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• W3205665823 abstract "This thesis develops an ethical critique of the implementation of community-based mental health care in Queensland, Australia. In the 1990s, reforms were introduced to develop community-based models of care and rehouse patients who resided in psychiatric hospitals. A key part of this was the implementation of supported housing as an alternative to institutional care. In this model, clients are provided with secure individual housing, assistance with the tasks of daily living and access to clinical care when required. This thesis presents a critical policy analysis of the supported housing model as it was applied in Queensland, focusing in particular on the day-to-day work of delivering care. The thesis draws upon a secondary analysis of data collected by the Service Evaluation and Research Unit located at The Park Centre for Mental Health in Brisbane. I was employed in the unit from 2007 to 2012, and one of the major projects we completed was evaluating the implementation of the supported housing model in Queensland. My role involved designing the qualitative components of the evaluation and interviewing research participants. The thesis draws on 77 interviews with workers who provided direct care to clients - support workers employed by non-government organisations (NGOs) and case managers employed by the Queensland Government Department of Health. Support workers were surveyed about their perceptions of the program, and 104 questionnaires were analysed. Program documentation, such as memoranda of understanding, program handbooks, project plans and service specifications were also analysed. The design of the supported housing program in Queensland was consistent with principles articulated by the recovery movement, a significant driver of reforms to mental health care. The recovery movement aims to empower people living with serious mental illness and articulates a critique of the medical model of care historically embedded in public health services. Recovery-focused services were pioneered by the community sector. Increasing funding to this sector was an important part of embedding a recovery focus in the wider mental health system. NGOs employed support workers to provide assistance based on ordinary knowledge, which avoids an overly medicalised approach. This, in turn, created distance between government and client, allowing clients to receive support independently of mental health treatment. Making funds available through tender encouraged multiple NGOs to offer support services, and allowed clients some choice in service provider.A simple explanation of these reforms to mental health services in Queensland would locate them as part of social progress. That is, institutional care was abandoned due to a growing awareness of the inhumane treatment that occurred, and the adoption of community-based care could act as a panacea for past wrongs. A more complex analysis can provide deeper insights into these reforms. Drawing on governmentality literature and the concept of “ethical critique” developed by Glynos and Howarth (2007), this thesis develops a substantial critique of the supported housing program in Queensland. The aim of ethical critique is to create an openness to contingency, that is, to illustrate that social practices are not fixed and that other ways of being are possible. In the case of mental health reforms, an ethical critique examines existing practices, and contemplates alternative logics to achieve social justice for people living with mental illness. Overall, the model of care adopted in Queensland was successful in supporting clients to live in the community. However, there were contradictory elements within the recovery vision that workers found difficult to operationalise in their day-to-day work with clients. The model of care relied on empowering clients, yet did so within a context of relatively few opportunities for genuine participation within the community. Survey results from support workers showed they felt they had adequate training for their role, but they wished to know more about mental illness symptoms, medications and the concept of recovery. Support workers felt out of their depth when clients’ health deteriorated and they had difficulties accessing clinical care for their clients. Both support workers and government health workers identified gaps in the provision of care due to the splitting of care between workers in different organisations. These empirical findings demonstrate that achieving social justice for people living with serious mental illness cannot occur by simply reducing direct service provision by governments. Significant investment in community services and collaborative mechanisms within government is also required.The neoliberal, small state ideology driving these mental health reforms limited the ability to deliver better mental health services. Instead of fearing a coercive state, social movement actors and policy makers can demand an affirmative state that promotes positive freedoms through democratic participation and inclusive citizenship. Policies based on an ethics of care, that sees relationships between persons as a primary focus, may deliver better outcomes for people living with serious mental illness." @default.
• W3205665823 created "2021-10-25" @default.
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• W3205665823 date "2021-03-17" @default.
• W3205665823 modified "2023-09-26" @default.
• W3205665823 title "The transition from institution to community-based mental health care in Queensland: a critical policy analysis" @default.
• W3205665823 doi "https://doi.org/10.14264/5a3cee2" @default.
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