Hmmm! This is strange coming from the person now in charge of "a 400-bed hospital on the (Concord) site (which) would create the biggest stand-alone mental health facility in Australia."
I suppose calling a 400-bed inpatient mental health facility a "Centre" instead of a "Hospital" gets around the embarrasment of having achieved with a NSW Labor Government something that Dr Storm, in 2002, did not want to achieve with a NSW Liberal Government. Ah well! Come March 2011, the political landscape could be quite a different colour.
New 'asylums' no answer to mental illness
By Victor Storm
April 22 2002
A proposal, reported in the Herald, (Psychiatric care gets $80m boost in Lib health plan, April 9) to rebuild a new 400-bed psychiatric facility on the Rozelle Hospital site in Callan Park, in Sydney's inner west, should be ringing alarm bells everywhere.
A 400-bed hospital on the site would create the biggest stand-alone mental health facility in Australia. It completely contradicts best practice in mental health care, which supports integration of acute psychiatric care into mainstream general hospitals. Other Australian states and most other countries are closing their stand-alone facilities and not building new ones. Victoria, for example, no longer has freestanding psychiatric hospitals.
When people attach a huge stigma to mental illness, they prefer to lock away patients behind closed doors. We need to reduce the stigma associated with mental illness, as it affects all of us.
Mental illness is increasing in incidence and in economic cost to society.
The figures are stark. By 2020, major depression will be one of the two most prevalent diseases worldwide. Only cardiovascular disease will exceed it in numbers and in burden to society. Already mental illnesses, excluding drug and alcohol abuse, account for four of the top 10 causes and 30 per cent of the total burden of chronic disability in Australia.
The move of mental health facilities into general hospitals is not new. It has been part of mental health policy in Australia and worldwide since the 1950s. The Richmond report, published in 1983, further accelerated the move towards de-institutionalising care.The National Mental Health Strategy includes changing the service mix from stand-alone facilities to integrated community and hospital services. It has also brought consumers, carers and clinicians closer together to improve the care given to the public.
At Rozelle Hospital, regarded as one of NSW's lead agencies in mental health-care delivery, we struggle to provide modern and safe care in buildings which date back to the 1920s. Once, thousands of patients were locked away and cared for long term in an asylum.
Many people associate long-term asylum care with tabloid horror stories. Fortunately, the findings of the Royal Commission of Inquiry into Callan Park Mental Hospital are far behind us.
Psychiatric inpatients are very ill. Mental health services all over the world are struggling to cope with patients whose illness is complicated by illicit drug use and sometimes associated violent behaviour.
While this is a challenge for all involved in the care of the mentally ill, the answer is not to reinstate the old asylums. The reasons to move the focus of care away from institutions remain sound.
Most people who live with a chronic mental illness do not want to be quarantined in large 19th-century asylums. They want access to 21st-century care in modern hospitals when they need hospital care, with the ability to live in appropriate housing, like any other citizen, for most of the time. To achieve this we need more quality supported accommodation and group homes throughout metropolitan Sydney and regional NSW.
We propose to upgrade most of our inpatient services at Rozelle service by moving them to new state-of-the-art facilities at Concord. The psycho-geriatric nursing home beds will be moved to another nearby site.
As well as reducing the stigma associated with mental illness, mainstreaming the patients allows us to treat the whole person and to attend to all relevant health problems.
As in all fields of medicine, new and powerful drugs are a major component of the treatment of most ill people. These patients require careful assessment and monitoring. They need access to diagnostic services and to treatment for other illnesses. People with mental illness often neglect their general health and it isn't until they become inpatients that we effectively manage co-existing illness, such as diabetes or hypertension. This overall treatment is best carried out in a general hospital.
We admit 2,200 patients to Rozelle each year. Each month 80 people are admitted to general hospital for care and treatment. We have to transport 100 a month for imaging and other investigations and conduct 1,500 pathology investigations. These investigations should be carried out on one site.
The proposals to move services at Rozelle to the Concord campus go a long way to addressing the hospital treatment needs. Accommodation and support services outside of hospital must also be addressed to provide people with appropriate care options.
Everyone involved in mental health foresees future care as a major challenge.
Dr Victor Storm is a psychiatrist and clinical director of mental health services at Central Sydney Area Health Service.
