Why does “Mental Health Reform” default to “Compliance and Control”?

Nov 5, 2023
Thinking Mechanism. Human head with gears inside.

‘Mental Health Reform’ has been a phrase bandied about for over 30 years in Australia. And while well intentioned, hopefully expressing the ‘Care and Concern’ felt by politicians, bureaucrats and health practitioners, it has always ended up defaulting to ‘Compliance and Control.’

As outlined in the previous articles on the Care Economy, we suffer from an all pervasive culture of others knowing best in the system that is dominated by ‘Experts in the Clinical Medical Model of Care.’

The same system that Prof. Ian Hickie described years ago as being impervious to reform, because it is beset by “siloes of self interest,” among all the competing ‘expert disciplines’ that control the inner workings of the Health System. And this is exacerbated by the neoliberal, economic rationalist, competitive nature of all care funding.

Meanwhile, the lived reality for people like me, a carer for three decades of adult children with serious mental health challenges, is that the main people with real hands-on engagement with my loved ones are Police, Railway Inspectors, Security Guards, Shopkeepers and Ambulance Officers. Precious few of whom have been properly trained in Person-valuing, Lived Experience Listening, Trauma Informed Care, Safe Restraint, or Relational Ways of engaging with people with psychosocial disability.

Community Mental Health is still a vague concept yet to be realised in the majority of Australian towns. And the most common use of the key word in that phrase is in the ‘Community Treatment Orders’ dished out by Mental Health Review Tribunal hearings in hospital wards, to reinforce Compliance and Control. This is said to be to ensure that patients are ‘safe from Being a Risk to themselves or others.’

But it is really a convenient and immediate way to exercise power over vulnerable people.

And the real power agenda is exercised by the ‘professions’ of the clinical medical system, who fight to claim the bulk of all funding to expand their empire, while starving Community Mental Health and Wellbeing programs.

Then, what does trickle down to the local level is atomised care through the National Disability Insurance Scheme. A well intentioned initiative that is yet to be made fit for purpose. All of which misses the point of funding programs for local communities to create places of Welcome and Support for people who are Different and Diverse.

What is chronically missing is a community-wide engagement with acknowledgment that all of us are vulnerable and affected by mental distress at times, and so we need to Share the Care. Not keep deferring to so-called experts, while they turn their backs on what is happening to the people that have been labelled by their expertise, sentencing them to a life of being ‘othered,’ stigmatised and generally shunned.

It’s a problem that the philosopher Arthur Schopenhauer described long ago:

“You may accumulate a vast amount of knowledge but it will be of far less value to you than a much smaller amount if you have not thought it over for yourself; because only through ordering what you know by comparing every truth with every other truth can you take complete possession of your knowledge and get it into your power.” (Schopenhauer, Essays and Aphorisms (Hat tip to Nat Eliason).

Physical and Pharmacological Restraint are the two dominant choices in exercising power in Australian mental health practice. Clinicians defer to the ‘body is a machine’ mentality that sees us as a set of electrochemical reactions occurring in a container of skin and bones. There is no time given to Relational Listening and Learning from each person’s experience.

Such an approach was promoted worldwide by Ron Coleman and the UK’s Hearing Voices movement decades ago. His heroic efforts were trying to break out of Stigma City and start accepting Difference and Diversity in Consciousness as a natural part of the human condition. Sadly, very few Australian ‘authorities’ embraced this Listening to Lived Experience approach. Their ‘expert knowledge’ didn’t leave space for other perspectives.

Nor has Australian ‘medical science’ ever taken the time to learn from our First People how best ‘to be’ (and heal) in this land. By following the sort of natural approach to engaging the Spirit of Place that Dr Miriam Rose Ungunmerr Baumann has taught us. Practising ‘Dadirri – Sit, Wait and Listen to the spirit in country.’

As we await the next phase of ‘Reforms’ that the Federal Government will be aiming to roll out, in response to the plethora of recent Royal Commissions exposing our failures right across ‘the Care Economy,’ we can only pray that the experts learn to Listen more to Lived Experience.

And invest in Whole Community Mental Health and Wellbeing, run by the community, not by privatised, competing rivals in a market economy.

You may be interested in these recent articles from the same author:

Disability care is still all about us without us 

Crushing the human connection: Managerialism does not deliver good care

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