The Australian experience of deinstitutionalization: interaction of Australian culture with the development and reform of its mental health services.
OBJECTIVE
To describe the Australian experience of deinstitutionalization of the Australian National Mental Health Strategy in the context of the history of mental health services in Australia, and of Australian culture.


METHODS
The development of Australian Mental Health Services is described with reference to developments in both psychiatric intervention research and Australian culture. The effects and achievements of national mental health reforms are described and critically examined.


RESULTS
The relationship in Australia between the development of mental health services and the development of Australian society includes the stories of colonization, gold rush, suppression of indigenous peoples' rights, incarceration of mentally ill people, and incompatible state service systems. Mental health services required reform to provide consistent services and support for full citizenship and rights for such individuals who are still on the margins of society. Recent national developments in service models and service system research have been driven by the Australian National Mental Health Strategy. The translation of national policy into state/territory mental health service systems has led to a 'natural' experiment between states. Differing funding and implementation strategies between states have developed services with particular strengths and limitations.


CONCLUSIONS
The effects of competition for limited resources between core mental health service delivery and the shift to a population-based public health approach (to prevention of mental illness and promotion of mental health), leaves our services vulnerable to doing neither particularly well. The recent loss of momentum of these reforms, due to failure of governments to continue to drive and fund them adequately, is causing the erosion of their considerable achievements.
Rosen
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Royal North Shore Hospital and Community Mental Health Services, Sydney, NSW, Australia. arosen@nsccahs.health.nsw.gov.au
D001315:Australia; D003466:Cultural Characteristics; D003688:Deinstitutionalization / Q000266:history*; D018166:Health Care Reform / Q000266:history*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D001523:Mental Disorders / Q000266:history*; D008605:Mental Health Services / Q000266:history*