Dear  ,

Kaya, Kia ora and Greetings from the Editor – Dr Noel Collins

Hello and welcome to the 3rd edition of the Australasian OAP and the first for 2025. In this edition we have a recap of the FPOA conference held last year in Christchurch and a preview of the 2025 event which will be held in my hometown of Fremantle. A retired eminent local WA colleague, Neville Hills, has also penned an article looking at another thorny issue: the question of psychiatric bed numbers, which remains as topical an issue as ever. Lastly, I want to wish everyone a peaceful and prosperous belated happy new year of the Snake and look forward to meeting some of you in Freo later this year.

Best,
Noel - Noel.Collins@health.wa.gov.au

View from the Chair – Dr David Lie

David is away but back later in the year.

Features:

Updates from the States and New Zealand

NSW
Faculty of Psychiatry of Old Age NSW Educational Event
NSW Faculty of Psychiatry of Old Age is hosting an educational event both online and in-person at the Kolling Institute, Royal North Shore Hospital, St Leonards, Sydney on Friday 28 March 2025.

This event will consider the Medicolegal, ethical and forensic issues in working with older adults

For more information, please go to https://www.ranzcp.org/events-learning/faculty-of-psychiatry-of-old-age-nsw-educational-event

QLD
​Join the Australasian Delirium Association's bi-annual conference, a premier event for healthcare professionals dedicated to advancing delirium research and care. This year's conference brings together nurses, allied health professionals, doctors, and researchers from across the region to explore the latest developments in delirium management, treatment innovations, and multidisciplinary approaches to care.

Dates:  Pre-conference workshops:  23rd July 2025
Main Conference:  24th - 25th July 2025
Location:  Shangri-La The Marina, Cairns + Online (Now Available!)
Theme:  Breaking Barriers to Delirium Care

RANZCP FPOA Conference 2024 Recap - A/Prof Gary Cheung

The Faculty of Psychiatry of Old Age (FPOA) conference in Ōtautahi Christchurch, held in September 2024, was a resounding success. With nearly 200 registrations, it was one of the largest FPOA conferences to date. The event was officially opened by the Hon. Matt Doocey, Minister of Mental Health in the coalition government. Keynote speakers Professors Rob Howard and Sube Banerjee from the UK delivered three inspiring presentations each over the 2.5-day conference, captivating and enriching attendees. Special thanks go to the dedicated organising committee: Yoram Barak, Chris Bloomer, Wini Manning, Bronwyn Copeland, and Anneliese Sayes, whose efforts made the conference possible.

Message from SATPOA Chair - A/Prof Gary Cheung

Kia ora colleagues,

It has been an eventful period for the Subcommittee for Advanced Training in Psychiatry of Old Age (SATPOA), and I am pleased to provide an update on our activities and progress.

Redevelopment of Fellowship Entrustable Professional Activities (EPAs)
With the ongoing redevelopment of the Fellowship Entrustable Professional Activities (EPAs), we are closely examining how these changes may impact our advanced training EPAs. Ensuring that our curriculum remains contemporary, fit for purpose, and aligned with the latest training standards is a key priority for SATPOA.

POA Advanced Trainee Numbers
As of early 2025, we have 90 trainees and 52 fellows across Australia and New Zealand, making a total of 142 individuals in our training pipeline. We continue to work towards equitable distribution of training opportunities, including balancing rural training placements with mandatory requirements such as the six-month POA inpatient component. We are also supporting trainees navigating dual POA and Consultation-Liaison (CL) training pathways.

Certificate of Advanced Training in Psychiatry of Old Age Awarded
Since January 2024, we have awarded 26 certificates of completion across various jurisdictions, a testament to the hard work and dedication of our trainees and supervisors.

Trainee Issues and Support
Several themes have emerged regarding trainee support, including:

• Extensions of training time, largely to complete research projects.
• Requests for retrospective accreditation of POA advanced training time in non-POA rotations.
• The importance of maintaining high-quality training experiences across jurisdictions.

2025 Binational Formal Education Lecture Series (1pm, AEST)
Join Zoom Meeting

Meeting ID: 985 1339 1386    Passcode: 173027

DATE                          TOPIC                                                SPEAKER
20 March 2025            Psycho-oncology                                 David Kissane
15 May 2025               Young onset dementia                         Sam Loi
19 June 2025              Human Rights                                     Carmelle Peisah
17 July 2025               Neuroimaging                                     Jeff Looi
18 September 2025     Movement disorders                            Jane Alty
4 December 2025        Drug and alcohol use in older people     Brian Draper

New Learning Opportunity for Advanced Trainees and Fellows
I am pleased to share an exciting educational opportunity for advanced trainees and fellows interested in broadening their expertise in gerontology and geriatrics. The International Association of Gerontology and Geriatrics (IAGG) is offering an online course aimed at promoting education in these fields across Asia and Oceania. I have been invited to teach in this course, specifically on acute mental health presentations in older adults for their session in November 2025.

This course covers a range of topics that are not actively taught in our POA advanced training, making it a valuable complement to our existing curriculum. Additionally, it provides a platform for trainees to engage with international colleagues, fostering collaboration and expanding their professional networks.

For those interested, more information about the course, including enrolment details and fees, can be found on the IAGG website: https://asio.iagg-fge.org/

Looking Ahead
We remain committed to ensuring high-quality training in POA and advocating for the necessary resources and recognition of our field. I encourage all members to stay engaged and provide feedback on training matters so we can continue to refine and enhance our processes.

Ngā mihi nui,

A/Prof Gary Cheung
Chair, SATPOA

Preview:  2025 FPOA Conference

“Faculty of Psychiatry of Old Age 2025 Conference | Save the date

 The Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) Faculty of Psychiatry of Old Age 2025 Conference will focus on the theme ‘Journey to the West: Discourse and discovery in old age psychiatry’. Speakers include Professor Elizabeth Sampson (UK) and Professor Carmelle Peisah (NSW).

The conference will be held across two and a half days at The Esplanade hotel in Fremantle (Walyup) from Wednesday 12 November to Friday 14 November 2025, in the vibrant portside town 30 minutes from central Perth in sunny WA. There will be a welcome function on the evening of Wednesday 12th November and an informal ‘Freo’ dinner on Thursday 13^th.  See you there!

Article: Bedlam on Beds – Dr Neville Hills

What is a bed?

Acute hospital beds are often a core component of crisis care for people of all ages including older adults.  A paper by Rosen et al in the ANZ Journal of Psychiatry noted, “Incredibly, there is no international agreed definition of ‘hospital’”.  What comprises a hospital bed is equally undefined. It has been claimed that we had too many beds for mental health patients. Beds were closed down allegedly to fund community services. At the same time, distressing cases where patients were denied admission to hospitals arose repeatedly.

The core issue is what a hospital bed represents in terms of the best and most appropriate range of health resources needed to match the needs of patients at the time. A hospital bed is not only a mattress on four legs; it is a metaphor that represents the physical resources and personal care provided by a wide range of people, from domestic workers to professional clinicians. Counting beds as if they equally provide the same accessibility, resource quality, or model of care makes no sense. Describing beds as acute, non-acute, sub-acute, community, etc. is unhelpful and confusing. As the term ‘beds’ is often preceded by “expensive”, the neoliberal intent becomes clear. How daily bed costs have been calculated is not usually explained, nor are the multiple roles of hospitals considered.

Bed blocking in Bromley

A 1986 British article “Bed blocking in Bromley” by Coid and Crome^[1] was in mind when I was a working psycho-geriatrician. The authors detailed a point prevalence survey of all acute beds in the Bromley district that found that more than one in 10 patients were classified by their doctors as bed blockers (one in five in the medical wards). There were appreciable clinical and demographic differences distinguishing bed blockers from patients whose stay had been prolonged and who were judged as still requiring acute beds. Social and administrative problems contributed to bed blocking so that further action by geriatricians, psycho-geriatricians, and social workers was needed to reduce the numbers. A substantial proportion of bed blockers, however, were highly dependent and could be transferred only to long stay wards or nursing homes. Bed blocking seemed inevitable in wards that were attempting to cope with the increasing proportion of elderly patients by using traditional models of acute care. What most affected me in the article was the comment:

In defining bed blockers as we have done, we recognise that many of them might still have benefited from assessment and treatment by geriatric or psychogeriatric specialists. Many more might have benefited had they either been admitted directly to a specialist unit or been referred earlier after their admission to hospital.

The survey showed, however, that many patients were not referred even after they had been classified by their doctor as bed blockers. It is hard to believe that non-referral was due to a lack of knowledge of the geriatric services in Bromley; a more likely explanation is a low expectation that action would be taken-that is, that the patient would be transferred from the acute ward to a geriatric or psychogeriatric ward. "There is no point in referring these patients’ was an attitude frequently encountered. I noted in the article appendix the number of consultant geriatricians in Bromley was listed as 2 whilst Consultant psycho-geriatricians were 0. This was in contrast to other areas in the UK. A very well-regarded unit for Older Adult Mental Health at Southampton I visited pursued a policy which I tried to emulate in WA, i.e. every referral to their service received by 10 am was responded to on the same day.  Prompt telephone contact and domiciliary visits are essential to ensure inappropriate admissions to scarce beds do not occur. This can be achieved with mobile teams of experienced, resourced, and committed staff. Long waiting lists for “assessment” should be unacceptable.

Situation closer to home

The purpose-built older adult mental health units (The Lodges) built in WA during the mid-1980’s were more than inpatient beds. Each comprised a core hub of services including a community assessment team, a day hospital and inpatient beds. Counting daily costs of hospital-based resources must consider the full range of services provided to the community population not just inpatient care. Labelling mental health hospital beds with names such as “stand alone”, “inefficient” and “outdated” ignores the wide range of health positive activities often undertaken in hospitals. These can include diverting patients from emergency departments and acute hospitals, which may have limited usefulness for some distressed older people needing a spectrum of flexible services, not a busy one-stop shop. The positive benefits of accessible, small, contemporary psychiatric hospitals should be acknowledged.

Unspecific claims that hospital beds are expensive, is not only covert discrimination against those with mental illness but faulty economics. Care that avoids a deterioration of illness, provides education and support to carers, shortens length of stay, and avoids inappropriate higher-level interventions such as the criminal justice system, is both just and cost effective. International comparisons of bed numbers are simplistic, as they do not account for vastly differing resources, demography, political policies, community standards and expectations for welfare. Within Australia, the notion that a standard formula allows useful comparisons between States as disparate in size and population as Western Australia and Tasmania, is nonsense. National planning should address desirable goals and outcomes, not prescriptive bench-marking that is frequently ignored. A well planned and responsive mix of general acute, secondary, and primary care services, integrated with community services, risks becoming lost in the quest to appear reformist and progressive but achieving neither. There have been many expensive inquiries into failures in mental health care. Could we have one that advances doing something constructive?

Dr Neville Hills, FRANZCP., MRCPsych, LLM, PhD.

^[1] Coid, J. and Crome, P., 1986. Bed blocking in Bromley. Br Med J (Clin Res Ed), 292(6530), pp.1253-1256.

Dr David Lie
Chair, Bi-national Faculty of Psychiatry of Old Age Committee