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

ABSTRACT

The paper presents an historical critical policy analysis of deinstitutionalisation and the introduction of neoliberal forms of governance in mental health policy. It focuses particularly on a major period of policy reform in the 1980s and 1990s in Victoria, Australia. Many of the particularities of the Victorian experience can be generally observed with deinstitutionalisation throughout the world. In particular, the policy discourse of rights and entitlements, consumer choice and empowerment, at times stood in tension with the service void created by the transition from large, stand-alone psychiatric institutions, to dispersed forms of service provision outside the hospital. Further, certain policy features could be seen to perpetuate patterns of coercion, abuse and neglect. This article offers a number of potential lessons for mental health law, policy and practice today, which is poised for further advances of neoliberal governance, including through the policy of personalised services, individualised disability funding and human rights-based reform.

KEYWORDS:

• Mental health policy
• mental health law
• deinstitutionalisation
• involuntary treatment
• neoliberalism

Acknowledgements

I would like to thank the anonymous reviewers for their valuable feedback on this article. Thanks also to my colleague, Dr Penelope Weller, for her helpful reflections on an earlier draft of this paper.

Disclosure statement

No potential conflict of interest was reported by the author.

ORCID

Piers Gooding http://orcid.org/0000-0001-5743-5708