Visions of Future Past
by Rob Ramjan
It was a time of unbridled hope. In the 70s it seemed that everything and anything was possible. As fate would have it, I landed the dream placement in my Social Work degree—a full time placement at the newly opened first Richmond Fellowship House in Australia. There were twelve residents, six male and six female, and one full-time worker who was covering twenty-four hours a day seven days a week—and she had broken her leg in the first week of the house’s operations. Her name was Elizabeth Tow and she was on twelve months secondment from Broughton Hall where she was senior social worker.
My lifelong journey was to begin within the first two weeks of the placement. I was just twenty-one and within the first two weeks, Liz and I were sharing responsibility. We each did sleep-overs, ran meetings within the house, and liaised with the Glebe Community Mental Health Team. It was my first contact with a therapeutic community, and it just seemed right. Almost fifty years later I know deeply that not only was it right, it worked as well. I ended up being involved with Richmond Fellowship for over fifteen years as a member of staff, and then as a board member and staff support person.
Rob Ramjan
Whilst we didn’t use the now very popular and misunderstood word ‘recovery’, we walked alongside people with serious and debilitating mental illnesses, mostly schizophrenia, with a focus on what they could do, what they liked doing, and what strategies they might use to deal with symptoms and live an enjoyable and fulfilling life.
Our people generally did quite well, to such a degree that over the next few years we were often accused of cherry picking the ‘best’ individuals to ensure good outcomes. Nothing could be further from the truth. We accepted people who were having up to seven admissions a year, many with a history of over thirty admissions to a psychiatric hospital. Referrals usually came from hospital wards and our service was their place of destination following discharge. Many were still quite unwell when they arrived.
We had one instance in which the treating psychiatrist, in completing the part of our referral form regarding prognosis, actually wrote the words ‘totally hopeless, we have kept a bed open for his return’. ‘Peter’ had a lengthy history of admissions and had spent the best part of the last seven years as an inpatient. That was about 1979. Peter has never had another hospital admission and currently has a very responsible job with a federal government department. As I like to say, this hopeless ‘case’ now has a job that pays better than any I have ever had, has a better car than I will ever drive, and has more expensive holidays than I could ever afford. Peter’s story is not an exception; he had many peers. The benefit to him and his peers was indisputable, but the benefit to the state government in savings was—massive. Peter now pays taxes, indeed a considerable amount of taxes, which is a benefit to the federal government. It was a no-brainer, yet we were confronted with no brains.
The support from the Glebe Community Mental Health team was exceptional. They were filled with the same hope that we had. Two full-time psychiatric nurses who, to use their own words, had escaped the hopelessness of the hospital, as well as a part time psychiatric registrar. Anne and David, the nurses, were a constant point of contact and unbelievably supportive. They educated the constant stream of psychiatric registrars who did a six-month rotation as part of the community mental health team. By this stage we had our core house with twelve residents and a string of about fifteen satellite houses and group homes, housing over fifty people. At that time, in 1979, we had two-and-a-half full-time staff positions covering twenty-four hours a day, seven days a week, including very special Christmas Day celebrations.
The community mental health team met with us every month to discuss each resident’s progress and current needs. These meetings often involved the resident, although not always, and became the base for the development and review of individual ‘contracts’ between the two services and the individual. And then, the contracts became the base of regular celebrations within the core house as individuals achieved their goals. Hope was at the centre of everything we did, and that hope was built into the success of each resident with their ‘contract’.
Stigma was so much worse during the 70s and 80s. There is still a long way to go even now, particularly with schizophrenia. Back then, there were so many false beliefs and great shame associated with mental illness. A disturbing example of this was evident at a public meeting where the proposal for Richmond Fellowship to open a second house was discussed. A number of local residents spoke of people with mental illness as axe murders, child molesters, criminals, and drug addicts. Whilst this was deeply upsetting for myself and members of the board who were present, it was devastating and severely damaging for the residents of the Glebe House who had bravely attended the meeting to discuss the benefits of the therapeutic community. Ignorance, misunderstanding, and fear dominated.
There was one event that I still remember with great fondness. We would often have social events that involved workers and residents who wished to attend. Monty Python’s movie, And Now for Something Completely Different, was playing in the city. We all decided that we would walk to the movie theatre as we all needed the exercise. Most residents were on a medication called Modecate, which could cause muscle stiffness and weight gain. So, eight of us walked into the city on a busy Saturday evening to see the movie. Seven were overweight while suffering muscle stiffness, which caused them to walk in an almost robot-like way. Their hands were locked in a claw-like position with thumbs stiffly pointing forward. We walked up George Street, then the cinema hub, chatting and laughing. Amazingly we had the street to ourselves, before we realised that people were quickly shooting across the road to the other side so they didn’t have to walk past us. One of the residents, Scott, started laughing and then said: ‘Now there is something completely different: we have the power to clear streets’. We all laughed. This was the first time I realised the power of stigma self-defence. I am forever grateful to Scott for his wisdom and his ability to turn something quite distasteful into something positive and powerful. And, by the way, we really enjoyed the movie.
Visitors, including international visitors, had no idea who was a staff member and who was a resident. We all dressed casually in the lovely clothes of that period. Quite intentionally, residents always conducted the tours for visitors and were always mistaken for staff members. I remember quite clearly that a very important visitor who, towards the end of the tour, asked the tour guide, a resident, about a member of staff who they thought was a resident, noting that that person must have some very significant problems. ‘What was their history?’, he asked.
It was such a different time as compared to today. Staff and residents lived together, worked together on common goals, ate together and shared the daily tasks—together. We grew together and found purpose and meaning together. Today it is all about symptom control and compliance with medication and sadly the real person and the power of a trusted therapeutic relationship is lost.
Simon Champ lived at the Glebe House of Richmond Fellowship when Rob Ramjan worked there.
Rob Ramjan at the time he was working for Richmond Fellowship NSW
We have often been accused of providing housing that was far short of desirable. People had to share bedrooms and there was a constant need for major renovations. The roof leaked. Yet those who criticised us were the ones who were holding the purse strings: during the many years I was involved with Richmond Fellowship there was never a cent granted to us from state government sources for capital expenditure while its officials repeatedly criticised the poor conditions of our houses. Our program screamed for adequate investment. It was saving the state very substantial amounts of money through reduced admissions—very expensive admissions—to psychiatric hospitals. To improve the conditions of our housing, we had to raise funds continuously, occasionally begging for money, selling cakes at the Glebe Fair each year, while contributing our own funds for projects that were dear to us as members of staff such as re-flooring the kitchen area. At one time, the chair of the board, a barrister, frustrated with the failure to attract government funding for repairs, apologised for leaving a board meeting early as he had a conference with a client. We later found a signed cheque for $5,000 from him on his seat. Amazingly, we now had the money to do a complete bathroom renovation. A future chair and a very respected psychiatrist eventually dealt with a leak in the roof by climbing up himself and fixing it. I note that the roof was four stories up!
Rob Ramjan started his long career in mental health as a social worker in the first residential facility of the Richmond Fellowship of NSW in 1974. He served as the CEO of the Schizophrenia Fellowship from 1991 to 2018. He worked as a Special Projects Offi cer in the Richmond Implementation Unit, was Co-ordinator of the Mental Health Co-ordinating Council, served on the initial Board of Mental Health Australia and is a Trustee with Psychosis Australia and Independent Director with Mental Illness Fellowship of Australia.
This reflection first appeared in Health and History 24 no. 2 (2022): 131-134.