Introduction: Government, Psychiatry and Community Mental Health
This paper looks at some of the issues debated by government and psychiatry as they formulated and implemented mental health policy in Victoria during the past fifty years. It tells the story by picking up various themes along the way: the Mental Hygiene Authority and its role in mental health education; social psychiatry and anti-psychiatry; the administrative amalgamation of mental health into the Health Commission; and the entry of psychiatric terms into broader public discourses about mental illness and its place in society. It is based on available files from Public Record Office Victoria (PROV) as well as the Royal Australian and New Zealand College of Psychiatrists, Annual Reports and the Department of Human Services. While a significant proportion of the Victorian State Government archives held by PROV which relate to policy development in psychiatric services over the last fifty years are closed to the public under the privacy provisions of Section 9 of the Public Records Act 1973, it is still possible to produce a picture of some of the public policy debates around mental health during this period.

The General Correspondence Files (Mental Health), which currently cannot be viewed without special permission, appear to contain many of the internal files on community mental health centres, administration and staffing. A subject card index is available, and this gives an idea of the areas of policy under consideration by government. The closure of all records which relate to service development is because records may reveal personal details of patients and their families. There are therefore voices in this story which for the current time remain unheard, especially those of patients, carers and staff in the services. This article is intended to further knowledge about how government and psychiatry related to each other - just one layer in what has to be a very complex picture of social and cultural change.

The philosophical debates which characterised policy around mental health and mental illness from the 1950s onwards resulted in a split between two policy objectives. The first objective was to design services for the treatment of mental illness in individuals that met the needs of a community-based rather than an institution-based service system. The second objective was to make the community itself a site where psychiatric concepts were readily understood and integrated into the social fabric of everyday life.

For the new service design to be successful, families and other immediate networks had to be able to identify symptoms of mental illness, evaluate their severity, feel prepared to seek assistance and, if necessary, seek admission of patients to hospital as well as readily receive them again after discharge. This required expertise which I will describe as 'mental health literacy'. The direction of policy attention moved away from the focus on institutions as being separate and largely disconnected from people's day-to-day lives, and increasingly toward a concept of mental health which attempted to make psychiatric concepts more easily understood by the general community.

Three Paradigms: Treatment, Prevention and Mental Health Promotion
Within the policy setting, three concepts can be inferred from the term 'mental health' as it was used by psychiatrists and government officials: mental illness treatment, mental illness prevention, and mental health promotion. These concepts were not mutually exclusive and often overlapped in practice, but for the purpose of this paper they will be treated as separate areas within the historical evolution of policy and practice. The first concept (treatment) refers to the ways people with a diagnosed condition received ongoing clinical care, the second (prevention) has a dual focus on identifying groups at risk of developing mental illness as well as on the factors which contribute to mental illness, and the third (mental health promotion) looks beyond an absence of mental illness and toward social and emotional well-being as its goal. All of these concepts involve a philosophical position about the relationships between the individual, their mental illness, and the role of the broader social and cultural context in creating, managing and preventing illness. How should a mental health system incorporate the various perspectives? What role should government play in mental health prevention and promotion?

In the 1950s and 1960s, the Victorian Mental Hygiene Authority (later the Mental Health Authority), led by the English psychiatrist Eric Cunningham Dax, combined the role of treatment with an active program to build a community with better mental health literacy. It sought to instil a sense of community responsibility for the treatment, rehabilitation and prevention of mental illness. This period saw government begin to take the lead in developing specialised mental health initiatives, closely aided by psychiatrists. From the 1970s, there was a move to integrate the administration of Victoria's mental health services with other health services, a trend which became more pronounced during the 1980s and 1990s. This move saw psychiatry redefine its parameters in relation to new professional groups. There was a redesign of treatment services away from isolated institutions where patients stayed for many years, and toward day hospitals, community rehabilitation services, and employment and housing support designed to prevent the need for hospital care.

The distinction between treatment and prevention has become recognised within the mental health industry as creating two tangible professions which, while overlapping, need to be treated as separate streams.² Some have argued that with limited and inadequate resources for programs to treat and support people with mental illness, there has been a steady decline in the image of public psychiatry.³ The impact of a split between mental health promotion and mental illness treatment on the lives of people with mental illness is not clear, but with limited resources in the health budget it is arguable that the treatment and care of people with mental illness has had to compete with mental health promotion for attention and resources. But how did this happen and why? How did the policy debates shape community treatment? In order to understand this process, it is necessary to start with the late 1940s when Victoria's mental health administration underwent a significant overhaul.

The Mental Hygiene Authority and the Creation of Mental Health Literacy
In the late 1940s and early 1950s there were high hopes that mental illness could be reduced through public educational activities. There were also wider social movements to create a society in which mental illness might actually not occur. The World Federation for Mental Health (WFMH) was formed in 1948 by the World Health Organisation and heralded a new era of post-war optimism that society could be re-built to prevent war. The goals of the WFMH included world peace, and its founding document 'Mental Health and World Citizenship' claimed that 'the ultimate goal of mental health is to help [people] live with their fellows in one world'.⁴ According to the WFMH, 'mental health' could be achieved through global harmony.

While lofty ideals were being articulated on the world stage, psychiatry in Victoria was establishing itself as a profession that could lead policy on mental illness treatment and prevention. During early attempts to professionalise psychiatry, the Australian Association of Psychiatrists (AAP), the precursor of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), began to consider questions of mental health literacy. In 1948 it formed a sub-committee to 'investigate the possible avenues of propaganda in education in the matter of mental hygiene'.⁵

The AAP also expressed a tendency to ascribe greater levels of mental illness to migrants, reflecting notions of eugenics which characterised the period.⁶ The post-war era was one in which homogeneity and social assimilation characterised policy around race, ethnicity and other difference.⁷ Indeed, the growing desire to return psychiatric patients to their families and community also reflected this interest in reducing the differences between people with mental illness and those without, by assimilating groups which had previously been separated back into society.