Academic literature on the topic 'Psychiatric hospitals Victoria'

Objective Victoria has low numbers of general adult psychiatric beds per capita by Australian and international standards. Hospital key performance indicators (KPIs) such as bed occupancy rates, emergency department waiting times and inpatient lengths of stay are proximal measures of the effects any shortfall in beds. We investigate the real-world performance of Victorian hospitals during the first year of the COVID-19 pandemic and the extended lockdowns in 2020. Conclusions The Victorian inpatient psychiatric system is characterised by high bed occupancies in many regions, extended stays in emergency departments awaiting a bed, and short inpatient lengths of stay, except for patients with excessively long stays on acute units (over 35 days) who are unable to be admitted to non-acute facilities. At the end of 2020, bed occupancies were high (above 90%) in 10 regions, with three regions having bed occupancies over 100%. However, state-wide average bed occupancy improved between 2019 (94%) and 2020 (88%). Other KPIs remained steady because acute hospitals did not experience the expected pandemic mental health demand-surge. For a more complete picture of the impact of the pandemic, Australia needs interconnected, centralised data systems.

The release of reports of inquiries into two related psychiatric hospitals (Lakeside and Aradale) in Victoria occurred in 1991. These inquiries identified deficiencies in patient care standards and organisational dynamics. Knowledge of institutional dysfunction was available from similar Australian and overseas inquiries but nonetheless this knowledge had not prevented organisational inertia and decline in these two psychiatric hospitals. This paper examines the possible contribution of a failed medical hegemony model to organisational dysfunction and discusses organisational life-cycles. It reaches the conclusions that politically motivated inquiries do not achieve long term positive outcomes and that there is a need for academic research into the organisation of psychiatric services and staff productivity and morale.

SummaryMental health services in the state of Victoria, Australia, have undergone enormous change over the past 15 years, with the closure of all stand-alone psychiatric hospitals and a shift of resources and services into the community. Although successful overall, various areas cause concern, including pressure on acute beds, a paucity of alternative residential options, and suboptimal integration of government and non-government agencies concerned with the care of people with mental illnesses. Certain groups, notably those with complex symptom sets such as substance use and mental illness, intellectual disability and forensic problems, remain poorly catered for by the system. Finally, community stigma and lack of work inclusion for mentally ill individuals are ongoing challenges.

When I reached Seychelles to start my new job with the Ministry of Health as a consultant psychiatrist at the Victoria Hospital I had hardly any idea about the islands, let alone its mental health service. But I decided to take the job partly out of curiosity and an interest to see what psychiatry would be on a tourist island in the middle of the Indian Ocean.

Objective: The main aim of this study was to document the perceptions of trainee psychiatrists and psychiatric medical officers regarding the psychiatric care of people with intellectual disabilities. Method: A 28-item self-administered questionnaire was developed by the investigators and pretested on eight psychiatrists and psychiatric trainees. A revised version of the questionnaire was then sent to 128 psychiatric trainees and 27 medical officers working in the public psychiatric services in Victoria. 116 questionnaires were returned, and the responses analysed. Results: The results indicate a high degree of interest in the psychiatry of intellectual disability, however this was tempered by a feeling that the respondents and their senior colleagues are inadequately trained. The respondents expressed major concerns regarding the care of people with dual disabilities in the hospital and community setting, and significant support for the development of specialised units and subspecialisation within psychiatry. The major concerns which were identified would in part explain why 30% of the respondents felt that they would prefer not to treat people with an intellectual disability and a psychiatric disorder. Conclusion: We can only support the assertion made by the Burdekin Report [12] that “there is an urgent need for academic research, increased clinical expertise and substantial increased resources in the much neglected area of dual disability.”

As more health authorities close large psychiatric hospitals the provision of small local facilities in which former residents of such hospitals are housed is increasing. Such houses tend to share many common characteristics dictated both by practical necessity and by deliberate policy – they tend to be large Victorian houses chosen because they have a larger number of bedrooms and they tend to be run in a much less formal manner than hospital wards (Goldberg, 1985).

Objective: To provide a biography of G Vernon Davies who took up a career in old age psychiatry in 1955 at the age of 67 at Mont Park Hospital in an era when there few psychiatrists working in the field. Conclusion: In the 1950s and 1960s, Vernon Davies worked as an old age psychiatrist and published papers containing sensible practical advice informed by contemporary research and experience, broadly applicable to both primary and secondary care, presented in a compassionate and empathetic manner. His clinical research in old age psychiatry resulted in the first doctoral degree in psychiatry awarded at the University of Melbourne at the age of 79. Before commencing old age psychiatry, he served in the Australian Army Medical Corps as a Regimental Medical Officer and received the Distinguished Service Order. He spent 3 years as a medical missionary in the New Hebrides before settling at Wangaratta where he worked as a physician for over 30 years. He contributed to his local community in a broad range of activities. Vernon Davies is an Australian pioneer of old age psychiatry.

In April 1995 the Royal Children's Hospital Mental Health Service in Melbourne piloted the use of videoconferencing in providing access for rural service providers and their clients to specialist child and adolescent psychiatric input. What began as a pilot project has in two years become integrated into the service-delivery system for rural Victoria. The experience of the service in piloting and integrating the use of videoconferencing to rural Victoria has been an important development for child and adolescent mental health services in Australia.

The relocation of chronic psychiatric patients in the community may be of unexpected benefit to town planners. Many Victorian mental hospitals, largely redundant in terms of medical use, are high quality buildings – some are listed or otherwise of architectural merit – and they are often set in mature landscaped grounds. Architect John Burrell has developed the idea of using former psychiatric hospital sites on the edges of cities as a basis for establishing a new urban core to outer suburban areas. His plans for the Woodford Green site won him the top prize in a national competition ‘Tomorrow's New Communities’, which was organised earlier this year by the Town and Country Planning Association and the Joseph Rowntree Trust, with the backing of the Prince of Wales.

To explore the pattern and prevalence of inpatient psychiatricmorbidity and to see how it differs from the pattern of psychiatric morbidity in community. Design: The details of all inpatients from the case register developed for a health information system was included in study Setting: In Departmentof Psychiatry and Behavioral Sciences, Bahawal Victoria Hospital, Bahawalpur. Period: From 1998-2003. Results: Atotal of 5426 patients were admitted in the six year. There was a slight difference of 0.8% in total number of males andfemales cases (i.e., 2764 males Vs 2662 females). Overall difference reported in the present study, in mean ages ofmales and females was 3.45 years (i.e., males = 31.85 Vs females = 28.40). Mean stay of patients in ward is 10-12days. Most patients were admitted with Conversion disorder 24% followed by Schizophrenia 23%, Depressive disorder20%, Drug Dependence 10%, Bipolar Disorder 7%. The patients with Neurotic Disorder and Organic Disorder werebelow 5%. Conclusion: The study showed that overall general pattern of inpatient psychiatric morbidity is in line withpattern of psychiatric morbidity in community and the partial variance can be explained in terms of social variables, asthis variance exist even across studies within community samples.

Aggression occurs frequently on many psychiatric wards; its assessment and management are crucial components of inpatient care. Consequences to inpatient aggression are profound, impacting on staff and patients, ward milieu and regime, and mental health services in general. Despite considerable research, which has primarily focussed on the assessment of demographic and clinical characteristics of aggressive patients, the nature of the relationship between mental illness, inpatient treatment and aggression remains unclear. Inconsistent risk assessment practices, management strategies and treatment plans, often derived from idiosyncratic beliefs about the causes of aggression, follow. Approaches to the assessment of inpatient aggression have been categorised as structural, which emphasise form, or functional, which emphasise purpose. Studies of inpatient aggression have primarily utilized a structural approach. These studies have resulted in the identification of demographic, clinical and situational characteristics of high-risk patients and environments. Resource allocation and actuarial assessments of risk have been assisted by this research. Conversely, functional assessment approaches seek to clarify the factors responsible for the development, expression and maintenance of inpatient aggression by examining predisposing characteristics, in addition to the proximal antecedents and consequences of aggressive behaviours. While functional analysis has demonstrated efficacy in assessing and prescribing interventions for other problem behaviours, and has been regarded a legitimate assessment approach for anger management problems, psychiatric inpatient aggression has been relatively neglected by functional analysis. Against this background, four studies focussing on the assessment of predisposing characteristics, precipitants and consequences, and purposes of aggressive behaviour, were undertaken to assist in the development of a functional analysis of psychiatric inpatient aggression. All four studies were conducted within the Thomas Embling Hospital (TEH), a secure forensic psychiatric hospital in Melbourne, Australia. The first of three initial studies involved a retrospective review of Incident Forms relating to aggressive behaviours that occurred within the first year of the hospital?s operation. The second involved a comparison of prospective assessment of aggressive behaviours with retrospective review of Incident Forms. The third involved a review of Incident Forms across two forensic psychiatric hospitals, the Rosanna Forensic Psychiatric Centre, and the TEH, to allow for the study of environmental contributors to aggression. The fourth, and main study, focussed on the assessment of patients and aggressive incidents, using a framework emphasising purpose, which was assessed using a classification system designed and validated as part of this study. Demographic and clinical information in addition to social behaviour, history of aggression and substance use were collected on the 204 patients admitted to the hospital during 2002. One hundred and ten of these patients completed an additional assessment of psychotic symptoms in addition to a battery of psychological tests measuring anger expression and control, assertiveness, and impulsivity. During 2002, the year under review, there were 502 incidents of verbal aggression, physical aggression, and property damage recorded. Staff members who observed these incidents were interviewed, and files were reviewed to record the severity, type, direction and purpose of aggression. Following 71 aggressive behaviours patients also participated in the assessment of purpose. Results from this, and the three initial studies, reinforced the contribution to aggression of a number of individual characteristics, including a recent history of substance use, an entrenched history of aggression, a recent history of antisocial behaviour, and symptoms of psychosis, including thought disturbance, auditory hallucinations and conceptual disorganisation. Somewhat surprisingly, a number of other characteristics shown through previous research to have a relationship with aggression, including anger arousal and control, impulsivity, and assertiveness did not show a relationship with aggression. Further, and perhaps a consequence of the peculiar characteristics of some patients admitted to the TEH, older patients and females were more likely to be repeatedly aggressive, yet neither age nor gender differentiated aggressive from non-aggressive inpatients. In this study acts of inpatient aggression were usually precipitated by discernible events, or motivated by rational purposes. Rarely was aggression the consequence of a spontaneous manifestation of underlying psychopathology occurring in isolation from environmental precipitants. A number of proximal environmental factors, most particularly staff-patient interactions associated with treatment or maintenance of ward regime, that were considered provocative or that threatened status, were evident in incidents of aggression perpetrated against staff. The perception of provocation and the need to enhance status were common precipitants of aggression between patients. There was little evidence to suggest that aggression was used instrumentally to obtain tangible items, to reduce social isolation, or to observe the suffering of others in the absence of provocation. Results of these four studies have implications for the prediction and prevention of inpatient aggression, and for the treatment of aggressive inpatients. These are discussed, as are the limitations of this research and suggestions for further research.
thesis (BPsychology(Hons))--University of South Australia, 2004.

This chapter offers a recollection of training and working as a nurse in Friern Barnet Hospital during the 1980s. As the era of the Victorian asylum drew to a close, the possibility of new and improved approaches to mental health provision loomed. Murdoch offers a personal account of working within and challenging the status quo. She describes prevailing policy and practice and a sense of the struggle to usher in the new while respecting and learning from the old. She offers insights into the contradictory permissiveness of the day, and the tolerance and celebration of eccentric and endearing aspects of life in the asylum. Murdoch conveys how much has changed and points to constant features in the search for effective, humane treatments over the three decades. Stigma, funding, freedom, responsibility, and structures to support care in the community all remain constants.

Abstract Case records examined here are those of inmates in two public institutions for the insane in colonial Victoria, Australia, and in Auckland, New Zealand, between 1870 and 1910. In the international field of mental health studies and histories of psychiatry, intellectual disability has been the subject of detailed historical inquiry and forms part of the critical discussion about how institutions for the “insane” housed a range of inmates in the nineteenth century. Yet the archival records of mental hospitals have rarely been examined in any sustained way for their detail about the physically disabled or those whose records denote bodily difference. References to the physical manifestations of various forms of intellectual or emotional disability, as well as to bodily difference and “deformity,” were part of the culture of the colonial institution, which sought to categorize, label, and ascribe identities to institutional inmates.

Chronic fatigue syndrome is a controversial condition, conflicts about which have frequently burst out of the medical literature into the popular media. Whilst these controversies may initially seem to be of limited interest to those who do not routinely treat such patients, they also exemplify important current issues in medicine. These issues include the nature of symptom-defined illness; patient power versus medical authority; and the uncomfortable but important issues of psychological iatrogenesis. The subject is therefore of relevance to all doctors. Fatigue is a subjective feeling of weariness, lack of energy, and exhaustion. Approximately 20 per cent of the general population report significant and persistent fatigue, although relatively few of these people regard themselves as ill and only a small minority seek a medical opinion. Even so, fatigue is a common clinical presentation in primary care. When fatigue becomes chronic and associated with disability it is regarded as an illness. Such a syndrome has been recognized at least since the latter half of the last century. Whilst during the Victorian era patients who went to see doctors with this illness often received a diagnosis of neurasthenia, a condition ascribed to the effect of the stresses of modern life on the human nervous system the popularity of this diagnosis waned and by the mid-twentieth century it was rarely diagnosed (although the diagnosis subsequently became popular in the Far East—see Chapter 5.2.1). Although it is possible that the prevalence of chronic fatigue had waned in the population, it is more likely that patients who presented in this way were being given alternative diagnoses. These were mainly the new psychiatric syndromes of depression and anxiety, but also other labels indicating more direct physical explanations, such as chronic brucellosis, spontaneous hypoglycaemia, and latterly chronic Epstein–Barr virus infection. As well as these sporadic cases of fatiguing illness, epidemics of similar illnesses have been occasionally reported. One which occurred among staff at the Royal Free Hospital, London in 1955 gave rise to the term myalgic encephalomyelitis (ME), although it should be emphasized that the nature and symptoms of that outbreak are dissimilar to the majority of those now presenting to general practitioners under the same label. A group of virologists and immunologists proposed the term chronic fatigue syndrome in the late 1980s. This new and aetiologically neutral term was chosen because it was increasingly recognized that many cases of fatigue were often not readily explained either by medical conditions such as Epstein–Barr virus infection or by obvious depression and anxiety disorders. Chronic fatigue syndrome has remained the most commonly used term by researchers. The issue of the name is still not completely resolved however: Neurasthenia remains in the ICD-10 psychiatric classification as a fatigue syndrome unexplained by depressive or anxiety disorder, whilst the equivalent in DSM-IV is undifferentiated somatoform disorder. Myalgic encephalomyelitis or (encephalopathy) is in the neurological section of ICD-10 and is used by some to imply that the illness is neurological as opposed to a psychiatric one. Unfortunately the case descriptions under these different labels make it clear that they all reflect similar symptomatic presentations, adding to confusion. Official UK documents have increasingly adopted the uneasy and probably ultimately unsatisfactory compromise term CFS/ME. In this chapter, we will use the simple term chronic fatigue syndrome (CFS).