Overview

Mental health and illness: Practice and service issues in the 21^st century

Editors: Anne-Maree Sawyer, Pauline Savy and Katy Richmond

This special edition of Health Sociology Review (volume 20/2, 2011) is prompted by ongoing claims about escalating mental health problems and their management in Australia and other affluent countries. High prevalence disorders such as anxiety and depression, and alcohol and substance abuse are said to be epidemic. Following the closure of many large asylums in Australia, a number of reports have raised questions about the efficacy, scope and accessibility to community-based mental health services (eg, Not for Service published by the Human Rights Commission and the Mental Health Council of Australia, 2005).

Mental health and illness: Practice and service issues aims to facilitate discussion of central issues relating to mental health treatment, including effective professional practice, community care, access and equity, and the marginalization of sufferers of mental illness.

Mental health policy development has been very progressive in Australia with its focus on the human rights and social inclusion of individuals with mental disorders, and endorsement of ‘active’ participation of service users and carers in treatment decisions and service planning (Commonwealth of Australia 2009; Victorian Department of Human Services 2009). Despite various advances in mental health service design since 2005, including the growth of anti-stigma campaigns, ‘step up/step down’ programs to support before and after admission to acute inpatient units, and early intervention services (e.g., Victorian Department of Human Services 2009:8), there is overwhelming consensus amongst many carers, service users, professionals and leading advocates of mental health care that these improvements do not go far enough (ABC Radio National 2010, 2011; Hagan 2010). Widespread dissatisfaction remains concerning the quality and availability of services. The principles of care are clear and well designed but, according to the above reports, their translation into practice is contentious.

A significant reason for the persistent gap between policy rhetoric and practice (though certainly not the only one) is that the roles of mental health professionals have been reshaped through modernising agendas and imperatives. The introduction of New Public Management into the public sector coincided roughly with the relocation of care from government- run and charitable institutions to the community throughout the late 1980s and 1990s in Australia. The rise of new forms of regulation, both in terms of rationalities (specific frames thinking) and technologies (specifi c forms of practice), are part of a larger story of social, economic and political change beyond the shift from institutional to community-based care. The act of service provision is now inseparable from a range of formal measures designed to optimize accountability – quality assurance, auditing, risk assessment and risk management, service targets and key performance indicators.

Recent research into the impacts of new regulatory regimes on the roles of human service professionals, including frontline mental health workers, claims that increased regulation has significantly diminished professional discretion and autonomy, greatly increased administrative monitoring and supervision, and reshaped professional identities around managerial rather than therapeutic skills, leading to high levels of stress and frustration, and the deskilling of professionals (e.g., Carey 2007; Ferguson 2007; Godin 2004; Jones 2001; McDonald and Chenoweth 2009; McDonald et al. 2008; Munro 2004, 2010; Newman and Lawler 2009; Webb 2006).

This title enquires into a range of social problems that characterise the landscape of early twenty-first century mental health practice and service provision. It suggests a variety of ways that services could be improved, along with the experiences of both professionals and service users. And it offers inspiration for much needed sociological research that identifies the particular structural conditions and other factors constraining the realisation of individualised care in practice.

Table of Contents

Introduction: Translating mental health policy into practice: ongoing challenges and frustrations
Anne-Maree Sawyer

The hegemony of cognitive-behaviour therapy in modern mental health care
David Pilgrim

Towards an integrated model of practice evaluation balancing accountability, critical knowledge and developmental perspectives
Paul Stepney & Ilmari Rostila

The dodo bird verdict and the elephant in the room: A service user-led investigation of crisis resolution and home treatment
Hugh Middleton, Rebecca Shaw, Ron Collier, Aimie Purser & Brian Ferguson

The slide to pragmatism: A values-based understanding of ‘dangerous' personality disorders
Susie Scott, Debbie Jones, Rachel Ballinger, Gillian Bendelow & Bill Fulford

Encounters with the ‘dark side': New graduate nurses' experiences in a mental health service
Michael Hazelton, Rachel Rossiter, Ellen Sinclair & Peter Morrall

‘Having those conversations': The politics of risk in peer support practice
Anne Scott, Dr. Carolyn Doughty & Hamuera Kahi

Medicalisation or under-treatment? Psychotropic medication use by elderly people in New Zealand
Pauline Norris, Simon Horsburgh, Kirsten Lovelock, Gordon Becket, Shirley Keown, Bruce Arroll, Jackie Cumming, Peter Herbison & Peter Crampton

The origins of a New Zealand suicidal cohort: 1971-2007
Cate Curtis & Bruce Curtis

Summary: Broadening the evidence base of mental health policy and practice
Lisa Brophy & Pauline Savy