Disaster responses and Commonwealth involvement in community mental health, 1973–1975

Abstract

Mental health was not part of the official government response to Cyclone Tracy in 1974–1975. However, the appearance of mental health in disaster responses was subsequently dated from this time. For much of the twentieth century, the Commonwealth had no involvement in mental health services. This did not change until 1973 when it intervened in community mental health services. This article introduces the historical context to the Commonwealth’s change in policy. It outlines the management of mental distress in the Northern Territory during the mid-twentieth century, when the federal government governed the Territory, and identifies concurrent changes in psychiatric practices. Analysis of federal legislation for community mental health services (1973) is made in conjunction with a consideration of the absence of mental health from the (federally-led) official response to Cyclone Tracy. It demonstrates that this absence exposed the structural division between hospital and community mental health care, and argues the separation had significant consequences.

Keywords:

• Mental health
• psychiatry
• commonwealth
• disaster responses
• community mental health services
• disaster studies
• medical history

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 ‘300 an Hour Leave Darwin: 1000 to go’, Papua New Guinea Post-Courier, 30 December 1974, 6. ‘The Tragedy of Darwin’, Australian Women's Weekly, 15 January 1975, cover; 2–11.

2 ‘The Tragedy of Darwin’, Australian Women's Weekly, 15 January 1975, 2. ‘The Darwin Cyclone Disaster: Response to Appeal in ACT “Good”’, Canberra Times, 27 December 1974, 7.

3 Due to the work of Darwin doctors and a rapid evacuation, the assistance of medical doctors was later described as an ‘over-response’. Department of Defence, The Defence Force in the Relief of Darwin After Cyclone Tracy (Canberra: Australian Government Publishing Service, 1980), 33.

4 Beverley Raphael and Warwick Middleton, ‘Mental Health Responses in a Decade of Disasters: Australia, 1974-1983’, Hospital and Community Psychiatry 38, no. 12 (1987): 1331.

5 Warwick Middleton and Beverley Raphael, ‘Consultation in Disasters’, International Journal of Mental Health 19, no. 1 (1990): 116.

6 Raphael and Middleton, ‘Mental Health Responses’, 1332.

7 Ibid., 1331.

8 Raphael and Middleton, ‘Consultation in Disaster’, 116. Beverley Raphael and Lenore Meldrum, ‘The Evolution of Mental Health Responses and Research in Australian Disasters’, Journal of Traumatic Stress 6, no. 1 (1993): 70.

9 See for instance Alan J. Tuckman, ‘Disaster and Mental Health Intervention’, Community Mental Health Journal 9, no. 2 (1973): 151–7.

10 Beverley Raphael, ‘Life, Trauma and Loss’, in Mapping the Wake of Trauma: Autobiographical Essays by Pioneer Trauma Scholars, ed. C. Figley (New York: Routledge, 2005), 154.

11 ‘Psychiatrists help meet widespread community needs’, [Queensland] University News, 22 April 1987, 3.

12 Beverley Raphael, ‘The Presentation and Management of Bereavement’, Medical Journal of Australia 2, no. 24 (13 December 1975): 909–11; ‘The Management of Pathological Grief’, Australian and New Zealand Journal of Psychiatry 9, no. 3 (1975): 173–80; ‘Crisis Intervention: Theoretical and Methodological Considerations’, Australian and New Zealand Journal of Psychiatry 5, no. 3 (1971): 183–90; ‘Preventive Intervention with the Crisis of Conjugal Bereavement’ (MD thesis, University of Sydney, 1974).

13 ‘I provided guidance to the doctors and health workers involved and saw and assessed some of the evacuees myself’, she recorded. Raphael, ‘Life, Trauma and Loss’, 155.

14 See for instance, Beverley Raphael, ‘The Preventive Psychiatry of Natural Hazard’ in Natural Hazards in Australia: Proceedings of a Symposium, ed. R. L. Heathcote and B. G. Thom (Canberra: Australian Academy of Science, 1976), 330–9; Raphael and Middleton, ‘Mental Health Responses’; Middleton and Raphael, ‘Consultation in Disasters’; Raphael and Meldrum, ‘Evolution’. From here, such responses gradually became ‘better orchestrated and appreciated’, demonstrated in the Granville train disaster (1977) and the Ash Wednesday bushfires (1983). Raphael and Middleton, ‘Mental Health Responses’, 1331.

15 ‘Darwin Today: Is there a Future? Special 10 Page Report’, Australian Women's Weekly, 17 September 1975: cover, 2–11.

16 Beverley Raphael was contacted by the author for an oral history interview in 2018. However, she declined, and died not long afterwards. Patrick McGorry, ‘Obituary: Professor Beverley Raphael AM (1934–2018)’, Australasian Psychiatry 27, no. 1 (2019): 98–100.

17 Commonwealth Franchise Act 1902. Dale Daniels, ‘Social Security Payments for the Aged, People with Disabilities and Carers 1901 to 2010’, Social Policy Section, 21 February 2011, https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BN/1011/SSPayments1.

18 The Hospital Benefits Act 1945 saw that all people could access public wards of hospitals free of charge; a 1946 referendum saw the Commonwealth gain new powers to provide social services, medical services and sickness and hospital benefits; the National Health Service Act 1948 allowed the Commonwealth to manage and maintain health services, and the Pharmaceutical Benefits Act 1948 created a new pharmaceutical benefits scheme. Anne-Marie Boxall & James A. Gillespie, Making Medicare: The Politics of Universal Health Care in Australia (Sydney: UNSW Press, 2013), 22–35.

19 The Commonwealth’s States Grants (Mental Institutions) Act 1955 (no. 67) provided funding for building maintenance for mental institutions, not psychiatric services.

20 Earle Page was a medical doctor and Minister for Health; he commissioned Alan Stoller – a Senior Psychiatrist of the Repatriation Department – to undertake the report (C. J. Cummins, A History of Medical Administration in New South Wales, 1788–1973 [Sydney: Health Commission of NSW, 2003], 115). Alan Stoller, with K. W. Arscott, Report on Mental Health Facilities and Needs of Australia (Canberra: Commonwealth Government, 1955).

21 The federal government would fund one third of the state government’s contribution, a formula detailed in the States Grants (Mental Institutions) Act of 1955 (no. 67).

22 Processes of deinstitutionalisation had already begun in different states at different times; on NSW, for instance, see Robyn Dunlop, ‘Mental Health as History: Psychiatry, Community, and General Practice’, Health and History 21, no. 2 (2019): 7. As deinstitutionalisation took place through state-based processes it will not be discussed in detail here.

23 A. K. Lie and J. Greene, ‘Introduction to Special Issue: Psychiatry as Social Medicine’, Culture, Medicine and Psychiatry 45 (2021): 333–42.

24 Milton Lewis, Managing Madness: Psychiatry and Society in Australia 1788-1980 (Canberra: AGPS Press, 1988). Stephen Garton, Medicine and Madness: A Social History of Insanity in New South Wales 1880-1940 (Kensington: New South Wales University Press, 1988). Catharine Coleborne, Madness in the Family: Insanity and Institutions in the Australasian Colonial World, 1860–1914 (London: Palgrave Macmillan, 2010).

25 Mark Finnane, ‘Opening up and Closing Down: Notes on the End of an Asylum’, Health and History 11, no. 1 (2009): 9–24. Katie Holmes, ‘Talking about Mental Illness: Life Histories and Mental Health in Modern Australia’, Australian Historical Studies 47, no. 1 (2016): 25–40. See also Dolly MacKinnon and Catharine Coleborne, ‘Introduction: Deinstitutionalisation in Australia and New Zealand’, Health and History 5, no. 2 (2003): 1–16.

26 Peter Yule, The Long Shadow: Australia’s Vietnam Veterans Since the War (Sydney: University of New South Wales Press, 2020). Effie Karageorgos, ‘Mental Illness, Masculinity, and the Australian Soldier: Military Psychiatry from South Africa to the First World War’, Health and History 20, no. 2 (2018): 10–29.

27 See for example, Scott McKinnon and Margaret Cook, ‘Introduction’, in Disasters in Australia and New Zealand: Historical Approaches to Understanding Catastrophe, ed. Scott McKinnon and Margaret Cook (Palgrave MacMillan, 2020), 1–17. Rebecca Jones, Slow Catastrophes: Living with Drought in Australia (Melbourne: Monash University Publishing, 2017). William Logan, ‘Bushfire Catastrophe in Victoria, Australia: Public Record, Accountability, Commemoration, Memorialisation and Heritage Protection’, National Identities 17, no. 2 (2015): 155–74. William M. Taylor and Michael P. Levine, ‘Investigating Catastrophe: Commemoration, Accountability and Records of Disaster’, National Identities 17, no. 2 (2015): 105–16. Peter Read, Returning to Nothing (Melbourne: Cambridge University Press, 1996). On the emotional toll of cyclones in particular, see Deb Anderson, ‘All the Love is on the Radio: Local Media, Cyclone Larry and an Injunction to Care’, Emotions: History, Culture, Society 4, no. 1 (2020): 128–45; ‘Where the Wild Things Were’, in McKinnon and Cook, 179–97.

28 See, for example, Alison Bashford and Stuart Macintyre (eds), The Cambridge History of Australia, Volume 2: The Commonwealth of Australia (New York: Cambridge University Press, 2013), 279.

29 The Northern Territory had its own Legislative Council from 1947, but a Department of Health in Canberra managed health-related issues. The Director of Health became a Member of the Territory’s Legislative Council in 1972–1973 and following the formation of a Legislative Assembly in 1974, the Territory achieved self-government on 1 July 1978 and a transfer of powers saw health administered by the Territory. A Department of Health was established on 1 January 1979. Department of Health, Annual Report of the Director-General of Health for Year 1972-73, Parliamentary Paper no. 232 (Canberra: Government Printer of Australia, 1973), 11.

30 David Lo, The Long Road to Territory Health: An Account of Clinical Medicine in the Northern Territory 1965–1985 (Darwin: Charles Darwin University Press, 2006), 9–10. George Wilson, The Flying Doctor Story: Authorised History of the Royal Flying Doctor Service of Australia (Sydney: Cyan Press Pty Ltd., 1993). There were smaller hospitals at Katherine, Tennant Creek and Alice Springs by the 1950s. R.C. Webb, ‘Medical Practice in Central Northern Territory’, Medical Journal of Australia 1, no. 14 (April 1957): 460–3.

31 This occurred under the Northern Territory Mental Defectives' Ordinance, 1940-1957; for a longer outline of relevant legislation, see J.E. Cawte, ‘A Psychiatric Service in the North?’, Australian Journal of Social Issues 2, no. 1 (1964): 20–32. See also his ‘Australian Aborigines in Mental Hospitals’, Oceania 36, no. 4 (June 1966): 264-82.

32 Cawte, ‘A Psychiatric Service’, 21.

33 See Garton, Medicine and Madness.

34 W.D. Rubinstein and Hilary L. Rubinstein, Menders of the Mind: A History of The Royal Australian and New Zealand College of Psychiatrists, 1946–1996 (Melbourne: Oxford University Press, 1996). Brian Davies, ‘Medical Students, Psychiatry and Medical Psychology’, Australian and New Zealand Journal of Psychiatry 1, no. 3 (1967): 112–5.

35 They included ‘open door’ approaches, group therapy and therapeutic communities. On their influence, see David C. Maddison, and H. J. Prior, ‘Voluntary Hospital in Australia is State Administered’, Psychiatric Services 9 no. 8 (1958): 14–7.

36 See for instance, Donald Fraser, Annual Report of the Inspector-General of Mental Hospitals for the Year Ending 30 June 1955 (Sydney: Parliament of NSW, 1956), 5.

37 NSW passed its Mental Health Act in 1958; Victoria in December 1959 (replaced 1986); Queensland in 1962 (replaced 1974). South Australia had Act Amendments from 1959 to 1974, and a new Mental Health Act in 1976–1977 (replaced 1993); Tasmania in 1963 (replaced 1996); Western Australia 1962 (replaced 1996). See ‘Australian Legislation by State’, Australian Psychiatric Care: A History of Psychiatric Institutionalisation and Community Care in Australia c.1811-c.1990, accessed 1 March 2021, https://www.ahpi.esrc.unimelb.edu.au/legislation-state.html

38 At UNSW then the Universities of Adelaide, Melbourne, Queensland, WA and Monash; see Davies, ‘Medical Students’, 113. In South Australia, funding for the first five years of the Chair was raised from the community: W.A. Dibden, A Biography of Psychiatry: The Story of Events and the People Involved in the Development of Services for the Psychiatrically Ill in South Australia 1939-1989 (Adelaide: Adelaide University Library, 1989), 94–7.

39 For instance, at Parkside Mental Hospital in Adelaide. Maureen Bell, ‘From the 1870s to the 1970s: The Changing Face of Public Psychiatry in South Australia’, Australasian Psychiatry 11, no. 1 (2003): 83.

40 Cawte worked at Enfield Hospital, a receiving hospital where people with experience of mental distress were admitted and assessed. Cawte, ‘A Psychiatric’, 28.

41 Cawte, ‘A Psychiatric’, 21–2.

42 Ibid., 23. Medical assessment of mental distress, and evacuation for psychiatric treatment, had very different implications for indigenous people than for Europeans, an issue that needs deeper consideration than can be given here. For more on this see: David Thomas, Reading Doctors' Writing: Race, Politics and Power in Indigenous Health Research, 1870-1969 (Acton: Aboriginal Studies Press, 2004); Philippa Martyr, ‘Behaving Wildly: Diagnoses of Lunacy among Indigenous Persons in Western Australia, 1870–1914’, Social History of Medicine 24, no. 2 (2011), 316–33; Edmund McMahon, ‘Psychiatry at the Frontier: Surveying Aboriginal Mental Health in the Era of Assimilation’, Health and History 9, no. 2 (2007): 22–47.

43 Cawte, ‘A Psychiatric’, 28. James A. Gillespie also comments on the dominance of the AMA in federal health in the 1960s, and the Whitlam government’s response; see The Price of Health: Australian Governments and Medical Politics 1910-1960 (Cambridge: Cambridge University Press, 1991), 285.

44 A psychiatrist was employed in May 1966 and joined by a clinical psychologist in March 1968. See G.O. Cowdy, ‘Clinical Psychiatric Service to the Aborigines of the Northern Territory’, Australian and New Zealand Journal of Psychiatry 4, no. 1 (1970): 3–5.

45 Ibid., 3.

46 Department of Health, Annual Report of the Director-General of Health for Year 1972-73, Parliamentary Paper no. 232 (Canberra, Government Printer of Australia, 1973): 103.

47 Interim Committee of the Hospitals and Health Services Commission and Sidney Sax, A Community Health Program for Australia (Canberra: Australian Government Publishing Service, May 1973). Sidney Sax, A Strife of Interests: Politics and Policies in Australian Health Services (Sydney: George Allen and Unwin, 1984), 103–4.

48 Prior to taking up the Canberra role, Sax has been Director of the Planning and Research Division of the NSW Health Commission. Sidney Sax, ‘Preface’, Community Health: Policy and Practice in Australia, eds, Frances Baum, Denise Fry and Ian Lennie (Sydney: Pluto Press Australia in association with Australian Community Health Association, 1992). xiv. See also Sax, A Strife, 104–6.

49 Legislation creating the Hospitals and Health Services Commission was passed in December 1973. Its membership was medical and did not include mental health or consumer representation; G.R. Palmer, Head, School of Health Administration and Commissioner, Hospitals and Health Services Commission, ‘The Hospitals and Health Services Commission’, Tharunka, 9 October 1974, 6.

50 See an account of an early community service on the Central Coast of NSW, for instance: Dunlop, ‘Mental Health as History’. See also the views of the NSW State Director of State Psychiatric Services, Dr William Barclay, who argued in Australia, community mental health services would develop out from mental hospitals as had occurred in Britain: W.A. Barclay, ‘Providing Psychiatric Services for the Community’, in Psychiatry and the Community, ed. Issy Pilowsky and David Maddison (Sydney: Sydney University Press, 1969), 67–74.

51 In parliamentary debate on the proposed Mental Health Services Act, several medical doctors spoke critically of institutional psychiatry. See comments from Dr Douglas Everingham, Minister for Health, and Dr Gun (Kingston, SA): Second reading of the Mental Health Services and Assistance Act. Australia. House of Representatives. 1973. Parliamentary Debates, 17 October. 2258. Dr Douglas Everingham, Minister for Health. https://parlinfo.aph.gov.au/parlInfo/genpdf/hansard80/hansardr80/1973-10-17/0044/hansard_frag.pdf;fileType=application%2Fpdf. ‘Mental Health and Related Services Assistance Bill’, 1973 Second Reading Tuesday, 6 November 1973, House Hansard, https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22hansard80%2Fhansardr80%2F1973-11-06%2F0123%22

52 It was discussed by the Mental Health Committee of the National Health and Medical Research Council (NHMRC) from 1970 and presented to the NHMRC itself around 1973 (Dibden, 198–99).

53 For instance, see the account of 13-year-old Tanya Williams and her Larrakia and West Arnhem Land family in K. Haynes, D. K. Bird, D. Carson, S. Larkin and M. Mason, Institutional Response and Indigenous Experiences of Cyclone Tracy: Report to National Climate Change Adaptation Research Facility (Gold Coast: National Climate Change Adaptation Research Facility, 2011), 36. See also Sophie Cunningham, Warning: The Story of Cyclone Tracy (Melbourne: Text Publishing, 2014).

54 Llorabel Reynolds wrote this description shortly after experiencing Cyclone Tracy. ‘The Profession: Events’, Australian Nurses Journal (February 1975), 10. See also Susan Sayers, ed. The Not So ‘Silent Night’: Cyclone Tracy Stories from Doctors, Nurses and Health Workers, Darwin, December 1974 (Darwin: Historical Society of the Northern Territory, 2015).

55 Ella Stack in Sayers (ed.), The Not So ‘Silent Night’, 29.

56 ‘Cyclone Tracy Wrecked RAAF Base Darwin’, RAAF News (1 February 1975), 4.

57 Department of Defence, 23. In the later account for the Medical Journal of Australia, no mention was made of mental health issues: C. H. Gurd, A. Bromwich and J. V. Quinn, ‘The Health Management of Cyclone Tracy’, Medical Journal of Australia 1, no. 21 (1974): 641–4.

58 Gurd, Bromwich and Quinn, ‘Health Management’.

59 Ibid., 642.

60 C. H. Gurd, ‘Public Health Aspects of Natural Disasters’, in Natural Hazards Management in North Australia: Proceedings of and Papers Arising out of a Seminar Held by the North Australia Research Unit of the Australian National University, ed. G. Pickup & North Australia Research Unit, Australian National University (Canberra: Australian National University, 1978), 361–72, 367–8, 371, 372.

61 Cowdy reportedly died in office in 1973 (Lo, ‘The Long Road’, 48).

62 Ellen S. Kettle, Health Services in the Northern Territory: A History 1824-1970, Part II (Darwin: Australian National University North Australia Research Unit, 1991), 300. J. R. Condon, G. Warman and L. Arnold L, eds, The Health and Welfare of Territorians. Epidemiology Branch (Darwin: Territory Health Services, 2001), 147.

63 The NDO replaced the Directorate of Civil Defence which stemmed from an agreement between the states and the Commonwealth in 1936 with civil protection aims, revived in the 1950s but having only a minor role. Research was not part of the NDO’s scope, but it ran the Australian Counter Disaster College in Mt Macedon, Victoria. Rear Admiral R.C. Swan, ‘The Role of the Natural Disasters Organisation’, in Pickup et al. (eds.), Natural Hazards Management, 336–7, 348.

64 In February 1974 ministers had agreed such an organisation be established to manage natural disaster responses (Department of Defence, 21-22). J. M. Power and R. L. Wettenhall, ‘Bureaucracy and Disaster II: Response to the 1967 Tasmanian Bushfires’, Australian Journal of Public Administration 29 (1970): 165–88.

65 Then-Brigadier Alan Stretton had been Deputy Director (Military) of the Joint Intelligence Organisation (1972-74), until his appointment to the NDO in July 1974. He was Australian of the Year in 1975. Damien Murphy, 'Stretton, Alan Bishop (1922–2012)', Obituaries Australia, National Centre of Biography, Australian National University, accessed 8 September 2020, http://oa.anu.edu.au/obituary/stretton-alan-bishop-22032/text31999. Hilary Robertson, ‘Darwin’s Churchill: The Role of Major-General Alan Stretton in the Days Following Cyclone Tracy’, Journal of Northern Territory History 10 (1999): 55. Stretton was director of administrative planning at headquarters (1966–69), and then chief of staff of the Australian forces (1969-70).

66 Alan Stretton, Darwin Disaster: Cyclone Tracy: Report by Director-General, Natural Disasters Organisation, on the Darwin Relief Operations, 25 December 1974 - 3 January 1975 (Canberra: Australian Government Publishing Service, 1975), 3. The legal authority of the management of the disaster response was subsequently questioned (i.e. see J. Eugene Haas, Harold C. Cochrane, Donald G. Eddy, The Consequences of Large-Scale Evacuation Following Disaster: The Darwin, Australia Cyclone Disaster of December 25, 1974, Working Paper 27 (Boulder, CO: Institute of Behavioural Science, University of Colorado July 1976), 15–6).

67 Alan Stretton, The Furious Days: The Relief of Darwin (Sydney: Collins, 1976), 44–9.

68 Through the National Research Council in Washington, DC. Charles E. Fritz and Harry B. Williams, ‘The Human Being in Disasters: A Research Perspective’, Annals of the American Academy of Political and Social Science 309 (1957): 42–51.

69 A. Adler, ‘Neuropsychiatric Complications in Victims of Boston’s Cocoanut Gove Disaster’, Journal of the American Psychiatric Association 123 (1943): 1098–101. Lindemann recognised that not all bereaved could access psychiatric help, and consequently recommended management techniques for grief reactions to be ‘passed on to auxiliary workers’, who could still refer people to the psychiatrist: Erich Lindemann, ‘Symptomatology and Management of Acute Grief’, American Journal of Psychiatry 101, no. 2 (1944): 141–8. In 1963 a Disaster Research Centre was established at Ohio State University, funded by the Office of Civil Defense [sic] and directed by sociologists.

70 E. L. Quarantelli, ‘Disaster Studies: An Analysis of the Social Historical Factors Affecting the Development of Research in the Area’, International Journal of Mass Emergencies and Disasters 5, no. 3 (1987): 295, 297.

71 Fritz, 1968, cited in E. R. Chamberlain et al., The Experience of Cyclone Tracy (Canberra: Australian Government Publishing Service, 1981), 6.

72 William Anderson and Robert Whitman, A Few Preliminary Observations on ‘Black Thursday’: The February 9, 1967 Fires in Tasmania, Australia, Research Report no. 19 (Columbus: Disaster Research Centre, Ohio State University, 1967).

73 Roger L. Wettenhall, Bushfire Disaster: An Australian Community in Crisis (Sydney: Angus and Robertson, 1975), 280.

74 Natural Hazard Research was associated with the Natural Hazards Centre at the University of Colorado and encompassed behavioural science, geography and environmental studies at Colorado, Clark University, Massachusetts and the University of Toronto. Geophysical events ranged from air pollution and water quality, to earthquakes and droughts. For a list of publications and memoirs of its founders see: ‘Natural Hazards Centre Working Papers’, accessed 30 October 2020, http://www.ilankelman.org/nhcwp.html.

75 Haas et al., Consequences of Large-Scale Evacuation.

76 Darwin Disaster Welfare Council, Final Report of the Darwin Disaster Welfare Council (Darwin: Disaster Welfare Council, March 1976), 9, 37. Sayers (ed.), The Not So ‘Silent Night’, 37. In March 1975 an American research team reported that rumours the cyclone was returning, and typhoid fever had broken out, ‘may or may not have been encouraged by officials as a technique to get people to evacuate’. The researchers also recorded that the rumour of looting reduced people’s willingness to leave (Haas et al., Consequences of Large-Scale Evacuation, 22, 39).

77 Stretton, Furious Days, 205-6.

78 Department of Defence, The Defence Force, 26.

79 Stretton proposed this to the Minister for the Northern Territory (Dr Patterson), who approved and discussed the evacuation with the acting Prime Minister and Leader of the Opposition on Boxing Day. Department of Defence, The Defence Force, 26.

80 Stretton, Furious Days, 205.

81 For his account of his time in Vietnam see Chapter 11: The War in Vietnam, in Alan Stretton, Soldier in a Storm: An Autobiography (Sydney: Collins, 1978), 199–216.

82 Classed as wounded, injured or ill. Ian McNeil and Ashley Ekins, On the Offensive: The Australian Army in the Vietnam War 1967-1968 (Crows Nest: Allen & Unwin, 2003), Appendix F, ‘Statistics’, 478.

83 N. Biedermann et al., ‘The Wartime Experience of Australian Army Nurses in Vietnam, 1967-1971’, Journal of Advanced Nursing 35, no. 4 (2001): 545. On the use and impact of helicopters in Vietnam, see Peter Bourne, ‘Helicopter Ambulance Crews’, in Men, Stress and Vietnam (Boston: Little, Brown and Company, 1970), 83–102. See ‘Casualties of War’, Medical Journal of Australia 2, no. 22 (1970), 991–2.

84 Stretton, Furious Days, 38.

85 Interestingly, this was not the case in the Australian and New Zealand Journal of Psychiatry where it was not until 1982 that an analysis of Australian psychiatrists’ involvement in Vietnam appeared: Bruce Boman, ‘The Vietnam Veteran Ten Years On’, Australian and New Zealand Journal of Psychiatry 16, no. 3 (1982): 107–27.

86 ‘On Psychiatry: Some Reflections Circa 1998’, Australian and New Zealand Journal of Psychiatry 32, no. 6 (1998): 741–52.

87 ‘Nursing in Vietnam’, Medical Journal of Australia 2, no. 23 (1966): 1109–10; B. A. Smithhurst, ‘A Physician in Vietnam’, Medical Journal of Australia 1, no. 12 (1969): 652–4.

88 G. S. Spragg, ‘Psychiatry in the Australian Military Forces’, Medical Journal of Australia 1, no. 15 (1972): 750.

89 From 1968 to 1969, when there were higher numbers of Australian troops and more combat action. This article makes no comment on the effectiveness of the military management of mental distress in Vietnam.

90 After the war it was calculated that of the Australian military psychiatric casualties from June 1969 to December 1970, only 18% were evacuated from Vietnam to Australia (Boman, ‘The Vietnam Veteran’, 114, 116; see also Boman, ‘The Vietnam Veteran’, 114 for consideration of the Australian rates of psychiatric casualties compared to the US rate).

91 ‘Air Force Doctor Works Non-Stop Carrying Injured’, The Australian, 27 December 1974, 2. Stretton, Darwin Disaster, 4. Department of Defence, 32, 34.

92 The second flight left at 6am, going to Brisbane. The decision to evacuate the whole hospital was then made and a plane loaded with 32 adult patients and 27 children – all but one less than three years old, including nine babies less than two days old (Department of Defence, The Defence Force, 32–3). The following Annual Report of the Director General of Health (1974–1975) reported that ‘to ensure adequate reserve facilities in the face of reduced services and an unpredictable future load, it was decided to evacuate many patients, including non-cyclone cases, to the southern States’. Department of Health, Annual Report of the Director-General of Health, 1974-75 (Canberra: Australian Government Publishing Service, 1975), 160.

93 People were asked to nominate a major city they wanted as their destination, but by 27 December this had changed ‘in the face of the overwhelming need to move people out of Darwin fast’. Evacuation was key, with on-going flights to reach final destinations where necessary (Haas et al., Consequences of Large-Scale Evacuation, 20, 23).

94 Chamberlain et al., The Experience of Cyclone Tracy.

95 Laurie Dee, ‘It’s Natural to Grieve’, Australian Women's Weekly, 16 February 1977: 29.

96 Darwin Disaster Welfare Council, Final Report, 12.

97 Raphael and Middleton, ‘Mental Health Responses’,1332.

98 In this case, the training was largely ineffectual because so many evacuees had disappeared into the community to stay with relatives and friends; initially there was no central way to contact them (Raphael and Middleton, ‘Mental Health Responses’, 1332). The reviewer of the article helpfully points to Queensland social worker Edna Chamberlain’s role after the Brisbane floods as a comparable figure; see Lesley Cooper, ‘Edna Chamberlain (1921-2005): A Leader through Times of Transition and Change’, Social Work and Society 7, no. 1 (2009).

99 ‘Cyclone Tracy’, Medical Journal of Australia 1, no. 21 (1975), 637.

100 ‘The Psychological Management of Disaster Victims’, Medical Journal of Australia 1, no. 21 (1975), 639.

101 Raphael and Middleton, ‘Mental Health Responses’, 1331.

102 ‘The Psychological Management’, 638–9.

103 See Dunlop, ‘Mental Health as History’, 14–5.

104 See for example the absence of discussion of mental health projects in Hospitals and Health Services Commission, Review of the Community Health Program (Canberra: Australian Government Publishing Service, March 1976), 29.

105 The report was based on nearly 100 interviews with administrators, survivors, relief workers and others (Raphael and Middleton, ‘Mental Health Responses’, 1333). Beverley Raphael, Australian and New Zealand College of Psychiatrists and National Disasters (Australian and New Zealand Journal of Psychiatry, 1976).

106 Beverley Raphael, ‘The Granville Train Disaster: Psychological Needs and their Management’, Medical Journal of Australia 1, no. 9 (1977), 303–5; ‘A Primary Prevention Action Programme: Psychiatric Involvement Following a Major Rail Disaster’, Omega 10, no. 3 (1979–1980), 211–26.

107 G. Milne, ‘Cyclone Tracy: Some Consequences of the Evacuation for Adult Victims’, and ‘Cyclone Tracy II: the Effects on Darwin Children’, Australian Psychologist 12 (1977): 39–54, 55–62. J. S. Western and L. Doube, ‘Stress and Cyclone Tracy’, in Pickup et al. (eds.), Natural Hazards Management, 375–402. Beverley Raphael, ‘The Preventive Psychiatry of Natural Hazard’ in Symposium on Natural Hazards in Australia, ed. Heathcote, R. L. & Thom, B. G. & Australian Academy of Science (Australian Academy of Science, 1976); Natural Hazards in Australia: Proceedings of a Symposium (Australian Academy of Science, Canberra, 1979); ‘Planning Psychological Services’ section in Planning for People in Natural Disasters: A Collection of Papers Presented at Three Public Seminars held in December 1977, ed. Joan Innes Reid (Department of Behavioural Sciences, Townsville: James Cook University of North Queensland, 1979); Pickup et al. (eds.), Natural Hazards Management. ‘Darwin Today’, Australian Women's Weekly, 17 September 1975: 2–11.

108 Gurd, ‘Public Health’, 371–2.

109 Beverley Raphael, The Problems of Mental Ill Health and Their Relevance to the Australian Community, Report Prepared for the Australian Federal Minister for Health, Dr N. Blewett (Melbourne: Royal Australian & New Zealand College of Psychiatrists, 1984). The first national mental health strategy was endorsed in April 1992 by the then Australian Health Ministers' Conference as a framework to guide mental health reform. It included a national mental health policy, plan and statement of rights and responsibilities. The Commonwealth’s first Minister for Mental Health was established in 2010.

110 Nicola Hancock and Jennifer Smith-Merry, ‘It’s Hard for People with Severe Mental Illness to get in the NDIS – and the Problems Don’t Stop There’, The Conversation, 21 January 2020.

111 For example, see Greg Hunt, MP, ‘COVID-19: $48.1 Million for National Mental Health and Wellbeing Pandemic Response Plan’, Media Release, 16 May 2020, https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/covid-19-481-million-for-national-mental-health-and-wellbeing-pandemic-response-plan

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Robyn Dunlop

Robyn Dunlop has a PhD in English on the ethical dimensions of representing traumatic pasts, and has worked as an institutional historian. In 2021 she was awarded a PhD (History) from University of Newcastle for a history of community psychiatry and mental health services with a particular focus on Newcastle and the Hunter Valley, NSW. She would like to acknowledge the generous feedback from the reviewers of this article.