The Adult Psychiatry Imperative

SUB.3000.0001.0070 The Adult Psychiatry Imperative Achieving parity of care Submission to the Royal Commission into Victoria’s Mental Health System July 2019 SUB.3000.0001.0071 SUB.3000.0001.0072 Consortium members and affiliations Disclaimer: the views expressed by members of the Adult Psychiatry Imperative consortium represent a chorus of individual psychiatric expert opinion. We do not imply support or endorsement of the opinions and recommendations contained in this submission by the organisations with which we are affiliated. Professor David Copolov AO Pro Vice-Chancellor, Major Campuses and Student Engagement and Professor of Psychiatry, Monash University Professor of Psychiatry, University of Melbourne Professor Tarun Bastiampillai Professor of Psychiatry College of Medicine and Public Health, Flinders University South Australian Health and Medical Research Institute – Mind and Brain Research Fellow Victorian Psychiatrists (in alphabetical order) Associate Professor Ravi Bhat Associate Professor of Psychiatry Department of Rural Health, Melbourne Medical School The University of Melbourne Professor Anne Buist Professor of Women’s Mental Health, Austin Health, University of Melbourne Dr Paul Cammell Senior Psychiatrist, Royal Melbourne Hospital Senior Fellow, Department of Psychiatry, University of Melbourne Research Lead, BPD Collaborative, South Australia Chair, Advanced Training in Psychotherapy, Royal Australian and New Zealand College Psychiatrists Professor Vaughan J. Carr Adjunct Professor, Monash University and Monash Health Professor of Psychiatry, University of New South Wales Senior Principal Research Scientist, Neuroscience Research Australia (NeuRA) Professor David Castle Professor of Psychiatry, University of Melbourne Consultant Psychiatrist Emeritus Professor Lorraine Dennerstein AO Department of Psychiatry, University of Melbourne Professor Maurice Eisenbruch Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University Emeritus Professor, Royal University of Phnom Penh, Cambodia Professor Carol Harvey Professor of Psychiatry, University of Melbourne Secretary, World Association for Psychosocial Rehabilitation – Australian branch i SUB.3000.0001.0073 Professor Malcolm Hopwood Ramsay Health Care Professor of Psychiatry, University of Melbourne Director, Professorial Psychiatry Unit, Albert Road Clinic Dr Kym Jenkins Immediate Past President, Royal Australian and New Zealand College of Psychiatrists Professor Fiona Judd AO Department of Psychiatry, University of Melbourne Menzies Institute for Medical Research, University of Tasmania Professor Richard A. A. Kanaan Chair of Psychiatry, Austin Health, University of Melbourne Professor Nicholas A. Keks Adjunct Professor of Psychiatry, Monash University Delmont Private Hospital Monash Medical Centre Professor Jayashri Kulkarni AM Director, Monash Alfred Psychiatry Research Centre Dr Vinay Lakra Director Clinical Services, North West Area Mental Health Service President Elect, Royal Australian and New Zealand College of Psychiatrists Professor Nicola T. Lautenschlager Department of Psychiatry, The University of Melbourne Associate Professor Steve Moylan Clinical Director, Mental Health Drugs and Alcohol Services, Barwon Health Clinical Associate Professor, Deakin University Professor Richard Newton Adjunct Professor, Department of Psychiatry, Monash University Professor George Patton Professor of Adolescent Health Research, University of Melbourne, Senior Principal Research Fellow, National Health and Medical Research Council Dr Bill Pring Member of the Executive, Independent Private Psychiatrists Group Immediate Past Chair of Council, Victorian AMA Dr Suzy Redston Consultant Psychiatrist, Austin Health Public and Private Mental Health Professor Emeritus Bruce Singh AM Emeritus Professor University of Melbourne Dr Danny H Sullivan Executive Director of Clinical Services, Victorian Institute of Forensic Mental Health (Forensicare) Honorary Senior Fellow, University of Melbourne Adjunct Research Fellow, Centre for Forensic Behavioural Sciences, Swinburne University Adjunct Clinical Professor Suresh Sundram Monash University Professor Emeritus John Tiller The University of Melbourne, Albert Road Clinic Associate ii ADULT PSYCHIATRY IMPERATIVE SUB.3000.0001.0074 Professor Philip Tune Clinical Director, Mental Health Services, Bendigo Health Authorised Psychiatrist, Loddon Campaspe, Southern Mallee DMHS Clinical Adjunct Associate Professor, Monash University Dr Richard Yeatman Consultant Psychiatrist Australian (non-Victorian) Psychiatrists (in alphabetical order) Associate Professor Stephen Allison College of Medicine and Public Health Flinders University, Adelaide, South Australia Dr Andrew Amos Director of Training, Northern Queensland Deputy Editor, Australasian Psychiatry Professor Malcolm Battersby Head of Psychiatry, College of Medicine and Public Health, Flinders University Clinical Director, South Adelaide Mental Health Services, Adelaide, South Australia Professor Assen Jablensky Head, Centre for Clinical Research in Neuropsychiatry, The University of Western Australia Associate Professor Jeffrey C. L. Looi Acting Head, Academic Unit of Psychiatry and Addiction Medicine, ANU Medical School, Canberra Hospital, Canberra, A.C.T. Professor Gin S. Malhi Head, Department of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia Professor Alexander C. McFarlane AO Director of the Centre for Traumatic Stress Studies, Professor of Psychiatry, The University of Adelaide Professor Philip Mitchell AM School of Psychiatry, University of New South Wales Professor Gordon Parker AO Scientia Professor of Psychiatry, University of New South Wales International Advisory Committee Professor Nancy C. Andreasen Andrew H Woods Chair of Psychiatry University of Iowa Carver College of Medicine, Iowa City, Iowa USA Professor Dr Mathias Berger Professor of Psychiatry and Psychotherapy at the Department of Psychiatry and Psychotherapy, University Medical Center, University of Freiburg, Germany Dr John Crichton Chair, Royal College of Psychiatrists in Scotland, UK iii SUB.3000.0001.0075 Professor Ian Everall Executive Dean Institute of Psychiatry, Psychology and Neuroscience Dean, International Partnerships King’s College London, UK Professor Allen Frances Past Chairman, Department of Psychiatry, Duke University School of Medicine Chair of the Taskforce that produced DSM IV Doris Fuller Consultant, Mental Illness Research and Advocacy Former Chief of Research and Public Affairs, Treatment Advocacy Center, USA. Distinguished Professor Julio Licinio Senior Vice President for Academic and Health Affairs Executive Dean, College of Medicine SUNY Distinguished Professor in the departments of Psychiatry, Medicine, Pharmacology, and Neuroscience and Physiology, USA Professor Richard O’Reilly Professor of Psychiatry, Western University, Canada Distinguished Professor Emeritus Robert T. Rubin Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine at UCLA Professor Steven S. Sharfstein, President Emeritus, Sheppard Pratt Health System Adjunct Professor, School of Medicine, University of Maryland, USA. Elizabeth Sinclair Director of Research, Treatment Advocacy Center, USA Professor Dominic Sisti Director, The Scattergood Program for Applied Ethics of Behavioral Health Care Department of Medical Ethics and Health Policy Perelman School of Medicine at the University of Pennsylvania, USA Professor E. Fuller Torrey Associate Director of Research, Stanley Medical Research Institute, Kensington, Maryland, USA Supporting organisations Mental Health Victoria The Australian Patients Association The Faculty of Adult Psychiatry, Royal Australian and New Zealand College of Psychiatrists iv ADULT PSYCHIATRY IMPERATIVE SUB.3000.0001.0076 Contents Executive summary vii Recommendations xi How our recommendations address the Royal Commission’s terms of reference xiii 1. Introduction – achieving parity of care 1 1.1. General introduction 1 1.2. Our foci – adults with serious mental illness 8 1.2.1. Why should serious mental illness be a priority? 8 1.2.2. Why should the treatment of adults be a priority? 13 2. Victoria’s current provision of care for adults with serious mental illnesses 21 3. The prevention of serious mental illness 29 4. Enhancing mental health care within the current system 34 4.1. Current services in Victoria 34 4.2. Community mental health 36 4.3. Inpatient care 39 4.3.1. The importance of inpatient care in psychiatry 39 4.3.2. Why inpatient bed capacity needs to be enhanced in Victoria 42 4.3.3. Can Youth Mental Health services reduce the need for adult (aged 25–64) specialist psychiatric beds? 49 4.4. Managing increasing mental health demand in emergency department settings 50 4.5. Drug and Alcohol Services 52 4.6. Forensic Mental Health 53 5. Specialist Mental Health Centres 57 5.1. The case for Specialist Mental Health Centres – with comparison to other specialist hospitals in Victoria 57 5.2. Mental Health Acute-Care Centres 62 5.3. Mental Health Rehabilitation Centres 62 6. Integrating mental health services 63 6.1. Mental Health Integrated Services Hubs 64 6.2. Clinical information systems 67 6.3. Strengthening engagement between the public and private mental health sectors 71 7. Mental health research 73 v SUB.3000.0001.0077 8. Reshaping governance 74 8.1. Ministerial responsibility 79 8.2. The Mental Health Branch 80 8.3 Enhancing governance and oversight of quality and safety 82 8.4.

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