In some ways, the work of the MHA during the 1950s and 1960s benefited from the boom economy of the period, following the climate of post-war reconstruction, expanded social welfare, and expanded notions of social citizenship. Between 1939 and 1956 public employment rose from 67,000 to 154,000.²⁰ The total combined Commonwealth and State expenditure in health and community services grew from £160,450 in the period 1949-50 to £675,867 in the period 1961-62.²¹

This was also a period that saw increased optimism about the new treatments which enabled patients to leave hospital and use the new outpatient clinics. The project known as 'deinstitutionalisation' saw the number of patients in Victorian psychiatric hospitals decline by 33 per cent between 1963 and 1973.²² 'Largactil' (chloropromazine) and lithium were hailed by the psychiatrist JFJ Cade (himself a leading figure in the discovery of lithium) as allowing a 'multitude of schizophrenics [to be] maintained in the community, at home and working, whereas once they would have been foredoomed to spend the rest of their days as chronic mental hospital patients'.²³ On a similar note, Cade applauded the tri-cyclic anti-depressants and benzodiazepines as contributing to an environment where 'equanimity [is] brought on by prescription'.²⁴

But while psychiatry as an emerging profession was enjoying an increase in status as a result of these modern treatments, there was disquiet within its ranks about other competing professions in the community. For example, in 1959 the AAP discussed the government's support for Marriage Guidance Councils and clearly felt that it would be better if the government subsidised qualified psychiatric services to perform this role.²⁵ Psychiatry was keen to work beyond the traditional clinical focus and faced competition from agencies which were supported by the government to work with the community on broader social issues. This created an environment where psychiatry had to clarify its role and defend its expertise.

Social Psychiatry and Anti-Psychiatry
Beginning in the 1960s, there was interest amongst some psychiatrists in conducting collaborative research with a range of professionals including sociologists, psychologists and social workers as well as psychiatrists. As the historian George Rosen commented in 1968, reflecting on whether psychiatrists had a role in public mental health: 'the problem in mental hygiene is basically one of aetiology'. Therefore, psychiatrists saw themselves as having expertise to offer in determining what caused mental illness. Nevertheless, Rosen also observed that 'many of the weaknesses in the mental hygiene movement reflect the deficiencies that psychiatrists have brought to it'.²⁶ It was a time for reflection and the re-orientation of psychiatry if the profession were to build a place for itself in the public dialogue about the cause-and-effect relationships between the environment and mental illness.

The late 1960s saw the partnership between biological and psychological and social approaches strengthen.²⁷ This was difficult when psychiatry itself was divided about the respective roles of biology and environment in causing mental illness. As David Hamburg noted in 1970, 'It is no longer worth while to ask, Is schizophrenia genetic or environmental? The basic questions center on the specific nature of the gene-environment'.²⁸ To add weight to the argument about the relationship between illness and environment, Hamburg cited research 'a decade ago' which surveyed people with mental illness to look at whether mental illness was related to class, and found that schizophrenia was more prevalent in lower classes. It also found that patients from the upper classes were more frequently given psychotherapy and those from the lower classes were given ECT. Such a critique of the scientific objectivity of psychiatry fed into a climate of questioning how environment and illness interacted.

Psychiatry as a profession also turned to broader epidemiological questions through social research on the emergence of physical health issues. For example, the MHA published a study of Heyfield, a rural town in Gippsland, which covered both mental illness and certain physical conditions.²⁹ In Victoria, the Australian and New Zealand College of Psychiatrists also turned to social questions, with a 'Political Issues Committee' formed to develop positions on such controversial areas as abortion, homosexuality and capital punishment. Dax was encouraged to be the convenor 'because he has shown considerable interest in the matter on both the social issues and the political issues side'.³⁰ Psychiatry was keen to expand its mandate and influence a range of broader social concerns.

There was, however, a countering phenomenon which threatened to undermine the validity of psychiatry. The anti-psychiatry movement played an important role in questioning the ability of psychiatrists to offer disinterested advice and some groups went so far as to claim that psychiatrists violated civil liberties.³¹ Alongside this movement, there was an ascendancy of other groups who also claimed to represent a mental health industry, albeit one which saw itself as separate to, if not in opposition to, traditional psychiatry. These groups included social or welfare workers in community-managed organisations who worked directly with people diagnosed with psychiatric disorders, and who felt increasingly that people with mental illnesses should be involved in policy decisions. For example, Richmond Fellowship and the Schizophrenia Fellowship both became active in Victoria in 1977.³² While the government files of groups such as the Victorian Association of Psychiatric Patients (VAPP), Psychiatric Complaints Council and the Campaign Against Psychiatric Injustice and Coercion (CAPIC) are closed to the public, it is clear that groups existed that began to speak from a critical perspective about psychiatry and treatment.³³

Negotiating Boundaries: The Health Commission and Community Mental Health
In 1969, Cunningham Dax left Victoria for Tasmania and was succeeded by another psychiatrist, Alan Stoller. In 1975 the Health Commission was formed, integrating mental health under the broad umbrella of health.³⁴ The report which recommended the amalgamation of health services observed that mental health administration and its services had become too isolated. This foreshadowed the arrival of a multi-issue approach to health promotion which would attempt to incorporate mental health while also maintaining a separate policy area on community mental health services. This in turn saw psychiatrists developing specialisations in community treatment.

The Victorian Mental Hygiene Council (VMHC), an influential body in non-government mental health advocacy, took mental health to have 'sociological, psychological, anthropological, spiritual, educational, biological and medical aspects' in a letter it wrote to the Minister for Health in 1975.³⁵ Its wide definition meant that the tasks which were seen to be potentially related to 'mental health' could go far beyond the traditional medical treatment of psychiatric illness. In 1975 the VMHC's members included 'community leaders, teachers, clergymen, employers, housewives, retired people, office workers, doctors, nurses, psychologists, psychiatrists, and representatives of many agencies including social workers'. The group ran an Annual Prize known as the 'Victorian Council for Mental Hygiene Cunningham Dax Prize' which was 'awarded for an essay on Mental Health in its broadest sense'. In 1973 the prize went to an essay on 'The Survival of the Nuclear Family'. Alan Stoller, Chairman of the MHA, was asked by the Minister what he thought of the organisation and he wrote in a note that it should be supported.³⁶

The Commonwealth Mental Health and Related Service Assistance Program in 1973 provided for eight new community mental health services in Victoria. These services posed challenges in determining how much support was required and how roles should be defined. For example, communities which abutted psychiatric hospitals feared that early release of patients may make them unsafe. A letter written in 1978 from Steve Crabb, MLA for Knox and signed by many local residents, complained about the early release of one patient who had been guilty of indecent assault, and stated that residents were frightened to go outdoors. During this period, community mental health required increasingly careful negotiation between government and community about what was deemed to be acceptable practice in terms of managing people with mental illness who were discharged from hospitals.³⁷