Academic journal article Health Sociology Review

The Influence of Service Users and NGOs on Housing for People with Psychiatric Disability

Academic journal article Health Sociology Review

The Influence of Service Users and NGOs on Housing for People with Psychiatric Disability

Article excerpt

South Australia has long been influenced by a national mental health reform agenda, with the National Mental Health Strategy first introduced in 1992. Service user and carer participation within mental health policy and services has been promoted systemically in Australia since the introduction of the National Mental Health Strategy. The evaluation of the first National Mental Health Plan (Australian Health Ministers 1992b) claimed moderate progress in the achievement of consumer rights through mental health legislation review, anti-discrimination legislation and consumer advisory groups (National Mental Health Strategy Evaluation Steering Committee 1997). Nevertheless, the evaluation of the Second Mental Health Plan arising from this Strategy found that there was more scope for mental health services to establish partnerships with consumers, and particularly carers and families (Steering Committee for the Evaluation of the Second National Mental Health Plan 2003). Subsequently, the National Mental Health Plan 2003-2008 resolved to develop increased levels of full and meaningful consumer, family and carer participation in policy and in-service planning, delivery and evaluation at all levels with evidence of improvement in quality (Australian Health Ministers 2003:24).

The first National Mental Health Plan was supported by the Mental Health Statements of Rights and Responsibilities (Australian Health Ministers 1991) which included citizenship rights such as equitable access to housing. However, recent Australian mental health policy has been criticised for diverting from the realisation of 'citizenship rights'. For example, Rees (2003) argues that the first National Mental Health Policy (Australian Health Ministers 1992a) did not meet its human rights targets, and that the human rights focus was lost in the second National Mental Health Plan (Australian Health Ministers 1998). SANE Australia (2004) similarly claimed that rights enshrined in legislation have not been upheld, whilst the Mental Health Council of Australia (2005) pointed to the absence of a rights discourse in the second plan. Conversely, Hazelton (2005) observes that mental health policy in Australia has focused on improvements in treatment services, whilst overlooking the rights necessary to participate fully in life. It has also been argued that a greater focus on 'carer participation' in mental health policy has in fact served to create expectations for more privatised family care within a neo-liberal policy context (Henderson 2005).

These observations raise questions regarding the focus of 'participation' and advocacy activity for service users and their families. One prominent criticism of community participation in a mental health context is that 'participation' often becomes an end in itself, rather than a means to achieve improved social-structural conditions (Barnes and Bowl 2001). Following Arnstein's (1969) critique of 'therapy' as a form of participation, Barnes and Bowl (2001) warn that empowerment activity could be co-opted as a tool of therapeutic intervention of professionals, rather than a means to developing material and social change. Perceiving empowerment as an end-goal is seen as an obstacle to such change (Barnes and Bowl 2001). More empowering forms of community participation have been associated with political advocacy and coalition building (Carlisle 2000; Laverack 2005), access to decision-making affecting resources (Oakley 1991; Carlisle 2000; Laverack 2005), or increased control over life choices (Somerville 1998; Grace 1991).

This paper considers the relationship between participation within mental health and housing policy and progress toward the achievement of the universal human right to housing. Housing outcomes are a particular focus due to documented issues that people with mental illness have had with accessing housing and the experience of homelessness in Australia, since the time of the Burdekin Report (HREOC 1993). …

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