1969-70

VICTORIA

REPORT

OF THE

MENTAL HEALTH AUTHORITY

FOR THE YEAR ENDED 31sT DECEMBER, 1968

PRESENTED TO BOTH HOUSES OF PARLIAMENT PURSUA.J.'l"T TO ACT No. 6605, SECTION 13.

Approximate Cost of Report.-Preparn.tion, not given. Printing (260 copies), $1,415.

By Authon·ry: C. H. RIXON, GOVERNMENT PRINTER. MELBOURNE. No. 35.-2984/70.-Price 85 cents

MENTAL HEALTH AUTHORITY,

300 Queen-street,

Melbourne, 3000.

The Honorable the Minister of Health,

SIR,

We the undersigned have pleasure in submitting the accompanying Report concerning the exercise of the functions of the Mental Health Authority and the operation of the Mental Health Services in this State during the year ended the 31st December, 1968.

Yours faithfully,

ALAN STOLLER, Chairman.

J. R. McDONALD, Secretary.

INDEX

PAGE Mental Health Authority Report .. 7 Chief Medical Officer's Report 10 Chief Clinical Officer's Report 11 Pathologist's Report 15 Inspector, Mental Deficiency Training, Report 19

STATISTICAL TABLES Table I.-Showing Number of cases under the care of the Authority as at 31st December, 1968 21 Table H.-Showing details and percentages of Voluntary and Recommended patients 22 Table IlL-Showing admissions and re-admissions of Voluntary patients 23 Table IV.-Showing Approved and Voluntary patients in Intellectual Deficiency Institutions 23 Table V.-Showing number of Recommended patients boarded out in Benevolent Homes 23 Table VI.-Showing particulars of Geriatric Patients 24 Table VII.-Showing Primary Causes of Death of Patients in Mental, Psychiatric and Informal Hospitals and Intellectual Deficiency Institutions 24 Table VIII.-Diagnostic Summary 25

COMMUNITY SERVICES Statistical Summaries­ Day Hospitals 26 Out-patients 27 Therapeutic Industrial Workshops and Social Clubs 28 Hostels 28 Reports- Alexandra-parade (including Personal Emergency Service) 29 Ambermere (Shepparton) 30 Bouverie Clinic 31 Children's Clinic 32 Clarendon Clinic 33 Glenhuntly Rehabilitation Centre 34 Malvern Clinic and Day Hospital 35 Northern Victoria Regional Service 36 Observatory Clinic .. 37 Pentridge Psychiatric Clinic .. 38 Travancore Clinic 39 (Notes from other clinics are incorporated in the reports from the parent institutions).

RESIDENTIAL SERVICES Statistical Summaries­ Psychiatric Hospitals 41 Informal Hospitals .. 41 Mental Hospitals 41 Reports-{Psychiatric and Informal Hospitals)­ Ballarat 42 Novar 43 Dandenong 44 Malvern 47 Larundel 48 Royal Park 50 Pleasant View 50 Parkville Unit 53 Traralgon .. 55 INDEX-continued PAGE Reports (Mental Hospitals)­ Ararat 56 Ballarat 59 Beech worth 63 Kew 65 Larundel 67 Mont Park 69 Plenty 72 Sun bury 74 Warrnambool 76 Repatriation Mental Hospital, Bundoora 78

INTELLECTUAL DEFICIENCY SERVICES Statistical Summaries- Intellectual Deficiency Training Centres 81 Informal Intellectual Deficiency Centres (St. Nicholas and Sandhurst Boys Centre) 81 Intellectual Deficiency Training Schools 81 Reports- Ararat Training Centre 82 Beechworth Training Centre 84 Janefield (including Training School) 86 Kew, Children's Cottages 90 Sandhurst Boys' Centre, Bendigo 94 Pleasant Creek, Stawell 96 Sunbury Training Centre 98 Travancore Developmental Centre 101 St. Nicholas, Carlton 103

FINANCE TABLES Showing details of expenditure and maintenance costs of all institutions and services- Table IX .. . 106 Table X .. . 107 Table XL .. 108 REPORT

At the end of 1968 there were 50 patients less in residence than at the end of 1967. In 1968 deaths ofmales 65 and over, and of females 60 and over were 2151ess than in 1967, otherwise the bed reduction would have been much greater. Admissions to all hospitals were 9,206 and as the daily average number in residence was 9,086 there was more than 100 per cent. turnover. Jf however these figures are divided up into their respective categories they show that the direct admissions to 830 psychiatric hospitals beds were 7, 179, to 5,972 mental hospital beds were 1,585 and to 3,061 intellectually deficiency beds were 1,117. Other points of particular interest in the 1968 figures are that first admissions to the hospitals were reduced by 200 but that first admissions to the out-patient departments were increased by 750, showing the trend over the years to treat more patients within the community rather than in hospital. Nearly all the intellectually handicapped patients who are free of psychoses have now been removed to the training centres. This has been a gradual process because there was a great deal of resistance and sometimes hardship in moving to a place, more remotely situated, a patient who had been in one institution near his people's home for a considerable length of time. The apparent decrease in numbers of mental hospital patients and the increase in the intellectually handicapped is therefore more a paper than an actual figure.

GERIATRICS. Although the geriatric patients are aggregrated at Kew and in the hospital section of Mont Park there are still very many scattered throughout all the hospitals. Many have been there for a large number of years and are institutionalized and old, rather than suffering from a detorioration or psychiatric illness associated with ageing. In many cases their psychoses have disappeared but nevertheless they are quite unable to be discharged except to a benevolent home or a geriatric hospital, as they are without friends and need care and supervision. ln fact in 1957, 301 patients were boarded out to benevolent homes, in 1968 there were only 90, due to some apparent change in the policy. This is unfortunate as the geriatric hospitals and homes are better staffed and less crowded than the mental hospitals. Further relief could be given to the mental hospitals if additional funds were available for placement of many more patients in non-institutional accommodation. In the long run this restriction is shortsighted, the longer patients are forced to stay in institutions the less will be their chance of ever leaving. Kew has proved to be an excellent teaching unit and were a geriatrician on the staff of the University appointed to Mont Park and attached to the Austin Hospital this could fulfill an equally valuable function for the north of Melbourne. To be fully effective a geriatric day hospital and occupational therapy unit should be started at Mont Park on similar lines to that at Kew. On 1st July, 1968, a tragic fire at Kew, set alight by an old lady smoking in bed, caused the loss of six lives. The buildings in which the patients were housed were huts dating from the beginning of the century. They have since been vacated but this evacuation has only accentuated the overcrowding in the other wards. It is quite impossible to alter Kew in line with the complete recommendations of the fire brigade and, in fact, it is doubtful whether the buildings are worth the cost. Many of the simpler suggestions have been adopted, and there is no doubt that as soon as the Public Works Department can construct ramps these should be built on both the male and female divisions of the hospital, by which means a rapid evacuation of three upstairs wards on either side could be undertaken. Urgent alterations to the female wards are necessary, but there is an unfortunate deadlock between the wish of the Mental Health Authority for immediate improvements to the toilets and redecoration involving minimal structural alterations and the Public Works Department which has proposed a scheme for a complete remodelling of the building over some years for which no funds are presently available. A decision on major reconstruction or demolition and replacement by new accommodation is held up pending receipt of a detailed architectural report has been requested but is not yet to hand. In the meantime wards are closed and the inadequate conditions and overcrowding remain. 8

BUILDINGS. Despite the co-operation received from individuals the organization of the works programme is quite unsatisfactory and some very radical alterations are needed. Costs have risen alarmingly, the delays are prolonged and no advantages have been obtained from the policy of having standard designs for many types of buildings. After months of work with the Colac Planning Committee the architect was taken away and put onto another job, so that despite the urgent waiting list this means further delay. The new standard mental health unit for Footscray and Geelong has not been designed, the multi-storey building at St. Nicholas Hospital is lying vacant, wards at Kew Cottages needing alteration have been shelved for years and no progress has been made on the new wards at Beechworth, although the old buildings are literally dropping to pieces. Bendigo cannot open because staff accommodation and nurses hostels were not programmed to be available simultaneously with the treatment facilities. The Authority strongly feel that some of these jobs should be let out to private architects to be completely designed and supervised by them. A client-architect relationship should be established consistent with normal practices and subject to the overall approval of the designs, costs and general standards by the Public Works Department. At the same time the Authority needs its own architect to act as a liaison with the public works, to check the plans and to avoid the unnecessary mistakes and the problems of furnishing, painting and decorations that arise when the design architects are removed from the construction of the buildings they plan. There is no doubt that if a number of the hospitals had their artisan staff augmented they could undertake far more cheaply, expeditiously and efficiently some of the minor works now let out to contract. It is these delayed small jobs that cause the frustration, irritation and discontent throughout the mental health service. FIRE PRECAUTIONS. Following the fire at Kew another revision of all the fire precautions was made, so increasing the number of fire drills, re-examining the extinguishers and water supply, and having diagrams of all the fire precautions displayed in each ward and building. To install general sprinkler systems in all buildings is quite incompatible with the funds available and the best that can be done is to include these installations in all new buildings as they are erected. ALCOHOLISM. The new Act was passed but by the time it was on the Statute book its value was seriously impaired in the medical as opposed to the legal treatment of alcoholics. Sometimes in their anxiety to preserve the liberty of the subject the legal processes can ignore the welfare of the families and the community. It will now be necessary for a new medical service to be superimposed to treat the early cases and to encourage them to seek aid. Too little tuition is given on this subject and the solution to early treatment may be the setting up of alcoholism units at the various teaching hospitals, though it is likely that the Mental Health Authority will need to have a specialized early treatment unit for the in-patient care of early cases. If the general advice, financial subsidies and psychiatric care were supplied by the Authority, community groups could well take over the care of the rehabilitation hospitals for both the ambulant and the chronic sick alcoholics, as well as providing community hostels for them. CONDITIONS OF EMPLOYMENT. Some difficulties are experienced in staffing and maintaining therapeutic programmes because of factors outside the control of the Authority, for example prior to the end of 1968 the salaries of the occupational therapists in the general hospitals were raised by their wages board. Their colleagues who have joined the mental health services had to wait six months before receiving this award. This meant that the year's new recruits were lost to the Mental Health Department. It would seem that some consistency should be attained in the Health Services where there are many wages boards and wage fixing authorities with considerable overlap. The mental health services have lost laboratory technicians, electro-encephalographers, biochemists and others to the general hospitals. Moreover the matron of a hospital with 500 or 600 female beds in the psychiatric services can rate no more highly than the matron of a 20-bed general hospital, whilst the supervisor of a retarded children's centre with 8 staff and 100 attending and with considerably less training and experience gets approximately the same salary as the matron of say Kew Cottages with 500 beds and 200 staff. There has been some considerable activity in the nursing field towards the revision of courses and for this purpose training committees in the hospitals, and departmental committees have been appointed. Discussions took place as to the future training of the intellectual deficiency nurses the staff of the disturbed children's units, training for community service and the fostering of a closer relationship with the District Nurses. During the year the first residential revision course for the Matrons and Principal Male Nurses was held and was a great success, as were the post-graduate courses for senior nurses. The demand for places now considerably exceed the vacancies. 9

GENERAL. Amongst the more interesting general advances was the change of Travancore from its specialized intellectual deficiency functions to that of a centre for emotionally disturbed children. At the same time its outside activities have expanded so that the clinic supplies psychiatric advice and clinics to the school medical service, guidance to the staffs of the various residential childrens centres, supervision of the autistic children's groups as well as out-patient and in-patient care for disturbed children. Facilities for day care are planned for the future. Evidence was given to the Senate Select Committee of the Commonwealth Government and just prior to Christmas a long questionnaire was completed for the Commonwealth Health Department. It is with considerable regret that the Authority must again report that their representations and their repeated requests have produced no results in regard to the purchase of land for a mental health unit in the Ringwood area, or for land for mental health rehabilitation hospitals in Geelong or near Dandenong. There is no doubt at all that the proper future development of the mental health services is being placed in jeopardy by this lack of decision.

OVERSEAS VISITS. The Government allowed the Chairman leave to attend the World Health Organization to follow up his previous survey of the Mental Health Services in Western Malaysia and to examine again its psychiatric aid to the Philippines. It is a matter of great satisfaction that the Mental Health of Victoria Services have been able to give aid to a number of South-Eastern Asian countries both in the training of a large number of students and in the visits that have been made there by members of the staff. The Inspector of Mental Deficiency Training Mr. K. Cathcart visited the United Kingdom, United States and Scandinavia to investigate corresponding training methods for teachers of retarded children's centres and the most valuable testing methods for forecasting the development of the trainees. Dr. Alan Bartholomew was also away and visited correctional institutions in various parts of the world. VOLUNTARY ORGANIZATIONS. The continued enthusiasm of the voluntary organizations is most gratifying and their activities are a most essential part of our expanding mental health community programme. We are most grateful for the time given and kindness shown by so very many people connected with these dedicated organizations. OBITUARY. During the year the Authority were very sorry to learn of the death of the Honourable Sir Ronald Mack, M.L.C. Minister of Health from July, 1961 to 14th September, 1965, who had been such a very good friend to the department. Dr. Horace Edmonds who was Chief Medical Officer from 1954 to 1965 died after a long illness. He was a dedicated servant of the Branch. Dr. Grantley W. Wright died on 9th July. He had been in the department for 40 years and had been the Chief Medical Officer for 4 years before his retirement. It was sad he could only enjoy this for so short a time. Miss Muriel Yarrington the Nursing Liaison Officer died on 26th February after a long illness. She had devoted herself wholeheartedly to her work to the end despite her knowledge that time was quickly running away from her. The Mental Health Authority would like to thank you, Mr. Minister, for your support and understanding at all times. 10

CHIEF MEDICAL OFFICER'S REPORT. DR. D. J. OLDMEADOW.

Facilities for the Mentally Ill. There has been a further reduction in the total number of admissions to Psychiatric Hospitals ; both at Royal Park and Larundel. There is also a reduction in the total number of patients in residence in all institutions for the mentally ill (from 6,088 at the end of 1967 to 5,780 at a similar time in 1968). A small part of this has been due to bed shortage at certain key hospitals at times during the year, but the reduced numbers mainly reflect an extension of out-patient and day hospital facilities and an increasingly active rehabilitation programme assisting patients to be maintained at home, or in hospitals administered by the Department, or at approved hostels in the community. It should be remembered that such a programme demands supervision and regular visiting in the community by psychiatrists, social workers, and nursing staff and that in fact the promoting of such rehabilitation often calls for more staff and wider training than would be necessary to keep the same group of patients in a hospital setting. The pressure areas in the field of mental illness continue to be in the geriatric age group, younger brain damaged patient group (many resulting from motor car accidents) also need more accommodation. This Department endeavours to accept those patients in both groups whose care demands psychiatric medical, nursing and rehabilitation skills. It is not possible to accept as patients those whose needs are primarily for terminal nursing care. December saw the opening of new and renovated buildings at Ballarat, able to provide completely adequate psychiatric and administrative facilities for that area.

Facilities for the Intellectually Handicapped. There remains a pressing need for many more beds for this type of patient ; of whom there are more than 400 whose need for admission could only be described as urgent. The number of these patients in residence has increased from 2,008 in 1963 to 3,009 in 1968, but this does not really keep pace with the growing community needs. With the possibility of beds becoming available as a result of the rehabilitation programme it may be necessary to re-group patients and to increase the number of Training Centre wards. This is not without its difficulties because of (1) the level of suitability of wards (2) training and experience of staff generally. Regular meetings are being held with superintendents and senior social workers in this field, to consider policy, to review the most urgent waiting list, and to see that any beds available are offered to those in greatest need, and also to ensure that an optimum use is made of temporary and holiday placements.

Nursing Recruitment and Training. There still remains a serious shortage of nursing staff, both at student nurse and at q ualifled levels. As usual, it is more a problem in the city than in country areas, and some city hospitals have not had a full complement of nursing staff for many years.

RESULTS OF NURSING EXAMINATIONS-1968.

Number of Candidates. Percentage Passes.

1st Year- Male 73 53 Female 56 71 Total 129 62

3rd Year- Male 74 42 56 Female 67 50 75 Total 141 92 65

______.. ___ ·········-·------

The increased numbers of staff nurses following graduation (twelve more than last year) are more than welcome in the Department.

Institutional Visits and Inspection. I visited Institutions within the Department on many occasions during the year for the purpose of inspection and interviewing patients who were referred to me or who requested to see me. Registers and documents relating to the admission, detention and care of patients were examined. Full co-operation was given to me by all staff concerned at these Institutions, and I am convinced that real efforts are being made to still further improve the standards of care being offered to the patients. 11

CHIEF CLINICAL OFFICER'S REPORT.

DR. ALAN STOLLER. Introduction. The significant development this year in regard to post-graduate education has been the appointment of a Director of Post-graduate Studies and the further development and consolidation of existing educational programmes should occur in 1969. Arrangements have been made for the conversion of the existing out-patient department at Parkville, to provide a central focus for the independent departmental programme, though closely integrated with the Melbourne University Department of Psychiatry. Dr. Richard Ball is the first appointee to the position of Director of Post-graduate Studies. The Mental Health Research Institute, meanwhile, has become the Institute for Mental Health Research and Post-graduate Training under the general directorship of the Chief Clinical Officer. The general administrative running of this unit and the Parkville Psychiatric Unit has been consolidated under a newly­ appointed Executive Officer, Mr. K. Boyd, who has already made a first-class contribution.

Research. (i) Mental Health Research Institute. The Heyfield Survey is now completed, including computer analysis of correlations between physical, psychiatric and social data. A monograph is almost ready and it is hoped to arrange publication during 1969. The Metropolitan Health and Social Survey has been completed and analysis of the collected data undertaken in 1969. It is hoped to publish the result in monograph form in 1970. The statistical system is being translated to 80-column cards and they are to be placed on magnetic tape with subsequent monthly up-dating of records. The Commonwealth Bureau of Census and Statistics (Victorian Branch) has been of great help in this regard and during 1968 and 1969 will be processing the Statistical Bulletins and bringing them up-to-date. After 1969, it is anticipated the records will be on magnetic tape and we will then be able to process our previous year's data within the first quarter of the following year. A central computer with telephone up-dating would be ideal and this, no doubt, will eventually come. Meanwhile, we have helped the Commonwealth also, in organizing the chapter on mental health for the report of their general practitioners' morbidity survey ; in contributing to the standardization of mental health statistics and the development of classification and glossary ; and in helping in the production of a booklet on the use of psychotropic drugs in general practice. Arising out of the general statistical collection, in relation to the period between the two Commonwealth Censuses (1961 and 1966), is a series of papers being prepared by Dr. Krupinski and myself on patterns of intake and outcome, in terms of various diagnostic groups. Schizophrenia and Alcoholism has so far been prepared and the next two will be on Depressive and Psychogeriatric disorders. This work will gradually lead to a monograph which will be determining risk-rates for hospitalization and outcome and, in some instances, could lead to community prevalence and life-long expectancy rates. During 1968 data on early bereavements and sibling position of schizophrenics have been added to the Statistical System and these will be analysed during 1969. Season of birth of schizophrenics is also being analyzed. Our cohort study is almost nearing completion and should finally be completed and written up in 1969. Cumulative Case Registers, such as we have established, are now beginning to attract considerable interest overseas ; as have the statistical researches. The adolescent intake researches to early treatment centres, including the comparative study at Turana, are still being processed, and will be written up in 1969 ; as will be the study of attitudes to mental health and the researches into the health of deserted mothers and their children in Victoria. The study of the epidemiology of anencephalus in Victoria was published. Meanwhile, Dr. Collmann and I have undertaken a study to see whether the diminishing fertility rates in women over the age of 35 will decrease the incidence in mongolism ; we have also collected 3-400 three-generation family histories relating to congenital anomalies, leukaemia and cancer, to see whether these cluster together in terms of the virus-chromosome hypothesis of mongolism we have formulated. We are also looking at grandmaternal ages in cases of mongoloid births to see if they were unduly high at the time of birth of their mothers-in line with a hypothesis put up by Penrose. Other Research institute studies include an historical study of general paralysis in Victoria (with Mrs. Emmerson, Museum Curator) ; patterns of marital breakdown (Dr. Krupinski, with the Marriage Guidance Council of Victoria) ; and studies of adolescent Aborigines (with Dr. E. Gault). The Social Sciences Research Council of Australia is including the Mental Health Research Institute in its overall plan for studies of migrants and it is anticipated funds will be forthcoming for a study of mental illnesses in Displaced Person immigrants. Help is being given to a large number of Departmental officers and outside bodies. The liaison with the University of Melbourne Department of Psychiatry is close and fruitfuL We have also received fruitful co-operation from other University departments in both Mel­ bourne and Monash Universities.

(ii) Departmental. The comprehensive analysis of the population of the Children's Cottages, Kew, by Drs. Roboz and Pitt, is now nearing finality and publication of the four papers will be completed next year. Phenylketonuria continues to be investigated by Dr. Pitt in association with the Royal Children's Hospital, and almost 100 families have been located. Among investigations proceeding are changes in serum phenylalanine levels with age and cases of PKU with normal intelligence. Psychological testing of treated phenylketonurics is being carried out to assess the value of a low phenylalanine diet. The study on congenital toxoplasmosis at the Children's Cottages has been completed and published. Dr. Pitt has worked out risk rates for 12 various retardation syndromes, utilizing many of our Victorian findings. A study of the use of gamma globulin in an epidemic of infectious hepatitis at the Children's Cottages is being prepared for publication. Finally, Dr. Pitt is investigating the hypothesis that the rhythm method of contraception is associated with higher incidence of congenital malformations, utilizing departmental statistics and a special sample of cases. At Sunbury, Dr. Drew has completed a study of continuing educability of retarded young adults, and is examining the relationship between mental retardation and psychoses. Dr. Pillutla is proceeding with his investigation of mental retardation and epilepsy and will proceed next year to folic acid and Vit. B 12 estimations of cases receiving different drug therapies. Mr. Benjamin is examining sociological aspects of lowering of hospital/community barriers in placement of long-term patients in the community. Dr. N. Gold is completing his study of psychological disturbances in young pregnant mothers and their husbands ; the data will be analysed in 1969. Dr. Buckle has obtained a sample of children of long-term schizophrenic mothers and is determining their mental status. Dr. Wong has completed and published a study of children admitted to Allambie babies' centre and is now conducting a follow-up research on children placed in foster-care, in association with the Social Welfare Department. In the geriatric field, Dr. C. McDonald published his findings regarding the treatment of mentally disturbed geriatric patients, the use of a metronome test to distinguish confusional cases, and he has established a biomodal pattern for senile dementia. Dr. H. Bower is continuing his isotope studies, in conjunction with Melbourne University Department of Psychiatry, in the estimation of cerebral blood flow and its application to the effects of stimulation in senile cases. He has also written up the functioning of the newly-established psycho-geriatric Day Hospital. In the drugs field, Dr. Kessell has been estimating blood bromides in newly-admitted patients and is preparing his findings for publication. He has also detected an interesting interactional side effect between Mandrax and thioridazine and has instituted a study to determine whether the effect is from the methaqualone or the diphenhydyamine. The nortriptyline study still awaits publication. The chromosome laboratory has produced further extra-Y cases but, of interest, is the growing number of Klinefelter cases being detected. One normal XYY male has been found and a description published. Dr. Bartholomew and colleagues are involved in the latter. Studies are also proceeding on the value of fluphenazine deconoate, and on criminal aspects of incest and vagrancy. An investigation has begun on a general survey of female prisoners at Fairlea prison and on the intelligence of male prisoners, in terms of the usage of standard intelligence tests. Besides the study on Aborigines already mentioned (Dr. E. Gault), Dr. Kidson has been involved with a more primitive group of aborigines in the Kimberley region of Western Australia ; whilst help has been afforded Dr. Sarfati in a study of drinking habits among Aborigines in East Gippsland, in association with the Victorian Department of Aboriginal Affairs. A study, carried out by Dr. Mellsop, relating to admission incidences to Ballarat in terms of distance from psychiatric facilities, is likely to produce findings significant for psychiatric planning. Finally, studies are proceeding at Royal Park on lithium therapy. Initial findings suggest a possibility of detecting lithium responders through a short four-hour loading test, and even the possibility that the phenomenon of lithium response may cut across existing nosological entities.

Education. Post-graduate Medical. As already stated, Dr. Ball is the newly-established Director of Post-graduate Medical Studies and a building is being prepared for his use. The programme is largely as set out. in the 1.967 .report. It has been found appropriate to gear the course to both the A.N.Z.C.P. membership exammatwn as well as to the Melbourne University Diploma in Psychological Medicine. It has been decided to allot Parkville places flexibly-not necessarily in the third year. It may become advisable to organize this instruction during second year. Attention is again drawn to the need for Regional Clinical Directors (Consultant level) to act as teaching supervisors at key centres-e.g., Ballarat, Larundel, Royal Park initially and perhaps for Dandenong and Traralgon later. Meanwhile, arrangements are being made for senior staff to visit peripheral hospitals regularly for teaching purposes. Two week-long courses are being arranged for newly-recruited medical officers next year-one clinically based and one to review Departmental facilities.

Other. The usual courses for other professional staff-psychologists, social workers and occupational therapists-have continued. Our Mental Health Educat~on Officer, besides. her usual full programme of educational activities, which include courses to theological students, has mtroduced a new course for industrial nurses.

Library. An increase in the allotted budget has been most welcome, and the up-dating of peripheral institutional libraries is proceeding on a sound plan. Attention is again drawn to the need to increase Public Library staff to three and raise the status of the present appointments. 13

Clerical. In view of the large amount of typing involved in publications and increased teaching responsibilities, a shorthand-typist should be added to the clerical staff of the Institute, even though valuable relief has been afforded by the installation of the Xerox machine. The latter has, of course, proved of enormous value in obtaining reprints and copies for research and training, and has hugely expanded the clinical service we are able to give to individual consultants and various Departmental units.

Sociology. In line with this rapidly developing field of social psychiatry, the Research Institute is urgently in need of the new creation of a post of sociologist. Application has been made for this.

Pathology. The growing quality of pathology services is being reflected in the better clinical services available to our patients and are opening up prospects of research activities. Meanwhile, a need to rationalize and plan for integrated laboratories at Kew, which will provide for geriatric and intellectually handicapped services is being mooted. The continuing lack of a neuro­ pathologist is being keenly felt and it is hoped the position will be filled soon.

Surgical facilities. The rationalization of the neurosurgical and surgical facilities at Mont Park has been discussed during the year, but no finality reached as yet. There would be many advantages in integrating the two under a Consultant.

General Remarks. The Consultants' Meeting, which takes place four times a year, has ranged over a wide series of clinical topics and is proving a most valuable exercise. Clinical demonstrations of current interest are being included in the proceedings. A sub-committee is concerned with drugs and is preparing a pharmacopoea for Departmental use. An attempt is being made in 1969 to up-date and revise the Medical Officers' Manual. A review of E.C.T. machines is also currently being undertaken. Funds for researches are beginning to be donated through outside bodies and are acceptable via the Mental Health Donations Trust Fund Account. A committee has been appointed and a constitution formulated for the use of such monies for intra-Departmental researches. The Chief Clinical Officer again expresses his deep gratitude to the Authority for its continued interest and support.

1968 Publications-Departmental Staff. BALL, J. R. B. "Transsexualism and Transvestitism (II)". Aust.N.Z.J.Psychiat., 2 : 24, 1968. BALL, J. R. B. "A case of hair fetishism, transvestitism and organic cerbral disorder". Acta psychiatrica Scandinavia, 44 : 249, 1968. BALL, J. R. B. "A father is being beaten". Roneoed paper presented at A.N.Z.C.P. Congress, Adelaide, October, 1968. BALL, J. R. B. and KmsoN, M. A. "The Capgras syndrome. A rarity?". Aust.N.Z.J.Psychiat., 2 : 44, 1968. BARTHOLOMEW, A. A. "The psychological and psychiatric aspects of drug addiction". Med.J.Aust., 2 : 1068, 1968. BARTHOLOMEW, A. A. "Alcoholism and Crime". Aust.N.Z.J.Criminal, 1 :pp 1-30, 1968. BARTHOLOMEW, A. A. "The pill society". Health Bulletin, 135, 3, 1968. BARTHOLOMEW, A. A. "A long-acting phenothiazine as a possible agent to control deviant sexual behaviour". Amer.J.Psychiat., 124:17, 1968. BARTHOLOMEW, A. A. "The extra Y-chromosome and criminal behaviour". Aust.N.Z.J.Psychiat., 2 : 6, 1968. BARTHOLOMEW, A. A. (with Rapke, Judge and Johnston, S. W.). "Whipping as a penal sanction. Its consideration in a recent case". Aust.N.Z.J.Criminol., I : pp l-16, 1968. BUCKLE, D. F. " La psychiatrie de !'enfant". Press Universitaires de France, pp 297-312, 1968. BucKLE, D. F. "Drug trial and the assessment of symptom changes in childhood". Paper presented at A.N.Z.C.P. Congress, Adelaide, October, 1968. COLLMANN, R. D. and STOLLER, A. "The occurrence of anencephalus in the State of Victoria, Australia. J. Ment., Def Res., 12 : 22, 1968. DAx, E. C. " Responsibility and alcoholism". Inaugural Leonard Ball Oration, Alcoholism Foundation of Victoria, January, 1968. DAX, E. C. "Suicide in todays society". Med.J.Aust., 2 : 1197, 1968. DAX, E. C. "Moral codes in human care". J.Religion and Health, 7 : 299, 1968. DAX, E. C. "Psychiatry in Australia". Amer.J.Psychiat., 124 : 84, 1968. DAX, E. C. " The post-graduate training of psychiatrists in relation to the developing social process". Excerpta Medica, International Congress Series No. 150, pp 724-728, 1968. DREW, L. R. H. "Alcoholism as a self-limiting disease". Quart.J.Stud.Alcohol., 29 : 956, 1968. 14

DREW, L. R. H. "Alcohol and Health. Preventive aspects ". Chap. 35 in Good Health, ed. V. H. Wallace, Cheshire, Melbourne, 1968. GAULT, E. I. "Psychiatric and behavioural disturbances in adolescent aborigines in Victoria". Aust.N.Z.J. Psychiat., 2 : 128, 1968. GoRMAN, J. "Adolescence-factors influencing normality and abnormality". J.Soc.lssues, 2 : 19, 1968. GRAY, F. J. and HossACK, D. W. "Retrograde advancement and plication of the colon for non-strangulating sigmoid volvulus". Aust.N.Z.J.Surg., 37 : 102, 1968. KESSELL, A. "The borderlands of the depressive states". Brit.J.Psychiat., 114 : 1135, 1968. KESSELL, A. "Parameters of research into depressive states". Aust.N.Z.J.Psychiat., 2 : 272, 1968. KESSELL, A "Drug interaction". Aust.N.Z.J.Psychiat., 2 : 64, 1968. KmsON, M. A. and JONES, I. H. " Psychiatric disorders among Aborigines of the Australian western desert". Arch.gen.Psychiat., 19 :413, 1968. KRUPINSKI, J. and STOLLER, A. " Occupational hierarchy of first admissions to the Victorian Mental Health Department, 1962-1965 ". Aust.N.Z.J.Sociol., 4 :55, 1968. KRUPINSKI, J. and STOLLER, A. "Statistical Bulletin-Admissions, discharges and deaths", No. 7 1966, pp 1-127, 1968. KRUPINSKI, J. "The immigrant family in Australia ". Chap. 14 in Ethnic Minorities, ed, H. Throssell, A.C.O.S.S., Brisbane, 1968. MACLEAN, R. E. G. "Good mental habits". Chap. 15 in Good Health, ed. V. H. Wallace, Cheshire, Melbourne, 1968. McDoNALD, C. "The pattern of neurotic illness in the elderly". Aust,N.Z.J.Psychiat., 1 : 203, 1968. McDONALD, C. "Treatment of the mentally disturbed geriatric patient". Mod. Med. in Aust., 51 : 13, 1968. PITT, D. "The multiply handicapped retarded child". Proc. 1st Cong. Int.Assn.Sci.Stud.Ment.Def., Surrey, England, Michael Jackson, 1968. PITT, D. "Phenylketonuria". Proc. 2nd Asian and Oceanian Cong. Neurol., p 149, 1968. PITT, D. and RoBoz, P. "Congenital toxoplasmosis", 2 : 238, 1968. ROBOZ, P. and PJTT, D. "Studies on 782 cases of mental deficiency". Part I Aust.Paed.J. 4 : 79, 1968. RoBOZ, P. and PITT, D. "Studies on 782 cases of mental deficiency". Part If. Aust.Paed.J., 4 : 266, 1968. STOLLER, A. "Stress in Australian immigrants". Chap. 15 in Ethnic Minorities, ed. H. Throssell, A.C.O.S.S., Brisbane, 1968. STOLLER, A. "Man's humanity to man". Presidential Address-World Federation for Mental Health, 18th Annual Meeting (Bangkok), 1968. STOLLER, A. "Virus-chromosome interaction as a possible cause of congenital anomalies". Proc. 1st Cong. Int. Assn. Sci. Stud. Ment. Def., pp 56-65, 1968. STOLLER, A. "Public health aspects of community mental health". Chap. 8 in Community Mental Health : An International Perspective. eds. R. H. Williams and L. Ozarin, Jossey-Bass, 1968. STOLLER, A "Psychiatric illness". Chap. 34 in Good Health, ed. V. H. Wallace, Cheshire, Melbourne, 1968. STOLLER, A. "Adolescence". U.N.A 66, 115, 1968. STOLLER, A. and Emmerson, R. " Shower cabinet in the treatment of the mentally ill in Victoria : A historical note". Aust.N.Z.J.Psychiat., 2 : 101, 1968. TER, L. and McDoNALD, C. "A pilot study of an objective test to differentiate senile dementia and confusional states". Aust.N.Z.J.Psychiat., 2 : 143, 1968. WEINER, S. "A 'normal' XYY male". Lancet. WEINER, S. "XYY males in a Melbourne prison". Lancet, January 20, p 150, 1968. WoNG, G. H. "Activities of a psychiatric unit attached to a children's reception centre". Aust.N.Z.J.Psychiat., 2 : 134, 1968. 15

REPORT OF PATHOLOGIST. DR. s. WEINER.

In its second year the Mont Park Pathology Centre has reached the fully operational stage. The number of tests performed grew ninefold and their range enclosed all types of investigations one could reasonably expect to be used in the area. Clinical data supplied with requests and personal contacts invariably create interest among laboratory Staff members and result in better services. Incorrectly filled, illegible, soiled request cards, unlabelled specimens, aged samples, wrong containers, &c. were still much too common. On the other hand, Medical Officers who kept in touch with the Centre drew the full benefits from co-operating laboratories. Quality control was instituted from the start ; all three main laboratories of the MPPC have done well in the 1968 control testing, and it was particularly satisfying to see the Microbiology Laboratory to achieve 100 per cent. correct results in the survey conducted by the College of Pathologists.

MP PC-Biochemistry. Within various types of tests there were no significant seasonal peaks, except for a rise in Transaminases performed for St. Nicholas Hospital in January-February when the Hospital was threatened by an epidemic of hepatitis. Most M.O's take advantage of the wide range of tests offered, and only 7 out of 69 tests available in 1968 were not requested at all. Only two tests (P.B.I. and B-12/Folate) had to be sent to outside Laboratories; however, the total number of requests in this group represented only 0 · 08 per cent. of all tests performed by the Biochemistry department in 1968. Most common single tests in sample groups were : Urea, transaminases, glucose and electrolytes in blood /serum ; Proteins, uric acid and colloidal gold in C.S.F. ; Glucose and ketones in urine. Physiologically arranged, the investigations roughly concerned : % Protein metabolism and electrolytes m 33 ·05 Liver function tests , 24 · 95 Renal function tests " 19.78 Carbohydrate metabolism " 12·86 Fat /cholestrol metabolism 4·19 Other, incl. metals, bromides, &c 5 ·17 " 100·00

PKU Laboratory. The PKU screening, centralized for Victoria at MPPC in 1967 was continued in 1968. A total of 44,537 Guthrie tests were performed ; this is approximately 177 tests per day, or just over one "plate". However, the distribution is uneven and monthly totals vary between 2,831 (April) and 4,146 (November), with a peak of 5,451 (October) caused, apparently, by a response to Dr. M. Wilder's vigorous campaign via Hospital and Charities Commission.

It is estimated that 66 per cent. of all newborn babies in Victoria were screened m 1968 ; in addition, a number of treated cases was tested routinely.

Fourteen cases of hyperphenylalaninaemia were detected in 1968 and 3 PKU confirmed, bringing the total of cases, detected since the introduction of the scheme, to 68.

Further streamlining is necessary ; an automatic American punch and indexer have been approved at a cost of $6,027. 16

MPPC-Haematology. This was the busiest laboratory in 1968 and accounted for 5,753 tests. The incidence of tests performed was as follows :- % V.D.R.L. 20 Haemoglobin 17 Haematocrit 14 Blood film 14 White cell count 11 Differential W.C.C. 10 Erythrocyte sedimentation rate 5 Cross matching 3 Blood grouping 2 Pregnancy test 1 Prothrombin 1 Mean Corp. Hb. Cone. 1 Other 1

100

The entire range offered in our "Laboratory Tests" lists has been used by the M.O.'s ; additional 4 test-types were performed on request outside the list. As yet, automation of procedures is not warranted ; however, the variety of tests slows down work considerably in case of a single worker. On the average, daily work would involve 24 tests of 10 types ; in addition, the Haematologist took over the Bacteriologist's work while the latter was on leave.

MPPC-Microbiology. This laboratory performed 2,296 tests for the Mont Park area, and assisted in setting up and conducting bacteriological investigations in the Kew area which became self efficient in 1968. Although all requests were fulfilled, more survey work could have been done but for the engagement of the Bacteriologist in histological work (vide infra). A thorough analysis of effectiveness of antibiotics was prepared from sensivity tests performed, and appropriate tables were submitted to interested M.O's and the Drug Committee of the area.

MP PC-Histology. Histological work was centralized at the MPPC for the metropolitan area. The completely equipped laboratory was, unfortunately, not fully utilized throughout the year. Towards the end of the year a new Laboratory Assistant was taken into training. Under these circumstances, only 2,418 slides were produced ; 98 per cent of them were prepared from paraffin, and 2 per cent from frozen blocks. The material was derived from autopsies in 75 per cent, and from surgical specimens in 25 per cent. It is intended, staff conditions permitting, to expand the work and, gradually, to increase the application of frozen section to routine autoptical work : in this manner the reports can be concluded faster, the routine work costs less, and storage problems are minimized.

MPPC-Autopsies As in 1967 all Metropolitan autopsies were centralized at MPPC. The Autopsy room has been fitted with U.V. and deodorizer tubes ; these in combination with antiseptics and thorough scrubbing made it impossible to grow any micro-organisms in spot checks of autopsy tables and floors between working periods. The biggest single problem was to secure a permanent attendant ; as with other positions, the MPPC is not in the position to compete with public hospitals. As a result, we had three different attendants in 1968 and, between changes, we appreciated the help of Mr. Quigley from the Coroner's Court. 17

Three hundred and twenty-eight p.m. examinations were performed in 1968. Hospital breakdown M. F. Kew .. 100 101 Mont Park 17 34 Bundoora 26 La run del 14 5 Children's Cottages 12 4 Royal Park 3 4 Plenty 4 Janefield 2 Pleasant View

Total: 328 178 150 Average age: 69·5 66·3 72·6 years Duration of hospital stay prior to death was 0-57 years, averaging 7 ·4 years. (Of the listed material, 326 cases represent 2,411 years of medical and nursing care. A phenomenon not encountered in public hospitals is the long-term patient. In our material, the stay of, e.g., nearly 300 patients admitted after the Second World War (1948 or later), is balanced by 34 patients who first became I.P. sometime between 1912 and 1947.) Autopsy reports.-Our reports compromise the needs of both, the M.O. and the Coroner, i.e., they contain short descriptions of all pathological changes found, and conclude with a Cause of death followed by listing diagnoses in order of their importance. Cause of death grouped according to the AMA system is shown below with subgrouping offered in the 1967 report. In. 1968 1967. 0. Systemic involv~ment 12 21 l. Skin and breast 1 3 2. Locomotor System I 0 3. Respiratory System 162 131 4. Cardiovascular 51 52 5. R.E.S. 4 l 6. Digestive apparatus 22 14 7. Urogenital System 26 28 8. Endocrine System 4 1 9. C.N.S. 45 37 Total autopsies 328 288 Kew Area. Pathology work in the Kew Area was conducted in three units :- (1) In the main laboratory of the Kew Mental Hospital by one Biochemist and, for a part of the year, by one Laboratory Assistant. This laboratory, after establishing previously nonexisting facilities for routine bac­ teriology, has performed remarkably well and coped with all biochemical and bacterio­ logical, and most of haematological routines. The newly introduced bacteriological screenings were of great assistance to the medical staff. (2) All haematological routines indicated at Children's Cottages were performed by Dr. J. E. Chakanovskis. In addition, she conducted a considerable amount of screening for chromosomal abnormalities. {3) A biochemist was employed specifically for screening tests for inborn metabolic disorders among the patients on the waiting list for, or admitted to, Children's Cottages. The work turned out to be beset with difficulties and interruptions. The problems arising from the fractionation of laboratory work within the entire Kew Area have led to preliminary discussions on reorganization and rationalization of services. Royal Park. This laboratory continued to conduct investigations for the Royal Park area. On and off there was some hope that a Neuropathologist would apply for the vacancy and continue work begun by the late Dr. MacKiewicz. In the meantime the Senior Biochemist Miss Andrews, helped by another Biochemist, and two Laboratory Assistants, has put into use the new, recording spectrophotometer for both routine drug detection and research on Lithium excretion. Approximate numbers of routine tests are enclosed in the Summary Table {v.i.). 2984/70.-l 18

Summary. Each area relies on the local laboratory with respect to basic, routine investigations in Biochemistry, Haematology and Microbiology ; at the same time, specialized services are being centralized regionally for better efficiency and economy. In 1968 this trend is shown by a complete centralization of Morbid Anatomy and Guthrie' testing at M.P.P.C., and drug identification at Royal Park. By comparison with 1967, the number of tests performed has more than doubled without a corresponding growth in the staff employed. There is an urgent need for a Pathologist in the Royal Park area, and new laboratories in the over­ crowded Kew area. In the meantime the available facilities are utilized as fully as possible. The expected growth of services will require considerable expenditure for new quarters, equipment and, above all, staff improvements. The research potential of the MHA complex has hardly been tapped. The new MPPC is an expression of efforts to update the essential services, and an example of sound planning. Similar development is envisaged for the remaining areas.

M.H.A. METROPOLITAN PATHOLOGY LABORATORIES 1968. Tests Done in the Laboratories.

! MPPC. Kew. Royal Park. Cottages. • Totals.

Biochemistry ...... 3,124 1,568 2,560 540t 7,792 P.K.U...... 44,537 ...... 44,537 Haematology ...... 5,753 4,344 1,449 1.885 13,431 Histology ...... 2,408 ...... 2,408 Microbiology ...... 2,296 6,751 3,945 8 13,000 Autopsies ...... 330 ...... 330 Biopsies ...... 148 ...... 148 Other tests ...... 9 9 Totals 1968 . . .. . 58,596 12,663 7,954 2,442 81,655 . . .. . i Totals 1967 ...... 6,285 19,463 8,935 1.701 36,384

• Done by Dr. J. E. Chakanovskis. t Including •272 tests done by Cottages' Biochemist. 19

REPORT OF INSPECTOR, MENTAL DEFICIENCY TRAINING. At 31st December, 1968 the enrolment at Day Training Centres reached 1,732, an increase of 8.25 per cent on the previous year. The accommodation at almost every Centre is fully occupied, and waiting lists continue to grow. The total number of Centres reached 36. Committees of existing Centres are being encouraged to consider the fostering of new Centres in neighbouring districts. This has proved successful in some areas, and at present two Centres : Northcote and Coburg, both much pressed for space, are interested in possible developments at Thomastown and Broadmeadows. The pressure on workshop units in the Day Training Centres cannot be expected to ease. Virtually it is only through death or admission to an institution that people leave workshops. As the best possible solution, the establishment of large regional workshops is necessary. In the past, reference has been made to the very dependent children, who cannot be cared for in the usual physical condition of a Day Training Centre. One voluntary body has established a "Minding Centre" and at least one other is projected. In principle, the idea is very useful. It appears important to stress that any centre of this kind must have adequate medical supervision. The primary need of the dependent child is physical care, so that a minding centre should depend on the doctor and nurse for advice in the handling of children entrusted to it.

Developments. During the year hostels have been established by the committees of Box Hill and Dandenong Day Training Centres. Financial assistance has come from Commonwealth funds. It will be interesting to observe the measures which will need to be taken for the supervision of these and similar hostels by the local committees, the Commonwealth body or the State Mental Health Authority. The Victorian Autistic Children's Association has opened a Centre at Cheltenham. To a minor degree, this will ease pressure on Day Training Centres for the intellectually handicapped, which occasionally admit autistic children. The Autistic Children's Centre is receiving financial assistance from the Government, through the Mental Health Authority. An interesting workshop development, not a new scheme, but one that would now repay inspection by anyone interested, is the farm attached to Day Training Centre, Terang. This is a notable example of community participation in the care and management of the intellectually handicapped. Perhaps its greatest merit is that in a town where lack of secondary industries precluded the use of sub-contract industrial use, the staff, committee and people of the district have combined to provide a workshop in the best sense of the term. The social and work training have been of incalculable benefit.

New Centres. Centres. Two new Centres were opened, at Echuca and North Geelong. Buildings. Buildings were completed at North Geelong, Balwyn (extension), Shepparton (junior unit). The building for the new Knoxbrooke Centre at Ferntree Gully was begun. Building is proposed at Ballarat (new kindergarten), Bendigo (workshop), Footscray (alterations and extension), Oakleigh (extension), Portland, Frankston (workshop). It is to be noted that the examination of plans and buildings to ensure that they conform to the special prescriptions for the care of the intellectually handicapped is one of the duties of the Mental Deficiency Training Services. The Senior Adviser devotes much of her time to this work. There is a pressing need for a Buildings Officer, equipped by training, and without other calls on his time, to carry out this work.

Training Course. Of the ten students in the 1967-68 teachers' training course, seven obtained certificates, two were deferred and one withdrew from the course. Mental Health Trainees participated, but opinions on the success of the plan are not ventured until they have completed their Mental Deficiency Nursing Course. It is to be expected that their work with the intellectually handicapped will have benefied. Twenty students entered the 1968-69 Course. This number included one Thai candidate under the Colombo Plan and one returned from the 1967-68 Course. As usual the Mental Deficiency Training section was much indebted to visiting lecturers, and to the many agencies that permitted visits for observation. The help of the Education Department is gratefully acknowledged. Permission to attach students to infant schools and special schools was of great value.

Training in Centres. Increases in teachers' salaries have proved a strain on the finances of the Centres. The marked improvement over the years in the quality of the teaching is a reflection of the effects of teacher training. It is imperative that this improvement be maintained, even though the employment of trained teachers is necessarily more expensive than the use of untrained staff. The need remains acute for additional advisers to assist in the training of country children, both attending Day Training Centres and in remote areas where attendance is impossible. 20

The training in the Centre workshops is at a good level, It could be improved considerably by the appointment of an adviser to assist workshop staffs.

St. Nicholas Workshop. Thirteen of the trainees were placed in employment. Of these two returned to the workshop. The average attendance was 45.

Staff. Reference has been made to the need for the appointment of regional advisers in the country, and for a buildings officer. Increased clerical assistance is nesecsary. The growing numbers in the Centres, but particularly the pressure of the waiting lists, leads to a greater need each year for this help. At present professional officers are forced to carry out routine clerical tasks. It is gratifying to note that a second Social Worker is to be appointed in 1969. TABLE I.-Showing the Number of Cases under the Care of the Authority on the 31st December. 1968.

Recommended Psychiatric Voluntary and Approved Hospital Patients on Total Number Leave of on Books. Name of Institution. Patients. Patients. Absence.

M. F. I Total. I M. F. Total.

Mental Hospitals. Ararat 204 349 553 7 13 20 l 13 14 212 375 587 Ballarat 440 445 885 75 86 161 12 15 27 527 546 1,073 Beechworth 414 284 698 15 4 19 4 4 433 288 721 Kew .. 407 470 877 47 79 126 14 18 32 468 567 1.035 Larundel 289 184 473 20 43 63 309 227 536 Mont Park 329 507 836 36 131 167 13 18 370 651 I 1,021 Plenty 256 213 469 41 87 128 8 8 297 308 605 Sunbury .. 162 162 29 30 59 5 5 29 197 226 Warrnambool . . . . i91 191 1 I 192 192 Repatriation Hospital Bundoora 297 297 92 92 2 2 391 391

Psychiatric and informal Hospitals. N,_. 4 8 12 2 6 19 25 10 17 27 2 2 16 38 54 21 9 12 21 9 12 21 40 49 89 86 126 135 261 '49 '46 · 9s 175 181 356 13 3 10 13 3 10 13 17 3 14 17 3 14 17 22 11 ll 22 11 11 22 22 22 37 59 22 37 59 'is 47 75 53 81 105 186 22 "29 51 104 134 238 32 10 22 32 10 I 22 32

Intellectual Deficiency Training Centres. Ararat 107 107 116 223 223 3 10 236 Beechworth 178 178 206 206 3 3 2 211 211 Janefield 30 32 178 iso 304 484 304 484 Kew Cottages 182 450 286 554 345 899 7 10 ·io . i9 367 948 Sandhurst 83 83 83 83 Sunbury io1 '74 175 367 468 300 768 12 6 is 'i3 20 326 819 St. Nicholas i62 86 76 162 76 162

Intellectual Deficiency Training Sohools. Stawell 168 98 70 168 Travancore 16 8 8 16 2,187 I 2.011 4,258 72 104 176 i 1,931 534 I 4, 798 i 4,288 9,086 I 466 ! 577 lt043 82 115 TABLE H.-Showing the numbers at the end of each year of:­ (a) Voluntary and Informal Patients resident in Mental, Psychiatric and Informal Hospitals. (b) Resident Patients (ex Defence Service Personnel) treated under Section 59 of the Mental Health Act 1959. (c) Recommended Patients resident in Mental and Psychiatric Hospitals. (d) Total Number of Patients resident in Mental, Psychiatric and Informal Hospitals.

------Voluntary and Informal P}!-tien!". Recommended Patients. Total Number in Residence. (Excluding Repatriation Cases).· Resident Ex Defence Personnet (Excluding Repatriation Cases). (Excluding Repatriation Cases).

Percentage Percentage of Total of Total Resident in Mental, Psychiatric Numbers of Resident Patients. Resident in Me-ntal, Numbers of Mental, Psychiatric and Year. and Informal Hospitals. all Patients and Psychiatric Hospitals. all Patients Informal Hospitals. Resident in Resident in Mental, Mental, ~ -. Informal and Informal and Psychiatric Psychiatric Male. Female. Total. Hospitals. Rec. Vol. Male. Female. Total. Hospitals. Male. Female. Total.

I 1963 .. .. 776 987 1,763 24·6 262 2 2,613 2,772 5,385 75·4 3,389 3,759 I 7,148 1964 .. .. 750 985 1,735 25•7 303 2 2,572 2,437 5,010 74•3 3,322 3,423 I 6,745 I 1965 .. .. 835 1,095 1,930 28·9 310 2 2,461 2,274 4,735 71·1 3,296 3,369 6,665 1966 .. .. 1,072 1,351 2,423 38·7 I 299 7 1,979 1,856 3,835 61·3 3,051 3,207 6,258 1967 .. .. 1,114 1,285 2,399 39·4 291 14 1,892 1,797 3,689 60·6 3,006 3,082 6,088 1968 .. .. 1,020 1,268 2,288 39·6 277 20 1,781 1,711 3,492 60·4 2,801 2,979 5,780 ! - 23

TABLE III.-Showing admissions to Psychiatric and Mental Hospitals in terms of first and re-admissions, together with the percentage of Voluntary Patients.

I Males. Females. ! Total. Year. Type of Admission. Percentage Admitted. Percentage Admitted. of V.P. P<;Fv.~:~· 1 Admitted. of V.P.

I 1968 ...... First .. . . 1,730 49·0 I 1,687 58·5 3,417 53·7 2,778 71·5 3,007 77·0 5,785 74·3 Re-admissions .. : Total . . .. 4,508 62·8 4,694 70·3 9,202 66·7 I

TABLE IV.-Showing the numbers at the end of each year from 1963 of :-(a) Approved, Voluntary and Informal Patients in residence at Intellectually Deficiency Institutions. I Voluntary and Informal Percentage Approved Patients in Total Numbers in Percentage Year. Patients in Residence. of Total Residence. I of Total Residence. Numbers Numbers 1~-· Resident. --····- Resident. Male. Female. Total. Male. Female. Total. Male. Female. Total. :

! 1963 .. .. 598 612 1,210 60•3 431 367 798 39·7 1,029 979 2,008 1964 .. .. 627 661 1,288 57·3 432 526 958 42·7 1,059 1,187 2,246 1965 .. .. 717 690 1,407 59·5 436 522 958 40·5 1,153 1,212 2,365 1966 .. .. 871 745 1,616 60·7 537 510 1,047 39·3 1,408 1,255 2,663 1967 .. .. 945 798 1,743 63·6 516 483 999 36·4 1,461 1,281 2,742 1968 .. .. 1,222 845 2,067 68·7 478 464 942 I 31·3 1,700 1,309 3,009 I

TABLE V.-Showing numbers of Recommended Patients Boarded Out in Benevolent Homes from 1950.

Year. Male. Female. Total.

1950 113 121 234 1951 114 122 236 1952 122 126 248 1953 157 128 285 1954 165 135 300 1955 156 128 284 1956 155 123 278 1957 166 135 301 1958 138 104 242 1959 113 71 184 1960 113 68 181 1961 108 67 175 1962 93 67 160 1963 96 56 152 1964 93 52 145 1965 85 43 128 1966 65 43 108 1967 63 33 96 1968 58 32 90

TABLE VI.-Showing particulars of Male Patients over 65 years and Female Patients over 60 years. (a) Patients resident as at 1st January, 1968, showing the proportion of males over 65 and females over 60 years- Number of resident males over 65 years 1,087 or 19·7 per cent. Number of resident females over 60 years 2,115 or 40·1 per cent.

(b) Admissions and deaths per 10,000 of the Victorian population-

First Admissions :- Males Females (over 65) (over 60) Hospital Admissions 25·4 19 ·1 Out Patient Clinic Admissions 7·1 14·0 Total 32·5 33·1 24

TABLE Vl.-continued.

273 Males, 65 years or over died during 1968, this represented 24 · 0 per 10,000 of male population in this age group.

384 Females, 60 years or over died during 1968, this represented 16·7 per 10,000 of female population in this age group.

The average age at death of males in this age group was 77 · 0 years.

The average age at death of females in this age group was 79 · 0 years.

(c) The diagnostic distribution of patients who died in the above age groups was as follows :-

Males Females Senile Brain Disorders 158 228 Schizophrenic states 41 59

Other Psychoses 14 27 Other Organic Brain Disorders (including Alcoholism) 35 34 Mental Deficiency 10 8 All Other 15 28 Total 273 384

(d) The causes of death in these age groups were as follows :- Males Females Diseases of the Circulatory system 88 129 Diseases of the Respiratory system lOO 147 Senility .. 17 24 All Others 68 84 Total 273 384

TABLE VII.-Showing Primary Causes of Death of all Patients in Psychiatric and Mental Hospitals and in Training and Special School Centres, during the year ended 31st December, 1968.

Psychiatric and Mental Training and Special Hospitals. Schools. Total. Causes of Death.

Male. Female. Total. Male. Female. Total. Male. Female. I Total.

Infective and parasitic diseases . . . . 6 3 9 6 3 9 Acute alcoholism ...... 1 I 1 1 Neoplasms of brain and other parts of the nervous system ...... 6 4 10 6 4 10 Other malignant and benign neoplasms .. 27 17 44 27 17 44 Vascular lesions affecting central nervous system 30 34 64 30 34 64 Epilepsy ...... · · · · 1 1 2 4 4 5 1 6 Other diseases of nervous system and sense organs 4 3 7 4 3 7 Arteriosclerotic heart diseases, including coronary disease ...... 64 93 157 ...... 64 93 157 Other diseases of the heart . . . . 24 20 44 1 2 3 25 22 47 Other diseases of the circulatory system . . 23 23 46 1 . . 1 24 23 47 Pneumonia ...... 106 136 242 10 8 18 1]6 144 260 Other diseases of the respiratory system . . 26 26 52 ...... 26 26 52 Diseases of the digestive system . . . . 7 8 15 ...... 7 8 15 Diseases of the genito-urinary system . . 12 15 27 ...... 12 15 27 Congenital malformations ...... 2 7 9 3 1 4 5 8 13 Other general diseases ...... Accidents ...... 8 . . 8 2 . . 2 10 .. 10 Suicides ...... 3 3 6 ...... 3 3 6 Homicides ...... Senility ...... 17 24 I 41 . . : : : : i 7 24 41 Cause not yet ascertained . . . . 9 5 14 3 4 7 12 9 21 Total ...... :: 376---m-17981----z4--15___ 39-~4oo-~----;m- 837 ______25

TABLE VIII.-(a) Diagnostic Summary-Showing patients treated, resident, and admitted for the first time in 1968. (Absolute figures.)

First admissions.

Persons Treated Resident on Total. Of those. in 1968. 1968. Diagnostic Category. To •• To O.P.C.

Males. Females. Males. Females. Males. Females. Males. Females. Males. Females.

Mental retardation .. 2,393 1,848 1,904 1,544 294 192 123 68 171 124 Schizophrenic states .. 3,212 3,259 2,076 1,939 439 405 325 274 114 131 Depressive psychoses .. 605 1,525 76 223 307 648 100 225 207 423 Other functional psychoses 206 318 89 137 38 43 33 26 5 17 Alcoholism .. .. 2,077 525 477 250 716 113 363 75 353 38 Senile brain disorders .. 501 863 283 582 190 246 167 197 23 49 Other organic brain disorders 468 384 267 192 120 115 83 77 37 38 Depressive psychoneuroses .. 747 2,035 54 134 428 1,124 128 299 300 825

Other psychoneuroses . ' 690 1,155 60 67 390 613 56 95 334 518 Personality disorders .. 1,345 943 168 126 705 448 151 143 554 305 Transient situational trait disturbances .. .. 1,000 873 16 22 709 618 81 110 628 508 Diagnosis deferred or no psychiatric illness .. 499 415 53 61 351 255 120 98 231 157

Total .. .. 13,743 14,143 5,523 5,277 4,687 4,820 1,730 1,687 2,957 3,133

(b) Showing prevalence and incidence rates of mental disorders. (Per 100,000 of Victorian population, 1968.)

I Of those. Patients under Persons resident First admissions I treatment in 1968. on 1st January, 1968. in 1968. Diagnostic category. To institutions. To O.P.C.

Males. Females. Males. Females. Males. Females. Males. Females. Males. Females.

Mental retardation .. 145·8 • 113·2 116·0 94·6 17·9 11·8 7·5 4·2 10·4 7·6 Schizophrenic states .. 195·6 199·6 126·4 118·8 26·7 24·8 19·8 16·8 6·9 8·0 Depressive psychoses .. 36·8 93·4 4·6 13·7 18·7 39·7 6·1 13·8 12·6 25·9 Other functional psychoses 12·6 19·5 5·4 8·4 2·3 2·6 2·0 1·6 0·3 1·0 Alcoholism .. .. 126·5 32· 1 29·1 15·3 43·6 6·9 22·1 4·6 21·5 2·3 Senile brain disorders .. 30·5 52·9 17·2 35·6 11·6 15 ·1 10·2 12·1 1·4 3·0 Other organic brain disorders 28·5 23·5 16· 3 11·8 7·3 7·0 5·0 4·7 2·3 2·3 Depressive psychoneuroses .. 45·5 124·7 3·3 8·2 26·1 68·9 7·8 18·3 18·3 50·6 Other psychoneuroses .. 42·0 70·7 3·7 4· 1 23·8 37·6 3·4 5·8 20·4 31·8 Personality disorders .. 81·9 57·8 10·2 7·7 42·9 27·4 9·2 8·8 33·7 18·6 Transient situational trait disturbances .. .. 60·9 53·5 1·0 1·3 43·2 37·9 4·9 6·8 38·3 31·1 Diagnosis deferred or no 30·4 25·4 3·2 3·7 21·4 psychiatric illness .. 15·6 7·3 6·0 i 9·6 Total .. .. 837·0 866·3 336·4 323·2 285·5 295·3 105·3 103·5 191·8 26 THE COJVIMUNITY SERVICES

Travancore is in the process of being converted into a unit for disturbed children and the out-patient activities are being extended in accordance with this policy. It is hoped that the day pupils will increase in numbers to reduce the in-patient demands to a minimum.

The residential units at both Shepparton and at Bendigo will soon be ready for use providing more medical staff can be obtained. As it is, the out-patient loads for the psychiatrist-superintendents of both clinics are much too heavy.

The day-patients from the Observatory have never been able to be fully accommodated following upon the fire in October, 1968. Clarendon has been upgraded to take workshop patients of rather better prognosis and Glenhuntly Clinic has accepted some of its trainees ; only a few of the Observatory patients were able to go to either of these workshops.

The number of family guidance clinics in the metropolitan area is still quite inadequate and more staff are needed. The Bouverie Clinic would be capable of expansion to fulfill a wider function if there were available more medical staff with child psychiatry training.

The Alexandra Parade Clinic would benefit from being subdivided into one clinic for the forensic cases and alcoholics, and a second unit for the Personal Emergency Advice Service, the Emergency Clinic and the ever increasing number of training courses for volunteers.

During the year some reorganization of the Children's Clinic took place but further changes are needed.

The Mildura District Hospital will soon have its own four-bed psychiatric unit and an additional six beds at a later stage. In the first place it will only take disturbed patients, geriatric cases, alcoholics with delirium tremens and acute psychiatric patients pending their removal if needs be. At present our senior staff conduct clinics two days every three weeks but because many patients travel over 50 miles to see them, an occasional clinic at Robinvale and Ouyen would be most helpful.

The hostels continue to function satisfactorily. The most interesting development is at Ararat where with the help of the staff six middle-aged patients who had been in hospital for many years took over a house, which they are running themselves, with an agreed division of labour and most satisfactory results. It is hoped that others may follow suit.

Still more important to the future development of mental health services in this State, however, is the provision of adequate services for the community within the community. This means in fact the provision of staff specifically for community services, especially psychiatrists, nurses, social workers and occupational therapists. There has been during the last several years a radical re-orientation throughout the world towards providing this sort of service. By doing so, patients are kept out of hospital, and from hospital are returned to the community far more rapidly, thus effecting considerable economies overall.

OUT-PATIENTS AND COMMUNITY SERVICES-STATISTICS. (a) Day Hospitals.

I On Books Admitted. On Books - 1st January, 1968. Discharged. 31st December, 196 8.

Dandenong ...... 68 334 264 138 Malvern ...... 189 123 117 195 Kew ...... 84 128 33 179 Preston ...... 36 162 153 45 I 27

(b) Statistical Table of Cases Seen at Psychiatric and Out-patient Clinics.

' Number of Number of Number of Review and Clinic. Psychiatric New Cases. Ex-hospital Total Cases. Interviews. Cases.

Alexandra Parade, Fitzroy 5,190 1,188 Ararat District Hospital 218 22 62 84 Ararat Mental Hospital 485 64 108 172

Bairns dale 0 0 198 46 35 81 Ballarat {Norwood) 1,800 165 455 620 Ballarat (Children) 260 70 36 106 Benalla 205 53 137 190 Bendigo 2,615 331 321 652 Bouverie Street, Carlton 5,644 417 225 642 Castlemaine 157 30 22 52 Charlton 40 6 4 10 Children's Oinic, (incl. Turana & Winlaton, etc.) Details listed below Clarendon, East Melbourne 5,200 1,900 Dandenong .. 4,176 698 780 1,478 Echuca 202 48 134 182 Ferntree Gully 256 85 44 129 Glenhuntly 446 26 25 51 Hamilton 510 59 52 111 Kerang 100 10 13 23 Leongatha 262 41 50 91 Malvern 8,946 992 1,098 2,090 Maryborough 267 27 71 98 Mildura 260 122 72 194 Mooroopna .. 236 25 158 183 Observatory, South Yarra 9,597 338 1,242 1,580 Pentridge Details listed below

Personal Emergency Service 0 0 Details listed below Preston, " Ernest J ones " 5,261 927 686 1,613 Royal Park .. 3,984 174 1,149 1,323 Sale 177 43 34 77 Shepparton 1,713 234 927 1,161 Stawell 342 42 44 86 Swan Hill 189 32 35 67 Traralgon 1,029 209 162 371 Travancore Details listed below Wangaratta .. 685 122 124 246 Warragul 146 35 23 58 Warrnambool 1,208 171 84 255 Wimmera Base Hospital, Horsham 380 88 74 162 Yallourn 466 65 89 154 28

Children's Clinic Number of Interviews by Psychiatrists (Clinic, Turana, Winlaton and Allambie) 2,629 Social Worker Interviews 460 Psychologist Interviews 984

Pentridge Clinic­ Reports .. Petty Sessions 208 General Sessions 181 Supreme Court 29 Parole Board 91 Miscellaneous 175

Personal Emergency Service Letters and Telephone Calls 4,411

Travancore Clinic­ Examinations New Cases 455 Old Cases .. 148

Interviews Clinic Psychiatrist 829 Other 1,480 (c) Therapeutic Industrial Workshops.

Discharges. - Daily Average New Attendance. Attendances. Further Employment. Training. Discontinued.

Clarendon ...... 38 49 21 18 18 Glenhuntly ...... 73 44 25 23 25 St. Nicholas ...... 43 14 13 3 10

Attendances-Social Clubs. Average per gathering. Bluebird Club 26 Clarendon 39 Malvern 35 Glenhuntly 54

(d) Hostels (Female).

Bed Capacity. Discharged. Admitted.

Ballarat 20 13 20 Carmel .. 17 21 21 Denham House 14 Edith Pardy 24 30 37 Kink ora 12 66 66

Hostels (Male).

Bed Capacity. Discharged. Admitted.

Trelowarren 20 98 98 Winstay 18 2 4

Hostels (Intellectually Defective-Female).

Bed Capacity. Discharged. Admitted.

Kew, Cottages ...... 40 2 6 Moorakyne ...... 30 2 6 St. Nicholas ...... 16 16 18 29

ALEXANDRA PARADE CLINIC.

PsYCHIATRIST SUPERINTENDENT : DR. A. A. BARTHOLOMEW. Comments. The clinic at the present time is undertaking too many different tasks : alcoholism, forensic psychiatry, general psychiatry, P.E.A.S. work-" crisis therapy", &c. At one level this may make for interest but at this time makes for confusion.

Lecturing. This year there has been a very heavy commitment in terms of lecturing various groups in a variety of topics-mainly drug dependency. A conservative estimate is that 84 lectures have been given and a number of these have been to school gatherings, both State and Private. In addition to this we have had the "Rotating Interns", visiting groups with the D.P.M. students. A paper was read at a Victorian Branch Meeting of the A.M.A. in April on "Drug Addiction" by Dr. A. A. Bartholomew which was later published in the Medical Journal (Aust.) (1968) ii 1068.

PERSONAL EMERGENCY ADVISORY SERVICE. There have been no changes in the working technique over the last twelve months and the statistics of the service show no significant changes. The figures in the year indicate that we received 3,522 telephone calls and 183 letters-a total of 4,411. This is an increase over the previous year of some 17 per cent.

Volunteers. The volunteers have continued to staff the service. In addition there is greater emphasis being placed on " in-service " training, selecting volunteers for " group leaders " that they may augment the clinic social worker in the training of new volunteers, and gathering together a panel of volunteers as a " Speakers Group " : 20 meetings were addressed last year. , Apart from the training of volunteers for the P.E.A.S., training at the Alexandra Clinic has also been undertaken in the Citizen's Advice Bureau.

Research. The major research interest this year has been in the selection and training of volunteers. Selection in terms of both clinical interview and psychological testing and training success in terms of psychological test-retest results.

Comment. The training of volunteers and counsellers required is now becoming a big undertaking and can no longer be seen as just another minor function of the Alexander Clinic. This work must clearly increase still further and demand greater integration with other agencies including the churches. If this is to succeed then there must be a full-time senior social worker in charge backed by an adequate staff-training personnel, secretariat and a backing psychiatric service. At the present time the staff are also involved with other commitments at the Alexandra Clinic. 30

AMBERMERE PSYCHIATRIC CLINIC.

PsYCHIATRIST SuPERINTENDENT : DR. T. W. MuRRAY. SECRETARY : MR. I. ARNEL. Throughout 1968 the pattern of Clinical Services established in 1967 continued to be followed. Regular out-patient clinics continued throughout 1968 at both Echuca and Benalla District Hospitals. At each centre two sessions were held every fortnight and a steady flow of new referrals continued to be seen as well as a considerable number of reviews of patients previously treated. Every effort was made to return each patient completely to the care of the referring general practitioner as early as possible and it is essential that this policy be continued. Naturally this sometimes involves individual patients being seen by a psychiatrist less frequently than would be desirable. Similar problems exist concerning the number of psychiatric patients who can be treated either as in-patients or out-patients at the Mooroopna Base Hospital. One out-patient session was held per week throughout 1968. A substantial number of psychiatric problem patients tend to depend upon this Department for long-term care and management. As in 1967 many patients in hospital for general medical or surgical reasons were referred for psychiatric opinion. In addition, again as in the previous year, many in-patients of the Base Hospital received treatment from the Psychiatrist Superintendent of Ambermere in his capacity as Honorary Visiting Psychiatrist to the Base Hospital. At Ambermere itself out-patients only, continued to be assessed and treated. Reconversion of the original building continued throughout 1968 and by the end of the year only a few minor alterations remained to be done. The new combined Occupational Therapy and Out-patients building was completed in November and during December the clinic activities were transferred to this building. Painting and maintenance work on the building thus vacated was begun at the end of the year. As in 1967 the part-time services of the Social Worker proved invaluable. It is hoped that the additional appointment of a full-time Social Worker will be made early in 1969. Then more extensive visiting may prove possible and patients who at present are not being referred at all to the Social Worker should be able to receive the attention they deserve in this field. In late August, 1968, Mr. I. Arnel was appointed as full-time Secretary to Ambermere and during the latter quarter of the year much more detailed planning for the future development of the unit thus became possible. Similarly, day to day administration became more flexible and efficient than had previously been possible when Ambermere's administrative needs were dependant upon periodic visits from the Secretary at Beechworth. The absence of any medical staff apart from the Psychiatrist Superintendent continued to be keenly felt throughout the year and it is abundantly clear that future expansion of the existing clinical services simply cannot be achieved until such appointments are made. 31

BOUVERIE CLINIC.

PSYCHIATRIST SUPERINTENDENT ; DR. G. A. GODING. The increase in the number of new cases seen is largely due to cases seen by Mrs. Edwards at kinder­ gartens. These cases are in general of a less severe nature and can be dealt with by short-term methods. Even with the more severe cases we find that as the staff grows in experience more cases can be dealt with by using short-term and crisis intervention techniques. Nevertheless many of our families require long and intensive therapy before they reach the stage of being able to cope adequately with their problems on their own. The need for two extra full-time psychiatrists at this Clinic becomes more apparent year by year. By using strict criteria of urgency we are still able to see urgent cases at short notice, but a number of severely disturbed families must wait many months for treatment. There has been no radical innovation in treatment methods during the year. Family group interviews are being used increasingly, but for the most part in the diagnostic phase and- at certain key points in later treatment. We have rarely found it of value to conduct therapy on a family group basis throughout though we are still experimenting in this direction. Two additional children's groups were commenced during the year, making four in all. One of these is for early adolescents, the other is a small group of autistic or psychotic children. We have continued to conduct two groups for parents and two for Social Studies Students. Dr. Saunders has continued to conduct the psychiatric Clinic at the St. John's Home for Boys and Girls and is also acting as consultant for the Citizens Welfare Service.

Prevention. Mrs. Eileen Edwards has replaced Dr. Isla Stamp as psychologist to the Infant and Maternal Welfare Branch. She has been working mainly in the kindergartens apart from a considerable amount of work in staff training and general consultation. She also sees a number of cases at the Clinic in the pre-school age group. In last year's Report, reference was made to a pilot experiment in training lay group leaders to deal with family problems. After a brief training course and with minimal organizational backing these women were able to conduct two continuing groups of mothers throughout the year. Careful enquiry suggests that group members made definite gains through the group.

Training. The training of Clinic staff was carried out through individual supervision, group supervision, case conferences, theoretical discussions and various less formal procedures. Two fourth year Honors psychology students were placed at the Clinic this year. They were given training and supervision in diagnostic testing and therapy with a small case load.

Research. A small group of autistic children and their families were given special attention. A paper, "The Psychology of Marriage Breakdown" was published by Butterworths in "Divorce, Society and the Law" edited by H. A. Finlay. It is fortunate that for several years our staff turnover has been low. It is pleasing to note that staff morale is high and staff relationships are unusually harmonious. This is clearly reflected in the quality. quantity and flexibility of the work being done. 32

CHILDREN'S CLINIC.

PSYCHIATRIST SUPERINTENDENT : DR. J. L. GORMAN. The Children's Clinic continues with its now well-defined function of treating juvenile anti-social behaviour. This includes anti-social behaviour cases referred by private Medical Practitioners as well as those referred by the Courts. The great majority of cases are referred by the Children's Court Magistrates. These two Magistrates are now permanent, and this has been a great advance on the old system of the Children's Court being only a step in the whole system of Stipendiary Magistrates. There is a very close liaison with these Magistrates, and they are very adept with regard to referring the type of case which can be helped by the trained Clinic Staff of Psychiatrists, Psychologists, and Social Workers who work as a team. The results are excellent and very few cases remain anti-social after treatment at this Clinic. Not only is the individual child treated, but treatment extends to the whole family as the basic social unit. This treatment of all the children and the parents has far reaching beneficial results, which do not show in the ordinary statistics. Many cases are still seen at the various Remand Centres-"Turana" for older boys, "Baltara" for younger boys, "Winbirra" for older girls and "Allambie" for younger girls. This visitation system originated as an emergency measure through shortage of staff in the Social Welfare Department a few years ago. It would be appreciated if the original system of interview at the Clinic could be reverted to. Once again it must be stressed that Private Referrals could be better treated by a branch of the Clinic situated in not so obvious a proximity to the Children's Courts. Finally it must be emphasized that the success in this type of work depends essentially on close co­ ordination of the various agencies involved. 33

CLARENDON CLINIC.

PSYCHIATRIST SUPERINTENDENT : DR. J. L. FORDYCE. During 1968 the major points regarding the Clinic have been as follows :- (1) The workshop has run efficiently as a rehabilitation centre with only a few very long-term patients remaining. Most patients are now capable of moving uphill to the level of obtain­ ing outside employment within 1-2 years. As the general level has improved, the programme has become more precise and sophisticated. It is better able to care for the individual needs of patients. (2) For several years Sunbury Mental Hospital has been the chief source of our out-patients. Now that we are receiving very few patients from this hospital, and have only one Sunbury Doctor attending each week, our out-patient population is changing. Instead of dealing primarily with fairly straight forward psychotics in quite large numbers, we are gradually seeing more and more problem cases. These are both the ex-hospital ones who are too difficult to pass on to their local doctors, and people referred by general practitioners in the region or by outside agencies. (3) Since September, 1968, the Psychiatrist Superintendent has attended at Glenhuntly Rehabilitation Centre four half-days per week. Although the team spirit has been very good, it has been impossible to provide complete psychiatric supervision of the 85 workshop trainees. To build Glenhuntly up to 100 trainees (which the building will hold), further medical, social work and workshop staff will be necessary.

2984/70-3 34

GLENHUNTLY REHABILITATION CENTRE. Staff. Due to the resignation of the consultant Psychiatrist, the medical staff has been reduced to a part-time Psychiatrist Superintendent, and a half-time Medical Officer. For this reason the general out-patients clinic has been discontinued. Many trainees who have been successfully rehabilitated require follow-up treatment, and this together with the continued growth of the centre, has placed great strain on the present inadequate medical staff. As in previous years the centre has been fortunate to have the assistance of a number of voluntary helpers, and the Commonwealth Employment Office provides a very keen officer who successfully places a number of trainees in employment.

Functions of the Centre. The centre continues to operate as a day centre for the assessment, rehabilitation, vocational training, and resocialization of persons suffering from a wide variety of psychiatric and related chronic disabilities. The training programme includes repetition light engineering, spray painting, sheet metal work, spot welding, general assembly and packing. A conveyer belt has been installed as a means of efficient training for industry. The hard working Parents and friends Auxiliary have throughout the year provided many amenities for the centre, and organized socials, outings, and sporting fixtures for the trainees. Despite staffing problems, the centre continues to operate as a highly successful rehabilitation unit. 35

MALVERN CLINIC PSYCHIATRIC SUPERINTENDENT: DR. N. GOLD. The following statistics represent the number of new patients and their sources for the year 1968 Referrals from- General Practitioners 776 Mental Health Authority Facilities 141 General Hospitals 23 Psychiatrists in private practice 20 Other Sources 32 Total 992

The number of out-patient interviews was 8,946. This does not include the Day Hospital interviews which were not recorded separately. The out-patient Department has been carrying the main therapeutic load and it is becoming increasingly obvious that more senior full-time staff are needed in this area as well as a medical officer who could make use of the excellent training facilities that are available. The Day Hospital programme has undergone several alterations. To allow for patients to be fully assessed, they are expected to attend 5 days a week for the first 2 weeks. After this they are allocated according to whichever group it is felt they will benefit from most. There are now five distinct programmes running concurrently, catering for patients who may require intensive treatments through to those who require a supportive form of therapy. The alternation in therapists throughout the week with the different patient groups is working very satisfactorily. It prevents a dependency relationship occurring and allows the staff to have several observers for the same patient under differing circumstances. The Resident Unit has continued to fulfill a very useful function. An "Informal" Resident Unit allows for the well-motivated patient to be treated for the psychiatric problem without any impediments. The age range has been extended so that suitable patients in their 70's have been successfully treated. The patients in the Resident Unit attend all the Day Hospital functions that their own specific therapy allows them. The new out-patient department building, when available, will free four single bedrooms which had been used in the Resident Unit by doctors as their consulting rooms. This has reduced our bed capacity through the year, particularly for those patients who might have benefited from single room accommodation. The Nurses' Home is in the process of being renovated and the self-contained suite there has now been used by an Interstate visitor. It is hoped that further visitors from Interstate and possibly overseas will be able to make use of this in the future. Staff changes have been considerable in the past year. Dr. R. R. Webb, the original Psychiatrist Superintendent of the Malvern Clinic, retired after 33 years with the Mental Hygiene Branch. A considerable turnover occurred in the nursing staff, mainly due to them going overseas or leaving for domestic reasons. We do have two male nursing staff. This has improved the ability of young male patients to relate to therapists. A further problem has arisen that due to the delay in which new patients wait to be seen after they are referred, there has been an increase in the number of patients who do not attend for their initial appointment. We have had a large number of Interstate visitors. These have included those employed by the Department of Health of N.S.W. and from other States, overseas psychiatrists from Japan, New Guinea, New Zealand and Great Britain. The Senate Select Committee on Health Services spent a morning collecting information on the concept and function of Mental Health Units. The occupational therapists visiting Melbourne for their annual convention also visited the Clinic. 36

NORTHERN VICTORIA REGIONAL SERVICE. PSYCHIATRIST SUPERINTENDENT ; DR. J. P. BOMFORD. During the past year, a total of 409 new patients were seen in Northern Victoria ; this included 71 children, 3,101 interviews were given over the same period. Compared with previous years, Bendigo and Swan Hill have had slightly fewer new patients but Kerang and Charlton more. At present the outlying clinics are served as follows ;- Castlemaine 3 sessions a month Swan Hill 2 , " Charlton " " Kerang 2 " " Alexander I " " Bendigo Home and Hospital for the Aged , , Orphanage , " The clinic got its new furniture early in the year and it is very satisfactory. New Cases .. 55 New case problems­ Employment 19 Placements O.T. Day Hospital Workshop 12 Accommodation 10 Finance .. 31 Family support 28 School problems .. 2 Court problems and support 8 Total home visits 412 Calls for information 171

The Psychologist has continued to provide a most useful service in her two sessions a week for the clinic and Boy's Centre.

Teaching. With the increase in resident medical staff at Bendigo Base Hospital, facilities for post-graduate teaching were looked for. Through the year, a first year resident attended the clinic every week to write up a case and discuss it afterwards at length with the Superintendent. Courses of six lectures in psychiatry were given to third year nurses and refresher courses given to the midwives.

Sandhurst' Boys Centre. Boys were regularly reviewed throughout the year on admission and some were seen from time to time who presented with clinical problems. Staff meetings were held towards the end of the year to work out a way of filling the boy's spare time with exercise. Several enlightened ideas were produced by the staff and some acted upon.

The New Hospital. Work on this project has advanced with fair rapidity. By the end of the year the short-term psychiatric unit was well advanced and the two Industrial Wards at the lock-up stage. 37

OBSERVATORY CLINIC.

PsYCHIATRIST SuPERI~TENDE~T: DR. R. E. G. MACLEAN. There has been only one full-time psychiatrist, namely the Psychiatrist Superintendent, on duty, although the demand for the clinic's child and adult service is increasing.

Therapeutic. 1. Industrial Training Centre. After continuing to develop in a very satisfactory way along the lines given in the 1967 report, disaster struck in the form of a fire on the evening of 8th October. Lit by a former member of the group of patients at the Centre, this outbreak did damage such that no hope remained of reconstruction in the same hall ; and since this hall was on loan from the Weights and Measures Department, it was decided to return it. The Centre was caring for 28 patients, ranging in age from 14 to 31 years, and during the year 21 referrals had been made to it. Eight patients had moved directly into employment and several others entered into jobs some time after leaving the group. Some placements were made elsewhere in the Department, and some patients continued with the clinic as ordinary out-patients. It will be realized that a need exists for this (and other) Industrial Units specially organized for the adolescent patient whose emotional growth and parental dependence is still continuing, and who is often disruptive if placed in adult industrial groups. The staff of this clinic strongly recommends that even if this unit cannot be continued or recreated here, at least one similar unit be set up elsewhere.

2. Social Club. The Social Club continued only in a small way in the latter part of the year, and seemed likely to fade away by the end of 1968.

3. Treatment Centre. The usual monthly E.E.G. service was continued, with the co-operation of staff from the Mont Park Neurosurgical Centre, and at the Pharmacy 10,310 prescriptions were filled. Sixty-eight abreactions were given by medical staff. Day patient attendances totalled 943, the separate monthly figures showing that this service is growing as facilities are built up. Among these are several groups for adult women, but among groups which have been established for patients other than day patients are one for adolescents and another for the mothers of severely disturbed children who are themselves receiving intensive treatment. Progress has been made in the use of films as a prelude to group work with adult patients, and in the occasional home visiting by nursing staff of patients unable for the time to continue visiting the clinic. Apart from conventional group therapy, facilities such as play-reading book-discussion, music, sewing, handicrafts and painting have been available to day-patients ; the probability being that 1969 will see an elaboration of such aids to socialisation and communication.

General. Thanks are due to the Mental Health Authority and to the staff of Head Office, as well as to the staff of the Observatory Clinic for help and co-operation in what was one of the most difficult years experienced since the clinic opened in July, 1949. 38

PENTRIDGE CLINIC. PSYCHIATRIST SUPERINTENDENT: DR. A. A. BARTHOLOMEW. There has been no significant changes to note since the last report.

Reports. The same type of reports have been prepared this year as last year but again the numbers have further increased. The figures are :- Court of Petty Sessions 208 Courts of General Sessions 181 Supreme Court 29 Parole Board 91 Miscellaneous 175 684

This is an increase of nearly 8 per cent. over the twelve months.

Therapy. This has continued under Dr. J. Allison-Levick but he badly requires help and support with (a) the work load and (b) the difficulties of working in a prison environment. If ever really worth while work in the field is to be done then two things have to happen :- (1) Segregation of the different types of prisoner must be made :­ (a) The neurotic in psychotherapy. (b) The "chronic" patient such as the mentally subnormal, the gross psychopath, the schizophrenic, &c. (c) The physically ill. (2) The removal of a treatment unit away from the prison to a separate institution with a psychiatrist in charge. Research. This has continued but in a very spasmodic term as time has been at a premium. It is to be noted that in March, 1968, the first number of the newly-founded Australian and New Zealand Journal of Criminology was published and by December, 1968 the four numbers making up Volume 1 had been published.

Overseas Visit. In April-June, 1968, Dr. A. A. Bartholomew went overseas and whilst away visited correctional institutions in Singapore, England, Chicago and New Zealand. The Government is thanked for the opportunities offered. 39

PSYCHIATRIC CLINIC TRAVANCORE. PSYCHIATRIST SUPERINTENDENT : DR. K. M. BENN. General. During the course of this year, activities have continued to be modified and extended, in conformity with the intention of providing a fully integrated service for the emotionally disturbed child. The year proved itself a testing ground on which certain organizational techniques were tried but rejected, whilst others proved to be satisfactory.

Organizational. A number of innovations were introduced, found to be acceptable and absorbed into our clinic techniques. lntake Procedure. It is now felt that the uncritical and routine use of home visits is frequently wasteful of our social workers' time. Accordingly, greater use has been made of their time in conducting school visits, serving as consultants to the residential programme, and as negotiators in our community programmes, which are, as yet, merely in their developmental stages.

Community Projects. In addition to the extension of such previously established projects as consultant services to Social Welfare Department and School Medical Services, a number of additional projects have been commenced. Supervision and limited training facilities has been offered to the recently established Cheltenham School for Autistic Children. In addition, a very comprehensive series of 60 lectures and 60 tutorials has been commenced, in order to broaden the technical competency of Child Care Officers. The first course of lectures will be offered by a range of clinic professional staff during 1969. However, preparation of the training program, has required a deal of discussion and planning during this year. In addition, a total of eight lectures or talks were given to a variety of outside organizations.

The New Out-patient Department. The renovated building to serve as the new out-patient building is nearing completion and should be occupied in early 1969. This building will provide a fully integrated diagnostic and therapeutic program utilizing both physical and psycho-therapeutic techniques of treatment. The building, represents the latest thinking in this field by making available, play therapy suites, conference rooms and an attractive blending of functionalism and comfort in the office appointments. As before, emphasis will be placed on the team approach and this should be facilitated by the expected increase of establishment of one social worker and a consultant psychiatrist.

Training and Research. Weekly clinical meetings for all members of staff are now a regular feature, provision being made for a clinic staff meeting in addition to a general clinical meeting for all teaching, nursing and professional staff. In terms of morale building and professional competence, not to speak of confidence, the time spent on such meetings has been well spent. During the year, Dr. Wong published the results of his research on "Activities of a Psychiatric Unit attached to a Children's Reception Centre". Further research into a retrospective foster care study and also a drug trial of efficacy of SERENACE in the treatment of child emotional disorders is being undertaken.

Extramural Activities. A psychiatrist assisted by a part-time psychologist from Travancore, has during the year, allocated a greater amount of time to in-service training of School Medical Officers and nurses ; consultations with school staff, and inter-disciplinary meetings. During the year, four lectures were given to teachers in training at Mercer House, and schools were visited on twelve occasions when invited to give consultative advice. Social Welfare Department continued to obtain a consultative service. A total of 48 homes were covered, mainly within a radius of 25 miles of Melbourne. About two-thirds of the homes visited were Family Group Homes. A total of 85 visits were made during the year. Lectures were delivered, as in previous years, to the child care staff at Allambie and four afternoon sessions were held with social workers of Family Welfare Division. In addition, eight lectures were given at the Training Division to social workers working in fostering and adoption fields. 40

THE RESIDENTIAL SERVICES FOR THE MENTALLY ILL.

With the reduction in numbers there is some relief of overcrowding though it still is very obvious at Kew and in parts of Beechworth. However all the matresses are off the floor and those veranda beds which were unprotected from the weather have been taken down. Nevertheless there are still patients in temporary accommodation at Ararat, Mont Park and Beechworth, and it is likely to be a long time before this can be remedied. This is also an added fire risk.

In time, both Ararat and Beechworth are likely to be wholely converted to training centres for the intellectually handicapped, in the same way as Sunbury where the psychotic patients have gradually been moved elsewhere.

However there is an urgent need for more longer-stay rehabilitation beds in the metropolitan area. These are likely to be indirectly provided by the following means :- (1) A rehabilitation hospital should be built at Geelong to take the 300-400 patients from that area in metropolitan hospitals. (2) A rehabilitation hospital should be build for Dandenong and the Peninsula. (3) The geriatric patients should be reduced as better geriatric services are made available elsewhere. (4) The alcoholic patients should be reduced as the alcoholism services for the chronically ill become available. (5) The new psychiatric unit planned for Larundel will free short stay rehabilitation beds there. (6) New early treatment psychiatric units at Footscray, Geelong and the Ringwood area will avoid longer stay patients accumulating.

Nevertheless we must face the fact that Beechworth, Kew and Ararat are 100 years old, that the bluestone wards (the Hill wards) at Sunbury are completely outdated, that two of the wards at Ballarat are uneconomical to renovate and that Royal Park is no longer a modern psychiatric hospital.

A separate fund is needed to replace these hospitals on a planned programme. They cannot be further renovated to bring them to modern standards. It is quite impossible to undertake this work with current funds.

Security Patients. " J " Ward at Ararat, for security patients, should be replaced by a modern unit in the Plenty Hospital area in Melbourne. This will need much planning and it should begin as soon as there is any likelihood of its being able to be put on the building programme. The present psychiatric unit in Pentridge Prison is not very satisfactory and a number of the prisoners would benefit by being in a psychiatric security unit instead of in prison. Although "J" Ward is unsatisfactory from many points of view, nevertheless, an improvement has been made by enclosing a vegetable garden area and so allowing more work and exercise to a number of the patients. This gives some sub-classification into the ward workers, those in the occupational therapy department, in the front garden, in the vegetable garden and the two exercise yards, which unfortunately have no claim to be much else though a few games are played there. 41

STATISTICAL SUMMARIES, 1968.

PsYCHIATRIC HosPITALS.

(R Recommended Patients; V.P. Voluntary Patients.) R. V.P. Total. On Books, 1st January, 1968 699 Admitted, Direct 2,453 3,350 Transferred from other Mental Institutions 117 436 6,356

Total under Care 7,055 Discharged, Direct 1,976 3,373 Transferred to other Mental Institutions 542 392 Died 25 40 6,348 Remaining on Books, 31st December, 1968 707

INFORMAL HOSPITALS.

(Informal Patients.) R. V.P. Total. On Books, 1st January, 1968 115 Admitted, Direct 1,376 Transferred from other Mental Institutions 108 1,484 Total under Care 1,599 Discharged, Direct 1,457 Transferred to other Mental Institutions 35 Died 2 1,494

Remaining on Books, 31st December, 1968 105

MENTAL HOSPITALS. R. V.P. Total. Remaining on Books, 1st January, 1968 6,802 Admitted, Direct 542 1,043 Transferred from Psychiatric Hospitals 500 346 Transferred from other Mental Institutions 350 449 3,230

Total Number under Care 10,032 Discharged, Direct 831 1,219 Transferred to other Mental Institutions 396 465 Died 474 260 3,645 Remaining on Books, 31st December, 1968 6,387 42

PSYCHIATRIC HOSPITAL: BALLARAT.

PSYCHIATRIST SUPERINTENDENT : DR. C. S. HAUGHTON.

SECRETARY: MR. K. C. TURNER.

Statistics. Patients.

lst 1anuary, 1968. 31st December, 1968. I I Male. Female. Male, I Female. Total. Total. Rec. Vol. Rec. I Vol. Rec. Vol. Rec. Vol.

In residence .. .. 3 5 3 10 21 4 2 8 11 25 On trial leave .. .. 14 1 13 2 30 10 . . 17 2 29 Boarded out ...... Absent without leave ...... Total on books .. .. 17 6 16 12 51 14 2 25 13 54 I I

Male. Female. - Total. Rec. Voluntary. Rec. Voluntary.

Admissions- Direct ...... 99 89 111 142 441 From Psychiatric Hospitals ...... Transferred IN and Reclassified ...... 4 10 6 19 39 Discharges ...... 72 87 56 135 350 Transferred OUT and Reclassified ...... 34 15 50 25 124 Deaths ...... 1 2 . . 3 Average number resident during year ...... 3 3 6 6 18 Persons under care during year ...... 119 96 130 163 508 Cases admitted, aged (male 65, female 60) years and over .. 12 9 21 24 66 Cases (male 65, female 60) years and over on books as at 31st December, 1968 ...... 2 1 1 4

Staff figure~~ are common to all Ballarat Iostitutions.

The report on the Psychiatric Hospital is incorporated in that of the Mental Hospital, Ballarat. 43

NOVAR INFORMAL HOSPITAL : BALLARAT.

PSYCHIATRIST SUPERINTENDENT: DR. C. S. HAUGHTON.

SECRETARY : MR. K. c. TuRNER.

Statistics. Patients.

1st January, 1968. 31st December, 1968.

- ~~Female .. ! Male. Female. Total. - Total. Infonnal. Informal. Informal. Informal.

In residence ...... 4 17 21 3 14 17 On trial leave ...... Boarded out ...... Absent without leave ...... Total on books ...... 4 17 21 3 14 17

Male. • Female. Total. Informal. Infonnal.

Admissions- Direct ...... 31 99 130 From psychiatric hospitals ...... 28 60 88 Transferred IN ...... 2 12 14 Discharges ...... 58 158 216 Transferred OUT ...... 4 16 20 Deaths ...... Average number resident during year ...... 6 12 18 Persons under care during year ...... 57 165 222 Cases admitted, aged (male 65, female 60) years and over ...... 3 28 31 Cases (male 65, female 60) years and over on books as at 31st December, 1968 .. 1 3 4

Stall' figures are common with all Ballarat Institutions.

The report on Novar Hospital is incorporated in that of the Mental Hospital, Ballarat. 44

PSYCHIATRIC CENTRE : DANDENONG.

PSYCIDA TRlST SUPERINTENDENT : DR. A. KESSELL.

SECRETARY : MR. B. HoGAN.

Statistics. Patients. ' 1st January, 1968. 31st December, 1968. I Male. Female. Male. • Female. Total. Total. InformaL I Informal. Informal. Informal.

In residence ...... 12 20 32 9 12 21 On trial leave ...... Boarded out ...... Absent without leave ...... Total on books ...... 12 20 32 9 12 21

Male. Female. -- Total. Informal. Informal.

Admissions- Direct ...... 134 215 349 From psychiatric hospitals ...... Transferred IN ...... D ischarges ...... 137 222 359 Transferred OUT ...... Deaths ...... I I Average number resident during year ...... 11 19 30 Persons under care during year ...... 123 197 320 Cases admitted, aged (male 65, female 60) years and over ...... 11 22 33 Cases (male 65, female 60) years and over on books as at 31st December, 1968 .. 2 1 3 1

Staff.

1st January, 1968. 31st December, 1968. -- Male. Female. Male. Female.

Medical-Psychiatric ...... 3 .. 4 .. Professional-Non-medical ...... 2 .. 2 Nursing ...... 11 I9 10 20 Administrative ...... 2 5 2 5 Services /Tradesmen ...... 6 .. 6 1

1968 was, as shown by the statistical data, a productive year for the Centre and especially for the out-patient clinics which showed an increase of 30 per cent. over the previous year in the number of new referrals. There was also increased participation in community activities in collaboration with members from local statutory and voluntary organizations and there was an increased participation by the trained nursing staff in coping with the large volume of emergency problems which presented daily.

Out-patients. The out-patient figures showed a considerable rise over those for the previous year, 546 more patients being seen with 249 of these being new referrals. The 824 new referrals seen represented a 30 per cent. increase over the number seen in the previous year. 45

Requests for urgent out-patient consultations were met by the medical staff alone, or by the medical staff in conjunction with the senior nursing staff. Out-patient clinics continue to be run at Leongatha and Ferntree Gully. Because of the demand for psychotherapy which could not be met on an individual basis because of the pressure of referrals, therapy groups were experimentally started at Leongatha, two groups led by a charge nurse who visits weekly proving successful, although the major problem has been to eradicate the fear held by patients within a small community that what is said in groups will become public. At Dandenong, out-patient group facilities were increased through the introduction of group sessions at nights and weekends, made possible by introducing charge nurses as group leaders. This has proven to be highly successful and 206 patients undertook these nursing staff groups during the year.

Home Visits. Home visiting by the nursing staff was found to be a valuable adjunct to the other services available and 73 home visits were recorded.

Day Hospital. Sixty-eight patients were admitted during this year and 66 patients discharged, demonstrating that the day hospital functions largely to provide relatively short-term treatment and avoids dependence on the Centre. Institutionalization is also reduced through the participation by the day patients and the in-patients in the same programme of activities.

In-Patients. The increased admission rate in 1967 was maintained for the current year when 349 patients were admitted. It has been noted that since the Centre opened an increasing proportion of admissions have been teenagers in accord with the concept of our early treatment programme. Twenty per cent. of admissions were aged 21 years or under and to balance this, some 10 per cent. of admissions were in the aged category. The full range of treatment programmes were provided, combining physical therapy with psychotherapy. The group programme was strengthened by changes that were designed to increase efficiency and also allow for a more individual approach. Both day patients and in-patients are involved together within the same group programmes. There is a close liaison amongst the professional staff, and on three mornings a week the staff meet for clinical discussions. The psychiatrist superintendent and head nurse also meet patient representatives weekly.

Social Work. The social work department was under considerable pressure throughout the year because so many of the people referred to the clinic were suffering from problems that were both multi-family and involved social factors. An increase in establishment would seem necessary, even more so with the opening of a Child Guidance Clinic early in the new year. Time was also found by the two social workers to help train a number of student social workers throughout the year who attended as part of their in-service training.

Dandenong and District Hospital. Good relationships were maintained with the adjoining District Hospital which is well on its way to becoming a 300-bed teaching hospital linked with Monash University. The psychiatrist superintendent and consultant psychiatrist are on the honorary consultant staff for the hospital and members of the Medical Board. The staff of the two hospitals participated in a number of combined social activities and a trophy was presented for competition. Permission was granted by the Board of Management of the Dandenong and District Hospital to build a tennis court which would sit partly on their land. A request has also been received that we provide nursing staff with psychiatric lectures within the framework of the new midwifery training programme.

Occupational Therapy. The occupational therapy department played a major role in the daily programme of patient activities. Evening socials are held each fortnight and a number of other activities were arranged throughout the year including visits by a drama group, a Christmas party and Carols by Candlelight. An ex-patients' social club conducted a number of functions both within and outside the hospital and were able to make several donations to the social worker to be used on behalf of the patients. 46

Community Activities. A considerable number of talks were given to a variety of organizations by the senior professional staff. The psychiatrist superintendent spoke at a number of local service clubs and church groups as also did the social worker and consultant psychiatrist. A roof organization of local welfare bodies, Dandenong Welfare Liaison, was formed with the social worker and the consultant psychiatrist on the executive committee, the organization meeting regularly at this Centre. It is sponsoring the opening of a Citizens' Advice Bureau and community creche. Two marriage guidance counsellors from the Victorian Marriage Bureau continued to visit the Centre weekly to see referrals from the area. Dr. Jewell has also played a major role in the in-service training of marriage guidance counsellors. Dandenong branches of Alcoholics Anonymous and Alanon meet weekly at this Centre. The increasing and inevitable involvement in the community life of the district creates a burden that must be taken into account when considering the establishment needs of Centres such as this one. 47

INFORMAL HOSPITAL, MALVERN.

PSYCHIATRIST SUPERINTENDENT: DR. N. GoLD.

SECRETARY: MR. A. WALKER.

Statistics. Patients.

1st January, 1968. 31st December. 1968.

-- Male. Female. Male. Female. --- Total. Total. Informal. Informal. Informal. Informal.

In residence ...... 5 13 18 3 10 13 On trial leave ...... Boarded out ...... Absent without leave ...... Total on books ...... 5 13 18 3 10 13

Male. Female. -- Total. Informal. Informal.

Admissions- Direct •...... 34 95 129 From Psychiatric Hospitals ...... Transferred IN ...... Discharges ...... 36 97 133 Transferred OUT ...... Deaths ...... 1 1 Average number resident during year ...... 3 9 12 Persons under care during year ...... 39 108 147 Cases admitted, aged (male 65, female 60) years and over •• ...... 1 16 17 Cases (male 65, female 60) years and over on books as at 31st December, 1968 .. 1 2 3

Staff. -- lst January, 1968. 31st December, 1968. Male. Female. Male. Female.

Medical-Psychiatric ...... 2 2 2 2 1 0 time) Professional-Non-medical ...... 1 3 1 4 Nursing ...... 17 2 16 Administrative ...... 1 2 1 3 Services {Tradesmen ...... 2 6 2 6

Notes by the Psychiatrist Superintendent are incorporated in the Malvern Clinic report. 48

PSYCHIATRIC HOSPITAL: LARUNDEL.

PSYCHIATRIST SUPERINTENDENT : DR. M. K. BENJAMIN.

SECRETARY : MR. J. T. GARVEY.

Statistics. Patients.

1st January, 1968, 31st December, 1968.

- Male. Female. Male. Female. Total. I Total. Vol. Rec. Rec. Vol. ! Rec. Vol. Rec • Vol.

• In residence .. . . 40 98 37 77 252 40 86 49 86 261 On trial leave . . .. 58 . . 24 . . 82 48 .. 45 . . 93 Boarded out ...... Absent without leave .. 2 ...... 2 1 . . l . . 2 Total on books .. .. 100 98 61 77 336 89 86 95 86 356

Male. Female. - Total. Rec. Voluntary. Rec. Voluntary.

Admissions- Direct ...... 492 709 552 770 2,523 From Psychiatric Hospitals and reclassified ...... 133 . . 132 265 Transferred IN ...... 8 13 8 22 51 Discharges ...... 450 781 412 736 2,379 Transferred OUT and reclassified ...... 49 70 112 168 399 Deaths ...... 12 16 2 11 41 Average number resident during year ...... 44 98 36 93 271 Persons under care during year ...... 325 587 318 624 1,854 Cases admitted, aged (male 65, female 60) years and over .. 22 54 73 133 282 Cases (male 65, female 60) years and over on books as at 31st December, 1967 ...... 3 20 3 33 59

Staff.

Medical-Psychiatric .. Professional-Non-medical Nursing Administrative Services /tradesmen

Staff. Common with Mental Hospital. For Larundel Psychiatric Hospital, 1968 presented two major difficulties :­ (1) Shortage of medical staff, both at medical officer and senior level. (2) Shortage of long-term rehabilitation beds, particularly for male patients. As a result of medical staff shortages adequate clinical care was difficult to maintain at a level desired in a hospital responsible for both under-graduate and post-graduate teaching. Patients waiting for transfer to mental hospitals need different levels of activity and with insufficient long-term beds available it was difficult to plan therapeutic programmes. 49

Despite handicaps, significant changes were made in the function of the hospital. The psychiatric hospital was divided into two units, each containing one male and one female ward, and each unit having an autonomous team of staff both medical, paramedical and nursing. The two closed wards were used by both units for disturbed patients, but once leaving these closed wards, patients were involved in the individual units, functioning somewhat differently, with programmes planned by the separate staff. The broad development of both these units along therapeutic community lines, using team Management and increasing group activities and group therapeutic procedures modified to acute admission units, was most gratifying. With adequate staffing such an arrangement could give increasing impetus and satisfaction to all staff involved, and more satisfying therapeutic results. The Therapeutic Community (Fawkner House) has developed into a most satisfactory treatment area of 35 beds. The wide range of and large numbers of professional visitors from Victoria, interstate, and overseas and their enthusiastic commendation, confirm one belief that this development represents a major advance in therapeutic technique in Australia. It has proved a centre from which changing patterns for the whole hospital have developed. Nurse recruitment gives cause for alarm. The number of recruits has fallen markedly since 1967 and at no time were nursing establishments filled. The development of a bigger social work department associated with community nursing services, is an urgent need. Occupational therapists have proved adaptable in the new programs though the provision of additional craft supervisors would make this therapeutic area more effective.

2984/70.-4 50

PSYCHIATRIC HOSPITALS ROYAL PARK AND PLEASANT VIEW.

PSYCHIATRIST SUPERINTENDENT : DR. J. F. J. CAnE.

SECRETARY : MR. F. B. HOWELL.

Statistics. (a) Royal Park. Patients.

1st January, 1968. 31st December, 1968. 1---~--~-- ~- ---- ...... ~·-~- - Male. Female. Male. Female. -- Total. Total. Rec. Vol. Rec. Vol. Rec. Vol. Rec. Vol. •

In residence .. .. 39 52 38 I 73 202 28 53 47 58 186 On trial leave .. .. 21 . . 29 .. 50 21 1 29 . . 51 Boarded out ...... Absent without leave .. ! I ...... l 1 ...... 1 i I Total on books .. .. 61 52 67 73 253 50 54 76 58 238 I

Male. Female. - Total. Rec. Voluntary. Rec. Voluntary.

Admissions- Direct ...... 617 802 581 836 2,836 From Psychiatric Hospitals ...... 42 64 47 24 177

Transferred IN ...... ; ...... Discharges ...... 531 812 452 819 2,614

• Transferred OUT and Reclassified 134 51 163 56 404 Deaths .. 5 4 10 Average number resident during year 38 50 39 64 191 Persons under care during year 607 684 671 649 2,611 Cases admitted, aged (male 65, female 60) years and over 42 38 79 124 283 Cases (male 65, female 60) years and over on books as at 31st December, 1968 7 10 16 34

············-~------~----.. ·~~-----

Staff.

1st January, 1968. 31st December, 19~8. ; Male. Female. Male. Female.

Medical-Psychiatric ...... 21 3 14 5 Professional-Non-medical ...... 9 16 9 11 Nursing ...... 76 106 76 105 Administrative ...... 8 16 8 lO I I Services/Tradesmen ...... 68 25 75 21 ...... I 51

Statistics. (b) Pleasant View. Patients.

1st January, 1968. 31st December, 1968.

- Male. Female. Male. Female. Total. Total. I r Rec. Vol. Rec. Vol. Rec. I Vol. Rec. I Vol. I I

In residence ...... 23 : . . 36 59 . . 22 . . 37 59 On trial leave ...... Boarded out ...... Absent without leave ...... I i Total on books ...... 23 . . 36 59 .. 22 . . 37 59 : I I

Total. Recom­ mended.

Admissions-· Direct .. 3 From Psychiatric Hospitals 7 7 Transferred IN 3 2 9 14 Discharges 6 Transferred OUT 7 Deaths .. ll Average number resident during year 60 Persons under care during year 79 Cases admitted, aged (male 65, female 60) years and over 3 10 14 Cases (male 65, female 60) years and over on books as at 31st December, 1968 32 46

Staff.

I I 1st January, 1968. 31st December, 1968. - Male. ! Female. Male. Female. i

Medical-Psychiatric ...... p rofessional-Non-medical ...... N ursing 8 20 7 21 ...... I A dministrative ...... 1 . . 1 .. services/Tradesmen ...... 7 I 14 7 13 ' Bed Shortage. This position is slightly worse that it was last year because of the increasing demand for beds in mental hospitals for long-stay patients, particularly chronic psychotics, patients with permanent brain damage and young patients with malignant disorders, and therefore the shortage of beds to which the patients from Royal Park can be transferred. It will be noted that 69 fewer patients were transferred to Mental Hospitals in 1968 than in 1967. This is due in only small part to the fact that there were fewer admissions (3,013 in 1968, 3,129 in 1967). The main reason has been the non-availability of beds. Social Work Department. The most significant development was the institution of "Intake Interviews" by a P.S.W. with relatives or friends accompanying patients on admission to hospital. Besides being able to give a report to doctors within a day of admission, the social workers themselves have noted the relief of stress in relatives and friends. Their involvement at this stage considerably helps the patient's rehabilitation and what is more, is vastly economical of social worker's time. 52

Occupational Therapy Department. The O.T.'s opened and staffed a shop within the department during the year. It has proven a great convenience and success. This, plus the profits of the vending machines, profits from the sale of various popular articles mass produced in the department and payment for industrial work have placed the Patient's Comfort Fund in a singularly healthy condition.

Pathology Laboratory. The following figures give some idea of the volume of work during the year :­ Tests done in 1968. Biochemistry 2,560 Bacteriology 1,141 Haematology 1,449 Serology 2,804 Total 7,954

Bromide Intoxication. The attached table (Appendix A) compiled by the senior biochemist illustrates forcibly the dangers inherent in unrestricted and unsupervised self-medication with bromides. Most of the positive results are due to the ingestion of proprietary bromureides purchased " over the counter". There are a number of alternative minor tranquillizers of equal or greater efficacy which are not cumulative as bromureides are.

Research. (a) Dr. M. Serry has commenced a study that shows great promise. It is, briefly, the use of urinary excretion test to identify those patients who are likely to respond to lithium medication. It seems likely that there are considerably more lithium responsive psychotic reactions than was supposed until quite recently. (b) The hospital has been co-operating with the University Department of Psychiatry in another serological and electrolyte study being conducted by Dr. I. K. Jones of that Department.

Students' Representative Committee. An important line of communication was opened up during the year when the nursing students formed their own S.R.C. This meets regularly with senior medical nursing and teaching staff and is already proving its usefulness as a forum for an exchange of views and ideas.

APPENDIX A.

NUMBER OF RAISED BROMIDE LEVELS DETECTED EACH YEAR.

Year.

Male.

1968 109 82 27 1967 3,129 1,519 1,610 135 110 25 1966 3,406 1,642 1,764 136 113 23 1965 3,429 1,616 1,813 93 80 13 1964 3,372 1,679 1,693 77 68 9 1963 3,492 1,755 1,737 85 71 14 1962 3,645 1,708 1,837 76 66 10 1961 3,593 1,705 1,885 106 95 11 1960 3,537 1,652 1,885 79 78 1959 4,191 1,936 2,225 36 31 5 1958 4,596 2,204 2,392 11 9 2 1957 4,169 2,091 2,078 7 7 0 53

PARKVILLE PSYCHIATRIC UNIT.

PSYCHIATRIST SUPERINTENDENT ; DR. R. J. B. BALL.

SECRETARY: MR. K. A. BOYD.

Statistics. Patients.

1st January, 1968. 31st December, 1968.

-- Male. Female._! Male. Female. Total. Total. Informal. Informal. Informal. Informal.

In residence ...... 8 12 20 11 11 22 On trial leave ...... Boarded out ...... Absent without leave ...... Total on books ...... 8 12 20 11 11 22

Male. Female. Total. Informal. Informal.

Admissions- Direct ...... 127 174 301 From Psychiatric Hospitals ...... 2 4 6 Transferred IN ...... Discharges ...... 126 177 303 Transferred OUT ...... 2 2 Deaths ...... Average number resident during year ...... 12 16 28 Persons under care during year ...... 120 161 281 Cases admitted, aged (male 65, female 60) years and over ...... 2 2 4 Cases (male 65, female 60) years and over on books as at 31st December, 1968 .. 1 1 2

•

Staff.

············------Is! January, 1968. 31st December, 1968.

Male. Female. Male. Female.

Medical-Psychiatric .. 3 4 Professional-Non-medical 5 5

Nursing 7 16 7 15

Administrative 5 2 5 Services {Tradesmen .. 12 9 13 9

------

Although the Parkville Psychiatric Unit opened in October, 1965, this is the first separate annual report of the unit because it was not until October, 1968 that the unit had its own separate administration. Initially we operated entirely as a day hospital. Since then steady progress has lead up to the present time where we are now fully operational and only minor gardening and furnishing installations remain to be completed. The first few months were a time of trial and error and staff learning to work together. From then on the teaching activities of the Unit began to expand with the arrival of the first Melbourne University students in January, 1966. Since that time, except for academic holidays, under-graduate teaching has continued with from twelve to twenty medical students here at any time. The medical students from Royal 54

Melbourne Hospital spend three weeks full time here and three weeks at the Royal Melbourne Hospital Psychiatric Unit whilst students from St. Vincent's Hospital spend a full six week block here with some sessions during this period each week at St. Vincent's Hospital. The students are involved with patient records, participation in and observation of treatment, and all other activities within the Unit.

In the early stages of the development at Parkville it was agreed that the Unit would serve as a post-graduate teaching centre for the Mental Health Authority hospitals, and an arrangement was made that in the third year of formal psychiatric training doctors would be attached to Parkville for six months experience and tuition, during which time they would be relieved of all duties in their parent hospitals. At the end of 1968 a total of 31 doctors have attended here in this training capacity, where they work under the direct supervision of the Senior Clinicians in a team system and obtain further experience in general clinical psychiatry in the main with a limited caseload allowing adequate time for teaching. Simultaneously they are given training in formal psychotherapy and instructions in psychopathology. These attachments seem to have been successful and are highly regarded by the medical officers. All modern forms of treatment are undertaken within the Unit including appropriate use where indicated of physical methods of treatment and much individual and group therapy of varying intensity.

The range of patients with psychiatric disorders attending the clinic has been deliberately kept as wide as possible in order to allow under-graduate and post-graduate students to have the widest range of clinical experience. Exceptions relate to patients under the age of sixteen for whose care we are not properly equipped, patients with a primary diagnosis of alcoholism for the same reason, and patients with chronic psychogeriatric problems because of problems of disposal and also because opportunity exists elsewhere for under-graduate and post-graduates to obtain experience in this field.

Limited research activities have been undertaken on various drug studies, examination of psycho-somatic problems, psycho-sexual disorders and examination of various personality problems. 55

HOBSON PARK, INFORMAL HOSPITAL: TRARALGON.

PSYCHIATRIST SUPERINTENDENT : DR. E. L. ROBERTS.

SECRETARY: MR. J. E. COTTER.

Statistics. Patients.

31st December, 1968.

Male. Female. Total.

Informal. Informal. i

In residence 9 15 24 10 22 32 On trial leave Boarded out Absent without leave Total number on books 9 15 32

Male. Total.

Admissions~-

Direct 209 258 467 From Psychiatric Hospitals Transferred IN Discharges 203 248 451

Transferred OUT 5 3 I 8 Deaths .. i Average number resident, during the year 11 17 ! 28 Persons under care, during the year 148 204 352 Cases admitted, aged (male 65, female 60) years and over 7 28 35 Cases (male 65, female 60) years and over on books as at 31st December, 1968 .. 2 2

Staff

1st January, 1968. 31st December, 1968, - ! Male. Female. Male. I Female.

i Medical-Psychiatric ...... 4 . . 4 . . Professional-Non-medical ...... 1 . . 1 Nursing ...... 8 22 8 25 Administrative ...... 2 3 2 3 Services /tradesmen ...... 12 I 6 16 8 56

MENTAL HOSPITAL, ARARAT.

PsYCHIATRIST AcTING SuPERINTENDENT: DR. G. D. BuRRows.

SECRETARY: MR. c. H. FELLOW-SMITH.

Statistics. Patients.

lst January, 1968. 31st December, 1968. I - Male. Female. Male. Female. I I Total. Total. Rec. Vol. Rec. Vol. Rec. Vol. Rec. Vol.

In residence .. .. 133 70 184 187 574 150 54 184 165 553 On trial leave . . .. 14 1 9 9 33 5 1 13 13 32 Boarded out ...... Absent without leave 2 .. .. 2 2 .. 2 .. I ...... Total number on books .. 149 71 193 196 609 157 55 197 178 587

•

Male. Female. - ···-- Total. Rec. Voluntary. Rec. Voluntary.

Admissions- Direct ...... 15 20 2 38 75 From Psychiatric Hospitals ...... 5 . . 2 .. 7 Transferred IN ...... 17 2 27 4 50 Discharges ...... 17 14 11 42 84 Transferred OUT ...... 4 3 2 5 14 Deaths ...... 8 21 14 13 56 Average number resident during year ...... 142 61 178 176 557 Persons under care during year ...... 170 90 215 221 696 Cases admitted, aged (male 65, female 60) years and over .. .. 6 l3 l3 32 Cases (male 65, female 60) years and over on books as at 31st December, 1968 ...... 28 28 99 Ill 266

Staff.

Jst January, 1968, 31st December, 1968.

Male. Female. Male. Female.

Medical-Psychiatric ...... 3 .. 4 .. Professional-Non-medical ...... Nursing ...... 135 105 131 103 Administrative ...... 6 . . 4 .. Services/tradesmen ...... 99 22 100 22

General Health. A satisfactory standard of general health was maintained during the year. With the excellent co-operation of Mr. G. Lewis, Honorary Surgeon and the Board and Nursing Staff of Ararat and District Hospital, 30 major surgical operations were performed this year. As the patients were accompanied by a member of our nursing staff to theatre and returned to Aradale on the day of operation, excellent opportunity was afforded for nurse training and experience. 57

Special Services. The two dentists from the town provided good service, and this year dental treatment under general anaesthesia has allowed them to catch up on the backlag. The optometrist visited as required and several patients were referred to the Opthalmologist in Ballarat.

Community Nursing. The nurses' home visiting continued to play a valuable role in community activities. This year due to the enthusiasm of the nursing staff and their relatives, it was possible to place six women patients who had a mean duration of hospitalization of 25 years into a house within the town. Thus " Aradale Hostel " has been formed and for the last six months these patients functioned as an independent unit.

Patient Occupation. The trade instruction unit is now in full production and has been responsible for the repair of hospital furniture and the construction of wardrobes with individual compartments for each ward patient has enabled better care of private clothing in the Training Centre. The Industrial Therapy Unit (integrated patients) now engages some 30 patients and is producing a variety of articles for sale and for hospital use. Under the control and supervision of the recently appointed Craft Supervisor the unit has shown increased and extended activity and is beneficial to patients and the hospital. The Female Therapy, Regressed Unit and Dress Shop are further units providing daily occupational activities. These units are well patronized and the scope of their activities is continually being extended. The enthusiasm of the newly-appointed craft supervisors has produced marked changes.

"J" Ward. This maximum security ward is at all times fully occupied and on occasions causes some embarrassment when unexpected admissions arrive. However, there has not been any serious problems during the year and the morale of the patients and staff appears to be higher than for a number of years. The vegetable garden has been brought under cultivation and not only provides occupation for a number of patients but also supplements the supply of vegetables. This further occupational activity has proved invaluable to the more active "J" Ward patients. Although the number who can be occupied at any one time is necessarily limited the Therapy Unit provides an interest for a selected group of patients. The articles produced, particularly basket ware, are of first class quality and eagerly sought after. The new craft supervisor has organized therapy for almost all patients.

Clothing. The purchase of clothing for Training Centre patients has considerably raised the standard in this section of the Hospital and has resulted in a marked improvement in the appearance and condition of the patients. This has also permitted additional funds being channelled to the female division and the male patients of the Mental Hospital where the improvement in the appearance of the patients has been noticeable.

Staff The shortage of medical staff persisted throughout the year. With the increasing outpatient services, and an increasing, although as yet small, number of referrals from H.M. Prison, Ararat, it is apparent that the minir:nal medical staff should include the psychiatrist/superintendent, consultant or psychiatrist, and two medical officers. The administrative staff was also short in numbers and with the added burden of Training Centre patients, clothing records and the other additional administrative duties entailed in this sphere the volume of work at times became embarrassing. However with the co-operation and enthusiasm of the remaining staff this work was carried out. This year a monthly meeting was held between nursing and medical staff. Communications were kept free, informal and as relaxed as possible. These meetings demonstrated the enthusiasm of the staff which has given the hospital a happy atmosphere. The number of nursing staff particularly on the female side has increased and towards the end of the year reached establishment figures. This was most encouraging as a number of the later appointees had the qualifications necessary to undergo training. Few vacancies existed on the artisan staff and it was noted that applicants for the various advertised positions were generally of better standard than in previous years. 58

Nursing Training. The School of Nursing functioned efficiently and lectures by members of the medical staff, the Tutor and demonstrations by the medical staff were well attended by those in training. In all twenty nurses were in training and of these eight were successful in graduating. This high percentage is indicative of the increasing standard of training in the school. During the year negotiations were continued with the Ararat and District Hospital and the Nursing Council for the introduction of a nurse-exchange programme. It now appears that this scheme will eventuate and the results, which should prove most beneficial to all concerned, are eagerly awaited.

Voluntary Organizations. The Auxiliary continues to operate the Kiosk to the benefit of patients and staff alike. The monthly visits of this organization are appreciated by the patients. The Country Womens Association has maintained its keen interest in the Housecraft Centre and has done much in helping rehabilitate a number of female patients. The Ward Adoption scheme has proved a valuable community link and has been of great benefit to the Hospital. Christmas parties were again arranged by the Auxiliary and adopting groups, and the Christmas cakes were distributed to all wards. The Red Cross Library provided a valuable service and thanks must be extended to the small band of very willing workers. The numerous outings arranged by the various interested groups during the year were greatly appreciated. The annual bazaar was once again a success and gave the community an opportunity to purchase the many articles produced in the Therapy Units. 59

MENTAL HOSPITAL, BALLARAT.

PSYCHIATRIST SUPERINTENDENT : DR. C. S. HAUGHTON.

SECRETARY: MR. K. c. TURNER.

Statistics. Patients.

1st January, 1968. ' 31st December, 1968. ;

Male. Female. Male. Female. Total. I ------Total. Rec. Vol. Re c. Vol. Rec. Vol. ! Rec. I Vol.

• ln residence . . .. 318 i 115 329 121 883 340 100 320 125 885 On trial leave .. .. 59 17 68 27 171 46 12 69 15 142 Boarded out .. .. 25 .. 19 .. 44 28 .. 17 . . 45 Absent without leave .. l ...... 1 J 1 ...... 1 Total on books .. .. 403 132 416 148 1,099 415 112 406 140 1,073

Male. Female. Total. Rec, Voluntary. 1 Rec. Voluntary. I ------Admissions- I Direct .. 54 116 39 92 301 From Psychiatric Hospitals 37 30 32 27 126 Transferred IN and Reclassified 17 5 29 16 I 67 Discharges 50 145 47 120 362 Transferred OUT and Reclassified 9 12 30 16 67 ----- Deaths .. 37 14 33 7 91 ----- Average number resident during year 337 114 330 133 i 914 Persons under care during year 510 262 515 267 1,554 Cases admitted, aged (male 65, female 60) years and over 25 13 42 33 113 Cases (male 65, female 60) years and over on books as at 31st December, 1968 107 47 174 74 402

Staff.

lst January, 1968. 31st December, 1968. - • Male. Female. Male. Female. -···--- Medical-Psychiatric ...... 7 .. 10 1 Professional-Non-medical ...... 3 3 2 1 Nursing ...... 155 180 160 178 Administrative ...... 7 5 6 6 Services/tradesmen ...... 106 38 116 52

At a ceremony on 15th December, attended by a good representation of townspeople and Departmental personnel, the Minister of Health, Mr. V. 0. Dickie, officially opened Parklands Clinic, the new psychiatric hospital to replace Dana House. Parklands Clinic was originally Wards I and 2 of the Mental Hospital and has been redesigned as a geriatric admission unit for the Mental Hospital. However, because of the urgent need to replace Dana House as an acute psychiatric hospital, it was decided to use Parklands Clinic for this purpose until a new early treatment centre can be built in the city area. The increase in capacity from 28 to 48 patients together with the modern treatment facilities should make for more efficient care of a greater number of patients with less need to transfer patients to the mental hospital. 60

At the same ceremony the new administrative building, created by the remodelling of a former nurses' home, was officially opened. This building has enabled the medical, senior nursing and general administrative staff to be together. The occasion of the opening of these two buildings was used to introduce officially to the public the new name for Ballarat Mental Hospital-Lakeside HospitaL

Patient Care. General. The Ballarat Psychiatric Services appear to incorporate most of the facilities for maximum rehabilitation of those who become mentally ill. The first line of treatment consists of the out-patient clinics at Ballarat and Maryborough. (The out-patient clinics run from Bendigo, Ararat, Warrnambool and Mildura play an important role here too.) The next consists of the Psychiatric Hospital and Novar, where mostly in-patients, but also a few day patients, are treated for acute psychiatric illnesses and psychoneuroses respectively. For those who need rehabilitation the integrated admission ward of Lakeside Hospital provides the treatment setting. For those who fail to respond the treatment in the admission ward, longer term integrated rehabilitation wards are available. The net result is that the long-stay wards largely hold brain damaged, mildly mentally retarded and schizophrenic patients who have failed to make the grade in the rehabilitation wards.

Special Treatment Units in Lakeside Hospital. It has become apparent that the planned programme of a therapeutic community with the use of group pressure, the incentive of money, increasing privileges and pharmacotherapy is only a partial solution in the rehabilitation of chronic schizophrenics. The experience gained from the R.T.S. programme has fostered the smooth integration of other areas of the hospital. Similarly, the realistic assessment of patients in working areas has led to improved training of working skills.

Industrial Unit. An average of 70 patients, male and female, attended this unit throughout the year. New furniture including work benches, work tables and chairs were provided during the year relieving overcrowding and allowing more efficient use of space available. All patients continued to be graded according to their work ability and have been paid accordingly. The most striking feature in the work situation during the year has been the increase in the quantity and variety of work supplied by V.A.T.M.I. which sent a weekly delivery. 70-80 per cent. of the patients in this unit were occupied with this work. Local industry provided the remaining work. During the coming year it is hoped to increase the proportion of work that is being obtained from local industry. There is an urgent need for more storage space for the unit. The acquisition of a commercial van financed largely by the C.W.A. obviated the need for a large storage area for local contract work as the work could be delivered when it was finished but the problem of storage of V.A.T.M.I. work remains. Nursing staff under the leadership of a male charge nurse who doubles as work shop manager and employment officer worked very well in this unit.

Joinery Unit. This very well equipped workshop also had a good year occupying up to eighteen patients many from R.T.S. One trend which caused concern, particularly in the joinery unit, was the emphasis on" productivity" of the unit rather than rehabilitation of patients. At times this unit was under great pressure as a result of committing its production to a level well beyond the capacity of the unit. Occupational units, assessment units and ward therapy units also functioned satisfactorily.

Social Activities. Inter-ward socials were held regularly in all wards and seemed to be enjoyed. Honour dances and card evenings are held fortnightly .. The f~ncy. dress ball held in Sep~ember was a ?reat success except for overcrowding in the hall. An mnovatwn m 1968 was the formatiOn of a teens group to meet the needs of younger patients. Sporting activities such as football, cricket, tennis and bowls appeared more popular than they had been for some time. Some inter-hospital matches in football and cricket were much enjoyed. The Patients' Recreation Club continued to make progress under the guidance of the recreation officers and continued to allow patient participation in the planning of activities for patients.

Patients' Clothing. Female clothing continues to show improvement. The Matron attributes this partly to the better type of clothing issued, but mo~tly ;.o the. interest shown by the nursing staff in the appearance of the patient and the care of the patients clothmg. 61

The general standard of outer clothing worn by male patients should be much better. Some of the problems can be remedied immediately, others are long term. With the co-operation of the secretary and nursing staff it is hoped to institute a special drive towards improvement in one or two male wards in 1969.

Buildings, Equipment and Artisan Activities. Due largely to the enthusiasm and interest of the secretary, extensive maintenance, renovations and additions to buildings and grounds have considerably improved the hospital. Many wards have benefitted from installation of heating, redecorating, alterations and provision of curtains, bedspreads and new furniture. The outstanding achievement of 1968 was the restoration of Ward 17-a very old building which had become derelict to the extent that it was no longer in use-to provide very comfortable patient accommodation. Carpenters, painters and engineering staff worked enthusiastically on the project.

Laundry. Lakeside Hospital now provides a linen service to Pleasant Creek Training Centre, Stawell, as well as to Ararat Mental Hospital. A new manager will be appointed in 1969 when it is hoped some of the present difficulties will be largely eliminated.

Nursing Training. The number of student nurses in training has fallen steadily since the higher educational entry standard was introduced. We now have 36 students in training, the lowest ever. As more students are staying on at school to obtain higher qualifications this may be only a short-term problem. We have a number of male temporary ward assistants who are attempting to obtain the educational qualifications necessary for entry to psychiatric nursing training by attending night school. All requirements of the mental nursing syllabus were met in 1968. Some changes in the ward training programme for student nurses are being reviewed and will be instituted in 1969. It is also planned to form a nursing education committee in 1969. Educational visits of 75 students from senior forms of several Ballarat and District secondary schools were arranged in conjunction with "careers week". The students had indicated an interest in psychiatric nursing, social work, occupational therapy and teaching and nursing of the intellectually handicapped. To date the visit has resulted in no new student nurses.

Dana House (Psychiatric Hospital). The admission rate of 471 was about the same as the previous year and treatment was maintained at a reasonable level. The standard of care provided was handicapped, however, by a shortage and in some cases the absence of ancillary professional staff in particular psychologist, occupational therapist and social worker. The last was affected by shortage of transport. As in previous years the reduced number of occupational therapists meant that their services were restricted to patients in the mental hospital. Although it is good for nurses to shoulder full responsibility for occupation of patients in the psychiatric hospital it is apparent that they are limited by lack of training in this area. It is hoped to remedy this in 1969 by using the senior occupational therapist in a supervisory and training role to enhance the skills of nurses. Dana House has been the acute psychiatric hospital for Ballarat since 1912. This is the last occasion it will appear as such in the annual report as with the proposed move to the new Parklands Clinic, Dana House will become, after renovation, a second rehabilitation hostel.

Novar (Informal Hospital). Admission rate was about the same as last year, 230. The female to male rate remained at 3 to 1. Drugs, E.C.T., short-term psychotherapy and behaviour therapy have constituted the major forms of treatment used. A few babies were admitted with their mothers during the year. This unit has continued to function extremely well with integration of sexes, both patients and staff, under an excellent charge nurse.

Out-patient Services. Although fewer new adult patients were seen at the Norwood Clinic, more patients were seen for follow-up. All out-patient commitments were met for the year. The consultant psychiatrist in charge of medical officer training arranged for medical officers to attend in rotation a weekly out-patient clinic at which new cases were interviewed and assessed. The out-patient clinic at Maryborough was conducted weekly by the psychiatrist. Norwood Children's Clinic was affected by the absence of a psychologist and the limited availability of our only social worker so that the traditional child guidance team approach had to be abandoned. However, 70 new referrals were seen. This is very gratifying and stresses the importance of this primary psychiatric service. 62

Sturt Street Hostel. The hostel continued to function very well during the year. The turnover of male patients who suffer mainly from chronic schizophrenia is quite small and it is becoming evident that many male patients who do leave the hostel are unable to care for themselves in the outside community and have to be returned to hospital eventually.

Voluntary Services. The Ladies' Auxiliary have continued to maintain a high standard in the running of the kiosk. From the profits of the kiosk they have provided many comforts for our wards to benefit patients including 3 television sets, 3 sewing machines, I radio, 2 bicycles, 180 bedspreads, curtains and plastic flowers and prizes for various social functions. In addition they have arranged a monthly Sunday afternoon concert which is very popular, and also picnics and bus trips in conjunction with various voluntary organizations. The Community Psychiatric Volunteer Service has been very active throughout the year organizing reading, walking and singing groups as well as various hobby groups such as dressmaking, pottery, physical culture and make-up classes. English language classes for New Australians were reinstituted and were well attended. Mrs. lngram who had been honorary director of the volunteer service since its inception in 1961 relinquished the post. We were very sorry to lose her services as she had been the mainstay of the volunteer service seeing it through many difficulties. Miss P. Skinner took over as director and has done very well already especially in the recruiting of younger members. A training course for new volunteers was arranged during the year and was well attended. The Country Womens Association has continued to give service generously in the housecraft centre, C. W.A. cottage and in providing various outings for patients. This group also provided money to allow the purchase of a Volkswagen Commercial van for the use of the Industrial Unit and the Joinery Unit which was much appreciated. Other Voluntary Groups.-The Ballarat Teachers' College continued to take an active interest in R.T.S. (Ward 18) by providing activities for the patients four nights a week. Many other groups including Red Cross, St. Vincent de Paul, School groups, and Returned Soldiers have visited regularly and their interest and help is appreciated.

Summary. 1968 has been a year of consolidation. Slowly there is being built up a nucleus of senior staff­ medical, nursing, secretarial and ancillary which will provide stability in the Ballarat Psychiatric Services. The next development will undoubtedly be in the area of community psychiatry using visiting nurses and the day hospital and plans are already being formulated for this. 63

MENTAL HOSPITAL, BEECHWORTH.

PSYCHIATRIST SUPERINTENDENT : DR. G. R .. JENSEN.

SEcRETARY: MR. A. J. McDoNALD.

Statistics. Patients.

lsl January, 1968. 31st December, 1968. ;-- -·--- Mate. Female. Male. Female. -~~t:~--, Total• [ Rec . I Vol. Rec. Vol. Rec. Vol. Rec. Vol. •

• n residence .. .. 353 93 I 264 39 749 306 108 223 61 698 0 n trial leave . . .. 9 .. 8 .. 17 7 4 3 . . 14 B oarded out .. .. 7 .. I .. .. 7 6 ...... 6 I I A bsent without leave .. 2 .. I .. 3 2 .. I 1 . . 3 I T otal on books .. .. 371 93 273 39 776 321 112 227 61 721 I ··-··------

Male. I Female. Total. ! Ree. 1 Voluntary. Rec. Voluntary.

Admissions- Direct 5 101 4 97 207 From Psychiatric Hospitals 28 .. .. 33 Transferred IN 15 9 1 27 Discharges 54 75 39 70 238 Transferred OUT 29 9 4 .. 42 Deaths .. 15 7 14 6 42 Average number resident during year 346 95 255 41 737 Persons under care during year 416 191 284 124 1,015 Cases admitted, aged (male 65, female 60) years and over 6 23 3 36 68 Cases (male 65, female 60) years and over on books as at 31st December, I 968 88 37 134 41 300 '

Staff.

1st January, 1968. 31st December, 1968. - Male. Female. Male. Female.

Medical-Psychiatric ...... 3 .. 5 .. p rofessional-Non-medical ...... 4 1 2 . . N ursing ...... 110 111 108 110 A dministrative ...... 6 2 6 2 scrviccs/tradesmen ...... 85 23 87 28 . I

The current year 1968 proved to be a busy one for the hospital in many respects. Community services were expanded with lectures to community groups, increasing contact with the Wangaratta Base Hospital where we have provided an in-patient consulting service as well as an active out-patient service. The number of out-patient appointments during the year reached a record total of 685 compared to 587 in the previous year. Over the last five years out-patient services have trebled. In addition to the services at Wangaratta urgent cases such as in-patient suicidal attempts and geriatric cases were assessed at Wodonga Hospital or at the general practitioners consulting rooms. 64

Admissions have increased by 100 over the preceding year with increasing emphasis on accepting more regional responsibility for acute cases and treating them where possible as voluntary patients in our integrated admission ward. This increasing activity in the hospital has proved interesting to our staff and has pointed out the need for increasing nursing, medical and paramedical staff as well as the need for an early treatment centre in this area. Buildings and patient accommodation are in many areas out-moded and are reaching the end of their effective life, so that our artisans are increasingly involved in maintenance work to keep these buildings serviceable. It is hoped that the new wards planned for the hospital will soon be built so that more effective treatment and better accommodation can be provided. Patient activities have increased markedly during the year. There has been re-organization of some wards and of nursing staff duties and reclassification and transfer of many patients within the hospital to enable new activities to be set up in a number of wards. We continue to receive regular support from many voluntary organizations, including the Wangaratta Mental Health Auxiliary, the Country Women's Association, the Returned Services League, the Red Cross and from the visiting Chaplains and individual members of the community. 65

MENTAL HOSPITAL: KEW.

PSYCHIATRIST SUPERINTENDENT : DR. C. G. BURT.

SECRETARY : MR. J. P. BATTISCOMBE.

Statistics. Patients.

1st January, 1968. 31st December, 1968. I - Male. Female. Male. Female. Total. Total. Rec. Vol. Rec. Vol. Rec. Vol. Rec. Vol. I

In residence 861 328 79 350 120 877 .. .. 321 80 354 106 I On trial leave .. .. 55 13 77 29 174 46 14 79 18 157 Boarded out ...... Absent without leave .. 2 ...... 2 1 ...... 1 Total on books .. .. 378 93 431 135 1,037 375 93 429 138 1,035

Male. Female. - Total. Rec. Voluntary. Rec. Voluntary.

Admissions- Direct ...... 110 65 114 57 346 From Psychiatric Hospitals ...... 22 4 15 7 48 Transferred IN ...... 33 30 28 38 129 Discharges ...... 18 22 22 28 90 Transferred OUT ...... 36 26 32 29 123

Deaths ...... 114 I 51 105 42 312 Average number resident during year ...... 327 80 349 117 873 Persons under care during year ...... 542 177 585 215 1,519 Cases admitted, aged (male 65, female 60) years and over .. 111 64 128 84 387 Cases (male 65, female 60) years and over on books as at 31st December, 1968 ...... 187 70 346 133 736 I I

Staff.

1st January, 1968. 31st December, 1968. - Male. Female. Male. Female.

Medical-Psychiatric ...... 8 3 10 2 Professional-Non-medical ...... 2 7 2 3 Nursing ...... 141 147 143 140 Administrative ...... 9 5 8 5 Services/tradesmen ...... 104 58 104 73

Statistics and General Health. Successive years' figures show that since 1964 admissions to Kew have been falling off; this is basically related to the decreasing death rate which in turn could be at least in part due to the system of controlled admissions in force since 1964. Such a system with its inevitable waiting list tends to reduce the incidence of moribund admissions. Not without impact on admissions has been the re-introduced and expanded pre-admission assessment service-out-patients and domiciliary-which has resulted in the diversion of at least 25 per cent. of patients referred for admission. No serious epidemics occurred in the year though six female patients lost their lives in a ward fire.

2984/70-~ 66

Treatment. General medicine and general nursing techniques bulk largely in a hospital such as this and this aspect of patient care was maintained at a high leveL Some use was still found for E.C.T., occasionally for leucotomy and of course psychotropic drugs find quite a considerable application even in geriatric patients. The appointment of a sessional neurologist was a forward step in the light of our intake. Occupational, stimulation, social and recreational activities are destined to become ever more fundamental as our population changes in our chosen direction. The O.T. department's efficiency should increase with the step towards its centralization represented by its fine new industrial therapy building and the development of an assessment unit. However the growing need is for ward based programmes. Physiotherapy is in its infancy here but there are indications of possible staff augmentation in 1969. The Kew Surgical Unit with its largely orthopaedic function had a busy year as did the associated radiography and pathology departments. lt is felt that this hospital requires its own dentist for an adequate service. The Day Centre completed its second full year and is now an integral part of Kew. It now has the buildings and staff establishment to allow of significant growth-if further transport is available. Out-patient treatment remains sporadic, at least half of the 400 interviews being devoted entirely to diagnosis. Additionally however, both consultants held weekly sessions elsewhere and the Superintendent visited many discharged patients during the year.

Amenities. Classification continues to become an increasingly difficult problem at Kew and with few of the wards "closed", there is a good deal of staff anxiety over confused" wanderers". No further significant progress was made with clothing though hopes are still entertained for a " clothing care unit " being established.

Staff. Medical staffing was reasonably satisfactory throughout the year though it must be pointed out that a domiciliary service is considered essential and that this will occupy-even at a purely assessment level-a good part of a trained officer's time. Nursing staff shortages, (especially female) r·emained unrelieved and our most pressing problem. Nevertheless considerable initiative was display~d in attempts both to rationalize roles and to educate. The acquisition of a third social worker was a very welcome step forward in this most important section which underwent some useful internal reorganization and is badly in need of further case aides.

Occupational therapy staffing was strengthened by the reclassification of ten nursing positions to craft supervisors and it is hoped this will enable augmentation of ward programmes. The appointment of a resident Roman Catholic chaplain (shared with The Childrens Cottages) was most welcome.

Teaching commitments continued to increase and this would seem inevitable in view of the growing size of the population segment we serve. The paucity of psychiatric student nurses is most disappointing but refresher lectures were given to our own trained staff and most disciplines were represented at weekly clinical conferences. Many groups come to Kew for educational purposes and are a source of stimulation to us-medical under-graduates and graduates, nurses from various specialties, theological, social work, occupational therapy students and numbers of others. A successful Gerontological Society seminar on geriatric psychiatry was held in our hall, contributors all being members of our staff.

Voluntary Organizations and Public Relations. This hospital is fortunate in the number of individuals and organizations interested in it and our warm appreciation is expressed to V.S.A. members, our auxiliaries, many church groups, the Australian Red Cross and others for their time, efforts and donations. The panel of official visitors is also thanked for its interest and support.

Talks were given to various bodies by several members of the staff and one of the consultant psychiatrists, Dr. Bower, was an invited participant in several congresses.

GENERAL. In many ways this has been a difficult year with the fatal fire dominating recollections. I must, in this connexion, record my appreciation of the efforts of so many members of staff and of the efficiency and kindness of fire brigade and police personnel.

Admission pressures were considerable but were reduced by measures taken to cope with them and throughout, it is felt, the nursing staff are to be commended on their efforts in maintaining such a high level of patient care. 67

MENTAL HOSPITAL: LARU~DEL.

PSYCHIATRIST SUPERINTENDENT : DR. M. K. BENJAMIN.

SECRETARY: MR. J. T. GARVEY.

Statistics. Patients.

lsl January, 1968. 31st December, 1968,

Male. Male. Female. • Total. Total, Rec. Vol. Vol. Rec. Vol. Rec. Vol.

In Residence .. .. 102 189 134 480 103 186 65 ll9 473 On Trial Leave .. .. 23 .. .. 68 l7 .. 43 . . 60 Boarded Out ...... I ...... 1 Absent Without Leave .. l ...... l 2 ...... 2 Total on Books .. .. 126 189 lOO 134 549 123 186 108 119 536

Male. l'emale. - Total. Re c. Voluntary. Rec. Voluntary.

Admissions- Direct ...... 1 20 7 64 92 From Psychiatric Hospitals ...... 34 46 74 137 291 Transferred IN ...... 10 12 6 27 55 Discharges ...... 25 55 74 213 367 Transferred OUT ...... 15 18 3 23 59 • Deaths ...... 8 8 2 7 25 Average number resident during year ...... 105 186 58 122 471 Persons under care during year ...... 171 267 187 362 987 Cases admitted, aged (male 65, female 60) years and over .. I 9 7 72 89 Cases (male 65, female 60) years and over on books as at 31st December, 1968 ...... 7 40 14 65 126 ; -

Staff.

-~~--~ 1st January, 1968. 31st December, 1968. I Male. Female. Male. Female.

Medical-Psychiatric ...... 13 .. 12 2 Professional-Non-medical ...... 2 11 2 11 Nursing ...... 120 139 132 Administrative ...... 7 8 7 Services/tradesmen ...... 80 118 93

In 1968 the Mental Hospital was divided into three units on the basis of the patients' diagnosis and classification in terms of chances of rehabilitation. The divisions consist of :- (1) La Trobe Unit : a geriatric unit consisting of two wards in the Psychiatric Hospital and two wards in the Mental Hospital. Urgent attention should be given to providing an integrated four-ward geriatric unit with increased nursing establishment to cope with the physical nursing of physically frail and ill patients. (2) Hoddle Unit : a schizophrenic rehabilitation unit of 135 beds, 90 males and 45 females. Based on the Ballarat scheme, this unit aims at social and work rehabilitation for schizophrenics, many 18-25 years. 68

The unit needs a workshop, or factory in the North-eastern metropolitan area for realistic training and rehabilitation. Our therapy areas and V.A.T.M.I. programs are not extensive enough nor suitable for such a unit. (3) Mitchell Unit which is a scattered unit of two female wards and four male wards. A long process of reassessment is under way to attempt to subdivide this area of six wards into two sub-units based on social and work function of patients. There is a need for another occupational therapy building on the north side of the hospital. Mention must be made of the changing nature of the Hospital, with modern techniques of treatment and rehabilitation and with the development of community care programs, we can anticipate that the trend which became obvious this year, of only admitting increasing numbers of brain damaged and regressed male patients to mental hospitals will continue. These patients of poor prognosis and permanent need for institutional care, have increased in numbers in the mental hospital and trends in early 1969 suggest this patient will predominate in transfers in the future. These patients will require an increasing number of staff, particularly craft supervisors, to manage them. In view of the shortage of trained psychiatric nurses, more provision for alternative staff is necessary. 69

MENTAL HOSPITAL: MONT PARK.

PSYCHIATRIST SUPERINTENDENT : DR. T. A. PEARCE.

SECRETARY: MR. E. H. GUPPY.

Statistics. Patients.

I st January, 1968. 31st December, 1968. Male. Female. Male. I Female. Total. Total Rec. Vol. Rec. Vol. Rec. Vol. Rec. Vol. I In Residence .. .. 266 98 345 171 880 258 71 351 156 836 On Trial Leave .. .. 57 3 127 13 200 27 5 129 13 174 Boarded Out . . .. 1 ...... 1 2 .. 1 . . 3 Absent Without Leave .. 3 .. 2 .. 5 7 .. 1 . . 8 Total on Books .. .. 327 101 474 184 1,086 294 76 482 169 1,021 I

Male. Female. - Total. Rec. Voluntary. Rec. Voluntary.

Admissions- Direct ...... 23 81 30 105 239 From Psychiatric Hospitals ...... 38 33 79 29 179 Transferred IN and Reclassified ...... 58 48 42 64 212 Discharges ...... 64 108 61 98 331 Transferred OUT and Reclassified ...... 77 72 46 71 266 Deaths ...... 11 7 36 44 98 Average number resident during year ...... 273 81 358 162 874 Persons under care during year ...... 442 245 624 364 1,675 Cases admitted, aged (male 65, female 60) years and over .. 10 17 32 78 137 Cases (male 65, female 60) years and over on books as at 31st December, 1968 ...... 29 27 164 148 368

Staff.

ht January, 1968. 31st December, 1968. - Male. Female. Male. Female.

Medical-Psychiatric ...... 13 1 13 1 Professional-Non-medical ...... 8 7 10 9 Nursing ...... 114 175 103 205 Administrative ...... 8 7 10 ll Services/tradesmen ...... 187 77 173 48

General Health and Treatment. The hospital has two sections, one caring for psychiatric patients, the other for psychiatric patients with physical illness. In the psychiatric section the general physical health of the patients was satisfactory, and no epidemic of infectious disease occurred. There was no routine screening for tuberculosis in 1968 ; but all patients requiring h were inoculated against typhoid. The treatment aim continues to be directed where possible to full physical and mental rehabilitation ; the main aim is the return of patients to the community. 70

Clinical Treatment. There is no gross over-crowding in the hospital now. The patients continue to come from many referring sources but there is little change in the pattern of sources to previous years. There were no major changes in the treatment program in individual wards during the year but the rehabilitation programs are now on a firmer basis and are proving their worth as permanent features in the hospital. By the end of the year in the employment areas, excluding the population of the special units and the geriatric section, 75 per cent. of all male and female patients were considered to be in some form of employment. Treatment and activity plans are designed so that they are available to both the male and the female division. So far complete integration has only occurred in one or two areas but at social times, at meal times, in outings, and during discussion and group activities part integration takes place. The rehabilitation and social centre at the hospital is a great success. The Centre has become the focus point for most activities in the hospital and has given rise to continued enthusiasm in both staff and patients. It is one of the most successful endeavours undertaken within the last few years.

Geriatric Section. The rebuilding of the South-East Block is now complete and Wards F7 and 8 were occupied at the end of the year. This has allowed forward planning for the Geriatric Section of the hospital to take place. There is now an admission ward, a rehabilitation psychogeriatric ward, two totally dependent wards and two war.ds for ambulant patients with moderate hope of rehabilitation and two wards for patients with fair hope of rehabilitation. The male geriatric population was evacuated to Plenty Hospital during most of 1968 while Ward M7 was being redecorated. During this time there was an increasing number of admissions of brain damaged patients to this ward. By the end of 1968 more than half the ward population fell into this group.

Neurosurgical Unit. The pattern of work in this unit continues as before and most cases are of acute or chronic brain syndrome, atypical neurotic or psychotic reactions, personality disorder and epilepsy. Relatively few leucotomies were offered in 1968 and it seems that the total number will stabilize out at sixteen per year. The radiography department is associated with this unit but does much general work as welL It was fully staffed through the year and gave an excellent service. Photography was continued as a part-time duty of one of the electro-physicists.

General Surgical Unit. This unit operated smoothly throughout the year and was relatively free of the crises that beset it in 1967. The amount of work performed was comparable to what was done previously though the total number of operations dropped a little since in the first three months of 1968 there was no resident surgeon. Again it is suggested that an experienced physician attached to the unit would enable it to be used to capacity.

Infectious Diseases Unit. Seventeen cases were admitted during the year and 32 patients cared for in the year. Sixteen were discbarged, 4 died and by December 12 patients remained in the ward. Of the patients who died two had carcinoma of the lung.

Typhoid Carrier Unit. There were no admissions, discharges or deaths in the ward during the year in the population of 10 women. Statutory examinations carried out over the year were negative in all cases. The patients remain potential intermittent excreters and must continue to be isolated.

Ancillary Staff. The Occupational Therapy unit was reasonably staffed throughout the year and maintained its programs. It increased its work in the sphere of hospital activities and it is recognized that work done by nurses and occupational therapists is coming closer together. During the year the physiotherapists treated 120 female patients and 45 male patients and gave a total of 6,938 therapy sessions to individual patients. The dental service extends its activities to Plenty Hospital and has also made itself responsible for the dental care of the children of Janefield Colony. The dentist attended 1,814 patients at these hospitals in the year. In addition he managed to survey a number of the wards in Mont Park Hospital on a review basis. The Chiropody Department reviewed all geriatric patients at least once during the year and maintained a high treatment level as welL The total treatments given for the year was 5,068.

Social Activities. During 1968 the scope of social, recreational and rehabilitation programs widened further. The Social Rehabilitation Centre was the site where much of this took place. A holiday camp was held at Camp Wilkin, Anglesea, in February, 1968 when 40 patients enjoyed their first holiday for many years. The camp lasted for 10 days and was most successful. A second week-end camp was held at Mount Martha during November. The second annual fete was held on 23rd November and raised over $5,000. Payment on a 23-passenger bus for use of the patients was completed. This deserves special mention since it was a total effort by all branches of staff to provide a gift to the patients. 71

Chaplains' Department. Three full-time chaplains continued to work at the hospital. A seminar for parish clergy was held at the hospital during Mental Health Week. The seminar was attended by 120 chaplains, 60 of whom were resident for five days.

School of Nursing. In 1968 3 men and 4 women from Mont Park and 2 men from Plenty Hospital graduated as psychiatric nurses. Six men and 4 women commenced training at Mont Park and one at Plenty, 5 students discontinued training. At the end of the year the total number of students was 26, 11 men and 12 women at Mont Park, 2 men and 2 women at Plenty. Two presecondment courses for General Nursing training were held which prepared 13 nurses for genera[ nurse training. A post-graduate nursing administration course for 32 nurse administrators was held at this hospital. There was also a one-week seminar for senior nursing administrators. The executive of the occupational therapy therapists held a conference at the school, a number of V.S.A. accreditation ceremonies took place. A student nurses club was formed in the year.

Staff. The male nursing complement was almost complete during the year. The female nursing complement varied between 170 to 180 nurses out of an establishment of 235 and there was the continual difficulty of being short of 11 charge nurses.

General Comment. Our efforts have continued to be directed towards rehabilitation and the development of a team with high morale to undertake this. The discharge of long-term patients continues but has slowed down as the residue of these patients have poor discharge prospects. We continue to be stimulated by the amount of redecoration that has been offered to us and accept that any local inconvenience produced by this is well worth tolerating. Many of our newer projects arc now well organized within the hospital, arc subjected to routine examination and encouraged to continue. Many have an energy of their own which is encouraging. Achievement in different sections of the hospitals of course vary according to facilities and staff and some schemes fade away but this does not matter. New schemes are always being proposed from below. I continue to stress that planning must often be temporary and should always be flexible. Achievements over the two years have stimulated and maintained a number of loyal and co-operative permanent members in each staff division and our younger colleagues continue to bring enthusiasm with them. We have had to face up to the fact that some 30 per cent. of our patients will never leave hospital. We have made realistic reassessmcnts of this situation and modified our endeavours to suit the prognostic needs of these patients. The team of senior specialists and administrative staff have worked well together throughout the year and this has been most helpful to me. I am most appreciative of their efforts and have personally had a pleasant year with them. It is pleasing to record the steady increase in number of outside helpers from our district who wished to be linked with us. Our relationships with the local community are greatly improved nowadays. 72

MENTAL HOSPITAL : PLENTY.

PSYCHIATRIST SUPERINTENDENT: DR. H. S. PAULL.

SECRETARY: MR. G. D. THOMPSON.

Statistics. Patients.

lst January, 1968. 31st December, 1968.

Male. Female, Male. Female. Total. Total. Rec. Vol. Rec. Vol. Rec. Vol. Rec. Vol.

In Residence . . .. 94 122 78 135 429 104 152 63 150 469 On Trial Leave .. .. 43 2 65 7 117 41 . . 87 8 136 Boarded Out ...... Absent Without Leave . . 2 ...... 2 ......

Total on Books .. .. • 139 124 143 142 548 145 152 150 158 605

Male. Female. - Total. Rec. Voluntary. Rec Voluntary. i Admissions- Direct ...... 7 26 4 33 70 From Psychiatric Hospitals ...... 30 Il 90 20 151 Transferred IN and Reclassified ...... 26 35 4 35 100 Discharges ...... 38 27 53 50 168 Transferred OUT and Reclassified ...... 15 8 37 10 70 Deaths ...... 4 9 1 12 26 Average number resident during year ...... 105 143 72 146 466 Persons under care during year ...... 202 196 241 230 869 Cases admitted, aged (male 65, female 60) years and over .. 7 26 3 22 48 Cases (male 65, female 60) years and over on books as at 31st December, 1968 ...... 3 29 12 85 129

Staff.

I st January, 1968. 31st December, 1968.

Male. Female. Male. Female.

Medical-Psychiatric ...... 4 . . 6 .. Professional-Non-medical ...... 1 3 4 8 Nursing ...... 56 58 70 49 Administrative ...... 3 t 4 3 Services/tradesmen ...... 1 .. 22 7

During the year, the three new Geriatric Wards were all occupied. However the constitution of the hospital remained unchanged from the previous year. The physical health of the patients remained, in general, good. There were always a number of patients away at Surgical and Medical Units undergoing treatment for physical illness.

Medical Staff. During the year, there was a Psychiatrist Superintendent, a Consultant Psychiatrist for the first six months, who then left and was replaced by a Psychiatrist, and three Medical Officers. Two of the Medical Officers gained the Diploma of Psychological Medicine during the year. 73

Psychiatric Social Worker. This was the Social Worker's first full year in the hospital. Whilst he was single-handed, he did have students seconded to him near the end of the year, and received a good deal of help from the Social Involvement Group from Latrobe University.

Occupational Therapy. There have been three trained Occupational Therapists throughout the year. During the year, the post of Craft Supervisor was introduced. Five women and three men have been appointed to this grade of employment. This increase in staff enabled the programme to be altered extensively so that now all patients have an individual program in which they spend part of each day on industrial therapy and part of each day on group activities. The inadequate amount of space in the two buildings occupied has been rather marked because of this change. It is hoped that the post of Senior Occupational Therapist will be established at some time.

Nursing Staff. During the year, the posts of Principal Male Nurse and Principal Female Nurse were established. The total establishment for nurses on both sides was markedly increased. Unfortunately, this has not been filled. The average number of nurses on the female side for the year was 45 for 240 patients. Seventy-five per cent. of these nurses are ward assistants. On the male side, the average was 60 staff for approximately 260 patients. Of these, 34 are trained, including administrative nursing staff.

Buildings. The third of the new geriatric wards was opened in April. It was occupied by geriatric patients from Mont Park whilst the ward in their parent hospital was undergoing renovation. During the year, renovations on Wards C and R were commenced and were well under way when the year came to an end. Work on the Assembly Hall and an Occupational Therapy Department has still not been started.

The Mental Health Auxiliary. This body continued to be generous with gifts from the proceeds of their Canteens. The visiting service of the Auxiliary reached 70 in number. Fifty of these are regularly engaged in the running of a Kiosk. A one-day orientation course for V.S.A. members within the hospital was held during the year. 74

MENTAL HOSPITAL: SUNBURY.

PSYCHIATRIST SUPERINTENDENT ; DR. L. R. H. DREW,

SECRETARY : MR. K. M. BAIRD.

Statistics. Patients.

-~-- ···--~-~~···-~---·····----- 1st January, 1968. 31st December, 1968.

Male. Female. Total. Total. Rec. Vol. Rec. Vol. Re c. Vol.

In Residence 95 63 110 119 387 162 On Trial Leave 23 11 35 7 76 5 25 Boarded Out 30 24 39 Absent Without Leave Total on Books .. 148 74 29 226

---·-······--

Male, Female. . i I Total. I Rec. I Voluntary. Rec. I Voluntary. i ----······-~-~-·------,------:------' j ···--- I Admissions- Direct .. 4 50 From Psychiatric Hospitals 3 3 Transferred IN 24 137 Discharges 121 250 Transferred OUT 22 206

Deaths .. 7 19 Average number resident during year 104 337 Persons under care during year 179 653 Cases admitted, aged (male 65, female 60) years and over 29 Cases (male 65, female 60) years and over on books as at 31st December, 1968 96

Staff.

1st January, 1968. 31st December, 1968. -- I ! Male. Female. Male. Female.

M edical-Psychiatric ...... 4 1 5 . . p rofessional-Non-medical ...... 2 2 2 3 N ursing ...... 123 124 121 122 A dministrative ...... 9 4 9 4 services/tradesmen ...... 95 48 96 49

~~------~.------~------

1968 has again been a year of considerable change and of serious staff shortages. The administrative re-organization instituted last year has been consolidated with continuing benefits. Efforts have been directed towards reducing the number of Mental Hospital patients and improving programs geared towards the needs of the mentally retarded. Mentally ill patients were exchanged for mentally retarded patients from other hospitals, and a substantial number of patients were accommodated in the community. At the end of 1968, the institution contains only 150 persons who can legitimately be held in a mental hospital. General Health of the population remained good with less illness and no more deaths than expected in such an aged population. 75

Treatment.-Activation and de-institutionalization of those whose mental illnesses had remitted took place with little use of drugs or E.C.T. The gradually increasing participation and improved levels of skills of many old men and women has been rewarding, as has the happy adjustment made by many persons placed in sheltered community environments, once they lost their early fears. Most of these placements have been successful. Some have resulted in renewed interest by relatives in persons from whom the stigma of " mental hospital patient " was lifted. Occupation was centred on the Activity Centres and was dependent on V.A.T.M.I. projects, although a considerable number of patients are still employed in hospital industry and as ward workers. Many older people can only be occupied with magazines, drawing, knitting and walks.

Recreation.-The Amenities Officer has again made commendable efforts~directing a program of entertainment at ward and hospital levels .. Many patients enjoyed a holiday of one or two weeks at the beach. Most patients have had at least one outing away from the hospital. Many have been on a dozen or more day trips.

Social Work.~There have been increased demands, with an increase of over 80 per cent. in the number of referrals above 1967. The appointment of a second social worker was invaluable. Two more appointments are urgently required. The continued use of two welfare assistants and a domiciliary (charge) nurse has been essential. There has been a decreased emphasis on seeking employment and an increase in search for accommodation, in the provision of aftercare for patients, and in long-term support for the operators of Nursing Homes and Boarding Houses. The Social Work Department also has responsibility for directing the holiday schemes, V.S.A. activities, community education, the training of domiciliary nurses, and the supervision of field work by students from the Department of Social Studies, Melbourne University.

Accommodation. Classification and Facilities.~ Wards MI, 2 and 3, were gazetted part of Sunbury Training Centre in December, 1968, so that the Mental Hospital now consists .only of Wards Fl, 2, 3 and 3A. The alterations of Wards Ml and Fl, first planned in 1958, are still incomplete. Toilet facilities for the Staff Mess Room have been greatly improved and the floors of Ward M3 have finally been concreted and covered with vinyl sheeting. A second new industrial therapy building was completed and came into operation. A central sterilizing service has been established. Tuition within this area is an important aspect of nurse training. The pathology laboratory is only in very partial use. The recruitment of a laboratory technician is still needed. Transport.---Throughout the year the two official cars travelled well in excess of 50,000 miles and there was an additional considerable usage of private cars. An extra car is an urgent necessity. Without it out-patient services by medical staff and the placement and supervision of patients in the community will certainly have to be curtailed or a considerable expenditure upon private mileage will have to be accepted. Farm and Garden.-Even through the severe drought during the summer months, which caused the closing of the piggery, milk supplies were about average. Unfortunately the same could not be said of the vegetable garden, although root crops were maintained, and it was necessary to purchase more than the usual quantity of vegetables during this period. 76

MENTAL HOSPITAL: WARRNAMBOOL.

PSYCHIATRIST SUPERINTENDENT : DR. T. J. LEONARD.

SECRETARy : MR. c. E. HAY.

Statistics. Patients,

1st January, 1968. 31st December, 1968 .

- Mate. Female. Male. • Female. Total. ·········- Total. Rec. Vol. Rec. Vol. Rec. Vol. Rec. Vol.

In residence .. .. 128 69 .. . . 197 I 120 71 .. .. 191 On trial leave .. .. I ...... 1 1 ...... 1 Boarded out ...... Absent without leave ...... Total number on books .. 129 69 .. .. 198 121 71 .. . . 192 ! • I •

Male. Female. - Total. Rec. Voluntary. Rec. Voluntary.

Admissions- Direct ...... 4 9 . . .. 13 From Psychiatric Hospitals ...... 2 ...... 2 Transferred IN ...... 3 8 .. . . 11 Discharges ...... 5 .. . . 5 Transferred OUT ...... 1 2 . . . . 3 Deaths ...... 16 8 . . . . 24 Average number resident during year ...... 124 68 .. . . 192 Persons under care during year ...... 137 83 . . .. 220 Cases admitted, aged (male 65, female 60) years and over .. 2 3 .. . . 5 Cases (male 65, female 60) years and over on books as at 31st December, 1968 ...... 33 18 i . . . . 51 ~~······

Staff.

lst January, 1968. 31st December, 1968. - Male. Female. Male. Female•

Medical-Psychiatric ...... 1 • .. 1 . . Professional-Non-medical ...... Nursing ...... 48 . . 47 . . Administrative ...... 2 2 3 Services /tradesmen ...... 20 6 21

General Health. The general health of the patients has been satisfactory. During the year ten patients were transferred to the Warrnambool and District Base Hospital for treatment.

Occupational Therapy. The Occupational Therapy Centre continues to be very well managed and financially self supporting through the sale of wooden toys and basketware. As usual, donations of toys, &c. were made to local charitable organizations. With the advent of the new wards an extension of the occupational therapy space is essential and plans to extend the occupational therapy building are in hand. The East Warrnambool 77

Rotary Club has adopted as a community service project the raising of $5,000 which will partly defray the cost of the proposed extension. The extra space when it becomes available will be used for the industrial section of the occupational therapy. At present industrial occupational therapy and general occupational therapy activities are carried on in the same area and it is considered desirable to separate them. At the present time the possibility of extending the scope of industrial occupational therapy activities by taking on contract work from the Warrnambool Woollen Mills is being explored.

Social and Recreational. The only major change in the social and recreational program from that of the previous year has been the completion of two tennis courts which have been completely financed from the hospital Kiosk. These have proved to be an important extension to the recreational facilities, and are much enjoyed by both patients and staff. Unfortunately, owing to last year's drought, work on the bowling green was held up but final arrangements for its completion in the very near future are now well in hand. The patient's Concert Group was again active during the year.

Voluntary Organizations. As in previous years the hospital has received much help and support from many voluntary organizations, including the Country Women's Association, the Catholic Ladies' Guild, St. Vincent de Paul Society, Red Cross, the Methodist Ladies' Fellowship, the Anglican Women's Guild and R.S.L.

Staff. The post of psychiatrist was advertised towards the end of the year but as yet no appointment has been made. Because of the continuing steady increase in the volume of out-patient work, it is becoming progressively more difficult for the psychiatrist superintendent to perform all his duties efficiently. The fact that the number of out-patient interviews increased from 749 during 1967 to 1,718 during 1968 indicates the size of this problem. The nursing staff has remained at full strength during the year. One second year student and one final year student passed their examinations. The artisans have carried out their duties satisfactorily. Co-operation between the artisan and nursing staff in patient rehabilitation programs continues to be very good.

Nurse Training. The main part of the formal training of student nurses is carried out at the Ballarat Mental Hospital School of Nursing. Additional lectures have been given at Warrnambool on one day in each month by the Senior Nursing Educational Officer from the Ballarat Mental Hospital.

Out-patients. Out-patients have been seen by the Psychiatrist Superintendent at the Warmambool and District Base Hospital and the Glenelg Base Hospital in Hamiltom. It is considered desirable that an out-patient centre should be established at Portland as, at present, patients from Portland must travel more than 60 miles to be seen at Warrnambool. However, until there is an increase in the medical staff, this will not be practicable. 78

REPATRIATION MENTAL HOSPITAL: BUNDOORA.

PSYCHIATRIST SUPERINTENDENT : DR. H. C. STONE.

SECRETARY ; MR. L. c. HIGGINS.

Statistics. Patients.

1st January, 1968. 31st December, 1968.

-~-····--···---··· Male. Female. Male. Female. Total. I Total. Rec. ! Vol. Rec. Vol. Rec. Vol. Rec. Vol. -- ····---····- I In residence . . .. 291 I 14 . . . . 305 277 20 . . . . 297 On trial leave . . . . 82 .. I . . . . 82 92 2 . . . . 94 Boarded out ...... Absent without leave .. 2 . . 2 ...... Total on books . . .. 375 . . 389 369 22 . . . . 391

! Male. Female, : - Total. Rec. Voluntary. Rec. Voluntary. -!

~-----

Admissions- Direct ...... 118 74 . . . . 192 From Psychiatric Hospitals ...... 4 2 . . . . 6 Transferred IN and Reclassified ...... 4 7 . . . . 11 Discharges ...... 85 70 . . . . 155 Transferred OUT and Reclassified ...... 7 4 . . . . 11 Deaths ...... 40 I . . . . 41 Average number resident during year ...... 278 15 . . . . 293 Persons under care during year ...... 501 97 . . . . 598 Cases admitted, aged (male 65, female 60) years and over .. 19 5 . . . . 24 Cases (male 65, female 60) years and over on books as at 31st December, 1968 ...... 102 1 . . . . 103

'

Staff.

1st January, 1968. 31st December, 1968, -----,------Male. Female. Male. Female.

Medical-Psychiatric ...... 4 . . 4 . . Professional-Non-medical ...... 1 . . 1 Nursing ...... 66 .. 70 .. Administrative ...... 4 3 5 3 Services/tradesmen ...... 43 22 45 24

This institution is reserved solely for the treatment of recognized repatriation male patients and there has been no change in this policy. Some new areas of " War Service" have been proclaimed but to date have had little effect on the number of admissions. Discharges remain fairly constant and the only statistical change is the increase in the number of voluntary patients now being treated. 79

The care and treatment of patients continues in the pattern set in previous years with the emphasis again being placed on group activities. Meetings cover all phases of both patients and staff interest and special efforts are being directed towards the activation of families of patients into this pattern. Groups from " Alcoholics Anonymous " have been particularly active, and "Al-Anon " family groups are now well established with good attendences at weekly meetings. The response by patients to motovational counselling conducted by the Clinical Psychologist has become apparent.

Day meetings are conducted for patients on trial leave and attendances at the rehabilitation centres at the Repatriation General Hospital, Heidelberg and Rockingham continuue to progress.

Out-patient services are mainly provided by specialists from the Repatriation Department, but every effort is being made to expand and develop an out-patient program at this hospital on a purely local basis.

The recruitment of nursing staff remains very difficult and there are few nurses in training.

The Red Cross fully maintains its services to the hospital and patients, and tremendous support is given by ex-service and other interested groups. 80

THE INTELLECTUAL DEFICIENCY SERVICES. The retarded children's day centres continue to expand with new centres at Echuca and North Geelong and extensions at Balwyn and Shepparton so that by the end of 1968 there were 1,750 trainees attending. Advantage has been taken by four centres of the Commonwealth grant to finance hostels for those attending the workshops. The policy of making direct grants to the centres instead of through the Authority as their agents is useful, but is not a satisfactory arrangement for there is no mechanism within the Commonwealth Department of Social Services for the supervision of the hostels or workshops, whilst the Authority already has the responsibility for the centres and the teachers. The waiting list remains about the same and between 400 to 450 places are urgently required. A number of names could be taken off the waiting list if there were hostels, perhaps run by community agencies where the trainees could board whilst attending a centre or workshop and then return home at the weekends and during holidays. Although many children are admitted to the training centres during the absence of others on holiday, the vacancies are never sufficiently numerous to fulfil the real needs. The accommodation provided at Janefield through the efforts of the Helping Hand Association has already been of great value in this way. Conditions in the training centre at Beechworth are poor, especially in Myrtle House where a portion of the building is subsiding to the extent of becoming dangerous, but apparently nothing can be done except to pull it down and there are no funds to replace it. Two new dependent wards at Stawell are finished ; wards for moderately retarded children and a day centre will be added later, to which children from the surrounding neighbourhood will be admitted. A new administrative block and out-patient centre is required and in this way all grades of retardation will be covered and supervision of the region can be arranged from Stawell. The Authority is given greater attention to the use of psychologists as possible directors of training within the training centre and it is hoped that funds for the appropriate establishment will be granted by the Treasury. If the centres are to be organized in keeping with modern practice facilities must be made available for parents to board in the centres and learn to look after their children. These " schools for parents " have been very successful in other parts of the world. Sunbury needs wards for children if there is to be a complete programme of training. This will necessitate a school and Female 3 Ward would convert very well for this purpose when the geriatric patients have been evacuated and more accommodation is available. Sunbury is too large though plans can be made for its use on a diminished scale when a number of the Hill Wards are pulled down, though this cannot be done for some years ahead. The Colac Planning Committee has met as either a full committee or as sub-committees on many occasions. Much extremely interesting work has been done, new principles have been worked out and such matters as future staffing have been given much thought. The next step is to examine and discuss the sketch plans of the architect who has been with the Committee throughout. Unfortunately the Public Works Department have decided to remove him to another job, in the meantime everything is held up and the waiting list continues to grow. It would appear that at least one firm of outside architects have specialized in this field and it is a matter of the utmost regret that they were not given the chance to participate if the Public Works Department are not prepared to fulfil their obligations in the Mental Health field. It is hoped that when the Colac plans are finished other centres may be designed for Traralgon and Cranbourne.

Staff. Great difficulty is being experienced in obtaining medical staff interested in the Intellectual Deficiency field. It is very necessary to build up a regional service but this can only be done by having interested senior members to run it. 81

INTELLECTUAL DEFICIENCY TRAINING CENTRES.

(App. = Approved Patients, Vol. Voluntary Patients.) App. Vol. Total. On Books, 1st January, 1968 2,126 Admitted, direct 40 900 Transferred from other Mental Institutions 54 96 1,090

Total under care 3,216 Discharged direct 87 234 Transferred to other Mental Institutions 39 103 Died 29 26 518

Number on Books, 31st December, 1968 2,698

INFORMAL INTELLECTUAL DEFICIENCY TRAINING CENTRES. (St. Nicholas Hospital and Sandhurst Boys Centre.) Number on Books, 1st January, 1968 262 Admitted, direct 123 Transferred from other Mental Institutions 11 134

Total under care 396 Discharged direct 136 Transferred to other Mental Institutions 4 Died 11 151

Number on Books, 31st December, 1968 245

INTELLECTUAL DEFICIENCY TRAINING SCHOOL CASES.

On Books, 1st January, 1968 472 Admitted, direct 279 Transferred from other Mental Institutions 134 413

Total under care 885 Discharged, direct 595 Transferred to other Mental Institutions 100 Died 6 701

Total on Books, 31st December, 1968 184

2984/70.-6 82

TRAINING CENTRE: ARARAT.

ACTING PSYCHIATRIST SUPERINTENDENT : DR. G. D. BURROWS.

SECRETARY : MR. c. H. FELLOW-SMITH.

Statistics. Patients.

1st January, 1968. 31st December, 1968. - -- Male. Female. Male. Female. I I Total. Total. App. Vol. App. Vol. A pp. Vol. A pp. Vol.

In residence .. .. 108 116 .. . . 224 107 116 .. . . 223 On trial leave .. .. 3 9 . . .. 12 2 10 .. .. 12 Boarded out ...... Absent without leave ...... 1 ...... 1 Total on books .. .. 111 125 .. . . 236 110 126 . . . . 236

Male. Female. -- Total. A pp. Voluntary. ·-··A pp. Voluntary.

Admissions- Direct ...... 8 5 .. .. From Psychiatric Hospitals ...... 1 1 .. .. Transferred IN ...... 2 ...... Discharges ...... 6 2 .. . . Transferred OUT ...... 1 ...... Deaths ...... 5 3 .. . . 8 Average number resident during year ...... 109 123 .. . . 232 Persons under care during year ...... 118 122 .. . . 240 Cases admitted, aged (male 65, female 60) years and over ...... Cases (male 65, female 60) years and over on books as at 31st December, 1968 ...... 4 19 .. .. 23

Staff.

1st January, 1968. 31st December, 1968.

Male. Female. Male. Female.

Medical-Psychiatric ...... Professional-Non-medical ...... Staff Common Mental Hospital Nursing ...... Administrative ...... Services/Tradesmen ......

The Training Centre has now been functioning for two years and as such has accomplished much towards the rehabilitation of the patients in this section of the Hospital. In the four more active wards the patients are occupied with farm and garden activities, industrial therapy and other tasks beneficial both to the Hospital and themselves. Ward committees have been formed, and with minimal nurse supervision, are responsible for the internal running of their respective wards. 83

The cumulative pension has enabled the purchase of clothing which has greatly enhanced the general appearance of the patients. This, indirectly, has permitted the purchase of better additional clothing for the remainder of the Hospital.

The habit training program adopted in the two Training Centre Wards where the lower grade dependant and infirm patients are housed has shown pleasing results. This has been markedly evident in Ward T.C.6.

There has been an ever increasing demand on the bed situation and the Training Centre is now carrying five patients above the original establishment figure. There seems little likelihood of any change in the situation and the demand will continue to outweigh the availability of beds.

The staff have been enthusiastic in their approach to the training of the patients and, following a visit to the Special School at Stawell, new ideas were incorporated in the social and educational training program of the patients.

The advantages of housing mentally retarded patients in their own " institution " has been apparent and the results attained so far have been pleasing and rewarding. 84

BEECHWORTH TRAINING CENTRE.

PSYCHIATRIST SUPERINTENDENT : DR. G. R. JENSEN.

SECRETARY: MR. A. J. McDoNALD.

Statistics. Patients.

lst January, 1968. 31st December, 1968 .

-- Male. Female. • Male. Female. Total. Total. App, Vol. A pp. Vol. App. Vol. App, Vol.

In residence ...... 183 27 210 .. .. 179 28 207 On trial leave ...... 2 2 4 .. .. 2 2 4 Boarded out ...... Absent without leave ...... Total on Books ...... 185 29 214 .. .. 181 30 211

Male. Female. Total. Approved Voluntary. Approved. . Voluntary.

Admissions- Direct ...... 1 4 5 From Psychiatric Hospitals ...... Transferred IN ...... 1 1 Discharges ...... 4 4 Transferred OUT ......

Deaths ...... ' . .. .. 5 .. 5 Average number resident during year ...... 183 29 212 Persons under care during year ...... 186 33 219 Cases admitted, aged (male 65, female 60) years and over ...... Cases (male 65, female 60) years and over on books as at 31st December, 1968 ...... 28 2 30 I

Staff.

1st January, 1968, 31st December, 1968. -- Male. Female. Male. Female.

Medical-Psychiatric ...... Professional-Non-medical ...... Staff Common with Mental Hospital Nursing ...... Administrative ...... Services /Tradesmen ......

Admission Statistics. There is very little patient movement in the Training Centre which consists, at present, of two female "pensionable" wards and one other ward for the severely retarded. Vacancies are very rare so that there were only five admissions from the waiting list during 1968.

Waiting List and Admission Policy. It is appreciated that there is a long waiting list from which the Chief Medical Officer must select the most urgent committee cases. When a vacancy occurs the Chief Medical Officer is notified and the cases then admitted are usually on a long-term basis. 85

In two cases we arranged short-term placement to relieve a family in distress and it is greatly regretted that there are insufficient beds to meet the requests received for this type of placement.

General Health. There has been no significant epidemics throughout the year. There are a large number of quite elderly patients in the Training Centre and a good deal of chronic illness has needed attention from the Medical Officers and the Visiting Physician.

Buildings and Amenities. As has been pointed out before the wards are not structurally adapted for their purpose as Training Centre Wards. Some effort has been made to improve Myrtle House and the day-room area is now more attractive. There are also plans to improve the outside yard area to provide more out-door activities for these severely retarded patients.

Training Program. Members of the Nursing Administration have helped organize training activities in all three wards and there has been improvement particularly in Myrtle House. Banksia House having the highest grade of patients continues to run a good program.

Entertainment-Social Activities. The Training Centre patients take a very active part in hospital entertainments, attending picnics, socials, films and dances. Many patients were involved in the pantomine this year. Individual patients have shown special aptitudes, e.g., one patient assists with the production of the hospital magazine.

Voluntary Workers. This portion of the hospital benefits, as does most of the rest of the hospital, by the work done by the Wangaratta Mental Health Auxiliary, Church Organizations and the Country Womens Association.

General. The patients in the pensionable wards benefit greatly from their pensions. They are attractively dressed, have many outings and receive birthday presents and Christmas presents. The provisions of pensions has enabled Banksia and Wattle Houses to provide an attractive home-like atmosphere for their patients. In general the Female Training Centre has been quite active during the year. 86

JANEFIELD TRAINING CENTRE AND TRAINING SCHOOL.

PSYCHIATRIST SUPERINTENDENT: DR. H. c. STONE.

SECRETARY; MR. F. S. CLAREBROUGH.

(a) TRAINING CENTRE.

Statistics. Patients.

1st January, 1968. J 31st December, 1968. -- Male. Female. Male. Female. Total. Total. I App. Vol. A pp. Vol. A pp. Vol. • A pp. Vol. ! I ! In residence .. .. 1 3 37 4 45 I 2 I 178 30 274 484 On trial leave ...... Boarded out ...... Absent without leave ...... I Total on books .. .. 1 3 37 4 45 2 178 30 274 484 I

I Male. Female. -- Total. A pp. I Voluntary. A pp. I Voluntary.

I

Admissions- Direct ...... 185 . . 276 461 From Psychiatric Hospitals ...... Transferred IN ...... 1 ...... 1 Discharges ...... 10 6 5 21 Transferred OUT ...... 1 . . 1 Deaths ...... 1 1 Average number resident during year ...... 2 30 33 49 114 Persons under care during year ...... 2 187 37 280 506 Cases admitted, aged {male 65, female 60) years and over ...... Cases (male 65, female 60) years and over on books as at 31st December, 1968 ......

Staff.

1st January 1968 31st December 1968

-- ' I Male. Female. Male. Female.

Medical-Psychiatric ...... 1 . . 2 . . I Professional-Non-medical ...... 3 . . 6 Nursing ...... 12 60 51 64 Administrative ...... 4 1 4 2 Services /Tradesmen ...... I 26 16 43 20 --····· ···----- ····- 87

JANEFIELD TRAINING SCHOOL.

Statistics.

Patients.

1st January, 1968. -~~~31st December, 1968. ············- - Male. Female. Male. Female. Total. . -- Total. Informal. Informal. Informal. Informal.

In residence ...... 53 211 264 ...... On trial leave ...... Boarded out ...... Absent without leave ...... Total on books ...... 53 211 264 ......

Male. Female. Informal. Informal. Total.

A dmissions- Direct ...... 112 113 225 From Psychiatric Hospitals ...... Transferred IN ...... 81 28 109 D ischarges ...... 231 340 571 T ransferred OUT ...... 13 11 24 De aths ...... 2 1 3 A verage number resident during year ...... 126 221 347 p ersons under care during year ...... 193 141 334 c ases admitted, aged (male 65, female 60) years and over ...... c ases (male 65, female 60) years and over on books as at 31st December, 1968 ......

Staff.

lst January, 1968. 31st December, 1968.

Male. Female. Male. Female.

Medical-Psychiatric ...... Professional-Non-medical ...... Staff rnmmon with Training Centre Nursing ...... Administrative ...... Services /Tradesmen ......

During the year three new 48-bed wards were opened, and the old male staff quarters was converted into patient accommodation for six male patients. The total number of patients at Janefield is now 484. Janefield was gazetted as an entire Training Centre on the nineteenth day of November, 1968. 88

The Patients. The number of short-term admissions rose even higher than in 1967, and it is obvious that there is a great demand for short-term beds. Table (I) shows the causes for these admissions :- No. of Temporary Reason for Admission. Patients. Severe hyperactivity 10 Severe epilepsy 8 Severe behaviour problem 7 Aggressive 2 Totally dependent 3 Incipient police action Sexual problem For investigation only 2 For training only 4 Death of mother 6 Absence of mother from home 5 Physical illness of mother 5 Surgical operation on mother 6 Admission of mother to Mental Hospital 2 Psychiatric treatment of mother 16 Stress of mother 15 Alcoholism of mother 3 Mentally defective mother 2 Threatened suicide by mother 3 Senility of mother I Pregnancy of mother .. 6 Death of father 8 Absence of father from home 9 Illness of father 3 Alcoholism of father 2 Threatened suicide by father 1 Senility of father 3 Siblings physically ill Very large families 4 Other causes .. 5

A total number of 66 out-patients were seen by the Psychiatrist and the Social Worker. Most of these cases were classified as most urgent, but it is quite clear that many of them will have to wait some years before a bed is available. Six patients were rehabilitated, and the Social Work Department and the Psychiatrist still keep watch over their placement in the community. There were two deaths during the year-one from epilepsy, and one from post-operative pneumonia. Shigella continues to be a problem, particularly in the toddlers' ward. Efforts are being made to disseminate toddlers throughout the hospital, and thus eliminate Shigella completely. The Public Health Branch has visited the hospital twice during the year, and their recommendations regarding the control of infectious diseases have been implemented. There was also a small out-break of hepatitis during the year. The hospital now contains some 70 epileptic patients, many of whom are behaviour problems. There are some 30 spastic patients, as well as autistic children, and several delinquents, who are also retarded.

Training Programmes. Training programs have been somewhat depressed, owing to the large influx of patients, but it is hoped with more buildings, and with the already increased staff establishment in Occupational Therapy, that this matter will improve. The total number of patients in training amounts to 372.

Special School. For the first time boys attended the school but this has not caused any problems. The total number in attendance is approximately 120, for which there are nine teachers at the moment. 89

Occupational Therapy. Two pre-school groups, two lower-level groups for patients over sixteen years of age, and one high-level group for patients over sixteen years of age have been maintained throughout the year. All these groups have functioned only on a half-day basis. The total number in attendance at Occupational Therapy has been 240, for which there have been four staff. Approximately twelve to eighteen patients have continued to be trained at the Sewing Room, Vegetable Garden and Farm ; which have provided satisfactory training for patients about to leave the hospital.

Community Involvement. The Social Work Department.-There has been an immense increase of work necessary in this department. A total number of 1,041 interviews were conducted throughout the year by the Social Worker and by the Case Aide. Much of the time of the Social Worker and Case Aide is spent answering telephone calls and letters regarding requests for admission. V.S.A. Course.-A course of ten lectures was given, and some 23 women received Accreditation Certificates. Most have continued to show an interest in the hospital. V.S.A. Youth Course.-Sixty-seven high school and university students attended a specially designed whole day course on Mental Retardation during their September holidays. Seminar on Autism.-Some 80 visitors from outside the hospital attended a seminar on this subject. Janefield Auxiliary.-The auxiliary has continued to provide special amenities for the patients, and has continued to be active throughout the year. Janefield Chapel Building Fund.-This committee was commenced during the year, and its fund raising activities are now well in progress. The Red Cross has continued to bring patients for appointments, and has also provided regular transport for children living in the Gippsland area, to enable these children to go home for week-ends and holidays. The Commonwealth Government Clothing Factory, Victorian Railways, Country Women's Association, and many other groups have continued their support and interest throughout the year.

Staff The shortage of medical staff and nursing personnel has continued. The teaching of student nurses, case conferences, and out-patient assessments are demanding, and for the most part of the year there was only one medical staff. All artisans performed their duties in a satisfactory manner. General maintenance was carried out on buildings in conjunction with the Public Works Department. The farm continued to supply milk required for the hospital, and also a certain quantity to Mont Park Mental Hospital. Vegetables were obtained in good supply from the vegetable garden, whilst the ornamental grounds were maintained at the usual high standard. 90

KEW CHILDREN'S COTTAGES, TRAINING CENTRE.

PsYCHIATRIST SuPERINTENDENT : DR. 1. L. EvANS.

SECRETARy : MR. D. NU GENT. Statistics. Patients.

1st January, 1968. 31st December, 1968. ······----·····-- ! Male. Female. Male. Female. Total. Total. ! A pp. Vol. A pp. Vol. A pp. Vol. A pp. Vol.

In residence . . .. 317 253 189 146 905 268 286 182 163 899

On trial leave .. . ' 11 15 4 11 41 7 20 3 19 49 Boarded out ......

Absent without leave .. ! ...... i ! I I ! Total on books .. 328 268 193 157 946 275 306 185 182 948 .. I I I '

I Male. Female. Total. Approved. I Voluntary. Approved. I Voluntary.

! A dmissions- ! Direct ...... 2 134 .. 78 214 From Psychiatric Hospitals ...... Transferred IN ...... 10 9 7 4 30 D ischarged ...... 45 90 3 50 188 T ransferred OUT ...... 11 9 7 4 31 Deaths ...... 9 6 5 3 23 A verage number resident during year ...... 293 274 188 163 918 p ersons under care during year ...... 325 374 190 216 1,105 Cases admitted, aged (male 65, female 60) years and over ...... c ases (male 65, female 60) years and over on books as at 31st December, 1968 ......

Staff.

lst January, 1968. 31st December, 1968.

Male. Female. Male. Female.

Medical-Psychiatric ...... 5 2 6 2 Professional-Non-medical ...... 2 8 2 9 Nursing ...... 119 173 114 176 Administrative ...... 4 3 4 3 Services/Tradesmen ...... 38 19 45 27 _.. ------·-·------~---- - The Children's Cottages, Kew, have completed another difficult year. Although very great advances have been made during the last decade, there is still very much to be done to bring standards up to a proper level and to reduce the gross over-crowding which continues in some areas. There have been significant changes in the type of patient admitted to the Cottages over the years. As the result of the extreme shortage of accommodation and the pressures of the large waiting list, patients admitted are tending to become more severely retarded and to have a higher incidence of physical illness and deformities. Of our in-patient population, which averaged 918 throughout the year, 54 per cent. are within the profoundly retarded range. More than 200 patients are suffering from associated physical disabilities so severe as to require special nursing and specially designed accommodation. There is, however, a serious shortage of special accommodation, and a number of these patients are housed in wards designed for other purposes. 91

The general health of the patients has on the whole been very satisfactory and is a credit to the members of the staff at all levels who have contributed to this result. A minor epidemic of infective hepatitis occurred during the year but this was stopped dramatically by the administration of gamma globulin to every in-patient. Shigellosis continues to be a worrying problem. Special clinics were held by a number of visiting consultants (paediatric surgeon, dermatologist, ophthalmologist and cerebral palsy consultants) and it is hoped that an ear, nose and throat surgeon will be appointed on a sessional basis. Thirty-five patients were admitted to non-departmental hospitals for medical or surgical treatment and 23 were admitted to the Kew Surgical Unit. The Paediatric Hospital Unit, under the control of out Consultant Paediatrician, remains the centre for the general medical functions of the institution. Research activities of a medical nature were also based on this unit. A formally organized out-patient department was set up and it has now become a firm policy that no patient is accepted for addition to the waiting list without a full investigation by our Social Work Department and by our medical staff at the Out-patient Department. Laboratory services, which in the previous year had been undertaken single-handed by Dr. J. Chakanovskis in three half-day sessions per week in addition to her work as a full-time member of the medical staff, were expanded during 1968 with the appointment of a full-time biochemist. Nine hundred and forty-eight consultations were carried out at the Children's Cottages by our dentist who shares his time approximately equally with the Kew Mental Hospital. Because of the high incidence of unco-operative patients a good deal of treatment had to be carried out under general anaesthesia. It is essential that the full-time services of a dentist be available to the institution. The Social Work Department has experienced a rather unsettled year with a number of changes of staff. Only two social workers were available for a greater part of the year. A good deal of the work of the social workers relates to the waiting list. New referrals are, however, only a fraction of the total caseload, many families who had previously been admitted to the lengthy waiting list being in crisis situations most of the time. The Social Work Department has also played an active part in educational activities, both inside and outside the Cottages, and has also been engaged in a number of worthwhile community activities. An additional psychologist was appointed early in 1968 making a total of two. The work of this Department of the Cottages consisted largely of assessment, teaching, research and therapy. The psychologists also have been actively involved in educational activities. A large number of lectures were given to student nurses and also to a wide variety of other groups within and without the Cottages. Because of the very heavy demands made upon the psychologists it is clear that two are unable to cope adequately. For the greater part of the year the Occupational Therapy Department was staffed by six trained occupational therapists and 61 unqualified assistants of varying degrees of experience. The majority of children were involved in group activities of kindergarten, junior training, or workshop type but a small number were seen for individual therapy. The Special School No. 4431 continued its excellent work during the year. It was staffed by six full-time and two part-time teachers provided by the Education Department. Sixty-one children attended the school during 1968. New admissions during the year numbered 17 and 7 boys left school at the end of the year, having reached the age of 16. Language, communication and competence in social and physical skills continued to be the areas of emphasis and attention was given to meeting the needs and individual differences of the children. The speech therapist provided three sessions per week throughout the year. These sessions were conducted in the special school in close association and co-operation with the teaching staff. Although an establishment exists for two full-time physiotherapists or four half-time therapists, for the greater part of the year the total staff consisted of two half-time staff members. The services of the Royal Children's Hospital's splint shop and of the bootmaker, carpenter and engineer at Kew Mental Hospital were frequently called upon and their assistance was much appreciated. Chaplaincy services are shared on an equal basis with Kew Mental HospitaL A notable advance during the year was the appointment of a Roman Catholic priest, Father J. H. Scannell, to supplement the efforts of the Anglican Chaplain, the Rev. H. A. Cairns. A noteworthy feature of the chaplaincy services has been the high level of friendly co-operation between the two chaplains. The Anglican chaplain conducts a well attended service in the Geiger Hall every Sunday, while the older boys and girls of the Roman Catholic faith who are able to do so attend Mass at Kew Mental Hospital. Although the School of Nursing at the Cottages is the central training school for the whole of Victoria for mental deficiency nurses, and provides training programmes for nurses from four institutions, the number of students who commenced their training in 1968 was 21 (15 females, 6 males). This is the lowest number since the school opened in 1962. Many applicants had to be rejected because they lacked the minimum educational standard required by the Victorian Nursing Council. A feature of the year was the increasing number of psychiatric nurses wishing to undertake mental deficiency nurse training as a post-basic course, and sixteen such students were enrolled during the year. Twenty-one students from the Children's Cottages graduated during 1968. An important feature of the year was the presentation of a full-time refresher course for charge nurses and other senior nursing staff. The course was of one week's duration and was given three times to enable all relevant staff to attend. The course, the subject matter of which was recent developments in mental deficiency, was enthusiastically received by all who participated. 92

The only major works which went on during 1968, and they are still very incomplete, were the reconstruction of covered ways in the older section of the Cottages. It must be reported with regret that a great deal of major work is required at the Cottages to bring this institution up to a reasonable standard of accommodation for its patients. It is true that a great deal has already been done in recent years but much still remains to be done. One of the most urgent projects must be the demolition and replacement of Ward 16A. The provision of adequate toilet and bathing facilities for Wards 11 and 21 are also very urgent. It is clear that both of these wards require either extensive remodelling or complete replacement. Ward 26-27 is also in an unsatisfactory condition for the purposes it is endeavouring to fulfill, and priority must also be given to the inadequate bathing and toilet facilities in this ward.

A very urgent need is the provision of an administration block. Some of the many problems which exist at the Children's Cottages are a direct result of the fragmentation and lack of co-ordination arising from the absence of a centralized administration. The Children's Cottages simply cannot be expected to work as a co-ordinated, smoothly-running and harmonious institution until this essential facility is provided.

In addition to all of these works it is also necessary that a central linen store, adequate facilities for artisan staff, a garage for hospital vehicles, a chapel, and a small block of motel-type units to provide temporary accommodation for parents who are visiting seriously ill children be provided as soon as possible.

An interesting innovation during the year was the installation of means of supervising and controlling the boilers at the Children's Cottages by remote control from the boiler house at Kew Mental Hospital. Both boiler houses can now be supervised by one attendant, and without additional staff an extended boiler service to both institutions becomes feasible. It may now soon be possible to provide 24-hour heating for wards and a continuous hot water service during the night.

Maintenance in the fields of carpentry and engineering presents special difficulty because the staff involved are attached to Kew Mental Hospital and the Cottages does not have an independent staff of its own. The administrative staff has had difficulty in coping with an increasing volume of work which is associated mainly with invalid pensions. There is also a lack of experience amongst the members.

A constant source of frustration, both for professional staff and for parents of patients, is the lack of an effective external telephone system. Only one ward is connected to the P.M.G. telephone system, and an extension to every ward is an absolute essential.

Salaried medical staff consisted at the end of 1968 of seven full-time and one half-time members. These numbers are barely adequate.

Despite the encouraging numbers of graduates at the final examinations, nursing staff shortages are still very serious. It has never been possible to approach even remotely the filling of the female nursing staff establishment. Although the male nursing staff establishment has never been filled, the shortage on paper has not appeared to be so serious.

The waiting list continues to be a major problem. The centralization of all departmental waiting lists for the retarded under the control of the Chief Medical Officer, together with his regular monthly meetings with Superintendents and Social Workers of the Training Centres concerned, has added to the efficiency with which the waiting list is organized.

As in previous years, an attempt was made to provide some temporary relief for families with patients on the waiting list at the time of school holidays when a number of children are taken home by their parents. It is possible at such times to fill the temporarily empty beds for the duration of the holiday. In addition a small number of patients were admitted on a temporary basis at other times to tide families over emergencies such as confinements, parental illness, bereavement, &c.

Moorakyne Hostel, which has functioned semi-autonomously for years as a departmental hostel for mildly retarded girls, came under the control and supervision of the Cottages during the year. This Hostel provides accommodation for 30 girls. In the last year or two, however, it has accommodated an average of 20 to 22 girls, but this was increased by the end of 1968 to 27. The majority of the girls are in full-time employment but some receive pensions and attend sheltered workshops or are occupied doing simple domestic work in the district or at the Children's Cottages. The Superintendent and Secretary visited regularly in the latter half of the year.

The Cottages were, as in previous years, very fortunate in the recognition and support which they obtained from a large number of individuals and organizations in the community. Contributions of money and of service were many and generous. 93

An interesting and encouraging feature of the year was the very large number of older school children who came to the Cottages to help in various ways and to participate in the work of the institution. This augurs well for future acceptance of the Cottages by the community ; the only problem is so many children wish to help that their numbers are occasionally an embarrassment. The Visiting Service of Auxiliaries, as in previous years, provided sterling service. A large number of these people worked in wards, supplementing and complementing the work of the nursing staff. In addition to the work carried out within the Cottages a large number worked in the community, assisting the parents of retarded children, baby sitting while mothers went shopping, providing transport to day centres and clinics, and numerous other tasks. Training and orientation courses were held at the Cottages and at Essendon and the response was most gratifying. Two small swimming baths were presented to the Cottages during the year by generous citizens. The Children's Cottages is a large training centre for the mentally retarded. Its facilities are variable, some being of quite excellent standard and a few being worthy only of immediate demolition. Much has been done in the last year to ensure the co-ordination and harmonious interaction of the various sections of the Cottages, but this work is hindered by the lack of a central administration block, and by an inadequate communication system. Despite many difficulties, much excellent work is being done by a devoted staff and there is a great deal to be proud of. 94

SANDHURST BOYS' CENTRE.

PSYCHIATRIST SUPERINTENDENT : DR. J. P. BOMFORD.

SECRETARY : MR. D. FLYNN.

Statistics. Patients.

1st January, 1968. 31st December, 1968.

- Male. Female. Male. Female. Total. Total. Informal. Informal. Informal. Informal.

In residence ...... 85 . . 85 83 .. 83 On trial leave ...... Boarded out ...... Absent without leave ...... Total on books ...... 85 .. 85 83 . . 83

•.. Male. Female. -- Total. Informal. Informal.

Admissions- Direct ...... 13 13 From Psychiatric Hospitals ...... 1 1 Transferred IN ...... 10 10 Discharges ...... 22 22 Transferred 0 UT ...... 4 4 Deaths ...... Average number resident during year ...... 78 . . 78 Persons under care during year ...... 109 .. 109 Cases admitted, aged (male 65, female 60) years and over ...... Cases (male 65, female 60) years and over on books as at 31st December, 1968 ......

Staff.

1st January, 1968. 31st December, 1968. -- Male. Female. Male. Female.

Medical-Psychiatric ...... 1 .. 1 .. Professional-Non-medical ...... Nursing ...... 14 .. 14 .. Administrative ...... 3 . . 3 .. Services/Tradesmen ...... 11 4 11 4

General Health. The health of the boys has been maintained at a high level, and beyond the usual seasonal ailments and accident cases, no major illnesses were reported. Nursing staff have kept a check on optical and dental defects, and these have been dealt with promptly.

Behaviour. Only one lad had to be transferred for misbehaviour, and this because of his persistent wandering off the area. Behaviour on outings was excellent, however there have been a larger than usual number of acts of vandalism, and irresponsible behaviour within the Centre. This has probably been brought about by the number of immature lads at present in residence. 95

Training. All workshops are in full operation, and the boys under their respective instructors have worked well. Evening hobby classes have produced a variety of articles which are ultimately sold at the Annual Fete conducted by the Ladies' Auxiliary. Some 1,200 slippers were manufactured for departmental use, by the boys in the leather work group. The maintenance groups responsible for the upkeep and cleanliness of the area have performed a difficult task in a splendid manner. Weekly instructions are given by the visiting Chaplains, and boys attend their various services each Sunday.

Voluntary Organizations. The Ladies' Auxiliary provide the only regular assistance in this field, and through their generosity a new set of stage curtains was obtained, and a supply of sporting equipment was purchased. These ladies give freely of their time, and are very popular figures around the Centre. During the year several other voluntary groups have provided entertainment for the boys, and their visits are greatly appreciated.

Amusements and Amenities. The boys have enjoyed a variety of entertainments, including a swimming carnival, Sports Day, Fancy Dress Ball, and Picnic Day Trip. The Speech Night was again the highlight of the year, and the standard of entertainment provided reflects great credit on the organizers of the programme. Those who did not go home for holidays, enjoyed two weeks at the Toe H Camp at Point Lonsdale. Football and cricket are the most popular of all sporting activities, and provide great entertainment both for spectators and participants. The staff and boys have just completed the preparation of volley ball courts, which wiJI provide an additional sporting outlet.

Working Boys. There has been a drop in the number of boys in local employment, and currently only nine boys go to work each day from the Centre. However several others are engaged in part-time work, and are employed for one or two days each week. Most of the lads are employed on either market gardens or poultry farms. A total of eleven boys were discharged to employment during the year, and this figure is consistent with those of recent years.

Staff. There have been two changes of staff during the year and the newcomers one a fireman, the other a Training Assistant have fitted in well. The staff have generally performed quite well.

Two vacancies for Ward Nurse still exist, this has been the case for over two years, and it is obvious that we cannot attract trained nursing staff until such time as they can see some opportunity for promotion in this area. 96

PLEASANT CREEK SPECIAL SCHOOL : STA WELL.

ACTING PSYCHIATRIST SUPERINTENDENT: DR. G. D. BURROWS.

SECRETARY: MR. T. W. CousiNS.

Statistics. Patients.

1st January, 1968. 31st December, 1968. ! Male. Female. Male. Female. Total. Total. Informal. Informal. I Informal. Informal.

In residence ...... 80 58 138 98 70 168 On trial leave ...... Boarded out ...... Absent without leave ...... Total on books ...... 80 58 138 98 70 168

I Male. Female. -- Total. Informal. Informal.

Admissions- Direct ...... 28 20 48 From Psychiatric Hospitals ...... Transferred IN ...... l3 12 25 Discharges ...... Transferred OUT ...... 20 20 40 Deaths ...... 3 .. 3 Average number resident during year ...... 73 53 126 Persons under care during year ...... 121 90 211 Cases admitted, aged (male 65, female 60) years and over ...... Cases (male 65, female 60) years and over on books as at 31st December, 1968 ......

Staff.

1st January, 1968. 31st December, 1968.

; Male. Female. Male. Female.

Medical-Psychiatric ...... Professional-Non-medical ...... 1 P.T ...... Nursing ...... 12 20 32 38 Administrative ...... 2 1 3 1 Services/Tradesmen ...... 15 8 25 17

The year of 1968 has seen many changes at Pleasant Creek. The two new Dependent Wards were completed and occupied in September, with a gradual intake of patients. Site works around the buildings are being completed and it is anticipated that these will be finished in time for the official opening in March, 1969. The swimming pool was also completed during the year and has given hours of enjoyment to the children. Once again we must compliment the Ladies' Auxiliary on their tremendous efforts over the past twelve months in arranging the Quarterly Birthday Meetings, Christmas Tree and Picnics. They were also instrumental in making and obtaining a bountiful selection of both soft and wooden toys for use in the new Dependent Wards. 97

Church Groups, Sun Toy Fund, State School Mothers' Clubs, the Country Women's Associations and local organizations still continue to give their support to the children with outings and treats as well as Birthday and Christmas presents. The general health of the children throughout the year has been very good. The general medical practitioners from Stawell continue to give medical and surgical care to the children when required. The erection of an Administrative Block with an Out-patient Clinic is urgently required as there is a shortage of office accommodation for Administrative, Medical and Nursing Staff. Production in the vegetable garden was greatly increased during 1968 to cope with the increase in patients and staff in the Dependent Wards. An excellent supply of fresh vegetables was maintained throughout the year (66,562 lbs.). Extensive site works have been performed around the grounds, particularly in the area surrounding the Dependent Wards where landscape gardens have been established. Lawns have also been sown around the new Swimming Pool section. Several tours of senior students from various surrounding High Schools have been conducted with the view of obtaining girls with necessary educational qualifications to train as Mental Deficiency Nurses. Nurses in Training- 3rd Year 2 Females 1 Male 2nd Year Female 2 Males Examination Results- 1st Year 2 Males-Passed 2nd Year 1 Male-! Female-Passed. Holiday placement for children, from families living in the area, has again been provided with good results. This also helps the families concerned to obtain some relief from the tensions which these children create at home. The assessment panel, under the leadership of the Psychiatrist Superintendent, held their discussions regarding the placement of the children when they attain the age of 16 years. There appears to be an ever increasing problem regarding the placement of these children to suitable environment.

2984/70.-7 98

TRAINING CENTRE: SUNBURY.

PsYCHIATRIST SuPERINTENDENT: DR. L. R. H. DREW.

SECRETARY : MR. K. M. BAIRD.

Statistics. Patients.

i 1st January, 1968. 31st December, 1968.

------~·-----~·--~----- ~-~---~ I ! Male. Female. Male. Female. I Total. -----· ! Total. ! Rec. Vol. Rcc. Vol. Rec. Vol. Rec. Vol. i

In residence .. . . 90 230 I 74 I 230 624 101 367 74 226 768

On trial leave .. ' . 12 27 6 16 61 12 13 6 20 51 I Boarded out . . . . '......

Absent without leave ...... ' . '...... I Total on books .. . . 102 257 80 246 685 113 380 ! 80 246 819 I I I '

Male. Female. -- Total. Rec. Voluntary. Rec. Voluntary.

Admissions-

! Direct ...... 29 190 . ' 28 247 From Psychiatric Hospitals ...... 2 I 2 1 6

Transferred IN ...... ' . '. . . 12 45 17 34 108

• Discharges ...... 12 56 15 I 17 ! 100 Transferred OUT ...... 17 50 2 40 109 '. I I ! Deaths ...... ' .. 3 7 2 6 18

Average number resident during year .. . ' . . 95 214 75 235 619 Persons under care during year ...... 129 342 109 295 875 Cases admitted, aged (male 65, female 60) yC".ars and over .. 2 .. . . 6 8 Cases (male 65, female 60) years and over, on books as at 31st December, 1968 ...... 17 16 3 4 40

Staff-Common with Mental Hospital. General Comment.-1968 has again been a year of considerable change, of serious staff shortages, and services in many ways inferior to those which should be expected. The administrative reorganization instituted last year has been consolidated with continuing benefits. Efforts have been directed towards reducing the number of Mental Hospital patients and improving. programs geared towards the needs of the mentally retarded. Mentally ill patients were exchanged for mentally retarded patients from other hospitals and a substantial number of patients were accommodated in the community. At the end of 1968 the institution contains only 150 persons who can legitimately be held in a Mental Hospital, and only three wards remain to be gazetted as part of the Training Centre. General Health of the population remained good, with a surprisingly low death rate. This fact alone will necessitate expansion of services for mentally retarded people in the future. There were no further sudden deaths among epileptics. Treatment.-The emphasis in treatment in that section catering for the moderately and severely retarded was upon their increasing involvement in occupation and recreation. In the section catering for the mildly retarded the emphasis was upon preparation for, and placement in the community. When staffing permitted, one doctor spent her whole time selecting, placing and supervising people within the community. Results have not been dramatic, but they are substantial as a result of a team effort between all staff at the institution. Our efforts have been hampered by the lack of community resources to which patients may be referred-and thus discharged. Particularly pressing is the general need for male hostel accommodation. Many patients have been admitted for short periods (2-6 weeks) to relieve parental pressures. Most patients return home happy in the anticipation that they may spend a further " holiday " at Sunbury at a later date. Some of these " temporary admissions " are persons on our " most urgent waiting list," for whom a permanent vacancy cannot be found. 99

The use of drugs has been further reduced although anticonvulsants, and in some instances tranquillisers, are needed. Improved classification, and the subdivision of large groups of patients, has resulted in a far more pleasant atmosphere for both staff and patients. Patients have responded to this. A central sterilizing service has been established. Although there is relatively little call for sterile equipment tuition within this area is an important aspect of nurse training. Occupation was centred on the Activity Centres and was dependent on V.A.T. M.T. projects, although a considerable number of patients are still employed in hospital industry and as ward workers. The aim has been to provide a balanced program, in a group setting, for each patient. Over 400 patients in the training centre are now incorporated in programs directed by the Occupational Therapist, within activity centres, and there are only about 20 patients (in the hospital ward) for whom no active program is provided. All staff have been surprised at the enthusiasm with which severely retarded patients attack productive occupation-far preferring this to fun and play activities. We have also been surprised at their previously unsuspected potentials. The Occupational Therapy Department (a quite inappropriate name) is certainly the backbone of our program for the moderately and severely retarded patients. Further space and staff have been provided this year, but still more of each is needed. A very welcome advance has been the increased participation of ward staff in the activities programs. Communication.-An automatic exchange was installed at Sunbury and telephone communication with other centres has improved. Recreation.-The Amenities Officer has again made commendable efforts directing a program of entertainment at Ward and Hospital levels. A large number (300) of patients have had at least one holiday at the beach during the year. A new departure was for a group (Males and Females) to go on a "school tour" to Bright. These experiences, and single day excursions, are extremely important in deinstitutionalizing people, giving them increased community awareness, and in awakening an enthusiastic outgoingness which so often has been lacking. Social Work.-There have been increased demands, with an increase of over 80 per cent. in the number of referrals above 1967. The appointment of a second social worker early in the year was invaluable. The continued use of two welfare assistants and domiciliary (charge) nurse have been essential. There has been a decreased emphasis on seeking employment and an increase in search for accommodation, in the provision of after-care for patients, and in long-term support for the operators of Nursing Homes and Boarding Houses and in work with the waiting list. The Social Work Department also has responsibility for directing the holiday schemes, V.S.A. activities, community education, the training of domiciliary nurses, and the supervision of field work by students from the Department of Social Studies, Melbourne University. Accommodation and Classification.-Wards M l, 2 and 3 were gazetted part of Sunbury Training Centre in December, 1968. Efforts have been made to keep retarded persons segregated from those who are mentally ill, but this has not always been possible. Although there have been many administrative problems the patients do not appear to have been unduly disturbed by such failures. Certainly geriatrics mix in well, regardless of their previous intelligence. Efforts have been made to subdivide the remaining large wards. Already M5, M8 and F6 have each been divided into two wards of 30 patients. Ward M6 was converted to a disturbed ward with a group of 20 mildly, and a group of 15 severely retarded and disturbed patients. Toilet facilities in most wards are in urgent need of renovation. These renovations should be undertaken in conjunction with other work. Other work was completed in Ward F4. Approval was given for the demolition of small central wooden sections on each side of the Hill Wards, to reduce the fire hazards. Our new industrial therapy building went into use in February. Extensions and renovation of toilet facilities at the staff mess room have been completed. It is imperative that early consideration be given to arriving at a comprehensive plan for the use, reconstruction or demolition of all buildings at Sunbury. An important new departure was the conversion of the Old Nurses Home into a Hostel for young mentally retarded adults-one section with 5 men who work outside the hospital, and the other section with 10 men and 10 women who have a comprehensive training program to equip them to return to the community. The appointment of an education officer is essential to this project which is integrated closely with the program of Wards M6A and F9. The Education Department has signified its inability to meet this need. More time must also be spent here by a Psychologist. The need for further specialized wards and programs is becoming increasingly apparent. Mentally retarded patients with psychiatric disorders, and adults who have had childhood psychosis, need to be segregated from the others. A special adolescent ward is needed ; and facilities to deal with disturbed, handicapped (but not really retarded) persons, are also needed. Furnishings in the "Hill Wards" are inadequate. Particularly poor are the lounge room furnishings in the male wards. 100

Transport.-Throughout the year the two official cars travelled well in excess of 50,000 miles and there was an additional considerable usage of private cars. The increase in Out-patient services by Medical staff, attention to the waiting list, the demands of placement and supervision of patients in the community, and increasing involvement of staff in training courses and conferences, are such that an extra car is a very urgent necessity. Clothing.-Considerable attention has been given to improving the standard of private clothing, particularly in the male side where improvement was most needed. The care of clothing, for such large numbers, remains a great problem. Efforts at individualization of all clothing have been made, but much nursing staff time is taken in this way. No easy solution presents itself. 101

PSYCHIATRIC DEVELOPMENTAL CENTRE : TRAVANCORE.

PSYCHIATRIST SUPERINTENDENT: DR. K. M. BENN.

SECRETARY : MR. W. ]. SERTORI.

Statistics. Patients.

lst January, 1968. 31st December, 1968.

! - Male. Female. Male. Female. Total. Total. Informal. Informal. Informal. Informal.

In residence ...... 44 26 70 8 8 16 On trial leave ...... Boarded out ...... Absent without leave ...... I .. I Total on books ...... 44 26 70 8 8 16 I

Male.

Informal.

Admissions-

Direct 3 From Psychiatric Hospitals Transferred IN

Discharges 3 7 10 Transferred OUT 14 50 Deaths Average number resident during year 17 17 34 Persons under care during year .. 47 29 76 Cases admitted, aged (male 65, female 60) years and over Cases (male 65, female 60) years and over on books as at 31st December, 1968 ----·--··--···----· Staff.

I 1st January, 1968. 31st December, 1968.

-- I Male. Female. Male. Female.

M edical-Psychiatric ...... 1 . . 1 . . Professionai-Non-medical ...... I ...... I N ursing ...... I . . ! 18 . . 11 A dministrative ...... 1 1 1 1 Services /Tradesmen ...... 4 11 4 I 5 ··--~··--

General. Reference to Table 1 suggests a great deal of activity in regard to admission and discharge, however, the figures merely reflect the activities associated with the changeover of function. Early in the year, the children occupying two wards were transferred to other Centres, in order for rebuilding activities to be conducted on these two buildings. One building allocated as a new admission ward is close to completion and will be ready for occupation in early 1969. This building will provide the latest residential facilities for twelve emotionally disturbed children and care will be intensive. In spite of the closure of the two buildings, a good deal of work has continued with the residential population of children, temporarily restricted to 24 children. During 1968 for the first time residential facilities were restricted to emotionally disturbed children. 102

The Residential Program. Associated with the change of function it has been necessary to introduce a number of temporary changes of child care procedure. A regular play program each afternoon has become the responsibility of the professional staff on a rostered schedule. Invaluable help has been given by the Social Involvement Group of University High School in implementing this program. The enthusiasm and idealism of this group of young people has been truly wonderful and has suggested to us, a number of ways by which this help might be further widened. There has been a number of staff losses during the year which will, no doubt be offset by the expected influx of child care officers and psychiatric nurses in 1969. Some reorganization of allocation of professional time has been necessary in order to cope with the increased clinical responsibilities within the residential unit. During the year therefore, an increased and significant amount of time was utilized by psychiatrists, psychologists and social workers in treatment and testing of the children. Regular staff conferences of teaching, nursing staff and professional staff took place during the year. An increased allocation of time has been necessary to work with the parents of the children in residence.

The School Program. Due to the influx of disturbed and sometimes quite inaccessible children, it has been necessary to re-organize the activities of the school, and the division of function between teachers. Small intake groups of 2-3 children for brief periods of contact are used in order to create an atmosphere conducive to the development of satisfactory pupil-teacher relationships. As the process develops, so the children move into larger groups, where academic activities are more to the fore. However emphasis is placed on mobility of activity as this seems to be an essential requirement for children with a poor attention span. With such an arrangement, crisis intervention has proved to be possible and more meaningful, but again, this has needed a great deal of staffing support from the various clinic teams.

Social Activities. Emphasis has been placed upon return of the child to his home during week-ends and holidays, but due to some children being inaccessible because of distance from country homes, it has been necessary to arrange social activities of all varieties. As in previous years, it would be impossible to list or to thank adequately the large number of kind friends and worthy organizations, who have been in large measure, responsible for this program. In particular, mention must be made of the Lions Club (Essendon), various sections of the Scout movement, and the Coburg Holy Trinity Church Youth Group, who time and time again arranged picnics and parties for the children. In a similar manner, a number of donations to the Comfort Fund were received, from old and loyal friends of Travancore but far too many to list. 1968 has been an exciting and very promising year for Travancore. There seems no reason to believe that 1969 will be any less successful or satisfying. 103

ST. NICHOLAS INFORMAL TRAINING CENTRE : CARLTON.

PSYCHIATRIST SUPERINTENDENT : DR. D. W. MAGINN.

SECRETARY : MR. J. W. HAYES.

Statistics. Patients. 1st January, 1968. I 31st December, 1968. ! - Male. Female. Male. J Female. Total. Total. In!'ormal. 1 Informal. i Informal. Informal. I : In residence ...... 81 96 177 86 76 162 I On trial leave ...... I ...... Boarded out ...... Absent without leave ...... I I I Total on books ...... 81 I 96 177 I 86 76 162 I _' I

Male. Female. Total. Informal. Informal.

Admissions- Direct ...... 54 56 110 From Psychiatric Hospitals ...... Transferred IN ...... I ...... I Discharges ...... 45 69 114 Transferred OUT ...... Deaths ...... 4 7 11 Average number resident during year ...... 80 88 168 Persons under care during year ...... 135 152 287 Cases admitted, aged (male 65, female 60) years and over ...... Cases (male 65, female 60) years and over on books as at 31st December, 1968 ...... i l

Staff.

lst January, 1968. 31st December, 1968.

- I Male. Female. Male. Female.

Medical-Psychiatric ...... 2 I . . 2 . . Professional-Non-medical ...... 1 I 1 1 3 Nursing ...... I 64 ...... I . . 74 Administrative ...... 2 . . 2 i . . Services /Tradesmen ...... 34 28 37 I 26

Hospital Patients. There is an apparent decrease in the number of patients in residence, due to the fact that during the year, girls in the hostel were removed from the list of patients, and are now regarded as boarders as in other hostels outside institutions. It has been possible to admit more children on a permanent basis during the year, as twelve of our patients were transferred to the new Dependent Wards at Stawell, and five of our more advanced children could be accommodated at Janefield. The number of temporary admissions has decreased because of the urgency of admitting children on a permanent basis. In spite of these admissions, the most urgent waiting list continues to grow due to new referrals as well as increased difficulties in families of children who had been regarded as less urgent. This problem will be dealt with further in the Social Worker's report. 104

The small number of eleven deaths in the profoundly retarded children we have in residence is a tribute to the continued high standard of nursing care provided by Matron and staff. A further illustration of this care was the control of an outbreak of infectious hepatitis in January, 1968. Even though there was almost an epidemic in the general population, only three clinical cases, and 23 sub-clinical cases were detected in the children and staff.

Assessment Clinic. The number of attendances during the year was 200. Of these 179 were seen for the first time, and 21 were for follow up interviews. It is felt that the main contribution of the Clinic is seeing the parents and relatives of retarded people with a minimum of delay and advising them about management, as in many cases it is found that parents have been desperate, not knowing where to turn for help. In addition to the numbers quoted above, 64 people have been seen by medical officers from Sunbury.

Psychology. It has been the policy for some time to encourage the psychologist to do some work with normal children. Accordingly, the present psychologist spends one day weekly at the Mission of St. James and St. John Children's Clinic.

Social Work. Waiting List.-Forty-three children were permanently admitted to St. Nicholas in 1968, and twenty children on the waiting list died. Ninety-two families were willing to keep their children at home for some time yet, provided they could have temporary admissions for holidays and in times of family crisis and in 1968, 70 different children were admitted to St. Nicholas for temporary periods, many of these several times. Some children came regularly for week-ends, others during mother's confinement or the school holidays. Children were placed privately where possible. Three hundred and seventy home visits were made, 30 of these being done by social work students. Parents of children already admitted to St. Nicholas were not visited unless there were particular problems, but some of those attended fortnightly parents' discussion groups. Hostel.-Employment was found for eight girls, and except for one girl who had to change her job once because she moved to another hostel, these girls all are satisfactory employees. Social work students helped in contacting employers, &c.

Physiotherapy. We were fortunate in obtaining the services of a full-time physiotherapist in June. In addition to the work done with in-patients, she has some regular out-patients and is available for advice to parents of children who come for assessment.

Dental Service. We have been fortunate in continuing to retain the services of Mr. F. H. Burrage, who comes from Royal Park one day weekly. He has reviewed all the children and hostel residents. The treatment of dental care in the patients has been expedited by the use of regular general anaesthetics given by Dr. Elizabeth Kenny. In general, these patients are a high anaesthetic risk, and more time than normal is required to obtain satisfactory anaesthesia. During fourteen sessions, a total of eighteen children were given much needed dental treatment. In addition it has been possible to treat some children with local anaesthesia.

Nursing. While in general the staffing has been adequate, extra beds have needed to be created from time to time in emergencies, putting extra strain on the staff. The continued standard of nursing care is indicated by the small number of deaths and the fact that the difficult task of controlling an outbreak of hepatitis was achieved in a relatively short time. There continues to be a large turnover of Ward Assistants, but the total establishment has been filled most of the time. Eight Ward Assistants passed in the Departmental Examination held in November. Seven girls commenced the Course for Mental Health Trainees in 1967. Of these, three have resigned and four are now Second Year M.D., Nursing Trainees. Of the seven girls who commenced this course in 1968, two resigned during the year, three commenced M.D., Nurse Training in November and two remain as Mental Health Trainees as they were too young to commence Nurse Training in November. There is now a total of twelve Mental Deficiency nursing trainees attached to St. Nicholas ; eight second year, and four first year. 105

Girls Hostel. Residents, lst January, 1968 ll Admitted 18 Discharged : Home (not working) 2 Home (working) 3 Other Hostels (working outside) 7 "Live in" jobs 2 Larundel I Kew Cottages

Total 16 Residents, 31st December, 1968 13

The girls resident on 31st December, 1968 were occupied as follows Employed outside 2 Housework in Hostel 3 Training Workshop 2 Ward Work .. 4 Ward Kitchen Maids 2

Total 13

It will be seen that during the year a total of nine girls were found employment in normal industry, and have remained in their jobs. This is due largely to the social training given to them by the Hostel Supervisor, but also to the job training received in the Workshop. It is felt that the hostel is best suited to training younger girls, so that in future, preference should be given to girls of 16 years when they have completed special schooling.

Buildings. Maintenance of the renovated buildings continues to be high, but the local maintenance staff, with assistance from the Public Works Department have kept the buildings in a reasonable state of repair.

2984/70.-8 TABLE IX.-MENTAL HYGIENE BRANCH-DEPARTMENT OF HEALTH-RECEIPTS AND EXPENDITURE-YEAR ENDED 30TH JUNE, 1968.

STATEMENT OF RECEIPTS. STATEMENT OF EXPENDITURE. Maintenance of Patients- $ $ Repatriation Hospital, Bundoora 644,332 Maintenance of Mental Hospitals, Residential Training Schools and Centres for the Intellectually Defective ...... 20,524,737 Public Trustee 66,906 Expenses of committal of patients . • . • ...... 11,997 Child Endowment 60,890 Expenses of boarding patients out to benevolent homes, &c. 176,480 Subsidies to Centres for the training of Mentally Retarded Children .. 494,231 Social Service Pensions-Training Centres 763,218 Grant to the University of Melbourne for Mental Health Research .. 14,000 Accommodation and Meals- Deductions from Salaries 329,594 ~ Sale of Meal Tickets .• 44,711 Accommodation Fees .. 8,139 Commonwealth Pharmaceutical Benefits 192,821 Sales of Produce .. 20,245 Sales of Property 18,411 Other Receipts 5,968 Total Receipts 2,155,235 Total Expenditure .. 21,221,445 TABLE X.-TABLE OF MAINTENANCE COSTS OF MENTAL HOSPITALS, TRAINING CENTRES FOR INTELLECTUALLY DEFECTIVE, HOSTELS AND CLINICS INCLUDING DETAILS OF EACH ITEM OF EXPENSE FOR THE YEAR ENDED THE 30TH JUNE, 1968.

Daily Motor Total Overtime Pay in Fuel, Average lieu of Office Books Vehicles, Light, Clothing Drugs Mental Hospital or Number Cost of and -,;,;d· Requisites and Purchase and and Institution. Main­ Salaries. Penalty Long Chaplains. Power Stores. of Service bsiste1 and Publica­ and and Bedding. Medicines. Patients. tenance~ Rates. Equipment. tions. Running Leave. Expenses. Water.

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Kew 929 1,904,577 1,195,194 221,795 6,926 4,179 4,318 2,883 777 4,800 1,496 68,782 30,460 224,168 60,383 34,202 44,214 Children's Cottages .. 903 1,572,583 927,523 266,529 9,915 1,014 1,328 1,536 30 3,314 3,335 50,827 23,453 185,764 60,744 6,328 30,943 Ararat 798 1,456,886 916,863 136,459 6,868 2,211 4,499 1,663 1,604 6,256 6,298 88,688 22,792 163,401 49,098 25,918 24,268 Beech worth 960 I ,432,052 825,190 190,830 4,726 3,152 5,407 2,357 1,543 3,463 4,996 69,952 19,756 196,085 42,503 28,584 33,508 Sunbury 1,029 1,631,923 984,705 195,656 12,358 5,928 7,681 2,776 524 2,888 2,140 69,940 34,134 211,266 32,020 28,355 41,552 Ballarat 967 1,912,309 1,252,693 155,455 4,846 6,182 6,616 3,875 986 11,209 5,010 82,296 36,574 213,863 55 346 34,519 42,839 Royal Park 197 l,l71,898 898,121 49,267 11,059 6,508 1,997 4,373 614 14,154 3,518 41.851 11,049 79,430 8,774 2,573 38,610 Parkville Psychiatric 25 242,587 215,405 5,854 216 1,328 9,528 300 . . . . 572 . . . . 2,529 6,855 Pleasant View 59 154,144 107,885 14,853 1,945 704 I ,054 213 72 1.444 . . 6,386 2,219 15,520 498 481 870 Mont Park and Plenty 1.324 2,937,788 1,824,690 276,227 27,212 7,339 4,132 6,494 2,270 15,611 11,706 139,072 63,351 367,526 65,236 58,086 68,836 0 25,286 -.....:! Bundoora .. 297 619,947 372,671 88,823 3,852 2,388 224 822 321 3,008 306 27,833 7,976 76,098 7,310 3,029 Larundel .. 741 1,928,964 1,263,537 196,583 11,938 6,030 4,238 7,424 1,013 9,708 11,643 39,442 36,425 197,702 44,511 21.172 77,598 Warrnambool .. 195 371,255 225,760 21,422 1,219 574 428 286 2,242 2,348 17,343 3,550 59,207 10,479 23,153 3,244 Travancore .. 66 183,588 137,723 14,255 452 786 375 lO 2,766 427 6,229 677 15,888 1,846 · I ,530 624 Stawell .. 119 240,648 144,064 15,157 1,588 1,139 121 86 2.533 3,718 13.903 14,051 25.168 14.050 1 3.778 1,292 Janefield . . . . 330 524,368 307,984 76,611 2,618 1,349 4,750 675 31 1,288 3,462 26,258 ' 19,931 61,748 9,442 . 3,229 5,052 Sandhurst .. 72 151,985 89,107 15,082 431 92 541 10 1,327 888 9,856 i 4,429 21,564 4,255 4,169 234 Malvern . . . . 14 170,402 121,079 3,956 552 512 1,011 46 1,588 . . 3,524 807 8,793 433 9,849 18,252 Hobson Park, Traralgon 30 250,098 176,681 20,539 571 659 133 3,600 2,138 12,050 2,160 16,690 1.101 7,185 6,591 Mental Deficiency 45,113 42,365 1,097 537 12 492 .. 118 .. .. 492 Training Services St. Nicholas . . . . 160 419,997 312,237 27,130 442 137 1,076 10 4.499 95 15,179 5,827 34,212 5,715 7,436 6,002 Dandenong 32 219,331 142,864 12,725 284 1,629 10 2,021 1,056 8,428 2,647 30,933 743 3,859 12,132 Northern Region .. 18,620 12,298 183 ...... 17 158 ...... 1,476 4,488 Clinics 432,096 318,699 16 6,846 2,065 104 5,975 134 9,202 724 1,557 197 25,107 61,470 Glenhuntly Rehabilita­ 55,766 44,294 338 261 28 693 . . 2,461 1,539 453 132 464 5,103 tion Centre Ambermere .. 26,687 16,897 256 375 . . 632 207 1,803 1,019 265 . . 575 4,658 Head Office 449,125 319,371 11,581 16,719 14,503 36,952 7,886 14,442 4,530 1,690 4,648 209 7,643 243 Totals . . 75,994 60,000 57,000 113,145 79,872 815,993 347,930 12,: 1,949 ;* 345,721 t564,764

• Includes Trust Stock Transfe~ Central Pllarmacies issues and transfers from Trust Stock. TABLE XL-TABLE SHOWING THE AVERAGE WEEKLY COST OF MAINTENANCE OF PATIENTS IN MENTAL HOSPITALS, PSYCHIATRIC HOSPITALS, INFORMAL HoSPITALS AND TRAINING CENTRES FOR THE INTELLECTUALLY DEFECTIVE DURING THE YEAR ENDED 30TH JUNE, 1968.

Motor Vehicles, Fuel, Weekly Books and I Postal and Light, Net Chaplains. Publica- Telephone Purchases Power Stores. Provisions. Institution. and per Cost tions Charges. and per Running Water. Patient Expenses. tenance. per Week. Patient.

$ c $ c $ c $ c $ c $ c. $ c $ c $ c $ c $ c $ c $ c $ c $ c t1l '< Kew 0.09 0.09 0.02 0.10 0.03 1.42 0.63 4.64 1.25 0.71 0.92 39.43 > Children's Cottages, Kew 0.02 0.03 0.07 0.07 1.08 0.50 3.96 1.29 0.14 0.66 33.49 S: Ararat 25.55 0.05 0.11 0.04 0.15 0.15 2.14 0.55 3.94 1.18 0.62 0.58 35.10 a. Beech worth 20.45 0.06 0.11 0.03 0.07 0.10 1.40 0.39 3.93 0.85 0.57 0.67 28.68 '< Sunbury .. 22.29 0.11 0.14 0.01 0.05 0.04 1. 31 0.64 3.95 0.60 0.53 0.78 30.50 Ballarat 28.10 0.12 0.13 0.02 0.22 0.10 1.64 0.73 4.25 1.10 0.69 0.85 38.03 0 Royal Park 93.56 0·64 0·19 0.06 1.38 0.34 4.09 1.08 7.75 0.86 0.25 3.77 114.40 Parkville Psychiatric Unit 170.20 0.17 7.33 0.23 0.44 1.95 5.27 186·61 ~ Pleasant View 40.64 0.23 0.35 0.02 0.47 2.08 0.72 5.06 0.16 0.16 0.28 50.24 ~ Mont Park and Plenty 30.91 0.11 0.06 0.03 0.23 0.17 2.02 0.92 5.34 0.95 0.84 1.00 42.67 Bundoora 30.13 0.16 0.01 0.02 0.20 0.02 1.80 0.52 4.93 0.47 0.19 1.64 40.14 ~ Larundel .. 38.20 0.16 0.11 0.03 0.25 0.30 1.02 0.95 5.13 1.16 0.55 2.01 50.06 0 l. 0 0 Warmambool 24.38 0.12 0.06 0.03 0.22 0.23 71 0.35 5.84 1.03 2.28 0.32 36.61 - Travancore 44.41 0.23 0.81 0.12 1.82 0.20 4.63 0.54 0.44 0.18 53.49 00 ~ Stawell 25.99 0.18 0.01 0.41 0.60 2.25 2.27 4.07 2.27 0.61 0.21 38.89 Janefield .. 22.56 0.08 0.28 0.07 0.20 1.53 1.16 3.60 0.55 0.19 0.30 30.56 ~ Sandhurst 27.83 0.12 0.02 .. 0.35 0.24 2.63 1.18 5.76 1.14 1.11 0.06 40.59 Hobson Park 126.42 0.37 0.09 2.31 1.37 7.72 1.38 10.70 0.71 4.60 4.23 160.32 ~ St. Nicholas 40.84 0.02 0.54 0.01 1.82 0.70 4.11 0.69 0.90 0.72 50.48 p: Malvern .. 172.50 0.70 0.06 2.18 4.84 1.11 12.08 0.60 13.53 25.07 234.06 0.17 1.21 0.64 5.06 1.59 ~ Dandenong 93.50 0.01 18.59 0.45 2.32 7.29 131.81 ~ Head Office 0.99 g- Clinics, Hostels, Boarding Out and 21 Commiltals 1.69 ~ Total (Excluding Public Works Depart­ ment) 43.21 4.48 38.73 by Public Works Depart­ ment for Maintenance of Buildings and Equipment .. 2.19 2.19

Total 45.40 4.48 40.92