Stubbs Terrace Hospital

“I’ve never had anyone to talk to who’d been inside those walls.”

“I’ve been trying to find shit for years and I keep hitting dead ends.”

“It's near on impossible to find anyone, only found where people have mentioned

Stubbs in comments on Facebook that have appeared in Google.”

“The knowing we aren't alone and it's real is more comforting than any words.”

Stubbs Terrace Hospital was a specialist psychiatric facility for children in Shenton Park and was part of Western Australia's Child and Adolescent Psychiatric Services. Established in 1973, it treated primary school-aged children with serious emotional, behavioural and psychiatric problems for almost three decades before its residential role was progressively reduced and eventually replaced by the non-residential Family Pathways program.

The service appears under different names in government and public records, including:

Stubbs Terrace Hospital,
Stubbs Terrace Children's Home,
Stubbs Child & Family Mental Health Service,
Child Guidance Clinic,
Child & Adolescent Mental Health Services
and later, Family Pathways.

The nearby Selby Child and Adolescent Clinic was a separate service, providing community-based psychiatric and allied health treatment.

The hospital occupied part of Crown Reserve 20074, bounded by:

Stubbs Terrace to the east,
Grace Vaughan House to the north and
perimeter fences to the south and west.

The land is recorded as portion of Lot 13072, Certificate of Title LR3112, Folio 24. Although some early records give the hospital's address as 89 Stubbs Terrace and later material uses 231 or 233 Stubbs Terrace interchangeably, the hospital was located at 233 Stubbs Terrace.

Establishment

The origins of Stubbs Terrace Hospital existed within the Child Guidance service. The Child Guidance Clinic had been established in 1949 and by 1971-72, the new facility was under construction at Lemnos in Shenton Park, referred to at the time, as the Child Guidance Clinic.

The resulting Stubbs Terrace Hospital opened in 1973 with 15 beds for primary school-aged children. It was founded by psychiatrist Dr William Ernest Robinson for the treatment of emotionally disturbed children and became Western Australia's designated inpatient psychiatric hospital for children.

Dr William Ernest Robinson

Dr William Robinson had originally qualified in Scotland in 1945, obtaining:

Licentiate of the Royal College of Physicians of Edinburgh,
Licentiate of the Royal College of Surgeons of Edinburgh and
Licentiate of the Royal Faculty of Physicians and Surgeons of Glasgow.

Together these formed the Scottish Triple Qualification. He later obtained:

a Diploma in Psychological Medicine
and became a Member of the Australian and New Zealand College of Psychiatrists in 1964.

Robinson was first registered as a medical practitioner in Western Australia on 11 April 1958 and initially worked at the Child Guidance Clinic at 590 Newcastle Street. By September 1975 his registered professional address included Stubbs Terrace Hospital. He later became Superintendent Psychiatrist of the hospital.

Childrens inpatient unit

On 2 August 1974, Stubbs Terrace was formally identified as an inpatient unit for children.

Despite being a psychiatric hospital, Stubbs Terrace was not an “approved hospital” under the Mental Health Act. This distinction was raised in Parliament on 4 December 1979 when the Health Minister was asked whether psychosurgery or electroconvulsive therapy was administered there. The Minister replied that neither treatment was administered to patients at Stubbs Terrace and noted that it was not an approved hospital.

The Mental Health Order 1988 set aside Stubbs Terrace Hospital, 233 Stubbs Terrace, as an “inpatient child psychiatric hospital”, while separately identifying the Selby Child and Adolescent Clinic in Selby Street.

2008

The residential program

Stubbs Terrace was principally intended for primary school-aged children. Records variously describe its age range as six to 16 in its earlier history but government descriptions from the 1990s repeatedly identify its principal role as treating primary school-aged children, up to and including 12 years of age.

Children could remain at Stubbs Terrace for weeks or months. Former patients have recalled being told by their parents that they were only there for a short period of time, although the stay often felt longer to them. Most appear to have only been admitted once, although some returned on subsequent admissions. In some families, more than one sibling was admitted to Stubbs Terrace at different times.

The hospital generally operated as a residential program during the working week. Children were usually collected by parents and caregivers on Saturday morning at about 10am and returned by approximately 5pm on Sunday.

On rare occasions, children were returned to the hospital during the weekend when their parents were unable to cope with their behaviours.

Continuing education

Education continued during treatment, with children initially attending the nearby Graylands Primary School, which was later renamed Mount Claremont Primary School, while older children attended Hollywood High School. In later years, former patients from the mid-1990s recall attending Swanbourne Primary School.

Children wore their own school uniforms, which could distinguish them from the local pupils. Some former patients, particularly boys, recalled having a difficult time with other children at school as a result.

By September 1995, the Education Department was contributing one full-time-equivalent position to the hospital. A hospital school was subsequently established in Grace Vaughan House, allowing children who remained in treatment to continue their education, including during school holidays.

Stubbs Terrace within the psychiatric system

Stubbs Terrace’s function differed from Hillview Terrace Hospital, which principally treated adolescents aged 13 to 18 through a residential treatment model.

Princess Margaret Hospital also provided psychiatric beds and both inpatient and outpatient treatment, while clinics such as Selby and Warwick concentrated on community-based services.

Demand for psychiatric beds was high. In October 1991 Parliament was told that Stubbs Terrace had 15 beds which were understood to be occupied continuously. Princess Margaret Hospital had eight inpatient psychiatric beds and Hillview had 12, with all three facilities sometimes unable to meet demand.

The Health Minister nevertheless told Parliament that Western Australia had a higher availability of psychiatric hospital beds for children and adolescents than any other Australian state. He praised the staff working within the service and specifically referred to Princess Margaret Hospital, Selby Child and Adolescent Clinic and Hillview Child and Adolescent Clinic.

1992 review of child psychiatric services

A major review of Western Australia's child and adolescent psychiatric system was undertaken by the Ministerial Task Force to Review Child and Adolescent Psychiatric Services, established by Health Minister Keith Wilson.

Its report was released by Health Minister Ian Taylor on 10 December 1992 and was accepted by the government as part of its State Youth Strategy.

Recommendations included:

increasing expenditure on child and adolescent mental health services to at least one per cent of the total health budget,
distributing metropolitan resources according to population,
giving greater priority to children and adolescents considered at risk and
providing more equitable funding for country services.

2025

Stubbs Terrace Hospital - Selby Child and Adolescent Clinic

Proposed restructuring of services

Further major changes were proposed in December 1993.

The East Metropolitan Region Health Service announced plans to restructure services for children and adolescents with mental illness, partly because Western Australia had no dedicated approved hospital beds for severely disturbed or psychotic adolescents. These patients could instead end up in adult psychiatric facilities such as Graylands or Heathcote.

A new 12-bed unit was proposed at Bentley Hospital, including four approved beds for residential assessment and treatment of mentally ill adolescents. It was intended to replace the major component of the services then provided at the Hillview site, which included Hillview Hospital, Hillview Clinic and the Robinson Unit. Under the proposal, inpatient treatment for children would continue through Princess Margaret Hospital and Stubbs Terrace Hospital.

Services during the mid-1990s

Stubbs Terrace remained a 15-bed facility in March 1995, with a budget of $1,122,750 for the 1994–95 financial year.

By comparison:

Selby Child Psychiatric Services received $744,000.
Warwick Child and Adolescent Clinic received $1,172,000.
Princess Margaret Hospital’s psychiatric service received $1,547,206 in 1993–94.

Closure and major changes in 1997-98

Stubbs Terrace temporarily closed in late 1997 for refurbishment.

The timing caused concern because children had continued to be admitted in October for treatment programs expected to last approximately 10 to 12 weeks despite the pending closure. The government later said that no definite closure date had been known when those admissions occurred and that it was considered preferable to provide treatment rather than terminate the program. Individual lengths of stay were determined by clinical requirements.

Management of the service changed in 1997:

Until 30 June 1997, Stubbs Terrace was managed by the Health Department.
Responsibility then transferred to the Board of Management of King Edward Memorial Hospital for Women and Princess Margaret Hospital.
It subsequently came under Princess Margaret Hospital itself.
The service was renamed Stubbs Child and Family Mental Health Service.

The refurbishment cost $240,000, funded by the Mental Health Division. Work included:

the Psychiatrist Superintendent's office became a family therapy room,
two single bedrooms (previously used for punishment and isolation) were converted into offices
two rooms became nursing offices,
carpeting,
new furniture,
redesign of the reception area,
an external door from the dining area,
new fencing,
roofing over the pergola
a barbecue area
another external area near the laundry,
alterations to visitor toilets and
conversion of a female toilet into an examination room.

Operating changes

Before these changes, Stubbs Terrace had capacity for 15 inpatients, although the average number of patients was around 10.

When the hospital reopened in 1998:

it operated on weekdays only,
inpatient capacity was reduced from 15 to 10 beds and
a day-patient program was being planned.

Expenditure was also reduced following the changes:

nursing costs fell by $167,665,
medical expenditure fell by $194,660 and
an additional $181,000 was directed towards social work, occupational therapy, speech pathology and clinical psychology.

This produced a calculated net saving of $147,203.

The full-time Chief of Psychiatry position was not refilled. An independent review concluded that a full-time psychiatrist in that position was no longer required.

Three senior psychiatric nurses were also offered redundancies in June 1998. The government considered four senior nursing positions excessive for management of the reduced Stubbs Terrace Unit.

The loss of weekend treatment was significant. Parliamentary debate noted the importance of services outside normal working hours for families under pressure, particularly families outside metropolitan Perth and working parents. With Stubbs Terrace no longer providing weekend care, the Robinson Unit remained one of the relatively few alternatives.

Treatment of children described as “gender disordered”

One particularly controversial part of Stubbs Terrace's history involved eight primary school-aged children admitted at different times between 1975 and 1980 for what was then diagnosed as “gender disorder.”

The cases were later described by WA Director of Child and Adolescent Psychiatry Services Robert J. Kosky in a 1987 report published in The Medical Journal of Australia.

The eight children were admitted with their parents' permission for approximately two to six months, with only one child diagnosed in this way at Stubbs Terrace at any one time. Contemporary descriptions included boys who wore clothing then regarded as feminine or displayed behaviour considered inconsistent with conventional gender roles. The only girl strongly rejected her sex and was described on admission as wearing football clothing and carrying a football.

At their initial interviews, some were described as sad and lonely, some had suicidal thoughts and several were performing poorly at school. Teachers had also responded negatively to their behaviour.

Treatment reflected psychiatric thinking of the period. Children were encouraged to leave their rooms, play games, form friendships and improve their social confidence. Nursing staff encouraged what were described as age-appropriate behaviours in place of behaviour considered stereotyped, inappropriate or socially isolating.

Kosky stated that staff made no conscious attempt to encourage specifically masculine or feminine roles. Children could choose from a range of activities and boys who cross-dressed were not prohibited from doing so, although they were required to respect the privacy of others and not take girls' underwear.

The children generally attended the local primary school and participated in activities with other patients. Family members visited regularly and were encouraged to participate. Parents met weekly with a psychiatrist or social worker, discussed their child's progress with nursing staff and received counselling about their responses to the child and family relationships.

Hospital records described periods of anger and misery among some children lasting several weeks. Kosky reported that cross-dressing generally stopped soon after admission, although one child resumed after discharge and was readmitted for a further two weeks.

Other children treated at Stubbs Terrace during this period had conditions described at the time as:

neurotic illnesses, including depression, anxiety, conversion reactions and compulsions,
psychosomatic conditions, including anorexia nervosa, eczema and asthma,
adjustment reactions and
reactions associated with chronic illness.

Most were considered well enough to attend the local primary school each day.

Stubbs Terrace around 2000

Stubbs Terrace remained in operation into at least 2000. The system was by then generally known as the Child and Adolescent Mental Health Service, or CAMHS.

Family Pathways

Following a “future directions workshop”, the residential service changed between September 2001 and January 2002 into a non-residential, intensive community-based program known as Family Pathways. In 2002, it merged with the Princess Margaret Hospital Day Program.

Children could attend the Family Pathways classroom or remain at their regular school. Those not attending the classroom regularly could be assessed there for their academic, behavioural, emotional and social functioning, with the results used to develop a Documented Education Plan incorporating individual education, behaviour and therapeutic plans.

By the time many children reached Family Pathways, their difficulties had existed for years and previous attempts by other services had often failed. Some children were refusing to attend school or could no longer be managed safely in ordinary classrooms. Some families were described as having reached the point where they no longer expected agencies to provide effective help.

Family Pathways identified a wide range of possible risk factors affecting children and their families.

For children, these included:

anxiety and attachment disorders,
difficult temperament, hypersensitivity, irritability and inattention,
developmental delay and learning disability,
prematurity, low birth weight, pregnancy or birth complications,
feeding problems and chronic illness, and
experiences of loss or separation.

Parental and family factors included:

severe conflict, divorce, separation and custody disputes,
teenage parenthood and difficult or unwanted pregnancies,
parental mental health problems, maternal depression and chronic illness,
criminality and substance abuse,
unresolved trauma, loss and intergenerational problems and
family violence.

Parenting and interaction factors included harsh criticism or punishment, abuse or neglect, failure to protect a child, rejection, negative attitudes towards the child and highly inconsistent parenting.

Other circumstances included single-parent families, social isolation, poverty, reliance on welfare and repeated changes of home or school.

Children referred to Family Pathways could have multiple diagnoses or difficulties, including:

anxiety disorders, panic attacks and phobias,
aggression and violence,
developmental disorders, dyslexia and learning disability,
autism spectrum disorder,
oppositional and defiant behaviour,
serious socialisation difficulties,
attention disorders and ADHD,
self-harm and suicidal thoughts,
obsessive-compulsive symptoms,
feeding and sleeping problems,
depression and attachment disorders,
enuresis and encopresis and
lying and stealing.

Other difficulties recorded alongside these included post-traumatic stress disorder, adjustment disorder, low self-esteem, school refusal, truancy and problems regulating emotions.

Tier 4 treatment service

Family Pathways was a Tier 4 service for the relatively small proportion of families with the most severe, persistent and complex problems, estimated at around 8 to 10 per cent of the community.

Because treatment was relatively short, the program also worked with parents and other agencies to coordinate ongoing support. Children usually returned fully to their regular school and community services afterwards.

Around 85 per cent of referrals came through CAMHS, with others from private psychiatrists, psychologists, paediatricians and services within the Psychological Medicine Clinical Care Unit. Referrals were first discussed with a clinician to determine whether ordinary CAMHS treatment had been insufficient and whether an intensive multimodal service was required.

By 2010, Family Pathways was still operating from the former Stubbs Terrace site in Shenton Park, with allocated psychiatrist time, two clinical psychologists and 4.8 full-time-equivalent case managers providing therapeutic counselling.

Selby Child and Adolescent Clinic

Government records consistently listed Stubbs Terrace Hospital and Selby Child and Adolescent Clinic separately. Stubbs Terrace principally provided inpatient psychiatric and clinical treatment, while Selby provided community-based psychiatry and allied health services.

Dr Arvid Lind, who worked from the Selby Centre at the corner of Selby Street and Stubbs Terrace between 1988 and 1991, was recorded as Selby’s psychiatrist in May 1994, having replaced Dr Hugh Cook. A speech therapist was employed there by September 1981.

Across five financial years, Selby received $3,628,420 in funding, compared with $6,258,500 for Warwick.

By 1999, Selby’s future at Shenton Park was uncertain. Although the government denied reports of its immediate closure, Princess Margaret Hospital and the North Metropolitan Health Service were considering relocation due to the proposed new high school and greater demand for services in Perth’s northern suburbs.

The issue remained unresolved in 2001, when the government began reviewing North Metropolitan CAMHS as a whole, including Selby, Clarkson, Warwick and Princess Margaret Hospital. Options included several service bases supported by outreach programs.

By March 2002, the Department of Education had acquired the Selby site and relocation was considered unavoidable. A review group chaired by Graham Giffard was established, comprising Dr Anne Hodge, Danute Paweleck, Patrick Marwick, former Health Minister Keith Wilson, carer representatives, Basil Hanna, Dr Arvid Linde and Karen Milligan.

Selby nevertheless remained a substantial clinical service. In 2002–03, its clinical staffing included approximately:

1.08 FTE nurses
1.93 psychologists
1.82 social workers
2.01 psychiatrists

Administrative staffing increased from 2.50 FTE in 1999–2000 to 3.92 FTE in 2002–03, while funding rose from $735,600 to $1,013,900 over the same period.

Selby was still identified as a Child and Adolescent Mental Health Service in April 2004, providing mental health care to children from birth to three years and their parents as part of the metropolitan and regional CAMHS network.