Archives
From therapy to administration: deinstitutionalisation and the ascendancy of psychiatric 'risk thinking'
Anne-Maree Sawyer
School of Social Sciences, La Trobe University, Melbourne, Victoria, Australia
Abstract
Crisis Assessment and Treatment Teams (CAT Teams) were established in Victoria in 1988 to provide crisis intervention and home treatment as an alternative to hospitalisation for the seriously mentally ill. These teams were set up to prepare for the closure of the large-scale, state-run psychiatric institutions over the following decade. Increasingly, concerns are being expressed in the media over the failure of the new community-based services to provide adequate care and protection to the mentally ill. This paper offers a preliminary attempt to make sociological sense of one such aspect of deinstitutionalisation, the major changes that have occurred in the practice and delivery of CAT Team services since inception. I suggest that a shift has taken place from a therapeutic consciousness, centred on providing home treatment, to a risk consciousness, centred on protocols to evaluate and document a client's 'risk factors'. Drawing on my personal experiences as a clinician in a Melbourne-based CAT Team since 1991, I probe these changes through the lens of sociology. In so doing, I utilise several insights from Nikolas Rose's (1998) analysis of risk as a foundation for social intervention.
Keywords
deinstitutionalisation, psychiatry, sociology, risk, therapy, administration
References
Abercrombie, N. and Urry, J. (1983) Capital, Labour and the Middle Classes London: Allen and Unwin.
Andrews, F. (1995) 'A psychiatric crisis assessment and treatment (CAT) service in Victoria' Mental Health in Australia July and December: 22-24.
Beaumont, L. (2005) 'Saving teens from the hell of mental illness' Melbourne: The Sunday Age January 9.
Beck, U. (1992) Risk Society: Towards a New Modernity London: Sage.
Beck, U. (1999) World Risk Society Cambridge: Polity Press.
Beck, U. (2000) 'Living your own life in a runaway world: individualisation, globalisation and politics' in W. Hutton and A. Giddens (eds) On The Edge: Living with Global Capitalism London: Vintage, pp. 164-174.
Beck, U. and Beck-Gernsheim, E. (2001) Individualization: Institutionalized Individualism and its Social and Political Consequences (translated by Patrick Camiller) London: Sage.
Braverman, H. (1974) Labor and Monopoly Capitalism: The Degradation of Work in the Twentieth Century New York: Monthly Review Press.
Brett, J. (2003) Australian Liberals and the Moral Middle Class: From Alfred Deakin to John Howard Port Melbourne, VIC: Cambridge University Press.
Canter, A. (1984) 'Contemporary short-term psychotherapies' in R. A. Munoz (ed.) Therapeutic Potential of Mood Disorders Clinics - New Directions for Mental Health Services (No. 23) San Francisco: Jossey-Bass, pp. 13-31.
Considine, M. (1994) Public Policy: A Critical Approach Melbourne: Macmillan.
Considine, M. (2001) Enterprising States: The Public Management of Welfare-to-Work New York: Cambridge University Press.
Craighead, W. E., Hart, A. B., Craighead, L. W. and Ilardi, S. S. (2002) 'Psychosocial treatments for major depressive disorder' in P. E. Nathan and J. M. Gorman (eds) A Guide to Treatments that Work (2nd ed.) New York: Oxford University Press, pp. 245-261.
Denzin, N. K. (1989) Interpretive Interactionism Newbury Park, CA: Sage.
du Gay, P. (1999) 'Setting limits to enterprise' The Review of Education/ Pedagogy/ Cultural Studies 21(3): 227-246.
Editorial (2004) 'Australia through the looking glass for the mentally ill' Melbourne: The Sunday Age December 12.
Editorial (2005) 'Caring for the forgotten people' Melbourne: The Age February 18.
Elder, J. (1995) 'Searching for a kinder, gentler force' Melbourne: The Sunday Age June 18.
Ellingsen, P. (2004a) 'Holding bays doling out "sub-humane care"' Melbourne: The Sunday Age December 12.
Ellingsen, P. (2004b) 'The shame of our "forgotten people"' Melbourne: The Sunday Age December 12.
Ellingsen, P. (2005) 'More beds needed for mentally ill' Melbourne: The Sunday Age January 9.
Ellis, C. and Bochner, A. P. (2000) 'Autoethnography, personal narrative, reflexivity: researcher as subject' in N. K. Denzin and Y. S. Lincoln (eds) Handbook of Qualitative Research (2nd. ed.) London: Sage, pp. 733-768.
Ellis, P. M. and Smith, D. A. R. (2002) 'Treating depression: the beyondblue guidelines for treating depression in primary care' The Medical Journal of Australia (Supplement) 176: 77-83.
Foucault, M. (1991) Discipline and Punish: The Birth of the Prison (translated by Alan Sheridan) Harmondsworth: Penguin.
Fulford, M. and Farhall, J. (2001) 'Hospital versus home care for the acutely mentally ill? Preferences of caregivers who have experienced both forms of service' Australian and New Zealand Journal of Psychiatry 35: 619-625.
Giles, T. (2004) 'Bed crisis blamed for deaths' Melbourne: Herald Sun February 19.
Gregory, P. (1994) 'Coroner deplores ill man's treatment' Melbourne: The Age January 5.
Gurvich, M. (1994) 'Record of investigation into death', case no. 174/93 Melbourne: Victorian Public Records Office.
Holstein, J. A. and Gubrium, J. F. (2000) The Self We Live By: Narrative Identity in a Postmodern World New York: Oxford University Press.
Hoult, J. (1986) 'Community care of the acutely mentally ill' British Journal of Psychiatry 149: 137-144.
Kalucy, R., Thomas, L. and King, D. (2005) 'Changing demand for mental health services in the emergency department of a public hospital' Australian and New Zealand Journal of Psychiatry 39: 74-80.
Kenny. S. (2004) 'Risk and contemporary life' Professorial Lecture, Deakin University, Burwood Campus (Melbourne), November 3. http://www.deakin.edu.au/arts/news.php#professorial
Krieger, S. (1991) Social Science and the Self: Personal Essays on an Art Form New Brunswick, NJ: Rutgers University Press.
Meadows, G., Singh, B., Burgess, P. and Bobevski, I. (2002) 'Psychiatry and the need for mental health care in Australia: findings from the National Survey of Mental Health and Wellbeing' Australian and New Zealand Journal of Psychiatry 36: 210-216.
Nader, C. (2004) 'Suicide warning for mentally ill' Melbourne: Herald Sun February 19.
Painter, M. (1997) 'Public management: fad or fallacy?' in M. Considine and M. Painter (eds) Managerialism: The Great Debate Carlton, VIC: Melbourne University Press, pp. 39-43.
Pegler, T. (1993) 'Coroner urges tight surveillance for psychiatric patients' Melbourne: The Age June 19.
Powell, T. J., Yeaton, W., Hill, E. M. and Silk, K. R. (2001) 'Predictors of psychosocial outcome for patients with mood disorders: the effects of self-help group participation' Psychiatric Rehabilitation Journal 25(1): 3-11.
Power, M. (1997) The Audit Society: Rituals of Verification Oxford: Oxford University Press.
Rose, N. (1996) Inventing Our Selves: Psychology, Power, and Personhood Cambridge: Cambridge University Press.
Rose, N. (1998) 'Governing risky individuals: the role of psychiatry in new regimes of control' Psychiatry, Psychology and Law 5(2): 177-195.
Santor, D. A. and Kusumakar, V. (2001) 'Open trial of interpersonal therapy in adolescents with moderate to severe major depression: effectiveness of novice IPT therapists' Journal of the American Academy of Child and Adolescent Psychiatry 40(2): 236-240.
Sennett, R. (1998) The Corrosion of Character: The Personal Consequences of Work in the New Capitalism New York: Norton.
Smith, D. E. (1987) The Everyday World as Problematic: A Feminist Sociology Boston: Northeastern University Press.
Stein, L. I. and Test, M. A. (1980) 'Alternative to mental hospital treatment. 1: Conceptual model, treatment program and clinical evaluation' Archives of General Psychiatry 37: 392-397.
Victorian Government (1986) Victorian Mental Health Act 1986 Melbourne: Victorian Government Printing Office.
Victorian Government Department of Health and Community Services (1994) Psychiatric Crisis Assessment and Treatment Services: Guidelines for Service Provision Melbourne: Psychiatric Services Division.
Weber, M. (1978 [1922]) Economy and Society, Volume I: An Outline of Interpretive Sociology (translated by Ephraim Fischoff et al., edited by Guenter Roth and Claus Wittich) Berkeley: University of California Press.
Wilmoth, W. (1993) 'Record of investigation into death', case nos. 3902/91, 3903/91, 3904/91, 3905/91 Melbourne: Victorian Public Records Office.
Winkler, T. (1995) 'Health cuts blamed for death' Melbourne: The Age August 14.
eContent Home