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Thursday, 27 October 1955

Senator COOPER (Queensland) (Minister for Repatriation) [11.57 j. - I move -

To appreciate the necessity and wisdom of the Federal Government's approach, by a substantial contribution to capital buildings and equipment; in attacking the Australian mental disease problem, it is necessary to recapitulate the history of mental treatment by governments. Early in our history, it was recognized that mental treatment needed ample space, reasonable privacy for treatment, and opportunities for occupational employment. The same three main features of successful treatment were applied in those days as obtain to-day - (i) They aimed at accurate diagnosis and investigations; (ii) relaxation of the patient by hospital treatment or sedatives; and (iii) occupational therapy. All of these required ample space, both in hospital buildings and grounds, as well as modern equipment.

A measure of privacy for the sick patient is indispensable, as is room for occupational therapy. If you can keep the hands of the mental patients busy, you can keep their heads cool. At first, all these desiderata were available at Callan Park and Gladesville in Sydney, Kew, in Melbourne, and so on. As well, quite a number of extensive private hospitals were established, like Bayview, with 30 or 40 acres of ground to permit these facilities. The growth of population, especially the metropolitan population, with the intense congestion of the urban areas, not only brought in more patients, but also interfered with these essential conditions. The congestion of the city tended to jam the mental treatment areas and, as well, increased numbers were crowded into hospitals which were designed to carry 600 patients properly, but were forced to carry 1,600. This meant the destruction of all the essentials of treatment.

First, there was invasion of the recreation space in the hospitals for bedrooms, then the dayrooms were taken over, then the verandahs, and even the kitchens and pantries. Finally, numbers increased so greatly that the patients were literally jammed into even these wards, where there was scarcely standing room and not enough space for ample beds, so that many were forced to sleep on mattresses on the floor. With all this, very little extra lavatory and other amenity accommodation could be provided. It was found impossible any longer to give the doctor a special room to examine his sick patient and to find out, by gaining the confidence of the patient, the complexes which started his nervous disorder. This overcrowding limited the chances of obtaining single rooms for patients. Even general patients, of all sorts, in all stages of mental disease, were crammed into common-rooms, which became both dayrooms and bedrooms. Some even slept on the floor. There was no room for segregating patients into their different classes, nor room to provide appropriate occupations for all.

It was obvious, therefore, that the first and most important and indispensable step to remedy this condition of affairs was to provide accommodation to overcome the overcrowding. The provision of this accommodation will substantially help the maintenance costs of the hospital, but, more important, it may easily restore to normal civil life many patients who otherwise would simply be absorbed into the whirlpool of the permanently mentally disordered. Existing hospitals can give quite good service for the numbers for which they were originally built, and dayrooms and recreation space, &c, will again be available in those hospitals for the diminished numbers. The important thing is to get the excess siphoned off into new buildings.

If the acute cases could be diagnosed accurately, at the beginning of their sickness, many would be cured and never have to go into general mental hospitals at all. If there is room for individual examination and diagnosis, many others would be found to be able to be trained for jobs in which they could stay in hostels at night and earn ordinary wages during the day. Others might be housed at night at home and treated in hospitals during the day. Thousands of others would be found able to carry out a curriculum of work which prevented their further mental degeneration, gave them a great deal of enjoyment in life and enabled them to help to maintain themselves by useful work in properly provided hospitals.

The Australian Government, therefore, decided to have a complete examination of the whole position and ascertain, first of all, what shortage of accommodation existed. That examination has been made by Dr. Stoller and Mr. Arscott. From this, it is obvious that at least 10,000 beds are necessary immediately, which, at the cost of £3,000 each, would mean a total cost of £30,000,000. The Commonwealth will find one-third of this amount, or £10,000,000, which is more than twenty times as much as was ever given in any one year to the States by the Commonwealth for mental treatment, and five times as much as has been given in the whole history of the Commonwealth. This amount will bo available just as quickly as the States get on with their job of providing the 10,000 indispensable beds, and will be divided on a per capita basis.

The purpose of this bill is to authorize grants totalling £10,000,000 to the State governments for the provision of additional beds in mental institutions throughout Australia. For some time, there has been widespread public concern regarding conditions in State mental institutions. Mental health is a matter for the States, and the Commonwealth is responsible neither for the conditions which have developed nor for any action which must be taken to improve those conditions. But because the problem has reached such serious dimensions, the Government believes that it is proper that the Commonwealth should make a financial contribution towards expediting building for the alleviation of overcrowding and the improvement of treatment facilities, which is really the indispensable starting point of bringing modern conditions of mental care into operation.

This is the second occasion on which legislation has been introduced into the Commonwealth Parliament for the purpose of assisting the States in the field of mental health. The first Commonwealth legislation in this field was the Mental Institution Benefits Act' 1948. This act authorized the government of the day to make a five-year agreement with each of the States. The main provisions of the agreement, as authorized by the act, were -

(1)   The Commonwealth would pay the States a benefit equal to the amount then being collected by the States from the relatives and estates of mental patients by way of charges for maintenance ; and

(2)   The States (would cease making charges for the maintenance of mental patients.

The agreements authorized by the Mental Institution Benefits Act were made with all States in 1949. The amounts paid by the Commonwealth to the States under the agreements were about1s. per patient per day. The cost to the Commonwealth was less than £500,000 a year. The agreements expired in the latter half of 1954. The present Commonwealth proposal is for a sum twenty times the annual amount provided, and is in addition to State resources.

Quite early in the life of the present Government, the attention of the State governments was drawn to the defects of the agreement, and an offer was made to cancel the agreements and establish a fresh approach to the whole problem. However, none of the States took advantage of the Commonwealth's offer and the 1949 agreements therefore ran for the full five years.

The principal weakness in the 1949 agreements, from the State governments' viewpoint, was that the States received no extra money for the maintenance of mental patients but merely a Commonwealth benefit in substitution for their existing fees. One effect of this arrangement has been that mental institutions have been starved of the funds necessary for their development. The present Government believes that a stipulation which interferes with the right of a State to determine its own policy in relation to charges should not be made a condition of Commonwealth assistance.

Early in 1954, as the termination of the 1949 agreements became imminent, the present Government decided that a prerequisite of any new offer of Commonwealth assistance in this field should be an expert Australia-wide survey of the needs of mental institutions. The State governments agreed with the Commonwealth proposal that this survey should be made. The task was entrusted to Dr. Alan Stoller, formerly Consultant (Psychological Medicine), Repatriation Commission Head-quarters, Consultant, World Health Organization, Corresponding Fellow, American Psychiatric Association, and now Chief Clinical Officer, Mental Hygiene Department, Victoria, whose services were made available by the Victorian Government, and to Mr.K. W. Arscott, Administrative Officer, Commonwealth Department of Health.

Their survey covered the whole field of mental health in Australia. The report was released in May of this year. It represents the first statement on the problem of mental disease on an Australian basis. The outstanding revelation in the report is an appalling state of overcrowding and treatment conditions.

The report makes it clear that the remedy of overcrowding is the first step to be taken for the relief of the existing uphappy conditions, and for better treatment. Dr. Stoller estimates that the immediate accommodation required to meet the existing shortage is 10,000 beds, estimated to cost approximately £3,000 each -a total cost of £30,000,000. The Commonwealth offered to supply £10,000,000 towards this cost, on the basis of £1 for every £2 spent by the States.

The report was discussed at the conference of Commonwealth and State Ministers which was held in Canberra in June of this year. It was made clear by Commonwealth representatives at the conference that each .State government has to decide for itself what it is going to do about the conditions revealed in the report, but that extraordinary efforts are clearly called for. All authorities are agreed that no real progress can be made in overcoming the present conditions and improving standards of treatment without a costly building programme running into many millions of pounds.

The Government's view is that, because of the urgency of the matter and because of the great financial problem which is confronting the States in this matter, the Commonwealth should contribute to a £30,000,000 capital expenditure pro gramme on the basis of £1 for each £2 of capital expenditure on mental institutions by the States. It is a grant on these terms that is provided for in this bill. The Commonwealth's grant will come out of its own budgetary resources and will be paid to the States as their funds are expended. The States' expenditure may come out of loan funds or any other sources they have available.

Overcrowding defeats the three main features of successful mental treatment, which are, first, accurate diagnosis and investigation; secondly, relaxation of the patient by hospital treatment or by sedatives - whichever of these is adopted the mental patient must have ample room to minimize noise; thirdly, occupational therapy, such as farming, carpentering, dressmaking - things to do with the hands to do away with mental tension, recreation and room for the patients. Each one of these necessitates ample space combined with efficient organization so that the available accommodation may be wisely used. Suggestions for improved treatment of mental disease all depend for their success on more accommodation for facilities needed. For instance, accurate diagnosis and investigation of the patient must be the very base of any improvement. This can be secured only if separate rooms are available for every doctor to examine his patients. No mental patient can be diagnosed unless he is examined in a separate room. No mentally disturbed patient will talk frankly, or with confidence except in a separate room with his doctor. How could the disturbed patient tell about himself with others listening. Relief of overcrowding must be the first step taken both in the provision of more humane conditions and better treatment, and is indispensable in all other recommendations for improvement.

The actual cost of maintenance of the whole system may very easily be reduced as the result of increased accommodation, with provision of diagnostic and therapeutic facilities, and improved conditions will be accompanied by a lessened load on the community. Many patients, who would otherwise become chronic mental cases, may be cured. in the early stages and return to active, normal life and full working capacity. The aged could be specially provided for and related to general geriatric treatment.

The mentally deficient and chronic mental cases may well be able to be placed in a position of largely maintaining themselves by their vocational activities, as illustrated at the Convalescent Hostel, Tomaree, Nelson Bay, in relation to which Dr. Stoller reported -

It. will be evident that this capital works programme is not the whole solution to the problem of the mentally ill. It still rests with the States to lift the standards of care and treatment. But without large capital expenditure such care and treatment will be grievously handicapped and many curable cases will suffer fatal neglect.

Debate (on motion by Senator Tangney) adjourned.

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