Planning for
Mental Health
Facilities
Prepared by Catherine Lourey
Manager, Mental Health Service and Capital Planning
Statewide and Rural Health Services’ and Capital Development Branch
April 2011
Cumberland Hospital
Themes
 Yesterday - The 1800s and 1900s asylums
 Today – Integration in the 21st century
 Tomorrow - Planning drivers for change
 Emerging planning issues
Lunatic Reception House,
Darlinghurst Sydney 1800’s
YESTERDAY – THE
ASYLUMS
Yesterday: The 1800s asylums
• The first asylum at Tarban Creek, Gladesville for
80 patients in 1838, growing to 642 by 1876
• By 1855 a second asylum had been built at
Parramatta, with 279 patients
• In 1871 the Newcastle Psychiatric Hospital was
opened with 120 patients
• In
1879 Callan Park Asylum at Rozelle was built,
for 666 patients
• Followed by the Rydalmere Asylum in 1888, to
close 100 years later.
Gladesville Hospital ward
 By the early 1880s psychiatric
outpatient clinics had been
established nine hospitals:
– Royal Prince Alfred; Sydney; St
Vincent’s; Lewisham; North Shore;
Parramatta; Newcastle; Goulburn
and Orange.
Parramatta Hospital for the Insane
The 1900s: from asylum to integration
 Four new rural hospitals:
– Kenmore Hospital in 1901 503 patients growing
to 1,107 in 1962;
– Morisset Hospital in 1909, 78 patients growing to
1,403 in the 1960s,
– Stockton Hospital in 1910 and Bloomfield
Hospital at Orange in 1924
 Finally followed by Macquarie Hospital at North
Ryde in 1959 for 1,400 patients
Recasting the
Service Paradigm
James Fletcher Hospital Newcastle
 In 1901 there were 4,423 inpatients in NSW psychiatric hospitals
 By 1958 there were 13,761 inpatients.
 By 1990 there were 2,864 inpatients
 The model of care paradigm had been recast:
– Expansion of community mental health
– New pharmacological therapies supported shorter hospital
stays and patients living in the community
– New mental health units on general hospitals: at RNSH in
1965 of 28 beds, Westmead Hospital in 1978 of 22 beds
INTEGRATION IN THE 21ST
CENTURY
Directions for the 21st century
– Expanding new models of care
e.g. youth services, PECCs
Young Adult Mental Health
Unit, Campbelltown Hospital.
– Provision of specialist inpatient services e.g. Child &
Adolescent, Mental Health ICU
– Leaving the stand alone psychiatric hospitals behind
– Strengthening the forensic mental health service
– Collaborative role with the NGO sector in community
based rehabilitation services (HASI)
– Facilities which are more conducive to the care and
treatment of the mentally ill
Mainstreaming of services
 Relocating the stand alone mental health
facilities on general hospital campuses
– Rozelle Hospital to Concord Hospital 174 beds in
2008
– James Fletcher at Mater Health Newcastle 100
beds in 2009
– Bloomfield integrated with
Orange Hospital 218 beds in
2011
Mater Mental Health, Newcastle
From inmates to inpatients
 Relocating the forensic hospital from the State
Corrections Service to the Forensic LHN with a
purpose built 135 bed hospital (2008).
Integrated units
 Developing co-located mental health inpatient
services on general hospital sites such as:
- Liverpool 50 bed unit; Lismore 40 adult and 8
C&A beds; Caritas 27 bed acute unit
- New tertiary mental health units within each
of the two campuses of the Sydney Children's
Hospital Network
Hall Ward – CAMHS Unit,
Westmead Children’s Hospital
Nexus C&A Unit,
Newcastle
A responsive service mix
 Recovery model focus – development of five 20 bed non
acute rehabilitation units, plus two state-wide specialist non
acute secure units including one for forensic clients
 Services across the life span – new older persons mental
health units at Wyong, Wollongong and Bloomfield; five new
child and adolescent units, with two currently in construction;
young adult unit Campbelltown
 Balance hospital focussed care – new C&A day program
units at Shellharbour, Orange; new older persons day program
planned in the new Nepean mental health development; new
community health facilities at Liverpool, Sutherland and Lismore
 Networking of services
Liverpool Hospital Mental Health Centre
Feb 2006 – 50 acute beds and community mental health.
Light filled corridor
Bedroom
Community health
Lecture room
One Courtyard
Dubbo Hospital
Acute Unit
THE PLANNING DRIVERS
FOR CHANGE
National and State Plans
 The Fourth National Mental Health Plan
Priority Area 3 Service access, coordination
and continuity of care:
“Develop a national service planning framework that
establishes targets for the mix and level of the full
range of mental health services, backed by
innovative funding models.”
 The NSW State Plan priorities include:
“Improved outcomes in mental health.”
State Health Plan
 Mental health priorities and directions for –
– Improve awareness, prevention, early
identification and detection of mental illness,
especially of people at risk, including children and
adolescents.
– Cross sector working with non-government and
private providers, and Commonwealth programs,
to improve integration
– Improving treatment services to better respond to
the onset of mental illness.
– Improving emergency health responses
A New Direction for Mental Health 2006
 This plan’s direction is significant in that for the first time it
aims to balance hospital focused care with community
care.
 A $939 million program of additional expenditure to be
implemented over five years, comprising:
– $601 million in recurrent funding, of which $279
million was for community based care
– $338 million in capital works, including additional
funding for new capital works, works-in-progress,
and privately financed projects.
State Mental Health Planning Tool
The Mental Health Clinical Care and Prevention (MH-CCP) model is a
population-based planning model for mental health services, published and
endorsed in 2002.
It uses assumptions about the prevalence of mental disorders and the
packages of care needed for those disorders to estimate the resources
(community staff, acute beds, non-acute beds) required to meet the
specialist mental health care needs of a population.
The MH-CCP model has been revised over the past 12 months, with an
updated version soon to be finalised.
EMERGING PLANNING
ISSUES
Mental Health Service Planning Priorities
 Services closer to home: New units in population growth
zones - Campbelltown, Nepean, Shellharbour; in rural areas Broken Hill, Dubbo, Orange, Goulburn, Lismore, Bega
 Expansion of integrated specialist services: mental health
intensive care units at Hornsby, Orange and in construction
at Prince of Wales; five C&A units; five non acute units
 Development of new models of care: 12 Psychiatric
Emergency Care Centres; a tertiary rehabilitation adolescent
unit; seven sub acute units in planning; young adult services
 Engagement of the NGO sector: Housing And Support
Initiative started in 2002/03 with 100 high support consumers,
now delivers services to 1135 consumers.
Emerging planning issues
 Multi storey mental health facilities – can they be safe
and afford patients space and light?
 Agility - in philosophy; building design, staff skill and mix to
take advantage of contemporary and new models of care
 Mainstreaming inpatient services – principles for
locating mental health units; for providing ECT services;
for locating community mental health
 Responsive to changes patterns in demand - emerging
co-morbidities, earlier onset, ageing
 Commonwealth sub acute mental health projects – new
service models
And as health planners ...
 Support mainstreaming, recovery and patient centeredness
in our policies, building design and service plans
 Advise on the service/capital interface to ensure/promote
effective built solutions which support optimal care and health
outcomes
 Continue to engage with all stakeholders: consumers and
carers; clinicians across disciplines; service providers in the
inpatient, community health, non government sector and
private sectors
 Increase service evaluation and use of evidence based
planning
Thank you,
Broughton Hall
Hairdressing Salon 1957
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yesterday – the asylums - Capital Projects and Service Planning