Can deinstitutionalisation work? Mental health reform from 1993 to1998 in Victoria, Australia

Abstract

From 1993 to 1998, mental health services underwent a major transformation in Victoria, Australia. The changes aimed to create a community-oriented service system under general health, instead of one based on psychiatric institutions. Community treatment was to be the first option, with hospitalisation as a backup. State psychiatric institutions were closed, and replaced by new area-based mental health services, providing local inpatient, residential and community-based care. This included mobile extended hours services, available seven days per week.

The article examines the rationale and nature of the changes. It argues that Victoria’s reforms largely avoided problems usually attributed to deinstitutionalisation. This was because alternative services that were comprehensive and locally accessible were established before institutions were closed. Start-up funding from federal and state governments helped this transition, with institutional savings reinvested in new services. By 1998, the changes were substantial, although institutional practices were not transformed as thoroughly as the structures.

Key Words:

• psychiatric deinstitutionalisation
• mental health service reform
• implementing mental health reform
• community mental health care
• mental health care in the community