Newsletter No. 43

WINSTON RICKARDS MEMORIAL ORATION 2014
The fifth Winston Rickards Memorial Oration was held at the Royal Children’s Hospital on Tuesday 4th March 2014.
The Orator, Professor Louise Newman, presented her paper: “Cry Freedom! – Child asylum seekers in Australia: the intersection of mental health and human rights” to a packed house.
This was an exciting and challenging presentation which captivated the audience. As Professor Newman spoke without notes it has been necessary for us to arrange a transcript of her oration before we can post it on our website where earlier Orations are also to be found.

Inspired by the Oration, we have received the following note from one of the audience.

Hello colleagues,
I want to pass on some important information I heard on ABC radio regarding a request from the Refugee Council concerning music for refugees in the detention camps.
They have established music programs in the camps to provide stress relief by providing music classes and jam sessions (this is done by volunteers).
However they need donations of unwanted musical instruments to keep these programs operating.
Any instruments would be welcomed including percussion, strings, guitars, wind instruments. You name it & it will be gratefully received!!
Oh, and spread the word if you wouldn’t mind.
Put ‘music for refugees’ or ‘instruments for refugees’ into your search engine & you’ll be able to get more details.
There are drop-off points at Uniting Churches in Essendon and Glen Waverley.
Regards,
Helen Lechte, Honorary Social Worker, Infant Team, Alfred Child and Youth Mental Health Service (Alfred CYMHS), Level 2, 999 Nepean Highway, Moorabbin Vic 3189. Phone: 8552 0555

A Special Welcome to all the new readers who joined us as new Members or Associates at the recent Oration.
We hope you find our Newsletters of ongoing interest.

Language Development and Juvenile Justice

Language is an essential part of our human functioning. Not only is communication crucial for our social relationships but it is a fundamental component of our thinking processes and our emotional state. Impairments or delays in language development are highly correlated with impairments in executive functioning. ie capacity for impulse control, reflective thoughtfulness, delay of gratification, strategic planning, tactfulness and consideration of consequences.
Two thirds of young people in the Juvenile Justice system have impaired language development. Whilst this may or may not have been the primary cause of their misbehaviour it is always a major factor in the outcome. Not only do they almost always have poor executive functioning that contributes to their poor judgment of consequences, impulsiveness and lack of consideration for others, but also have poor abilities in understanding the complexities of their situation and what has to be done to resolve it. These impairments make it difficult to deal with problem behaviour and make it more likely that it will keep happening in the future. It is in the young person’s best interests, and in the best interests of society as a whole, for improvements in their executive functioning, social and emotional and communication skills.
Research indicates that appropriate programs can make a difference to communication skills. Improved communication skills can make a difference to social competence, emotional well-being and executive functioning. This improves the outcome for the young person in terms of quality of life and for the Juvenile Justice system in terms of reduced recidivism.
This has been recognized by the Juvenile Justice authorities in Victoria through participation of all young offenders in schooling programs enhanced by specialist assessments and interventions with language development programs. This is aimed at helping the young people become more productive members of society and less likely to engage in recidivist offending. Ongoing evaluative research is being undertaken to clarify the effectiveness of various interventions.
The cost of implementing such programs is believed to be small compared to the benefits of greater productivity and reduced costs of recidivist delinquent behaviour and necessary ongoing social support programs, possibly even to subsequent generations. The verification of the estimated cost- effectiveness of these interventions will take some years of follow-up research. Even a cost- neutral outcome would be a program success, but the benefits are likely to be shown to be much greater. An interesting question is whether the programs can be effective with young adult offenders who have developmental language delays, which could warrant consideration of implementation in the adult forensic system.
There are more profound implications for the general education system. If language development programs can work for seriously impaired adolescents, how much better will A Special Welcomethey work for mildly impaired young children? Pedagogic research tells us that the earlier a remedial program can be implemented, the greater the response. If the language enrichment of universal early childhood education programs could be intensified for children seen to have developmental delays, rather than waiting
until failed schooling has led to Juvenile Justice intervention, the degree of response might well avert many of these later complications.
The above notes are a summary of a MHYFVic Project. Further information and References are included in the Projects Pages of our website.

Project Coordinators : Laura Caire and Dr Allan Mawdsley

This project has the goals of :
 Extending the understanding of language
development in relation to Juvenile Justice
 Evaluating the effectiveness of interventions to improve communication
skills and executive functioning
 Exploring the applicability of these principles to other groups such as adult prisoners or younger developmentally-
delayed children
The process will be to gather information about research findings and best practice models, and publish this progressively on this website until it can be formulated into an advocacy policy for MHYFVic to lobby the authorities.
If you have any ideas to contribute or if you want to help to develop the project, please call. Members welcome
Contact Laura Caire on (03) 9389 4389 or caire.laura.m@edumail.vic.gov.au
Contact Allan Mawdsley on 0419 77 00 66 or mawdsley@melbpc.org.au
Allan Mawdsley

HISTORY CORNER: 1952 and 1991
Just as the 1935 work of Kanner, Child psychiatry, announced the establishment of a new modern profession, the 1952 publication of Peplau and the 1991 publication of Heideman and Crabbe, announced the
professionalization of psychiatric nursing and of child psychiatric nursing. During the 1930s, when cohesive mental health nursing unionism became established in Britain, another important change was manifested within asylums, that of inpatient psychodynamic psychotherapy. Fromm- Reichmann and Sullivan (Peplau, 1952) in America and Main in London (Nolan, 1993) established specialist treatment units within institutions where the total community of medical, nursing, and ancillary staff and the patients themselves, provided a milieu for treatment through interpersonal relating. Each staff category had its particular roles and responsibilities, but all were conducted in a manner designed to enhance relationships. All staff were given credence for being skilful in therapeutic interpersonal communication.
Out of such work came Peplau’s Interpersonal relationships in psychiatric nursing in 1952. A new focus of professional activity was established. Subsequent developments have confirmed Peplau’s vision. In America, other signs of professionalization had been established before the First World War with the production of a journal and the establishment of tertiary training courses (Church, 1987).
Professionalization of mental health nursing was placed on the Australian national agenda with the First National Mental Health Nurses Congress in Melbourne in 1975 (Martyr, 1999). After three such conferences the first national body was formed in 1977: the Australian Congress of Mental Health Nurses (ACMHN). This became the Australian and New Zealand College of Mental Health Nurses in 1991. As early as the convention of 1980, Victorian child psychiatric inpatient unit nurses were seeking status as a special interest group of the ACMHN (Martyr). In 1980, the organization produced the first issue of the Journal of the Australian Congress of
MHYF Vic: promote mental health, reduce stigma, advocate, resource, and collaborate 3
Mental Health Nurses. The journal changed names three times, becoming trans-Tasman as the Australian and New Zealand Journal of Mental Health Nursing (ANZJMHN), before it became the International Journal of Mental Health (IJMHN) Nursing in 2001. The ANZJMHN/IJMHN has been externally refereed since 1992.
Nursing education was within tertiary institutions, Australia wide, by 1993 (Martyr, 1999). The first tertiary psychiatric nursing intake was at the University of New South Wales in 1985 (Martyr). More recently, nursing courses have been structured to provide general training in undergraduate courses, with mental health nursing an option to be pursued through post-graduate study (Martyr).
Psychiatric nursing has never held its members captive. Trained psychiatric nurses have chosen to move into general nursing, child psychiatry, and a range of welfare related positions for decades. Within the asylum walls, significant sub-groups of staff advocated for patients’ rights and the abolition of the institutions (Varcarolis, 1996). Community health and community mental health centres have facilitated the acquisition of the role of autonomous professional by many psychiatric nurses. The re-definition of the psychiatric nursing role as inter-personal relating by Peplau (1952) liberated both nurses and patients. For child psychiatric nurses, child guidance was the bridge to establishment of the specialty and then to professional status. In this sense, child psychiatry was instituted as a place to which psychiatric nurses could go, away from the constraints of asylum wards.
Heideman and Crabbe (1991) located the first American child psychiatric nurses as assistants to the child psychiatrists who administered pharmacotherapies to children in child guidance clinics following the Second World
War. The course of history appears to have been in reverse to that of adult psychiatric nursing. Whereas adult mental health nursing began in institutions and extended into community settings, community clinics for children did not have a place for nurses, originally (Heideman & Crabbe). Over time, and in line with Peplau’s new description of interpersonal nursing, the space within child guidance expanded to include the nurse in a greater range of activities. The development of inpatient psychiatric services for children and adolescents saw the mental health nurse providing specialty services by intervening:
1) To assist children with new learning regarding themselves and their world,
2) To assist children and their family with relearning of roles, relationships, and expectations, and
3) To assist in restoring deprived aspects of living. (Fagin, 1972; cited in Heideman & Crabbe, 1991)
Heideman and Crabbe (1991) described the steady building in the United States of the separate profession of child psychiatric nursing with the establishment of post- graduate courses in this area in the 1950s, development of the specialty within the 1960s, publication of separate texts and the formation of a professional association in the 1970s, and the establishment of standards of practice and a professional journal in the 1980s. Child mental health nurses practice across the range of psychosocial interventions provided in contemporary American child and adolescent mental health services.
In Victoria, Australia, child psychiatric nursing has been a recognized sub-discipline since the late 1970s, especially with respect to inpatient settings (Martyr, 1999), and from 1980 Victorian inpatient mental health nurses were seeking status as a special interest group within the then Australian Conference of Mental Health Nursing. Over time, a separate chapter of the professional association (with its several names) was established with members in all states and from 1985, independent practitioner status has been a documented concern of the Association of Child Mental Health Nurses (ACMHN) from 1985 (Martyr).
Over the course of establishing child and adolescent mental health nursing as a separate professional entity in Australia, inpatient units throughout Australia have been closed down as expensive and as antagonistic to the treatment goal of having children reside with their parents. Mental health nurses have taken up positions in community child and adolescent mental health clinics, with responsibilities for case management and the provision of therapeutic services identical to those of other allied health professionals. Many intake workers have mental health nursing backgrounds.
It is proposed here that the currently high prevalence of mental health nurses among child and adolescent mental health services intake workers in Australia can be seen as emerging from the social history of nursing discussed above. It can be seen as representing coalescence of three social changes and of one social continuity. Firstly, the nurses wanted professional independence. Secondly, they did not want to work under direct medical control or to conform to the group nursing culture of the mental hospital. However, and this is the social continuity, mental health nurses liked the security of regular hours and the handover of responsibility at the end of the shift.
The third social change was that social workers gave up ownership of the role of community liaison built up by generations of psychiatric social workers. Social workers, individually and as a profession, sought to assert independence from doctors (Wood,
1996) by becoming clinicians, especially in the field of family therapy (Furlong & Smith, 1995), or by becoming social policy analysts and planners. Although social workers remain a significant occupational category among intake workers, the relinquishing of ownership allowed for a stepping-stone to materialize by which means mental health nurses could leave inpatient work and move to become independent practitioners (Freestone, 1994).
Once there were three child guidance professions: psychiatry, psychology, and social work. Since the Second World War in Australia, there has been added mental health nursing, teaching, occupational therapy, speech pathology, and art therapy. The professions have evolved in complex ways. The only profession that has grown through union action and organization has been mental health nursing. The union story goes back into the second half of the 19th century and influenced all professionals in the securing of appropriate employment conditions.
References
Church, M. (1987). The emergence of training programs for asylum nursing at the turn of the century. In C. Maggs (Ed.), Nursing history: the state of the art. London: Croom Helm.
Freestone, L. (1994). Review of Royal Children’s
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Hospital/Travancore Information Service, document.
Telephone internal
Furlong, M., & Smith, J. (1995). Laundering good ideas? Social work’s relationship with family therapy. Australian Social Work, 48, 41-50.
Heideman, J., & Crabbe, V. (1991). Historical overview and current status of child psychiatric nursing. In P. Clunn (Ed.), Child psychiatric nursing. St Louis: Mosby.
Kanner, L. (1935). Child psychiatry. Springfield, IL: Charles C. Thomas.
Martyr, P. (1999). Setting the Standard: A history of the Australian and New Zealand College of Mental Health Nursing Incorporated. Sydney: ANZCMHNI.
Nolan, P. (1993). A history of mental health nursing. London: Chapman & Hall.
Peplau, H. (1952). Interpersonal relations in psychiatric nursing. New York: Putnam.
Varcarolis, E. (1996). Psychiatric nursing: past, present, future. In E. Varcarolis (Ed.), Foundations of psychiatric mental health nursing (3rd edn.). Philadelphia: WB Saunders.
Wood, A. (1996). The origins of family work: The theory and practice of family social work since 1880. Australian and New Zealand Journal of Family Therapy, 17, 19-32.
Jolyon Grimwade

OUR UPDATED WEBSITE
After much thought our website has been significantly revised to give casual visitors immediate information about what we do and what we stand for, whilst at the same time allowing members to go straight to specific sections such as Projects or Newsletters or Events, without having to navigate past reams of information.
Now that the main revision has been implemented we are working on tasks of development of Projects to give us the evidence base for our advocacy. There are quite a few items under development at the present time which are not yet reflected in the website but over the next few months we expect to see a burgeoning of activity.
Visit us on mhyfvic.org

FORTHCOMING EVENTS 2014 MHYFVic 2014
Annual General Meeting
The AGM will be held on Wednesday 27th August 2014 at Pacific Rim restaurant in Albert Park. The after-dinner speaker will be Vicki Cowling describing developments that have occurred over the last two decades in support services for children whose parent has a mental illness.

2013 MHYF Vic Committee
* President, Jo Grimwade
* Vice-President, Jenny Luntz
* Past President: Allan Mawdsley
* Secretary, vacant
* Treasurer & Membership Secretary,
Lillian Tribe * Projects Coordinator, Kylie Cassar
* WebMaster, Ron Ingram
* Newsletter Editor, Allan Mawdsley
* Youth Consumer Representative, vacant * Members without portfolio:
Suzie Dean, Miriam Tisher, Sarina Smale, Zoe Vinen.