Richmond Recommendations

7/27/2019 Richmond Recommendations

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INQUIRY INTO HEALTH SERVICES FOR THE PSYCHIATRICALLY ILL AND DEVELOPMENTALLY

DISABLED

SUMMARY OF RECOMMENDATIONS

MARCH 1983

PART 1 - GENERAL PROPOSALS

The f ol l owi ng r ecommendat i ons ar i se f r om Par t 1:

1. That ser vi ces be del i ver ed pr i mar i l y on t he basi s of a

syst em of i nt egr ated communi t y based networks, backed upby speci al i st hospi t al or ot her ser vi ces as r equi r ed.( r ef er t o Sect i on 5)

2. That t he t wo pr i me oper at i onal obj ect i ves be t o -

( i ) f und and/ or pr ovi de ser vi ces whi ch mai nt ai n cl i ent s i n t hei rnor mal communi t y envi r onment ; and

( i i ) pr ogr essi vel y r educe t he si ze and t he number of exi st i ng Fi f t hSchedul e hospi t al s by decent r al i si ng t he ser vi ces t hey pr ovi de. ( 5)

3. That ser vi ces f or t he devel opment al l y di sabl ed, as f ar as

possi bl e, be f unded separ at el y and ser vi ces del i ver ed underseparat e management f r om ment al heal t h servi ces and

t hat pr i or i t i es f or f undi ng i n devel opment al di sabi l i t y be

( i ) pr ovi si on of addi t i onal communi t y ser vi ces st af f t o pr ovi dedi agnost i c assessment , ear l y i nt er vent i on and home suppor t servi ces;

( i i ) devel opment of smal l communi t y r esi dent i al uni t s t o r e- houser esi dent s f r om exi st i ng i nst i t ut i ons;

( i i i ) devel opment of smal l communi t y r esi dent i al uni t s par t i cul ar l yf or adul t s unabl e t o cont i nue l i vi ng wi t h t hei r f ami l i es;

( i v) pr ovi s i on of oppor t uni t i es f or t r ai ni ng of exi st i ng Fi f t hSchedul e hospi t al st af f f or new r ol es i n communi t y ser vi ces. ( 5)

4. That pr i or i t i es f or f undi ng i n ment al heal t h be -

( i ) pr ovi si on of addi t i onal communi t y based cr i si s t eams;

( i i ) pr ovi si on of st af f i ng t o pr ovi de adequat e f ol l ow up f orment al l y i l l peopl e i n the communi t y;

( i i i ) pr ovi si on of psychi at r i c staf f f or assessment ser vi ces i ngener al hospi t al s;

( i v) pr ovi si on of l i nked net wor ks of host el s and sat el l i t e housi ng;


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( v) pr ovi si on f or oppor t uni t i es f or t r ai ni ng exi st i ng Fi f t hSchedul e hospi t al st af f f or new r ol es i n communi t y and speci al i sed hospi t alser vi ces. ( 5)

5. That t he cur r ent di r ect pr ovi si on of ser vi ces f or t hement al l y i l l , devel opment al l y di sabl ed and t he aged t hr oughFi f t h Schedul e hospi t al s and communi t y heal t h servi ces be

t r ansf er r ed f r om t he di r ect admi ni st r at i on of t heDepar t ment of Heal t h and pr ovi ded i nst ead under t hemanagement of Boar ds of Di r ect or s, i n t he f or m of ei t heran Ar ea Boar d, a newl y created Boar d f or a par t i cul arspeci al i sed ser vi ce, or t he r econst i t ut ed Boar d of anexi st i ng publ i c hospi t al as appr opr i at e t o par t i cul arser vi ces or l ocat i ons as pr oposed i n t hi s Repor t . ( 7)

6. That st af f pr esent l y empl oyed i n t he pr ovi si on of t heseser vi ces i n Fi f t h Schedul e hospi t al s and communi t y heal t hser vi ces be t r ansf er r ed f r om t he pr ovi si ons of t he Publ i cSer vi ce Act , 1979, on t he basi s and condi t i ons pr ovi ded

f or i n Schedul e Thr ee of t he Heal t A Admi ni st r at i on Act ,1982, t o become empl oyees of t he above Boards. ( 7)

7. That st af f commenci ng empl oyment i n t hese areas i n f ut ur er ecei ve sal ary and other empl oyment condi t i ons appl i cabl et o st af f empl oyed under t he cur r ent Second and Thi r dSchedul es of t he Publ i c Hospi t al s Act . ( 7 , 8)

8. That member shi p of exi st i ng and proposed Boar ds ofDi r ect or s encompass r epr esent at i on r ef l ect i ng t he r angeof cl i ent i nt er est s of t he ser vi ces cover ed by thi s Repor tand t hat t he si ze of exi st i ng hospi t al boar ds be expanded,

wher e appr opr i at e, t o achi eve t hi s end. ( 7)

9. That pr ovi si on be pr ogr essi vel y made f or el ect edr epr esent at i on f r om empl oyees on al l Hospi t al and ot herBoar ds. ( 8)

10. That t he Depar t ment of Heal t h and t he Publ i c Ser vi ce Boar dest abl i sh a Task For ce t o i mpl ement Recommendat i ons 5 and6 i n consul t at i on wi t h t he Labor Counci l of New Sout hWal es. ( 11)

11. That t hese ser vi ces be managed t hr ough a management

st r uct ur e based on -

admi ni st r at i on by a Chi ef / Ar ea Execut i ve Of f i cer ;

a gl obal and i ncent i ve budget syst em as pr oposed by t hePar l i ament ary Publ i c Account s Commi t t ee r athert han a st af f number and est abl i shment cont r ol . ( 7)

12. That as a pr i or i t y t he Heal t h Depar t ment devel op aprogr amme budget i ng approach t o t he f undi ng of t hese ar easof heal t h car e i n or der t o moni t or t he l evel of r esour cesut i l i sed f or par t i cul ar pr ogr ammes or cl i ent gr oups. ( 7)

13. That i n f undi ng of heal t h ser vi ces gener al l y a hi gher


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pr i or i t y f or t he next t hr ee year s be gi ven t o t hepr ovi si on of i mpr oved ser vi ces t o meet ment al heal t h needsand those of t he devel opment al l y di sabl ed. ( 7)

14. That t he di st i nct i on i n cur r ent New Sout h Wal es Governmentbudget al l ocat i ons bet ween "r ecogni sed" and "nonr ecogni sed" hospi t al s be el i mi nat ed t o pr ovi de f or a t ot al

al l ocat i on t o t he Mi ni st er f or Heal t h. ( 7)

15. That f or each of t he next t hr ee years an amount of hal fof one per cent per annum ( appr oxi matel y $9 mi l l i on perannum) of t hese f unds be "ear marked" f or speci f i c pur posef undi ng of t he new servi ces pr oposed by t hi s Repor t whi char e necessar y t o provi de adequat e communi t y based suppor tand t o f aci l i t at e r educti on i n t he si ze of t he exi st i ngi nst i t ut i ons , i ncl udi ng pr i or i t y pr oj ect s . i n def i ci tRegi ons. ( 7)

16. That a speci f i c budget ( commenci ng wi t h $1. 7 mi l l i on i n

1983/ 84) be al l ocat ed to f und communi t y non- pr of i torgani sat i ons t o pr ovi de suppor t i ve accommodat i on andi nnovat i ve ser vi ces. These f unds, separ at el y ear mar ked f orment al heal t h and devel opment al di sabi l i t y ser vi ces, t o bepr ovi ded f r om Recommendat i on 15 above, and by r edi r ect i onof exi st i ng heal t h f undi ng of nongover nment or gani sat i ons.( 7)

17. That as savi ngs ar e achi eved f r om t he r at i onal i sat i on andr educt i on of exi st i ng hospi t al s, t hese savi ngs be commi t t edt o t he devel opment of communi t y servi ces. ( 7)

18. That f r om 1984/ 85, t hese savi ngs be pr ogr essi vel y used t of und the communi t y ser vi ces proposed by t he I nqui r y andt hei r f ut ur e expansi on; f r om 1986/ 87 t hese savi ngs t o bet he maj or sour ce of f undi ng f or such ser vi ces, r epl aci ngt he al l ocat i on pr oposed f or 1983/ 84, 1984/ 85, and 1985/ 86i n Recommendat i on 15. ( 7)

19. That f ees pol i cy f or l ong st ay pat i ent s i n speci al i sedpsychi at r i c hospi t al s be r evi ewed and t hat t he pat i entcont r i but i on be i ncr eased f r om 66. 6 per cent t o 87. 5 per centof t he pensi on t o br i ng t hi s cont r i but i on i nt o l i ne wi t ht hat r equi r ed by pr i vat e and def i ci t f i nanced nur si nghomes. ( 7)

20. That subj ect t o "her i t age" ar i d envi r onment al consi der at i onsl and cur r ent l y unused on t he exi st i ng si t es, or r el easedt hr ough t he r at i onal i sat i on pr ogr amme be r el eased f or ot herpur poses and any pr oceeds r eal i sed be avai l abl e f orexpansi on of communi t y heal t h servi ces. ( 7) .

21. That act i on be t aken t o pr ogr essi vel y i nt r oduce 8- hourshi f t s t o r epl ace 12- hour shi f t s i n t he car e of t hepsychi at r i cal l y i l l and devel opment al l y di sabl ed. ( 8)

22. That gr eater emphasi s be gi ven t o t he use of par t - t i mest af f t o cover excessi ve wor kl oad per i ods i n hospi t al s ( t or educe over t i me expendi t ure and- excessi ve wor k demands onf ul l t i me staf f ) . (8)

23. That i n t he pr ocess of t r ansf er of t hese ser vi ces t o t heSecond Schedul e syst em a revi ew be under t aken of t he number


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of pr omot i onal posi t i ons i n t he speci al i sed hospi t al s t oensur e that adequat e number s ar e mai ntai ned t o meet war dmanagement r equi r ements. ( 8)

24. That a more ef f ect i ve i ndependent gr i evance pr ocedur e beest abl i shed wi t hi n t he heal t h syst em t o deal wi t hcompl ai nt s of i ndi vi dual st af f agai nst management deci si ons

af f ect i ng t hei r empl oyment . ( 8)25. That at t he l evel of i ndi vi dual hospi t al or Ar ea Boar ds,

i mpr oved consul t at i ve mechani sms be est abl i shed wi t h t heUni ons t hr ough t he upgr adi ng of exi st i ng "wel f ar e"meet i ngs. ( 8)

26. That i n t he devel opment of a Si ngl e Regi st er Nur seeducat i on pr ogr amme, adequate t heoret i cal and cl i ni calpsychi at r i c nur si ng cont ent be i ncl uded, and t hat t he vi ewsof exper i enced psychi at r i c nur se educat or s be sought i nt hi s regar d. ( 9)

27. That cl i ni cal educat i on of psychi at r i c nur ses be pr ovi dedt hr ough an i nt egr ated ar r angement i nvol vi ng communi t y

ser vi ces, gener al hospi t al s and r ehabi l i t at i on ser vi ces i nspeci al i sed hospi t al s and t hat t he Nur ses Regi st r at i onBoar d r emove exi st i ng pr ocedur al const r ai nt s on t hi sar r angement . ( 8)

28. That t he cur r i cul um of t he Fi r st - l i ne Management Cour sebe revi ewed t o pr oduce a r ef r esher cour se f or nur sest r ai ned pr i or t o t he i nt r oduct i on of t he 1000 hoursyl l abus. ( 9)

29. That t he Depar t ment of Heal t h consul t wi t h t he Col l ege ofGener al Pract i t i oner s r egardi ng appr opr i ate pr ogr ammesdesi gned t o encour age i mpr oved co- ordi nat i on betweengener al pr act i t i oner s and publ i c sect or ment al heal t h

ser vi ces. ( 9)

30. That cl i ni cal educat i on of psychi at r i st s be pr ovi dedt hr ough an i nt egr ated ar r angement i nvol vi ng communi t yser vi ces, gener al hospi t al s and speci al i sed hospi t al s,( bot h publ i c and pr i vat e) and that t he Depar t ment , t het r ai ni ng bodi es, and t he Col l ege of Psychi at r i st s r evi ewcur r ent ar r angement s i n or der t o achi eve t hi s obj ect i ve.( 9)


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PART 2 - SERVI CES FOR THE DEVELOPMENTALLY DI SABLED

1. That t he Mi ni st er f or Heal t h -

( i ) endor se t he pr i nci pl e t hat t he pr ovi si on of ser vi ces f or t hedevel opment al l y di sabl ed wi t hi n t he heal t h admi ni st r at i on shoul d be based on:

( a) promot i on of maxi mumdevel opment and educat i on of eachi ndi vi dual ;

( b) pur sui t of t he obj ect i ves of nor mal i sat i on and i nt egr at i on;

( c) pr omot i on of t he r i ght s of peopl e wi t h di sabi l i t i es; and

( i i ) r ecommend t o t he gover nment t hei r adopt i on and appl i cat i on t oal l ar eas of gover nment pol i cy r el at i ng t o t he car e of t he devel opment al l ydi sabl ed. ( r ef er t o Secti on 3. 2)

3. That t he r ol e of heal t h ser vi ces i n t he ar ea of devel opment al

di sabi l i t y be endor sed as f ol l ows:

( i ) Devel opment and i mpl ement at i on of prevent i ve progr ammes;

( i i ) Pr ovi si on of compr ehensi ve di agnost i c/ assessment and associ at edcounsel l i ng.

( These ser vi ces shoul d be avai l abl e t o al l devel opment al l y di sabl ed chi l dr enand t hei r f ami l i es) ;

( i i i ) Pr ovi si on of ear l y i nt er vent i on pr ogr ammes ( i n consul t at i on wi t h t heEducat i on Depar t ment and the Depar t ment of Yout h and Communi t y Ser vi ces t o

ensur e a r ange of progr ammes ar e devel oped) ;

( i v) Pr ovi si on of home suppor t ser vi ces ( i n consul t at i on wi t h t he Depar t mentof Youth and Communi t y Ser vi ces, t he Home Car e Servi ce of N. S. W. and LocalGovernment as appr opr i ate) ;

( v) Devel opment of smal l communi t y r esi dent i al uni t s t o r ehouse r esi dent sf rom exi s t i ng i nst i t ut i ons ;

( vi ) Devel opment of smal l communi t y r esi dent i al uni t s f or t he sever el ydi sabl ed, par t i cul ar l y t he sever el y i nt el l ect ual l y handi capped, and ot her s wi t hsever e physi cal condi t i ons, bot h chi l dr en and adul t s, who ar e unabl e t o

cont i nue di vi ng wi t h t hei r f ami l i es;

( vi i ) Pr ovi si on of r espi t e and shar ed car e ar r angement s wi t hi n t hese uni t s;

( vi i i ) Pr ovi si on of speci al i sed t her apeut i c ser vi ces as r equi r ed;

( i x) Access t o gener al heal t h ser vi ces f or t he "r out i ne" physi caland ment al heal t h needs of t he di sabl ed. ( 5)

3. That an amount of $200, 000 be al l ocat ed i n 1983/ 84 f r omt he Hospi t al Heal t h Pr omot i on Progr amme f or a publ i ceducat i on pr ogr amme on the i mpor t ance of ant e- natal car e

and t he avai l abi l i t y of screeni ng and genet i c counsel l i ngser vi ces. ( 6 . 1)


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4. That f r om t he speci f i c al l ocat i on r ef er r ed t o i n Par t 1( appr oxi mat el y $9 mi l l i on per annum f or t he next t hr eeyear s) , an amount of $4 mi l l i on per annum be al l ocat ed t odevel opment al di sabi l i t y ser vi ces. ( 6. 1, 8. 1) .

5. That $1. 5 mi l l i on of t hese f unds be al l ocat ed per annum

t o t he expansi on of di agnost i c, assessment and communi t ysuppor t ser vi ces, wi t h pr i or i t y t o the West er nMet r opol i t an, Hunt er , Sout h- East and Cent r al West Regi onsi n t he f i r st year . ( 6. 1, 8. 1)

6. That al l publ i c hospi t al s i mpl ement a pol i cy t o ensur e t hatpar ent s of al l handi capped chi l dr en i dent i f i ed at or soonaf t er bi r t h ar e aut omat i cal l y gi ven access t o counsel l i ngand assessment and ear l y i nt er vent i on servi ces. ( 6. 1)

7. That t he Heal t h Depar t ment i mpl ement a pol i cy t hat al ladmi ssi ons t o heal t h ser vi ces r esi dent i al f aci l i t i es and

par t i ci pat i on i n pr ogr ammes be dependent on pr i orassessment and subj ect t o regul ar r evi ew by communi t yassessment ser vi ces. ( 6. 1)

8. That each Regi on est abl i sh a Resi dent i al Pl acementCommi t t ee ( 6. 1) .

9. That Regi onal and l ocal management r evi ew t he l ocat i on ofwor k or i ent ed f aci l i t i es and i ni t i at e t hei r r el ocat i on t ocommuni t y- based premi ses. ( 6. 1)

10. That t he Depar t ment of Heal t h consul t wi t h t he Depar t ment

of Soci al Secur i t y r egar di ng t he pot ent i al expansi on ofco- oper at i ve ar r angement s i n t he pr ovi si on of act i vi t y andwork- r el ated pr ogammes. ( 6. 1)

11. That t he Heal t h Depar t ment adopt a l ong t er m pol i cy ofpr ovi di ng al l heal t h car e r esi dent i al ser vi ces f or t hedevel opment al l y di sabl ed i n smal l r esi dent i al uni t s ( wi t hvar yi ng st af f i ng l evel s dependi ng on par t i cul ar cl i ent s'l evel s of di sabi l i t y) .

12. That i n each Regi on a network of communi t y r esi dent i aluni t s whi ch woul d normal l y be ordi nary houses each

accommodat i ng f r om5- 10 peopl e be est abl i shed t o pr ovi debot h shor t ( i ncl udi ng r espi t e) and l ong t er m r esi dent i alcar e and soci al and l i vi ng ski l l s t r ai ni ng f ordevel opment al l y di sabl ed peopl e. ( 6. 2)

13. That f r om t he speci f i c al l ocat i on ( $4 mi l l i on per annum)r ef er r ed t o i n Recommendat i on 4, an amount of $2 mi l l i onbe al l ocat ed t o Regi ons t o assi st i n t he devel opment( ei t her di r ect l y or t hr ough nongover nment or gani sat i ons)of communi t y r esi dent i al uni t s t o r e- house adul t s cur r ent l yr esi dent i n i nst i t ut i ons and t hose at home ur gent l y i n needof pl acement . ( 6. 2)

14. That pr i or i t y f or t he f undi ng of such uni t s i n t he f i r st


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year shoul d go t o t he Hunt er , West er n Met r opol i t an,Sout her n Met r opol i t an and Nor t her n Met r opol i t an Regi ons.( 6. 2) .

15. That i ni t i al l y t hese ser vi ces be f unded f r om t he t ot alhospi t al budget ; and t hat f r om 1984/ 85 r esour ces f or t hi spur pose be augment ed f r om savi ngs t o be achi eved t hrough

pr oposed r educt i ons i n t he si ze and number of exi st i ngi nst i tut i ons. (6. 2) .

16. That f r om t he speci f i c al l ocat i on ( $4 mi l l i on per annum)r ef er r ed t o i n Recommendat i on 4, an amount of $500, 000 beear mar ked f or t he suppor t of i nnovat i ve progr ammes such assuppor t i ve accommodat i on f or devel opment al l y di sabl ed womenwi t h chi l dr en ( "Women i n Li mbo" pr oposal ) . ( 6. 2)

17. That t he Mi ni st er f or Heal t h, i n consul t at i on wi t h t heMi ni st er f or Yout h and Communi t y Ser vi ces, negot i ate wi t ht he Mi ni st er f or Soci al Secur i t y t o i mpr ove co- or di nat i onof pl anni ng and ser vi ce del i ver y and t o devel op pr oposal sf or j oi nt Commonweal t h/ St at e f undi ng of t hese ser vi ces.

( 6. 2)18. That t he Mi ni st er f or Heal t h negot i at e an ar r angement wi t h

t he Mi ni st er f or Housi ng wher eby a pr opor t i on of wel f ar ehousi ng st ock i n exi st i ng and pr oposed devel opment s i s

` speci f i cal l y made avai l abl e as communi t y r esi dent i al uni t sf or devel opment al l y di sabl ed peopl e. ( 6. 2)

19. That wi t hi n exi st i ng hospi t al s emphasi s i n cl i ent car e bebased on t he i mpl ement at i on of i ndependent l i vi ng t r ai ni ngpr ogr ammes. Di r ect car e st af f t o be r esponsi bl e t o thepr ogramme st af f f or pr ogramme mai nt enance and achi evement .( 6. 2)

20. That as r esi dent number s i n exi st i ng hospi t al s decr ease,

t he r at i o of di r ect car e st af f per r esi dent at St ockt onHospi t al be gr adual l y i ncr eased. ( 6. 2)

21. That Regi onal Di r ect or s negot i at e f or mal cont r act ualar r angement s bet ween hospi t al s and Regi ons t o pr ovi desoci al wor k, psychol ogy and occupat i onal t her apy ser vi ces,wher e recr ui t ment di f f i cul t i es are exper i enced. ( 6. 2)

22. That a new cat egor y of di r ect car e st af f be est abl i shed- t o be t i t l ed "Resi dent i al Car e Assi st ant ". Thi s cat egor yt o be used i n t he expansi on of communi t y resi dent i al uni t s`and event ual l y as di r ect car e st af f i n hospi t al s. ( 7. 1)

23. That t he Depar t ment of Heal t h negot i ate wi t h t he Depar t ment

of Techni cal and Fur t her Educat i on f or t he devel opment ofan appr opr i ate "appr ent i ceshi p- t ype" educat i onal pr ogr ammef or t hi s cat egor y of staf f . ( 7. 1)

24. That t he empl oyment of "Pr ogr amme of f i cer s" be expanded asa maj or st af f cat egor y i n communi t y devel opment aldi sabi l i t y t eams, and i n speci al i sed hospi t al s. ( 7. 1)

25. That t he Depar t ment of Heal t h negot i ate wi t h t heappr opr i at e educat i on aut hor i t i es f or t he devel opment ofa sui t abl e under graduat e or post graduat e progr amme atCol l ege of Advanced Educat i on l evel f or t hi s cat egor y ofstaf f . (7 . 1)

26. That at t he appr opr i at e l evel ( Regi onal or supr a- Regi onal )

a communi t y based Boar d of Di r ectors be est abl i shed wi t ht he r esponsi bi l i t y f or t he management of al l ser vi ces


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wi t hi n t he heal t h admi ni st r at i on f or t he devel opment al l ydi sabl ed, bot h r esi dent i al and non- r esi dent i al . Appr opr i at eadvi sor y mechani sms shoul d be est abl i shed t o ensur e i nputf r omparent and vol unt ary gr oups and f r om l ocal gover nmentand t he Depar t ment s of Yout h and Communi t y Ser vi ces,Educat i on and Soci al Secur i t y. ( 7. 2)

27. That t hese servi ces be managed by a Chi ef Execut i ve of f i cerr esponsi bl e t o the above Boar d. ( 7 . 2)

28. That car e of t he devel opment al l y di sabl ed i n speci al i sedhospi t al set t i ngs shoul d be separ at ed f r om t he car e of t hepsychi at r i cal l y i l l by t he est abl i shment of a di st i nctmanagement organi sat i on, r esponsi bl e t o t he above Boar ds,and by the degazet t al and physi cal separ at i on of ser vi ces.( 7 . 2)

29. That t he r ol e of t he Seni or Speci al i st f or Devel opment alDi sabi l i t y Ser vi ces i n t he Cent r al Admi ni st r at i on of t heHeal t h Depar t ment be st r engt hened by i nvol vi ng hi m or her

t o a gr eat er ext ent i n budget deci si ons af f ect i ngpr ovi si ons of ser vi ces. ( 7. 2)

30. That t he Mi ni st er f or Heal t h consul t wi t h t he At t or neyGener al r egardi ng the devel opment of appr opr i ateguar di anshi p l egi sl at i on f or t hese cl i ent s. ( 7. 4)

31. That t he f ol l owi ng t ar get s be adopt ed f or t he expansi on ofcommuni t y r esi dent i al ser vi ces r ecommended above and t her educti on of exi st i ng i nsti t ut i onal ser vi ces f or t hedevel opment al l y di sabl ed by 1986. ( The f ol l owi ng t ar get sshoul d be vi ewed as i nt er i m pendi ng t he f ur t her expansi onof communi t y ser vi ces) . ( 8. 2)

Regi on FI FTH SCHEDULE HOSPI TALS Communi t yTar get

Cur r ent Reduct i ons Tar getResi dent i al Tot al

Tar get 1986

West er nMet r opol i t an 871 301 570 390 960Sout hernMet r opol i t an 276 244 32 300 332

Nort her nMet r opol i t an 316 174 142 150 292Hunt er 1052 382 670 390 1060Sout h- East 200 100 100 100 200Cent r al West 198 100 98 100 198I l l awar r a 12 12Nor t h Coast 12 12Or ana & FarWest 12 12South- West 12 12

New Engl and

Tot al 2913 1301 1612 1478 3090


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PART 3 - MENTAL HEALTH SERVI CES AND SERVI CES FOR THE MENTALLY I LL

The f ol l owi ng r ecommendat i ons ar i se f r om Par t 3:

1. That as a mat t er of pol i cy t he hi ghest pr i or i t y i n ment alheal t h servi ces be t he communi t y- based car e andr ehabi l i t at i on of t he ser i ousl y ment al l y i l l . ( r ef er t o

Sect i on 3. 1)

2. That t hese servi ces be pr ovi ded i n an i nt egr ated mannerf or each def i ned cat chment area, t hr ough the appoi nt mentof one per son wi t h j oi nt cl i ni cal r esponsi bi l i t y f or t hei npat i ent and communi t y ser vi ces ser vi ci ng that catchmentar ea. ( 3. 2)

3. That t he Heal t h Depar t ment i mpl ement a pol i cy t hat al ladmi ssi ons t o publ i c sect or psychi at r i c ser vi ces bedependent on pr i or assessment by a communi t y- basedassessment t eam. ( 3. 2)

4. That each Regi on devel op a prevent at i ve progr amme whi chi s t i ght l y def i ned and t ar get ed at speci f i c cl i ent gr oupsor needs. ( 4 . 1)

5. That t he hi ghest pr i or i t y i n t he f undi ng of ment al heal t hservi ces be gi ven t o the devel opment of adequatel y st af f edcommuni t y- based assessment , cr i si s- car e and t r eat menta.ser vi ces. ( 4. 1)

6. That f r om t he speci f i c al l ocat i on r ef er r ed t o i n Par t 1( appr oxi mat el y $9 mi l l i on per annum f or t he next t hr ee

year s) , an amount of $5 mi l l i on per annum be al l ocat ed t oment al heal t h ser vi ces. ( 5. 3 ; 6)

7. That f r om 1983/ 84 a speci f i c f und be est abl i shed ( $1. 2 mi l l i on i ni t i al l y)f r om t hese f unds f or t he f undi ng of nongover nment non- pr of i t or gani sat i ons t opr ovi de suppor t i veand t her apeut i c host el and group- home accommodat i on f or t hement al l y i l l , and ser vi ces f or speci al needs gr oups. ( 4)

8. That gui del i nes be devel oped t o ensur e adequateaccount abi l i t y of or gani sat i ons al l ocat ed f undi ng. Thesegui del i nes shoul d be devel oped i n consul t at i on wi t h t he

Depar t ment of Yout h and Communi t y Ser vi ces and t heCommonweal t h Depar t ment of Soci al Secur i t y. ( 4. 1)

9. That wi t hi n t hi s non- government f und an amount , of $400, 000be "earmarked" i n 1983/ 84 f or t he suppor t of i nnovat i veprogr ammes t o meet speci al needs, such as Loui sa LawsonHouse and the Ki ngs Cr oss Youth Ref uge assessment ser vi ce.( 4. 1)

10. That t he Mi ni st er f or Heal t h, i n consul t at i on wi t h t heMi ni st er f or Yout h and Communi t y Ser vi ces, negot i ate wi t ht he Mi ni st er f or Soci al Secur i t y t o i mpr ove co- or di nat i onof pl anni ng and ser vi ce del i ver y and t o devel op pr oposal sf or j oi nt Commonweal t h/ St at e f undi ng of t hese ser vi ces.


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( 4. 1)

11. That t he Mi ni st er f or Heal t h negot i at e an ar r angement wi t ht he Mi ni st er f or Housi ng wher eby a pr opor t i on of wel f ar ehousi ng st ock i n exi st i ng and pr oposed devel opment s i sspeci f i cal l y made avai l abl e as host el and gr oup homeaccommodat i on f or ment al l y i l l peopl e. ( 4 . 1)

12. That t he Mi ni st er f or Heal t h expl or e wi t h t he Mi ni st er sf or Pl anni ng and Envi r onment , Housi ng and Yout h andCommuni t y Ser vi ces, potent i al f or i mpl ement at i on of apr ogr amme of subsi di es t o pr i vat e boar di ng- houses f orhousi ng of peopl e wi t h l ong- t er m psychol ogi caldi sabi l i t i es. ( 4. 2)

13. That as a mat t er of pol i cy al l acut e psychi at r i c admi ssi onser vi ces be l ocat ed i n gener al public hospi t al s ; exi st i ngacut e admi ssi on uni t s and st af f i n st at e psychi at r i chospi t al s shoul d be r el ocat ed or admi ni st r at i vel y at t ached

t o gener al publ i c hospi t al s. ( 4. 1)

14. That al l acut e psychi at r i c uni t s i n gener al hospi t al s beaut hor i sed f or admi ssi ons under t he Ment al Heal t h Act .( 4. 1) .

15. That i n associ at i on wi t h Recommendat i on 13 above, ser vi cescur r ent l y pr ovi ded i n gener al publ i c hospi t al s f or peopl ewi t h acut e psychi at r i c di agnoses be upgr aded t hr ough t heempl oyment of psychi at r i c nur ses and sessi onalpsychi at r i st s t o pr ovi de di r ect ser vi ces and a f or malconsul t ancy ser vi ce i n acci dent and emergency depar t ment sand i n gener al hospi t al war ds. ( 4. 1)

16. That as psychi at r i c ser vi ces i n gener al publ i c hospi t al sare upgr aded t hese hospi t al s be aut hor i sed f or admi ssi onsunder t he Ment al Heal t h Act . ( 4. 1)

17. That use of Enr ol l ed Nur si ng Ai des be expanded i n t hestaf f i ng of speci al i sed psychi at r i c hospi t al s. ( 4. 1;5. 1)

18. That t he Heal t h Depar t ment and t he Nur ses' Regi st r at i onBoar d ur gent l y r evi ew t he cur r i cul um and l engt h of Nur si ngAi de t r ai ni ng wi t h a vi ew t o upgr adi ng t he psychi at r i ccomponent . ( 4. 1)

19. That Regi onal Di r ect ors negot i ate expansi on of ar r angement sf or pur chase of soci al wor k, psychol ogy, and occupat i onal

t her apy ser vi ces bet ween hospi t al s and r egi ons. ( 4. 1)20. That ser vi ces i n psychi at r i c hospi t al s be made mor e

speci al i sed on t he basi s of di agnost i c gr oupi ngs andprogr ammes. ( 4. 1)

21. That i n st af f i ng t o meet cl i ni cal needs wi t hi n avai l abl er esour ces, mor e use be made of sess i onal ar r angement s f oruse of pr i vat e pr acti t i oner s. ( 5. 1)

22. That Regi onal Di r ect or s negot i at e ar r angement s f or gr eat eruse of aut hor i sed pr i vat e psychi at r i c hospi t al s f or t hepr ovi si on of ser vi ces f or publ i c pat i ent s. ( 4. 1)

23. That wi t hi n hospi t al s emphasi s be pl aced an r ehabi l i t at i onpr ogrammes devel oped and moni t or ed by pr ogramme st af f .Di r ect care ward st af f be responsi bl e t o t he pr ogr amme


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st af f f or progr amme mai ntenance and achi evement . ( 5. 1)24. That t he Depar t ment of Heal t h appr oach t he Col l ege of

Nur si ng t o devel op a t r ai ni ng pr ogr amme t o f aci l i t at e t het r ansf er of nur ses t o communi t y car e ser vi ces. ( 5. 1)

25. That ser vi ces f or chi l dr en and adol escent s ( l ocat ed i ncommuni t y heal t h cent r es, chi l d health centres or i nhospi t al s) be admi ni st er ed as a speci al i sed net wor k at

r egi onal or sub- r egi onal l evel . ( 5. 2)26. That Advi sor y Commi t t ees on Chi l d, Adol escent and Fami l y

Ment al Heal t h be est abl i shed at r egi onal and st ate l evel ,i ncl udi ng r epr esent at i ves of t he Depar t ment s of Yout h andCommuni t y Servi ces and Educat i on. ( 5. 2)

27. That f r om t he speci f i c al l ocat i on ( $5 mi l l i on per annum)r ef er r ed t o i n Recommendat i on 6, an amount of $3. 8 mi l l i onbe al l ocat ed t o Regi ons t o devel op communi t y ment al heal t hassessment cr i si s- car e and t r eat ment ser vi ces necessary t of aci l i t at e r educti on i n t he ut i l i sat i on and si ze of t heexi st i ng speci al i sed psychi at r i c hospi t al s. Pr i or i t y t o begi ven t o t he West er n Met r opol i t an, Hunt er , Sout her n

Met r opol i t an and I l l awar r a Regi ons. ( 5. 3)28. That t he exi st i ng psychi at r i c ser vi ces i n t he f ol l owi ng

hospi t al s be r esponsi bl e t o t he Boar ds of t he f ol l owi nghospi t al s:

Rozel l eand Gl adesvi l l e Hospi t al s - Royal Pr i nce Al f r ed Hospi t al Boar d ( wi t hwi dened member shi p t o r epr esent psychi at r i c ser vi ces)

Par r amat t a Psychi at r i c Cent r e ( and ser vi ces at Rydal mer e Hospi t al unt i l 1985j 6)- Par r amat t a Hospi t al s Boar d ( wi t h wi dened member shi p t o repr esent psychi at r i cser vi ces)

Macquar i e Hospi t al - Royal Nor t h Shore Hospi t al Boar d ( wi t h wi dened membershi pt o r epr esent psychi at r i c ser vi ces)

Newcast l e Psychi at r i c Cent r e and Mor i sset Hospi t al

Regi onal Psychi at r i c Boar d ( wi t h t eachi ng hospi t al r epr esent at i on)

Kenmor e Hospi t al - Ar ea Boar d f or Goul bur n

Bl oomf i el d Hospi t al - Ar ea Boar d f or Or ange

29. That t he f ol l owi ng t ar get s be adopt ed f or t he expansi on

of communi t y ser vi ces and t he r el ocat i on of acut e admi ssi onser vi ces, and t he r educt i on i n si ze of speci al i sedpsychi at r i c hospi t al s:

Regi on PSYCHI ATRI C HOSPI TALS Target TargetCurr ent Pr oposed Pr oposed Tar get

Beds Reduct i on Transf er Beds i t yMent alHeal t hPosi t i ons

West er nMet r opol i t an 803 100 100 603 n 56


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0

Souther n tMet r opol i t an 1155 305 100 750 20

sNor t her n pMet r opol i t an 286 - 40 246 e

c

Hunt er 591 241 100 250 i 29f

Sout h- East 39. 6 106 40 250 i 10c

Cent r al West 467 245 60 162 a 101

I l l awar r a 1 15Y

South- West 29Or ana & a 29Far West 1

1

Nor t h Coast 0 29c

New Engl and a 29ted

3698 997 440 2261 500 256

30. That i n each speci al i sed psychi at r i c hospi t al a mi gr antheal t h advocate be desi gnated f r omamong t he exi st i ngstaf f . (7. 1)


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8. That exi st i ng Fi f t h Schedul e Nur si ng Homes be t r ansf er r edt o t he Second Schedul e of t he Publ i c Hospi t al Act andl i nked t o r egi onal or ar ea ger i at r i c ser vi ces as f ol l ows:

Al l andal e Hospi t al - i ni t i al l y a separ at e Boar d wi t h r epr esent at i on f r om t heCessnock, Kur r i Kur r i and Mai t l and Hospi t al Boar ds ( subsequent l y t o become par tof a r egi onal ger i at r i c ser vi ce) .

Li dcombe Hospi t al - separate Boar d.

Garr awar r a Hospi t al - t r ansf er t o management of t he Boar d of St . GeorgeHospi t al .

St r i ckl and House - t r ansf er t o management of t he Pr i nce Henr y/ Pr i nce of Wal esBoard.

9. That t he Boar ds r esponsi bl e f or t he management of t heseser vi ces be gi ven t he cl ear r esponsi bi l i t y t o decent r al i seand r at i onal i se t he accommodat i on f aci l i t i es, t hr ough t he

devel opment of smal l er communi t y based accommodat i on,expanded day hospi t al f aci l i t i es and i mpr oved home car e.( 6. 2)

10. That use of t he t er m "psychoger i at r i c" t o descr i be t heconf used or di st ur bed el der l y be di scont i nued. ( 1)

11. That t he r ol e of Davi d Ber r y Hospi t al i n ger i at r i c, r ehabi l i t at i onand l ong- t erm car e be expanded, and the hospi t al be l i nked f or managementpur poses t o ot her heal t h ser vi ces i n t he Shoal haven ar ea, and t r ansf er r ed t ot he Second Schedul e of t he Publ i c Hospi t al s Act . ( 6. 2)

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