The Health Department/Social Welfare Department Standing Committee provided one forum for this negotiation. In 1978 there were debates about how to manage people with mental illness who required services from the Social Welfare Department, with the committee deciding that it was not necessary to get the approval of the Head Office of the Mental Health Department to assess state wards. Its minutes noted that even though small reception centres were being developed in regional areas it was difficult to find psychiatrists. There were also practical issues to resolve about patient records. The committee decided that all medical records, including psychiatric problems and treatment, should be included in the one folder. It was noted, however, that 'some officers of the Mental Hygiene Branch of the Health Department, insist that the psychiatric records are the responsibility of their Branch'.³⁸

While the administrative borders were being negotiated, the profession of psychiatry was also continually questioning its role in the public policy debates. In 1983 there was a forum on ethics in psychiatric practice at which Dax spoke on the topic 'Are we treating the wrong patients?'. Dax considered that the scope of psychiatry had to include all the social issues which were attended to under the 1977 Inquiry into Human Relationships. He observed that 'the public mental health services may in the future have the major task of organising the care of the community's chronic psychosocial needs. I therefore imagine the future mental health services to become "Departments of Social and Preventative Psychiatry"'. He also cautioned that there would be 'demarcation disputes if there [were] perceived to be a threat to invasion of the social field'³⁹ and pointed out that if psychiatry were to assume its responsibility in this field, there would be opposition to the 'medical model' and labelling. This caution was well-founded as voluntary groups became more organised and expressed strong views about their roles as advocates for people with mental illness.⁴⁰

1980s Health Promotion and Mental Health Literacy
Mental health administration had become increasingly integrated within the bureaucratic structure of the Health Commission, consistent with the trend towards linking policy around mental health and generic health. This also applied to the area of health promotion. In 1980, a meeting of all the commissioners and divisional directors of Health made recommendations about how a sum of $50,000 should be allocated to health promotion. The Mental Health Division was included in this process. The aim of health promotion was to 'raise people's awareness that they can do things to improve their health and to reduce health costs'. A second aim was to 'promote the corporate identity of the Health Commission of Victoria' and establish favourable attitudes toward the commission. There were plans for a logo, slogan, jingle, posters and media coverage.⁴¹ Health promotion was to be encouraged, and mental health was seen as part of the definition of health.

The concept of health promotion at this time was not unanimously endorsed within the bureaucracy, however. Patricia Mundy, from the Health Promotion Unit, wrote a memo to J Bennie, Convenor of the Health Promotion Committee, on the subject 'What is meant by health promotion?'. She expressed concern that the commissioners and Health Promotion Committee did not understand health promotion the same way. She wrote that 'the definition of Health Promotion implies a positive state of health, valuable in its own right', which could be achieved by providing people with self-help information, helping people acquire the skills to use this information, and outlining the services available.⁴² The Director, Building and Services Division had another view, stating that as far as they were concerned, people should be provided with 'care and attention when something goes wrong rather than being helped to live a healthier life'.⁴³ Herein lay a dilemma for the government in deciding how to invest in health promotion. To what extent should health services, including mental health services, devote resources to people who are not actually ill?

In the area of mental health, as we saw from the early 1950s, there was an interest in improving mental health literacy. This had continued throughout the 1960s and 1970s. The Mental Health Division of the Health Commission had continued to have its own mental health education staff, with Rachelle Banchevska still leading government work in this area. In a remarkable similarity to the model which Dax had requested thirty years earlier, there were two health education workers (one of whom was Banchevska) and a stenographer/typist. In 1980, it was noted by JL Evans in his report for the Health Promotion Committee on health promotion that the mental health education role could be spread into a wider field, while recognising Banchevska's role and status as a professional with twenty years' experience. An integrated health promotion unit appeared to be the preferred model, with mental health operating within a larger administrative health bureaucracy.⁴⁴

This approach was consistent with the move to treat people in the community and to improve the community's mental health literacy. By 1986, with the passing of the new Mental Health Act 1986 (Vic) it was clear that the closure of the large psychiatric institutions was government policy. The money required to sustain these buildings and staff was greater than for community-based day services. The treatment preference was for 'the least restrictive environment' and the civil liberties of patients was to be more clearly enshrined in legislation. The report which recommended the closure of Willsmere Hospital, the former Kew Asylum, stipulated that budget requirements favoured this approach, alongside the social benefits of community-based services.⁴⁵ In the ten years from 1975 to 1985, 1600 beds were closed in Victoria and by 1985 there were 15 Community Mental Health Clinics and 17 Outpatient Clinics at hospitals.⁴⁶

As mental health literacy was essential in this environment where people were to be treated outside of hospitals, psychiatrists saw an opportunity to apply for funds to run their own mental health education activities. In 1986 the Mental Health Foundation of Australia and the National Association of Mental Health sought funding from the Federal Minister for Health, Neal Blewett, to develop a community awareness program that discussed problems of mental health. In the same year, the Australian Government released a report on 'The Better Health Commission', which included just two paragraphs on mental disorders as one part of a much wider discussion of a health promotion program.⁴⁷

Whilst the health promotion model was being developed and trialled, psychiatrists also looked at their own profession and found there was still a lack of unity in its approach. For example, the psychiatrist Graham Burrows, Chairman of the Mental Health Foundation of Australia, told the national conference of the Australian National Association for Mental Health in 1989, 'We have to stop the silly fight, between psychology, sociology, psychiatry, medicine and physical health. The debate about whether it is psychological or biological must stop'.⁴⁸

The late 1980s saw the further development of community organisations taking a leading role in defining how people with mental illness should be treated. Voluntary groups were given an even stronger role in service planning with the establishment of a peak body for psychiatric disability support services known as VICSERV, first funded in 1987. Its members were non-government agencies such as the North Eastern Alliance for the Mentally Ill (NEAMI) and the Outer East Council for Development of Mental Health Services, and offered alternative models of care. In the Melbourne suburb of Essendon, for example, there was an organised response from within the community to the establishment of a new community mental health service in 1989. A discussion paper on the topic reported that 'new structures are developing and roles and responsibilities defined. There is still opportunity for new players to be involved and have an impact'. The paper warned however that bureaucratic constraints made input difficult: 'The cumbersome nature of the operations of psychiatric services which place emphasis on the differences between professions and client confidentiality ... can preclude co-ordination.' Service providers were interested in the question 'Where does decision-making power lie?'.⁴⁹