Mental health reform, citizenship and human rights in four countries.

ABSTRACT

Mental health is now seen as a major global problem. In recent decades acknowledgement of the global cost of mental illness has prompted mental health reforms in many countries. While there have been national differences in how the reforms have been played out, in virtually every case there has been an intensification of governmental interest in mental health, resulting in the adoption of deinstitutionalisation and community care as the officially sanctioned options for providing mental health services. At the same time, the new policy directions have been characterised by concern for the citizenship participation and human rights protection of mental health service users. This paper compares recent mental health reforms in four countries--Australia, the UK, Italy and Brazil--with particular emphasis on the relationship between deinstitutionalisation, citizenship and human rights. The paper concludes by arguing that the question of whether deinstitutionalisation has worked is best addressed using an international comparative approach.

KEY WORDS

mental health; mental health policy; deinstitutionalisation; citizenship; human rights; sociology

Introduction

As part of the recent public debate surrounding the cases of Cornelia Rau and Vivian Alvarez (Solon), women with histories of mental illness who were treated as illegal immigrants by Australian immigration officials, there have been claims that the deinstitutionalisation of mental health services is a failed public policy (Kearney & Cresswell 2005). While such claims are not new--there have been frequent demands to reverse the program of closing psychiatric hospitals and transferring mental health care to the community since its inception (Isaac & Armat 1990; Lamb 1992)--there is currently a widely held perception that the Australian mental health system is in disarray and that the current problems reflect a policy approach that is both misguided and uncaring.

While not wishing to deny the very real problems facing Australian mental health services at present, it should be acknowledged that in recent decades deinstitutionalisation has become a global phenomenon. The recognition that about 450 million people are affected by mental illness worldwide (World Health Organisation 2001), and that the majority of these are in developing countries (Goldberg et al. 2000) has prompted policy changes in many countries, with deinstitutionalisation and community care usually being adopted as the best options for providing mental health services. While the new policy directions have not gone unopposed they have also attracted much support for seeking to bring increased citizenship participation and greater human rights protections for the mentally ill (Morrall & Hazelton 2004).