With Mark’s blessing, I thought I’d check the view from on top too. Two weeks out from the provision of the Palmer Inquiry to Minister Vanstone — which is set to uncover, amongst other things, that Cornelia Rau didn’t receive psychiatric treatment for some 3 months — I wanted to give a very brief history of changes to mental health provision in New South Wales. I suppose it’s also a follow up to Naomi’s post on homelessness and, also, gives some political background to Kate’s wonderful piece on disability.
Halfway through the dilapidated sprawl of North Ryde, on my last trip to Macquarie University as an undergraduate, my bus pulls up to lights. Across the other side of a waist-high iron fence is a nondescript red brick house — probably some kind of community housing. A man with a navy jumper and worn brown pants is awkwardly holding a rake as he makes a slow, stunted shuffle across a leaf strewn lawn. He has awful posture. He pauses after just a few steps and looks up. I wonder when a carer visited last.
A few months before I was born, in 1982, then N.S.W. Minister for Health Laurie Brereton, announced the establishment of an inquiry into health services for the psychiatrically ill and developmentally disabled. Submissions were called for, a call-in was organised, sites were visited and eight months later, The Richmond Report, was published.
With the walls around the infamous Callan Park Hospital knocked down some two decades earlier, a plan of action for deinstitutionalisation was long overdue. The 1961 McClemens Royal Commission into that institution which led to this symbolic recognition of patients’ rights found overcrowding, inadequately skilled staff, and appalling conditions for patients and staff. Erving Goffman coined the term ‘total institutions’ in his classic work on Asylums (published that same year) to critique these microcosms of authoritarian, rationalised bureaucracy — bifurcated between patient and staff worlds. Moreover, the very basis of institutionalisation was coming under scrutiny alongside criticism of practical administration. Szasz weighed in, wrestling with Cartesian dualism to the point where psychiatric diagnoses were no longer medical but behavioural pathologies; a point also expressed in Foucault’s genealogical works on normality and madness. In their own ways, these critiques exposed a vicious cycle of institutionalisation: highly bureaucratised structures of contemporary patient life fostered the dependence on routine and pathological behaviours on which the legitimacy of institutions hinged.
Libertarian advocacy groups for sufferers of mental illness began exploring patients rights by suing doctors and hospitals in the 1970s. The movement for deinstitutionalisation also led to the articulation rights of the mentally retarded (uttered in 1971 included the right to work) as well as seeking greater transparency in admission and treatment. In 1970, the landmark ruling by the Supreme Court in Allen v Superintendent of Callan Park required hospitals to have cases of involuntary admission brought before a magistrate for approval as soon as feasible. During this time, it was all too common for patients to be discovered suffering conditions normally thought of being ‘outside the current orthodox definitions of mental illness.’ In other words, whether their vulnerability and dependence was a result of mental illness, the effects of long term institutionalisation, or cognitive incapacity was often unknown or somehow lost to the staff.
However, the oil price shocks precipitated a crisis in the welfare state throughout the 1970s; and the lacerations of stagflation would eventually be operated on during various Wran budgets. The health care rationalisation under that government followed Fraser’s carving up of Medibank which begs the question - why David Richmond wasn’t called upon 5 years earlier?
The 15 years to 1991 would see the national ratio of the population in psychiatric institutions fall by more than two thirds; whilst the ratio of disability hostel accommodation would more than triple during that time. However, 1991 also marked a new recognition for patients’ rights which the Richmond Report had articulated, but never really saw the light of day. It was a vision of community based psychiatric health service delivery during the major structural economic reforms, and there was industrial relations turmoil. Remaining mental institutions were destined for underfunding and understaffing and would languish as fiscal priorities at least until the election of the Greiner Government.
I don’t want to go into the details of the Richmond Inquiry here. David Richmond spells out the major changes here (pdf). I suppose two things really stand out for me in terms of our responsibilities to provide services to the mentally ill and, also, the developmentally disabled since his recommendations were largely adopted two decades ago.
Firstly, despite the Richmond Report making strange bedfellows of economic reformists, fiscal rationalists, and libertarian social movements, were the recommendations just a bit too convenient? The coming of the Post-Industrial Society, as the brilliant sociologist Daniel Bell labelled it a decade earlier, would see enormous pressure on the marketplace being able to support unskilled/low literacy positions in affluent liberal democracies across the globe. Moreover, the leap of the Sydney Olympic Committee members after Juan Antonio’s fatefully uttered ‘the winner is Sydeney’ would, I believe, mark a new fin-de-siecle spirit in this town; the worst manifestation being the growing conspicuousness of latte sipping inner city glitterati. Richmond’s colleagues arguably couldn’t have foreseen changes to the stratification of the city which have developed. Perhaps the overcrowding of homeless shelters and unintentional delegation of treatment to staff there — tasks previously carried out under the authoritarian gaze of qualified men behind closed doors — are the ugliest credentials for membership into the club of elite knowledge-based cities with the likes of New York and Tokyo.
Secondly, mentally ill and developmentally disabled persons are overrepresented in the state’s jails. How many cases like Cornelia Rau’s interstate wandering will it take for us to seriously re-evaluate how the ethic of ‘least restrictive’ service provision intersects with a tough on Laura Norder rhetoric which has seen the total N.S.W. prison population rise by 50% in the last 10 years? I say seriously evaluate because it faces two formidable opponents: fiscal rationality ($50 000 per prisoner per annum vs. $200 000 per mental health bed in a public hospital per annum) and great soundbites (’keeping more criminals off the streets’). As long as it must compete with handing down less taxing balance budgets and being able to stay ‘tough on crime’ for headlines and 6pm news time, I suppose it’s never really going to happen.
“dilapidated sprawl of North Ryde” ???
I’m sorry but have you actually spent any time in Nth Ryde or just cruised down Epping Rd on a bus? Having grown up there (and left) there is lots of bad things I can say about it but its hardly dilapidated. Just standard middle class suburbia.
I now live in a “latte sipping inner city” area where, perhaps because they are more visible in a densly packed suburb, I see more people who are clearly the once institutionalized. I just don’t see this stratification you are talking about. It seems you are generalizing a lot from casual observations.
Steve is right.
I have lived around this area most of my life ( Ryde, eping, West Ryde, Eastwood)
and I think the Eastern suburbs are far worse.
The richmond report was merely an excuse for the State government to spend less money Psychiatric care.
Patients out in the public sounds good but it was and is a disaster
We shouldn’t be too hard on DIMIA, Qld Police, Baxter officials, etc for not recognising the odd mental health problem, when 47.3% of the community couldn’t and still can’t it seems http://news.ninemsn.com.au/article.aspx?id=20125
OTOH perhaps it’s all a bit taboo and just best to be sorry.
I suspect the dagginess or otherwise of Ryde is moot. The key thing is that ppl are entrusted to the care of the “community”. What that really means is that in inner city suburbs, real estate agents put out glossy brochures about the “colouful street life”. What they don’t mention is that you have to give $5 per block (if yr a nice person) to the deinstituionalised folk whose boarding houses have been sacrificed on the altar of development. Some community…
ps - excellent post, dk.au.
I’m not sure the least restrictive principle has been ‘a disaster’ though. The science, ethics and administration of institutions weren’t sound. That’s pretty clear. I think evaluations need to separate the ‘pure thinking’ behind deinstitutionalisation, as Richmond articulated it, from how various Governments have funded the recommendations.
As for this ‘invisible stratification’, well perhaps there would be more breadth for outrage if Kim was spot on and it was direct displacement like that (and there may be cases where that has happened). But my point is more that rush to cut expenditure downplayed the necessity for integration and ongoing support services and infrastructure. Less handicapped/ill are better off, but at what cost?
A significant part of the problem is that we don’t really know enough about it eg. reliable data on the number and characteristics of homeless, the number of mentally ill who need ongoing treatment but end up in prison/Baxter etc.
dk.au, I can’t comment on Sydney because when I visit I only inhabit Glebe and/or Newtown, but Brisvegas is full of cases of direct displacement… our host Mark lives in New Farm which was heroin addict/corruption/prostitution central in the late 80s/early 90s. Now it has the second highest house prices in Brissie (ave = 800k) behind the old money citadels on Hamilton Hill. A few years ago, there was a protest in NF Park where they erected 60 crosses to symbolise the number of boarding houses demolished in the interest of land value.
So you get heaps of crazy, dirty folk on the streets.
And sometimes - and it’s happened twice since I’ve been living in Bris again after I moved back from the states, you come across cops in NF Park putting a blanket over dead people.
I live over the river in Bulimba which used to be a mega dockies/wharfies area, but is now gentrified central - where our local member Kevin Rudd MP goes to the very beautiful weatherboard High Anglican church on Oxford St on Sundays. It’s also a big dyke area (YAY!). But the inner city Brissie suburbs are object lessons in the degree to which there is no longer any “community” in which eccentric and a bit odd ppl can live (I’m with Foucault and Szasz on this one)…
It’d probably be much quicker for me to list the suburbs within 5kms of the GPO here which don’t have an average house price of $800k, high crime rates and some homeless population.
But bugger it. Long live Gesellschaft. Gemeinschafts don’t have iPods.
Two things, dk.au
Average house price in Brissie is
Yikes my comment died, and can’t be retrieved!
I think what I was trying to say was that the average house price in Bris is less than 300k.
Ok, my point was… ??? that what has gone from being a very heterogenous area… bifurcated from the 1860s onwards with narrow streets and workers’ cottages on the left of Brunswick St and very wide streets, beautifully fig lined and with big blocks on the right (river) side of Brunswick St, has increasingly become homogenous… to the detriment of genuine life (ie colourful street life in the real estate brochures…) but it still has a nice urban feel, and benefits greatly from being queer central of Brissy… but the new SUV driving massive mortgage paying Liberal voting yoof who want to buy into the area really put pressure on the Council to clear crazy mad folks off the street… not to mention Murris. Sad!
ps - Mark lives on the nice fig tree lined side of the street… which is one of the reasons why I go visit…
ps - it’s been a long, long time since there was any Gemeinschaft in Oz.
I used to visit friends who lived opposite that kitsch shop on Brunswick (absolutely something or other - I think its called) and from their balcony we’d get a slab of beers and sit and watch the hookers ply their trade.
Not the slimy part but the whole car stops, windows open, car parks around the corner, woman gets in and 3 minutes later gets out, car drives away part. Used to beat Channel 7, I tell you that much.
When these guys sell out, you know you’re pretty unlikely to find one anywhere. But that’s for another time…
What the hell goes on with the news/ninemsm links sometimes? My above link was to an article where Jeff Kennett, who had initially said Mark Latham was bipolar and gave his reasons for saying so, had to retract that and apologise after Latham rang him up rather angrily. The link is now to Beasley on IR reforms and a search can’t find the original article now. I have experienced this before. Do the news networks pull some stories, perhaps after legal advice?
Hmmm? Found this very watered down article here http://www.news.com.au/story/0,10117,15778643-2,00.html
Who knows observa. Sounds plausible. Or they could have a really strange site policy. I did read (hear?) another report in the last couple of days where Kennett wondered if Latham was sufferring from some sort of depression. And yeah, I was expecting, and heard the questions on programs like 7.30 Report as to whether Latham was unstable or ‘mad’.
Ah yes, here we go, o: here, here, here, here….take your pick.
I wonder too if some commentators and bloggers (eg Slatts) should perhaps apologize for suggesting that Latham’s pancreatitis was due to alcoholism.
I worked in a sandwich shop in Fitzroy for three years, and got to know many of the local down and outs. The poor and insane and weak preyed upon each other with terrible regularity. A woman who lived in the same street as the shop and had lived there since 1962 told me how she had been twice raped by another deinstitutionalised local fixture, the same man who had been banned from our shop because he would come in and announce that he could smell cunt juice. This man was later hit by a car on Brunswick St and killed.
Well Saint, they’re all very watered down versions of the comprehensive quoting of Kennett I read in the ninemsn news link originally. It also said Kennett withdrew and apologised after Latham rang him up angrily, etc. Seems to me the legal eagles got involved and it was pulled.
cmon observa - show us your google cache hunting skills…