Department of Psychiatry

Academic Unit for Psychiatry of Old Age

St. Vincent’s Aged Psychiatry Service (SVAPS)and
The Academic Unit for Psychiatry of Old Age,
Department of Psychiatry, the University of Melbourne      

Professor Nicola Lautenschlager is the current Head of the Academic Unit and the director of SVAPS, and is recognised and respected as a world leader in Old Age Psychiatry. Professor Edmond Chiu was the founding Head from 1989 to 2004, followed by Professor David Ames who was Head from 2005 to June 2008. The Academic Unit undertakes teaching of undergraduate and postgraduate students, ongoing upskilling programs for GPs and other health professionals, and training programs in Old Age Psychiatry throughout the Asia Pacific Region as part of the Asia-Australia Mental Health Consortium. The main areas of the Academic Unit’s research include mental disorders in the elderly, prospective dementia research, Huntington’s disease and clinical psychopharmacology trials of new medications.

The Academic Unit for Psychiatry of Old Age is an integral part of St. Vincent’s Aged Psychiatry Service, providing both clinical leadership and academic support to SVAPS.

Leadership in the Asia Pacific Region

As a recognised leader in research and innovations in Old Age Psychiatry, the Academic Unit and SVAPS provide training programmes and a model in Old Age Psychiatry for doctors and health professionals in the Asia Pacific region (Singapore, People’s Republic of China, Republic of Korea, Thailand, Hong Kong, Japan, Philippines, and Taiwan).

In 2003 this program was incorporated into the St. Vincent’s Health Postgraduate Overseas Specialist Training (POST) Program

The St. Vincent’s Aged Psychiatry service is recognized as a model for service delivery in the Asia Pacific Region.

International Best Practice Care for Mental Disorders

World Psychiatric Association (WPA) and World Health Organization (WPO) Policy documents provide essential guidance for the best practice organization and provision of care for people with mental health disorders all around the world.

The Academic Unit has contributed to the establishment of the following WHO/WPA documents:

St. Vincent’s Aged Psychiatry Service (SVAPS)

SVAPS services older residents (mostly 65+ years) in the municipalities of Boroondara, Yarra, and part of the City of Darebin, providing a comprehensive service ranging from community care through to residential care. Catchment area = 450,000 individuals, 10% of them are elderly (45,000).

In 1995 the Aged Psychiatry Service was transferred from the North Eastern Metropolitan Psychiatric Service to St George’s Hospital, as part of the mainstreaming of mental health services in Victoria (see attachment “Mental Health Services Reforms in Victoria, Australia”).  In 2001, St. George’s Aged Psychiatry Service became part of St. Vincent’s Mental Health Services, and in 2005 was transferred to St Vincent’s Aged Care and Allied Health Directorate.

SVAPS Staff – a Multi-disciplinary team:

The Academic Unit provides leadership, education, training, and support for SVAPS staff:

Inpatient Service

Acute Inpatient Assessment and Treatment Unit – Normanby Unit
20-bed, purpose built unit provides comprehensive assessment, management and treatment for the elderly with mental disorders.
Admission to the Acute Unit

In most cases people are admitted after they have been assessed by the Aged Psychiatry and Assessment Team (APATT). If community treatment is not possible, the option of admission of the client to Normanby Unit is considered.
At all times, an approach to achieve an “informal” (voluntary) admission is sought by the APATT case managers. However, to facilitate an admission, the case manager may be required to exercise the statutory powers contained in the Victorian Mental Health Act (1986).

Admission during Business Hours

The APATT is a primary access point for the Aged Mental Health Service.
Referrals from out-of-area admission are made directly to the APATT duty worker who will contact the Consultant Psychiatrist or appropriate delegate to discuss the case and approve the admission if required. In cases of emergency, patients living outside of the catchment area may be admitted if a bed is available in Normanby Unit and admission approved by the senior on call. Once an out-of-area client has been admitted all attempts are made to return him/her to the equivalent hospital closest to his/her place of residence.

Direct after hours (5.00pm – 8.30 am weekdays, weekends and public holidays) admission can occur in cases of emergency. This needs to be arranged via St Vincent’s Aged Psychiatry Service (SVAPS). Contact can be made through the St Vincent’s Switchboard, asking for the Psychiatric Triage Nurse.

The Psychiatric Triage and the on-call Psychiatrist will advise about planning out-of-hours admissions.

Community Service

Aged Psychiatry Assessment and Treatment Team (APATT)

The APATT is a multi-disciplinary community-based service for persons over 65 years of age with mental health disorders. In certain circumstances patients under the age of 65 may also be assessed.

Access to APATT

APATT is the entry point to care in St. Vincent’s Aged Psychiatry Service. Referrals are received by the duty worker and assessed on the basis of risk, urgency, distress and degree of illness or disability.
The duty worker is available to answer questions and assist with access to the service. Out of hours, advice can be sought from the psychiatric triage service at St. Vincent’s Hospital who will then hand over to APATT in working hours.

Referrals are received from many sources such as:

After taking the referral, a case manager is appointed and members of the APATT team will visit the client at home or wherever is most convenient for the client. Usually assessment occurs within three to five working days of referral. Urgent assessment can occur on the day of referral based on risk.
Following assessment the team will devise an agreed care plan and work with the person, family, carers and other organizations and services to ensure that the most appropriate care and treatment is provided. This may involve admission to Normanby Unit for more extensive assessment and treatment.

APATT community treatment may include:
Process of Assessment and Treatment by APATT

The primary focus of APATT is to treat psychiatric illness, maintain the patient’s independence, build support and provide care in the home or residential setting. This occurs in conjunction with the family-nominated GP and any current support services. The case manager facilitates assessment, treatment, management and discharge from the service.
Written consent is requested, for the purpose of ensuring the patient’s privacy and to ensure that the patient is aware of the referral and planned treatment period.
Often investigations occur as part of this process and may include organic screenings (e.g., blood tests, X-rays, and head scans) and Mini Mental State Examination (MMSE).

Discharge from APATT
Discharge from APATT is indicated when the treating team is of the opinion that the problems on presentation and initial assessment have been resolved or are being managed effectively by GPs and/or other service providers and the client is not at risk of significant physical, emotional or social harm.

The decision to discharge from APATT will be discussed directly with the consultant psychiatrist in the weekly clinical team meeting. This decision will also involve the client’s views and the view of family, significant others, carers and/or other health professionals such as the GP, private psychiatrist, residential and social support services where appropriate.

The APATT communicates relevant information to aid in future management to the GP, private psychiatrist, family, residential and social support services so that they understand the role of the service in relation to the client’s care. Documentation includes a discharge summary to the GP and/or treating agency.

Following discharge, the APATT may be contacted at any time if the client requires further assistance from our service.

Dementia Behaviour Management Advisory Service (DBMAS) Vic

Behavioural and Psychological Symptoms of Dementia (BPSD) are common in dementia and are presented by each individual in a particularly unique and subjective manner. DBMAS Vic is a 24-hour telephone-based advice and consultancy service that will be available to family, carers and service providers caring for people living with dementia.  Service consumers will be able to access expertise in best practice, evidence-based behaviour management strategies, by method of care planning, education and clinical supervision. This service values cultural diversity and is committed to the continuous improvement of service responsiveness and accessibility for consumers of all cultural and linguistic backgrounds.

DBMAS Vic activities include:

Residential Support Program (RSP) for residential care facilities

The RSP comprises multi-disciplinary specialists experienced in aged mental health, including occupational therapists, nurses and a recreational therapist. It supports residential care facilities in the management of residents who display moderate to severe behaviours secondary to BPSD or persistent psychiatric symptoms.

This program provides short term intensive involvement that focuses on the use of non medication based approaches to managing behaviours of concern.  The program aims to support carers in more effectively managing the client’s behaviours of concern thereby minimizing the risk of accommodation changes or hospitalization.  Where appropriate, the RSP also assist clients in making the transition from the Normanby Unit to residential care.  RSP staff work closely with clients, family, carer workers, and the APATT case manager to devise practical management plans that assist care workers in managing the clients behaviours and promote the clients quality of life. In addition to this, the program provides carer workers at residential care facilities with education regarding special needs including psychosocial and behavioral methods of managing challenging behaviors.

RSP staff will visit the client’s residential care facility at regular intervals, such as one, two, or three times a week to provide support. This may include working alongside residential care workers and families to develop the best way of caring for the client. Advice regarding the provision of services (e.g. community resources) and the use of activities to improve quality of life is incorporated in the management plan where appropriate. Discharge from the RSP occurs when the client has obtained maximum benefit from the service, has settled in his/her accommodation or where there is no longer a role for the program.

The RSP also operate an innovative program called the Leisure Resource Library.  This library was established in order to address the lack of access and funding residential care facilities experience in providing activities that are appropriate to their residents.    The library loans residential care facilities activity based resources that care workers can use to maximizing the quality of life of their residents.  Examples of activities that are loaned include: sensory tablecloths, bubble tubes and reminiscing kits.  Education is provided as part of this service.  The library is staffed by volunteers under the direction of the RSP staff.

Specialist Ambulatory Clinics operated by the Academic Unit

Memory and Related Disorders Clinic (MRDC)

Monday PM, Thursday
Brochure

Psychotherapy Clinic

Thursday AM
Brochure

Speech and Communication Clinic

Thursday
Brochure

Huntington’s Disease Clinic

Monday
Brochure

Research Clinic

Weekdays
Brochure

 

Additional services

Occupational Therapy (OT) Driving Assessment

Run by an Occupational Therapist to offer OT driving assessment for older drivers, patients with mental health issues, cognitive disabilities and physical impairment

Residential Service – Psychogeriatric Nursing Homes (PGNH)

Auburn House
Riverside House

Auburn House (Hawthorn) and Riverside House (Richmond) are 30 bed psychogeriatric nursing homes providing high level specialist residential care and extended care for people who require high level care and exhibit behaviors that cannot be managed in a mainstream general nursing home. The homes are interim care facilities and when a person no longer presents with behavioral issues, they can be transferred to a mainstream nursing home, in consultation with family and carers.

Admission is via the APATT and ACAS (Aged Care Assessment Service) and in the majority of cases people are discharged from Normanby Unit.

 

top of page