By 1992, the state, territory and commonwealth governments had decided that a more co-ordinated approach to mental health issues was required. All governments agreed on a National Mental Health Policy which encouraged the states and territories to adopt a consistent approach to the treatment of mental illness, including the closure of stand-alone psychiatric hospitals. It also codified responsibilities for mental illness prevention and mental health promotion and applied the broad thinking about health promotion to the mental health sphere.

In 1993 the Human Rights and Equal Opportunity Commission released its Report of the National Inquiry into Human Rights of the Mentally Ill. This report focused on the experiences of people with mental illness and reflected a widespread recognition that the treatment, rehabilitation and social participation of people with mental illness since the advent of deinstitutionalisation had been below the standards of a caring society.

For the mental health industry, it could be argued that the last fifty years have seen an increased specialisation of professionals and a competition for resources and talented staff between the streams. The treating of people with mental illness in the public sector may have suffered a loss of status and, according to some, is now perceived to be the 'second best' stream within the profession.⁵⁰ While policy discussions over the last fifty years or so have revolved around the intention of reducing mental ill-health and suffering, it is debatable whether this goal has been reached, with research in 2001 finding that fewer than 40 per cent of people with mental disorders had received any care in a twelve-month period compared with almost 80 per cent for other common physical health problems.⁵¹

Mental Health, Psychiatric Language and Government Policy
Differing concepts of mental health and mental illness have translated into robust debates about professional and policy roles and responsibilities. Government has been prepared to take leadership from psychiatry, while psychiatry has also had to adapt to the changing cultural landscape. The relationship between government and psychiatry has been even more complex because psychiatry itself has often been under the 'conflicting influences of ideologies which are difficult to reconcile with each other and often contradictory'.⁵² It has been argued that one of the reasons that psychiatry has struggled to find its role in the social debates about mental health is because as a profession it has lacked clarity about cause and treatment, especially the weightings it gives to biological or genetic, versus social or environmental, explanations.⁵³

Moreover, the very definition of mental illness itself has evolved. The Diagnostic and statistical manual of the American Psychiatric Association, first published in 1952, was 100 pages long, while the fourth version, produced in 2000, is 943 pages. This explosion in the scale of psychiatry suggests that as forms of mental illness have multiplied, the expertise required to diagnose, differentiate and treat has also become more specialised.⁵⁴

In 2002, the historian Roy Porter observed that the language of psychiatry had permeated Western culture, partly because the profession was unable to reach agreement about the role of medical and social factors in mental illness and treatment. Psychiatry:

still lacks the cognitive and professional unity enjoyed by general medicine and remains torn between bio-psychosocial and medical models both of its object and its therapeutic stages. Meanwhile, partly because of the proliferation of psychiatries, more people are said to be suffering - indeed claiming to be suffering - from a proliferation of psychiatric syndromes, in a 'victim culture' in which benefits may appear to lie in buying into psychiatric syndromes ... as the idioms of the psychological and psychiatric replace Christianity and humanism as the ways of making sense of one's self.⁵⁵

This proliferation of psychiatric syndromes can be seen in the government policy tendency to slip between different medical and social constructs of mental health. It can be argued that government has been increasingly prepared to accept the role of community as a major defining element in mental illness, its prevention and treatment. This is at least partly because the individual with mental illness is no longer seen as an object to be incarcerated in a large stand-alone psychiatric institution, but rather as a subject who exists in an active relationship with his or her community. The current mental health policy now includes attention to the impact of mental health issues on the whole community.⁵⁶ Therefore the very quality of community has become a central concept in mental health policy and informs the thinking behind policy and service delivery.

Conclusion
The policy debates about mental health have been characterised by many different concepts and intended aims. In Victoria, there has been a move from a central Mental Hygiene Authority, with responsibility for all aspects of mental illness, treatment and education, to a more integrated concept of mental health with a multitude of stakeholders and perspectives. Objectives related to treatment have always been paramount in policy formulation, but increasingly the wider community has taken centre stage.

Psychiatric terminology entered the public arena through the influence of psychiatrists operating within government and also through the increasing advocacy of voluntary agencies. These struggles took place against a backdrop of new models of health promotion which gained ascendency in the public administration, and while psychiatry has influenced the formation of this model it has also had to adapt to the changing public policy context.

One of the key defining features of the policy context was the shift toward community care. While many files which relate to this issue are closed to the public, it is hoped that further research can be conducted to deepen our understanding of how policy evolved in relation to community mental health. This article has suggested that the closure of the psychiatric institutions required a greater focus on community education about mental illness to encourage people to recognise symptoms of illness and seek earlier treatment. This process posed challenges for psychiatry as it sought to define its various roles in both clinical treatment and the improvement in mental health literacy. Further research on the development of the different educational approaches and the evolving relationships between the various professionals involved will further advance our understanding of the complex area of mental health policy in Victoria and beyond.