From mental hygiene to community mental health: Psychiatrists and Victorian public administration from the 1940s to 1990s

This paper offers an overview of public policy in Victoria as it changed its approach to the treatment and prevention of mental illness from the late 1940s to the 1990s. While this has come to be understood as a move away from institutional to community care, I argue that there is still a great deal to understand about how government policy managed this process and how the concepts beneath community mental health have been applied. In this paper I look at the role of psychiatry and suggest that during this period there were a range of ways psychiatrists came to influence public policy. I pay particular attention to the perspectives of the first chairman of the Mental Hygiene Authority, the psychiatrist Eric Cunningham Dax (1908-2008). I hope to offer insights into the way debates and perspectives about mental health evolved in Victoria by looking at government archives from the period and contextualising them within the internal debates within psychiatry. There are three factors that are suggested as defining features in this policy environment. The first was the move in the locus of treatment from a hospital setting to a community setting, fuelled by improved medication and the high costs of maintaining old and large separate institutions. The second was the changing role of psychiatrists, in response to their increased role in the community. The third was the administrative amalgamation of health and mental health from the 1970s which enabled a generic model of health promotion to become a public policy priority. The paper draws on the available public records to describe the story of how government modified its approaches over time. Records which reflect these policy debates have been accessed through Public Record Office Victoria, the Department of Human Services, and the Royal Australian and New Zealand College of Psychiatrists. It concludes with a recommendation that further research be conducted in this area across State and Commonwealth governments to identify how government achieved a shift in mental health care into the community and what this meant for services, staff and patients.