The Central Coast Programme is considered to have begun in December 1969 with the arrival and commitment of Dr Donald Scott-Orr (specialist psychiatrist) in the Central Coast, and with the parallel commitment of the then Medical Superintendent of Morisset Hospital, Dr Howard Gorton to support the development of a regional programme for the Central Coast. It was decided not to re-establish any clinics and so avoid waiting lists. There was an emphasis on groups as a means of interaction and a family orientation in the work.
In the early years the role of the nurse was changing. Initially, the extramural role was expected by the hospital to be ‘following-up’ patients. However, the service was based on commitment to a community rather than hospital. Increasingly the nurses’ work was directly referred to them independently of hospital admissions. Staff visited general practitioners (GPs) on the Central Coast in their surgeries and regular letters were sent keeping the GPs informed of changes in the service. Consultations and transactions were recorded on referral forms and files were opened on all persons concerning whom the service was consulted. A client's name was always linked with the name of their general practitioner who was encouraged to make telephone contact freely to seek consultative support in connection with problems in their practice.
Priority for crisis intervention and orientation towards family and group was backed up by domiciliary visits and widespread communication and consultation. The attempt was made to use therapeutic community principles for the in-patient programme. The processes of care were seen as being as important as the content of care in assuring an optimum quality care.
There is a continuing need to focus on the flexible interchange between intra- and extramural staff in providing continuity for clients in care and integration with primary care services and agencies. In January 1978 Dr Max Chapman was appointed director of the psychiatric and mental health services on the Central Coast and he is currently in that position.