A History of General Hospital Psychiatry in New South Wales

Abstract

This dissertation offers a narrative account of the evolution of psychiatric services in the general hospitals of New South Wales (NSW) and then compares that account with published accounts concerning the evolution of psychiatric services in the United Kingdom (UK) and the United States of America (USA). At the start of the twentieth century, to improve the early identification and treatment of mental symptoms and to prevent their advancement to overt insanity, some leading psychiatrists proposed that persons who had incipient mental disorders and who wished to avoid legal certification to mental hospitals, should be admitted to general hospitals.

It will be demonstrated in this dissertation that, in NSW, between 1900 and 1960, psychiatry gained a small but significant foothold in the general hospitals. The advent of powerful new biological treatments for psychosis between 1938 and 1955, made possible the commencement of a second phase of general hospital psychiatry (GHP) in the 1960s, during which there was a massive migration of acute psychiatric services into the general hospitals. In the 1970s, public psychiatric services in NSW split into community-oriented services and consultation-liaison services, each of which had a secure base in the general hospitals.

The evolution of GHP followed similar but non-identical pathways in NSW, in the UK, and in the USA. The pathway adopted in NSW was initially like that followed in the UK but started to diverge from it after 1948. After 1960, psychiatry in NSW became even less reliant on British influences and more open to ideas from the USA concerning preventive psychiatry, community psychiatry and consultation-liaison psychiatry. By 1994, psychiatric services in NSW were following a trajectory that was determined by local experience and expertise and were no longer greatly dependent on influences beyond the Australian shores.