Report Mental Hygiene Authority

1958 VICTORIA REPORT OF THE MENTAL HYGIENE AUTHORITY FOR THE YEAR ENDED 31sT DECEMBER, 1957 - ------ --·---- ----~------------ PRESENTED TO BOTH HOUSES OF PARLIAMENT PURSUANT TO ACT No 5519, SECTION 11. [Appro:runatt Oo11 of Report.-Preparation, nut given Printing (!100 ropirs), £660.] By Authority: A. C. BROOKS, GOVERNMENT PRINTER. MELBOURNE. No. 38 ~.-[6s. 6n.]-10192/58. MENTAL HYGIENE AUTHORITY, 300 Queen-street, Melbourne, C.1, 30th April, 1958. The Honourable the Minister of Health, SIR, The Mental Hygiene Authority has pleasure in submitting, in conformity with Section 11 of the Mental Hygiene Authority Act 1950, the accompanying Report concerning the exercise of its functions and the operation of the Mental Hygiene services in this State for the year ended 31st December, 1957. Yours faithfully, E. CUNNINGHAM DAX, Chairman. CHARLES R. D. BROTHERS, Deputy Chairman. E. R. H. EBBS, Administrative Member. OBITUARY It is with the greatest regret that the Authority reports the death of Dr. William Emest Jones, C.M.G., on lst May, 1957. He was. 89, born in the same year as Ararat and Beechworth Hospitals were opened. He came to Victoria from Wales in 1905 as the first Inspector-General and he retired in 1937. He was an outstanding person, and despite the shortage of funds he managed to build Royal Park Receiving House, Mont Park Mental Hospital, Travancore Centre, and Janefield Colony. He made considerable improvements in the mental hygiene acts and it was due to his foresight that the voluntary-boarder system was introduced in Victoria eighteen years before the English mental-treatment Act was proclaimed. He was a charming person with a delightful wit and manners but he was forthright and uncompromising in his disapproval of the Mental Hygiene Authority Act which he maintained left a mental hygiene authority without authority. Another of his platforms was the loss to other departments of Mont Park land for which he had worked so hard to acquire. He was awaiting the Authority on the first day of their taking up duties, frequently ca1led into the office to discuss the changes in the Department, and his interest and encouragement remained unabated even in the last days of his illness. By his passing the Mental Hygiene Branch lost not only a pioneer, but a great gentleman and a very true friend. REPORT In this Report attention is particularly given to future planning in the Mental Hygiene Branch. The overcrowding, the increasing number of admissions, and the expansion in the hospital population all make it necessary to look ahead to see how beds can be saved by comnnmity rather than in-patient hospital treatment, by early care instead . of long-term rehabilitation and by earlier discharge from hospital. At the same time provision must urgently be made to supply the necessary hospital accommodation to relieve the overcrowding and to keep pace with migration and the natural increase of the population. STATISTICS. Admissions. In 1957 there were 4,674 admissions to the Receiving Houses and 1,114 direct admissions to the Mental Hospitals, a total of 5,788 admissions. In 1956 the corresponding admissions to the Receiving Houses were 3,985 and to the Mental Hospitals 857, and the total was 4,842. The increase in admissions during 1957 was, therefore, 946. The Voluntary Boarders who sought treatment increased from 51·1 per cent. of the admissions in 1956 to 57 ·6 per cent. in 1957. In the past six years the percentage of voluntary boarders admitted has been trebled with a corresponding decrease in the certified patients. <:tltRPH 5How•Ne, R~R1toi'I.SHtP o~ C~R.T•F•~O To Vot..vNTIIIA'Y i>t9 11£.N TS.. I I IOOf0 i Soofo ~~ , . \ 0 fl·7 - <A s .& bo fo ~ - .. :1- 'f .iq. ~~ -~I 4-0°/o ! I ~~-q ~ I J 2.0/.~~) --~ Jqst S2. 56 54- ss S6 S7 fl = Ce.rh }'e.d Cases. 8:: Volunta.r':J Cases. The urgent need for more Receiving House beds for early treatment is emphasized by the figures, which show that a greater percentage of patients in 1957 were transferred from the receiving houses to the Mental Hospitals for treatment than in 1956. In consequence, the discharge rate from the mental hospitals went up because more early cases were being admitted. These findings indicate that many more early recoverable patients than necessary were transferred to the mental hospitals, because of the overtaxed receiving-house accommodation. Discharges. The combined discharge rate for the mental hospitals and recmvmg houses is equivalent to 75 · 6 per cent. of the admissions which is a slightly higher figure than in 1956. But the discharge rate from the Receiving Houses is lower and from the Mental Hospitals higher than in 1956, for reasons explained under the preceding paragraph. Deaths. The mental hospital death rate continues to be high at 9·9 per cent. of the average number resident, though the number of elderly admissions aged 65 and over was the lowest for four years. There seems to be no obvious explanation other than the over crowding, which remained extre:q1ely grave throughout 1957. 8 Overcrowding. No further progress was made during the year in the relief of this overcrowding. Some wards which were shut for repairs were opened, but others in their turn were closed for alteration. The new hospital blocks at Beechworth and Ballarat were occupied, the first two wards at \Varrnambool were opened and also a ward at Stawell. These gave nearly 200 more beds but this was more than offset by the 350 more patients under care at the end of 1957 than at the beginning of the year. The situation should be somewhat relieved in 1958 when about 1,300 more beds are coming into commission, but this will still leave an overcrowding figure of nearly 1,500. The present rate of increase is between three and four hundred patients a year. Therefore, the overcrowding will be as bad as ever if urgent steps are not taken to build quickly enough (a) to overcome the present bed shortage, (b) to provide beds for the additional patients due to increase in population, (c) to allow for the extra patients prepared to enter hospital who have previously been kept out by the unsatisfactory conditions. Even though a large number of patients will be kept out of hospital by the better out-patient psychiatric services, and others will be discharged earlier to community care, nevertheless, a minimum of 500 beds a year must be built for the next ten years if the services are to be adequate by the end of this time and the overcrowding is to be overcome. STAFF. The provision of beds is only a small part of the needs, and an even greater problem is the provision and training of another two thousand staff that will be required by this time. By then there will be six thousand employees in the department controlled by the Public Service Board, through the Health Department, through the Mental Hygiene Authority to the hospitals where they work. It is clear that early thought should be given to means of amending the Acts to plan more responsibility and disciplinary powers at the hospital level, to put the day to day affairs concerning all the staff in the hands of the Mental Hygiene Branch and to vest the functions of the permanent head in the Mental Hygiene Authority. The appointment of the Victorian :Nursing Council is helping to improve the understanding between the various branches of nursing. The curriculum for psychiatric nursing is in need of complete revision following the Geneva Nursing meeting and the changes made in the syllabus elsewhere. This will also give the opportunity to make joint courses for general and psychiatric nurses, so that both the certificates can be obtained within four years. The certificate should also provide a basic psychiatric nursing course so that specialization for nurses within the psychiatric field can follow. Thus within the compass of psychiatric nursing there seem to be opportunities for future special training in acute psychiatric and sick nursing, in occupational rehabilitation, in social therapy, in intellectual deficiency, and in the community fields. It would be worth investigating the possibility of a joint occupational therapy and psychiatric nursing training. Frequently we have beeh too much concerned with reciprocity and have been inclined to tag along behind the English courses for this reason. There is every possible reason for using the advantages inherent in a new nursing council and their flexibility to plan ahead ; if this is done reciprocity is hardly likely to be refused. It is believed that such plans can be made in the psychiatric nursing field ; but that difficulties putting this into action are more likely to arise from the changes needed in rosters and penalty rates than the new academic material that needs to be incorporated in the syllabus. Penalty rates are a considerable handicap to progress in the department, as they necessitate all staff being put on an equal and frequent week-end roster whether or not they can most usefully be used at these times. A higher salary rate which would consolidate the penalty rates would be very much more satisfactory. It would, through its increased efficiency and economy of staff, be a definite economic saving even if the increases were substantial. Another valuable aid to efficiency, good staff relationships, and economy would be for staff cafeterias to be generally introduced throughout the department particularly if staff recreational facilities were provided with them. The common staff cafeteria at Royal Park has been highly successful. There is much discontent at the present rationing scheme which is unfair to certain grades of staff and produces difficulties for those on a diet.

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