Qualifying as a psychiatrist in the mid 1950s, Dr Neville Yeomans was in 1959 the founding director of Fraser House, a psychiatric therapeutic community unit in North Ryde psychiatric hospital in Sydney, Australia.
People who were visitors or residents of Fraser House a therapeutic community residential unit in North Ryde, Sydney were key folk that Dr Jim Cairns met in Paddington to plan the first ConFest.
So who were these Fraser House people?
Fraser house was a short-term residential unit addressing the social basis of mental illness and criminal behaviour. Every aspect of Fraser house intervention was sociologically oriented. It was based upon a social model of mental dis-ease and a social model of change to ease and well-being.
Residents had been transferred to Fraser House from NSW mental homes and prisons. Yeomans observed social dysfunction as a consistent predicative indicator of diagnosable psychopathology and criminal behaviour (he was at the time a government advisor on psychiatric diagnosis). This networked dysfunctionality among prospective patient networks was the focus of change at Fraser House. Consistent with this, before admittance was considered, a prospective Fraser House patient was required to attend Fraser House big and small groups twelve times along with members of his or her family/friend network (typically under six members), with all the network members attending groups signing in as outpatients.
Admittance was also dependent on the network members undertaking to continue attending Fraser House groups as outpatients throughout a patient’s stay. During the 1960s, Fraser House had around 13,000 outpatient visits per annum. Fraser house patients arrived at Fraser House typically with a small (less than six) dysfunctional family friendship network and left in twelve weeks (the maximum stay) with a functional network of around seventy people, most of whom lived in the same locality as the patient. Fraser house processes ensured these expanded networks engaged in social networking and were being linked into other Fraser House based networks in an extended network of networks.
Neville was looking for the best people he could find to explore global futures and he reckoned that people with the backgrounds these people had were ideal as they essentially had the mainstream system knocked out of them.
The following gives some flavour of the Fraser House processes that had such dramatic results. It also briefly outlines psychiatrist Dr Neville Yeomans’ (1928–2000) pioneer of psychiatric and social psychiatric approaches in Australia.
In the 1960s and 1970s Yeomans pioneered community psychiatry, psychiatric nursing, community mental health, suicide/crisis telephone services, psychosocial domiciliary care, small residential therapeutic communities and dispersed non-residential therapeutic communities, as well as professional and peer-led psychosocial self-help groups.
Photo - Neville and nurse at Fraser House in 1960 (Yeomans 1965a).
Today, few people inside Australia – and even fewer outside – may have heard of psychiatrist Neville Yeomans. In 1963, however in an article entitled ‘the big seven secrets Australians were first to solve’, the Sydney Sun newspaper[i] placed Neville in a select group of pioneers and innovators which included Sir John Eccles, winner of the 1963 Nobel prize in the physiology of medicine, and Sir Norman Greg, nominated for the Nobel prize in physiology and medicine in 1958.
When anthropologist Margaret Mead, co-founder (1948) and president (1956-57) of the world federation of mental health[ii], visited Fraser House in the early 1960s she called it ‘the most advanced unit she had visited anywhere in the world’[iii] and which was also praised by therapeutic community pioneer Maxwell Jones[iv].
During his career in Fraser House Yeomans served on numerous national and international bodies[v], which included the committee of classification of psychiatric patterns of the National Health and Medical Research Council of Australia, the Departmental Conference of Clinicians Panel (of which he was chairman), and the National Foundation for the Research and Treatment of Alcoholism and Drug Dependency (of which he was founding director).
Though largely overlooked today, Dr Neville Yeomans’ pioneering work in Australia between 1959 and 1968 placed him then among the internationally recognised innovators of the day, and includes him now in the pantheon of therapeutic community pioneers, such as Tom Main and Maxwell Jones in the United Kingdom, and Harry Wilmer in the United States of America.[vi]
Yeomans took his first degree in biology in the early 1950s, became a psychiatrist in the mid 1950’s, and in the early sixties completed further studies to become a sociologist and psychologist. He went on to become a barrister in the early seventies.
Dr Yeomans recognized that in 1957, with considerable upheaval and questioning in the area of mental health in New South Wales and a royal commission being mooted into past practices, there was a small window of opportunity for innovation in the mental health area. Yeomans had the backing of the head of the department in setting up Fraser House as an experimental unit within the grounds of the North Ryde Psychiatric Hospital. That Australia’s psychiatry profession was being questioned at the time is indicated in Robson’s historical paper[vii] on Eric Cunningham Dax’s pioneering of psychiatric change in the Australian state of Victoria around the same time. Hinting at the state of Australia’s psychiatric system Robson described Dax as ‘a focal point for the modernization of a decrepit psychiatric system’. Robson quotes Ellery’s[viii] autobiography describing Dax coming to Australia ‘to rectify the discrepancies and supply the deficiencies of half a century’s inadequate administration of the state’s lunacy department. Robson[ix] also quotes Russell Pargeter, a Tasmania psychiatrist who wrote of Dax as ‘trying to reform the dreadful state of mental hospitals in Victoria at the time’.
As founding director, Yeomans had the Fraser House 80-bed residential unit purposely built for him by the New South Wales Health Department during 1958-1959. Yeomans was aged thirty-one when he obtained the go-ahead from the health department to take in male patients at Fraser House in September 1959. The female ward opened in October 1960.
Yeomans core values included caring for and respecting others and their functional capacities. His values framed the unit’s evolving milieu that supported dysfunctional people turning to functional living. Yeomans respected staff, patients, outpatients, and visitors’ capacity to recognise and realise well being when they sense and experience it in their lives. He wanted to explore processes with others that would recognise and use people’s capacities for contributing to their own return to health.
The Fraser House Social system was structured for staff and patient alike to be fully involved in evolving transformative processes in situ. Yeomans ensured that every aspect of Fraser House was contributing to returning residents and their social networks to functional living in society, and it achieved that aim. Within two years the maximum length of stay was reduced to 12 weeks. Residents could return up to three times by negotiation for further 12 weeks stays.
Yeomans was looking for someone else to research his lifework at the PhD level since the late 1960s.
Like Maxwell Jones[x] in the UK, Yeomans evolved Fraser House as a transitional community and the unit’s social system was designed to be tentative. Yeomans intentionally kept these structure and processes up for continual review, change and innovation. Sometimes a whole new set of rules and processes would be written and the old ones dropped. Everything was in constant change and flow – staff, patients, outpatients, processes, policies, and procedures.
Yeomans sustained Fraser House as a balanced community in a number of respects:
o Half the patients at any one time were from asylum back wards where no change was anticipated, and half were from prisons.
o Half were male and half were female.
o Half were under-active and half were over-active.
o Half were under-controlled and half were over-controlled.
o Half were under-anxious and half were over-anxious.
Having opposites sharing the same dorm was based on the principle that the presence of opposites creates a metaphorical normal position in the middle. Fraser house research showed that there was indeed a tendency towards the mean, with the under-controlled becoming more controlled, and less active, and the over-controlled becoming less controlled and more active.
Yeomans was quoted as saying:
We have a plan to transfer to the Centre over a period of time all fifty Aborigines who are now patients in NSW mental hospitals[xi].’ This happened and apart from a few that needed full time care because of associated medical conditions, all of these people passed through Fraser House and returned to their respective communities.
Yeomans set up within Fraser House a very tight and socially ecological professional framework in which staff, patients and outpatients together could test the potency of a specially form of caring values based community as therapy. Contexts rich in possibilities for re-socializing were repeated many times every weekday. Therapeutic communities in the UK and USA had periodic whole ward meetings with up to 80 patients and thirty staff present. In Fraser House, total community big groups (staff, patients and outpatients attending) were held for one hour twice a day on all weekdays, with up to 180 in attendance five days a week, all year round.
The following terms were used in referring to the whole community meeting – ‘collective therapy’, ‘big group therapy’, ‘big meeting’, ‘big group’, ‘community meeting’, and ‘large group psychosocial therapy’.
A Fraser House Handbook[xii] refers to audience and crowd behaviour, especially contagion, being a central aspect of Big Group[xiii]. In Yeomans’ paper, ‘collective therapy – audience and crowd’[xiv] he wrote:
The skilled use of collective forces is one of the paramount functions of the socio-therapist and such skills are defined by the team as ‘collective therapy’.
In Yeomans’ paper, ‘Sociotherapeutic Attitudes to Institutions’ he wrote:
Collective therapy, both audience and crowd, utilizes social forces in the patient’s primary group’.[xv]
Yeomans engaged all involved in Fraser House (staff, patients and outpatients) in recognizing, understanding and utilizing these social forces.
A half hour break followed Big Group where staff reviewed the Big Group. After the half hour break, staff and attendees were split up into many small groups where group membership was based on a revolving set of sociological categories. The composition of small groups varied daily. All the small groups at any one time were based on the same category. The social categories were: age, age and sex, kinship, locality, married/single status, and social order (manual, clerical, or semi-professional/professional).
People in pathological social networks would be all together with everyone else in Big Group. However, because of the continual changing composition in small groups, the members of these pathological networks were regularly split up for the small group sessions. For the small groups based on locality, Sydney was divided into a number of regions. In most cases, groups of people came regularly on the same trains, buses and each other’s cars so they all got to know each other. Patients and outpatients would attend the small groups allocated by locality for their region of normal domicile. This was one of the many aspects leading to increase in size of resident networks.
The Unit’s aim was to increase the patients’ role-taking functionality and psychological comfort. Progressively, the patients and outpatients interaction with the Unit’s structure and process did create more functional roles and provided ample support for residents to take on those roles. This role-taking functionality and psychological comfort supported their returning to functional life in their local community with an extended and functional family/friendship/workmate network. This meant that people who may have previously had a social network that was smaller than typical in society, ended up having one that was typically larger in terms of the number of people in the ‘closely known and regularly interacting’ part of their social network.
After a time at Fraser House these individual patient family/friendship networks would expand to have members with cross-links to other patient’s networks, and with a continual changing Unit population, with overlap in stays, these nested patient-networks became very extensive. As well, all these people had Fraser House experience in common, and a common set of mutual support skills. This networking aspect of Fraser House was a key feature that Neville extended into the wider world. Refer:
Within Fraser House Yeomans pioneered psychiatric patient committees in Australia. He set up a process whereby patients, and their family-friendship networks as outpatients, were massively involved in meetings and committee work – what Neville termed ‘Governance Therapy’. Members of patients’ family friendship networks were required to offer themselves for election to serve on committees. Fraser house patients and outpatients progressively took on responsibility for their own democratic self-governance. While other professionals in the UK had used patient committees, in Fraser House the committee process was extended such that patients and outpatients effectively became responsible for the total administration of Fraser House.
Yeomans spoke[xvi] of three levels of governance at Fraser House– local, regional, and global. Every patient along with his or her respective family-friendship network was engaged in his or her own local self-governance. The committee for locality-based transport called the Outpatients, Relatives and Friends Committee (one of the Fraser House committees) was engaged in ‘regional’ self-governance. The parliamentary-pilot committees, in association with the other sub-committees of the parliamentary committee were engaged in ‘global’ self-governance of the Fraser House ‘global commons’. The committee structure was essentially bottom-up with committees reporting to the Parliamentary Committee to keep this wider committee of committees informed. This three-fold governance model involved everybody in a cross linking network of governance. All were involved at their local level. All were involved at their regional level. And they were all linked into global governance level process as a serving committee person, or being engaged by, and by interfacing with the global governance (by for example being assessed by the patient-based Patient Assessment Committee as discussed below).
This three level (local, regional, and global) governance at Fraser House is a micro-model of the ‘local regional global self-governance’ model that Yeomans detailed in his paper called ‘On Global Reform’[xvii] setting out how community psychiatry may contribute towards societal transition to a more caring and humane world – Epochal Shift. Yeomans was not alone in this; other people in the therapeutic community in the UK evolved models for social reform[xviii]. However, Yeomans took the pioneering step of applying his model in systematic sustained and prolonged action research and making this action research very public and accessible. He also went further in evolving action research towards global epochal transition.
It was commonly acknowledged by my interviewees and within archival records that Fraser House psychiatric patients and outpatients became the most skilled in the emerging new field of community psychiatry – even ahead of the Fraser House psychiatric staff whose prior education and training had in no way prepared them for the Fraser House evolving milieu. Residents and Outpatients who became experienced in community psychiatry were elected as members of the Patient Assessment Committee. The archival material, especially the Fraser House Handbook written by patients to train new staff[xix], and the research interviews all support the view that Residents and Outpatients became highly skilled in carrying out their committee and other work. In a Fraser House Staff Handbook it was reported that patients were engaged in doing the following work:
Perhaps the most immediate observation made by a nurse coming to work in this therapeutic community for the first time, is that the patients themselves have had a great deal of authority delegated to them. Indeed, in some matters they are virtually the sole authority. At first glance it will seem fantastic that patients assess and admit new patients; review progress and institute treatment procedures; make new rules and alter old ones; mete out discipline, etc.[xx]
Committees of patients prescribed community non-drug based treatment. At first this may sound a bizarre and dangerous notion. And yet all the reports in archival material and from interviews with the psychiatrist, psychologists - and a senior charge nurse said the same thing - the patients quickly emerged as the most skilful in community therapy. According to Yeomans and the ex-staff members Warwick Bruen, and Phil Chilmaid, none of the professional training of the unit’s staff had in any way prepared them for engaging in community therapy. Patients had the advantage that they lived therapeutic community every day in the Fraser House milieu. They were immersed in it.
As an indication of the staff, patient and outpatient competence, they effectively self-organised and ran the unit for a number of weeks after Yeomans left for his nine month overseas trip in 1963 as there was no replacement psychiatrist (because of no replacement being found in time by the health department) and during these weeks things went smoothly in the unit.
Fraser House became the centre for training psychiatrists in community psychiatry[xxi], with the patients as the primary source of training. Three years after the unit started, the Australian and New Zealand College of Psychiatry co-opted Fraser House patients as trainers of trainee psychiatrists in the new area of community psychiatry (Yeomans, Dec, 1993, July 1998).
Linked to this patient/outpatient ‘work’ in Fraser House governance, assessment, and therapy was the use of ‘work’ as therapy. Progressively, patients with staff and support from other patients took on all staff roles. The principle was ‘give the job to those who can’t do it, with support so they learn to do it through experience’.
To provide refreshments during the break between Big and Small Groups, the patients sought and got permission from the North Ryde Hospital Director to set up, own, and operate their own canteen. As another example of work as therapy, Fraser House residents tendered for a public contract to build an outdoor bowling green in the grounds of Fraser House. They won the tender and built the bowling green. The area is still functional to this day – now a recreational garden. Work as therapy was also evolving in the UK therapeutic community movement[xxii].
Fraser house pioneered home visits and domiciliary care by psychiatric nurses and patients. A Fraser House monograph reports that follow-up groups to homes became routine in 1962[xxiii].
Photo two - patients building the Fraser House bowling green in the sixties
with a dormitory in the background
(A photo from the Sydney morning herald, 11 April 1962)
Residents, who had substantially changed to being psychosocially functional, and had been assessed as being proficient as co-therapists, and were anticipating leaving the hospital themselves, became involved in this Domiciliary Care process and would call on ex-residents and their families and friends to assist and resolve difficulties[xxiv]. Fraser house, residents were helping ex-residents settle back into the community before they became ex-residents themselves.
Resident members of the Domiciliary Care Committee started to go on suicide crisis calls into the community often late at night using a red Kombi Van owned by the Residents that was purchased and maintained by the Residents from surplus emerging from the Resident run canteen that provide drinks and snacks after Big Group and before the following Small Groups[xxv]. A group of patients would often go, without staff, on these domiciliary visits. Yeomans wrote that these patients involved in domiciliary care and crisis support were very skilled[xxvi]. Participating in domiciliary care was not time based - ‘so many months prior to leaving’ - rather ‘psychosocial health and competency’ based.
Fraser house’s external community crisis support service was the precursor to today’s crisis telephone line services. The patients used red Kombi Van that the patients used for domiciliary care for suicide crisis calls. This community-based suicide support’s precursor was Fraser House’s ‘specialling’ process. Fraser house adopted the process of having patients and staff constantly around potential suiciders as a support and crisis intervention group so that suicidal people were never left alone. This was termed ‘specialling’. Any person who was in a heightened emotional state, disturbed or suicidal would be immediately ‘specialled’. Patients would be co-opted as therapeutic enablers (supporting others to be able) and patients could and did take on the role of being caring support for other patients, especially those in danger of self-harm. Processes were set up such that a cooperating team of patients, with or without staff, would take on the responsibility of providing twenty-four hour support to other patients at risk of suiciding, and in the process this support team would gain response ability. This meant that two patients, or a patient and a staff member, would continually stay awake with that person around the clock (and be replaced by another shift if necessary) until, on the say so of a group, the ‘specialled’ status was removed.
Fraser house’s transforming of the dysfunctional people at the margin of the dominant society was in the context of Yeomans sensing that these people were the very best people to explore how to reconstitute societies and evolve humane caring global futures[xxvii]. Everything Yeomans did in and following Fraser House was designed to fit with everything else naturally - what Yeomans called ‘the survival of the fitting’. Everything complemented and supported other aspects. Things that did not work were fine-tuned or discarded. Issues that arose in one context were resolved, or passed on to other contexts. In Fraser House, what worked (as well as problematic aspects) was discussed with everyone in Big Group. Issues not resolved in Big Group were passed on to small groups and vice versa. Issues within committees were resolved, or passed on to the Parliamentary Committee. The Pilot Committee reviewed issues within the Parliamentary Committee. Change to functionality within three months was expected. Every aspect of Fraser House was contributing to functionality. This pervasive inter-connected weaving of everything with everything and connecting all of this to functionally living together contributed to Margaret Mead describing Fraser House as the most complete and most total therapeutic community she had ever seen, and why Maxwell Jones said that evolution was inevitable (1969).
Yeomans set up Fraser House as a research institute and involved the staff, patients and outpatients in the continually studying the Unit from within. Yeomans also set up an External Research Team focusing on Fraser House that was headed up by Dr Alfred Clark, a psychologist from University of NSW. Additionally, Yeomans set up the Psychiatric Research Study Group that met on the grounds of Fraser House. To this group Yeomans attracted professionals from many disciplines. Any ideas presented at the meetings of that group that had any relevance for Fraser House were immediately implemented within the unit.
Yeomans maintained a very public profile for himself and Fraser House and regularly gave public addresses about Fraser House and wrote many press releases. Yeomans had academics and the media attend Groups at the Unit and opened up his work and the Unit to public gaze and scrutiny allowing the day-to-day Big Groups and Small Groups to be ‘data’ on public display. People from religious, business, academic, non-government and government organizations including the Federal Government Foreign Affairs Department attended Fraser House Groups. Requests to attend were typically granted and Fraser House became a major centre for learning group skills. Patients and outpatients taking on functional roles during the unit’s Big and Small Groups were on public display to these professional and lay visitors. All visitors were signed in as Outpatients and all were fully involved. No one attended as just an observer. Yeomans left others to draw their own theoretical perspectives about what was happening.
Yeomans was immensely confident born of his experience of the Unit’s functioning. When asked about ‘miracles’ at Fraser House [xxviii] Yeomans replied:
Of course it was miraculous. We were the best in the planet, and we all believed this, so we would acknowledge our failings, as we were streets ahead of everyone else. I was accused of being an impossible optimist. I sense i was more of a fatalistic optimist. I was context driven – if I go to ‘creative context’ then ‘everything is creative’ - it worked like that. As for the miraculous - well that was a calm night. Peaceful. Remember we were filled with the very bad and the very mad - the under controlled and the over controlled.
In 1968, Neville wrote a job description for a new role, that of NSW Director of Community Mental Health. He applied for the job and was given the job. Later he became the Founding NSW Director of Community Health as well.
It was in these roles Neville started many self-help and mutual-help groups. He worked with people in these groups to get the series of Festivals started that were precursors to ConFest.
[ii] Brody (2002)
[iii] Yeomans, N (1965a Vol. 5). This comment was confirmed in an interview with anthropologist psychologist Margaret Cockett who was working at Fraser House during Mead’s visit.
[iv] Clark, A. W. and N. Yeomans (1969). Maxwell Jones wrote the following about Yeomans’ Fraser House structure in the preface to Clark and Yeomans book on Fraser House, ‘Given such a carefully worked-out structure, evolution is an inevitable consequence.’
[v] Yeomans, N. (1965a).
[vi] (Therapeutic Community Open Forum 2006a)
[vii] Robson, B. (2000).
[x] (Jones, M. (1968).
[xi] Daily Mirror (1962).
[xii] A number of Staff Handbooks were written.
[xviii] Griff Fyrd" is an example - an English inter-war organization from which Hawkpsur Camp arose ("The Hawkspur Experiment") (Wills, D, 1941).
[xix] Yeomans N. 1965a, Vol. 4, p. 17-20, 50-54). This Handbook had sections on the Role of the Psychiatric Nurse at Fraser House, and the Role of the Leader during Big and Small Groups.
[xx] Yeomans, N. 1965a, Vol.4, p. 17
[xxii] For example Bertram Mandlebrote and Littlemore Hospital in Oxford also used tendering (Planned Environment Therapy Trust Archive and Study Centre 2006), and a number of 'farm-based' therapeutic communities set up outlet shops (Gould Farm Monterey, Massachusetts 2007; Camphill Communities 2006; Newton Dee Community 2006
[xxvii] Yeomans, N. (197a, 1971b).