Rural News

Reminiscences of 36 years in Rural Psychiatry

Before 1960, mental health problems in the northwest region of Tasmania were dealt with by a few local GPs (one did ECT) with backup mainly from the state mental hospital, which was a long, five or six hour drive away.

The first resident psychiatrist was Dr. Geoffrey Harrison who came in 1960 and stayed for four years or so. Thereafter the situation reverted to the local GPs with weekly visits from Launceston psychiatrists -Dr Cedric (Sandy) Simpson and Dr Brian Crawford.

The inpatient unit was in a converted surgical ward of the district hospital at Wynyard and was not in use till I arrived in 1967. There were 17 beds and within a week or so of opening it was full — with a surprising number of alcoholics, some of whom developed delirium. I was grateful for my experience as a physician in the British Army and as a psychiatric registrar in a large Glasgow general hospital psychiatric unit in which there was a steady flow of alcoholics with delirium tremens.

From the beginning, I had help from the local GPs. In particular, Dr Freda Cook who did all the routine physicals, and Dr Dougie Reid who did the anaesthetics for ECT. Mr Gerry Gunton was the only community psychiatric worker for many years and like me spent the rest of his professional life here — a very competent and caring man.

The population of the region has remained the same — at about 110,000 — well spread out. I established outpatient clinics in Devonport, Burnie, Wynyard, Smithton and briefly at Queenstown. Travelling time to Queenstown proved too much for me and so for many years Gerry did the area by himself — assessing patients and supporting GPs. For the first few years there was no time for private practice but then I gradually began to see patients in GPs’ surgeries in the various centres. In this way, GPs could get an early consultation for their patients and I think the arrangement worked well for everybody. Many patients, private and public, were referred back to their GP as soon as possible.

I've always had competent nurses and nearly always good morale in the ward. Josef Oetterli who had worked with John Cade was in charge in the early years. Local GPs provided after hours on call services and I could get away to fish or work on the farm.

I had grown up in the midst of agricultural country just north of Stirling in Scotland. My mother and I were relatively poor after my father went to World War II, and from an early age (12) I worked on farms and became independently minded. This was reinforced in the army when I was sent to a small military hospital in North Malaya to be physician in charge of the medical department. Prior to this posting I had been in the Alexandra Road Military Hospital in Singapore rotating around the medical specialties-pediatrics, infectious diseases, dermatology, venereol-ogy and the main adult medical ward. I had excellent teaching from senior officers there and I have always believed that coming into psychiatry with several years varied experience like this was a great advantage.

Clinically, the north-west coast of Tasmania was of special interest. Before World War II some communities had been relatively isolated — a serviceable road to Smithton was not put through till the late 1930s. Familial bipolar and schizoaffective conditions became well known to us and we have now treated three generations of some families.

In the early days, I discouraged patients with personality disorder and neurosis on the basis that I believed then that our service had little to offer them. They were seldom admitted or became chronic. This was before drugs of abuse were common or psychologists and counsellors had become such a force.

From the start we had an average occupancy of 80 to 90 per cent in our 17-bed ward and an average stay of 10 days. We sent about 10–12 patients to the mental hospital in Southern Tasmania per year. Very early on I instituted routine physical screening procedures — a practice not as well accepted then as it is now. I was always interested in the connection between cryptic physical illness and psychiatric breakdown and kept some figures resulting in a paper being accepted for publication in the College Journal (1974). Nowadays, staffing numbers have increased in the community and the hospital. We now participate in the teaching of rural medical school students, RMOs and registrars in training. The Internet and TV conferencing has been a big change. Patients too have changed; not clinically but in many other ways.

I would do it all again if I could.