Clinical Services The Thomas Embling Hospital operated at 99.12% capacity in <strong>2004</strong>-<strong>2005</strong>, providing care and treatment to a total of 146 inpatients. 5,611 referrals for psychiatric assessment and/or treatment and care were made to <strong>Forensicare</strong>’s prison mental health service at the Melbourne Assessment Prison during the year. 12 The Community Forensic Mental Health Service had 16,497 client contacts in <strong>2004</strong>- <strong>2005</strong>, and provided 328 psychiatric and psychological reports to Victorian courts.
Clinical Director’s <strong>Report</strong> The Thomas Embling Hospital is now fully commissioned. Our community service is similarly now fully established. This should be an occasion for moving towards an exclusive focus on the goals of consolidation and quality improvement. But time has not stood still since the current service was planned in the early 1990’s. The assumptions on which our service levels were determined have in the event proved over optimistic. Firm predictions of prison numbers in Victoria peaking at less than 2,500 have crumbled before a current reality of almost 3,700 inmates. A particularly distressing aspect of this escalation has been the increase in female prisoners – an 80% increase since 1998. The reform of the insanity legislation was a welcome step forward, but has greatly increased demands on our inpatient and community services. The assumption by Government that the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 would have little or no resource impact has proved incorrect. The increased pressure on our beds has been alleviated to some extent by an emerging trend toward a reduction in the median length of stay among mental impairment patients to 4-6 years. The shorter admissions have not been associated with any increase in offending on return to the community, which continues to be almost zero (two relatively minor offences not involving violence in the last 5 years). The reality is however, that unless we have a significant increase in bed numbers over the next year or so, our ability to care for both mentally ill prisoners and mental impairment cases coming from the courts will further, and critically, diminish. For people with a serious mental illness in prison, many remain untreated, and in order to admit them to Thomas Embling Hospital, we are forced to return to prison people whose illness is only partially treated. This situation carries considerable risk for prison management, and for downstream illness deterioration and reoffending. Bed pressures also place unacceptable constraints on our ability to respond to much needed demand for secure care from general mental health services, struggling with challenging and often high risk violent patients. In the community service over the last 5 years the annual number of court reports prepared has increased from less than 200 to well over 300 specialist forensic assessments, for general mental health services from 50 to over 200, and patient contacts from 9,574 in 1998-1999 to 16,497 in <strong>2004</strong>-<strong>2005</strong>. Continuing to meet this rate of service demand increase is not sustainable. Success comes at a price. We have a bright new hospital and a well functioning and comprehensive community program. We have excellent staff, arguably amongst the best of any service in the state. Unlike many mental health services, we manage disturbed patients with, in many instances, histories of serious violence, without resorting to security staff or physical restraints. We are productive academically. We attract a high and largely positive public profile. Compared to many areas of Victoria’s mental health services, we are privileged and fortunate. The situation of perceived privilege and real success, is however fragile. It depends on being able to provide the current level of services to our patients, and the current levels of job satisfaction to our staff. Our service capacity is threatened by the current pressures. Our situation is fragile because we are a small service, performing a highly specialised function, for a potentially very difficult group of patients. When a forensic service begins to falter, a range of underlying risks become more elevated. Such risks impact on the safety of people with a mental illness in prison, on prison staff, and ultimately on the community. We are doing well as a service at this moment, but unless a major increase in our resources is delivered soon, this will inevitably erode. <strong>Forensicare</strong> is at the crossroads. Paul E. Mullen MB BS, DSc., FRANZCP, FRC Psych. Professor of Forensic Psychiatry, Monash University Clinical Director, Victorian Institute of Forensic Mental Health 13
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