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Can Deinstitutionalisation Work? Mental Health Reform from 1993 to1998 in Victoria, Australia
Valerie Gerrand
Department of Political Science, University of Melbourne, VIC
Abstract
From 1993 to 1998, mental health services underwent a major transformation in Victoria, Australia. The changes aimed to create a community-oriented service system under general health, instead of one based on psychiatric institutions. Community treatment was to be the first option, with hospitalisation as a backup. State psychiatric institutions were closed, and replaced by new area-based mental health services, providing local inpatient, residential and community-based care. This included mobile extended hours services, available seven days per week.
The article examines the rationale and nature of the changes. It argues that Victoria's reforms largely avoided problems usually attributed to deinstitutionalisation. This was because alternative services that were comprehensive and locally accessible were established before institutions were closed. Start-up funding from federal and state governments helped this transition, with institutional savings reinvested in new services. By 1998, the changes were substantial, although institutional practices were not transformed as thoroughly as the structures.
Keywords
psychiatric deinstitutionalisation, mental health service reform, implementing mental health reform, community mental health care, mental health care in the community
Article Text
Conclusion
Victoria's approach to deinstitutionalisation stands out in the uneven history of this movement in the mental health field. The traps have long been known, such as not securing the reinvestment of institutional savings, failing to establish an adequate range of replacement services or allowing those services to ignore the needs of the most disabled. Victoria's mental health reforms managed to avoid most of these pitfalls. Ten years on, the service framework is still firmly in place, with recent initiatives such as step-up/step-down acute services augmenting rather than replacing the core service elements (Metropolitan Health and Aged Care Services Division 2002). Despite its flaws, the redesigned service system has provided a solid basis for further reform, and fertile ground for sociological research.
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