Academic journal article Health Sociology Review

From Deinstitutionalisation to Consumer Empowerment: Mental Health Policy, Neoliberal Restructuring and the Closure of the 'Big Bins' in Victoria

Academic journal article Health Sociology Review

From Deinstitutionalisation to Consumer Empowerment: Mental Health Policy, Neoliberal Restructuring and the Closure of the 'Big Bins' in Victoria

Article excerpt

Introduction

In Australia, the fastest and most comprehensive transition from large-scale psychiatric institutions to a dispersed mental health 'system' occurred in Victoria in the 1980s and 90s (Commonwealth Department of Health and Aged Care, 2000; Gerrand, 2005; Meadows & Singh, 2003). This process of deinstitutionalisation saw the depopulation of stand-alone psychiatric institutions and the dispersal of authority for service provision and coercive powers to a range of entities in society, such as hospitals, communitybased services and mental health tribunals. By the early 1990s, mental health policy had transformed under so-called neoliberal governance (sometimes referred to as 'new public management') setting an important precedent for policy change throughout Australia (Carney, 2008).

In Victoria, Australia's second most populous state, a period of intense reform occurred between 1994 and 2000 in which all 14 stand-alone psychiatric institutions were closed (Gerrand, 2005). The closures were celebrated as an example of progressive mental health policy to treat mental illness 'in the least restrictive environment possible' (MHA 1986 (Vic)). Commentators have noted the significance of this era in redefining the nature and standard of mental health services (see Gerrand, 2005; Lammers, 2002; Meadows & Singh, 2003). The 2000 federal government National Mental Health Report, for example, stated that 'the degree of structural change achieved by Victoria was greater than the efforts of all other jurisdictions combined' (Commonwealth Department of Health and Aged Care, 2000, p. 36).

The Victorian reforms aimed to promote social inclusion by giving greater power to mental health service users. This policy objective was sought in relation to people with disabilities generally, including people with intellectual disabilities, whose treatment in law and policy was entwined with the mental health context in important (if somewhat ambiguous) ways. A system of hospital and community-based services were created, and socalled 'rights-based legalism' saw the development of greater procedural protections over involuntary treatment and detention (MHA, 1986 (Vic)). These changes reflected a discursive policy shift from viewing people in mental health crises as passive recipients of care to citizens with agency and civil rights, capable of deciding on (and refusing) available support services. Yet the service void created in this transition, combined with certain regulations which perpetuated patterns of exclusion and control, led to the disadvantage of people with mental health crises in new - though sometimes familiar - ways (see HREOC, 1993; HREOC, 1995).

This article will chart some of these contradictory outcomes within the broader sociohistorical picture of Victorian mental health policy and practice. Although this article pursues an historical, critical policy analysis, it is presented with an eye to contemporary developments, such as the United Nations Convention on the Rights of Persons with Disabilities (which came into force in 2008), contemporary disability and mental health policy and the current era of global financial austerity and continued privatisation of government services. In this sense, the paper reflects Rose's(1994, p. 53) model of a 'history of the present,' which he formulates as an investigation 'from the point of view of a problem that concerns one today, the diverse connections and liaisons that have brought it into existence and given its saliency and its characteristics' (see also Weller, 2015). For Rose (1994, p. 53), this includes an unearthing of the ways in which 'practices of truth situate persons in particular relations of force'. To do so, the first section will provide background by briefly sketching the fall of the asylum-era in Victoria, considering the development of the post-war welfare state, and the increasing medicalisation of mental health law, policy and practice. …

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