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Mental health reform, citizenship and human rights in four countries
Michael Hazelton
School of Nursing and Midwifery, University of Newcastle, NSW
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.
Keywords
mental health, mental health policy, deinstitutionalisation, citizenship, human rights, sociology
Article Text
Conclusion
In Australia, the recent controversy surrounding the cases of Cornelia Rau and Vivian Alveraz (Solon) have opened up a space for public debate on mental health reform and substantial changes in policy direction seem likely. One possible future is an increasingly post-liberal mental health system which separates patients considered to be treatable and non-threatening from those thought to be treatment-resistant and dangerous. In such a future mental health facilities are tough, security-minded places; staff are more risk-managers than therapists; and all patients are treated as if they might be dangerous. In another possible future, a progressive coalition forms around the need to take seriously, the humanising and democratising values that have sometimes been associated with recent mental health reforms. There are demands that in addition to the usual range of clinical and social indicators mental health services should also be evaluated in terms citizenship and human rights principles. If sociology played an important role in the mental health reform movements of the 1960s and 1970s, it has largely abandoned this area in more recent decades. Given the current debate over the 'failings' of the Australian mental health system, there has never been a greater need for the kind of analysis that only the sociological imagination can provide.
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