Can deinstitutionalisation work?: Mental health feform from 1993 to 1998 in Victoria, Australia
Valerie Gerrand
Department of Political Science, University of Melbourne, VIC
PP: 255 - 271
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
References
Aged Community and Mental Health Division (1996a) Victoria's mental health service: Working with consumers - guidelines for consumer participation in mental health services, Victorian Government Department of Human Services, Melbourne.
Aged Community and Mental Health Division (1996b) In partnership: Families, other carers and public mental health services, Victorian Government Department of Human Services, Melbourne.
Andrews G, Teesson M, Stewart G and Hoult J (1990) Follow-up of community placement of the chronic mentally ill in New South Wales, Hospital and Community Psychiatry 41(2): 184-188.
Auditor General Victoria (2002) Mental health services for people in crisis, Auditor General Victoria, Melbourne.
Australian Health Ministers (1991) Mental health - statement of rights and responsibilities: Report of the mental health consumer outcomes task force, Australian Health Ministers, Canberra.
Australian Health Ministers (1992a) National mental health policy, Commonwealth of Australia, Canberra.
Australian Health Ministers (1992b) National mental health plan, Australian Health Ministers, Canberra.
Bachrach L (1980) Overview: Model programs for chronic mental patients, American Journal of Psychiatry 4(137): 1023-1031.
Bachrach L (1997) Lessons from the American experience in providing community-based services, in Leff J (ed) Care in the community: Illusion or reality? John Wiley & Sons, Chichester.
Bachrach LL (1982) Assessment of outcomes in community support systems: Results, problems, and limitations, Schizophrenia Bulletin 8(1): 39-61.
Bachrach LL (1984) Principles of planning for chronic psychiatric patients: A synthesis, in Talbott JA (ed) The chronic mental patient: Five years later, Grune & Stratton, Orlando FL, pp.165-182.
Bachrach LL and Lamb R (1982) Conceptual issues in the evaluation of deinstitutionalisation, in Stahler GJ and Tash WR (eds) Innovative approaches to mental health evaluation, Academic Press Inc, New York.
Barham P (1992) Closing the asylum: The mental patient in modern society, Penguin Books Ltd, London.
Boardman J (2005) New services for old - an overview of mental health policy, in Bell A and Lindley P (eds) Beyond the water towers - the finished revolution in mental health services 1985-2005, Sainsbury Centre for Mental Health, London.
Commonwealth Department of Health and Aged Care (2000) National mental health report 2000: Sixth annual report. Changes in Australia's mental health services under the first national mental health plan of the national mental health strategy 1993-98, Department of Health and Aged Care, Canberra.
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.
Costar B and Considine M (1992), Introduction, in Considine M and Costar B (eds) Trials in power: Cain, Kirner and Victoria 1982-1992, Melbourne University Press, Melbourne.
De Sisto MJ, Harding CM, McCormick R et al (1995) The Maine and Vermont three decade studies of serious mental illness. II longitudinal course comparisons, British Journal of Psychiatry 167: 338-342.
Dixon LB and Goldman HH (2003) Forty years of progress in community mental health: The role of evidence-based practices, Australian and New Zealand Journal of Psychiatry 37: 668-673.
Ellingsen P (2004) Home to 20, a house that's 'unfit' for care, The Sunday Age 26/12/04, p.10.
Farhall J and Love A (1992) Delivering better mental health services: Staff development as a strategy for change, in Veno A and Thomas D (eds) Psychology and social change: Creating an international agenda, Dunmore Press, Palmerston North, NZ.
Gerrand V (2005) Transforming mental health services from 1993 to 1998 in Victoria, Australia: A case study of policy implementation, PhD thesis, Melbourne.
Green D (2002), Homelessness and mental illness, New Paradigm, April 03-09.
Grose R (1986) Project manager's report to the Minister for Health, Willsmere Hospital - proposed decommissioning strategy, Health Department Victoria, Melbourne.
Harding CM, Brooks GW, Ashikaga T et al (1987) The Vermont longitudinal study of persons with severe mental illness: II long-term outcome of subjects who retrospectively met DSM III criteria for schizophrenia, American Journal of Psychiatry 144: 727-735.
Harkness A (1999) Prognosis negative: Health care economics and the Kennett government, in Costar B and Economou N (eds) The Kennett revolution - Victorian politics in the 1990s, University of New South Wales Press, Sydney.
Health and Community Services (1994) Victoria's mental health service: The framework for service delivery, Psychiatric Services Division, Victorian Government Department of Health and Community Services, Melbourne.
Health and Community Services (1996a) Victoria's mental health service: The framework for service delivery - better outcomes through area mental health services, Victorian Government Department of Human Services, Melbourne.
Health and Community Services (1996b) Victoria's mental health service: The framework for service delivery: Aged persons services, Victorian Government Department of Health and Community Services, Melbourne.
Health and Community Services (1996c) Victoria's mental health service: The framework for service delivery: Child and adolescent services, Victorian Government Department of Health and Community Services, Melbourne.
Health and Community Services (1996d) Purchasing better mental health services in Victoria: 1996-97, Victorian Government Department of Health and Community Services, Melbourne.
Health Department Victoria (1991a) Report of a board of investigation appointed by Mr T Daly, chief general manager, Health Department Victoria, to enquire into certain clinical and management practices at Lakeside hospital Ballarat with specific reference to the death of patient x and the ward twenty two outing of 30 August 1990, Health Department Victoria, Melbourne.
Health Department Victoria (1991b) The investigative task force's findings on the Aradale psychiatric hospital and residential institution, Community Services Victoria and Health Department Victoria, Melbourne.
Healy B and Renouf N (2005) Contextualised social policy: An Australian perspective, in Ramon S and Willams JE (eds) Mental health at the crossroads: The promise of the psychosocial approach, Ashgate, Aldershot.
Hoult J, Reynolds I, Charbonneau Powis M, Weekes P and Briggs J (1983) Psychiatric hospital versus community treatment: The results of a randomised trial, Australian and New Zealand Journal of Psychiatry 17: 160-167.
Hoult J (1983), Psychiatric hospital versus community treatment, Australian and New Zealand Journal of Psychiatry 17: 404-410.
Hoult J (1986), Community care of the acutely mentally ill, British Journal of Psychiatry 149: 137-144.
Hoult J (1992) The Sydney experience, in C Dean and H Freeman (eds) Community mental health care: International perspectives on making it happen, Gaskell and The Centre for Mental Health Service Development, London.
Human Rights and Equal Opportunity Commission (1995) Human rights and mental illness Victoria: Report of the reconvened inquiry into the human rights of people with mental illness (Victoria), Human Rights and Equal Opportunity Commission, Canberra.
Lamb HR and Shaner R (1993) When there are almost no state hospital beds left, Hospital and Community Psychiatry 44(10): 973-976.
Lammers AJ (2002) The reforms to mental health and their impact on the empowerment of consumers and carers, PhD thesis, University of Melbourne.
Leff J, Thornicroft G, Coxhead N and Crawford C (1994) The Taps Project. 22: A five-year follow-up of long-stay psychiatric patients discharged to the community, British Journal of Psychiatry 165(suppl. 25): 13-17.
Lippmann L (1982) Melville evaluated: An experiment in community mental health care, Special Publication No. 11, Mental Health Research Institute, Health Commission of Victoria, Melbourne.
Mahoney J (1988) Finance and government policy, in Lavender A and Holloway F (eds) Community care in practice: Services for the continuing care client, John Wiley & Sons Ltd, Chichester.
Meadows G and Singh B (2003) 'Victoria on the move': Mental health services in a decade of transition 1992-2002, Australasian Psychiatry 11(1): 62-65.
Metropolitan Health and Aged Care Services Division (2002) New directions for Victoria's mental health services - the next five years, Victorian Government Department of Human Services, Melbourne.
Middleton P, Stanton P and Renouf N (2004) Consumer consultants in mental health services: Addressing the challenges, Journal of Mental Health 13(5): 507-518.
Moynihan P (1992) The fear effect: An exploration of attempts to introduce reform into public psychiatry, PhD thesis, La Trobe University.
National Community Advisory Group on Mental Health (1994) Let's talk about action: Redressing human rights abuse, discrimination and inequity in the community's response to the plight of people with a mental illness or a psychiatric disability, National Community Advisory Group on Mental Health, Canberra.
Neami (2002) Annual Report 2002, Melbourne.
Office of Psychiatric Services (1991) Continuing Victoria's reform of psychiatric services general information sheet, Office of Psychiatric Services, Melbourne.
Office of Psychiatric Services (1992a) Policy and strategic directions for public psychiatric services in Victoria, Health Department Victoria, Melbourne.
Office of Psychiatric Services (1992b) Audit of standards of treatment and care in psychiatric hospitals in the state of Victoria, Health Department Victoria, Melbourne.
Osborne D and Gaebler T (1992) Reinventing government: How the entrepreneurial spirit is transforming the public sector, Plume, New York.
Patmore C and Weaver T (1991) Community mental health teams: Lessons for planners and managers, Good Practices in Mental Health, London.
Psychiatric Services (1993b) Victoria's health reforms: Psychiatric services - discussion paper, Victorian Government Department of Health and Community Services, Melbourne.
Psychiatric Services Branch (1994) Victoria's mental health services: Improved access through coordinated client care, Health and Community Services, Melbourne.
Ramon S (1988) Community care in Britain, in Lavender A and Holloway F (eds) Community care in practice: Services for the continuing care client, John Wiley & Sons Ltd., Chichester.
Richmond D (1983b) Inquiry into health services for the psychiatrically ill and developmentally disabled, Part 3 Mental Health Services and Services for the Mentally Ill, NSW Department of Health, Sydney.
Rimmer JR, Buckingham WJ and Farhall JF (1988) Achieving continuity of care in comprehensive psychiatric service systems - Victoria's approach, Office of Psychiatric Services, Health Department, Victoria, Melbourne.
Robson B (2000) From philanthropy to profession - the evolving identity of psychiatric disability services, New Paradigm August 8-14.
Rosen A (1992) Community psychiatry services: Will they endure? Current Opinion in Psychiatry 5: 257-265.
Rosen A (1999), From colonial rivalries to a national mental health strategy, in Thornicroft G and Tansella M (eds) The mental health matrix: A manual to improve services, Cambridge University Press, Cambridge.
SANE (2004) Sane mental health report 2004, SANE Australia, Melbourne.
Shepherd G (1998) Models of community care, Journal of Mental Health 165-177.
Social Development Committee (1985) Inquiry into the future use of Willsmere hospital, Social Development Committee, Parliament of Victoria, Melbourne.
State of Victoria (1986) Mental Health Act 1986, Reprinted incorporating amendments as at 01 June 2000.
Stein LI and Test MA (1980) Alternative to mental hospital treatment: 1. Conceptual model, treatment program and clinical evaluation, Archives of General Psychiatry 37: 392-397.
Stein LI (1992a) Creating change: A case study, in Dean C and Freeman H (eds) Community mental health care: International perspectives on making it happen, Gaskell and the Centre for Mental Health Services Development, London.
Stein LI (1992b) Innovating against the current, in Stein LI (ed) Innovative community mental health programs, Jossey-Bass Publishers, San Francisco, vol. 56.
Stroul BA (1986) Models of community support services: Approaches to helping persons with long-term mental illness, National Institute of Mental Health, Boston.
Suicide Prevention Taskforce (1997) Report of the taskforce on suicide prevention, Victoria Government Department of Human Services, Melbourne.
Talbott JA (1979), Deinstitutionalization: Avoiding the disasters of the past, Hospital and Community Psychiatry 30(9): 621-624.
Thompson KS and Griffith EEH (1990) A historical review of the Madison model of community care, Hospital and Community Psychiatry 41(6): 625-634.
Thornicroft G and Bebbington P (1989) Deinstitutionalisation - from hospital closure to service development, British Journal of Psychiatry 155: 739-753.
Tobin MJ (1993) Inquiries at Lakeside and Aradale hospitals: Lessons and advances? ANZ Journal of Psychiatry 27: 333-340.
Turner-Crowson (1993) Reshaping mental health services: Implications for Britain of US experience, Research Report No. 16, King's Fund Institute, London.
Wadsworth Y and Epstein M (2005) Book review of From Signposts to Pathfinders - Consumer Evaluation of Consumer Participation in Mental Health Services in Victoria. Evidence-based strategies for the way ahead. By Allan Pinches, New Paradigm March: 48-55.
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