‘Psychiatry at the Coal Face’: patients and the development of community mental health services in New South Wales, Australia, 1960–1980

The second half of the twentieth century was a period of major reform in the administration of mental health in Western democracies, when the orientation of state mental health services turned from legally certified to voluntary patients and psychiatric treatment moved from hospital to community settings. This thesis tells the story of reform of the administration of mental health during the development of community mental health services from 1960 to 1980. It positions the changing role of the patient as crucial to these reforms. I argue that Newcastle and the surrounding Hunter Valley region in New South Wales, Australia, was a site of particular importance in genealogies of patients. Newcastle, an industrial, regional city, was undergoing shifts representative of wider demographic and economic trends in the West during this period, and was the location for experimentation in the administration of mental health. These developments were linked to the emergence of patient rights and obligations, and developments influenced psychiatry and medical education. While the changing authority of patients in the administration of mental health has received little scholarly attention, in this study I argue that it has a central place in mental health histories. I demonstrate this by reconstructing the rollout of voluntary patient and community mental health services for implied patients in New South Wales in 1960-1980, with particular reference to Newcastle. I read source material against the grain to bring social and cultural perspectives to developments that shaped, and were negotiated by, patients. I draw on material from academic, health administration and community sectors, held in the David Maddison Collection in the University of Newcastle Archives, New South Wales, Australia; oral history interviews with former mental health staff and family members of patients; government reports; and interviews and published material by patients available in the public domain. In doing so I expose the lineage of twenty-first century mental health patient roles. I argue that changes in patients and services reflected an expansion in what mental health services were seen to address, and that approaches trialled in the administration of mental health have had a powerful influence on public health policy over time.