Pub: Sydney Morning Herald
Hospital land sale no walk in the park
Selling public assets to pay for mental health care is not the long-term solution, writes Elizabeth Farrelly.
Asylum means protection, right? Refuge, shelter, relief. That’s the theory, but practice seldom mimics it. In the bad old days, people disappeared into lunatic asylums; now it seems they disappear out of them. We call this move from the Dickensian to the Orwellian, progress. Which, when shaken with assorted politico-property interests, makes a murky cocktail indeed.
The old Callan Park Asylum (now Sydney College of the Arts’ Kirkbride Building) may look forbidding but at the time, 1883, it was cutting edge. Both the James Barnet building and its Charles Moore landscape were based on American Thomas Kirkbride’s theory of the curative powers of delight. Open, airy wards with sunny courtyards and serene garden/harbour views set the therapeutic tenor.
A decade ago, defeated by the trials of delivering state-of-the-art medicine from the crumbling fabric, Callan Park Hospital moved from Kirkbride into the architectural miscellany that surrounded it, merging with Broughton Hall to form the new Rozelle Hospital. Now the Government wants to move it again, onto the grounds of Concord General Hospital, and wants to flog some 13 per cent of its 61-hectare garden to pay for it.
Sounds simple. Logical even. There are plausible reasons to “mainstream” mental with general health care relating mainly to stigma reduction and the availability of general medical and diagnostic services to support a whole-patient approach. Mainstreaming, says Michael Wallace, the deputy CEO of the Central Sydney Area Health Service (CSAHS), is accepted best practice, and has been part of policy since 1996.
Plus, the buildings are daggy and the grounds, however beautiful, are underlit and potentially dangerous, especially at night.
On the face of it the development proposals, too, are comparatively benign. The sketches depict leafy streets where children frolic outside dignified terraces or Japanese-style villas. The development, four storeys max, is kept mainly to the city edges of the site, leaving 47 hectares of restored mature parkland along the waterfront.
And while the locals argue against any sale of public land it’s also true that (despite hefty bouts of recent development) the peninsula is comparatively well served in the open-space department, especially along the foreshore. Forty-seven hectares is still a big park comparable to the Botanic Gardens, twice the size of Hyde Park and, as the Government argues, it’s new parkland, since it isn’t currently a park at all but a hospital with park-like generosity.
It’s East Circular Quay syndrome, in a way, where people get attached to an illusion of public space an illusion intensified here by the corporatisation fiction, which forces institutions avidly to guard their assets as sources of essential funding and feel betrayed when that illusion is threatened. But such passions only obscure the real issue the artificial and unholy nexus between planning, property and health.
You can see how it’s come about. CSAHS owns the site, needs to modernise, examines options; finds relocation to be, if anything, slightly cheaper than refurbishing or rebuilding on site. But it still needs funding. So it proposes the partial sale-and-development of its land, employs the Government’s own Urban Design Advisory Service (UDAS) to hand-knit a careful, villagey master plan and submits this to the minister for approval. All hell breaks loose.
For the public, though, the arguments embedded in the master plan have strange and uncomfortable strings attached. To oppose the sale of public land implies keeping the hospital as is (this may be the first time in history residents have fought passionately for a psychiatric institution in their midst), while supporting the hospital’s move implies assent to the development.
This curious tangle may connote a Machiavellian divide-and-rule cynicism on the Government’s part, or mere cross-eyed muddle. It springs, though, from the intellectual murk beneath economic rationalism, which forces government agencies to value and rationalise assets and services as quasi-businesses.
But if government could be run as a business, there’d be no need for it: the market would do it for us. Economically, it goes like this. The Government expects around $85 million from the land sale, of which $40 million will build the new 263-bed mental health unit at Concord, while the rest funds remediation and restoration of the new park, including demolition of 80-odd non-heritage
buildings across the site.
But if the property market collapses? Or for some other reason the yield drops? Do we sell more land? Allow bigger buildings? Shrink the hospital? Or the park? For commonsense to re-enter the Rozelle Hospital / Callan Park debate the issues must be separated, and the funding links severed.
In planning terms, it’s about whether the sale of eight hectares of hospital land for housing to allow the conversion of the remaining 47 hectares to parkland (six hectares being occupied by existing institutions on the site) brings a net public benefit. Whether the Government’s commitment to public foreshore access should reasonably extend back to Balmain Road; and whether the proposed maximum heights and densities are appropriate.
And probably, on balance, the proposition is reasonable. Densities up to a maximum of 2:1 on the Balmain Road ambulance station site are high, for residential higher than Kirribilli (1.5:1), Paddington (1:1), and Leichhardt (0.5:1). But the ambulance site is a fraction of the whole, the height limit is still four storeys, and it fronts a major regional park. So is this a problem? An interesting issue arises from the cosiness of the planning arrangements. The master plan was prepared by UDAS, which sits within Planning NSW but acts, says the minister’s spokesperson, as any other private firm except for the guaranteed workload/income. Minor point. The plan is then submitted to the minister for consent, before the land is sold to Landcom, at a price dependent on the planning result.
Which puts protagonist, consent authority and developer under a single ministerial hat. Vampire in charge of the bloodbank and the donors as well. So whaddya mean, conflict of interest? It’s just good business.
The health care issues are more complex, more Orwellian. The Government favours relocation, so the Opposition proposes instead to double the numbers on-site. Well, you have to say something. The experts are divided. Some say go. Some say stay the buildings are OK, there’s lots of space, fabulous gardens, the stigma thing follows anyway and the inner city is friendlier to people with mental illness than the burbs.
Yet others say stay-go is not the issue; the funding priority should be community-based care, where people are treated at home or in special cluster-housing, as anticipated in the 1983 Richmond report. The great majority of mental health consumers being non-dangerous, capable, and more likely to recover in normal surroundings. No surprise there.
Since the Richmond report, though, something like 800 psychiatric beds have closed in NSW; a recent Corrections Health Services survey of NSW prisons indicates twice that number suffer from severe psychiatric disorders. In women it’s higher some 50 to 70 per cent have a history of mental illness. On the streets, it’s higher still.
And while some doubt the validity of “trans-institutional” drift (from hospital to prison) it is clear, says psychiatrist Dr Anthony Samuels, that there are some people who are severely disabled and need the protection asylum of long-term hospital care.
Such people now, post-1983, have an average hospital stay after a major psychotic episode of 14 days, when according to Samuels it “should probably be more like months”. On being returned to the “community”, they’re lucky to get a phone call or a five-minute follow-up visit. They drift around, doss in boarding houses or on the streets, commit minor crimes and end up in jail where their illness may be simply overlooked.
And, while NSW has the most stringent screening process for psychiatric admission, we’re making it ever easier to fall into jail. It’s community-based care, sans funding. A quick cost comparison $500 a day for hospital and $184 a day for jail makes it clear which option the bean counters prefer.
You might think such issues would form the substance of the parliamentary select committee inquiry into mental health care under way. You might even expect such major strategic moves as Rozelle-to-Concord to be made after such an inquiry, not before. Think again, says Leonie Mann, chair of the Mental Health Foundation of NSW, who would welcome a proper inquiry but says this one is just a pre-election political exercise, with neither side taking it seriously and submissions filtered through the minister’s office.
So, what is the answer for Callan Park? It’s hard to believe there isn’t a profit motive in there somewhere for the Government.
To fund mental health by selling off public assets is not a sustainable proposition. Less than 5 per cent of our health budget goes to mental health; in Victoria it’s 11 per cent and in New Zealand 30 per cent. Just a smidgin of the Government’s recent $900 million stamp-duty windfall would easily fund a hospital and a decent community service.
A public meeting on Callan Park is planned for tomorrow at Tigers leagues club in Balmain.
ILLUS: Not a park yet …
as the Government argues, this is a hospital with a park-like generosity.
Bottom: a protest sign erected by Leichhardt Council.
Photos: George Fetting