Dr Steve Prowacki1
1Private Practice, TBC, Australia
Biography:
Steve Prowacki trained as a psychiatrist in Toowoomba and in 1990 was the deputy medical superintendent of Baillie Henderson Hospital. In 1991 he opened and was the first director of the Logan Hospital mental health service. From 1993 he was in private practice at the Belmont Private Hospital, Brisbane and between 1993–2010 served on the hospital Medical Advisory Committee. From 1995 he was director of the Electroconvulsive Therapy Program and between 1996–2010 he was director of the Psychiatric Intensive Care Unit. In 1994 he obtained a Master of Health Administration. Between 2000–2004 he was on the Australian Clozapine Guidelines Committee.
Abstract:
Since the 1950s the world-wide trend towards de-institutionalisation has prioritised reducing psychiatric hospital beds without properly resourcing community mental health services. More recently the paradigm of “recovery” although poorly defined, has become the fundamental principle of mental health care in Australia and New Zealand. There is an increasing trend for public community mental health services to discharge patients to “GP care” with or without the oversight of a private psychiatrist. When a public mental health service refers a patient, “best practice” requires comprehensive information-sharing including a detailed history, risk assessment, monitoring guidelines and contingency planning for untoward developments. Without a community case manager and the support of a multi-disciplinary team, the shared care of a patient with treatment-resistant schizophrenia is extremely challenging and psychiatrists in private practice will have difficulties managing a patient who wants to cease clozapine or has actually self-ceased clozapine or has stopped attending reviews. It becomes even more problematic when, in confidence, a family member raises concerns about any deterioration in the mental state of a patient with treatment-resistant schizophrenia. One of the most important recommendations from the Bondi Junction Coronial Inquest was that the Royal Australian and New Zealand College of Psychiatrists assumes the role of lead organisation in collaboration with the Royal Australian College of General Practitioners to develop shared care guidelines to optimise the management of patients with chronic schizophrenia including treatment resistant schizophrenia.