Breaking new ground

Treating women’s mental health

The idea for Australia’s first women’s-only mental health facility didn’t emerge in a lightbulb moment – it’s a concept that has been widely recognised within clinical circles as having intrinsic benefits by providing a safer, potentially more supportive environment for women. But making it happen? Well, that’s a bit harder.

Cabrini Health CEO Sue Williams had been thinking there was a need for a mental health facility somewhere within the Melbourne hospital’s five main sites. She knew the data – one in five Australians had some form of mental illness in their life. Many experiencing mental health issues found themselves in hospital emergency departments, not always with the best treatment outcomes. After one particular episode at Cabrini Emergency, Sue resolved to do something about it.

“We had two smaller sites in the organization that were not fit-for-purpose and we felt it was an opportunity to refurbish those sites and convert at least one of them into a mental health facility,’’ Sue said. While she was working out what a new 30-bed unit would look like, Sue was reacquainted with Jayashri Kulkarni, Professor of Psychiatry and Director, Monash Alfred Psychiatry research centre, who has been a tireless advocate for women’s mental health.

“And Jayashri sent me an email one day and said: ‘Have you ever thought about running a women-only mental health facility?’ And it’s just grown from there,’’ Sue explained.

But there was one more critical ingredient to come. The Gandel Foundation has had a long association with Cabrini – the award-winning Gandel wing at Cabrini’s Malvern site was opened in June, 2019.

So, it was perhaps not completely surprising that the Gandel Foundation, working with the Cabrini Foundation, would be a supporter of the new facility.

Added to that has been the Gandel Foundation’s long-standing support for mental health initiatives, with a strong emphasis on more vulnerable groups including women and children. The new facility at Cabrini’s Elsternwick site will be called the Lisa Thurin Women’s Health Centre, after Gandel Foundation director Lisa Thurin.

Lisa, who generously donated towards the construction of this hospital and has been involved throughout the project, said she felt strongly about women prioritising their health and having the opportunity to meet their own particular health needs.

“Through this centre, we have a unique opportunity to help women with their distinct and specific mental health needs in a space and surrounding they can feel safe and secure in,” Lisa said.

“This is truly a silent epidemic which is not being addressed appropriately and it requires a concerted effort to provide personalised approach to women’s needs and issues.”     

Just how much of an epidemic is clear from Jayashri’s own research, identifying a significant increase in depression in women aged from 42 to 52, in what is considered the perimenopausal stage of life. She refers to it as a “sleeping statistic’’ that has potentially profound consequences for families and communities.’

Once the ball was rolling on the new facility, it soon gathered pace. Jayashri was amazed at how quickly things moved from the early discussions just over a year ago to the facility already receiving some clients. “So, when I put this to Sue, I was so thrilled because she got it within seconds and within a week there was action going on. Cabrini has been hailed for having the guts to do something innovative and therefore provide the model of care and the model of capital works in a sense the building being for women-only - to be the premiere and to be the pilot,” Jayashri said.

“Mind you, some people have said: ‘Have you got rocks in your head – you’re opening a new service in the middle of a pandemic in a place that hasn’t had a mental health facility,’’ she said. “But nonetheless you can see it, you can feel it, that this is going to be something really premiere – they’re in a centre of excellence.’’

There is universal agreement about the problem that the new centre has been created to fix. “We cannot keep having our mothers, and daughters and sisters and wives and girlfriends experience the horror of what happens when people are managed in a mixed gender ward and this is not just in the public sector, it also happens in the private sector,’’ Jayashri said.

The centre will have its own priorities - depression and anxiety, post-traumatic stress disorder (often related to domestic violence) and substance abuse disorder, including drugs and alcohol. And it will also deliver the treatment differently. “Let’s bring the woman in, and she will agree to take part in all of the activities, and they will have an individualized but structured program with really intensive therapy that will go for 7-10 days,’’ Sue explained.

 “And when they go home they have really intensive community support because about a third of patients bounce back – they’re recidivist patients – so what we wanted to do was to continue therapy…, because if a woman comes from a dysfunctional environment and she gets put back in a dysfunctional environment she’s going to bounce back,’’ she said.

It meant putting a different model of care to the hospital’s health fund managers: it was about shorter time in the facility, with different treatment strategies followed by intensive community support, with links to the woman’s GP or psychiatrist on discharge.

Sue acknowledged that there was a risk attached to the whole idea – the health funds, for example, could have said “no.’’

“But why would they say “No’’ when ultimately, they’re going to save money because they’re not staying in hospital for such a long time? This can actually disrupt the model across the country. There were risks but we were prepared to take the risks because we thought were in a pretty good position,’’ she said.

On the strength of the data, Vedran Drakulic, CEO of The Gandel Foundation, didn’t see a risk either.

“It’s innovation definitely, but it’s not a risk because evidence already shows there’s a need to provide this kind of support for women that is tailored,’’ he said.

“Often when we talk about philanthropy, we talk about is there a gap? Is there a genuine need? These are the first two things our board says – is there a genuine need for this? Clear answer yes. Is there a gap? Again, clear answer yes,’’ Vedran said.

“To me, it was not really a risk element but there is a strong element of innovation and fulfilling that need in society.’’

For Jayashri, this is the kind of breakthrough that can potentially provide a template for other health services.

“This is a really important innovative development. We’ve been given this opportunity, so no way is this going to fail. But we’re feeling our way and we are handicapped by COVID because some of the community programs we do we have to do by Zoom,’’ she said.

“If there was ever anything good that came out of the pandemic it was that suddenly it’s OK to talk about not being mentally OK. You can’t just raise awareness – you have a whole bunch of aware people, but they need facilities, and they need services and that’s what we’re all trying to cope with now.’’

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