Authors: Rob Warriner, NEW ZEALAND
Event: 2005 TheMHS Conference
Subject: Taking Issue, deinstitutionalisation
Type of resource: Conference Presentations and Papers
Abstract: The shift of mental health service delivery from hospital to the community has proven to be, and continues to be a complex matter. Huge gains have been achieved in a relatively short period of time. We now articulate the focus of mental health services as being to support people to live well in their community; to promote relationships where people are active participants in their recovery, rather than passive recipients of treatment. Supporting people to overcome issues of disadvantage and social exclusion have become contemporary imperatives of community-based mental health services. However I think at best, we need to consider such development and progress as “a good start”. I get concerned when people speak of “deinstitutionalisation” in the past tense – as if we’ve done that, what next? The process of reform of mental health services is very much a work in progress. A fact I believe we need to always be aware of; “change never rolls in on the wheels of inevitability”. I’ve used the story of the “Emperor’s New Clothes” as a metaphor to illustrate what may now be lacking in mental health services. We can now speak quite articulately of recovery, of service-user led services, of community-based mental health services… but scratch the surface and you can commonly find some quite vague and sometimes oppositional understandings of what these are about and what they look like. We risk being as the emperor; duped into believing such finery truly exists, when in fact the substance of such finery may not be that tangible. What this paper will argue is that the evolution of post institutional mental health services requires not just a change in policy or practice, but the development and propagation of a philosophy and range of values which will underpin such contemporary practices. This emerging framework raises an agenda which is potentially in conflict with biomedical psychiatry as the fundamental driver of mental health service provision.