Annual Report 2004-2005 - Forensicare

Clinical Director’s Report
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 2004-2005. 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. Forensicare 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
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