The WA government has announced plans to close Graylands Hospital within 10 years. This decision has been a long time coming and will be welcomed by many in the community. At the same time there will also be concern, as some in the community will wonder what is going to replace it.
Large scale psychiatric hospitals have been the mainstay of mental health services in Western Australia for too long. Graylands is an institution with its roots in a model of mental health care from the 19th century, and it is the last institution of this type remaining in Australia.
Stand-alone psychiatric hospitals are no longer supported or appropriate as they are stigmatizing environments. They perpetuate difficult organisational cultures and provide an environment where the historical culture of custodial care and pockets of counter-therapeutic practices are maintained, which are a concern.
The type of person-centred, recovery-oriented care espoused in the Government’s new Mental Health Plan cannot be provided in institutions of this scale and environment.
Australia is failing to deliver mental health services where they are most sorely needed because governments have previously directed funding too heavily towards acute care.
Governments have had endless debates about pressure on acute care in hospitals; the perception is that hospitals are the only solution for people with mental health problems.
However, acute care does not help people with mental illness be re-established back in the community safely and well, reducing or eliminating the need to return to hospital. This makes acute facilities like Graylands hospital self-perpetuating.
Many of the human and financial resources required for the model of service provision detailed in the Government’s Plan have been locked up in running Graylands.
However, closing the facility without considering other strategies is not enough. Clearly, workforce reform will be a major and essential piece of work required in the period of transition and closure. There will need to be a process of professional development for managers and clinical staff to bring about a change in service and care culture. There will need to be competencies developed benchmarked against contemporary standards of best and wise practice. This will require a clear authority to be given to the person appointed to manage the reform of staff work practices and attitudes.
Mental illnesses are often life-long and the best place to treat them is in the community. We need active collaboration between acute services and community based mental health employment and housing services.
There will need to be vastly better systems for the newly integrated mental health system to engage with mental health consumers, their families and carers. WA will also need to get the balance right between the Mental Health Commission, the Department of Health and the many community organisations providing a wide range of important mental health services. These relationships need to work effectively to benefit the consumer and to be consistently consumer focused at all points in the service processes and outcomes to ensure both quality of life and care.
Re-allocation of resources is critical, especially in a State as large as ours. Community mental health services are under-resourced and shrinking. This means people are not receiving the early care when needed and the corollary of this is they end up presenting at hospital emergency departments with acute mental illness.
Of course it’s important to fund hospitals and acute care beds, but not at the cost of enabling people to live well in the community, with appropriate housing and employment. We must make sure community services interact with all these systems because the future challenge of mental health care is to ensure its provision is in the community.
This alternative care strategy will help more people; it is possible to fund three to five supported accommodation packages for each hospital bed in a public psychiatric hospital. Such a strategy would support more people in a manner consistent with current evidence and be committed to recovery.
Closing Graylands will not be easy; it will be tempting to keep admitting people with a mental illness into this institution. I suggest it needs a radical intervention that identifies measures to enable admissions and transfers to Graylands to cease; and these measures to be put in place as a matter of priority.
I welcome the government’s commitment to close of Graylands Hospital; I only wish it could happen sooner.
by Revd Dr Lucy Morris
Previously published in the West Australian