Mental Health

Ofﬁce of the Public Advocate Community Visitors Annual Report 2007 MENTAL HEALTH

OFFICE OF THE PUBLIC ADVOCATE AN INDEPENDENT STATUTORY OFFICE ACCOUNTABLE TO THE VICTORIAN PARLIAMENT ISSN 1833-9387 Community Visitors Annual Report 2007 Mental Health Act 1986 Produced by the Office of the Public Advocate 5th floor, 436 Lonsdale Street Melbourne 3000 Victoria Telephone: 1300 309 337 (for the cost of a local call) 2 www.publicadvocate.vic.gov.au Contents

1 EXECUTIVE SUMMARY 3

2 RECOMMENDATIONS 4

3 MESSAGE FROM THE CHAIRPERSON 5

4 INTRODUCING THE BOARD 6

5 MESSAGE FROM THE PROGRAM MANAGER 7

6 INTRODUCING THE STAFF 8

7 INTRODUCING COMMUNITY VISITORS 9

8 GOALS, OBJECTIVES AND GUIDELINES OF THE BOARD 2006-07 10

9 THE FINDINGS, 2006-07 10

10 COMMUNITY VISITORS MENTAL HEALTH STREAM 10

The Community Visitors Program is a program of the Ofﬁ ce of the Public Advocate and its aims are incorporated within the mission of the Ofﬁ ce. The mission is to provide a responsive and accessible service that informs and engages with Victorians to promote and protect the rights and dignity of people with a disability, and reduce exploitation, abuse and neglect.

ISSN 1833-9387 Ordered to be printed VICTORIAN GOVERNMENT PRINTER Dec 2007 No 71 Session 2006-07 MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 1 30 October 2007

The Honourable Lisa Neville MP Minister for Mental Health Level 22, 50 Lonsdale Street MELBOURNE VIC 3000

Dear Minister

RE: COMMUNITY VISITORS (MENTAL HEALTH) ANNUAL REPORT

In accordance with the Mental Health Act 1986, please find enclosed the 2006-2007 Annual Report of the Community Visitors Mental Health Board. This year, Community Visitors celebrated 20 years of the program. We commend this report to you.

Yours sincerely

BARBARA CARTER RUTH BAKER OAM KEN LOCKE Acting Public Advocate Board Member Board Member

5th Floor - 436 LONSDALE STREET • MELBOURNE VICTORIA 3000 TELEPHONE: (03) 9603 9500 • VICTORIA: 1300 309 337 FAX: (03) 9603 9501 • TTY: 9603 9529 DX 210293 • E-MAIL: [email protected] www.publicadvocate.vic.gov.au

2 1 Executive Summary

The 2007 annual report is an analysis of data collected The Board calls on the Government to increase the number from across the state and examined by the Board. of mental health beds and services in relation to demand and the expanding population growth. This includes The key findings provide the Board with evidence to inform government addressing the ongoing chronic shortage of the Victorian Government with an up-to-date commentary secure extended care beds. on public mental health services, including inpatient and residential services from 1 July 2006 to 30 June 2007. Shortage of professional and allied health staff: The report provides relevant information to demonstrate, • There remain continuing staff shortages with, at times, where, in the assessment of Community Visitors, service significant delays in recruitments to critical key staffing deficits are evident and where improved standards of positions that provide essential rehabilitation and treatment and care have been observed or are required. inpatient services. The Board through the activities of the Community Visitors The current recruitment initiatives undertaken by has continued to monitor services across the state to the government must continue in order to ensure that current 106 mental health facilities providing accommodation and and future positions within mental health services are inpatient mental health services. The Community Visitors maintained and the optimal mental health services are received in excess of 178 referrals from the Office of the delivered. Public Advocate’s Advice Service to respond to enquiries from patients, carers and interested persons in relation to Delays in maintenance and cleaning: various aspects of services and treatment of people with a • Significant delays in maintenance have been a mental illness. disturbing trend reported by the Board in some of the The Board remains concerned that, while there have state’s major metropolitan hospitals providing mental been significant funds announced by the Federal health services. Government in 2006 and encouraging signs towards a Government must increase maintenance funding, ensure much-improved state mental health system, the delays that hospital management is held accountable for the in the implementation impact on the day-to-day lives of provision of maintenance and cleaning services and ensure people with a mental illness. There is continuing need for that the rights of patients to a safe, clean and attractive improvements to address the ongoing demands on the environment are respected. current mental health services system. Shortage of low-cost rental accommodation Some significant key findings of this report are: The Board calls on the Government to address the Shortage of beds: shortage of low-cost rental accommodation in both the • The shortage of acute beds remains a key finding that private and public sector to ensure that options are has been reported by the Board to the Minister since available for patients on discharge. 2003. The Board further calls on the Victorian Government • The shortage of secure extended care beds remains; to continue to implement and invest in the provision of there are no such facilities in Hume and Barwon–South prevention and recovery care accommodation services West regions, with patients being inappropriately which are accessible statewide and to explore and accommodated in adult acute inpatient units waiting research ways of providing care for patients who require for secure extended beds and with some patients individualised secure accommodation that is currently remaining in acute units for more than eight months. unavailable. • There is a shortage of appropriate community accommodation on discharge and a lack of capacity by the state to meet the needs of patients with dual and complex needs.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 3 2 Recommendations

The Community Visitors Mental Health Board recommends that the Victorian Government:

1 Increases the number of mental health beds and services in relation to demand and to the expanding population growth areas, such as Barwon-South West Region

2 Urgently addresses the shortage of secure extended care beds to help ease the pressure on adult acute beds

3 Takes action to reduce the common practice of locking acute units by providing additional high dependency beds where needed

4 Increases funding for the Multiple and Complex Needs Initiative and the Integrated Rehabilitation and Recovery Care Program to ensure they are effective and responsive to the requirement of patients with particular needs who are in hospital units

5 Maintains and extends initiatives to increase the number of professional allied health staff and psychiatric nurses

6 Increases maintenance funding and ensures that hospital management is held accountable for the provision of maintenance and cleaning services that are effective, responsive to immediate needs and respect the rights of patients to a safe, clean and attractive environment

7 Takes action to overcome the chronic shortage of low-cost rental accommodation in both the private sector and public sector to ensure accommodation is available on discharge from mental health facilities

8 Further expands the provision of prevention and recovery care accommodation services state-wide

9 Explores and researches ways of providing the care and accommodation needs of patients for whom individualised secure accommodation is required which is currently unavailable. An opportunity may exist to consider such a model of care within the proposed facility to be built at Heidelberg.

4 3 Message from the Public Advocate as Chairperson of the Board

For twenty years, Community Visitors have been informing The Board will monitor the impact of the State government about issues affecting the most vulnerable Government’s tobacco reforms relating to restricting members of our community. The Community Visitors are smoking in public places and venues taking effect from the eyes, ears and voice of the community. The Community 1 July 2007. A study quoted by SANE Australia found Visitors also provide a voice for people with a disability who that smoking rates in people with schizophrenia are up may be unable to advocate for themselves. to three times those of the general population. Nicotine withdrawal symptoms usually occur and can be very This annual report is based on the dedicated work of the distressing. It will be crucial for Community Visitors in the Community Visitors in the Mental Health stream of the mental health stream to oversee the potential impact of program who conducted 1251 visits to facilities in 2006-07. the reforms and ensure people have access to adequate On behalf of the Mental Health Board, I thank all nicotine replacement management and specialised group Community Visitors for their commitment, time and energy programs, for example SmokeFree programs, while in in promoting the rights of patients and residents in the mental health care and affected by the reforms. facilities. The Community Visitors perform a most valuable I appreciate the support and cooperation provided to role and the production of this report is an important part of Community Visitors by service providers and DHS program the advocacy effort of the Office. staff and rural regional staff. The day-to-day discussion and The Board has welcomed implementation of mental cooperation assists us to protect rights and tackle issues of health initiatives in Victoria announced in the May 2006 patient wellbeing. State Budget. This report details many current shortfalls Julian Gardner, the former Public Advocate, was a member in service provision, in particular, the shortage of beds of the Mental Health Board for all but two months of the features as it has for several years. The findings of the year. The Board, Community Visitors and staff thank Julian Community Visitors are largely about the impact of bed for his vision, inspiration and support. I also thank the shortages on the whole system of care. Community Visitor members of the Mental Health Board Many patients are remaining in acute care units well past for their many hours of work in producing this report and the time when they need this level of clinical care with its their many other valuable contributions this year towards associated practices and restrictions. This is because improving the lives of people who are patients in the mental there is a severe shortage of secure extended or longer- health facilities we visit. term accommodation for people past the acute stage Barbara Carter of their illness. This has the double effect of effectively Acting Public Advocate/Chairperson, breaching the civil liberties of those placed under an Community Visitors Mental Health Board unnecessary level of restriction and making it more difficult for patients needing acute care to receive the help they need. The situation is further exacerbated by staff shortages, particularly in some rural areas. The impact of this regrettable situation is also felt in the supported residential services sector, where Community Visitors report that people with mental illness are not receiving the level of care they need to live a life of basic human dignity. There is still work to be done twenty years after the de- institutionalisation of psychiatric care.

A particularly disturbing event for the Board was the identification in the daily print media of a patient who was on planned release as part of his treatment program from the Thomas Embling Hospital. The incident was a most disturbing reflection on the media’s approach to the rights Former Public Advocate, of the patient. The legal advice from the Department of Julian Gardner Human Services (DHS) was that, in the circumstances, the media did not breach the patient’s privacy.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 5 4 Introducing the Board

The Community Visitors Program is accountable, through the Program Manager, to the Public Advocate. The legislative framework establishes a board, the Community Visitors Mental Health Board. The Board is responsible for reporting the activities and issues of the Community Visitors to the Victorian Parliament each year.

Board members for 2006-07:

Barbara Carter Ruth Baker Ken Locke Acting Public Advocate/Chairperson OAM, BA, BEd, DipRE FAIM AMIET, JP of the Community Visitors Mental Ruth Baker was appointed as a Ken Locke was appointed as a Health Board Community Visitor in the Mental Health Community Visitor in 2004. Prior Barbara Carter has been the Acting stream in 1999. to retirement he was CEO of an Public Advocate between the international transport company, Prior to her retirement in 1998 she was appointments of Julian Gardner and having spent thirty years in the Head of the Junior Secondary School Colleen Pearce. She has been with the industry. Appointed a Bail Justice on of MLC, Kew. She has also taught in Office for 15 years and her substantive the introduction of the office in 1990, a number of government secondary position is Manager of Advocacy he has also been a Justice of the colleges, worked for some years and Guardianship (West). She first Peace for some thirty-five years. in youth and pastoral care work at joined OPA as the co-ordinator of the Wesley Church, Geelong, and trained After three years experience as a Community Guardianship Program as a nurse at Prince Henry’s Hospital. Community Visitor in the Mental and she has substantial experience Health stream, Ken was interested working in volunteer programs as well In 2005 she was awarded the Medal in broadening his exposure to the as being a volunteer in the community. of the Order of Australia for “service stream by becoming a member of to the community through a range of Barbara started her working life as a the Community Visitors Mental organisations, particularly in relation secondary teacher in the technical Health Board. to mental health services, and to education system and after post- education”. graduate study was a Lecturer in Political Science and Political Philosophy at Monash University.

6 5 Message from the Program Manager

This year, the Community Visitors Program celebrated Recognising the particular demands and complexities for twenty years of service. Community Visitors in the Mental Health stream, the Board proposed changes to the induction and training program. At our annual general meeting and conference in June, we There has been a significant emphasis on improving the focused on achievements and celebrated the fact that the training for Community Visitors in all streams, including service system for people with a disability in Victoria has the production of a DVD for training purposes which is undergone major reform in the twenty year period. currently being developed. The government, the Department of Human Services I acknowledge the work of the staff of the program, (DHS) and service providers are to be applauded for the particularly Jacqui Schultz, the Coordinator responsible progressive measures and redevelopment of the mental for supporting the Mental Health Board. Jacqui has health services in Victoria. The services are increasingly primary responsibility for consulting with the senior policy more accessible and diversified. and program people at DHS and advising the Office of While there is much to celebrate, we are mindful that there the Public Advocate in relation to policy and advocacy is a continuing need for the inquiry, reporting and advocacy priorities. of the Community Visitors Program. Ron Tiffen As mental health services diversify, the Community Visitors Manager, Community Based Programs Program is seeking to define its role in new service types. A particular interest has been the prevention and recovery care services, which are auspiced by health services which have established a collaborative partnership with non-government services. These services do not have 24- hour nursing care so are technically outside the mandate for Community Visitors. The Board is seeking to have the services included in our mandate and so has initiated discussion with the Minister and DHS towards this.

With the support of DHS, the Community Visitors have commenced visits to emergency departments of acute hospitals to monitor situations where people with mental illness are being assessed and triaged.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 7 6 Introducing the Staff

The recruitment, training and ongoing support of the Community Visitors is the responsibility of staff in the Community Based Programs Unit.

Back row: Leonie Swift, Coordinator, Health Services; Ruth Moeller, Training and Development Coordinator; Ron Tiffen, Manager, Community-Based Programs; Jacqui Schultz, Coordinator, Mental Health; Nik Vracatos, IT support;

Front Row: Jo Hallenstein, Coordinator Disability Services; Mary Macgregor, Recruitment Coordinator; Jennifer Watt, Coordinator Continuous Improvement; and our colleague Julianne Fogarty, Coordinator, Independent Third Persons Program.

The Community Visitors Program is also ably supported by administration officers Margaret Canzoneri and Liz Smith.

8 7 Introducing Community Visitors

Community Visitors are independent volunteers who safeguard the interests of people with a disability.

The Community Visitors Program is part of the Office of the Public Advocate. The Program is arranged in three streams to reflect the type of services visited:

• Mental Health – visits are made to patients and residents in mental health facilities providing 24-hour nursing care. • Disability Services – visits are conducted to institutions, congregate care and community-based residential facilities for people with a disability Community Visitors who have served 10,15 and 20 years • Health Services – visits are made to people who require of volunteering. assistance with daily living who reside in supported residential services (SRSs) The legislative framework is derived from the following Acts of Parliament: Visits by Community Visitors

• Mental Health Act 1986 Community Visitors made 5,620 visits this year, representing a decrease of 8 per cent from the previous • Disability Services Act 1991 year, due to budget constraints. • Intellectually Disabled Persons Services Act 1986* Number of visits by streams • Health Services Act 1988 * Replaced from 1 July 2007 by the Disability Act 2006. 04/05 05/06 06/07

The legislation also establishes three Community Visitors Disability Services 3,008 3,210 3,090 Boards: Disability Services, Health Services and Mental Health Services 1,617 1,528 1,279 Health. The Boards are responsible for reporting the Mental Health 1,489 1,374 1,251 activities, issues and findings of the Community Visitors TOTAL 6,105 6,112 5,620 to the Victorian Parliament each year, through the respective Minister. While the vast majority of visits are scheduled and The Community Visitors are appointed by the Governor unannounced, a significant number are in response to in Council. They are empowered by legislation to visit specific complaints. This includes 412 referrals to the specified facilities, to make enquiries of residents and staff program via the Office’s Advice Service. On occasions, and examine selected documentation in relation to the repeated visits are necessary to certain facilities over a care of people residing at the facilities. Community Visitors short period, in response to serious issues identified. usually make unannounced visits. They visit in teams of two or more. At the conclusion of each visit, the Community Visitors prepare a report summarising the findings and indicating items where action is required. A copy of the report is provided to the most senior staff member at the facility or the proprietor in the case of an SRS.

Where an issue cannot be resolved at facility level, it is usually taken to a more senior manager in the agency and/ or the DHS regional office. Serious matters may be referred for action within the Office of the Public Advocate and dealt with as part of the Public Advocate’s broader powers.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 9 8 Goals, Objectives and Guidelines of The Board, 2006-07

The goals and objectives have been developed by the Goal Three Community Visitors Mental Health Board for Community Visitors appointed under the Mental Health Act. In To assess and report on the appropriateness and achieving the goals and objectives, Community Visitors standard of facilities for accommodation, physical well- follow the principles and values of fairness, objectivity, being and welfare of people with a mental illness integrity, honesty, conscientiousness and commitment to Community Visitors aim to meet this goal by: the public interest. • inspecting all areas noting levels of physical comfort, cleanliness, safety, privacy, maintenance and security Goal One • inquiring into clients’ personal care needs (clothing, To visit each mental health service providing residential toiletries, dietary requirements) services and 24-hour nursing care at least once a • reporting on problems and following up on any month with the objective of promoting the individual proposed action to remedy deficiencies rights and dignity of people with a mental illness • observing the appropriateness of a facility and raising Community Visitors aim to meet this goal by: any concern if it is felt the facility is inappropriate for a • being alert to signs that the rights and dignity of specific client’s needs individuals are not being respected • inquiring into the incidence of serious assault and illicit • investigating complaints about treatment and care drug use in the facility. • following up referrals from the Office of the Public Advocate’s Advice Service Goal Four To assess and report on the opportunities for • providing the required reports of visits and following recreation, occupation, education, training and up actions and outcomes of any issues of concern. rehabilitation of clients Goal Two Community Visitors aim to meet this goal by: To advocate for the best possible assessment and • observing the availability and suitability of areas for treatment services and adequate human and physical these purposes resources in each mental health service • inquiring into client satisfaction with programs and Community Visitors aim to meet this goal by: facilities • raising issues of concern encountered in the admission • discussing programs (such as Individual Service Plans process (including treatment in the emergency and activities) with staff with reference to a specific department) client’s concerns. • monitoring the availability and distribution of beds in the services Goal Five To assess whether the environment and the manner • inquiring into access to treatment options for both of service provision are the least restrictive and least psychiatric and non-psychiatric treatment with reference intrusive possible, consistent with the clients receiving to specific clients the best possible treatment and care appropriate to • inquiring into discharge-planning procedures and the their needs availability of suitable accommodation on discharge Community Visitors aim to meet this goal by: • regularly asking about the number of professional and • understanding the provisions of the Act regarding ancillary staff and noting any shortages a person’s rights (including restraint and seclusion • reporting on issues of concern both at the facility provisions) and being prepared to act on their behalf and systemically. where there appears to be a breach of the legislative provisions • checking that clients are fully informed of their rights and assisting with appropriate information where this is needed • observing whether the accommodation is the least restrictive environment possible (including the reasonableness of any restriction). 10 9 Key ﬁndings against the goals and objectives 2006-07

Goal One CASE STUDY: GOAL 1 Phil contacted the Office of the Public Advocate Advice To visit each mental health service providing residential Service and requested a visit by a Community Visitor. services and 24-hour nursing care at least once a month Phil was concerned about his medication, treatment and with the objective of promoting the individual rights and care that he was receiving at a community care unit. dignity of people with a mental illness Phil’s concerns were discussed with the staff and he was FINDINGS: advised of this; however, he continued to be concerned about his ongoing treatment and care and further The major category of problems was with medical care requested assistance. �� The nature and extent of requests to see Community The Community Visitor spoke with the treating medical �� Visitors�� has highlighted a broad range of concerns relating staff and a review of Phil’s treatment was conducted. to the quality ��of the mental health systems.�� Subsequently a change was made to his medication. �� The graph below depicts issues relating to medical care�� A follow-up visit by the Community Visitors reported �� as being the most significant when responding to referrals that Phil was extremely pleased with the outcome of his �� from the Office’s Advice Service. review which was a direct result of the intervention of �� Community Visitors. ��

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Advice Service Calls (Total calls - 178) 2006/07

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�� MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 11

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�� Goal Two Shortage of appropriate community accommodation on discharge: To advocate for the best possible assessment and • There is an acute shortage of appropriate community treatment services and adequate human and physical accommodation available on discharge across all resources in each mental health service regions. Patients who have reached their optimum FINDINGS: level of rehabilitation need to remain in the system for periods of up to two years due to the lack of Shortage of beds in mental health services continues to appropriate accommodation. create blockages in the system and prevents access to appropriate forms of treatment • Public housing waiting lists are extensive and private rental accommodation is in short supply and prohibitive Acute beds: in most cases due to the increased cost in the rental • The shortage of acute beds continues and has been market. reported as a key issue for the past four years. Shortage of professional and allied health staff: • Readmission rates placed greater emphasis on • The shortage of mental health staff continues. accessing acute beds, particularly with alternative accommodation and community-based support • The shortage of psychiatric nurses has resulted in bed services being limited within the region. closures in acute and adolescent units. • Emergency departments at many of the hospitals • Vacancies in occupational therapist positions have often have patients awaiting admission to an adult resulted in several units being without occupational acute inpatient unit for periods up to 48 hours. therapists and, therefore, patients wait for appropriate Maroondah and Geelong Hospitals are examples of this activities programs for periods of up to eighteen occurrence. months.

Secure extended care beds: • The consumer consultant position remained vacant for over eight months in one region. • A small number of high needs patients remain in acute units for periods of up to 6 to 8 months awaiting • The lengthy delays occurring in finding replacement admission to a secure extended care unit. psychiatrists are having an adverse effect in terms of delays in patients being reviewed and having the • There are no secure extended care unit beds in several opportunity to discuss their treatment plans and, thus, regions including Eastern Metropolitan, Hume and impacting on their overall rehabilitation. Barwon-South West regions; consequently, patients have been inappropriately accommodated in adult Lack of suitable accommodation for long-stay patients acute inpatient units while waiting to access secure with specific care needs: extended care unit beds. • Community Visitors/Office of the Public Advocate • Even in regions with secure extended care unit beds, – Long Stay Patient Project, which commenced patients remain in adult acute inpatient units waiting for early 2007, has already identified a serious lack secure extended care beds. accommodation options for patients with specific care and accommodation needs. To date, in excess of 60 such patients have been identified across the state. • These include long-term patients who require supervised care with supported access to the community and others who cannot cope with shared accommodation due to their mental illness, requiring short-term intensive care and rehabilitation combined with longer-term individualised care.

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�� Adequate�� support and assistance for patients who are Goal Three �� subject to the new tobacco reforms introduced ��in 2006: �� • Community Visitors will continue to monitor the impact To assess and report on the appropriateness and of the reforms to ensure adequate ‘Quit’ programs are standard of facilities for accommodation, physical well- �� being and welfare of people with a mental illness �� implemented and provided to all mental health patients. �� FINDINGS: �� The�� graph highlights the fact that the majority of issues �� during visits to facilities were relating�� to patients’ medical �� (a) The overall program of maintenance is variable, with care. areas of high standards and major hospitals having unacceptable, poorly maintained buildings. Community �� Visitors have reported that mental health services are frequently the poorest in terms of standards of Treatment / Resources 2006/07 accommodation. Community Visitors report significant delays in maintenance �� and the remedying of physical problems that contributed �� to deterioration of buildings and open spaces, health and �� safety hazards, disrupted use of utilities and inconvenience�� to staff and patients. However, improvements in �� maintenance have been reported for Peninsula Health units �� and Latrobe Regional Hospital. �� The following maintenance issues were reported at the �� Austin Hospital child and adolescent inpatient units in �� Marion Drummond building: �� • Renovations to a cramped, dilapidated laundry were

�� only completed 15 months after the problem was �� reported. �� • Removal of a considerable amount of debris in �� spouting causing water damage and fire risk, was �� completed two years after the initial report. �� CASE STUDY: GOAL 2 • Three years of reports by staff and Community Visitors Sue is well known in her community. She has a guardian about the cramped, poorly located and physically appointed�� from the Office of the Public Advocate. In fragile high dependency unit were not acted on until a 2005, with the assistance of her�� guardian she was able serious incident in 2006. to access�� a community care unit bed. Despite many • Since 2003, Community Visitors have reported the agencies providing support to assist her to remain within �� unsafe exterior areas of the building with access to the community, Sue found it difficult to cope in that �� internal roads, an adjacent car park and adjacent major environment.�� The Community Visitors became aware that roads but, while some areas are now secure, the area her behaviour was adversely affecting other residents �� between the units and the school remains a degraded, residing in the community care units. Several incidents

�� unsecured space. occurred� involving Sue which necessitated the need for her to be admitted to an adult acute inpatient unit in early • Action to make safe a staircase from the child unit’s 2007. Sue is now waiting for alternative accommodation main activity room to an upper level occurred four

and care which�� can provide long-term�� support that �� months after staff reported the risk. �� cannot be�� provided by a community care unit and, as �� • A bathroom was unusable for a week due to a delay in such, she is occupying an adult acute inpatient bed �� repairing minor damage to a wall. when she no longer requires acute care. • Potentially dangerous unstable metal racks in the children’s bedrooms remain eight months after Community Visitors reported the risk.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 13 At Werribee Mercy’s adult acute unit: At Bendigo Hospital’s adult acute unit:

• A delay of several months in repairing a clothes drier • The paving in the garden area and the high caused problems for patients needing to launder and dependency courtyard needs regular cleaning and dry clothes which led to accumulations of piles of the walls need to be kept free from graffiti with regular clothes in the unit. cleaning and painting. • A patient’s bedroom could not be locked for privacy or At Monash Medical Centre’s mental health units: security for six months until the lock was repaired. • Community Visitors report a long-standing problem with • A sizable hole in the rotting wall of the dining room was the standard of cleanliness in both external and internal not repaired for over four weeks. areas.

• Unstable and damaged furniture needed replacing. (c) Improved facilities have been recorded in several At Bendigo Hospital’s adult inpatient acute unit: services. Redevelopment of some units has occurred, providing • Patients were sleeping on mattresses on the floor extra beds and space while at other units new fittings and because the sagging wire bases of their beds were too furniture have been provided. uncomfortable. Despite the urgency of this situation, it was several months before all unsatisfactory beds were At Inner East community care units: replaced. • Extensive renovations have occurred which have At Bendigo Hospital’s aged persons acute unit: created ten additional beds. • Mattresses, already very thin, had deteriorated to At the Alfred Hospital’s adult acute units: the extent that the vinyl surfaces were cracked and wrinkled and unsuitable for frail elderly patients. • Extensions to the high dependency units have provided Funds for replacement had been difficult to obtain four additional beds. As a consequence, there has so that eventually the unit manager replaced them, been a reduction in the need to use seclusion. four per month, from the small monthly allowance for At Dandenong Hospital’s mental health units: incidentals. • Refurbishment of units and courtyard has improved the In Hume region: environment for patient care. • Delays in maintenance are an issue in most units, At the Maroondah Hospital: particularly the community care units at Beechworth and the adult acute inpatient unit in Wangaratta. • The adult acute inpatient unit is being re-developed to two 25-bed units. (b) Many facilities are struggling to maintain a clean At the adult acute inpatient units at Wangaratta and and tidy environment for patients. Shepparton: While some regions report improvements in cleaning, problems remain. The littering of gardens and courtyards • Changes to the high dependency units have with cigarette butts is frequently reported for adult units at considerably improved safety and security. Bendigo, Austin, Werribee Mercy, Broadmeadows, Royal Melbourne and Northern Hospitals.

At the Austin Hospital’s building that houses the child and adolescent units:

• The exterior of the building is now shabby and dirty with peeling paint, uncleaned windows and unused furniture stored on the dusty verandah.

14 (d) Patients report that there are much improved The graph below depicts significant issues relating to conditions in several services. maintenance matters. At the Austin Hospital:

• In December 2006, patients were moved from temporary Amenities / Environment issues 2006/07 accommodation, following the closure of Larundel Hospital in 1998, into the two new units: a 30-bed, adult �� acute unit that also incorporates the specialist Mood, �� Eating Disorders and Mother and Babies programs, �� and a 25-bed, secure extended care unit. Patients have �� commented enthusiastically about the better conditions, �� particularly having their own bedrooms�� and en-suite �� facilities. �� At Thomas Embling Hospital: �� • an 18-bed, sub-acute unit opened to meet the strong demand for beds for persons with a mental illness in the �� prison system. �� At Blakiston Lodge, Geelong: �� • a new building provides 15 additional aged persons �� mental health residential beds. �� At the Royal Melbourne Hospital:

• in the adult acute inpatient unit, a new short-stay Prevention and Planning Unit has been established to CASE STUDY: GOAL 3 relieve pressure on the emergency department. �� In an adolescent high dependency unit in December �� At Box Hill Hospital: �� 2006,�� a serious assault of a nurse led to the closure of �� • a new building is nearing completion to house the the high dependency unit. Subsequent admissions were �� adolescent unit being transferred from�� Maroondah restricted to non-aggressive patients. �� Hospital. For ��three years, Community Visitors had reported�� concerns about the inadequacy of this ��adolescent unit �� in terms of safety and supervision. They had cited the �� unsatisfactory� location of the high dependency unit, its �� cramped conditions and the fragile nature of the walls. �� The location of the recreation�� room and the number of ��

exterior doors also contributed�� to the concerns about�� safety and supervision. While solutions are being sought ��

�� to remedy the design problems�� of the building, the on- �� going reduction in the service provided by this unit is �� having an impact on other adolescent inpatient units. ��

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In the Hume region: Goal Four �� • Community Visitors report high quality and innovative To assess and report on the opportunities for programs at the adult acute inpatients units at recreation, occupation, education, training and rehabilitation of clients Shepparton and Wangaratta and the aged-persons mental health residential unit at Beechworth. �� FINDINGS: �� (b) There are examples of particularly good �� (a) Programs for recreational activities vary in quality. improvements in the provision of areas for activities. �� Some services have well-developed programs while At Bundoora�� Extended Care: others lack even basic provisions. �� Generally, inpatient and residential units are providing • the new activities room�� at the aged persons acute unit �� has been invaluable in providing a ��bright and spacious appropriate activities, both therapeutic and recreational �� and, where needed, independent living skills and an area to support the extensive activities program. �� introduction to employment opportunities. At the Austin Hospital: �� At St.Vincent’s Hospital’s adult acute inpatient unit, a �� • the newly�� completed�� playground for the child unit with � comprehensive activities program has reduced absconding �� its custom-built adventure�� play equipment, rubberised�� behaviours of patients. However, in some inpatient units �� flooring for safety, cubby house and delightful, three- �� considerable problems still exist. �� dimensional mural on�� the retaining wall is an excellent �� space for recreational and therapeutic activities. �� In Western Metropolitan Region: �� • Community Visitors state that some adult acute �� units seem to have difficulty retaining occupational Activities / Programs 2006/07 therapists. Activity rooms remain locked most of the time or are not used at all. Lack of games and reading �� material is a common complaint. �� At Ballarat Hospital’s adult acute inpatient unit: �� • With no professional activities person,�� nurses had been providing some activities but were then required to �� provide one-on-one therapeutic activities rather than �� group activities. Patients complained they had nothing ��

�� to do and Community Visitors reported little provision or � opportunity for recreational activities. At the secure extended care unit at Ballarat: �� • There had been no occupational therapist for over �� twelve months so nurses were expected to provide �� activities. Patients particularly complained about the loss of outings and bus trips that had previously been provided. CASE STUDY: GOAL 4 At Bendigo adult acute inpatient unit: In a major regional city, Community Visitors report serious • the continuing inadequacy of the activities program concerns about the lack of consistent activities programs prompted one group of 15 patients to present a in all five mental health units. Lack of appropriate staff submission complaining of these inadequacies and (e.g. occupational therapists) seems to be one reason offering suggestions for activities. but unavailability of funding is also cited. In three units, nurses were expected to provide activities without sufficient training. Patients complained about the lack of, or limitation of, activities and in the secure extended care unit, patients particularly missed the bus trips and outings previously enjoyed.

16 Goal Five The following graph outlines matters raised regarding patient rights and use of seclusion. To assess whether the environment and the manner of service provision are the least restrictive and least intrusive possible, consistent with the clients receiving Least Restrictive Services 2006/07 the best possible treatment of care appropriate to their �� needs �� FINDINGS: �� (a) Locking doors is now routine in many acute �� inpatient units. This is thought to also�� be due to the �� inappropriate placement of some patients. �� Community Visitors in several regions reported the almost �� routine locking of acute adult units, generally because of � concerns about particular patients at risk of absconding.

�� At Ballarat in the adult acute inpatient unit: �� • Following a coronial inquiry, the height of the courtyard �� wall was increased significantly and obvious security �� cameras were installed. Patients can only use the second courtyard under supervision because its CASE STUDY: GOAL 5 �� fence is considered too low. Community Visitors reported that the environment appears more custodial Felicity is a young female patient whose extreme than therapeutic and was a much more restrictive behaviour posed a risk to others. As part of her treatment environment for all patients. plan, she was nursed in a seclusion room of an acute unit. Some furniture and a television were provided to �� (b) Progressive management has resulted in a reduced make�� it more comfortable. use of seclusion of patients. �� As ��Felicity’s ability to interact peaceably with others Reduction in the use of seclusion was reported specifically �� improved, she was able to spend an increasing amount �� at the Alfred Hospital. The reduction in the use of seclusion of time�� out of seclusion until eventually she could move was multifactorial. During the renovations, the available �� out of seclusion into a bedroom of her own. Felicity �� seclusion rooms were reduced so the service introduced spoke gratefully of the care she received from staff �� other measures to manage disturbed ��behaviour, including �� but she also described the negative effect of being in �� increased�� staff availability to patients requiring higher �� seclusion for such a long period. For the Community �� levels of care. Practice changes contributed to the �� Visitors who�� knew her, this young woman’s situation�� reduction. Frankston Hospital is practising a more intensive �� highlighted the need for a specialist facility that could �� diversional program to reduce the use of seclusion. In the �� provide appropriate care without having to nurse the �� adult acute inpatient and secure extended care units at �� patient in the isolation of a seclusion room. �� the Austin Hospital, there has been a reduction in the use �� of seclusion in both number of episodes and number of �� patients involved. �� At the Northern Hospital’s adult acute unit: ��

• following a patient’s complaint about mistreatment in seclusion, Community Visitors have reported their �� concern at the use of the general hospital’s security �� staff to help manage a patient in seclusion.

��

�� MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 17

�� 1

During the year, Community Visitors welcomed the opening of the new Austin Health facility in the Northern Region after many years of reporting the previous inadequate facility at the Austin Repatriation site.

18 3 6

1. Back row, l-r: Parliamentary Secretary for Health, Daniel Andrews; Local MP, Craig Langdon; Community Visitors Mental Health Co-ordinator, Jacqui Schultz; Local MP, Danielle Green 2. Lounge/kitchen, Parent/Infant Unit 3. Dining/lounge, Acute Psychiatric Unit 4. Nurse Unit Manager Acute Psychiatric Unit, Mary Apostolidis 5. Acute Psychiatric Unit 6. Courtyard, Parent/Infant Unit 7. Recreation area, secure extended care unit 8. Health Minister, Bronwyn Pike, unveils the plaque for 4 the new unit with Community Visitor, Helen Reid.

7 8

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 19 10 Findings - Barwon-South West Region

This region extends from Geelong through to Warrnambool. It is anticipated that, with the introduction of the prevention In Geelong, there are three facilities: one adult acute and recovery care beds (PARC), the region will be able to inpatient unit, one community care unit and one aged offer a more flexible service for the people in the Geelong persons mental health residential unit. Warrnambool has area and the surrounding areas. one adult acute inpatient unit and a community care unit.1 Since meals have been supplied by an external provider, patient meal selections are offered but are not provided. Findings against the goal: Patients are offered a choice of meals; however, when the meal arrives at the unit patient, choice is not evident, as To advocate for the best possible assessment and patients do not receive their requested meals. This appears treatment services and adequate human and physical to be an unresolved issue. resources in each mental health service (c) There has been an increase in aged care beds in (a) There is a shortage of beds in the region and the Geelong. availability of beds is concentrated in two towns. At the aged persons mental health residential unit at Community Visitors report the ongoing concerns that Geelong, a new building provides 15 additional beds that there remain few options in the region for people who are much needed in the region. require long-term care and accommodation outside the current community care units located in Geelong and Warrnambool. The lack of beds in this region and the Findings against the goal: continual demands on mental health accommodation and care services will remain with the population growth in the To assess and report on the appropriateness and region. standard of facilities for accommodation, physical wellbeing and welfare of people with a mental illness There are still no secure extended care unit beds in this region and, as a result, there are several patients (a) Substance abuse by some residents in community inappropriately placed. They either remain in adult acute care units creates problems for all residents. inpatient beds, unable to access secure extended care Community Visitors continue to report and highlight their beds in other regions, or remain unsuitable to access concerns about residents of the community care units in community care beds. Subsequently, there remains the Geelong accessing illicit drugs. While Community Visitors ongoing demand to access the community care unit beds understand there is a drug policy for residents living at in Geelong with patients in the adult acute patient unit the community care units, there is little evidence of any waiting to be transferred to the community care unit. This is proactive strategies to address these ongoing concerns. further emphasised when residents in community care units This continues to have an adverse impact on other are unable to find alternative appropriate community-based residents who are exposed to the behaviours of drug- accommodation in the region, particularly when they no affected residents. longer require services and care provided in the community care units.

(b) Patients are remaining for longer than necessary at Warrnambool services because of the lack of available There are still no secure accommodation in the community. There remains ongoing evidence that patients at the extended care unit beds in adult acute inpatient unit and the community care unit this region and, as a result, at Warrnambool have remained in these facilities for an extended length of time as they cannot access alternative there are several patients accommodation in the region. Some patients have exceeded 12 months at the adult acute inpatient unit and inappropriately placed. there are some residents who have stayed for several years at the community care unit unable to access alternative care or accommodation.

1 Within Barwon-South West Region these services are managed by South West Healthcare and Barwon Health.

Eastern Metro Region

This region, extending from St Vincent’s Hospital, Findings against the goal: Fitzroy, to Mooroolbark in the outer east, includes three adult acute inpatient units, two aged persons acute units, To assess and report on the appropriateness and an adolescent unit, three community care units, four standard of facilities for accommodation, physical well- aged persons mental health residential units and the being and welfare of people with a mental illness statewide personality disorder unit. In addition, the (a) There are considerable improvements in building emergency department at the Maroondah Hospital has maintenance; however, there remain delays. also been visited.2 While there has been extensive expenditure on refurbishments and new equipment in all facilities, often Findings against the goal: the day-to-day maintenance is lacking. Community Visitors have continued to report the lack of this to management To advocate for the best possible assessment and with little or no result. treatment services and adequate human and physical resources in each mental health service

(a) There are many examples of patients being delayed Findings against the goal: access to an appropriate bed and treatment. To assess and report on the opportunities for There have been many occasions when patients have had recreation, occupation, education, training and to wait unacceptable periods for appropriate treatment rehabilitation of clients options. These include delays of five to six months before (a) There has been a strong growth in activities transfer to secure extended care units, and delays of up programs. to 48 hours before patients can be transferred from the emergency department at Maroondah to the acute unit. The comprehensive activities program at the adult acute inpatient unit at St Vincent’s Hospital appears to have A patient with a dual disability had been treated at reduced the rate of absconding. All community care Maroondah Hospital but there was an unacceptable units have continued to be effective with a full range of delay (3-4 months) in the discharge from the acute unit to programs. People are being introduced to independent accommodation that was more appropriate. living and to employment opportunities where possible. People in community care units who have reached their optimum level of rehabilitation and need to transition to alternative community-based accommodation are required Findings against the goal: to wait up to two years for other accommodation. These To assess whether the environment and the manner delays continue to be attributed to the lack of alternative of service provision are the least restrictive and least options across the region. intrusive possible, consistent with the clients receiving the best possible treatment of care appropriate to their Requests for assistance for patients in the adult needs. acute inpatients units have been largely prompted by disagreements about medications prescribed and a need (a) The theme of locking units continues. for assistance regarding second opinions and accessing St Vincent’s manages to remain unlocked, but the the Mental Health Review Board. Maroondah and Box Hill adult acute inpatient units have Other complaints were about staff attitudes and behaviour been locked throughout the year. towards patients, for example, being abrupt with patients.

There continues to be staff shortages in the acute units and there remains an ongoing concern regarding lack of activities.

2 Within Eastern Metro Region services are managed by Eastern Health and St Vincent’s Health.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 21 Gippsland Region

The region’s mental health units are all based at the (b) The lack of accommodation options creates a Latrobe Regional Hospital in Traralgon, with the exception bottleneck of many patients. 3 of the community care units located in Traralgon. There are a number of long-stay patients and patients with There is one adult acute inpatient unit, one child and dual disabilities in the adult acute unit seeking alternative adolescent unit, one secure extended care unit, one aged accommodation which is limited or not available. While persons acute unit, one aged persons mental health the opening of the community care units was a welcome residential unit and one community care unit. The new resource to the region, there are further resources needed community care unit was operational in October 2006; this in East Gippsland. is a much needed resource in Gippsland. Findings against the goal: Findings against the goal: To assess and report on the appropriateness and To visit each mental health service providing residential standard of facilities for accommodation, physical well- services and 24-hour nursing care at least once a being and welfare of people with a mental illness month with the objective of promoting the individual (a) Maintenance and the physical appearance of the rights and dignity of people with a mental illness facilities have improved. (a) There is a lack of response to patient health needs There has been a marked improvement with maintenance between health services and mental health services. of all units. The delay and lack of cooperation between Latrobe Regional Hospital health services and mental health services severely impacted on the health and welfare of Findings against the goal: a patient. The consequence of this hindered the patient’s To assess and report on the opportunities for progress and access to appropriate health services. recreation, occupation, education, training and rehabilitation of clients Findings against the goal: (a) Recreational activities continue.

To advocate for the best possible assessment and There are a range of activities available in all units. treatment services and adequate human and physical For example, home economics activities are run in the resources in each mental health service community care units.

(a) Demand on the hospital emergency department highlighted flexible and effective care management. Community Visitors acknowledged the hospital management’s response to a sudden increase in emergency department admissions for those patients who required a mental health admission to the adult acute inpatient unit. During the year, up to 10 patients presented at the emergency department who required an adult acute inpatient unit admission but the unit was full. Temporary beds were opened in an adjacent vacant ward (with psychiatric care) to accommodate those patients who otherwise would have had to wait up to 48 hours in the emergency department until mental health beds became available.

3 Within the Gippsland Region services are managed by Latrobe Regional Hospital.

22 Grampians Region

Covering the area west from Ballarat to the South At Stawell, Community Visitors report that the aged Australian border, the Grampians Region has one adult psychiatric patients have had limited access to activities acute inpatient unit, one secure extended care unit, one which are available and provided to the rest of the patients aged persons acute unit, one aged persons mental health in the MacPherson Smith Nursing Home. residential care unit and a community care unit in Ballarat. There are several aged persons mental health beds in two (b) Lack of support created a missed opportunity to general nursing homes, one in Stawell and the other in assist a patient undertake further studies. Nhill.4 At the community care unit at Ballarat, a resident, with staff support, had enrolled at university and needed access to a computer. The hospital management agreed to supply a Findings against the goal: computer but, after six months, the computer still had not been provided thus jeopardising her participation in the To assess and report on the appropriateness and course and mental health rehabilitation. standard of facilities for accommodation, physical wellbeing and welfare of people with a mental illness (c) The rural area provides examples of good (a) Some services have markedly improved facilities. quality care. At the community care unit, new carpets and kitchen The activities program at Iona House, Nhill, is an excellent appliances have been installed in the units and residents example of good patient care in an aged persons mental have been delighted. In the secure extended care unit there health residential unit where, despite the distance from have been improvements to the courtyard, including new many services, every effort is made to provide the furniture, and new carpet has been installed in the adult particular care needed. acute inpatient unit. Findings against the goal:

Findings against the goal: To assess whether the environment and the manner To assess and report on the opportunities for of service provision are the least restrictive and least recreation, occupation, education, training and intrusive possible, consistent with the clients receiving rehabilitation of clients the best possible treatment of care appropriate to their needs (a) There has been a decline in the provision of activities. (a) The security measures at Ballarat Base Hospital are custodial in style and detract from the therapeutic In the adult acute inpatient unit at Ballarat Base Hospital, approach. nurses had been providing activities but Community As a result of a coronial inquiry, changes in the adult acute Visitors noted that this was no longer happening. Staff said inpatient unit at Ballarat Base Hospital include installation that more one-to-one time was being spent by nurses on of obvious security cameras and very high fencing of therapeutic activities. However, patients complained they one courtyard. The second courtyard with its lower fence had nothing to do and the Community Visitors reported is no longer available for patients unless escorted by that there was little provision or opportunity for recreational staff. The Community Visitors reported a more restrictive activities. They had requested that daily papers and recent environment for all patients that appears custodial rather magazines should be available in the lounge rooms. than therapeutic. At the secure extended care unit at Ballarat, there has been no occupational therapist for over twelve months, leaving nurses being responsible for providing activities. Patients complained particularly about the lack of outings previously provided. Similarly, at the aged persons acute unit in Ballarat, there is no designated person for activities and individual nurses provide some activities such as knitting.

4 Within the Grampians Region services are managed by Ballarat Health Services.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 23 Hume Region

The Hume Region covers an area of 40,000 square (b) Additional demands on mental health services are kilometres, bounded by Corryong to the east, Kinglake to occurring as more patients present with substance the south, Shepparton to the west and Wodonga to the abuse. north. There are six mental health facilities throughout the Community Visitors report that, at the adult acute inpatient region: an adult acute inpatient unit and an aged persons unit at Shepparton, more patients are being admitted mental health residential unit at Shepparton, an adult acute who have acute and complex needs arising from the unit at Wangaratta, a community care unit at Wodonga and apparent increase in substance abuse. These patients a community care unit and an aged persons mental health often show aggressive behaviour and invade personal 5 residential unit at Beechworth. space. Often combining these problems with a severe Following the government’s allocation in the 2005-06 mental illness, these patients are unpredictable and difficult budget of $6.5 million to redevelop the site of the former to treat. Incident reports show an increasing frequency Ambermere Hospital, accommodation for ten community of threatening behaviour and of staff assaults, including care beds and ten prevention and recovery care beds is one incident where a staff member was detained in a high being developed as well as a refurbished Centre for Older dependency unit by a patient who confiscated the keys Persons’ Health. and communication equipment from the staff member.

A review of aged persons mental health services in the (c) Poor communication between child protection Hume Region was commissioned in February 2007 and services and mental health services created a stressful consultants commenced interviews with stakeholders period for an expecting mother. and service providers. At the time of writing this report, A pregnant woman due to give birth by caesarean section the Community Visitors had not been consulted but were in three days was admitted as an involuntary patient to identified as key stakeholders in the project brief. It is an adult acute inpatient unit. The patient contacted the expected that consultation will take place following the Community Visitors via a referral from the Office of the release of a discussion paper. Public Advocate to protest that she believed she should be admitted to an obstetric ward of the local hospital rather than an adult acute inpatient unit. The Community Visitor Findings against the goal: contacted the staff who advised that the gynaecologist and psychiatrist had prepared a treatment plan. The patient was To advocate for the best possible assessment and treatment services and adequate human and physical assured that she would be properly cared for during the resources in each mental health service birth and would be transferred to a specialist mother and baby unit at the earliest opportunity. There was a clear lack (a) There is a shortage of 24-hour care accommodation of communication between the community mental health for patients who require follow-up or permanent care worker and child protection services prior to her admission. and rehabilitation after discharge, particularly from Child protection services were contacted and required to adult acute inpatient units. intervene during a crisis period. The distress caused to The units providing this service are the short-term the mother because of a lack of case management was community care units at Wodonga and in Beechworth, unacceptable to this patient and could have been avoided. but they rarely have vacant beds. Community Visitors do (d) Clearer processes for complaint mechanisms are acknowledge the PARC unit at Shepparton; however, it is needed in circumstance where police are involved and a concern to Community Visitors that despite the demand the delay in patient treatment needs reviewing. within the region, a patient from Maroondah Hospital was placed in the community care unit in Wodonga, as there A 60-year-old homeless involuntary male patient was were no beds available in Dandenong. Not only was this admitted to an adult acute inpatient unit by Victoria an unsatisfactory outcome for this out-of-area patient but it Police, presenting with a black eye, sore ribs and difficulty also reduced the availability of beds for patients within the breathing. The nursing staff were concerned about his region. injuries and the possible cause and documented his complaints. Two days after admission, a pneumothorax was diagnosed and emergency surgery was required. Staff communicated their concerns to the Community Visitors about the patient’s injuries on admission. Community 5 Within the Hume Region services are managed by Visitors were concerned a complaints mechanism was not Goulburn Valley Health, Beechworth Health, Northeast implemented. Because of the patient’s allegation of assault Health and Wodonga Health Services.

24 by Victoria Police, the Public Advocate referred the matter Findings against the goal: to the Police Ethical Standards Unit. Victoria Police are keeping the Office of the Public Advocate informed. To assess and report on the appropriateness and standard of facilities for accommodation, physical well- (e) There are ongoing difficulties in recruiting and being and welfare of people with a mental illness retaining psychiatrists and nursing staff. (a) There are unacceptable delays in maintenance. Difficulty in finding and retaining psychiatrists is evident in the region, particularly for the aged persons mental This continues to be an issue in most units, particularly health residential unit at Beechworth and the two at the community care units at Beechworth, where there community care units. At the aged persons mental health have been lengthy delays in remedying problems because residential unit, interviews between the patient and a of budget constraints and how priorities are determined. psychiatrist during periodic reviews have been replaced Consequently, Community Visitors reported a significant with a case conference led by a senior nurse. Residents number of cleaning and maintenance items that needed of the community care units who require mental health urgent attention in December 2006 and again in assessments are referred to an adult inpatient acute unit. February 2007. A high turnover of nursing staff is a concern at the adult The need for replacement of torn and unsuitable chairs acute inpatient unit at Shepparton. Some senior nursing at the adult acute inpatient unit at Wangaratta has been positions are being filled from overseas due to the poor regularly reported since September 2006 and is still not response to advertising in Australia. resolved. At this unit, there was a delay of over three (f) Staff have been supported to improve management months in dealing with water damage and a hole in a wall. of high risk behaviour. At the aged persons mental health residential unit at Following a serious assault and a staff member being Beechworth the main bathroom is being used as a storage detained by a patient at the adult acute inpatient unit at area for current and obsolete equipment. This is an unsafe Shepparton, staff have been provided with retraining in and inappropriate situation for staff and patients. behaviour management and self-defence methods. More thorough risk assessments of patients are also being undertaken on admission. Security officers have been employed to assist with seclusion breaks and, when The distress caused to the required, an officer is rostered into the high dependency unit. Management and staff have set a goal for 2007 to mother...was unacceptable reduce the number of adult seclusions. to this patient and could (g) Good practices in aged persons residential care units include responses to adverse events. have been avoided. In the aged persons mental health unit and the community care unit at Beechworth, an ‘adverse events’ register is used to continuously document strategies for dealing with the changing behaviours and health conditions of dementia residents. The adverse event acts as a trigger to initiate a review of the resident in question. Part of the process also requires the regular input from a dietician and a physiotherapist. The falls prevention program, combined with access to adjustable beds and all residents being fitted with hip protectors, has dramatically reduced the number of residents suffering fractures.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 25 Findings against the goal: Findings against the goal:

To assess and report on the opportunities for To assess whether the environment and the manner recreation, occupation, education, training and of service provision are the least restrictive and least rehabilitation of clients intrusive possible, consistent with the clients receiving the best possible treatment of care appropriate to their (a) High quality and innovative activities programs needs are being provided. (a) Improvements have been made to safety and Programs across all facilities are generally very good in security. providing patients and residents with a variety of activities. In the high dependency unit of the adult acute inpatient unit The program at the adult acute inpatient unit at Wangaratta at Shepparton, several observation windows have been has input from the allied health worker, psychologist, installed and glass panels inserted into all doors to ensure occupational therapist and activities officer. The activities more effective staff monitoring can occur. A reduction in provide educational, vocational and socialisation programs patients absconding is now evident, resulting from more for patients who are responding enthusiastically. effective security systems being implemented.

The adult acute inpatient unit at Shepparton has a new Alterations to the building layout and fixtures have also activities program, developed by the occupational therapist improved supervision and safety at the adult acute in consultation with the activities officer and resident inpatient unit in Wangaratta. Changes to the internal psychologist. The psychologist also provides individual spaces have provided more visibility of patients in the high therapeutic programs for patients. dependency unit while allowing sufficient privacy to be The aged persons mental health residential care unit at preserved. Identifying fixtures that could provide a hanging Beechworth provides activities for residents at all levels point for patients has resulted in shower rails, curtains and in the unit. A men’s shed program was introduced in door handles being replaced with designs that are more December 2006 and is still proving popular. The aged suitable. persons mental health residential care unit at Shepparton and the community care unit at Beechworth both plan annual holidays with their residents, raising funds throughout the year to support the activity.

Programs across all facilities are generally very good in providing patients and residents with a variety of activities.

26 Loddon Mallee Region

Loddon Mallee Region comprises four mental health units: Findings against the goal: an adult acute inpatient unit and an aged persons acute unit at Bendigo Hospital, an aged persons mental health To advocate for the best possible assessment and residential unit and a secure extended care unit including treatment services and adequate human and physical community care unit beds, all under the management of resources in each mental health service the Bendigo Health Care Group.6 (a) The lack of cooperation by hospital medical staff led to delays in treatment. Findings against the goal: At the aged persons acute unit at Bendigo Hospital, Community Visitors were informed about a patient whose To visit each mental health service providing residential prescribed electro-convulsive therapy had been delayed services and 24-hour nursing care at least once a for six weeks because no suitably qualified physician month with the objective of promoting the individual from the hospital had seen him to assess his medical rights and dignity of people with a mental illness condition preparatory to him receiving an anaesthetic. (a) Basic comforts, such as bedding are inadequate. Despite assurances given to Community Visitors by senior management at Bendigo Hospital that the matter would Early in 2007, Community Visitors became aware that be rectified immediately, it was another week before the some patients at the adult acute inpatient unit at Bendigo patient received the appropriate examination and the Hospital had removed their mattresses from the beds and prescribed psychiatric treatment could proceed. The were sleeping on the floor because the bed frames and Executive Director of Mental Health Services subsequently sagging wire bases were no longer comfortable to use. assured the Community Visitors that procedures had Despite protests by the Community Visitors, it was several now been established to ensure that appropriate medical months before funding was made available to purchase treatment and consultation would be readily available to new beds, which have finally been provided. patients in the aged persons acute unit in the future. At the aged persons acute unit at Bendigo Hospital, new (b) Good practice has been acknowledged at Simpkin mattresses had been needed for some time. The existing House. ones were thin and vinyl-covered and surfaces had become cracked and wrinkled and very unsatisfactory for Simpkin House, the aged persons mental health residential frail elderly patients. Eventually, the unit manager undertook unit in Bendigo, won a Better Practice in Aged Care award to pay for new mattresses from the unit’s small incidental from the Aged Care Standards and Accreditation Agency expenses allocation so that, over a period of months, all for its innovative reduction of psychotropic medication mattresses were replaced. program.

Community Visitors are aware of systemic resource issues for the Bendigo Health Care Group as evidenced by the time it has taken to order new beds for the adult acute inpatient unit and the delay in developing the planned Prevention and Recovery Care facility. That the unit manager of the aged persons acute unit had, of necessity, to purchase urgently-needed new mattresses at four per month using the unit’s small monthly allocation for incidentals is a further indication of this problem.

6 Within Loddon Mallee Region services are managed by Bendigo Health Care Group and Ramsey Health Services.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 27 Findings against the goal: Findings against the goal:

To assess and report on the opportunities for To assess and report on the appropriateness and recreation, occupation, education, training and standard of facilities for accommodation, physical well- rehabilitation of clients being and welfare of people with a mental illness

(a) Inadequate activities programs have led to patients (a) Maintenance and cleaning remains problematic at complaining about boredom. Bendigo Hospital. Patients at the adult acute inpatient unit at Bendigo For two years, Community Visitors to the adult acute Hospital have complained to Community Visitors about the inpatient unit at Bendigo have been reporting the poor inadequate activities offered to them, saying that there is condition of the high dependency unit’s courtyard. It is an nothing to do but smoke. Community meetings were not ugly, barren space, often needing cleaning and painting. occurring daily as expected. A petition was also submitted The exterior garden area of the unit is an unattractive space signed by 15 patients complaining about the inadequate with graffiti on walls, an unsightly shade cloth along a fence activity program and offering a number of suggestions. and littering of cigarette butts. As a result of requests by Finally, the walking machine which had been broken for the Community Visitors, some of the graffiti was painted years has been replaced, an exercise bike provided and an over but in general little was done to improve the area. activities program put into place. To get minor maintenance works done in a timely manner appears to be extremely difficult for the Bendigo Health At the aged persons acute unit, Bendigo Hospital, there Care Group. At the secure extended care unit at Bendigo, had been no activities officer for more than eighteen although replacement of some furniture in the main months as no funding was provided. Eventually, in early recreation room occurred, the lounge furniture in two of 2007, a part-time occupational therapist was employed to the secure units remained shabby and damaged for many provide activities. However, the lack of a suitable room for months. activities continues to hamper any program. For many years, Community Visitors have reported the problems with fluctuating and, at times, extreme temperatures in the adult acute inpatient unit at Bendigo Hospital because of the air-conditioning system. Hospital engineers have reported the problem too difficult to solve unless the unit is rebuilt.

(b) The lack of storage space has not been resolved in years. At the aged persons acute unit at the Bendigo Hospital, Community Visitors have been reporting for a number of years on the lack of storage space for equipment. A bathroom was crowded with nursing equipment, patients’ luggage and spare furniture. The bathroom has now been decommissioned to create an official storage area; however, racks and shelving have not been provided, thus making access to equipment difficult.

At the aged persons acute unit, Bendigo Hospital, there had been no activities ofﬁcer for more than eighteen months...

28 Northern Metro Region

Northern Metropolitan Region incorporates a Findings against the goal: comprehensive range of public mental health facilities: 18 units consist of two adult acute inpatient units (one To advocate for the best possible assessment and incorporating specialist beds for mood and eating treatment services and adequate human and physical disorders and the mothers and babies service), a veterans resources in each mental health service adult acute inpatient unit, two secure extended care units (a) There is a lack of suitable accommodation for (one being a brain disorders unit), an adolescent inpatient people with very particular needs. unit and the statewide Austin Health – Eagle Child Unit, one aged persons acute unit, one aged person mental health Through the Long Stay Patient Project, 18 patients in residential care unit, one community care unit and seven mental health units in this region have been identified forensic mental health units at Thomas Embling Hospital.7 as requiring either less restrictive accommodation or a more specialised type of accommodation. These include long-term residents of the now-closed large mental health Findings against the goal: institutions who will always need supervised care with supported access to the community; others, because of To visit each mental health service providing residential their mental illness, require opportunities for short-term services and 24-hour nursing care at least once a intensive care and rehabilitation combined with longer- month with the objective of promoting the individual term individualised care due to their difficulty in coping rights and dignity of people with a mental illness with shared accommodation. Some of these patients are (a) A media report that named a patient and his in high-security settings or acute units. Not only is this treatment centre has been associated with poor stressful for them but they are occupying beds urgently outcomes for the patient and fellow patients. needed for patients waiting for admission.

There have been two instances where forensic patients (b) Staff shortages contribute to a loss of treatment and were publicly named and details about them reported activity programs. by the media in a sensational and alarmist manner. The An acute unit at Thomas Embling Hospital and the secure negative impact of this on these people and other patients extended care unit at the Austin Hospital were without an at the hospital was considerable. The Acting Public occupational therapist for several months. Advocate responded with a public statement condemning such reporting. Shortage of staff at the adolescent unit at the Austin Hospital at one stage meant that only five patients could be in residence.

...forensic patients were Findings against the goal: publicly named and details To assess and report on the appropriateness and standard of facilities for accommodation, physical well- about them reported being and welfare of people with a mental illness (a) Management has failed to adequately address issues that place patients in danger. For the last three years, Community Visitors have reported concerns about safety at the Child and Adolescent Mental Health Service’s inpatient units at Marion Drummond building at the Austin Hospital, particularly the unsatisfactory location, cramped conditions and fragile nature of the construction of the high dependency unit. The number of exterior doors and elongated design of the adolescent unit also made supervision difficult.

7 Northern Metro Region services are managed by Austin Health, Melbourne Health and Forensicare.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 29 In December 2006, the serious assault of a nurse in blocks surrounded by a temporary plastic ’fence’. No the high dependency unit led to the involvement of effort had been made to replace a garden and hedge that Occupational Health and Safety officers, the Health and had provided some privacy for the child unit. In addition, Community Services Union and, under Work Safety windows needed cleaning and unwanted furniture was left requirements, the closure of the high dependency unit. on the veranda. Admissions were restricted to non-aggressive patients Thirdly, in the child unit, action to remedy the appalling and this inevitably placed pressure on other Child and conditions of the laundry has been very slow. Following Adolescent Mental Health Services units. Recommended a Community Visitors’ report in February 2006, on the changes to the design of the unit to provide for more dilapidated, mildewed and cramped facility located in effective supervision (including the relocation of the high a small room with a toilet, the walls were cleaned and dependency unit and the nurses’ station, the installation painted. Renovations including removal of the toilet and of video monitoring of external entrances and an alarm vinyl flooring were not completed until mid-2007. Problems system) had not been implemented by June 2007. in obtaining suitable machines meant the laundry was out Discussions regarding the future of the two inpatient units of action for several months until the end of June 2007. in Marion Drummond building are continuing. Also, a bathroom was out of use for a week due to minor Community Visitors have also reported a number of safety damage to a wall. risks to children in the child unit in Marion Drummond At the Northern Hospital, Epping, in the adult acute building: the unprotected exterior areas close to internal inpatient unit, failure to repair a vacuum system led to the roads, an adjacent car park and a major road; inadequate floors of bedrooms being left dirty. Community Visitors protection of access from the children’s lounge area to have reported significant litter from cigarette butts in an unsafe staircase and, in the bedrooms, unstable metal garden areas and the use of large tins instead of proper clothing racks that are easily moved and tipped and can be butt bins. Also of concern were the dilapidated state of the disassembled into potentially dangerous parts. Alterations high dependency unit, the stains on lounge furniture and to make the staircase safer occurred four months after staff carpets and insufficient seating in the dining room. Staff are submitted requests for action. currently working on cleaning the unit and redevelopment (b) Maintenance and cleaning delays are common in of the high dependency unit occurred during June 2007. child and adolescent services. At the Northern community care unit, Community Visitors At the Austin Hospital in the Marion Drummond building have reported the accumulation of rubbish in the garden. that houses the Child and Adolescent Mental Health This included rubbish scattered around, broken and Service’s inpatient units, Community Visitors have noted abandoned furniture and dangerously sharp metal objects. long delays in response to maintenance and cleaning The provision of a store room for unused furniture is a needs. Unit managers reported they had repeatedly matter of urgency. requested action to rectify the problems; however, the building and engineering services had failed to respond in (c) Air-conditioning and heating problems are leading a timely manner. to patient complaints. Community Visitors received numerous complaints from Firstly, the Community Visitors Program’s Annual Reports patients at Thomas Embling Hospital about the difficulties of 2005 and 2006 noted the failure of the hospital to clear in sleeping on hot nights. The lack of air-conditioning of significant debris from the spouting that was causing bedrooms had been reported in last year’s Annual Report damage and posed a fire risk. Some clearing of the but finance was not available until recently. As an interim adolescent unit’s roof occurred late in 2006 but the rest of measure, roof insulation was installed earlier this year. the spouting was not cleaned until mid-2007. In the child unit in the Marion Drummond building at the Secondly, in September 2006, an undertaking was given Austin Hospital, bedrooms were particularly hot at night, to Community Visitors that a maintenance audit of Marian causing considerable distress. Because of the limited Drummond building would be carried out and action power capacity in this old building, installation of air- would be taken to provide a safe and suitably landscaped conditioning for the bedrooms is not feasible. Other means garden to the east. No action followed and in June 2007 of ensuring cool air flow are being considered. Community Visitors were still reporting the same problems. By this stage the shabby and dirty exterior of the building Some initial problems with air-conditioning the new adult had deteriorated further and the garden to the east was acute inpatient unit at the Austin Hospital, particularly in the in a degraded state including a pile of large bluestone areas housing the mothers and babies, have occurred, for

30 example with the temperature being too cold and made Findings against the goal: worse by strong draughts under exterior doors. To assess whether the environment and the manner (d) Many patients have reported great satisfaction with of service provision are the least restrictive and least new or improved facilities. intrusive possible, consistent with the clients receiving In December 2006, patients were moved from temporary the best possible treatment of care appropriate to their accommodation, following the closure of Larundel Hospital needs in 1999, into the new, 30-bed, adult acute unit (that (a) Use of seclusion and treatment of patients could be incorporates the specialist mood and eating disorders prevented with better facilities. and the mother and babies programs) and the new, 25- bed, secure extended care unit at the Austin Hospital. At Thomas Embling Hospital, a patient with severe Patients have commented enthusiastically about the better difficulties in controlling her behaviour was nursed in a conditions, particularly having their own bedrooms and en- seclusion area for over six months. While modifications suite facilities. In the secure extended care unit, there was made it more comfortable and a careful management plan a dramatic reduction in assaults immediately following the ensured her gradual integration into the life of the unit, the relocation to the new building. patient told Community Visitors that the experience made her feel “helpless and powerless” and “bored”. She spoke In May 2006, a 20-bed, sub-acute unit opened at Thomas gratefully about the support and care provided by the Embling Hospital to meet the strong demand for beds for staff. For the Community Visitors, this case highlighted the mentally ill persons in the prison system. The consequent need for new facilities that could provide appropriate care move of rehabilitation units into the newly renovated without resorting to such a solution. Jardine Flats and Daintree building has been beneficial, providing greater opportunities for independent activity (b) Staff actions caused patient distress while in and living conditions. At the Northern Hospital recent seclusion. renovations to the high dependency unit have created a At the Northern Hospital, in the adult acute unit, a patient more spacious and attractive environment for the care of spoke to a Community Visitor about the distress and very unwell patients. humiliation she experienced in both the actions of staff prior to and in seclusion. Issues included the use of Painting and repairs have improved the veterans acute security staff, unexplained bruising of the patient and inpatient unit at Austin Health. conflicting accounts of the events. The Community Visitor The attractive new activities room at the aged persons notified senior staff of the concerns. It was acknowledged acute unit at Bundoora Extended Care is invaluable for the that this was a serious incident and Community Visitors excellent range of activities offered to patients. were assured that the staff were providing support for the patient. At the child unit at the Austin Hospital, the new playground is an interesting space with a variety of challenging (c) There has been marked reduction in the use of equipment, rubber paving for safety and a cubby house. seclusion in a major service. Community Visitors report a dramatic reduction in the At the Austin Hospital, in the adult acute inpatient unit incidence of assault in the secure extended care unit at and the secure extended care units, there has been a the Austin Hospital following the move to the new unit. reduction in the use of seclusion both in the number of However, they have also expressed concern about the episodes and the number of patients secluded. The facility possible impact of aggressive patients where there is a mix has new buildings and has implemented a progressive of vulnerable female patients in an acute setting such as model of care whereby alternatives to seclusion have been the new adult acute inpatient unit at the Austin Hospital. practised.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 31 Southern Metro Region

The Southern Metropolitan region extends from the (b) Service changes have improved discharge planning. Melbourne bayside area to the Mornington Peninsula and The Open Doors Initiative, a collaborative partnership to Berwick. between the Alfred Psychiatry and the Mental Illness There are seven adult acute inpatient units, four aged Fellowship was introduced in February 2007. This is an persons acute units, six aged persons mental health integrated model of care across Psychiatric Disability residential units, four community care units, one secure Rehabilitation and Support Services and clinical services extended care unit, one adolescent unit, one mother and to assist residents to transition from the community care baby unit and one eating disorder unit.8 units into more independent living within the current program. This also includes the opportunity for patients from the adult acute inpatient units at the Alfred Hospital to Findings against the goal: move directly to these units if they do not require intensive rehabilitation provided in community care units. To advocate for the best possible assessment and treatment services and adequate human and physical resources in each mental health service Findings against the goal:

(a) There is a shortage of secure extended care beds To assess and report on the appropriateness and resulting in patients remaining in acute units occupying standard of facilities for accommodation, physical well- beds needed by other persons requiring an admission being and welfare of people with a mental illness to an acute unit. (a) Monash Medical Centre continues to have problems Patients in the Frankston adult acute inpatient unit have with the standard of cleanliness, both internal and been continually exposed to a patient who is a risk to them external. because of violent behaviour. This patient has been in the unit for ten months pending the availability of a secure This remains unresolved despite these issues being raised extended care bed. consistently by Community Visitors with management. With the exception of Monash Medical Centre, the standard of Community Visitors continue to report on the acute cleanliness at other mental health facilities has improved shortage of appropriate accommodation on discharge in over the past year. all areas of the region. Some adult acute inpatient beds are occupied by patients needing a different type of Cleaning in the outdoor and kitchen areas of the mother accommodation, for example: and baby unit at Monash Medical Centre is inadequate.

• a patient with Huntington’s Disease recently spent During a visit to the aged persons mental health residential eight months in an adult acute inpatient unit due to the unit at the Kingston Centre (Allambee) Community Visitors unavailability of specialist accommodation providing found one toilet soiled with faeces which had trailed along long-term support and care. the corridor and into the recreation area. There was also an unacceptable odour of urine evident in Unit A. A strong • a patient with a dual disability spent 180 days odour of urine and faeces was also noted during another in an adult acute inpatient unit because a place visit to the Kingston Centre, Biala unit. in a community residential unit run by disability accommodation services was not made available. The refurbishment of the units at Dandenong Hospital, both internally and the courtyard, has improved the environment for patient care. An improvement with maintenance in all facilities of Peninsula Health Network continues.

(b) Various amenity issues create problems in supporting patients. Community Visitors persisted for over nine months before deteriorated furniture was replaced in the recreation room of the Monash Medical Centre’s mother and baby unit.

Some major cooking equipment at the aged persons mental health residential unit at Frankston has remained 8 Within the Southern Metro Region services are managed out of order for a period of 11 months. by Peninsula Health, Southern Health and Bayside Health.

32 At the Moorabbin community care unit, there has been a number of cooking and washing facilities out of order for Community Visitors many months. persisted for over nine Showerheads in the aged persons acute unit at the Kingston Centre, which presented as a suicide risk, took months before deteriorated seven months to be replaced. furniture was replaced At the St Kilda community care unit, there is no air- conditioning or fans in the bedrooms. Residents are asked to buy their own and take them with them when they leave. Findings against the goal: This policy was introduced due to the frequency of theft of fans previously provided by the management. To assess whether the environment and the manner of service provision are the least restrictive and least At the Caulfield Medical Centre’s aged persons acute unit intrusive possible, consistent with the clients receiving (Baringa) and the aged persons mental health residential the best possible treatment of care appropriate to their unit (Namarra) there is no air-conditioning or fans in the needs bedrooms and the air-conditioning in the common rooms does not operate effectively. (a) Improved programs have led to a reduced use of seclusion. The Community Visitors have been advised by The extensions of the high dependency units (HDU) of management that because of the current load on the two adult acute inpatient units at the Alfred Hospital have electrical grid system, no additional installation of increased bed numbers from 54 to 58 beds. Four of the equipment is permitted. 58 beds are allocated as statewide beds. The increased space allows for a multi-disciplinary approach to treatment Findings against the goal: which includes music therapy and art therapy and with the increase of HDU beds there has been a reduction in To assess and report on the opportunities for the use of seclusion. Frankston Hospital is practising a recreation, occupation, education, training and more intensive diversional program to reduce the need for rehabilitation of clients patients to be placed in seclusion.

(a) Lack of staff has led to an elimination of important programs. Community Visitors reported difficulties in units recruiting and retaining occupational therapists. This has reduced opportunities for psychosocial rehabilitation being offered to patients during their inpatient stay.

There have been several issues at the Monash Medical Centre mother and baby unit where, due to the lack of resources, both group and individual counselling sessions have not occurred when the regular psychologists have been on leave.

The patients in the adult acute inpatient unit at the Monash Medical Centre complained that they are restricted in their use of equipment for activities as this is dependent on the availability of staff to provide the necessary supervision.

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 33 Western Metro Region

This region extends from the inner-urban area of Parkville (c) The opening of a new unit has assisted throughput to rapidly developing outer-suburbia from Broadmeadows of patients. to Werribee, with 20 mental health units: four adult acute At the Royal Melbourne Hospital, in the adult acute units, one secure extended care unit, two aged persons inpatient unit, a prevention and planning unit has been acute units and four aged residential care units, two child established. This is a short stay unit designed to relieve and adolescent acute units, three specialist units (eating pressure on the emergency department by providing initial disorders, neuropsychiatry, mother and baby) and four treatment; patients are then admitted to the unit or are 9 community care facilities. able to return home not requiring an admission to the adult acute inpatient unit. Findings against the goal:

To advocate for the best possible assessment and Findings against the goal: treatment services and adequate human and physical To assess and report on the appropriateness and resources in each mental health service standard of facilities for accommodation, physical well- (a) Shortage of secure extended care beds results in being and welfare of people with a mental illness inappropriate lengths of stay. (a) There is a lack of access for physically disabled A shortage of secure extended care beds remains a patients. significant problem resulting in long stays in acute units The Royal Melbourne Hospital’s adult acute inpatient unit because the next stage of care is not available. In addition, does not have wheelchair access for those patients with a in secure extended care units there are patients waiting physical disability. long periods for appropriate discharge accommodation; for example, at the secure extended care unit at Sunshine (b) There are long delays in resolving maintenance Hospital there can be up to five patients awaiting discharge problems at Werribee Mercy adult acute inpatient unit. accommodation. There is a need for accommodation At Werribee Mercy, the dryer in the laundry was not working for long-term patients who have been in mental health for several months, with dirty clothing being left around. institutions for a long time and have chronic health and Washing of personal clothes was a problem. Over several behavioural problems that prevent their transition into months, Community Visitors reported problems with mainstream public housing. washing cups and utensils in the dining room and kitchen. (b) Recovery Framework in Mental Health Service is a During this period, a gastro-enteritis outbreak occurred and much-needed resource. there were no admissions to the unit for 10 days. Almost six months later, Community Visitors reported that the kitchen Community Visitors have been impressed with the needed an “an urgent overhaul” as “it seems to be a health implementation of the Intensive Treatment and Recovery hazard”. In the dining room a sizeable hole appeared in Framework in rehabilitation and secure extended care units a rotted section of the wall and was not repaired for more managed by North Western Mental Health Service. than a month. A patient’s bedroom was not able to be This aims for greater collaboration between consumers, locked for at least six months. Outdoor furniture had been carers and clinicians in terms of assessment, goal planning noted as unstable and needing fixing. and treatment tailored to an individual’s changing needs. Community Visitors report that, at Broadmeadows Hospital’s adult acute inpatient unit, the outdoor recreation areas are unsatisfactory; for example, dusty areas need paving, concrete areas need steam-cleaning, and landscape work is required to improve appearance. Some new outdoor furniture has been provided but more is needed. In addition, Community Visitors often report these areas being littered with cigarette butts. The lack of proper and timely disposal has been reported at several other units, including Royal Melbourne Hospital and Werribee 9 Within Western Metro Region services are Mercy. managed by Western Health, Mercy Health Services and Melbourne Health.

34 Findings against the goal:

To assess and report on the opportunities for recreation, occupation, education, training and rehabilitation of clients

(a) Community inclusion is welcomed in aged care units. Community Visitors report favourably on the variety of innovative activities for clients in both acute and long- term units. In particular, there are more outings providing interaction in the community.

(b) Staff shortages lead to reduced activities programs. Community Visitors report that adult acute units seem to have difficulty retaining occupational therapists. Activity rooms remain locked most of the time or not used at all. Lack of games and reading material is a common complaint. This is in contrast to those fully staffed units where excellent and creative activities are undertaken. The situation is better in aged care units where staffing and, therefore, activities programs are better maintained.

(c) A community awareness initiative has resulted in benefits to patients. South West Mental Health Service has conducted several community forums to help members of the local community have a better understanding of the needs of people with a mental illness. The Community Care Unit at Werribee held a barbecue for interested groups and, as a result of the increased public awareness, received money raised by the Wyndham Shire’s Mayoral Ball to build a glasshouse in the unit’s garden.

A shortage of secure extended care beds remains a signiﬁcant problem...

MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 35 10 Community Visitors Mental Health Stream at 30 June 2007

The Office of the Public Advocate acknowledges and thanks the other Community Visitors who participated in the program during the financial year 2006-07.

Mental Health Community Visitors

AARONS, Susan JACKSON, Terri SEAVERS , Brenda ATHAN, Sophy JACOBS, Noreen SEWELL, Paul ATKINSON, Joel JANSINK, Emmy SHERGILL, Michael BAKER OAM, Ruth JEANS, Bruce SINGER, Lisl BARBAGALLO, Josie KENNEDY, Lexie SPARROW, Jim BARLEE, Judith KILBRIDE, Margaret STAFFORD, Meredith BELT, Beth KILPATRICK, Bob STEADMAN, Ray BOLAND, Dominic LANG, Maurice STEVENS, Sandra BRUBACHER, Marc LLOYD, Vashti STROTHER, Rosalie BRYAN, Peter LOCKE, Ken TEW, Diane BUCKLES, Ian LOXTON, Kathleen TONZING, Dorothy CHAPMAN, Chris LUKE, Graeme TUNE, Marion CLARK, Cecilia MACINTOSH, Brian TYBEN, Lana CLOSS, Bernadette MANN, Victoria UDORLY, Michael COATE, Bruce MARRIOTT, Neville WALKER, Darby COE, Brian MAYNE, Arthur WALTER, Rosemary COLLINS, Maxwell McELVANEY, Carole WATERS, Jane CUNNINGHAM, Robyn McGRATH, Margaret WHITE, Maureen DEAN, Rebecca MCLEAN, Lyndall WILDE, Dianne FERREIRO, Oscar MILLER, Imogen WINTER, Ross FITZPATRICK, Frank MORRISON, Susan WINTER, Sheila FURTADO, Gemma MUSGRAVE, Pauline GLEESON, John NEWMAN, Paul GREEN, Ernest NWANKWO, Mary GROOM, Lawrie O’CONNOR, John GROSS, Kay O’NEILL, Anne GRUNDY, Jennie OWEN, Barbara GULIZIA, Donna PEARSON, Loes HABERL, Aileen PERERA, Stanley HADLEY, Michael PETERSON, Gary HALL, Dianne PORTER, Allan HARWOOD, Robin POULIER, Gillian HAYNES, Carol RAO, Sowmya HEWETT, Sam REID, Helen IRVINE, Terry RYLES, Graham

36 MENTAL HEALTH COMMUNITY VISITORS ANNUAL REPORT 2006/07 37 OFFICE OF THE PUBLIC ADVOCATE AN INDEPENDENT STATUTORY OFFICE ACCOUNTABLE TO THE VICTORIAN PARLIAMENT

5th Floor 436 Lonsdale Street Melbourne Victoria 3000 Telephone (03) 9603 9500 Victoria toll free 1300 309 337 Fax (03) 9603 9501 TTY 9603 9529 dx 210293 Website www.publicadvocate.vic.gov.au

38 This annual report is printed on Revive Laser, which is manufactured from 100% recycled fibre and is Australian made.