Outcry and silence: the social implications of asylum closure in Australia.(Editorial)

This issue of HSR is dedicated to sociological discussion of the social impact of mental health reform, particularly the closure of many publicly funded Australian stand-alone psychiatric hospitals over the last two decades. A recent Australian publication is highly significant to this collection of articles. Entitled Not for Service: Experiences of Injustice and Despair in Mental Health Care in Australia, (Mental Health Council of Australia and the Brain and Mind Research Institute 2005), this report concludes that government promises to establish adequate, networked, community-based services to replace institutional care have not materialised. Reverberating through this report are the voices of consumers, advocates, families, workers and politicians who give accounts of homelessness, lack of inpatient and community services, over-reliance on pharmaceutical treatment, undue confinement, imprisonment in gaols, and suicide.

Sociologists' voices are not among those included in the Not for Service report; their silence is both symptom and cause of sociology's lack of profile in regard to important social problems such as the treatment and everyday lives of individuals who suffer debilitating mental illness. With few exceptions, it is claimed, sociologists have been silent on even the most publicly debated of changes to the structure and delivery of mental health services--the closure of many large asylums across Australia (Willis and Broom 2004). In contrast, other provocative matters of the last two decades--HIV/AIDS, the human genome project and complementary or alternate medicine--have caught the imagination of a significant number of sociologists (Willis and Broom 2004).

This special issue of HSR constitutes a deliberate move to redress this silence. The first step took place at The Australian Sociological Association (TASA) Health Sociology Day at the annual conference in Beechworth, Victoria in December 2004. The theme of the day's proceedings 'Has Deinstitutionalisation Worked?' was energised by stimulating presentations and by the physical location of the conference. The site, now a campus of La Trobe University, was opened in 1967 as the 'Ovens Lunatic Asylum'. In its heyday in the 1960s, the asylum then renamed Mayday Hills Hospital, housed one thousand inmates. The papers in this issue, some authored by presenters at the 2004 Health Sociology Day, contribute to a much-needed revival of sociological interest in mental illness in Australia. They take up issues central to the Not for Service report: the need for reform and closure of asylums or stand-alone psychiatric hospitals, the political orientations and social impact of Australia's deinstitutionalisation program, human rights and the quality of everyday life for individuals diagnosed with mental illness, the provision of psycho-social treatments and community based support services, and the centrality of risk discourse within psychiatric services.

As guest editor, I see a threefold purpose in writing this introductory article. Firstly, the release of the Not for Service report begs an overview of the rise of the asylum as a humane model of care and its fall from grace as a total institution (Goffman 1961), an ungovernable form of publicly-funded care (see Gerrand this issue). For this reason, I will begin by sketching the history of asylums in Australia, noting that many calls and reform measures, all arguing for humane, dignified and therapeutic mental health care, run through and beyond this history. Secondly, having highlighted sociologists' relative silence on the social consequences of deinstitutionalisation, it is important to acknowledge the inspiring work that has been produced by Australian social scientists. I will refer to three publications that stand out in terms of their analyses of particular aspects of deinstitutionalisation, as well as the direction they provide for future research questions pertinent to the structural, therapeutic and lived-experience dimensions of mental illness in our times. Thirdly, I conclude with the principal and pleasing task of introducing the papers that constitute this issue, and add to the existing body of work.

The rise and fall of asylums in Australia

Debate over the necessity for and operation of stand-alone psychiatric institutions has been a perennial feature of societal responses to mental illness in the western world. It seems that abandonment of some of the most vulnerable individuals in our society continues to happen, whether they are in or out of asylums. Gostin (2004:11) notes that:

 
   Countless promises have been made to right the 
   wrongs, but new forms of neglect have always 
   emerged. The mentally disabled have ended up 
   in prison, in equally deplorable adult homes, or 
   on the streets, homeless and destitute, while the 
   wider society has averted its eyes.