The Commission is republishing the 1983 Richmond Report to make it available to researchers and the community.
The report of the Inquiry into Health Services for the Psychiatrically Ill and Developmentally Disabled is a valuable and much cited resource and came out of an inquiry conducted by David Richmond.
The Commission thanks the NSW Ministry of Health for its permission to reproduce online this landmark report, which was previously only available in hard copy through specialist libraries.
Download the report in Word and searchable PDF format below:
|Inquiry into Health Services for the Psychiatrically Ill and Developmentally Disabled - Full version||PDF (2.4 MB)|
|Inquiry into Health Services for the Psychiatrically Ill and Developmentally Disabled - Part 1||PDF (268 KB) |
Word (298 KB)
|Inquiry into Health Services for the Psychiatrically Ill and Developmentally Disabled - Part 2||PDF (430 KB) |
Word (1.1 KB)
|Inquiry into Health Services for the Psychiatrically Ill and Developmentally Disabled - Part 3||PDF (542 KB) |
Word (1.2 KB)
|Inquiry into Health Services for the Psychiatrically Ill and Developmentally Disabled - Part 4||PDF (284 KB) |
Word (581 KB)
|Inquiry into Health Services for the Psychiatrically Ill and Developmentally Disabled - Part 5||PDF (802 KB) |
Word (2.4 MB)
|Inquiry into Health Services for the Psychiatrically Ill and Developmentally Disabled - Part 6||PDF (246 KB) |
Word (580 KB)
The Richmond Report was about redressing the imbalance between institutionalised hospital care and community care in mental health services while advocating strongly for a more decentralised and integrated model of care and support.
David Richmond AO, author of the report, talks briefly about its history and its significance:
Contrary to the misconceptions of some, a significant exodus from institutional care through bed number reductions had already occurred in the 1960s and 1970s, well before the report, largely to meet budget pressure on the institutions.
With some notable exceptions, rarely had either money or services been channelled into community care to offset the impact on clients of these service reductions. Extra funding proposed by the report was, in part, designed to address this backlog.
Under the report, some institutions were targeted for closure, but not before both growth and compensatory community services were provided. As institutions were closed the funding which previously supported institutional care would transfer to community care and support.
The recommended reforms not only sought to change the dominant hospital-based model of care but, through changes to employment arrangements, also the culture of those providing that care.
The health services landscape of the early to mid-1980s was fraught with conflict – the movement of acute beds to Sydney’s west, closure and rationalisation of some central city hospitals, the bitter dispute with the procedural specialists over Medicare and, of course, the Richmond Report.
In this environment, political support for the report was often a thin veneer. There was union opposition to the reforms and numerous hospital-based psychiatrists and the medical profession in general were at best lukewarm.
In retrospect, few other social issues over the last 30 years have generated as much controversy as the proposals contained in the report. Thousands of letters, both for and against, were sent to parliamentarians, public meetings were held in many locations, often rowdy events, some health staff participated in strikes and at least one country town “closed down” for a day in protest.
Newspaper editorials were written and politicians and party members debated the proposals in Parliament and in many other forums, publicly and behind the scenes.
Ultimately, implementation commenced in mid-1984. Despite broad adoption of the Richmond philosophy, and some early implementation momentum, reform and progress have been slow and very much “stop/start” in nature.
More than 30 years later, despite numerous “pockets” of excellent practice, mental health is still underfunded and continues to be locked into hospital care, albeit often smaller in scale, more localised and more closely aligned with other health services than in the past. The way service provision is structured appears still largely provider driven when compared with client and family priorities.
The 30-year period since the report has been one of very significant social, economic and technological change, particularly in medical science and information and communications. Some of this has assisted reform but much has simply made the health services environment more complex and more competitive.
Issues such as housing and accommodation, employment, social inclusion and avoidance of stigma are still key challenges. On the demand side, significant changes have also made services more complex, for example, the growth in consumption of both legal and illegal drugs.
Enabling people to get as well as they can, and stay well with tailored levels of support and assistance is still paramount. This requires a strategic approach to achieve integrated, sustainable, client friendly systems and networks.
Strategy needs to address both the vital ongoing role that health sciences and treatment play and the significance of wider social and economic elements in contributing to individual wellbeing.
The Strategic Plan for Mental Health in NSW provides an opportunity to make real progress now and for the future.