In sight, in mind: mental health policy in the era of deinstitutionalisation.

ABSTRACT

This paper outlines the key goals of Australia's National Mental Health Strategy in attempting to persuade state governments to pursue the progressive deinstitutionalisation of Australia's stand alone public psychiatric hospitals and the mainstreaming of inpatient psychiatric care in wards of general hospitals. It utilises Goffman's (1961) critique of asylums and the comprehensive audit of Victoria's public psychiatric services in 1992 to illustrate some important deficiencies in the old asylum system of mental health care. The paper argues that, though the process of deinstitutionalisation in Australia is incomplete and there are many problems, sufferers from mental illnesses are now in a very real sense 'in sight' and 'in mind'. The paper concludes with proposals for sociological research in the mental health field.

KEY WORDS

mental health policy; stand alone psychiatric hospitals; deinstitutionalisation

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The central discussion in this paper concerns Australian public mental health policy. The paper will provide an overview of policies and pressures leading to the deinstitutionalisation of stand alone psychiatric hospitals and will point to some major consequences of this radical, though incomplete, social change.

There are many misunderstandings about deinstitutionalisation. Taken literally, the word 'deinstitutionalisation' suggests that sufferers from mental illness are no longer to be accommodated in 'institutions'. From this arises the common misconception that 'the mentally ill' are now 'on the streets' or 'in prison'. However Australia's 1992 National Mental Health Strategy (2) never intended that community care would take up the full spectrum of mental health treatment; inpatient care was always still part of the agenda. A central policy goal was, firstly, to downsize and close stand alone psychiatric hospitals as part of a community-oriented system of care and, secondly, to provide inpatient care, where necessary, for people with a mental illness in psychiatric wards co-located with general hospitals (National Mental Health Policy 1992: 2-3). Many sufferers of mental illness were not institutionalised in the past and do not need to be institutionalised now. Their mental health was, and is, adequately managed by general practitioners and private psychiatrists (AIHW 2004:19). Reducing stigma by increasing the visibility of sufferers of mental illness was another policy goal, alongside improving the physical health of psychiatric patients by permitting regular oversight by acute care health staff (National Mental Health Policy 1992: 12, 16, 22). But behind the scenes a key goal was to improve the standards of mental health treatment. So long as psychiatric hospitals were isolated, both geographically and socially, sufferers of mental illness tended to remain 'out of sight' and 'out of mind'.