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

Katy Richmond
School of Social Sciences, La Trobe University, Bundoora Campus, VIC

Pauline Savy
John Richards Initiative: Rural Aged Care Research, Faculty of Health Sciences, La Trobe University, Albury-Wodonga VIC

PP: 215 - 229

Abstract

For centuries 'deranged' and 'deviant' individuals were incarcerated in gaols and asylums, often for life. In these socially out-of-the-way places they were subjected to regular physical and mental abuse and the experimental, frequently lethal, psychiatric treatments of the time.

This paper summarises this prolonged dark period in the history of psychiatric treatment and identifies sociological analyses and arguments concerning the confinement of the mentally ill over the decades leading up to the closure of large mental hospitals. It goes on to examine deinstitutionalization as a contemporary response to mental illness and one that to date has been largely neglected by Australian sociologists.

The paper concludes by highlighting areas for research that would fill this gap.

Keywords

mental health policy; stand alone psychiatric hospitals; deinstitutionalisation


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References

Andrews G (2005) The crisis in mental health: the chariot needs one horseman, Medical Journal of Australia 182(8): 372-373.

Angrosino M (1998) Opportunity House: Ethnographic Stories of Mental Retardation, Walnut Creek: Altamira Press.

Australian Institute of Criminology (2004) Homicide in Australia 2002-2003: National Homicide Monitoring Program Annual Report, available at www.aic.gov.au.

Australian Institute of Health and Welfare (AIHW) (2005) Mental Health Services in Australia 2004, available at www.aihw.gov.au

Bachrach LL (1996) Psychosocial rehabilitation and psychiatry: what are the boundaries, Canadian Journal of Psychiatry 41(1): 81-88.

Barrett R (1996) The Psychiatric Team and the Social Definition of Schizophrenia: An Anthropological Study of Person Illness, New York: Cambridge University Press.

Bradstock S, Wilson A, Cullen M and Barwell K (2005) Telephone-based psychiatry advice service for general practitioners, Medical Journal of Australia 183(2): 90.

Brideson T and Kanowski L (2004) The struggle for systematic 'adulthood' for Aboriginal mental health in the mainstream: the Djirruwang Aboriginal and Torres Strait Islander Mental Health Program, Australian e-Journal for the Advancement of Mental Health 3(3): 1-9. http://amh.e-contentmanagement.com/archives/vol/3/issue/3/article/3370/moving-beyond-a-seasonal-work-syndrome-in

Brown P (1984) Marxism, social psychology and the sociology of mental health, International Journal of Health Services 14(2): 237-264.

Brown P (1989) Psychiatric dirty work revisited: conflicts in servicing non-psychiatric agencies, Journal of Contemporary Ethnography 18(2): 182-201.

Brown P (1995) Naming and framing: the social construction of diagnosis and illness, Journal of Health and Social Behavior extra issue, pp.34-52.

Busfield J (2000) Introduction: rethinking the sociology of mental health, Sociology of Health and Illness 22(5): 543-558.

Butterworth P (2003) The prevalence of mental disorders among income support recipients: an important issue for welfare reform, Australian and New Zealand Journal of Public Health 27(4): 441-448.

Carpenter M (2000) 'It's a small world': mental health policy under welfare capitalism since 1945, Sociology of Health and Illness 22(5): 602-620.

Chan J, Hudson C and Parmenter T (2004) An exploratory study of crime and brain injury: implications for mental health management, Australian e-Journal for the Advancement of Mental Health 3(1): 1-6. http://amh.e-contentmanagement.com/archives/vol/3/issue/1/article/3388/services-for-adults-with-intellectual-disability

Chesters J, Fletcher M and Jones R (2005) Mental illness recovery and place, Australian e-Journal for the Advancement of Mental Health 4(2): 1-9. http://amh.e-contentmanagement.com/archives/vol/4/issue/2/article/3358/mental-illness-recovery-and-place

Commonwealth Department of Health and Ageing (2002) National Mental Health Report 2002: Seventh report. Changes in Australia's mental health services under the first two years of the second national mental health plan 1998-2000, Commonwealth of Australia, Canberra. [NMHR 2002]

Commonwealth Department of Health and Ageing (2003) National Mental Health Report 2004: Eighth report. Summary of changes in Australia's mental health services under the National Mental Health Strategy 1993-2002, Commonwealth of Australia, Canberra. [NMHR 2004]

Conrad P (2005) The shifting engines of medicalization, Journal of Health and Social Behavior 46(1): 3-14.

Cook JA and Wright ER (1995) Medical sociology and the study of severe mental illness: reflections on past accomplishments and directions for future research, Journal of Health and Social Behavior extra issue, pp.95-114.

Cooksey E and Brown P (1998) Spinning on its axes: DSM and the social construction of psychiatric diagnoses, International Journal of Health Services 28(3): 525-54.

Dallaire B, McCubbin M, Morin P and Cohen D (2000) Civil commitment due to mental illness and dangerousness: the union of law and psychiatry within a treatment-control system, Sociology of Health and Illness 22(5): 679-699.

Dietrich S, Beck M, Bujantugs B, Kenzine D, Matschinger H and Angermeyer MC (2004) The relationship between public causal beliefs and social distance toward mentally ill people, Australian and New Zealand Journal of Psychiatry 38: 348-354.

Ellis G and King R (2003) Recovery focused interventions: perceptions of mental health consumers and their case managers, Australian e-Journal for the Advancement of Mental Health 2(2): 1-10. http://amh.e-contentmanagement.com/archives/vol/2/issue/2/article/3405/recovery-focused-interventions

Emerson RM and Pollner M (1977) Dirty work designations: their features and consequences in psychiatric setting, Social Problems 25: 243-254.

Estroff S (1981) An Ethnography of Psychiatric Clients in an American Community, Berkeley: University of California Press.

Fitzgerald PB, De Castella AR, Filia KM, Filia SL, Benitez J and Kulkarni J (2005) Victimization of patients with schizophrenia and related disorders, Australian and New Zealand Journal of Psychiatry 39(3): 169-174.

Fullagar S and Gattuso S (2002) Rethinking gender, risk and depression in Australian mental health policy, Australian e-Journal for the Advancement of Mental Health 1(3): 1-13. http://amh.e-contentmanagement.com/archives/vol/1/issue/3/article/3419/rethinking-gender-risk-and-depression-in

Garton S (1986) Medicine and Madness: a Social History of Insanity in New South Wales 1880-1940, Kensington, UNSW Press.

Goffman E (1961) Asylums: Essays on the Social Situation of Mental Patients and Other Inmates, Harmondsworth: Penguin.

Goldney R, Fisher L, Dal Grande E and Taylor A (2005) Changes in mental health literacy about depression: South Australia, 1998 to 2004, Medical Journal of Australia 183(3): 134-137.

Habibis D, Hazelton M, Schneider R, Bowling A and Davidson J (2002) A comparison of patient clinical and social outcomes before and after the introduction of an extended-hours community mental health team, Australian and New Zealand Journal of Psychiatry 36: 392-398.

Hazelton M (1993) The discourse of mental health reform: a critical analysis, Australian Journal of Mental Health Nursing 2(4): 141-154.

Hazelton M and Clinton M (2004) Human rights, citizenship and mental health reform in Australia, in P Morrall and M Hazelton (eds) Mental Health: Global Policies and Human Rights, London, Whurr, pp.41-60.

Henderson S (2003) Mental Illness and the Criminal Justice System, Mental Health Coordinating Council available at www.mhcc.org.au/projects/criminal_justice/aetiology.html

Herman N (1993) Return to sender: reintegrative stigma-management strategies of ex-psychiatric patients, Journal of Contemporary Ethnography 22(3): 295-330.

Hickie I, Groom G, McGorry P, Davenport T and Luscombe G (2005) Australian mental health reform: time for real outcomes, Medical Journal of Australia 182(8): 401-406.

Holmes ACN, Hodge MA, Bradley G, Bluhm A, Hodges J, Didio L and Markulev N (2005) Accommodation history and continuity of care in patients with psychosis, Australian and New Zealand Journal of Psychiatry 39(3): 175-179.

Horsfall J (1987) Psychiatric non-institutionalisation: whose needs are served? Australian Journal of Social Issues 22(3): 530-541.

Horsfall J (1998) Mainstream approaches to mental health and illness: an emphasis on individuals and a de-emphasis of inequalities, Health 2(2): 217-231.

Hyland B, Judd F, Davidson S, Jolley D and Hocking B (2003) Case managers' attitudes to the physical health of their patients, Australian and New Zealand Journal of Psychiatry 37: 710-714.

Johnson K (1998) Deinstitutionalising Women: An Ethnographic Study of Institutional Closure, Oakleigh: Cambridge University Press.

Jorm A. F, Christensen H and Griffiths K. M (2005) The impact of beyondblue: the national depression initiative on the Australian public's recognition of depression and beliefs about treatments, Australian and New Zealand Journal of Psychiatry 39(4): 248-254.

Karp D (1993) Taking anti-depressant medications: resistance, trial commitment, conversion, disenchantment, Qualitative Sociology 16(4): 337-359.

Kevin J (2002) An evaluation of telephone triage in mental health nursing, Australian e-Journal for the Advancement of Mental Health 1(1): 2-12. http://amh.e-contentmanagement.com/archives/vol/1/issue/1/article/3440/an-evaluation-of-telephone-triage-in-mental

Knapp M, King D, Pugner K and Lapuerta P (2004) Non-adherence to antipsychotic medication regimens: associations with resource use and costs, British Journal of Psychiatry 184: 509-516.

Krieg R (2001) An interdisciplinary look at the deinstitutionalization of the mentally ill, Social Service Journal 38(1): 367-380.

Lam L (2002) Aggression exposure and mental health among nurses, Australian e-Journal for the Advancement of Mental Health 1(2): 2-11. http://amh.e-contentmanagement.com/archives/vol/1/issue/2/article/3429/aggression-exposure-and-mental-health-among-nurses

Lee S and Mysyk A (2004) The medicalization of compulsive buying, Social Science and Medicine 58(9): 1709-1718.

Lee S, Lee MTY, Chiu MYL and Kleinman A (2005) Experience of social stigma by people with schizophrenia in Hong Kong, British Journal of Psychiatry 186: 153-157.

Leighton A (2000) Community mental health and information underload, Community Mental Health Journal 36(1): 77-95.

Link BG, Struening EL, Rahav M, Phelan JC and Nuttbrook L (1997) On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse, Journal of Health and Social Behavior 38(2): 177-190.

Manning N (1989) The Therapeutic Community Movement: Charisma and Routinization, Routledge, London.

Martin JK, Pescosolido BA and Tuch SA (2000) Of fear and loathing: the role of 'disturbing behavior', labels, and causal attributions in shaping public attitudes toward people with mental illness, Journal of Health and Social Behavior 41(2): 208-223.

Matthews JJ (1984) Good and Mad Women: The Historical Construction of Femininity in Twentieth-Century Australia, Sydney: Allen & Unwin.

McGorry PD and Yung AR (2003) Early intervention in psychosis: an overdue reform, Australian and New Zealand Journal of Psychiatry 37: 393-398.

McGrew JH, Wright ER and Pescosolido BA (1999a) Closing of a state hospital: an overview and framework for a case study, Journal of Behavioral Health Services and Research 26(3): 236-245.

McGrew JH, Wright ER, Pescosolido BA and McDonel EC (1999b) The closing of Central State Hospital: long-term outcomes for persons with severe mental illness, Journal of Behavioral Health Services and Research 26(3): 246-261.

Meadows G and Singh B (2003) 'Victoria on the move': mental health services in a decade of transition 1992-2002, Australasian Psychiatry 11(1): 62-67.

Mechanic D and Rochefort DA (1990) Deinstitutionalization: an appraisal of reform, Annual Review of Sociology 16, 301-327.

Mesch D, McGrew J, Pescosolido B and Haugh D (1999) The effects of hospital closure on mental health workers: an overview of employment, mental and physical health and attitudinal outcomes, Journal of Behavioral Health Services and Research 26(3): 305-317.

Mihalopoulos C, Magnus A, Carter R and Vos T (2004) Assessing cost-effectiveness in mental health: family interventions for schizophrenia and related conditions, Australian and New Zealand Journal of Psychiatry 38: 511-519.

Moncrieff J and Crawford M. J (2001) British psychiatry in the 20th century - observations from a psychiatric journal, Social Science and Medicine 53(3): 349-356.

Morrall P (2004) UK mental health policy: chaos and control, in P Morrall and M Hazelton (eds) Mental Health: Global Policies and Human Rights, London, Whurr, pp.1-23.

Morrall P and Muir-Cochrane E (2002) Naked social control: seclusion and psychiatric nursing in post-liberal society, Australian e-Journal for the Advancement of Mental Health 1(2): 2-11. http://amh.e-contentmanagement.com/archives/vol/1/issue/2/article/3430/naked-social-control

Morris P and Lloyd C (2004) Vocational rehabilitation in psychiatry: a re-evaluation, Australian and New Zealand Journal of Psychiatry 38: 490-494.

Mulvany J (2000) Disability, impairment or illness? The relevance of the social model of disability to the study of mental disorder, Sociology of Health and Illness 22(5): 582-601.

Nairn RG and Coverdale JH (2005) People never see us living well: an appraisal of the personal stories about mental illness in a prospective print media sample, Australian and New Zealand Journal of Psychiatry 39(4): 281-287.

Australian Health Ministers (1992) National Mental Health Policy, Commonwealth of Australia, Canberra: AGPS.

Newton L (2001) Self and illness: changing relationships in response to life in the community following prolonged institutionalisation, Australian Journal of Anthropology 12(2): 166-181.

Office of Psychiatric Services (1992) Audit of standards of treatment and care in psychiatric hospitals in the State of Victoria, Health Department Victoria, Melbourne. [Audit]

Phelan JC, Link BG, Stueve A and Pescosolido BA (2000) Public conceptions of mental illness in 1950 and 1996: what is mental illness and is it to be feared? Journal of Health and Social Behavior 41(2): 188-207.

Quirk A, Lelliott P and Seale C (2004) Service users' strategies for managing risk in the volatile environment of an acute psychiatric ward, Social Science and Medicine 59 (12): 2573-2583.

Reid J, Lloyd C and de Groot l (2005) The psychoeducation needs of parents who have an adult son or daughter with a mental illness, Australian e-Journal for the Advancement of Mental Health 4(2): 1-13. http://amh.e-contentmanagement.com/archives/vol/4/issue/2/article/3356/the-psychoeducation-needs-of-parents-who-have-an

Rey JM, Walter G and Guiffrida M (2004) Australian psychiatrists today: proud of their profession but stressed and apprehensive about the future, Australian and New Zealand Journal of Psychiatry 39: 105-110.

Samson C (1995) The fracturing of medical dominance in British psychiatry? Sociology of Health and Illness 17(2): 245-68.

Scheff TJ (1966) Being Mentally Ill: A Sociological Theory, Chicago: Aldine.

Scheid TL (2003) Managed care and the rationalization of mental health services, Journal of Health and Social Behavior 44(2): 142-161

Scheid-Cook TL (1991) The validity of social control critiques: psychiatric medication, side effects and outpatient commitment, Sociological Focus 24(1): 59-77.

Shankar J and Collyer F (2003) Vocational rehabilitation of people with mental illness: the need for a broader approach, Australian e-Journal for the Advancement of Mental Health 2(2): 1-13. http://amh.e-contentmanagement.com/archives/vol/2/issue/2/article/3406/vocational-rehabilitation-of-people-with-mental

Simpson AIF, McKenna B, Moskowitz A, Skipworth J and Barry-Walsh J (2004) Homicide and mental illness in New Zealand 1970-2000, British Journal of Psychiatry 185: 394-398.

Smoyak S (2004) US mental health policy: progress and continuing problems, in P Morrall and M Hazelton (eds) Mental Health: Global Policies and Human Rights, London, Whurr, pp.24-42.

Stannard C (1973) Old folks and dirty work: the social conditions for patient abuse in a nursing home, Social Problems 20(3): 324-342.

Stavely H (2004) Orygen Youth Health Young Persons Triage Service, unpublished Powerpoint presentation to The Mental Health Triage Forum, Bayside Health, Melbourne, 15 Nov.

Sutton J (1991) The political economy of madness: the expansion of the asylum in progressive America, American Sociological Review 56(5): 665-678.

Thomas-MacLean R and Stoppard JM (2004) Physicians' constructions of depression: inside/outside the boundaries of medicalization, Health 8(3): 275-293.

Tuffin K and Danks J (1999) Community care and mental disorder: an analysis of discursive resources, British Journal of Social Psychology 38(3): 289-302.

Wachholz S and Mullaly R (1993) Policing the deinstitutionalized mentally ill: toward an understanding of its function, Crime Law and Social Change 19(4): 281-300.

Wadsworth Y and Epstein M (1998) Building in dialogue between consumers and staff in acute mental health services, Systemic Practice and Action Research 11(4): 353- 379.

Waghorn C and Lloyd C (2005) The employment of people with mental illness, Australian e-Journal for the Advancement of Mental Health 4(2): 1-45. http://amh.e-contentmanagement.com/archives/vol/4/issue/2/article/3451/the-employment-of-people-with-mental-illness

Warren CAB (1979) The social construction of dangerousness, Urban Life 8(3): 359-384.

Weinstein R (1994) Goffman's Asylums and the total institution model of mental hospitals, Psychiatry 57(4): 348-367.

Whiteford H and Buckingham W (2005) Ten years of mental health service reform in Australia: are we getting it right? Medical Journal of Australia 182(8): 396-400.

Wright ER (1999) Fiscal outcomes of the closing of Central State Hospital: an analysis of the costs to state government, Journal of Behavioral Health Services and Research 26(3): 262-275.

Wright ER, Avirappattu G and Lafuze JF (1999) The family experience of deinstitutionalization: insights from the closing of Central State Hospital, Journal of Behavioral Health Services and Research 26(3): 289-304.

Wright ER, Gronfein WP and Owens TJ (2000) Deinstitutionalization, social rejection and the self-esteem of former mental patients, Journal of Health and Social Behavior 41(1): 68-90.

Zammit A (2004) Disability and the Courts, Victorian Office of the Public Advocate.



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