room "and enjoy the privacy of being away from the younger junior nurses when off duty. After a year's delay the three residences for medical staff are now being built. The first tenders were too high so the sites were altered and sewerage lines shortened and twelve months later a tender was finally accepted. In the meantime a tender for a separate sewer line from the gardener's old quarters was accepted for a considerable sum. It could have been incorporated in the sewer line of the new houses. Next, three more houses were approved and cited in the position of the original three and finally a preJabricated house has been placed in the same area and a tin pan provided. Ward hot-water supplies are nut entirely satisfactory, and in at least one ward the supply is very unsatisfactory. The heating of the wards was the subject of correspondence years ago, and it is expected that, with the installation of the steam generators, central heating and satisfactory hot-water services will be available in all wards in due course. The Hospital maintenance staff has large arrears to overtake. It is obvious that the Secretary and Assistant Secretary have much more work to do than in the past and they require more trained assistance. Nothing more has been heard of the appointment of a maintenance foreman; such a person is greatly needed. A considerable quantity of new furniture was purchased, including metal and plastic dining tables and chairs and plastic-covered lounge chairs. All male wards are now provided with a minimum of reasonable furniture but two-thirds of the women have nothing but wooden forms to sit on, and while their living rooms are entirely occupied with large dining tables and chairs no improvements can be made. Most of the old pattern slat bedsteads have been replaced by those with standard woven wire mattresses. The use of straw mattresses has been discontinued and replaced by either hair or rubber with plastic covers. Three hundred steel clothing lockers obtained for the men have improved the appearance of their clothes. Further supplies are required for the women.

Farm and Gardens. There is evidence of progress on the farm. The herd is being gradually increased and improved by weeding out the older cattle and rearing promising calves. One hundred quarts of milk are being produced daily at present in excess of what was coming in at this period last year. The unexpected loss of the boar interrupted pig production, but he has been replaced and recent litters give reason for satisfaction. Seventy-five chains of new fencing has been carried out. Other fencing to divide larger paddocks and give better control of grazing is in prospect. There was a good harvest and the new chaffcutter house, provided after some unexpected delay, has enabled the chaffcutter to be brought back into service, with corresponding better use of our fodder. New equipment has been provided but provision is awaited of prefabricated machinery and hay sheds approved almost six months ago. The reputation of the vegetable garden has been maintained and all the Hospital's requirements (over lOO tons) was produced-vegetables of first-class quality. Keen interest is being shown by the gardeners employed on the ornamental grounds and gradually the gardens and lawns are being improved. After much effort, the turf wicket and cricket oval was made useable, and a visiting cricket team playing in the Balbrat competition described it as the best turf wicket in Ballarat. The bowling green has also been reconditioned. A much greater participation by the patients in the gardening work in the vicinity of their wards is looked for. The staff are indebted to the Public Works gang for road and drainage improvements whilst the provision of kerbing has greatly improved the general appearance.

StaiJ:. All the medical staff have a similar variety of work and there is good co-ordination and keenness. Every medical officer works through each week day and the night work and week-end work is shared by the Psychiatrist and Medical Officers. Two more medical officers will allow the minimum satisfactory work to be done. It is hoped that an experienced Senior Medical Officer will be available soon to share the supervising work with the Psychiatrist, whose hands are very full ; for in addition to supervising treatment, and training medical and nursing staff, he has as many as twelve acute patients, a number of out-patients, and 150 Mental Hospital patients in his personal care. · It is thought that much benefit comes from regular discussions between medical, administrative nursing, occupational and teaching staff when they meet once fortnightly. The Principal Nurses, Seurotary, Psychiatrist, and Psychiatrist Superintendent also confer regularly. Many charge nurses have made progress in developing greater supervisory skill and some common frustrations have been removed. As the executive officers of the Hospital ward units, they meet the Psychiatrist Superintendent for discussion once a month. The junior nursing staff are being given more consideration by their seniors ami more responsibility. The Principal Nurses have delegated more responsibility and detail to their assistants, and the Hospital is benefiting from their freedom to direct nursing policy and attitudes. . ,The Head and Assistant Head Nurses are gaining knowledge of their supervisory work and in this section of the staff there is evidence of increasing teamwork and loyalty. · An effort has been made to facilitate staff communications by bringing to the notice of every section of the staff the importance of authentic and rapid information in the Hospital. Regular conferences and the issue of news letters to every employee are helping to decrease misunderstanding and mitigate rumour. 1304/56.-8 34

The recording of notes on individual patient~ by the nur~ing staff was commenced and has improvecL It appears to be leading, among other things, to better observation and better understanding of the patients. Also, the clinical records of every patient have been placed in the wards and are now available to the registered and student nurses as well as medical staff. This practice should facilitate an improvement in recording of medical and psychiatric data but particularly is it improving the knowledge the nurses possess of their patients. Much stress has been made on the question of professional ethics and the confidential nature of the records. Gradually a greater difference between the work of the qualified or student nurse and the ward assistant is being introduced. Uniforms distinguishing nurses from ward assistants will help. The male nursing staff is up to establishment in qualified personnel. On the female side it is fortunate that there is at the present time a qualified nurse in charge of each ward and next year it is expected that every deputy charge will be qualified. A campaign for nursing recruitment is proposed. Alterations to nursing staff salaries during the year brought about a reduction in margins ; many charge nurses received a greater monetary return than the Assistant Head Nurses; an anomaly which is unlikely to stimulate a desire for promotion. The imminent arrival of a full-time Chaplain and a male Occupational Therapist is very welcome. The artisan staff has received much needed additions. They include more general assistants for attending boilers and machinery ; drivers for new transport vehicles ; a carpenter to assist in reducing the estimated two years' accumulation of repair work ; and cleaners and labourers for cleaning windows not readily cleaned by patients or ward staff, and buildings not closely connected with wards. It is essential that all ward cleaning continues to be done by patients under the guidance of nursing staff who are obliged to work with their patients to obtain the best results. The impending appointment of more cooks will save a deteriorating situation for sickness and shortage of cooking staff has militated against planned improvements in the meal services ; nevertheless the menu approved has been followed. On the whole the staff are working more efficiently and with greater enthusiasm. There is evidence of closer co-operation and recently of better harmony and this in its turn is producing results of which the staff are becoming properly proud.

Staff Training and Teaching. There has been condiderable development by the Psychiatrist and Tutor in staff training. Lectures by medical staff and tutorials have continued throughout the twelve months. There has been an extensive use of teaching films and visual aids. The attitude of the student nurses has been pleasing and there has not been a. need for disciplinary action. Attendance at second and final year tutorials has been satisfactory but in first year there is room for improvement. The Tutor is of the opinion that regulations for entrance examinations should include a requirement to attend a percentage of tutorials as well as lectures. At present the nurses have insufficient practical knowledge The Hospital staff are pleased that the Authority encouraged the holding of a graduation ceremony after the October examinations and their attendance was greatly appreciated. It was particularly fitting that the Chairman should present the certificates on this first occasion. There were eight successful final year candidates. The attendance of student nurses at the current training course numbers thirteen first year, sixteen second year, and sixteen final year in approximately equal proportion of the sexes. There are some promising candidates among the final year class and several are New Australians. A scheme of quarterly reports on the student nurses by their charge nurses has been commenced. After comments have been added by the Principal Nurse and the Psychiatrist Superintendent, the student is given the report to read and it is returned to the care of the Psychiatrist Superintendent. One male graduate of last year has proceeded to the Ballarat Base Hospital to do his general training. In addition, films of a general psychiatric nature have been shown to student and registered nurses at regular intervals. Visiting speakers have addressed the nursing staff (from A.A., Langi Kal Kal) and special clinical meetings have been held for the registered nursing staff, some of which have been arranged to coincide with visits of the Chairman, Deputy Chairman, and Chief Clinical Officer. Weekly clinical meetings are held by the medical staff, and there are weekly meetings in wards between nurses and medical officers.

Voluntary Organization.-. The Ladies' Auxiliary has been able to develop more personal service to the patients generally and to some individuals in particular, because at last there is not the necessity for them to spend large sums of money on such things as sterilizers and radio sets, for these are now provided by the Department. This personal service is much more important and includes such things as providing correspondence courses, assistance to patients when discharged, outings to functions in the city, trophies for competitions, and an innumerable number of suchlike. The Auxiliary has brought new organizations into the Hospital sphere and in many ways helps to reduce prejudice. The Kiosk has maintained a useful service and requires more room. Many more patients attend the kiosk personally and it is expected that soon it will be organized to supply the entire needs of all the patients in the way of extra comforts other than clothing. 35

Helpful advice has been received from Auxiliary members and their attendance at important Hospital functions is always encouraging. A 10-mm. cine-eamera is to be purchased by the Auxiliary and will be used to record Hospital events, make films for public relations and for staff training. The C.W.A. have maintained their interest in the Cottage which has been mentioned above and many branches have provided outings and picnic:; which are arranged through the Auxiliary which supplies buses for transport. Individual voluntary help has been given by Mr. Neville Bunning in teaching painting; Miss Morcom in teaching dancing; and Mr. Simmons, the Hospital plumber, in conducting a weekly square dance. An increasing number of entertainments have included the Symphony Orchestra, Civic Choir, Williamstown Little Tb eatre, National Theatre, and many others which have been arranged by the Auxiliary.

Out-Patients. Out-patient services are now available at the Ballarat Base Hospital and at" Novar ",and vary between three to five sessions per week. The Psychiatrist now assists the Psychiatrist Superintendent at the Base Hospital Clinic, and three members of the staif have sessions at "Novar ". [t is not possible to consider travelling further afield until the medical staff increases. Ex-patients are also regularly seen at the Receiving House and the development of an ex-patients' social centre is currently being planned for "Novar ".

General Comments. Public Relati,ons.-Two Open Days were held during the year; the first included a display of craftwork in November and the second was held during the Begonia Festival when nearly 200 visitors were conducted through the Hospital in small groups by members of the staff. The beautiful floral float designed by Student Nurse Judd and made by many members of the staff and patients under her guidance obtained first prize in the Begonia Festival procession. It represented gardening by the patients. Several of the staff have given talks to local groups on the Hospital's activities and a set of colour transparencies for projection have been very useful for this purpose. The public is becoming more interested iu the development of the Hospital and information is frequently supplied to the Editor of the Courier \vlw shllws by hi~ co-operation that he recognizes the importance of this public service. The Coming Year.-During the next twelve months it is hoped to see the completion of" Novar" and the purchase of a hostel; the remodelling of the old building and opening of the training school, joinery section, and cafeteria ; a beginning on the subdivision of the three large 120-bed female wards ; the commencement of a combined hospital ward, recreation hall, laundry, kitchen, chapel, and additional office accommodation and dispensary. The Hospital staff plans to concentrate on the more disturbed and deteriorated patients now that those less so have received greater attention ; to increase occupation particularly in essential services and ward community work ; to promote more independence and responsibility of the patients in their recreational activities; to commence an ex-patients' soeial organization ; to improve the care of clothing, and to increase post-graduate training, particularly in staff-patient relationships. In conclusion, it is thought fair to say that this Hospital has made during the past year greater progress than during any year in its history. This progress is duP to mnny people in all its sections, and the staff are becoming proud of their Hospital. It is acknowledged that the J:lental Hygiene Authority's directi,m hr;,;, plu.yed a considerable part in the achievement of the Hospital and the staff appreciates the Authority'H n'c11gnitiun of what ha" been done and looks forward to continued inRpiration and support. MENTAL HOSPITAL, BEECHWORTH.

PsYOHIATRIST-StrPERI:'\TE:'\DEXT : DR. H. A. BowER.

STATISTICS, 1954. There were 651 patients in hospital on the 1st of January, 1954. Fifty-one patients were admitted during the year, of these 33 were voluntary boarders and 18 were certified. Thirteen patients were discharged and 24 allowed on trial leave. Twenty-eight patients were boarded out at the end of 1954, all of them at the Ovens and Murray Home. Thirty-two patients died during the year. All deaths were due to natural causes. On the 31st of December, 1954, the number of patients on the Hospital books was 696. Excluding patients over 70 yea):s of age and mental defectives, there were 33 direct admissions to the Hospital. Twenty-two patients, all belonging to this group were able to leave the Hospital within the same year.

General Health. The physical health of patients has been very satisfactory. A mass X-ray examination of patients and staff was carried out in November, 1954, and several patients showing X-ray evidence of some lung pathology were thoroughly investigated. In only one case could the diagnosis of pulmonary tuberculosis be established beyond doubt. Twelve cases were transferred to the Mont Park surgical unit for treatment. A small number of elderly patients who had suffe1·ed fractures of the neck of the femur were treated at the Hospital by conservative measures. One patient having suffered a bilateral fracture of the femur-neck had a nailing operation performed at the Wangaratta Base Hospital with an excellent result. An increasing number of patients are being provided with artificial dentures, in some cases resulting in improvement of their physical health and always producing a considerable aesthetic effect.

Tteatment. (a) Occupal'ional.-A large occupational therapy unit has now been completed and equipment allowing for a complete range of occupational therapy has been ordered. Low-level occupational therapy involving deteriorated patients has slightly increased in individual wards. A number of non-deteriorated female patients are carrying out higher-level occupational therapy with a gradual emergence of group therapy. Male patients are working with various artisan groups (painting, carpentering, engineer's shop, fireman, and bootmaker). Demolition of a section of the hospital brick wall, although organized and partly carried out by members of the staff, was considerably aided by patient labour who performed tasks like cleaning, removal, and stacking of bricks. Gratuities paid to working patients received a slight increase during the year producing a more powerful incentive for work and in some cases helping with the rehabilitation of patients. (b) Social and Recreational.-No essential changes have occurred in this sphere compared with last year's activities. Patients' committee meetings, picture and dance nights, record recitals, pleasant Sunday afternoons, and picnics are held regularly. Publication of the hospital magazine continues. Inter-ward visits have recently been organized by a Medical Officer. Invitations are being issued by individual wards to patients of the opposite sex. These social evenings involve the holding of table tennis tournaments, dancing, card games, and singing groups. The highlight of the evening is, of course, a carefully prepared supper. The organization of the evening rests entirely in the hands of the patients and it is most gratifying to witness the gay, carefree atmosphere and the socializing influence of these parties. Picnics and concert parties arranged by various auxiliary groups are now a regular part of the Hospital's entertainment programme, giving a great deal of pleasure to patients and staff alike. (c) Rehabilitation.-The Government Employment Officer stationed at Wangaratta has proved extremely helpful in finding suitable employment for selected patients who are either discharged or sent out on trial leave. A close liaison has now developed between this agency and the Hospital, resulting in the successful placing of patients in various types of employment.

Special Treatment. Electro-convulsive theraphy was given to a number of patients, in most cases constituting maintenance treatment and in some instances to control fluctuations in the psychotic process, making patients more manageable. Special emphasis was placed on the treatment of psychotic patients by means of pharmacological agents. Drugs like Largactil were used extensively and proved to be of great benefit, particularly in controlling agitated, elderly patients. In 1955, Serpasil, a comparatively new drug in the treatment of mental disorders, was used alone and in combination with electro-conv'1llsive therapy. Psychotherapy was given to a limited number of patients, mainly voluntary boarders who were advised to seek admission at the W angaratta out-patient clinic. The time factor and shortage of mental staff limited this form of therapy.

Reseatch. An organized research programme exploring the use of Serpasil was commenced in February, 1955, and i.., still continuing. A paper dealing with the clinical evaluation of Serpasil in the treatment of chronic mental patients was rea' I by H. :M:. Bower at a meeting of the Australasian Association of Psychiatrists in May, 1955, and subsequently published in the Medical Journal of Australia. 37

Amenities. (a) Freedom.-It has been the policy of the Hospital to grant an increasing amount of freedom to suitable patients. It must be admitted that this procedure involves the taking of a calculated risk but the inconvenience of dealing with an occasional absconder and the sending out of search parties is amply compensated by the gain in the sense of freedom patients experience resulting in a gradual disappearance of the mental hospital climate. Parole granted to patients is now graded into " Full Parole " which includes the township of Beechworth, " Hospital Parole " and " Group Parole " under which a number of patients accompanied by an attendant or a nurse may visit the picture theatre or do some shopping. Only carefully screened patients _are allowed full parole after 6 p.m. The patients' committee considers individual applications for parole, deals w1th law breakers, and is held responsible for the smooth functioning of the system. (b) Classijication.-Severe overcrowding of wards and an extensive re-building programme which necessitated continued shifting of patients to temporary quarters has hampered the proper classification of patients. The hospital badly needs a small, well-furnished and self-contained unit, preferably isolated from the rest of the Mental Hospital, for the admission of voluntary boarders whose illness, although requiring treatment, makes a separation from the chronic and largely deteriorated hospital population desirable. Completion of the new prefabricated hospital unit and construction of new male and female wards will facilitate the task of reclassifying the patient population. (c) Clothing.-Male patients of clean habits are now being issued with ready-made tweed coats and trousers. Deteriorated patients are dressed in khaki drill overalls manufactured by the hospital tailor shop. Shirts are no longer made in the institutional work-shop but are bought ready made. Old type institutional clothing has by now disappeared from the female division. However, the material of dresses at present issued is extremely poor, tears easily, does not stand up to the continuous laundering, and does not give enough protection against the severe Beechworth winter climate. Rubber raincoats have been ordered for working patients who at times have to walk some considerable distance to reach various workshops. The first samples of the re-designed uniform for male nurses have been received. (d) Diet.-The new diet scheme introduced last year proves to be most satisfactory, providing ample calories and sufficient variety. All patients look well fed and generally express their appreciation of the diet. Supper is now served in individual wards and is now a permanent part of the hospital diet. It bridges the long interval between the evening meal and the next day's breakfast.

Buildings. The burnt-out section of the Hospital has been rebuilt and patients have already been moved into two wards, immeasurably improved by modern bathing and toilet facilities, a tiled dining room, partitioned dormitories, an up-to-date pantry and central heating. The occupational therapy wing has also been completed and is temporarily housing evacuated patients from two male wards which are at present undergoing renovations. The social therapy wing, incorporating a patients' club room, Red Cross library, the hospital magazine printing room, a lecture room for nurses, a hair-dressing saloon, and separate shower cubicles for the staff have also been completed and awaits furnishing. Two light timber construction buildings have been erected, one to be used as a dining and day room for female mental defectives and the other as a low level occupational centre for female patients. ·' Fletcher's Homestead" has been converted into two self-contained flats for the hospital staff. The Principal Male Nurse and Catering Supervisor have already taken up residence there. Building on the prefabricated Bristol unit nears completion but progress is slow and interior finishings will probably delay the opening of this unit for a considerable period. This building will ultimately be used as a Hospital unit and will contain a small operating theatre, X-ray unit, laboratory, and wards for fourteen male and fifteen female patients. Brick walls surrounding the male section of the Hospital and also subdividing the actual hospital area have also been partly removed, providing more open spaces and changing the institutional appearance of the Hospital. The first floor of the administrative building which was previously taken up by staff living quarters has now been subdivided into seven spacious offices for the medical staff, matron, head attendant, and male and female deputy stafi. Living quarters for the female staff at the nurses' hostel have been reorganized, providing a bedroom and sitting-room for every nurse of the Charge Nurse or above. Furnishing of these sitting-rooms is well under way. The open verandah of one female ward had to be temporarily enclosed to provide additional sleeping space for patients, reflecting the state of overcrowding which at present exists at the HospitaL Planning for the next financial year includes the erection of six prefabricated male wards, four female wards, a new concert hall seating five hundred patients, four houses for additional staff, a dental unit, two light timber construction buildings, one to be used as an occupational therapy centre for male patients and the other one as a Country Women's Association centre and a. new :Mortuary. 38

In addition, a complete renovation of female wards has been planned, particular attention to be given to Ward No. 9 which will be converted into a mixed ward for voluntary boarders who will share dining and lounge rooms. Male and female cottage buildings where bathing and t-oilet facilities are quite unsatisfactory will be equipped with new ablution blocks. Approval has been given for the extension of the present store and erection of a new laundry.

Equipment. (a) Medical.-Additional items for the laboratory have been purchased, amongst others a binocular microscope. Other equipment includes a new E.C.T. machine, sphygmo-manometers, surgical equipment for the new hospital and various post-mortem instruments. (b) Non-Medical.-The day and dining room of one light timber construction building has been furnished and ward furniture for the new hospital unit has also arrived. The old forms which were used as seating accommodation in the concert hall have been replaced by attractive tubular-steel chairs in sets of four. The "Fletcher's Flats" are now fully furnished and the interior decorations of the nurses' sitting-rooms is proceeding rapidly. Six wards are now equipped with weighing scales and male wards have been issued with two electric razors each. Amongst many other items the Hospital obtained a Ferguson tractor, a "Lawtrac" tractor, a sanding machine, a tipping trailer, a new incinerator, a floor scrubbing machine. A petrol bowser has been installed near the hospital store. Occupational therapy equipment covering various arts and crafts has been ordered and should be available for the opening of this unit.

Artisan Work. Maintenance work was carried out most efficiently during the year, the work load having been increased by temporary evacuation of patients, and alterations in the lay-out of the Hospital grounds, involving erection of new fences, removal of working sheds, &c.

Farm and Garden. Two hundred and seventy-six acres of new land were added to the Hospital farm, 25 cows were transferred to the farm from the Kew Mental Hospital and twelve pig drinking fountains were constructed. :Minor repairs were carried out on the farm buildings.

The farm produced 52 tons of vegetables and milk production rose to 137,146 quarts. To obtain patient labour for agricultural work has become an increasingly difficult problem and the farm's occupational and rehabilitation value appears to be negligible. Ward garden surrounding the mental defective cottages has been laid out and surface sealing of some areas will be completed next year. The Hospital garden looks well kept and lawns will replace the unsightly area in front of the nurses' hosteL A small flower garden, to be used exclusively as a working ground for patients has also been laid out.

Staff'. (a) Medieal.-lt still consists of a Superintendent and two ::\-ledical Officers. This number is quite inadequate in view of the increasing complexity of psychiatric treatment and the planned increase in patient population. (b) Parwmedical.-A part-time laboratory assistant has been appointed, doing valuable work and relieving the ~1edical Officers of an additional burden. The opening of a large occupational therapy centre which will take place in the very near future makes the appointment of at least one fully qualified Occupational Therapist desirable. The appointment of an Amenities officer to the Hospital has been suggested by the Authority. This officer would be of immense value to the Hospital and could relieve the :Medical Staff from many organizing duties thus permitting them to concentrate on clinical work. (c) Clerical.-The Administrative Staff working at full strength during the year carried out its duties admirably. (d) Nursing.-The Male and Female Nursing Staff working a.t full strength performed its duties satisfactorily. A waiting list for male nurses is now in existence, making it possible to select applicants according to personality and past experience. (e)-Chaplains.-Two Chaplains have been appointed to the Hospital during the year, spending altogether 13! hours weekly at the Hospital. 39

In addition to holding religious services, their work consists of interviewing individual patients, visiting sick patients and running discussion groups which will eventually form a group therapy pattern. It is felt that their work will, in time, form an integral part of the social therapy programme carried out at this Hospital. (f) Teaching and Training.-Nine Nurses obtained their nursing diploma during the year. Lecture courses for all three years are in progress, lectures being held twice weekly. The completion of the nurses· lecture room and adjoining reading room will facilitate teaching and individual coaching. Post-graduate courses at Royal Park are providing a great stimulus to the senior staff. Refresher courses for charge nurses will be held locally during the coming year. Case conferences and meetings of the medical staff are held once a week. (g) Voluntary Organizations.-The Beechworth and Wangaratta Mental Hospital Auxiliaries have again done wonderful work during the year. Country Women's Associations in North-Eastern Victoria are increasing their efforts to organize recreational activities for patients and the number of " adopted " patients has risen considerably. The Red Cross organization has established a lending service from their record library providing the hospital witb music for their weekly record recitals. Final arrangements have now been made to establish a 700 volume Red Cross Library at the Hospit,al. Thanks are expressed to the Official Visitors who again have been most helpful during the year.

Out-Pat1:ents. Volume of work at the weekly out-patient clinic held at the Wangaratta Base Hospital has increased considerably during the year. Many patients are referred to the clinic by doctors practising some considerable distances from the hospital. The " facelift " given to the Beech worth Mental Hospital will facilitate the referral of patients as voluntary boarders to the Hospital.

General Comments. On the debit side, the outstanding features during the year were gross overcrowding, an exasperating slowness of the reconstruction programme, and shortage of medical as well as paramedical staff. On the credit side one must mention the gradual disappearance of the old dilapidated and unhygienic wards, an increasingly optimistic attitude of the nursing staff towards treatment and rehabilitation of patients, and finally the development of a hospital community life providing quite a number of patients with a " substitute " home. 40

REPATRIATION MENTAL HOSPITAL, BUNDOORA.

PsYCHIATRIST-SUPERINTENDENT : DR. H. C. SToNE.

STATISTICS, 1954. Patients on Books, 1st January, 1954-- 0n trial leave 46 Boarded out 1 Escaped .. 2 Remaining 227 276 Patients Admitted during 1954-­ Voluntary Section 234 27 27 Patients Discharged during 1954-­ From Hospital 5 From escaped 2 From on trial leave 17 24 Patients Died during 1954- In residence 12 Whilst on trial leave 3 15 Patients on Books at 31st December, 1954- 0n trial leave 46 Escaped .. 1 Remaining 217 264 As the statistics indicate, the number of admissions was less than that for the previous year. Admissions had to be restricted owing to alterations of dining-rooms in wards, internal painting of wards, and the white ant infestation in the floor of one ward. Shortage of medical staff also restricted admissions. Our total number on the books at 31st December, 1945, is actually twelve less than the previous year. Some of the admissions have been from other Mental Hospitals but most came straight from Repatriation Department Institutions and out-patients. The ratio of First World War patients and Second World War patients is virtually the same as last year. One Korean War patient is still on the books. There is still a preponderance of First World War patients.

General Health. General Health during the year was fairly satisfactory. Premature ageing of older patients with evidence of cardio vascular degeneration is common. This is considered to be related to the severe sustained physical stresses of the First World War. Acute physical illness was not common, and mostly responded to treatment. Chest X-ray survey made during the year. No new definitely active cases of pulmonary tuberculosis were detected, but some require further investigation .

.Treatment: Occupational, Social, Recreations. The social side of the patients' amenities is still very well catered for by the many good people who take a keen interest in their welfare. Many concerts, drives, picnics, and dances, and a liberal supply of varied comforts have been provided during the year. In addition, regular screenings of pictures including both normal film fare and occupational type films and music appreciation are regular features of the patients' entertainment. Their recreations are principally billiards, table tennis, soft ball, volley ball, football, and cricket ; many inter-Hospital games have been organized.

Special Treatment. Full coma insulin therapy commenced in February, this being made possible by the addition of a medical medical officer to the staff; 9 cases have been treated. Electra convulsive therapy with anaesthesia and relaxants~32 cases. Sleep therapy-3 cases.

Special Drug Treatment. Chlorpromazine-33 cases. Reserpine~88 cases. Several patients were also treated with sod-succinate both intravenously and by mouth. Research. Proper structured research to any degree has not been possible under existing staff conditions. All patients in the Hospital were tested for phenyl pyruvic acid.

Amenities: Freedom, Classification, Clothing, Diet. The clothing of the patients is in the process of being completely changed and a great improvement is being shown. Classification of patients is still not fully satisfactory. 41

This will be improved by the splitting of the largest ward into two smaller wards. When this is done it will enable the Hospital to rearrange the wards quite considerably, giving more positive classification and allowing more parole and freedom generally. The building of additional wards will very considerably help in the process of cla.ssifica.tion. Diet of patients was generally satisfactory but owing to the fact that some serveries are not up to standard, the food loses some of its appeal in the serving.

Buildings, Equipment, Artisan Work. Buildings at this Hospital are grossly in arrears numerically, and as regards maintenance, residences are urgently required to replace obsolete existing residences of the Head Male Nurse and Engineer. In addition, a residence is urgently required for a Medical Officer and one also to enable our Head Gardener to reside on the grounds. Additional wards are also required so that Repatriation patients accepted by the Repatriation Commissioner as due to war service can be transferred to this Hospital from other State Institutions, and to improve classification of patients. Improved heating of wards is still urgently required as is also a drying room. With increased Medical Staff, more equipment and more facilities will be required. The appointment of State Artisans and the supply of much needed new furniture and furnishings through the State Public Works Department has improved the comfort of the patients considerably. However, arrears of building maintenance, particularly interior painting of wards, is delaying many re-furnishing schemes. Fa·rm and Gardens. The gardens and grounds of the Hospital have been improved quite considerably. The granting of a strip of land alongside our main drive will enable a much needed break to be established which will improve the general appearance of the Hospital. Recent road alterations by the Commonwealth Works Department in raising road levels has meant that new areas of lawns and gardens will have to be delayed. The new vegetable garden is progressing well. Staff. The staff position generally is still bad. The Medical staff was increased by the appointment of a Medical Officer at the end of the year, but this is still not sufficient to maintain the special treatment and detailed care that is the desired standard of the Repatriation Department. The Nursing Staff, which is practically up to present establishment strength numerically, is grossly lacking in numbers of trained personnel. To maintain the standard of care and treatment required by the Repatriation Commission, a large amount of overtime has been necessary. Urgent requirements are more senior staff and an increase in total establishment. The Administrative Staff has had to operate at half strength for most of the year but is now, fortunately, up to strength. The Artisan Staff is sadly depleted in both the kitchen, where we are short of Cooks, and the Engineers where we are short of Firemen to keep some semblance of heating to our closed wards.

Staff Training and Teaching. Training and teaching of Nursing Staff is carried out by the Medical Staff. The appointment and availability of Tutoring Staff is a vital necessity to maintain standards of teaching without undue strain on existing Medical Staff. Numbers attending lectures this year show a marked increase from previous years. Voluntary Organizations. Numerous voluntary organizations have given their loyal support during the year and provided numerous dances, concerts, and outings which have been greatly appreciated by the patients. A combined meeting of interested organizations has recently been held with the view of co-ordinating their entertainment and encouraging them to adopt specific patients with a view to their rehabilitation. The Red Cross and Ladies of the Preston R.S.L. are to be commended for preparing afternoon teas. These organizations between them provide this amenity for six days per week. Out-Patients. A number of patients return to the Hospital as out-patients after discharge, but distance, transport difficulties, and limitation of medical staff time limit the number. Out-patient facilities are provided by the Repatriation Department for all cases following discharge. General Com,ments. Voluntary Boarders are still unable to be admitted to the Hospital. This is contrary to modern psychiatric principles. Legislation to overcome this difficulty is obviously necessary. Divided control between State and Commonwealth still causes many difficulties but it is hoped that some of these will disappear when the proposed new maintenance system is inaugurated by the Commonwealth Works Department. Lack of provision of finance by the Commonwealth is retarding many works of which there is quite an imposing list. The water supply is still not completely re-organized. We are still dependent on the continued use of a fire brigade pump to maintain supply at its present level. We are still requiring a properly organized sports oval with pavilion and amenities. Likewise we require a proper canteen to provide better facilities for patients. In this regard plans have been approved, but provision of finance is still awaited. 42

MENTAL HOSPITAL, KEW.

DEPUTY PSYCHIATRIST-SUPERINTENDENT; DR. w. A. J. BRADY.

STATISTICS, 1954.

Male. Female. Tots!.

On books, 1st January, 1954 .. 558 490 1,048 Admitted- Voluntary 38 30 68 Certified 96 99 195 134 129 263 Discharged .. 85 52 137 Died 52 43 95 On trial leave, 31st December, 1954 53 49 102 On books, 31st December, 1954 572 520 1,092

The overall picture continues to be one of gross overcrowding with a result that our limited number of wards have become strained almost to bursting point. Additional accommodation is urgently necessary.

General Health. In assessing the general health of the patients in the Hospital, the death rate at Kew, which is comparatively high, must first be considered. Old people now make up the greater percentage of admissions, and the Hospital is almost wholly comprised of these people, whose greatest trouble is broncho-pneumonia. The gross overcrowding and poor facilities for infirmary and hospital patients must be considered as contributory factors. Diarrhoea had also been a trouble amongst the old people, and again overcrowding and poor plumbing have been contributory factors. Among the younger patients the general standard of health is very good. There have been some troublesome cases of ringworm and scabies which are now under control. Once more the gross overcrowding in wards made treatment difficult. Recently there have been two cases of infective hepatitis, and isolation of these was difficult. Six patients have been treated for tuberculosis and are responding well. Two open cases were found in the last X-ray survey, but alternative placement was found for these cases in other hospitals. There are at present no known open cases of tuberculosis at Kew. Amongst the older women patients there has been a large number of cases of fractures of the femur and wrist. Here unsatisfactory accommodation and overcrowding is largely responsible. Young and old patients are crowded together. Many old people have to sleep on narrow couches. The poor surfaces of floors and airing courts, and the primitive bathing facilities are also a source of worry.

Treatment : Occupaticmal, Social, and RecreatiorwL One of the biggest advances at Kew in the last twelve months has been the increase in occupational, social, and recreational activities. The number of qualified staff has increased and there is also greater interest being displayed by nursing staff. Special courses at the Royal Park Training Centre have been valuable in fostering interest. Occupational activities will be further helped when the new buildings are completed. Patients are making increasing use of their Social Club Rooms and each recovery ward runs its own social evenings to which patients from other wards are invited. A start has been made with musical activities and further expansion is confidently expected. As well as the regular weekly films in the Recreation Hall, films are now being shown regularly in the disturbed patients' wards and on one extra evening for working patients who are not able to attend the daytime screenings. Volley ball and tennis clubs are functioning and it is hoped that we may be able soon to have inter-hospital competitions.

Special TreatrMnt. All the usual psychiatric treatments are carried out at Kew, with the exception that no insulin therapy is done as yet on the female division. This is due to the fact that no suitable female patients are being received at Kew. Full coma insulin is carried out on the male division only. On both divisions electro-convulsive therapy is done extensively, with and without relaxant, together with Serpasil, Largactil, and other accepted modern therapy.

Research. Little formal research was undertaken during the year except with drugs such as Largactil and Serpasil. A large nul:.m of patients have been put on Serpasil but it is a little early yet to assess the results. Nevertheless several patients in the disturbed wards are already showing benefit and some of the adult mental defectives are bebavina better after receiving the drug. Amenities. Freedom.-As many patients as possible are now being housed in open wards. G, G.1, F.1, and C.1 on the male division are all open wards, and the hospital (B ward) is semi-open. On the female side the Tents, E.x, and 1.1 are open wards and the patients are encouraged to make full use of this freedom. An increasing number of them go on shopping expeditions and attend local entertainments and sports meetings in Kew and adjoining suburbs. Cla.ssification.-Complete classification of patients is very difficult at Kew, owing to the preponderence of aged patients and adult mental defectives, gross overcrowding and the limitation in the number of wards available. However, classification is proceeding, although slowly, and some hitherto certified patients are becoming voluntary boarders. Clothing.-There has been a gradual but definite improvement in clothing for both males and females through both Government issue and gifts from voluntary organizations. In the main the patients are very pleased with this improvement and many of them take definite pride in their clothes. A large number of articles are sent each week to the d,ry cleaner but many articles of clothing must necessarily be washed owing to the habits of some of our patients. Diet.-The diet is being constantly improved through the co-operation of the Dietitian and the Senior Catering Supervisor and our own Catering Supervisor. The establishment of the hair-dressing salon has been most successful and the women patients avail themselves of this facility frequently and happily. Another valuable member of our staff is the Chiropodist, and his work, too, is very useful.

Buildings, Eq·uipment, Artisa.n Work. Two new Occupational Therapy blocks were erected during the year. One is in the vicinity of E.x and one near G.x. The one on the female division is now in use, the one near G.x has not yet been used owing mainly to the fact that no heating or lighting is yet provided. The renovation of Ward F.1 was completed and is now occupied. The general condition of this ward is a tremendous improvment on previous conditions and is very heartening to both staff and patients. The renovation of Ward D.1 is proceeding with painful slowness. General maintenance is a big task at Kew Hospital with its old wards and equipment. Carpenters have managed to make much shelving and cupboards and painters have made great improvements in Ward A.l. The engineering staff is still hampered by its obsolescent main boilers, and new boilers to replace these are being installed at last, eight years after the need for them was first stressed. The water supply to the main building has been steadily deteriorating for some years. In 1953 urgent action was asked for but no improvement has yet been made, and the supply becomes steadily worse. This poor supply is a continual worry to those responsible for the safety and comfort of the patients. Laundry work is hampered by poor steam pressure and poor water supply. A central linen room has now been established to serve the main building, and is working well. . Kitchen iltaff are doing their best with kitchens designed and equipped for simpler cooking and fewer numbers. Re-organization of kitchens at both main building and the Children's Cottages is urgently needed. Staff Mess Rooms.-The marked improvement in the Staff Mess Room at the Children's Cottages is regarded hopefully as an indication that something- similar will be done soon for the staff at the main building.

Fa·rm a.nd Gardens. The dairying activities of the farm cea;;ed during the year, and all milk used is now purchased. The vegetable garden had a poor season. With a larger staff, better equipment, and a new area added increased production is confidentally expected. The ornamental grounds are being maintained as well as possible by the small force of gardeners with the little help available from old and mentally enfeebled patients. Additional mechanical equipment is being obtained to help in this work.

Sta.jj. Medica.l.-~Medical staff is satisfactory in numbers, but very short of experienced personnel-the only Senior Medical Officer on the staff is acting at present as Psychiatrist Superintendent. There is also a grave shortage of resident medical officers of whom there are only three, who consequently carry a heavy burden of week-end and night duty. It is hoped that the completion of some of the houses will obviate this situation. Pa.ramedicctl Staff.-This was in&eased during the year by the appointment of an additional Social Worker and an Assistant Occupational Therapist. In addition a part-time Assistant Pharmacist was appointed. The Chiropodist has been on the staff since November, 1954. The full-time Psychologist appointed last year is now available to Kew on two days a week owing to a shortage of Psychologists throughout the Department. Administrative Sta.Jf.-The administrative staff, too, suffers from an acute shortage of experienced senior officers. Nursing Staif.-The actual numbers of nursing staff are reasonably satisfactory but include a large number of temporary Ward Assistants, and t.here is an acute shortage of senior nurBing personnel of Deputy Charge le~rei. 44

Artisan Staff.-There are several deficiencies on the artisan staff, markedly among Grade II. Cooks, General Assistants, Grade II. Laundrymen, Grade II. Laundresses, Cleaners, and Labourers.

Staff Training. A. full programme of teaching was carried out during the year by medical officers and tutors for First, Second, and Third Year Nurses, and the Mental Defectives branch. The results of nursing examinations were reasonably satisfactory. 10 candidates passed First Year ; one female nurse from Kew receiving the highest marks in the State. 15 candidates passed in Second Year. 9 candidates passed in Third Year, including one credit. 4 candidates passed the Mental Defectives examination, including one credit. Courses were also held at Royal Park Training Centre in the theory and principles of nursing and occupational activities.

Voluntary Organizations. The various branches of the Mental Hospitals Auxiliaries have carried out their good work very actively as usual, and have been responsible for numerous bus drives to the coast and hills, provision of musical instruments and furnishings, many gifts of clothing and two Fancy Dress Balls during the year, as well as a Fair in the Hospital grounds. The Savoy Auxiliary Concerts, which are much appreciated by the patients, were held each month until interrupted by a fire in the Concert Hall. The Kew Mental Hospital Welfare Group has been very helpful. There are many other benefactors­ individuals, groups, clubs, firms, and broadcasting stations-to all of these grateful thanks are extended.

Out-Patients. Most potential out-patients are now referred to the Observatory Clinic for their own convenience. However, for patients who are working and for those in need of maintenance E.C.T. this referral may not be practicable and they are seen on Saturday mornings by the medical officer on duty. Increasing numbers of patients are availing themselves of this opportunity.

General Comments. A good deal has been achieved during the past twelve months, but a colossal amount still remains to be done. The process of remodelling the wards proceeds at a painfully slow tempo which it is hoped will be accelerated. Exterior painting of the hospital is proceeding satisfactorily and is creating a feeling of general satisfaction. Overcrowding is still a major problem, accentuated by the increasing average age of patients admitted to the Main Building. It has become extremely difficult to find a hospital bed for a sick patient as both hospital wards are virtually overcrowded infirmaries. The new hospital unit, when erected, should prove a boon in this respect. Co-operation of members of the staff during a difficult period of adjustment is greatly appreciated. It is also desired to acknowledge ready co-operation and assistance from the Neuro-Surgical Unit, Mont Park, Peter MacCallum Clinic, St. Vincent's Hospital, the Eye and Ear Hospital, and the Royal Children's Hospital. 45

~IEN'fAL HOSPITAL, LARUNDEL.

PsYcHIATRIST-SUPERINTENDENT : DR. H. C. STONE.

STATISTICS, 1954.

Male. Female. Tot&!.

On books, 1st January, 1954 ...... 382 145 527 Admitted-· Voluntary ...... 75 41 116 Certified ...... 71 38 109

Total admitted ...... 146 79 225

Discharged ...... 92 61 153 On trial leave ...... 38 44 82

Died . . .. . ' . . . . ' . '. 20 10 30 On books, 31st December, 1954 ...... 419 177 596

General Health. This has been satisfactory throughout the year. Acute illnss has not been common. Chest X-ray survey carried out showed no definitely active lesions, but a few cases require further investigation.

T1·eatrnent. Occupational Therapy Department functions very satisfactorily under the circumstances. During the last six months there has been only one Therapist, who maintains this Department very efficiently and organizes therapy in the wards. There is an urgent need for more therapists. Recreation and social activity is seriously handicapped by lack of facilities, only cricket, football, soft ball, and basketball operative. Tennis courts, sports oval, recreation hall, and other facilities are urgently needed. Indoor games have been provided in all wards. Sixteen mm. pictures have been shown fortnightly, but we still rely on the generosity of Mont Park for 35 mm. pictures, dances, community singing, &c., because of lack of recreation hall. The patients' Social Club is a successful going concern.

Spec1:al Treatment. Full coma insulin therapy 53 cases Electro-convulsive therapy 89 Sleep therapy 15 " Reserpine therapy 71 " Largactil therapy 190

Research. The carrying out of properly structured research, to any appreciable degree, is not possible under existing staff conditions.

Amenities. This Hospital consists of fourteen wards, of which ten are open. .Many of the patients in the remaining four closed wards have parole of varying degree. Classification is able to be made reasonably satisfactorily. A bar to entirely satisfactory classification is the poor standard and dilapidation of the five wards which were originally the Farm Workers' Block of Mont Park. Olothing.-There has been a general improvement and appreciation by the patients of the clothing provided. The older Farm Workers' Block patients, of whom a number is deteriorated, who do not appreciate better clothing, have habits which make proper care and maintenance of clothing very difficult. Diet.-This is generally very good. The Catering staff are to be congratulated on their work during the year, but the serving and meal "atmosphere" could be improved. The patients in three of the wards in the Farm Workers' Block still dine in the old concert hall, and this is entirely unsatisfactory. The provision of proper serveries in each of all Farm Workers' Block wards has been urgent for many years. 46

Buildings, &c. The newer buildings have been repainted externally, and the Hospital now shows a marked improvement. The timber units under construction are proceeding slowly. The completion time of these buildings has been a disappointment, as none is yet ready for occupation. The Farm Workers' Block is still in its dilapidated condition, and is a sorry contrast to the newer wards; the renovation of the Farm Workers' Block has been extremely urgent for many years.

New projects, i.e., Nurses' Homes, Wards, and Residences have been commenced. Much equipment has been purchased, and the Hospital is now generally well equipped. Artisans are still hampered by lack of workshop accommodation. Maintenance work is generally up to date.

Gardens and Orchard. Landscape-there is a general improvement in the grounds; some untidiness must exist whilst building works are in progress. The central area is now showing to advantage, and conditions in the Nursery are good, following alterations and renovations. The output from the Orchard was very good, considering it was the " off season ".

Staff. Medical.-The Medical Staff is inadequate for the work of the Hospital, and there is a shortage of Nurses, particularly those of a senior rank.

Artisan.-Staff is generally up to strength, excepting the Laundry Staff, which presented the most problem. The Artisan Staff is hampered by lack of much needed workshop accommodation.

Administrative.-Generally understaffed. Owing to lack of experience and new activities increasing the work, the year has been covered with difficulty.

Staff Training and Teaching. Lectures were given by Medical Officers and Senior Nursing Staff. Lack of tutors was detrimental to training programme. There was a general reluctance on the part of many of the junior staff to sit for examinations. The liability of reduction from Student Nurse to Ward Assistant, because of failure to pass examinations, was not a serious deterrent in many instances.

Passes at Nursing examinations during the year were :­ First year 5 Second year 3 Third year 2

Voluntary Organizati

Out-Patients. A number of patients, following discharge, attend the hospital as out-patients. A much greater number should be followed up, but lack of medical staff, the distance involved, and difficult transport facilities preclude this.

General Comments. June of this year saw the commencement of an extensive building project. Two new Nurses' Homes, eight new wards (two male and six female) were started. These buildings, together with the ancillary services required, will completely change the Hospital, both in outlook and capacity, and will greatly improve the facilities as a functioning Hospital. It is to be hoped that the present lack of recreational facilities will be remedied in the near future. 47

MENTAL HOSPITAL, :VIONT PARK.

PsYCHIATRIST-SUPERINTENDENT: DR. G. A. WRIGHT.

STATISTICS, 1954.

~ I .Male. Felll.Ale. Total.

On Books, 1st January, 1954-

Certified patients ...... 510 900 1,410

Voluntary patients ...... 46 46 92

Admitted-

Certified patients ...... 162 161 323 Voluntary patients ...... 90 91 J 181 Total ...... 808 1,198 2,006

Discharged-

Certified patients ...... 75 69 144

Voluntary patients ...... 87 65 152

Died-

Certified patients ...... 69 80 149

Voluntary patients ...... 7 3 10

Total ...... 238 217 455

On Trial Leave at 31st December, 1954 ...... 81 124 205

Total remaining on Books, 31st December, 1954-

Certified patients ...... 548 938 1,486

Voluntary patients ...... 42 69 Ill

Transfers to and from Mont Park are not shown in above figures.

General Health. The general health of the many patients of this large community Hospital was very satisfactory throughout the year. No serious epidemic of disease occurred and no serious accident. The number of patients in residence steadily increased and further aggravated the gross state of overcrowding existing in the Hospital. The overcrowding is a serious problem and makes conditions of hospital administration, treatment of patients and care of their welfare much more difficult. Shortage of nursing staff added to the difficulties, and the satisfactory state of the health of patients throughout the year reflects a high standard of nursing and general care by the Staff.

Treatment. All general medical and surgical treatment necessary for the restoration and maintenance of the physical health of the patients was carried out within the Hospital and in this respect, particularly in surgical measures, the Hospital is developing as a centre for the maintenance of the physical health of patients within the Department generally. One hundred and ninety major surgical operations were successfully performed within the Hospital surgical unit. All forms of modern psychiatric treatment were available and carried out in the Hospital throughout the year, and 43 leucotomy operations were performed with gratifying results and considerable improvement in the majority of cases. As an adjunct to general medical and surgical treatment, occupational therapy was actively carried out within the Hospital throughout the year. The occupational therapy classes of this Hospital are well established and very practical, are well organized, highly efficient and specialized, and render a valuable contribution and play a great part in the restoration to health and the rehabilitation of many patients. Social and recreational therapy as another aid to the comfort, welfare, and r,outentment of patients was continued and even further developed than in former years. In the treatment of all patients the medical staff was materially assisted by the various ancillary departments within the Hospital, the dental clinic, pharmacy department, chiropodist, pathological department, social worker, and these all combined to help maintain a high standard of physical health and well being among the patients, and to bring relief to many of the mentally ill.

Special Treatment. Full coma insulin therapy was carried out during the year with relief and improvement in many cases of mental illness. Electro-convulsive therapy was administered where necessary, and benefited many patients. The neuro-surgical unit continued actively and efficiently as a surgical treatment centre for the whole of the Department. The unit is very modern, well equipped, and a credit to the Hospital and the Mental Hygiene Department. Special care and treatment of a number of cases of patients suffering from pulmonary tuberculosis was carried out, some cases being received from other hospitals for treatment. Our thanks are due to the medical staff of the Gresswell Sanatorium for advice in the care and management of such cases. A number of patients known to be carriers of typhoid fever were treated and cared for within the Hospital in an endeavour to remedy their state, as a safety measure to the many patients within mental hospitals.

Arnenities. The amount and nature of parole for patients was increased during the year and more freedom and social life extended to a larger number. Patients' committees and groups were encouraged and much recreation and social entertainment was afforded them. Intra and inter-hospital competition was encouraged ; visits, concerts, parties, dances, pictures, community singing, sporting :fixtures, tennis, soft-ball, volley-ball, football, cricket, hookey, table tennis, &c., were all enjoyed by many patients. A greater freedom of thought, movement, and activity were thus afforded the patients and this has been reflected in a better understanding between patient and staff, patient and Hospital, and a decided step forward. Of 24 wards, 11 are open wards, some with little supervision. A better classification of patients was made and good working patients were given open, brightly furnished, homely, and comfortable wards to live in apart from their usual place of Hospital employment. A much better classification of patients generally, however, is still difficult because of overcrowding. The clothing of patients was improved greatly during the year, and this helped considerably in granting more freedom and parole to patients. The food service to patients has improved out of all sight. Meals are much more varied with well planned menus and are amply supplied.

Buildings, Equipment, and Artisan Work. Several new buildings of timber construction of a standard classroom type were erected during the year and are being adapted for various purposes of hospital activities-a social therapy centre, ladies' hairdressing salon, male hairdressing saloon, occupational therapy departments, visitors' rooms, and artisan staff lunch rooms. The Public Works Department carried out painting works as follows:­ External.-South-east Block, F.O.l, Staff Residences. External and Internal.-Concert Hall, Male Infirmary Hospital, Male Staff Hostel (brick building), and portion of Female Staff Hostels Nos. 1 and 2. Farm buildings are being renovated by hospital artisans. Equiprnent.-A considerable amount of medical and surgical equipment has been purchased for various wards, including hospital and neuro-surgical units, and mechanical and electrical equipment has been obtained for farm, ornamental grounds, and various artisan activities. Much furniture has also been purchased for wards, staff hostels, etc. The work of the artisans is constant. There is always a great deal of maintenance required to buildings, furniture, mechanical and electrical equipment. It is difficult to obtain and retain skilled men such as plumbers, and the staff of boiler :firemen is never up to stNngth. Farm.-Early in 1954, a new Farm Manager (Mr. Guild) was appointed to the staff. Under his supervision, existing stables are being converted to a modern dairy complete with milking machines and can washing plant. The work of altering the buildings, &c., is being carried out by the Hospital Artisan Staffs, and it is hoped that machine milking will commence early in the new year. Milk production is being maintained. One hundred and forty-six pigs were sold by auction and 103 killed for pork for patients.

Vegetable Garden. This garden is improvinj.!:. Vegetables amounting to 191,000 lb. were supplied to the Hospital during the year. Nursing Staff shortage, particularly on the female division, remained very short. Trained and experienced mental nurses are becoming few and ward management is being seriously affected. It presents a serious prolJlem to the immediate future of mental hospitals and their service to the public. The numbers of Medical Staff increased, lmt with progress in mental hygiene and the quickening tempo of hospital activities it is still inadequate. The constantly changing staff makes administration difficult. During the year there were 244: new appointments and 222 left by resignation, transfer, &c.

F!taff Nursing Training. A Psychiatric Training Course for Student Nurses was carried out during the year and a total of 26 candidates sat for the annual examinations in October. The classification and results of the candidates were as follows :- Nursing ExarniMtions, 1954.

Male. FelllD.le.

First Year-

Candidates 4 7

Passed .. 7

Second Year--

Candidates 5 2 7

Passed .. 2

Third Year-·-

Candidates 7 5 12

Passed .. 4 5 9

Total Candidate~ 26

Total PasRed 22

---··---·-···-·--

The shortage of trained Psychiatric Nurses is very acute and most serious, and although five female nurses obtained their Psychiatric Nursing Certificates, three have resigned since. A study of the successful condidates in First and Second Years shows very few advancing for final qualification. Resignations and retirements of Charge Nurses will probably exceed new trained psychiatric nurses on the female division during next year.

Volttntary Or_ganiwtions. Various voluntary organizations as~isted greatly throughout the year in providing entertainment, recreation, comfort for out patients. The mental hospital auxiliaries are very active in this respect, and our thanks are extended to the Riversdale, Hawthorn-Kew, Yarra, City, Heidelberg, Ferntree Gully, and Kallista Branches for their many efforts on behalf of our patients' comfort and welfare. The fancy dress ball sponsored by the Riversdale Auxiliary was again a feature and an outstanding success. Our thanks are also due to the Country Women's Association for various treats, the Relatives and Friends of the Mentally Ill, and others for their sincere and kindly endeavours to improve the lot of the mentally ill.

A dtninistrat1:on. In circumstances of increasing administrative difficulties, the staff assisting in administration are to be eommended for their faithful and loyal co-operation. My thanks are extended to the Secretary and his staff for their co·operation and help in administration, to all senior and responsible officers of the staff in general for their loyalty and assistance in maintaining such a high standard of service to the community, and I am sure in gaining for the Mont Park Hospital the respect of the public in general and the gratitude of the relatives and friends of the mentally ill in particular. 1304/56.-4 JIIE:t\'l'AL HOSPITAL AND RECEIVINU HOl'SE, ROYAL PARK.

PiiYCHJATRlST-8FPERIXTE~DEXT. DR . .T. F. J. CADE. STATISTICS, 1954.

Male. Female. Total.

Rfreil,in,q House, Royal Park. On Books, 1st January, 1954 .. .')7 84 141 Admitted- Voluntary 460 518 978 Certified- 682 768 1,450 Discharged .. 573 701 1,274 Transferred to Mental Hospitals 552 536 1,088 On Trial Leave Died 10 24 34 On Books 31st December, 1954 •. I 64 109 173 Mental Hospital, Royal Park. On Books 1st January, 1954 M 150 234 Admitted 37 47 84 Discharged .. 120 196 316 On Trial Leave Died 1 1 2 On Books 31st December, 1954

Comments. The following points may be noted :- (a) The steadily rising total number of admissions year after year. (b) The increasing percentage of voluntary admissions-a sure index of the increasing confidence of the public in a psychiatric service. (c) The, unfortunately, steady rise in the number of admissions attributable to alcoholism. (d) Statistics for the Royal Park Mental Hospital cover the period 1st January, 1954, to 7th April, 1954. From the latter date Royal Park ceased to be a mental hospital and became a Receiving House. General Health. The main causes of severe physical ill health are alcoholism aml senility-the former several times commoner amongst men, whilst senile female admissions slightly outnumber male. Both categories require skilled nursing as well as psychiatric care. It is disturbing to find infestation with lice or scabies not infrequently in these groups. Treatment. The Occupational Therapy Department is being steadily developed to keep pace with the ever·increasing treatment demands made upon it. Unfortunately, it has been hampered by shortage of trained staff and inadequate accommodation. Both of these drawbacks should be overcome in the next year. The magnificent new social therapy building is under construction since the middle of the year. It will provide facilities comparable with the best elsewhere in the world for the latest development!\ in this sphere of treatment. This should he reflected in a tars to have considerable value in the control of states of restless excitement. It is quite amazing to see how confused, restless, uncontrollable old people respond to it. Within a few hours their excitement abates and, most important, they can be nursed with the same ease and efficiency as mentally clear patients. The new drug, serpasil, has too recently been introduced to permit an accurate assessment, but it does appear as if it too will prove a useful addition to therapy. With the new methods of controlling acutely excited states, psychiatric wards are rapidly approaching the atate of untroubled serenity that characterizes a good general hospital ward. Padded rooms are a thing of the past, and physical restraint has disappeared. Rese11;rch. There are unrivalled opportunities for first class research in a hospital such as this, with a huge intake of patients. The new research laboratories will provide the material means that have so far been lacking and it is hoped that vitally important work can soon be started in co-operation with the relevant university departments. The epidemiology of mental ill health is becoming a subject of increasing practical importance and work has commenced on certain aspects of this topic. Amenities. There has been a considerable improvement and modernization of furnishings and ward equipment to bring wards into line with modern requirements. This improvement in amenities and appearance has reacted most favourably on patients and their friends and relatives. It is seen in the increasing numbers of patients who consent to enter hospital voluntarily. 5l

The standard of meals and messiug has likewise been brought up to a high standard. Wards have been temporarily redecorated pending permanent structural alterations. The dreadful dinginess of " institution brown" has at last disappeared. It is certain that this alone has a profoundly beneficial effect on patients' morale and self respect.

Bttildings, Equ.iprnent, Artisan Wark. The most notable developments at Royal Park have been the huge new building programme and the remodernization of existing wards. (a) Rernodelling.-The reconstruction of the Male Receiving Ward continued throughout the year to bring it into line with modern hospital requirements. Unfortunately, the task had to be done piecemeal as the ward had to be in use. This has led to a lot of inconvenience both for patients and staff and for builders. It will be possible to evacuate the Female Receiving Ward when work is commenced there early in 1955. This should lead to much quicker completion of the work. But with the present Public Works Department work force allocated, it will take five years or more before reconstruction of existing wards is completed. Urgent consideration should be given to the question of allotting some of the work to independent firms. (b) New buildings either completed or commenced during the year were:­ (i) Female nursing trainees' hostel-completed. (ii) Male nursing trainees' hostel-completed. (iii) Female staff hostel-commenced. (iv) Cafeteria-commenced. (v) Kiosk-commenced. (vi) Social Therapy Building-commenced. (vii) Insulin Unit-commenced. (viii) Surgical Unit-commenced. (ix) Matron's Residence-completed. (x) Medical Officer's House-completed. (xi) At the old Receiving House, the new building to house the Clinical Research Unit, under the control of the (;hief Clinical Officer, was commenced. Farrn and Gardens. The vegetable garden continued to function satisfactorily but more mechanical equipment is necessary to enable future requirements to be met economically. With existing staff it is only possible to keep the bare minimum of ornamental gardens in order. When the surroundings of the new buildings and the grounds generally have been landscaped, a considerable increase in gardening staff will be essential.

Staff. There is a continual shortage of suitable young men and women offering for training in mental nursing. This is much more marked on the female side. As a result, there is only a trickle of senior student nurses and the probability of serious understaffing becoming more accentuated at the staff nurse and charge nurse leveL A four year combined general and mental nursing course, as just commenced in England, would probably be of great value for both fields of nursing. It would require close liaison between the psychiatric teaching hospital on the one hand and the general hospital on the other.

Staff: Trm:ning and Teaching. A series of refresher courses for the more senior nursing personnel throughout the Department have been held at the Nursing Training School during the year, and have proved highly successful in orientating staff towards the latest developments in psychiatry. As in research, so in teaching, the tremendous volume of patient intake is of extraordinary value for teaching at all levels-nursing and medical, under-graduate and post-graduate. It is a good sign that more and more people in these categories are seeking to utilize the better facilities available. An important point as far as nursing recruitment and wastage is concerned is that uniforms must be attractive. Xo nurse is going to get herself into a uniform that she feels is unattractive or inferior. It, therefore, must be given serious attention if recruitment (which is lagging badly) is to have any real chance of success.

Voluntary Organizations. The Yarra Branch Auxiliary has proved a tower of strength throughout the year, especially in maintaining the Kiosk service under most inconvenient conditions. Films were shown weekly and the arranging of the programme was left in the hands of the projectionists, Mr. Bagg and Mr. Donaldson. The Hospital is indebted to Mr. Arthur Stewart and his friends for conducting square dancing for the patients each Monday evening during the year. Donations of clothing, &c., were received from various branches of the Country Women's Association, and outings for the patients were arranged by the Kalorama Branch of this Association. The amenities section of the Central Council of Mental Hospital Auxiliaries also forwarded donations of furniture for the Male Receiving Ward at Royal Park.

General Oomrnents. The Psychiatrist-Superintendent was sent to Britain in the first six months of the year to study the latest developments in psychiatry. This was of extreme value to him in view of the tremendous expansion taking place at .Ro:ral Pa~k. It v.:as J?OSt desirabl~ that he sh?uld hav~, firs.t .hand an~ recent kn?;wledge of the best in psychiatnc hospital orgamzatwn and practiCe. (See h1s report Bntish Psychiatry, 1954 .) RIWETVIN

(Annexe to Receiving House, Royal Park.)

STATISTICS, 1954.

Female. TotaL

On Books 1st January, Hl54 .. 35 50

Admitted-

Voluntary Hi 31 4-7

Certified 4 17 21

Discharged .. 12 57

On Trial Leave

Died 2 5 7

On Books 31st December, 1954 21 34

General Health. The general health of the patients has been very good apart from the inevitable frailties and disorders associated with advanced age. There was no infectious illness.

Treatment. Treatment is confined largely to nursing care. Some of the patients are capable of doing simpler craft work under the supervision of a partly qualified occupational therapist, and those male patients, who are fit enough, enjoy light work in the garden. Films have been shown fortnightly through the courtesy of Mr. Gabb.

Special Treatment. Apart from the occasional patient who requires maintenance E.C.T., no special psychiatric treatment. is necessary for these old people.

Staff. Male nursing staff has been adequate but there have been shortages on the female side from time to time. A number of the female staff are locally resident married women, some trained in mental nursing, others not. Provided there is an adequate nucleus of trained staff, the bulk of the nunling staff can very well be untrained or semi-trained.

Amenities. Diet has been adequate and the Departmental dietitian has designed the menu with special regard to the needs of the aged.

Buildings, Equipment, Art'i,san Work. Requisitions have been submitted for the construction of six standard wards, each of 36 beds, plus the necessary new kitchen, boiler house, nurses' home (40 nurses), entertainment hall, and road and site works to service the enlarged hospital.

General Comments. With the increasing proportion of the population reaching advanced age, it is essential to greatly expand the present inadequate facilities and accommodation. Apart from the needs of the old people themselves, it is essential to relieve the case load on the main Receiving House at Royal Park. Already the admission rate is over 2,500 a year and rising steadily. Those in the 65 year and over age group, although only 8 per cent. of the population, comprise 18 per cent. of the total admissions. That is, the numbers in this group alone are sufficiently large to warrant special planning on their own account. Hence the projected expansion of Pleasant View. The :fire risk is a disturbing feature of the very old fashioned buildings at Pleasant View. This is accentuated by the extremely poor water supply, especially in summer. A new reticulation service was firsi requisitioned on 23rd September, 1953, but up till the end of 1954 no work had been commenced. MENTAL HOSPITAL, SUNBURY. PsYcHIATRIST-SUPERINTENDENT: DR. G. A. GoDING. STATISTICS, 1954. The movement of patients between this Hospital and the general community is indicated in the following table:- --·-·~------~ - ---~------In. Out.

C

1954 216 181 179 30 606 7 150 316 56 529

l\J:i3 210 87 144 H 482 21 72 250 64 407

One hundred and eight patients were discharged while on trial leaw. Sixty-five patients died in Hospital. 1~t .Januarv, :31st December, Patients on Books 1954 .. 1954. Resident L265 1,225 On trial leave 169 187 Boarded out 187 198 Absent without !ea ve :3 4

Total 1,597 1.,559

General Health. The physical health of the patients has been satisfactory and in spite of inadequate hospital facilities the death rate has been very low. The continued presence of both male and female patients suffering from active pulmonary tuberculosis constitutes a serious problem because of the inarlequate facilities and the lack of staff trained in nursing this type of patient. The dental care is still grossly inadequate as we have only the services of a school dental officer for six hours a week. A full-time dentist iR needed. Diet. The diet is still improving and is now reasonably adequate in both quantity and variety. It could be improved still further were it not for the inadequate cooking facilities anrl the shortage of cooks and kitchen-men on establishment. Clothing. The majority of the drab institutional type of clothing has now been replaced but the problem of finding suitable clothing for those patients who are unable to keep themselves clean and tidy has yet to be solved. Treatment. General.-The number of patients taking part in some regular occupation while in hospital is gradually increasing. There has been a slight increase in the number of patients working in the various utility departments, the farm and the gardens. The number of working parties around the grounds going out from closed wards has increased considerably and the completion of the three occupational therapy buildings has enablerl a much larger number of patients to take part in various handicrafts. In several of the closed wards the occupational therapists with the help of the nursing staff have been able to encourage a number of previously unoccupied patients to take part in games and handicrafts. There is still a very great deal to be done in this direction as the majority of the patients in the closed wards have no regular occupation. These patients are being denied the most important single measure than can effect a reversal of their withdrawal from social relationships. Shortage of staff, particularly of medical officers and of trained nursing staff is a great handicap in attempting to improve this state of affairs. As yet only 256 patients are in open wards, ~tn additional 121 patients from closed wards having parole of the grounds. The amount of freedom which can be given to patients depends on the general level of treatment and occupation in the Hospital, adequate segregation and the opportunity to assess the risks and advantages in individual cases. Effective segregation will be easier when the long awaited subdivision of the six " Hill " wards into ten wards has been completed. The chronic overcrowding, however, makes moving a patient to another ward a complex procedure as sometimes two or three other patients have to be moved around in turn to make room. Many more patients could undoubtedly be given parole if there were sufficient medical officers to assess their cases individually. The recreational programme is still progressing satisfactorily. The patients' General Committee meets weekly to co-ordinate the various recreational activities and to make valuable recommendations on almost every aspect of hospital life. The Sports Olub, Concert Club, and Music Club continue to hold regular functions and since the last report a Discussion Group, a Choir, and an Art Class have. been formed. The Concert Club, with the help of several staff members, staged a very successful Pantomime, giving performances in the Sunbury Memorial Hall and at Ballarat, Mont Park, and Kew Mental Hospitals. The Choir, apart from singing at the Hospital Church Services and the fortnightly patients' concerts, have sung the anthem in the local Anglican Church on several occasions. 54

The cricket and football teams have played several social matches against outside t

We have been fortunate in obtaining the services of the first full-time Chaplain appointed to a Mental Hospital in Victoria. Rev. W. H. Graham, as well as extending the religious services available to patients, has taken a leading part in the patients' activities and holds English cla.sses twice weekly for the new Australians on the staff. There is still no Psychologist on the staff and it seems unlikely that one will he obtained until he can be provided with a house. Administrat1:ve Staff.-Though the administrative staff has been only one officer below establishment this year it is clear that this establishment is too low to enable the large volume of work to be dealt with satisfactorily. The establishment is considerably lower than in other hospitals of comparable size. Artisan Staff.-In spite of the increase in artisan staff last year there is still more work to be done than our artisans can cope with satisfactorily. Houses have now been approved of for an electrician and a plumber ; it should be possible to obtain suitable applicants when these houses are completed. In general it can be said that the members of the staff have coped with their many difficulties in an admirable manner. Buildings and Equipment. The new nurses' home was opened by the ~Iinister for Health on 14th April. This beautiful and attractively furnished building should be a great asset to the Hospital Three new Occupational Therapy buildings have been completed and are being fully used. Alterations and renovations to the " Hill" wards were commenced in August, 1954, and should be completed by the end of 1955. The alterations should lead to a great improvement in comfort and efficiency and will enable u:; to split each of four large wards into two wards of reasonable size. The new boiler house was completed in May and is functioning satisfactorily. The pipe lines for conducting steam to the wards and other buildings for central heating and hot watm are still in the process of erection. The repainti11g of the front wards is now almost completed but plans have yet to he drawn up for urgently needed alterations to these wards. New accommodation for 200 patients is urgently needed to correct the present overcrowding which has been aggravated by the splitting up of the large wards. The day rooms and dining rooms throughout the Hospital were almost completely refurnished during the year with modern and attractive furnishings. This has caused a great improvement in the appearance and comfort of the wards. Two brick residences for medical officers were built and occupied during the year, two more are in the process of erection and it is expected that a further two will be commenced shortly. New workshops for all the artisan staff are in the process of erection ; several of these have already been completed and will be occupied shortly. Our long awaited Kiosk has at last been commenced and should be in operation by next September. PlanR have been approved for a new hospital ward and a chapel. These are both greatly needed. A small bio-chemical laboratory has been set up and the valuable equipment which has been installed therein is functioning successfully. Plans arc being prepared for a new kitchen which should fill a long-felt need. When the new kitchen is completed the present kitchen site will be taken over by the store which is now grossly overcrowded. Comments in the inadequacy of the kitchen and store have been made in every Annual Report since 1949. Farm and Garden. Favoured by good seasons, these sections benefited greatly and increases in production were the result. Milk and egg supplies increased by 10,268 gallons and 1,110 dozen respectively, and sales of pigs rose by £150. It is to be hoped that the new dairy will be erected and milking machines and pasteurization plant installed before the next report. The vegetable garden staff were provided with additional mechanical equipment. The vegetable supply increased by just over 10 tons and the fruit by st tons. The ornamental gardeners have also been provided with additional equipment and these gardens have improved greatly. The golf course has developed well and is providing valuable recreation for staff and patients as well as being a link between hospital and town. Volunta.ry Organizations. Once again valuable assistance has been given by a number of outside organizations. The Central Council of the Mental Hospital Auxiliaries of Victoria have donated a slide projector and have supervised the running of the Kiosk. The Sun bury .Mental Hospital Auxiliary has donated high quality amplifying equipment for the Concert Hall, a percussion set for the patients' band and a number of other items. With the co-operation of the hospital staff the Auxiliary organized the annual picnic and gave an attractive Christmas present to every patient. One of their members has been giving regular coaching to our concert party. A number of patients has been visited by the members of the Auxiliary and a birthday club for patients is at present being formed. Several Auxiliaries are at present helping in the preparations for the Fancy Dress Ball. The Country Women's Association has completely refurnished the lounge in our convalescent ward which now looks most attractive. Several Branches have acted as hosts to groups of patients or have made visits to the Hospital. The Australian Association of Relatives and Friends of the Mentally Ill made the usual valuable donation at Christmas time and have also donated other items. The Red Cross Society have conducted fortnightly live artist concerts for our music club. The music club is also using records from the Red Cross music record library. They have also donated a library of 600 books and members of the local Branch visit the Hospital weekly to assist in the running of this library. Numerous concert parties have given a concert at the Hospital on Sundays which have been greatly welcomed by the patients. The work of all these voluntary organizations has been of great value to the Hospital. General Com'ments. It will be seen that substantial improvements have been made to the Hospital during the period covered by this report. Although this has involved the Government in considerable expense, the outlay is being well repaid by the increased comfort and happiness of the patients and by the increased rate of discharge from Hospital. The greatest barrier to progress at the present time is the shortage of staff, particularly medical staff and trained nursing staff, and the overcrowding. CHILDREN'S COTTAGES, KEW.

DEPUTY PSYCHIATRIST SUPERINTENDENT: Dr. W. A. J. BRADY. STATISTICS, 1954.

i >Iale. Female. Total. I I On Books 1st January, 1954 313 196 ;)o9 Admitted- Voluntary 5 5 Certified 68 52 ! 120 : Total Admitted 68 57 125

Discharged .. 13 5 18 Died 19 19 38 On Trial Leave 39 15 54 On Books 31st December, 1954 322 231 553

Geneml Ii ealth. There has been a great improvement in the general health at the Children's Cottages during the past year as is evidenced by the lower death rate. This improvement is due to~ (a) Improved diets, with improved knowledge of infant feeding; (b) Antibiotics and sulphonamides ; (c) Co-operation of public hospitals, especially with regard to orthopoedic, eye, ear, and throat conditions. (Royal Children's Hospital, Eye and Ear Hospital, and St. Vincent's Hospital.) (d) Anti-epileptic drugs, reducing epileptic seizures. Treatment. The high-light of the year was the opening of the Occupational Therapy Centre by Councillor Maurice Nathan. in May, 1955. This beautiful building was the gift of the Melbourne Lions Club aided by funds from the Pamplin·­ Green bequest. It has all the necessary occupational facilities : store rooms, soaking tanks, light airy workshops, heating and ventilation, occupation rooms, offices, a toilet block, and cloak room. It is delightfully decorated. The Melbourne Lions Club has done very much for the Cottages. The Occupational Therapy Centre will always remind those visiting of the work which was done by them at the time when it was most needed. Three years ago there was no therapy whatsoever and up until May, 1955, occupational therapy was carried out in the wards and in one small room, and the present expansion is very welcome. The emphasis is on training- (a) to enable patients to be useful members of the institution community; (b) to prepare them for more advanced training at a centre such as Bendigo. In the Occupational Therapy Block the following activities are now carried out :-­ Sewing Classes-including use of electric machines. Cookery. Laundry. Housework. Pottery. Basket making. Painting. Felt work, &c. Type writing. Screening of selected filme. The Occupational Therapy Centre is used for other forms of treatment :-- (a) Encouragement of motor development and co-ordination by means of suitable play and gymnastic equipment, &c. (b) Social development. There is a great deal of emphasis on group work which is hoped will make the patient& more co-operative and helpful in the wards and happier in their relationships with one another. (c) Behaviour problems are often helped by individual attention given by occupational therapists. Social Activities.-The annual holiday camp at Point Lonsdale was again a very great success from every angle. For the first time it was possible to accommodate two groups of girls at Point I.onsdale under the leadership of therapists, after the conclusion of the series of boys' camps. In addition, there were many concerts and outings arranged by therapists, Country Women's Associatiom, voluntary helpers, and other groups. Recrootion.-Sport : a physical culture instructor as well as male nurses instruct boys in football, cricket, gymnastics, and simple team games. The Koala Club for boys meet one evening each week. There is a club committee which holds discussions and dancing, games, and gymnastics are indulged in. Many of the patients attend the weekly film screenings at the Main Building. A Square Dancing class is helrl regularly, arranged by a voluntary worker. Four of the senior girls attend local Ranger Company meetings. 57

Amenities. Freedom.-Many patients go on trial leave for shorter or longer periods and weekend visits home are common. More and more parents tend to take oetter grade children home for school holidays, &c. Several parole patients attend local pictures and football matches. Olassijication.-Definite attempts are made to segregate various grades of defectives but the situation is difficult owing to lack of accommodation in the high grade wards. Often it is just a question of finding a bed anywhere for a patient. Clothing.-This is slowly improving but the process is hampered by lack of storage space, the shortage of which is very acute throughout. Diet.-Diet has definitely improved, there being much more variety and more suitable foods for delicate patients.

Buildings, Equipment, and Artisan Work. Buildings.-It has been a difficult year with patients housed in inadequate temporary accommodation. Wards are, for the most part, grossly overcrowded, with insufficient space for storage, recreation, and toilet requirements. The lack of suitably fenced airing courts means that low grade children have to be kept indoors very often for safety, and it also has the effect that it is impossible to segregate the tougher, more aggressive patients from the frailer ones. The early erection of new Cottages is the only solution. On the credit side Ward 25 was completed and is occupied by the higher grade girls who are very happy there and appreciative of their nice surroundings. Wards 26 and 27 have been completed but several things are still required, for example more store rooms. to make them easily run wards. Ward 21 i.; a very satisfactory ward for the infants. ''Little Pell "has been completed for temporary accommodation but is difficult to run satisfactorily. '!'hill consists of three huts removed from the temporary housing accommodation at Camp Pell. In Ward 16 remodelling has commenced. The dining hall has been painted and new flooring has been provided. The effect is excellent. Equipment.-Much play equipment has been received and many articles have already been erected and are in use for the benefit and enjoyment of patients. Artisan Work.-The artisan staff is very much over-worked and a separate staff is really essential for the Cottages, the Laundry in particular appearing to be quite inadequate to cope with local needs. A separate sewing room for the Cottages is also desirable and maintenance in this department is very much behind, due to staff shortages. Nevertheless the artisans are to be commended for their willing co-operation under difficult conditions.

Staff. There is a severe shortage especially of senior trained staff. More encouragement could perhaps be given to induce people to take examinations if higher pay were given to Senior Staff who have to take responsibility. Excessive overtime is undermining the whole staff structure. Some junior and untrained people get too much money compared to the more interested and conscientious senior staff who are grossly overworked to the detriment of their health.

Staff Training and Teaching. Every effort is made to ensure that student nurses receive training in all aspects of the work.

Voluntary Organizations. The regular voluntary workers' group has continued to give very good service. The l\lental Hospit~tl Auxiliaries, particularly the Kew, Hawthorn, and Ringwood branches, have been very helpful with gifts, recreational outings, &c. 1\fembers of the Lions Club continue their active interest in the patients and were partly responsible for the equipping of the new Occupational Centre. In addition they did valuable work in organizing and participating in a series of Saturday painting and gardening projects. ~ The Kew Mental Hospital Welfare Group has been very helpful at all times as shown by their gifts and many personal activities and the Country Women's Association and Mothers' Clubs continue to take a keen interest in the children, " adopting " some of them and arranging many outings and birthday and Christmas treats. Other very active groups have been the Savoy Auxiliary and the Melody Club.

Out-Patients. One Medical Officer attends Observatorv Clinic for one session each week and another the Out-Patients at the Royal Children's Hospital. ·

General Comments. The transfer of our best working patients to Bendigo earlierin the year has greatly increased difficulties but the position has eased slightly with the appointment of cleaners. · · · More nursing staff is urgently required and unless the numbers are increased it will he impossible to carry out a reasonable programme. Every possible encouragement should be given to suitable trainees. The overcrowding has more than reached its limit for the safety of the patients. 58

JANEFIELD COLONY. PsYCHIATRIST-SuPERINTENDENT : DR. H. C. STONE.

STATISTICS, 1954.

I Cert!fted Cases. Voluntary and Special Cases. Totals.

Male. Female. Total. Male. Female. Total. Male. Female. I Total. I On Registers 1st January, 1954 . . .. 8 80 88 27 132 159 35 214 247 Admitted ...... 2 2 7 37 44 7 39 46 ! I Discharged or Transferred .. 14 14 4 17 I 21 4 31 35 Died ...... 1 1 2 I ...... 1 1 2 On Registers 31st Decem- ber, 1954- I I I On leave . . . . I 1 4 5 ...... I ...... Resident .. . . 6 63 69 I 30 l 152 182 36 215 251 i

General Health. Has been generally satisfactory. Twelve cases of measles occurred, a few cases of mild virus type influenza, and one case of infective hepatitis. Inoculations for diphtheria, whooping-cough, tetanus and typhoid-paratyphoid were carried out. Occupational Therapy. This department was functioning very satisfactorily with two therapist!!, and in January students from the Occupational Therapy school commenced attendance. Unfortunately recently both our therapists left the Department, one to another appointment and the other to go overseas, and the Therapy Department has had to be closed. This is very tragic and up to date no replacements have been made available. Recreation. Sixteen-mm. picture shows have been given weekly. The enlargement of the concert hall has just been completed in quite magnificent style. Included in the equipment is a 35-mm. projector, which will greatly improve the quality of the picture shows. Research. A research project is in progress involving cranial radiography of all possible patients at the Colony. The straight radiographs have been completed and the material is being examined and collated. The .Melbourne University is making a detailed study of a number of Mongoloid patients at the Colony. An investigation for cases of phenyl-pyruvic oligophrenia revealed one case. Amenities. All wards at the colony are open wards. Classification is not ideal largely owing to difficulty in restricting admissions to fairly strict categories and also due to length of sta)'" of some patients. Clothing is quite satisfactory. Diet has been maintained at a satisfactory standard. All wards excepting two have their own kitchens which facilitates the serving of food. The remaining two wards are catered for by a main kitchen, which is immediately adjacent to the wards concerned, and also provides staff meals. Buildings. It is pleasing to report that the Recreational Hall has now been completed. The children have now a pleasant place for amusement. The Therapy Room has been erected but cannot be used until electricity and water supplies are provided. An annex to the general store is being erected and some relief will be obtained with the care of stores. Equipment.-The institution has obtained a much required help with equipment in general. The wards, farm and garden, and the artisans have been supplied with all that has been requested. A motor vehicle is an urgent necessity for such details as transport of patients and cartage of light stores and laundry. Farm and Garden. The garden-vegetable and ornamental-and farm are functioning as well as can be expected with the labour available. Additional labour has been requested without avaiL The patient labour as assistance is limited as the reasonably good workers were transferred and those received are not very suitable. The gardens are being attended to by the two gardeners but the task is beyond their best efforts. These artisans are both excellent workers but they cannot be expected to do what is desired without further assistance.

Staff. As stated under comment concerning farm and garden additional labour is an absolute necessity for the outside work of the Hospital to be performed in the manner as is desired. There is a serious shortage of senior nursing staff. The turnover in junior temporary nursing staff is quite considerable. Remoteness of the Colony from the city, and inadequate transport is a serious bar to recruitment of staff. Staff Training. Lectures are provided by 'Medical Staff. The lack of a tutor impairs training efficiency. General. Sincere thanks are expressed to all members of the staff for their faithful and loyal service throughout the year. 59

PLEASANT CREEK SPECIAL SCHOOL, STA WELL.

PsYCHIATRIST-SUPEJUNTENDENT: DR. J. L. GoRMAN.

STATISTICS, 1954. I I Boys. Glrls. Total.

On Books lst January, 1954 61 19 80 Admitted 9 l lO

70 20 90

Discharged 11 3 14 Died 1 .. l

~"--~-~-- On Books 31st December, 1954 58 17

The ratio of boys to girls has remained constant but it is considered that more girls and less boys may achieve a uettcr family unit. This changeover could be made without any major alteration to buildings. Geneml Health. The general health of the children was very good. No epidemics occurred. A sixteen year old boy died from an acute kidney condition. Tonsillectomy was performed on four children and appendicectomy on two. One boy received surgical treatment for hernia. Efficient part-time medical and dental services were continued. All children were regularly checked, new admissions examined and attention given as required. Treatment. Occupafional.-The children attending school have enjoyed an extension of handcraft work. A comprehensive display of their classroom activities was included in the Mental Hygiene Exhibition at the lower Melbourne Town Hall in November. In their home life both boys and girls were encouraged to look after their own affairs as far as possible and take an interest in the work of the institution. During vacations children assisted in the laundry, sewing room and garden. Two ewes, two dogs, and a goat were added as pets for the children. Treatment. Social.-Numerous invitations were received to entertainments and sporting fixtures in the town. This year provided the first opportunity for many to attend the Ballet. A Guide Company has been commenced a.nd local Guides have joined with these children in some of their activities. Establishment of a group of Scouts still awaits the choice of a suitable leader. A library of children's books has been donated by the Red Cross and will be opened next month. Red Cross members will help with its operation. Recreations.-The older boys continued their interest in tennis, cricket, and football, but the small number of girls make the playing of team games rather difficult for them. Both cricket and football matches were played against teams from the town. Organized games, free play, and walks p·rovided the main recreation for smaller children. The school was again fortunate to secure the use of the Lord Mayor's Camp, Portsea, at Christmas time. Those who did not return home had a very enjoyable holiday. The Minister for Health distributed presents at a Christmas treat. Education. The education of the children at Special School standard continued efficiently under a Headmistress and five teachers. The teaching staff has proved to be both zealous and efficient. A staff room is to be provided for them, and new classrooms are almost ready for occupation. Amenities. Freedorn.-The older children attended church, pictures, and concerts in the town unescorted. Others were permitted to go for walks in the bush. Clas.~ijication.-Boys and girls up to about the age of eight share a dormitory. From this the girls move to a senior group but the boys are further divided into Junior and Senior sections. Clothing.--A great improvement has taken place in the clothing of the children. The majority appreciate it and show more care in their appearance. Sports blouses and tunics have been purchased for the girls and football guernseys for the boys. Diets.-The quality of the meals is excellent and considering the large number involved they are surprisingly appetising. Buildings and Equipment. Work began on excavations for a fire service dam and laying of pipes. Site works by the same day-labour gang followed but neither project has yet been completed. Each of these has been modified whilst in progress to allow for additional buildings and services being provided. 60

Syme Ward repairs and alterations, which were commenced in 1950, were completed. A standard type L.T.C. building was erected to provide additional classrooms but this cannot be put into use until various fittings and cupboards are supplied. A new ward to accommodate 28 pupils is almost completed. An L.T.C. building is in course of erection as a play centre for toddlers. Work has begun on a new Nurses' Hostel and a cottage for the Matron. The concert hall is to be enlarged. A number of maintenance works were completed but further attention is necessary to water supplies to bathrooms. Although often discussed, reorganization of the kitchen facilities has not commenced. This will be an urgent necessity with the opening of the new ward.

Artisan W ark. The appointment of a second general assistant gave much help in maintaining this 93-year-old building aR constant repair work is necessary. Several of the jobs now handled as minor contracts could be more quicklv done with a carpenter on the staff. . · Manufacture in the sewing room is now confined to Nurses' uniforms and clothing for those children who arc not a stock size. Repairs constitute the bulk of the work. The Kitchen and Laundry remain models of cleanliness and the standard of their work i,; high. The vacant position of a male cook was filled during the year. All sections worked with their customary efficiency and improvements in the institution are a tribute t

Farm and Garden. Production of vegetables continues to rise. Additional land is being cultivateu, an assured supply of manure obtained and improved varieties of some vegetables introduced. The carry-over of summer crops is sufficient to add variety to late winter and early spring meals. The necessity to buy vegetables has never occurred. Staff. Owing to the prolonged illness of the Head Nurse and absence on long-service leave of the Assistant Head Nurse, Miss C. Carter from Beechworth relieved from March to October. Advertisements in the district papers secured five girls to commence training as Student Nurses. The Nursing Staff position is now more satisfactory than it has been for some years. However, it is thought that some consideration should be given to raising the classification of senior male nurse from Deputy Charge to Charge Nurse. Stajf' Training and Teaching. First and Second Year Nursing lectures were given at the school by the medical officers from Ararat and the Psychiatrist-Superintendent lectured the Third Year (Mental Deficiency). One hundred per cent. passes were obtained. Practical training was given by the Head Nurse, and the Stawell District Hospital co-operated by giving experience in practical nursing training and ward work.

Voluntary Organizations. The Auxiliary continued its enthusiastic service to the children. The annual picnic and quarterly birthday parties were a feature of their work and were greatly appreciated by the children. Mrs. Heywood, President since the Auxiliary formed in 1937, tendered her resignation. Sincere thanks go to her for her kindness and work on behalf of the children. The Central Council of Mental Hospital Auxiliaries and Victorian Council for Mentally Retardeu Uhildren both forwarded donations for amenities for the children. Dane Bros., Pleasant Creek Masonic Lodge, and one old boy made donations for the same pttrpo;-;P. The Sun Toy Fund and various C.W.A. Branches again sent presents for the children at Christmas. Our grateful thanks are extended to all these individuals, organizations, and firms and in particular we thank those C.W.A. Branches and Mothers' Clubs who have " adopted " a child and write and continue their interest throughout the year.

G~neral Cornments. Pleasant Creek Special School can now claim the rare distinction of being a. first-class institution. The present aim is to make it a first-class home for the children, and to gradually relegate the " institution "atmosphere to the background. To this end dormitories are being partitioned into several sub-units ; more individual care is being given to the children ; social and community activities are being extended. As already mentioned, a. larger number of girls will be provided for, thus making roughly even numbers of the sexes. . There is a great need for the appointment of a part-time Psychologist, who could devote the balance of his time to the Ararat Mental Hospital and Out-patient Clinic. · The same applies to the appointment of a part-time Social worker. Both could be of assistance in beginning a research programme. Finally thanks must be given for loyal and efficient service to the Medical, Secretarial, Nursing, and Teaching Staffs. nl

TRAVANCORE DEVELOPMENTAL CENTRE.

PsYOHIATRisT-8UPEJUNTENDENT: DR. V. P. JoBNSON.

8TATISTIOS, 1954.

TotaL

On Books 1st January, 1954 :l~l 30 59 Admissions 20 14 34 Discharges 21 17 38 Deaths ..

On Books 31st December, 1954--~ Private Cases 22 36 C.W.D. Cases (State Wards) 6 29

28 65

General Health. Medical Officer's Report.-During the year the general standard of health of the children resident at Travancore remained good, and a high standard in nutrition was maintained. There was no serious epidemics except for a mild epidemic of chicken pox. Aa is usual with the disturbed type of child under treatment here minor ailments were common. There were no serious injuries of fractures. Dental inspection and treatment was carried out by the Schools' ~fobile Dental Bervices. This was carried out most efficiently and afforded the children much confidence in their dental treatment.

T1·eatment. Occupational, Socia~ Rec·reations.-During the year a Speech Therapist gave regular sessions of therapy at the school for individual cases of speech difficulty.

Special Treatment. Research.-Special courses of treatment with succinic acid parenterally and orally were carried out in selected cases of schizoid type. No permanent cures, however, were recorded. Also during the year a number of children had E.E.G. investigations carried ou·t.

Amenities. Freedom, Olassijica.tion, Clothing, Diet.-The following is a list of some of the entertainments and outings provided for the children during the year. Outings and picnics to Ferntree Gully, Mt. Evelyn, Coburg Lakes, Essendon Airport, Belgrave, The Museum, Beacombe Grove, Queen's Park, Geelong, Botanical Gardens, Zoological Gardens, Port Melbourne, Sandringham, Williamstown, football matches of leading teams, visits to the Tivoli Theatre, pictures at Ascot Vale and City Theatres. On Saturday nights pictures were shown in the hall here and were supervised by the Coburg Cb.urch of England Boys' Club. The Essendon Rotary Club gave a picnic to the Travancore children at Williamstown. Senior pupils from MacRobertson High School for Girls took groups for play therapy on Saturday afternoon. The older girls attended a party at Christmas time given at the Malvern Congregational Church Girls' Club Hall. The Coburg Church of England Boys' Club (organized by Mr. Gab b) gave a Christmas picnic at Ferntree Gully and a Christmas tree at Travancore at night. Mrs. Harris al;;o gave an early Christmas party at Travancore. During the Christmas the children who were unable to go home for holidays went to the Lord Mayor's Camp, Portsea, for ten days.

B-ttildings, Equipment, Artisan Work. Other disabilities of the Centre in need of ::ugent adjustment are the lack of a full-time Secretary, inadequate single rooms and isolation sick bay facilities, inadequate telephone intercommunication between the units of the Centre, inadequate storage facilities, inadequs.te artisan workshop facilities, a need for a modern method of garbage disposal, and a marked lack of facilitie:s and materials for developmental play activities.

8taJf' : Training and Teaching. As a result of the shortage of nurses and a.rtisan staff, the pre-school unit still remains unopened and the adequate staffing of the Centre generally is becoming an increasingly difficult matter. A particularly regrettable feature is the paucity of student nurses which, if it continues, will result in the Department havi!'lg few Charge and Deputy Charge Nurses in this type of work.

Voluntary Organizations. Coburg Church of England Boys' Club, S•mior pupils of MacRobertson. High School for Girls, The Essendon Rotary Club. 62

(}eneral Com·ments, The untimely death of Dr. A. Phillips, who had been in charge of the Centre since 1943, was felt deeply by both staff and children. All associated with Travancore held Dr. Phillips in high esteem and affection and his death was a great loss to both the Centre and the Department. Miss E. Watt, Assistant Matron, was transferred to Janefield in April and Miss M. Smith was promoted to Assistant Matron. The high percentage of children with severe emotional disturbance and behaviour problems creates great difficulties under present conditions of staffing and organization. It has become ohvious that it is impossible [or Travancore to function as both a residential clinic for severely disturbed children and a developmental centre for retarded children simultaneously without considerable re-organization of staffing accommodation and facilities. Travancore has yet to give the demonstration of how retarded children can be saved the emotional disturbance, and the character distortion inevitable if they are kept in competition in ordinary schools for any length of time. Until the pre-school unit is opened and functioning the admissions to Travancore will, in general, continue to be those who have suffered severe emotional damage of this nature.

TRAINING CENTRE, BENDIGO.

SECRETARY : MR. D. NuGENT.

The first group of boys, twelve in number, was received here from Kew on the 3rd March, 1955, and during the following fortnight groups from Stawell and Janefield increased our number of residents to 23. After a period of consolidation, further groups from Kew and Stawell and a few boys from other sources were received during May and June. The number resident at the end of June was 43. Almost without exception the boys settled down very quickly and they appear to be appreciative of their new surroundings and way of life. In a few cases boys have already shown a marked improvement in their attitude to work and general behaviour, and most of the others, particularly the younger ones, give every indication that they will eventually benefit from training here. There are some, however, whose prospects appear to be very doubtful and whose future should be regularly reviewed. All of the boys are in good physical health and some have developed most noticeably. There has been no case of serious illness or accident. All those then resident had a chest X-ray when the mass survey unit visited Bendigo in May. A full routine of activities has been gradually established over the four months. Ornamental and vegetable gardens and an orchard are rapidly taking shape although progress in the vegetable area has been badly hampered recently by bad weather. A group of boys has been constantly employed at painting and they have accomplished a great deal of good and useful work. In the field of carpentry extensive alterations to the interior of the huts have been completed and three garages and a double sleepout have been erected, but until we have a workshop it is now difficult to constantly employ many boys in this field. A requisition for the supply of materials for a large building to serve as a trades workshop is at an advanced stage. When this building is completed the Centre should be ideally set up for its purpose, both from the point of view of training facilities and the comfort of the residents. The boys' living quarters are quite comfortable and they are kept in a very creditable condition. In the fields of sport, physical culture, and entertainment the boys are adequately catered for. There are good facilities for both indoor and outdoor games within the Centre. A few of the bigger lads train and play regularly with local junior football clubs where they are well treated, some have been given the opportunity to join the Y.M.C.A. and enjoy their facilities, and all boys are allowed to attend regularly at local sporting functions and theatres. We have an active Social Committee which arranges regular Sunday evening concerts and dances for the boys and visitors. In a well equipped gymnasium, physical culture and gymnastics classes are part of the routine, and evening dancing classes have recently been introduced. All boys attend Sunday morning services at local churches and weekly religious instruction is given by Catholic and Church of England chaplains. The Centre appears to have had a very satisfactory start, and although it is too early yet to make predictions ~s to it~ future, ~he.re are. many. heartening signs. Although our activities ar~ not yet widely appreciated m Bend1go, there IS mcreasmg evidence that local people are prepared to help us m every way. I have had wonderful assistance, and it continues, from several quarters, particularly from the local Public Works Department and Commonwealth Employment Service officers, and I would like to acknowledge that fact here. We are fortunate, too, in having a good staff, mostly local recruits. They all take a genuine interest in the welfare of the boys which extends beyond their working hours. Finally, I must pay tribute to Mr. D. Walsh who was, and still is, the key figure in the development of this Centre. He has an admirable mixture of knowledge of his subject, personality, and devotion to duty which inspires everyone around him, and if his efforts receive their due reward then the Centre must be outstandingly successful. 63

:VIOORAKYNB HOSTEL, HAWTHORN.

HosTEL SuPERVISOR : }lRs. E. M. CAWSJH. Statistics, 1954. Number of Girls in Hostel on 1st January, 1954 34 Admissions during the year H 48 Left Hostel during the year-" Transferred to Janefield 2 Absconded 2 Returned home 5 To go to friends 6 15 Remaining in Hostel at 31st December, 1954 33

Several new firms have been added to the list of Employers. Girls are employed at the following firms Davies Coop 5 Australian Knitting Mills 7 Queen Victoria Hospital 2 Women's Hospital 6 Ansell and Co. 2 Rocking ham 1 Henry Buck 2 Yarra Falls 1 Miss Narik 1 Sheldon Laundry 1 Sherbridge Cross Knitting 3 A.J.C. Jam Factory 1 Bethesda (Florists) 2 Sargood Gardiner Ltd. 2 Dowd Accessories 1 Domo Pty. Ltd. 2 Business and Professional Women's Club .. 1 Bethesda Hospital 1 Linde and Co. . . 2 Slonim and Co. 2

Ernployment. Conditions were a little easier in the employment and there has been no difficulty in placing the girls.

General Behaviour. The behaviour has been mainly very good but as many girls come to the Hostel quite untrained for any kind of work, it is very difficult for them to settle down at once. The importance of everyone going to Janefield for training will be of great value and should make it much easier for the Staff and the employment of the girls.

Health. The health of the girls has been excellent and except for the usual colds only one or two cases of influenza are to be reported.

Reereational. The girls still have their club and worked for their Fete which realized £200. They held their Annual Meeting at which Miss Matheson presided in August. We are always grateful for the interest the members of the Authority take in the activities of this club; especially do we thank Dr. E. Cunningham Dax, Dr. Brothers, and Mr. Ebbs. The amount realized during 1;he year was £285 and this was distributed to various charities including some of our own institutions. This year we were entertained by the Oakleigh Mentally Retarded Centre and were given a wonderful time. The Bluebird Club also entertained us and we had a most enjoyable time there. We thank both of these Auxiliaries for this. In return we invited them to a special concert which they enjoyed immensely. Miss Matheson shows her interest in Moorakyne by coming to train the girls in folk dancing and physical exercises. She has been coming now for eleven years and is responsible for a great deal of the success of the concerts. We have had many bus trips throughout the year and several people have come to the Hostel to show pictures. The Staff situation has been Yery good towards the end of the year. I would like to thank them for their interest and loyalty.

Buildings and Equipment. All three houses were painted during the year and ll. sun porch was added to No. 6A. The latter patd from Hostel funds, altogether making a vast improvement both inside and out. We are still waiting for the hot water service to No. 6A, No 10 and the Staff quarters to be improved. 64

CHILDREN'S COURT CLINIC, MELBOURNE.

PsYOniATRIST-SuPERINTENDENT, DR. T. G. C. RETALLICK.

STATISTICS, 1954. Source of Referral :-- City .. 32 Suburbs 155 Country 19 206 Chief Probation Officer 34 Education Department 6 C.W.D., H.O., and Dr. Tewsler 56 Mental Hygiene Department Social Agencies 21

Total 323 Of 206 Court Referrals main charges were as follows Capital Offences Assault (including Robbery in Company) 9 Sex Offences .. 25 Breaking and Entering (and attempted breaking and entering) 45 Larceny 60 Arson 3 Wilful Damage 3 Traffic Act 9 Neglected Child 30 Other Types, including breach of probation 22

206 Physical and dental health of children's examinations 1953-54 was remarkably good. Number of Files:­ Males 254 Females .. 69 323 Cases Followed Up, including sex instruction (33) 181 Truants · 27 Truants, educationally retarded 86 Truants, educationally accelerated 4 Children, educationally retarded 196 Children, educationally accelerated 7

On 167 children above school age vocational adjustment or guidance was given. Forty-nine retarded children were to be given special schooling or placed in Opportunity Grades as result of co-operation with Education Department Psychology Branch. One Psychologist was seconded to the Children's Welfare Department and did much work on the various Wards of State there. Despite the greatly incl'!lased case load a preliminary research was undertaken on 151 of the 206 Court referrals for 1954. During the year there were attached to the Clinic two Social Wor·kers whose function was restricted chiefly to that of ascertainment of information for the Court. During the year, this clinic was visited from overseas and interstate by personnel interested in functions and practical help given to courts, parents, and children. These have included magistrates, psychologists, social workers, and students studying under the Colombo Plan. The Psychology Staff was supplemented when the Principal Psychologist, who previously had worked on special cases only, returned to the Clinic full time in August. A special psychological survey was carried out by him of children for likely placement in the Cottage system at the Children's Welfare Depot. Further " follow-up " was continued on these children to observe whether they progressed, and help given to the special staff placed in charge of them. The recommendation of the Clinic was, in the majority of the cases, referred from the Courts acted upon, a small minority comprising cases of Recidivism, or where homes had deteriorated since being seen. The work of the Psychologist in this Clinic has been, as usual, mainly of a diagnostic nature. The record high case load has also militated against any great amount of extended work with the children seen, though the Summary of Statistics shows that many cases were followed up. This work was of necessity curtailed after the resignation of two psychologists during the year. OBSEIWATORY f'LINIC, MELBOURNE.

An analysis of the numbers of patients under treatment in the year ending 31st December, 1954, 1s below:--

Patients Fill.!t Separate VIsits New Patient8, 1954. Seen 1953 or Totals. to Earlier. Psychiatrists.

Observatory Clinic-· Adults 163 155 318 1,866 Children 153 140 293 1,403

Total 611 3,269

Out-Patient Centre·-., AdultR 339 1,022

1 (218 sessions)

Yallourn Centre· Adults 16 20 Children 9 12

Total 25 32

Totals 975 4,323

Some of the 11dult clinic patients were seen at the Tuberculosis Sanatoria, including Fairfield, at Warragul Hospital, or in a few cases in their own homes or in other hospitals, when, having already attended the Clinic, mishaps prevented attendance for a time. For a while, active treatment of some patients was pursued at Trelowarren, so that this Hostel combined after-care and therapeutic functions. Out-Patient Centre. Reference to the figures in the table above will show that the work here is extending, four Psychiatrists attending throughout the year, and four for varying periods during 1954. }jjventually, up to 22 sessions per week might be provided. As before, patients needing prolonged psychotherapy or physical treatment were transferred to the Observatory Clinic. Yallourn. A fall in the number of patients seen is due partly to the reduction of the number of visits this year to eight, owing to the pressure of work in Melbourne, and partly to the change from the original Psychiatrist to another, followed by a change back after the latter left the Department. Diagnostic help was given, and sometimes brief psychotherapy. Treatrnent Centre. A noteworthy event was the erection of a Bristol aluminium building to serve as an extension of the Clinic, and to provide facilities for child and adult treatment. This was officially opened on 28th October by the Minister for Health, the Honorable W. P. Barry, and provided much needed room for the expansion of play therapy, physical treatment of adults, psychotherapy, &c., which had been employed during the five years of the Observatory Clinic's life, but with disabilitie~ such as insufficient space. Not only can there be more room for therapy and teaching, but opportunity now to plan t.owards creating a modified Day Hospital providing intensive treatment of early neurosis, &c. The Work of the Psychologists. For part of the year we were fortunate in leaving three Psychologists, and feel that this number is the ideal to be aimed at as the permanent establishment. To the work implied in the table below should he added that involved in examining 95 candidates for Health Department Scholarships (Kindergarten and Play Leader Courses), an important aspect of preventive work which continues each year. Remedial reading, educational guidance, and work with children, always in conjunction with Psychiatrists, together with instruction of visiting and outside groups has been continued as before, and the Psychologists have devoted time also to an enquiry into enuresis which is under way.

·rot-al. J ::iumber of Vhdt."'.

Adults .. 65 9 2()() Children 163 164 2,04\1

Total 228 173 2,315

The Work of the Social Workers. During the year the practice of Intake Interviewing of new adult patients was discontinued, but continued with child referrals, so that as with the system in which the Social Worker makes a routine home visit, the first contact with the family is still made by this worker, but usually at the Clinic. This is especially useful in those 1304/56.-5 66 cases in which mothers make a tentative approach, are coerced into coming, or are impelled by curiosity. With the position, towards the end of 1954, that only one full-time Psychiatrist remained on the staff instead of three (assisted, however, by part-time workers), a special burden in the child guidance field fell on the two Social Workers, who were faced with the making of initial contacts with many disturbed families to whom full psychiatric investigation and help could not be promised for som<' time. As the table shows, at the end of the year, 126 child cases were waiting. Child Referrals to the Observatory Clinic, excluding Children Referred to Y allourn Centre, and Children of Adult Patients Seen. Number of new child cases referred during 1954 337 Number of new referrals carried over from 1953 29 Number of referrals earlier withdrawn and now re-applying for help 12

378

Under treatment 153 Waiting 126 Referred elsewhere for more appropriate help, &c. 13 No response on attempt to establish contact by Social Worker 14 Withdrawn after contact established ...... 72

Total 378

Occttpational The·rapist. A gratifying new appointment was that of an Occupational Therapist, who from February onwards built up an Occupational Therapy Department centred in the hall in the old Observatory Building already used for lectures. The Therapist attended Trelowarren and Kinkora Hostels also for a total of ll days weekly until 13th August, and then two full days. In 1955 it is hoped that a part-time Therapist will be appointed to take over the Hostel work, however, as the local demands grow ; and it is hoped to arrange for an evening Social Club meeting at weekly intervals at the Observatory Clinic. From 14th August, the Occupational Therapist and one of the Medical Officers organized Saturday morning activities for a group of eleven girls ; and at the Exhibition of Occupational Therapv at the Melbourne Town Hall, photographs and drawings were exhibited. • Evening Clin:ics. These continued during January, but it was decided to provide an extra clinic service on Saturday mornings, rather than on Thursday evenings after this. During the year, the Saturday staff has included a Medical Officer, Psychologist, and Occupational Therapist, and it is hoped to extend this in 1955, so that an Out-patient Centre Psychiatrist may attend also, together with Nurse or Secretary. Mother Groups. These were continued, and meetings held in :March, August, and October with good response in the mothers of child patients attending. Educational Work. In addition, a course of tutorials was given to Theological Students and a demonstration given on the 2nd April to School :Medical Officers and Nurses at the Clinic in addition to the provision of two lecturers for the course at Royal Park arranged by the Chief Clinical Officer for this group in August. Demonstrations at the Clinic were given to third-year Kindergarten Training College Students, and to Students from Toorak Te11.chers' Training College, and to those from Mercer House. Three lecturers were provided to take part in the Infant Welfare Sisters' Course, two contributed to the Junior Schools Refresher Course held at :Melbourne Grammar School in August, and two to the :Medical Officers' Induction Course at Royal Park. Lectures by Psychiatrists were given to groups of mothers in some suburbs, and to a parent group at Carey Grammar School, while lectures were given to various groups in training with the National Fitness Council as group leaders, &c. Five members of the staff contributed to a case presentation to members of the Australasian Association of Psychiatrists on 14th October, while a Psychologist contributed a paper to the British Psychological Society Congress in Perth. Students from the Psychology Department and the Department of Social Studies were placed with the Clinic and received instructions and gained expeTience under supervision. Visitors. In addition to the official visit of the Advisory Committee to the Authority on 16th March, there were visits from 1\fr. Lumsden, Inspector of Special Schools from England, Dr. I. Waterhouse, and others.

Staff'. Ideallv, the Observatory Clinic itself should have a full-time medical staff of three, with three Psychologists and three So~ial Workers, two of each group being more permanent than the third of each-who could be regarded as " in training" a.nd placed with the Clinic until replaced with another. General. Thorough repair and decoration _were carried out, e_xternally and internally, at the Observatory Clinic building from 21st February ; larger wmdows were fitted m the darker rooms, and a glass door added at the northern end. This work has brought the general appearance of the older building much more into line with that of the Treatment Centre, as well as arresting deterioration and adding to the comfort of the patients and efficiency of the staff. There remain a few problems such as cooling during the hotter weather in both buildings, but the structural additions of the past yea: and the staff additions of the last six months give promise that, while the handling of a larger number of patients per year may not follow, more of the deeply disturbed patients will be given relief owing to the increased time available for their often lengthy treatment, and the greater variety of the facilities we are able to employ. 67

PSYCHIATRIC CLINIC, COLLINS-STREET, MELBOURNE.

PsYCHIATRlST-St:PERIYTENDENT: DR. J. V. AsHBURNER. Stati,~tics, 1954. During the twelve months to 31st December, 1954, there were 196 new cases and 782 re-visits to the Clinic. In the ensuing six months to 30th June, 1955, there were 151 new cases and 686 re-visits, but these figures do not include the 65 children seen a total of 178 times by the Psychologist attached to Maternal and Child Hygiene Branch. The comparative increase in cases in 1955 was due in part to staff increases and in part to a redistribution of duties within the Clinic.

Source of Patients. As in the past, most of the patients were children referred by Medical Officers of the Maternal and Child Hygiene Branch and of the Education Department, by social welfare agencies, and by private practitioners. In a number of cases the patient was self referred on the recommendation of a former patient. There is also a steady stream of patients referred by people who give advice on family problems in press and radio sessions. The main interest of the Clinic being in preventative aspects of mental health, the majority of patients seen were children but, in addition, some adult:> were accepted for treatment if the mental health of children was endangered, or if there was a threat of family disruption. In furtherance of these broad aims, over the eighteen-months period in question, there were fourteen lectures and clinical demonstrations 12:iven by memberR of the staff, including seven to theological students.

Staff Changes. Dr. V. P. Johnson, Psychiatrist-Superintendent, was transferred to the Travancore Clinic in November, 1954, and until Dr. J. V. Ashburner replaced him in February, 1955, Dr. A. Czulak acted in charge of the Clinic. A second Psychologist was appointed in April, 1955, and is engaged on full-time duties in Pre-School Centres controlled by the Maternal and Child Hygiene Branch. The services of a Speech Therapist have been made available for one-half day weekly since :May, 1956.

Psychological Work. The Clinic Psychologist reports that apart from routine testing of most new patients as part of normal diagnostic clinic procedure, she has undertaken a considerable amount of educational and vocational guidance and of adjustment counselling in adolescents, in llome oases over a prolonged period.

Summary of Clinic Psychologist's Work, 1st January, 1955, to 30th June, 1955. Total number of appointments 206 Number of patients seen 122 of which- New cases 111 Re-visits and cases carried .. 11

Types of Cases. Initial investigation of 111 cases. Adolescent counselling, 7 (average of 7 visits each). Educational counselling, 8 (avt•rage of 4 visits eaoh)-includes .t student priests. Vocational guidance, 3. Educational placement, 22 (including O.G. and remedial placements). Emotionally disturbed children in regular attendance for play-therapy/educational assistance, 2.

The Pre-School Psychologist is for the most part occupied in visiting pre-school centres, sorting out and advising on children with minor problems, and bringing more serious disturbances to the notice of the medical officers. She is also engaged in a good deal of formal and informal instruction of pre-school teachers, &c.

Social Work. The two Clinic Social Workers have been relieved of routing " intake procedure '' and their time is now more effectively occupied in verifying critical points in case histories and in carrying out social casework. Most of the latter f~lls .un~er the he.ad~ngs : s~h~ol placement, supervision of c?rresp.onde.r;ce lessons, arra~ging foster homes and mstltutwnal admtsswns, ass1stmg p::trents and foster parents m the1r attitudes and practtces in child care. This last includes long-term supportive work with inadequate mothers, and evening discussions with both parents together. An analysis of Social Workers' duties in the six month~ to 30th .June, l9fl5, iibows that they made a total of 652 contacts with or in connection with 13R 0aseR. New case:< 102 First visits llO Re-visits .. 212 School and kindergarten visit" 152 Other contacts 88 Discussions with other professional workers 65 LectureR 4

Clinic Nttrse. The duties of the Clinic Nurse have undergone considerable change with the addition of psychologists to the staff and the altered intake procedure. I am personally most grateful for the way in which she has not only accepted the brunt of these changes, but has provided the necessary continuity throughout staff changes. When present reorganization is completed it should be possible to make even more effective use of her long and intimate experience with the type of case dealt with in this clinic.

General Observations a.nd Recommendations. Several features of Clinic experience deserve brief comment. 1. Problem Families in New Suburbs.-A number of factors contribute to the perhaps unexpectedly large number of cases coming to us from new outer suburbs. Family finances are strained, parents are preoccupied with building and gardening, unmade roads, lack of readily accessible playgrounds, parks, recreation centres, picture theatres, churches, and shops all place a strain on the breadwinner, and an increasing burden on the housewife, which are reflected in emotional disturbances in the children. This is a real social emergency, in that formerly adjusted families are being disrupted, and should provide a fine scope for the kind of social welfare temporary services which were in wartime set. up in military establishments.

2. Few Cases frorn Older Inner Suburbs.--Of the many reasons for this, one is that many who could be helped are not aware of clinic facilities. In both these areas and the newer suburbs, there is place for a local sub-unit of the Clinic, perhaps a social worker in a lock-up shop, in contact with local problems and facilities, and able to bring the welfare resources of the community to bear in suitable cases.

Demand for Social Case-Work. It has become increasingly apparent that in a Clinic of this nature many of the cases can be relieved by social case-work, under the direction and guidance of the Psychiatrist. This Clinic could possibly use at least six social workers without placing strain on psychiatric and psychologist staff. At the moment this is impracticable owing to the acute shortage of social workers available for work in the Department.

Lack of Suitable Res1:dential Clinics and Day Treatment Centres. Much of the work of the Clinic is less effective than it could be owing to lack of a suitable residential clinic. We need under our own control a small, say twelve-bed home, for severely disturbed children requiring prolonged treatment, and also a day treatment centre, perhaps in conjunction with the residential clinic, for patients who can live at home. 69

TRAVANCORE CLINIC, FLEMINGTON.

PSYCHIATRIST·SUPERLNTENDENT: DR. V. P. JOHNSON.

The work of the Clinic suffered severely during the year owing to the untimely death of the Psychiatrist Superintendent, Dr. A. Phillips, on 16th 1\fay, 1954. This resulted in the Clinic being without a Psychiatrist for nearly six months. This misfortune, together with the absence of the Senior Social Worker, Miss Hillas, on special leave in England, faced the Clinic staff with many difficulties in both the administration and technieal functions of the Clinic.

STATISTICAL SUMMARY, 1954.

1. Number of New Cases 382

2. Number of Re-examinations 1Re-tests 143

3. Sources of Referral - Private 9H Mental Hygiene Authority 23 School Medical Services 44 Hospitals 31 Children's Welfare Department 3[> Helping Hand Groups .. 36 Education Psychology Department 21 Doctors 39 Religious Bodie~ 27 Kindergartens .. 16 Baby Health Centre 3 Other Organizations 8 382 4. Nature of Problems as Stated on Referral­ Backwardness of Development 245 Mongolism 28 Behaviour Disturbances 34 Epilepsy and Others 22 Organic Disease 18 Scholastic Retardation 35 382 5. Age and Sex Distribution of New Oases­

A,qe in M ontk~. Bnys. Girls. Totnl. l 12 2 2 13 24 l ~ 3 25~ 36 11 7 18 37 48 H 2 16 49- 60 21 17 38 61- 72 l4 13 27 73-- 84 32 20 52 85- 96 31 19 50 97-108 19 15 34 109-120 16 15 31 121~132 13 10 23 133-144 8 3 11 145-156 6 I 7 157-168 3 11 14 169~180 7 18 25 181-192 18 13 31

214 168 382

6. Total CaseR on t-he Clinic. Recoril~ on 31st December, 1954. 1-49R4 (to the end of 1954). 70

General Clinic Activities. Apart from the routine case work and advisory services to individuals and instrumentalities, extra mural teaching aetivities included instruction given to groups as follows :- 15 Second Year Nurses from Melbourne School of Nursing. 22 Students from the Kindergarten Training College. 10 Student Teachers from Mercer House. 20 Theological Students attending the course in Mental Health. 4 Infant Welfare Sisters. 20 l\iental Hospital Charge Nurses. 13 Medical Officers and Pre-School Supervisors from Maternal and Child Hygiene Branch. 2 Psychopathology Students. 9 Students from Department of Social Studies. Distinguished visitors who conferred with the Clinic at some length during the year included Mr. Lumsden of the United Kingdom, Senior Inspector of Special Schools; Mr. Watkins, Director-General of the Education Department, Queensland; and Dr. Stoller in connection with the Commonwealth Mental Health Survey. Extra Mural Educational activities included talks by Dr. Phillips to Parents' Group at Bendigo Retarded Children's Day Centre and Forrest Hills Mothers' Club ; by Dr. Trood to Brighton Helping Hand Association and Medical Women's Association; by Mr. Cathcart to Frankston, Mildura, Oakleigh, and Footscray Retarded Children's Centres ; Miss Miles and Miss Miller gave several talks to parents' groups.

Extra Mural Case-Work. Surveys were made by teams from the Clinic at the Children's Welfare Depot, Broadmeadows Foundling Home, Burwood Occupation Centre, Bendigo Retarded Children's Centre, Marillac House, Wonthaggi Retarded Children's Centre, Frankston Retarded Children's Centre, and Mildura Retarded Children's Centre.

Proposals for Clinic Development. Inadequate room accommodation in the Clinic building interfered greatly with the integration of clinic functions and staff functions. Individual members of the Clinic staff have had to work in rooms scattered throughout the Centre without intercommunication even by telephone. It it hoped that additional clinic room accommodation and an effective telephone intercommunication will soon be provided. SoCIAL WoRKER's REPORT. In the Clinic, social work has continued along the same lines as previous years, with Clinic case;; and with children and ex-children of Travancore. An interesting development has been the increase in work with adolescent girls through the medium of the Travancore Girls' Club. Apart from the social value of the club, many problems of employment and community contacts have been negotiated through this group. The parents' group associated with this club arranged a holiday week-end for their girls, and on this occasion a social worker accompanied them, being responFible for the activity programme. During the year social workers have accompanied the psychologist to country occupational centres assisting with history-taking and problems of social adjustment. Efforts to maintain contact with previous institutions, foster families, and interested Mothers' Clubs, has been the main emphasis in the work with Travancore children. Eight children accompanied the Girls' Club on the holiday week-end under the supervision of the social worker. There have been two social workers at the Clinic this year.

PsYCHOLOGisT's REPORT. Apart from normal intra-mural activities, the psychologists visited institutions already named in the Psychiatrist-Superintendent's report. Both consider this a very useful contribution to Clinic activities, because of the teaching function that can be served by actual contact with the institutional staffs.

Work in guidance and counselling has been assisted by the valuable extensions of the activities of th~: Psychology Branch, Education Department. Recommendations that were formerly impracticable can now be implemented. The Senior Psychologist was forced to undertake extra administrative duties after the death of Dr. Phillips. Both psychologists wish to express the deep sense of loss, professional as well as personal, felt not only by themselves but also by psychologists generally in Victoria. The increase in the number of occupation centres has resulted in a large number of examination commitments not met because of pressure of everyday clinic work. The psychologists assisted in lectures and demonstrations to visiting groups, e.g., kindergartners, medical officers, Departmental nurses, and theological students. Details of the number of cases seen are included in the Statistical Abstract section of the Psychiatrist­ Superintendent's report. However, these figures deal primarily with first examinations, besides which there were many sessions devoted to re-examinations, to interviews with parents and to guidance of disturbed children, as well as routine re-examination of children living in the Centre. 71

PATHOLOGIST'S REPORT FOR 1954.

DR. G. C. JAGO: PATHOLOGIST.

In the year ending 31st December, 1954, 315 post-mortem examinations were made in the Metropolitan ~!ental Hospitals as indicated below :- Mont Park 149 Kew 127 Royal Park 21 City Mortuary 18

315

There was a slight decrease in the number of autopsies--most noticeable in the Royal Park figures. Whilst old age was responsible for the deaths of approximately 190 patients, there were 54 cases of pneumonia recorded. Cardiac failure from v~rious causes accounted for 85 deaths. ln seven cases death was directly attributed to alcohol. There was one death from bacillary dysentery, and no serious outbreak of this malady occurred during the year in the metropolitan hospitals. Five deaths occurred from tuberculosis and ten from carcinoma. Obstructive lesions in the brain due to thrombosis or haemorrhage were recorded in 29 cases. The work at Royal Park has increased considerably during the past three yearB, and the fall in the death rate here has afforded more opportunity for comprehensive clinical pathology investigations. The new laboratory block is nearing completion and when occupied will provide excellent working conditions for the staff. A considerable amount of modern scientific equipment has been purchased or is on order. The laboratory space at Kew is quite inadequate for the volume of work, and provision of a new laboratory is an urgent necessity. In all hospitals an investigation into the incidence of phenylpyruvic acid in patients was made during the year. Another investigation was made of the mongoloid population in the hospitals. Further work in connection with these patients is being done in collaboration with the Anatomy Department of the University. I wish to express my appreciation of the work done by the laboratory staff. It will be seen that an ever increasing number of tests is made each year warranting an increase in the staff.

Tests Done in the Laboratories. Bacteriological~ Faeces, urine, blood, pus, swabs, agglutination, fermentation, &c. 334 Wassermann 1,520 Biochemical- Faeces, urine, blood-sugar and urea, gastric contents, liver function tests, &c. 304 Urine Analysis-~ Chemical and :Microscopic 2,112 Haematology-- Haemoglobin, film, cell counts, cell volume, &c. 405 Erythrocyte Sedimentation 637 Cerebro-Spinal Fluid- Pandy, cell count, colloidal gold curve, &c. 230 Histology 60

Total 5,602

DENTAL SERVICE. With the appointment of an additional dentist in the Mont Park, Larundel area during the year, three full-time dentists are now attached to the Departmental Staff. These officers treated a total of 3, 752 patients at the six metropolitan hospitals, whilst requirements at Sunbury were provided by officers of the School Dental Services. At the country hospitals at Ararat, Ballarat, Beechworth, and the Pleasant Creek Special School, Stawell, local dentists are engaged on a sessional basis. With so many of the patients in the upper age groups, the proportion of conservative dental work is not high. On the other hand, attention to dental health is of material a-ssistance in care and treatment generally. Noproblemof importance was reported by the dental staff. . . . In order to adequately cover the dental requirements for the Department it will, eventually, be necessary to appoint an additional two full-time dentists, one for the metropolitan and a second for the Ballarat and Ararat hospitals. 72

COST OF MAINTENANCE, ETC.

~!ENTAL HOSPITALS. Details of the receipts and expenditure for the financial year 1954-55 are set out in Tables XI., XII.. and XIII. The receipts and expenditure for each year for the past seventeen years are set forth in the following table:--

- ~------·- ---·-· -·----~------·-----·----· Dally Average Year. Number Resident. Receipts. Expenditure.

------·-· -~----~------

£ £ £

1938-39 6,493 81,162 477,898

1939-40 6,527 87,560 493,474

1940-41 6,650 89,404 513,019

1941-42 6,729 88,269 533,763

1942-43 6,684 126,096 578,355

1943-44 6,645 120,858 621,619

1944-45 6,662 137,584 625,967

1945-46 6,718 131,577 658,765

1946-47 6,670 154,521 730,815

1947-48 6,675 180,071 861,016

1948-49 6,656 212,647 1,031,237

1949-50 6,751 193,193 1,240,157

1950-51 6,909 249,449 1,547,063

1951-52 6,987 273,316 2,140,690

1952-53 7,122 296,269 2,587,399

1953-54 7,380 330,025 2,962,051

1954-55 7,543 210,142 3,620,945

ExPENDITURE.

Gross expenditure for the financial year 1954-55 was £3,620,945, an increase of £658,894 or 22 per cent., approximately, above that of the previous year. During the same period, the daily average number of patients and voluntary boarders in residence rose from 7,380 to 7,543, an increase of 163. The principal factors, apart from this increase in the numbers of patients in residence, contributing to the rise of £658,894 in expenditure were :- (a) Salary Vote increased by £226,232. Due to a numerical increase of 230 members of the staff and to a revision of salary rates as from 19th December, 1954. (b) Provision Vote increased by £97,464. Apart from an improvement in the patients' dietary scale and a 1-ise in costs of foodstuffs, generally, the increased numbers of patients and staff on rations account for the increase. (c) Medicine Vote increased by £35,298. Whilst a portion of the rise is attributable to further extension of modern treatment involving the use of drugs, it should be borne in mind that medical equipment is also charged to this Vote. During the year, there has been a policy of providing modern medical appliances throughout the Hospitals. 73

(d) Clothing and Bedding Vote increased by £129,604. Associated with the improved living conditions for patients, improvements in the standard of clothing, and purchase of bedding for Nurses' new homes accounted for the major portion of this increase. Apart from this, heavier clothing purchases than usual were necessary to replace ex-army clothing for male patients, and to provide ready-made dresses replacing out-moded items formerly used. (e) Stores Vote increased by £4 7 ,512. With a view to increasing efficiency and improving production of hospital farms and gardens, modern equipment has been purchased. In addition, motor vehicles have been substituted for horse drawn transport. (j) Incidentals Vote increased by £91,971. The payment of overtime and penalty rates to the staff accounts for £76,000 of this totaL As the number of staff increased, the payment for penalty rates rose in proportion. Secondly, with a rise in salury rates, the amounts payable to individual officers were automatically increased. (g) Fuel and Light Vote increased by £14,233. During the year, prices for firewood, coal, briquettes, gas, and electric light were considerably increased. Apart from this, modernization of buildings generally, the opening of new wards, occupational therapy centres, kiosks, &c., installation of appliances has involved increased consumption of electricity.

RECEIPTS. £ For financial year 1953-54 330,025 For financial year 1954-55 210,142

Decrease 119,883

The reduction in receipts was caused by the cessation of payments by the Commonwealth Government as from 1st August, 1954, owing to the termination of the State Mental Institution Benefits Agreement, the amount involved being £98,000 (approximately), and by a lesser amount (£17,500 approximately) collected by the Public Trustee from Repatriation Commission for maintenance of patients at Bundoora and a number of accepted cases in other mental hospitals. The average weekly cost per patient under the various subdivisions of the Contingencies Vote during the past five years is set forth in the following statement :-

Details of Average Weekly Cost. 1951-52. ! 1952-53.

8. d. .~. d. s. s.

Salaries 45 10 60 3 H 5} 84 7} 94 3!

Provisions and extra articles 17 O! 23 10! 27 O! I 27 Ot 31 5

Clothing, bedding, and material for manufacture 3 11! 7 5! : 6 11! I 6 ot 12 6 I Stores 8~ 2 l! j 3 JO! 4 I! 6 5

Fuel, light, and water 4 6! 5 0 6 9} 6 7! 7 3

Medicines and stimulants 0 ll:} 3f i 8 2 :3 ;j 11 Incidentals (including postage, travelling expenses, Chaplains' fees, &c.) 7! Average weekly cost per patient (Public Works Expen· diture not included) 180 4!

Daily average number resident 6,909 6,987 7,122 7,380 7,543

The average weekly gross cost of maintenance per patient during the period was £9 Os. 4!d. as compared with £7 10s. 11 !d. for the financial year 1953-54, a rise of £1 9s. 5!d. per capita per week. Apart from the expenditure mentioned above, which is chargeable against the votes of the Mental Hygiene Branch of the Health Department, expenditure by the Public Works Department on services and stores and for maintenance of buildings (excluding capital expenditure) during 1954--55 was £331,706, or 16ts. ll!d. per capita per week. After collections from the Public Trustee and from other sources were brought to account, the net cost to the State was £9 6s. 7£d. per capita per week. 74

MENTAL DEFECTIVES' BRANCH. Expenditure for the financial year 1954-55 was £205,921, an increase of £35,013 as compared with the previous year. There was an increase of 4:4 in the daily average number of children in residence, due principally to the opening of Bendigo Training Centre on 1st March, 1955. Generally speaking, the explanations shown above as regards the rise in expenditure for Mental Hospitals are applicable to this Branch. The amount collected from the Commonwealth Government under the Mental Institution Benefits Agreement and for Child Endowment was £6,632 as compared with £13,297 during 1953-54, the decrease being due to the cessation on 31st July, 1954, of the above-mentioned Benefits Agreement causing a reduction of £4,720 and the fact that while'five payments were received for Child Endowment in 1953-54, only four payments were received in 1954-55, caused another reduction of £1,945 in these payments.

H. J. MARTIN, A.A.S.A., Secretary. Mental Hygiene Authority. TAnLE XL" Showing the Total Receipts and the Total Expenditure of Department of Mental Hygiene (excluding Mental Defecti\·e,;' J{raneh and Expenditure by Public Works Department) for the year ended 30th .June, 1955.

RECEIPTS. £ £ ExPENDITURK. £ £

Collection by the Public Trustt1e for Maintenance of ex-servicemen Main to· ance of Menta.! Hospitals 3,438,945 patients a.t Repatriation Mental Hospital, Bundoora., and a. number Genera Expenses, Salaries at Read Office, Tmvelling Expenses, of aooepted oases in other Mental Hospitals for whom the Repat- Post: go, Telegrams, &c...... 66,640 r:ia.tion Department pays maintenance . . . . 143,793 Genera Expenses, Salaries, &c., at Children's Court, Child *Maintenance received from Commonwealth Government for main­ Psyo iatric, and Observatory ClinieR 32,523 tenance under the Commonwealth-State Mental Institution I Benefits Agreement .51,257 Total ~ ost Maintenance of Mental Hospitals . , 3,538,108 1- 1!l.S,or,o Subsidl !!- Sales 8,921 Tc •wards Centres for Training of Mentally Retarded Children 23,703 Fines 13 Expen1 s- Collootions, Fees, &c. 6,158 In connexion with Committ.1.l of Patient" 1,784 15,092 In eonnexion with Boarding-out of Patient~ 57,350

Total Receipts 210,142

Deficiency-Financed by Victorian Government 3,410,803 Total ' ther Expenditure 82,837

Total 3,620,945 Tota.l 3,620,945

• Tht• b "Commonwealth Contribution ln substitution for the amount formerly collected from patients or their relatives. This contrihution ceasod on 31.7.54.

TABLE Xll.- -Showing the Tot,al Cost of ;VIaintenance against each Mental Hospital (excluding Mental Defectives' Branch) the Sums Expended agaiu.st Each Vote, and the Amount of General Expenses for the Year ended 30th .June, 1955. ~ Incidentala, Dally Clothing, Stores, ForageJ Medicines, Postage, Average Bedding, Purchase of Fuel, Light, Mental Hoopltal. Total Cost of Sa.l&rlcs. Allowance to Provisions and Medical Telegrams, and Number Maintenanr.R:. Chaplains. Extra Articles. and Material for Stook, Books, and and Water. Comforts, &c. Travelllng Resident. Manufacture. Amusements. E.xpen!IOS.

~~-·-~~ ---- ~---~--

£ £ £ £ £ £ £ £ £

Kew and Kcw Children'~ Cottage.~ 1,481 626,8511 298,261 192 ll5,574 53,692 20,689 1!1,485 12,576 106,390

Arar~

Sunbury · · 1,247 446,963 213,058 665 90,655 51,043 15,201 13,223 11,199 51,919 ! Balla.rat a.nd Rooeiving House 920 392,610 215,093 132 72,350 19,346 13,440 24,492 6,921 40,736

Royal Park and Receiving House and lteooiving Hou~. Plea.sa.nt View ...... 227 271,222 167,455 81 32,472 4,020 11,289 13,098 7,275 35,632

Mont Park and Hepntriation ~hmtal Hospital, Hundoora l ,928 761,548 395,200 241 131,393 M,033 28,400 30,760 17,440 104,081

Larundel • ,' 509 247,145 128,080 '. 48,016 11,768 6,303 6,883 12,047 34,048

Genera.! Expenses . . 99,163 66,279 . . . . ' . 12,804 632 45 19,403 Totals 7,543 3,538,108 1,849,607 1,619 616,428 244,762 126,172 141,884 76,620 481,016

------·-·--~------TABLE XIII.--Showing the Average Weekly Cost of Maintenance of Patients in Mental Hospitals (excluding Mental Defectives' Branch) during the year ended 30th June, 1955.

Weekly Cost Medicines and Average net per Inci' 1ntals, Total Weekly CollectiollS per ProvisioDB Clothing, Stores, Forage, Medical I Patient, AUowanoo to Bedding and Purchase of Fuel, Ught, Comforts, Poata :e and Cost of Patient l/::r deducting Mental Hospital. Salaries. and Extra Telegra rns, and Maintenance Week or Cbaplallll!. Articles. MAterial for Stock, Books, and Water. Surgical Collootlou for Manufacture. Amusements. Instruments, Tra !lllng per Patient. MAintenance, MAintenance, &c. Ex IIJ!eS. Sales, Fees, Sales, Fees, Fines, &c. FIIWII, &c. ------.. ~- ~ ~ --~~ --- ~---1-

£ s. d. -'· d. £ 8. d. s. d. 8. d. £ 8. d. '· d. £ "· d. £ "· d. £ B. d. £ s. d. I Kew and Kew Children's Cottages :l 17 5~ 0 0! l 10 0! l:J ll t li 4! .~ 0! :{ 3! 7 7! 8 2 9!

Ara.ra.t 4 ll St 0 l I 12 7! 15 6 4 81 9 10! I Ill I 4~ 8 15 9! Beechworth .. 4 14 10! 0 Of: I 10 4! 9 4 4 3k 6 5i :J 10! :{ 61 8 ll 9!

:J () l 15 4 4 :l ;},\ Sun bury 5 8! 2! I 7 11! 9 8! 1 0 6 0 6 17 lOt

Ballarat and Receiving House 4 9 11 0 0! i l 10 3 8 5 7~ 10 :I :J 10~ 0 7 Ol 8 4 I ~ ~ Royal Park and Receiving Houoo and Pleasant View Rooeiving House .. l4 3 st 0 l! 2 15 Ot 6 ll.} lll 1! I 2 2~ 12 4 ;J 0 2! 22 19 6! Mont Park and Repatriation Mental Hospital, Rundoora l 4 13 4! 0 Of Ill 0! 12 9 6 8~ 7 :Jl 4 ~~ 4 i 8 19 11 Larundel 4 17 7! I 16 3t 8 !Of 4 9 ;) 2! ! 9 Jt 5 81 !) i 7 ..

C'~neral Expensea 0 5 0!

i ~~- 1--~~- I Total excluding Public Works Department Expenditure .. 9 0 4! 010 8J 8 9 8! l

--~·--- Depreciation and Interest on Capital Expenditure are not included in above Tables. MENTAL DEFECTIVES' BRANCH. TABU~ XIV.--Showing the Total Cost of Maintena.nce against each Institution, the Sums Expended against Each Vote, and the amount of General Expenses for the Year l:rJ ended 30th June, 1955. '<

> I I r:: Dally I Clothing, I I Incidentals, I Maintenance of G I Average I Total Cost of ~ I Provisions and \ Bedding, and Stores, Fuel, Ugbt, I Drugs and . Postnge, Children in 0 Institution. Salaries. Extra Materials for Purchase of Number Maintenance. 1 I I and Water. MedicinE& I Telegrallll!, and Non•Government :::!. Resident. Articles. Manufacture. Books, &c. 1 Travelling Illl!titutiom .... I 1 1 Expensoo~ · '< I I I I I

~

~, I I I £ £ £ £ .t I £ I £ I .£ I .1.: !5lc: ~ Travancore Developmental Centre and Clinic Mi I 42,389 28,882 4,369 778 I 1,372 1,681 19 5,288 ?- I i -:). €; I -:). < Pleasant Creek Special School 70 "'., I 37,366 21,160 6,185 3,417 1,741 2,039 201 2,623 s::s I .Janefield Colony .. . . I 243 100,253 51,192 19,637 2,755 5,679 8,963 662 I 11,365 ~I I I i I I i I 'tl

S: I .. Bendigo Training Centre .. 31 16,016 ! 6,175 I 1,467 3,202 2,726 I 1,582 I I 864 ~ I

General Expense~'! .. I I I er£ I 9,897 :J,398 I I i 743 I 5,7.')6 r::0 '1 ::1 !I' I I ' Total 389 ').(lfi 99.1 110,807 31,658 882 20,883 5.75o

I - Bendigo Training Centre opened 1st March, 1955.