From deinstitutionalisation to consumer empowerment: mental health policy, neoliberal restructuring and the closure of the ‘Big bins’ in Victoria

Prioritising Supported Decision-Making: Running on Empty or a Basis for Glacial-To-Steady Progress?

“…Article 12(3) follows articulation of the rights to 'recognition everywhere as persons before the law' (Art 12(1)) and to 'enjoy legal capacity on an equal basis with others in all aspects of life' (Art 12(2)). As is well known, the General Comment issued by the monitoring Committee for the CRPD reads Article 12 as requiring immediate withdrawal of any 'substitute' decision-making such as adult guardianship, or proxy-decisions such as under involuntary mental health powers (UN Committee on the Rights of Persons with Disabilities 2014; 3 Disability history reminds us of egregious unintended consequences of lofty principles such as deinstitutionalisation (Gooding 2016;Wiesel and Bigby 2015). Arstein-Kerslake and Flynn 2015, pp.…”

‘The government is the cause of the disease and we are stuck with the symptoms’: deinstitutionalisation, mental health advocacy and police shootings in 1990s Victoria

“…Tehan, interestingly, was reported to have replied in a letter to Burdekin, that 'private hotels were not her department's responsibility' (The Age, September 27, 1994), implying that those in crises beyond the bounds of hospitals and mental health facilities fell outside the remit of her department. This suggests there were some ambiguities about the governance of the 'mixed economy' of mental health services, which were comprised of public, private and quasi-private services subcontracted by government (see Gooding 2016). In the face of criticism from service users, families, professionals, and concerned public, the head of the psychiatric services division, Jennifer Williams, emphasized the slow process of systemic change: '[m]ental health reform is not going to be achieved in one year.…”

“…Although the policy of deinstitutionalization can be seen to have begun in Australia from the 1950s onward (Gooding 2016), the final decade of the 20th century proved a crucial tipping point in the closure of large-scale standalone psychiatric hospitals in Victoria. Between 1994 and 2000, all 14 of Victoria's standalone psychiatric hospitals were closed (Gerrand 2005).…”

“…'Community Treatment Orders' (or 'CTOs' as they are often referred to) provided for new forms of coercive intervention outside the hospital (MHA 1986; s14(2)), which extended the spaces of treatment, control and regulation to homes and residences (Gooding 2016). Conditions could be imposed on former inpatients discharged from hospital and typically entailed medication compliance.…”

What Justice, What Autonomy? The Ethical Constraints upon Personalisation

“…Across much of the developed world, including Australia, Canada, the USA, and Europe, the principle that services ought to become more personalised and sensitive to the demands of individual service users has driven innovation within health and social care services (Bonfils and Askheim, 2014;European Commission;Gooding, 2016;Lord and Hutchinson, 2003;Ungerson and Yeandle, 2007). Advocates of personalisation often characterise it not merely as a strategy for creating more efficient, higher quality services but also as a means of achieving ethically important goals (Mladenov et al 2015).…”