The Antecedents and Origins of Mental Health Social Work in Western Australia

From Social Policy to Social Work: The Antecedents and Origins of Mental Health Social Work in Western Australia

Marcia Foley B.A., Dip. Soc. Wk., M. Phil.

This thesis is presented for the Degree of Doctor of Philosophy at The University of Western Australia

Disciplines of History and Social Work and Social Policy

School of Social & Cultural Studies

Faculty of Arts, Humanities and Social Sciences

June 2010

THESIS DECLARATION

This thesis is all my own work and it does not contain work that I have published, nor work under review for publication.

Student Signature ……......

Table of Contents Abstract i Acknowledgements ii List of acronyms iii Prologue iv

Introduction The interconnectedness of cultural, social, political and economic factors in the development of mental health social work. 1

Organisation of thesis. 5

Chapter One The Research Journey 12 1.0 Research questions 12 1.1 History and historical controversies 14 1.2 History and hermeneutics 20 1.3 History, post-structuralism and Michael Foucault 22 1.4 History and feminism 25 1.5 History and critical inquiry 29 1.6 Holding the perspectives together 30 1.7 Methods 31 1.8 Data Analysis 44 1.9 Summary 45

Chapter Two Social Work and Social Policy 47 2.0 Emergence of social work 48 2.1 International 48 2.2 Britain 49 2.3 United States 55 2.4 Australia 60 2.5 Western Australia 70 2.6 Core themes 75 2.7 Summary 79

Chapter Three Mental Health – A Brief Overview 80 3.0 Development of mental health services 81 3.1 England 81 3.2 United States of America 89 3.3 Australia 93 3.4 Western Australia 107 3.5 Core themes 113 3.6 Summary 116

Chapter Four The Establishment Years – 1959-1972 119 4.0 Development of social work services 120 4.1 Conceptualisations of mental illness 121 4.2 Social work education 126 4.3 Establishment of social work in MHS 129 4.4 Mental health legislation 139 4.5 Deinstitutionalisation 143 4.6 Core themes 149 4.7 Summary 151

Chapter Five The Honeymoon Period – 1973-1984 153 5.0 Development of social work services 153 5.1 Political influences 153 5.2 Feminist influences 156 5.3 New mental health facilities 157 5.4 Establishment of a career structure for social work 165 5.5 Social work functions 169 5.6 Relationship of social work with other disciplines 174 5.7 Variations in the concept of mental health 175 5.8 Core themes 179 5.9 Summary 182

Chapter Six Professional Humpty Dumpty – 1985-1999 184 6.0 Development of social work services 184 6.1 Organisational change 184 6.2 Change in the Australian public sector 185 6.3 Western Australian Government reforms 195 6.4 Social work services in the Health Department of Western Australia 203 6.5 Core themes 216 6.6 Conclusion 219

Chapter Seven Conclusion 221

Appendix I 229 Appendix II 230 Bibliography 231

Abstract

This thesis offers an account of the development of social work in Mental Health Services (MHS) in Western Australia (WA). It provides an overview of developments overseas prior to the European settlements in Australia, and suggests new ways of examining issues which affected the implementation and treatment of mental illness. I argue that, although social workers were employed as early as 1959, the formalisation of mental health social work as a professional service in WA occurred around 1968 following the adoption of a policy of deinstitutionalisation of psychiatric hospitals. The thesis explores the way in which social work, which formerly had been dominated by a medical ideology, responded to the challenges provided by the new policies. In order to identify social work within the network of political and social changes I integrate significant bodies of knowledge in the fields of medicine, sociology and economics in particular the way gender and power impacted on the development of social work services in this country. The methodology is qualitative and is multi- method and multi-perspective revolving around the use of history, particularly of oral history.

The research identifies three historical periods of social work development in the Mental Health Services of Western Australia, each initiated by a political decision. The first commences in 1959 when the government decided to employ a qualified social worker to assist the attendance of psychiatric patients at a day hospital, and established the secondary nature of social work’s position in relation to psychiatry. The second starts in 1973 when a government policy of funding community programmes provided a ‘Honeymoon period’ enabling the coordination and expansion of social work activities to occur, and its recognition as an independent profession in the MHS. The final period begins in 1984 when, following the amalgamation of all health and mental health services in WA, social work services did a ‘Humpty Dumpty’ as the impact of neo-liberal privatisation policies ousted them from their elevated position in the professional hierarchy, and confronted the profession with unprecedented challenges.

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Acknowledgements

I have been fortunate to have had the supervision of Professor Maria Harries and Professor Charlie Fox, and appreciate their unstinted commitment to this thesis. I thank them sincerely for their good natured patience as I attempted to weave together a number of different theoretical research approaches and for support during the trying times when I wandered away from the topic, and needed to be guided back again.

I am particularly grateful to my colleagues in social work, psychiatry, psychology and nursing, who, by participating in research interviews, willingly shared their experiences of working in the Mental Health Services. In particular this thesis is a tribute to the skills and tenacity of those social workers who were employed in the foundation years of a relatively new profession.

My wonderful adult children Helen, Terry, Joanne, Michael, Patrick and Kathryn, have been my greatest champions and source of strength, particularly during the lonely and dispirited periods that occurred over the research years as I struggled with a volume of information. I seriously doubt that I could have done it without them. I thank Joanne for her support particularly with the proof- reading, and Michael for the many times he rescued me from a ‘computer crisis’.

Finally this thesis is inspired by the memory of my parents Muriel and Alex Clamp (now both deceased) who instilled in me a spirit of inquiry, and provided me with an education far beyond the level considered appropriate for girls of my generation.

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List of acronyms

AASW, Australian Association of Social Workers. ACOSS, Associated Council of Social Services. ANZJP, Australian and New Zealand Journal of Psychiatry. ARAFMI, Association of Relatives and Friends of the Mentally Ill. COS, Charity Organization Society. CPD, Community Psychiatric Division. CSA, Civil Service Association. CWD, Child Welfare Department. DSM, Diagnostic and Statistical Manual of Mental Disorders. ICD, International Classification of Disorders. MDD, Mental Deficiency Division. MHD, Mental Health Department. MHO, Mental Health Officer. MHS, Mental Health Services. MO, Medical Officer. NSW, New South Wales. NY, New York. PSW, Psychiatric Social Worker. SROWA, State Records Office of Western Australia. SWD, Social Welfare Department. UK, United Kingdom. UWA, University of Western Australia. WA, Western Australia. WAIT, Western Australian Institute of Technology.

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Prologue

This research journey began in August 1966 when I walked through the entrance doors of Heathcote Hospital, a Reception Home for Psychiatric Patients in Perth Western Australia (WA), to begin the first day of my appointment as a newly qualified social worker. Despite the fact that I had spent eight weeks there previously as a student, I was suddenly fearful and uncertain. My emotions told me to run home as fast as I could, but my body took me into the office of the Superintendent. The ‘journey’ was on its way! It would prove to be a long and unyielding journey as it wove together my personal and professional pathways. But I did not know that at the time. Neither did I know that some of the people I had just met would become lifelong colleagues and friends. That was a long time ago. Although my employment in the mental health social work services ended in 1984 I never really withdrew from it, and was engaged in private practice until the end of 1999. Consequently I find it difficult to disentangle my personal journey from the professional one.

At Heathcote Hospital the social worker was an ‘almost equal’ member of the professional team, headed by a psychiatrist. It was always the psychiatrist who made final decisions. My work duties involved providing social histories, which usually involved visiting the patient’s home environment and reporting back to the team before the treatment programme was decided. The hospital had a strong involvement in the promotion of mental health issues with the local community in which the social worker was encouraged to play a major role. All this happened before the era of community nursing, and social workers were frequently requested to visit families distraught by the presence of mentally ill relatives in the home, and to decide whether hospital readmission was necessary.1 The hierarchical structure of the hospital was a familiar aspect of my life, as it had been as a child within the boundaries of my traditional family. Therefore it posed no threat to me. Social workers and allied health staff were welcomed into the common room and dining room, formerly sacrosanct to doctors only, and this ‘elevated’ us from other staff.

1 Under terms of the Mental Health Act, 1962, patients admitted could be returned home and placed on After Care, enabling them to be returned to hospital when necessary, without the need for further committal (Mental Health Act 1962, Div 5, Section 2). iv

By the late 1960s my initial enthusiasm had waned, but my interest was aroused by the newly introduced specialty of Community Psychiatry, an exciting concept for social work at the time.2 I became involved in a departmental training programme for volunteer workers in the promotion of mental health activities throughout the community. However when a more senior position became available at Bentley Clinic in 1970 I felt it was time to let go my ties to Heathcote Hospital and move on.

Bentley Clinic was an entirely different experience! The clinic ostensibly was organised along the lines of a therapeutic community. It was ‘presided over’ by a male Superintendent. The all-female professional staff included community care nurses who, with the social worker, spent most of their time out of the clinic. Several of the patients were women who had formerly been long-term inmates of Claremont Hospital for the Insane but now faced the incredibly difficult task of adjusting to family life. I became involved in casework with couples and began to understand the principles underlying family therapy. I was also involved in organising facilities to enable patients to receive psychiatric treatment in their own homes rather than be admitted to hospital. All this occurred at the time when the women’s movement was becoming increasingly active in promoting the establishment of shelters for victims of domestic violence, via contact with local welfare and medical groups. These experiences at Bentley Clinic spoke loudly of the essential link that should have been maintained between a patient’s life during and after hospital admission, especially in regard to ongoing treatment and support. I was later to discover that this ideology was not unequivocally accepted throughout the Mental Health Service (MHS) in WA.

I moved again in 1973 when I was promoted to the position of Social Work Supervisor of the newly created Swanbourne/Graylands Psychiatric Hospitals. The hospitals comprised approximately 1000 patients from the original Claremont Mental Hospital, an institution looked upon with fear throughout the community. A single Social Welfare Department which had been initially established in 1968 to assist the

2 G. Elliot & A. Graycar, ‘Social Welfare’ in A. Patience and B. Head (eds.) From Whitlam to Fraser: Reform and Reaction in Australian Politics, Melbourne, Oxford University Press, 1979, pp.88-102. See also P. Mendes Australia’s Welfare Wars Revisited: The Players, the Politics and the Ideologies, revised edition, Sydney, New South Wales, UNSW Press, 2008, pp.27-32. He writes that in 1973 the Federal Whitlam government provided funds for the State government for the development of community health and psychiatric facilities; this policy was revised downward by the appointment of the Fraser government, but not discontinued completely. v

MHS deinstutionalisation policy, served both hospitals. Shortly after I was appointed, the hospitals were divided into a psycho/geriatric section at Swanbourne, and a psychiatric section at Graylands. I chose to remain with the psychiatric section at Graylands.

Graylands Hospital was the intake facility for residents of the northern districts of the metropolitan and regional areas of the MHS. However, unlike the regime at Heathcote Hospital, the ethos surrounding chronic patient care dated back to the early days of colonial settlement. An unshakable ideological gulf existed between the long- serving medical staff who, at Claremont, were accustomed to dealing with chronically ill and intellectually disabled patients, and the newly introduced allied health staff group. My attempts to establish social work as a member of the professional psychiatric team failed badly with this group of psychiatrists, although ultimately acceptance did grow; but it very much depended on the personalities of individuals concerned. Further, because of differences in approach, I did not communicate well with the Superintendent. He firmly insisted that the social work role should be confined to mundane welfare oriented issues of the patient within the hospital, and very much opposed involvement in the treatment regime of patients. Neither did he encourage ongoing contact outside the hospital walls. I believed differently, and was conscious of my responsibility to deal professionally with the situation as best I could. Despite these constraints, as Social Work Supervisor I was able to take part in orientation programmes for newly appointed psychiatrists and trainees to the hospital. With the cooperation of some of the more progressive senior psychologists and occupational therapists we gradually inculcated a tolerance to the presence of social workers and other allied health representatives in the treatment team.

At the same time as starting my job at Swanbourne/Graylands Hospitals it was also an eventful time in my personal life. A marriage break-up and all that goes with it happened in a short space of time. Until then the women’s movement had not been an influence on my life, but many of the ideals resonated strongly within me, and I began to reject the hierarchical power relationships that seemed to have controlled me. While I continued to work at Swanbourne/Graylands for the next six years it was also a time of personal growth that obviously impacted on the way I worked there vi

and in the future. In 1980 my appointment to a management position as Deputy Principal Social Worker for the MHS placed me in a position of power in a fairly autonomous situation in the mental health professional hierarchy. It also provided me with some insight into the machinations that were inherent in the formulation of departmental policy. Power, it seems is like beauty - in the eye of the beholder! I discovered this illusion when my reports to the Director, based on information from front-line workers concerning social issues relating to mental illness, consistently got ‘lost’ in the system. When in 1984 the MHS became incorporated into the much larger structure of the Health Department of WA rather than the more specific mental health authority, I felt the time had come for me to move on once more. It was a good decision! The decision involved leaving the employment of the government. I commenced work as a social worker in private practice in Perth and regional areas of the State, and continued until I retired at the end of 1999. The ideas for this research had been brewing for many years but the opportunity to write the history of mental health social work in WA had never presented itself. It now did, and I began the research for this thesis the following year.

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Introduction

The broad goal of this research is to provide an historical analysis of the development of mental health social work in Western Australia, and present new ways of examining issues that effected the implementation and treatment of mental illness. In an area of interest untouched by earlier social work historians, the research covers an extended field of scholarship in order to examine the interconnectedness of cultural, social, political and economic factors which impacted on the development of mental health social work in the state government department responsible for the provision of mental health services for the mentally ill, Mental Health Services (MHS) in the forty year period from 1959-1999.

On a personal level when I was employed as a mental health social worker I asked myself many questions. As a new graduate in 1965 my concern centred mainly on casework, and I was frequently asked the question ‘What do social workers actually do?’ My response always seemed to resemble a stumbling description of what in fact I actually did. As time proceeded, social work practice became modified by political decisions, changing ideologies of health and changing gender relations. Throughout the thirty years of my employment many definitions occurred to me, but I don’t believe I ever found one that adequately captured the work I did. That is, hopefully, until now.

The establishment of social work in Australia is comparatively recent and little has been recorded of its history. In mental health the situation is similar. In this thesis I will present several arguments: that social work traditionally has been dominated by a medical ideology in which gender has determined not only policy but also the status of the professional groups within its boundaries; that the history of social work in the mental health services in Western Australia (WA) began to unfold at a time when existing ideology was questioned, and revolutionary methods for caring for the mentally ill were introduced rendering their compulsory incarceration no longer necessary; that the boundaries between occupational groups became increasingly blurred, and social work was faced with a number of challenges as models of health and mental health were redefined. While working through the historiography one of

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the major challenges was to find ways of isolating one issue - the development of social work - as it was embedded in a chronology of political change and evolving social trends.

The research covers a period between 1959, when the first psychiatric social worker Margaret E. Stockbridge, trained in England, was appointed to the staff of the Child Guidance Clinic of the MHS in WA, and 1999, when the number of social work employees had grown subsantially, most of whom had trained in WA. By this time the proportion of males who were employed as social workers had increased although in the main it was still regarded as, and was, a female dominated profession. The forty year period saw a number of changes in medical knowledge and gender relationships, and saw the development of a community model of care and the deinstitutionalisation of the mentally ill. These changes occurred within the established hierarchical structure of the MHS and resulted in re-definition of established professional boundaries.

The research also aims to investigate the way mental health social work was constructed, particularly in WA. Using the sociology of the professions it examines the development of social work as a specific discipline in the context of the mental health services: the way it produced its own knowledge and the way this knowledge was recognised as legitimate or dismissed as illegitimate; the way it was appropriated by other disciplines; and its power relations with psychiatry and the other associated professions. It does not take the field of social work as a static construct but views it as a discipline in a state of construction in which refinements in social work policies and practices have occurred in response to changing concepts and community needs. Having indicated the circumstances promoting this research, and the broad framework in which it is located, the key question that emerges is:

How did mental health social work in Western Australia develop from its introduction in 1959, when it was shaped by the ideologies around nineteenth century charitable organisations, to its position in 1999 when it became shaped by a neo-liberal managerialist reform agenda?

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Broadly the question is divided into four sub sections:

1. What were the functions of social work in the Mental Health Services (MHS) of Western Australia between 1959 and 1999, how were they defined and how did they change?

2. In what way, if any, did social work give evidence that it differed from other professions involved in care of the mentally ill in the MHS?

3. What has been the historical place of social work in the mental health hierarchy?

4. In what way may the fact that social work was a predominantly female profession influence the development of social work in the MHS?

With regard to past histories, we can reflect on national and international developments. On an international level, social work’s origins have been traced back to the British Charity Organisation Society (COS) in the 1890s.1 With its roots in the populist and oppressive Poor Law ideology of ‘less eligiblity’ in which the conditions of relief in workhouses were to be harsher than the worst job outside, so harsh as to positively discourage anyone from applying for relief, the aim of the COS was to make recipients responsible for their own lives. Guidelines were spelt out for the principles of casework, group work and community organisation, many of which still continue in social work education and practice today.

In Australia the profession of social work began in the 1930s and its significance and development have been explored in only a limited way, the core texts being written by R. J. Lawrence in 1965 and by P. Boas and J. Crawley in 1976.2 More recently the work of Richard Kennedy and Phillip Mendes expand on these texts. Writing in the 1980s, Kennedy points out that, as most social workers were employed by

1 A.E. Fink, J.H. Pfouts & A.W. Dobelstein, The Field of Social Work, 8th edition, Beverley Hills, Sage publications, 1985. 2 R.J. Lawrence, Professional Social Work in Australia, Canberra, Australian National University, 1965, and P.J. Boas and J. Crawley, Social Work in Australia: Responses to a Changing Context, Melbourne, Australian International Press in association wih the Australian Association of Social Workers, 1976. 3

Government agencies, they increasingly became servants of the State, and consequently were obliged to uphold the prevailing values of the Government of the day.3 He asserts these values conflicted at times with principles concerning individual rights and decision- making, as set out in the Australian Association of Social Worker’s Code of Ethics.4 Philip Mendes, whose work spans very recent years, provides a clearer view of the role of social work in its current industrial and political context.5

In the field of mental health social work in Australia, Robert Bland is one of the foremost writers who have contributed to our knowledge of social work. In his most recent book, written with two collaborators, he argues that the strength of social work lies in seeking to locate the emergence of an awareness of mental illness and the experience and impact of illness on the broader family, community and social context. 6 By focusing on the rights of those who are mentally ill and their carers, he seeks to promote greater access to necessary treatment and support services. It is significant that one of the co-authors of this very recent book, Anne Tullgren is both a social worker and a self professed mental health consumer.

As I reflected on my professional journey that is captured in some part in this thesis, and on the research questions and the research journey, I am aware of the huge developments that have occurred in mental health social work in recent years. Maria Harries points out that as more social workers are now being employed in non- government rather than government services, it has become evident that people with mental illnesses constitute the clientele in every practice area, not just in dedicated mental health facilities.7 Partly as a result of this understanding and because so much attention has been drawn to the need to ‘upskill’ all mental health practitioners, attempts are being made to include mental health information as an essential component of generic social work courses. Whilst this provides a welcome signal

3 R.J. Kennedy, Charity Warfare: The Charity Organisation Society in Colonial Melbourne, Melbourne, Hyland House, 1983. 4 AASW Code of Ethics, 1999 edition, Australian Association of Social Workers. 5 P. Mendes, Australia’s warfare wars revisited: the players, the politics and the ideologies, revised edition, Sydney, NSW, University of NSW Press, 2008. 6 R. Bland, N. Renouf & A. Tullgren, Social Work Practice in Mental Health: an introduction, Crows Nest, N.S.W. Allen and Unwin, 2009. 7 M. Harries, ‘Mental Health Social Work in Australia’, in M. Connolly & L. Harms (eds.), Social Work: Contexts and Practice, 2nd edition, South Melbourne, Oxford University Press, 2009, p. 236. 4

about important developments in mental health social work in Australia in recent times, the concern of my research focuses on the antecedents to this and hopefully can shed some light on the context for the current reforms.

To answer my research questions, and guided by material from contemporary texts, I drew on my experience as a social work clinician and administrator, and utilised ‘insider research’ a term applied where the researcher has direct involvement or connection with the research setting.8 Within the early emancipatory frameworks set by research scholars such as Peter Reason9 and Jan Fook10 and the newly emergent traditions of autoethnography11 I situate myself firmly in this thesis, as I am both a participant in the period of this research and a researcher with others who themselves were both participants and colleagues on the professional (and personal) journey. Whilst this is not an autoethnography, it is a research project in which I am researching and writing as an insider and cannot separate myself from the time or the events. The prologue provides evidence of my personal investment in the research and intermittently throughout the research and writing I reflect on my own interpretations of the times and the stories that I am told.

A number of ethical questions arose immediately, as I intended to interview social workers who had worked in the mental health field. I had supervised the work of most of them at different times and it was very evident that it was possible that the pattern of our past relationships and agendas may intervene in their responses. These ethical questions and dilemmas are addressed in Chapter One.

Organisation of the Thesis

Chapter One contains the broad theoretical framework that informs this research. At the outset I found myself struggling with numerous paradigms and concepts as well as

8 S. Reinharz, On Becoming a Social Scientist, San Francisco, CA, Jossey Bass Publishers, 1979, argues for ‘human tools’ to be used as research instruments. See also A. Fontana and J. Free, ‘Interviewing: the Art of Science’, quoted in N.K. Denzin and Y.S. Lincoln (eds.), Handbook of Qualitative Research: Theories and Issues, 2nd edition, Thousand Oaks, Sage, 2000. 9 P. Reason (ed.), Human Inquiry in Action, Sage Publication, London, 1988. 10 J. Fook, The Reflective Researcher, Sydney, Allen & Unwin, 1996. 11 S. Holman Jones, ‘Autoethnography: Making the Personal Political’, in Denzin & Lincoln (eds.), (2nd ed.), Handbook of Qualitative Research. 5

trying to find a language that unites them. Ultimately I found Denzin and Lincoln’s use of the concept, bricoleur,12 Taylor and Bogdan’s commitment to understanding social phenomena from the perspective of those experiencing it,13 and Crotty’s utilisation of a ‘scaffolding’ approach, to develop a framework as a way of analysing and understanding the research process, to be most valuable.14

I found issues such as gender and power to be so interwoven with social work practice that I decided to use a framework of multi-method and multi-perspective methodology. This enabled me to include issues such as interpersonal relationships and cultural issues as legitimate elements in the research.15

The next task was to find an historical approach that could utilise these frameworks. Fortunately the current eclecticism of the discipline of History enabled me to do so. Richard Evans has shown how social and cultural history has allowed a range of objective and subjective elements to be incorporated into historical research.16 Thus history’s traditional reliance on empirical documentary evidence has now been supplanted by a broad acceptance of the idea that documents should be read for different meanings and the context in which these meanings were produced. Moreover, the discipline of history now accepts the use of oral evidence as a valid source, and a reputable alternative to documentary evidence where documentary evidence is not available, and/or as an adjunct source, where it is. Oral history is, par excellence, the historical method which allows actors to describe the world as they experience and see it.17

A different aspect to historical analysis is taken by Edward Carr who addresses the question of ‘What is History?’ Carr sees the historian as being engaged in a process of

12 Denzin and Lincoln, (eds.), Handbook of Qualitative Research., 13 S.J.Taylor & R. Bogdan, Introduction to Qualitative Research Methods: A Guidebook and Resource, 3rd edition, New York, John Wiley and Sons Inc., 1998. 14 M. Crotty, The Foundations of Social Research, Crow’s Nest, Allen & Unwin, 1998. 15 This approach is also supported by K. Healy, Social Work Theories in Context: Creating Frameworks for Practice, Houndmills, Basingstoke, Hampshire, Palgrave Macmillan, 2005, and L. Dominelli, Feminist Social Work: Theory and Practice, Basingstoke, Palgrave, 2002. 16 R.J. Evans, In Defence of History, London, Granta Books, 1997, p.84. 17 For an excellent survey of changes historical approaches see A. Green & K.Troup (eds.), The houses of history: a critical reader in twentieth-century history and theory, New York, New York University Press, 1999. On oral history see V. Raleigh Yow, Recording oral history: a guide for the humanities and social sciences, Walnut Creek, CA, Alta Mira Press, c2005, 2nd ed. and R. Perks &. A Thomson, (eds.), The oral History Reader, London, Routledge, 2006, 2nd ed. 6

melding together a multiplicity of causes of events or processes and attempting to establish some relationship or hierarchy between them.18 He does not see history as having a finite end, but as a slow process of development with occasional ‘leaps’ from time to time. I take from Carr the idea that historians explore the interconnectedness of events, I also I take advantage of the idea that history can move as ‘leaps’.

Having described the framework utilised in the research process this chapter also provides a description of the three primary analytical methods that inform the research. Arising from a review of the literature, the first entails a contextual analysis of social work and mental health services in England, the USA and Australia. The second is a detailed analysis of historical documents found in a variety of Western Australian repositories. The third is an examination of the data obtained from a series of semi- structured interviews with 25 senior mental health practitioners from a range of professions who were employed in various mental health services in Western Australia during the period under review.

In Chapter Two I trace the development of social work from the late nineteenth century from its origins in the English and American COS, to its establishment in colonial Australia, and demonstrate the enduring influence of British Poor Law legislation. 19 Distinctive approaches to ‘deserving’ and ‘undeserving’ applicants for charitable relief in each of these countries were modified over time according to changing political and cultural ideologies. The historiography of British welfare has tended to focus almost exclusively on the role of the State.20 In contrast Jane Lewis focuses on the role of the non-government voluntary sector and argues that Britain has always had what she refers to as ‘the mixed economy of welfare’.21 The organisation of welfare services changed when, following recommendations of the Seebohm Report in 1969, social workers were removed from specialist facilities and placed in community based bureaucracies and

18 E.H. Carr. What is History? 2nd edition, London, Penguin, 1984. 19 Fink, Pfouts & Dobelstein, The Field of Social Work, D. Rothman, Conscience and Convenience: The Asylum and its Alternatives in Progressive America, Boston and Toronto, Little Brown and Company, 1980, J. Brown, The British Welfare State: A Critical History, Oxford, Blackwell Publishers, 1995. 20 Brown, The British Welfare State. 21 J. Lewis, The Voluntary Sector, the State and Social Work in Britain: The Charities Organisation Society/Family Welfare Association since 1869, Aldershot, England, Edward Elgar, 1995. 7

organisations.22 Then in the 1980s, non-government organisations experienced considerable difficulties in responding to the increased demands imposed on them following the move towards a neo-liberal, managerialist regime, by the then Prime Minister, Margaret Thatcher.

In America the situation was different. Although voluntary and state, rather than federal, action was the favoured intervention in welfare provision, the ‘New Deal’, the famous government initiative established during the Great Depression of the 1930s provided short-term government funded relief.23 Government policies enabled the Americans to support whatever social services they considered appropriate. Government funded welfare programmes and newly introduced psychoanalytic and family therapy methodologies encouraged social workers to move into the area of private practice. However the social realities and policies of the eighties and nineties thwarted any attempts to reform the health and welfare systems.

Chapter Two then turns to Australia and describes the establishment of welfare services from colonial times until the end of the twentieth century.24 Richard Kennedy shows that welfare services, fashioned along the lines of English Poor Law administration and retaining traces of its colonial inheritance, retained much of the character of private philanthropy.25 As Weller and Davies show, community-based services were introduced in the early 1970s. Then in the 1980s, neo-liberal policies were introduced, resulting in attacks on welfare bureaucracies and a growing marketisation of state-run welfare institutions.26 Finally, the chapter turns to Western Australia, and explains how slow the development of social work was in this State, where opportunities for social workers were limited. Indeed it was not until the 1960s, when the first tertiary courses in social work were established, that the profession may be said to have ‘arrived’.

22 L. Prior, The Social Organisation of Mental Illness, London, Sage Publications, 1993, pp.39-42. 23 M. Katz, In the Shadow of the Poorhouse: A Social History of Welfare in America, New York, Basic Books, 1999. 24 P. Statham, ‘Swan River Colony 1829-1850,’ in C.T. Stannage (ed.), A New History of Western Australia, Nedlands, University of Western Australia Press, 1981. 25 R. Kennedy, Charity Welfare: The Charity Organisation Society in Colonial Melbourne, Melbourne, Hyland House, 1985. 26 P. Weller and G. Davies (eds.), New Ideas, Better Government, St Leonards, NSW, Allen and Unwin, 1996, and D. Osborne & T. Gabler, Re-inventing Government, New York, Penguin, 1993. 8

Chapter Three focuses on the history of mental health services. As with the previous chapter the research winds its way through developments in England and America before turning to Australia. Ever since the publication of Michael Foucault’s Medicine and Madness the historiography of mental illness has been in a constant state of flux. He noted that psychiatry as it is currently known is an invention of the nineteenth century. Further, he argued that both mental illness, and its obverse, reason, rationality and ‘normality’, and psychiatry do not exist outside of discourse and that, historically, the discourses of mental illness and psychiatry have been a product of their times. In this chapter I posit that in each country members of the community define the meaning of ‘normality’.

The change in community responses to mental illness is a core theme of this chapter. It charts the development of constructions of mental illness whereby a ‘trade in lunacy’ brought about the incarceration of mentally ill in custom built asylums and hospitals for the insane, subsidised by the State during the eighteenth century, and continues to the deinstitutionalisation and subsequent privatisation of many of these services in the latter half of the twentieth century.27

Changing ideologies underpin the historical development of mental health services.28 Commencing with the professionalisation of services to the insane, I provide an overview of the development of multidisciplinary teams, the introduction of community care policies, and the privatisation of psychiatric services.29 Interwoven with these issues is the impact of political decisions and of community action groups, which are particularly evident in the latter decades of the twentieth century. An important focus of the chapter is the recognition of cultural issues that distinguish Australian from overseas psychiatric orientations.

The forty year time-frame of my empirical research, from 1959-1999, is divided into three chapters, each representing a change in departmental policy in the delivery of

27 M. Foucault, Madness and Civilisation, London, Tavistock, 1967, A. Scull, Museums of Madness, London, Allen Lane, 1979, A. Scull, Decarceration, community treatment and the deviant: a radical view, Englewood Cliffs, New Jersey, Prentice Hall, 1977. 28 E. Freidson, Professional Dominance: The Social Structure of Medical Care, New York, Atherton Press, 1970. 29 M. Lewis, Managing Madness: Psychiatry in Australia 1788-1980, Canberra, AGPS publication, 1988. 9

services for the mentally ill and consequently of social work services. Chapters Four, Five and Six chart the development of social work in the MHS in distinct periods of time, each period a product of political decisions.

Chapter Four discusses the decision in 1959 by the Western Australian government to establish a Day Hospital and appoint a qualified social worker to assist patients with problems associated with admission and discharge. It finishes in 1973. Initially social work recruitment was difficult as training did not become available in WA until the mid 1960s. In 1968 a policy of deinstitutionalisation was introduced at Claremont Hospital and a Social Welfare Department was established to assist in the administration of this policy. In this way it became possible to coordinate and extend the activities of community nursing staff, welfare officers and social workers who were previously hospital based, into effective treatment teams. The effectiveness and implementation of this team directive was still very much in the hands of the hospital Superintendents. Decisions concerning social work appointments and functions were also made by the Superintendents. Unfortunately a lack of coordination existed in the type of work performed and in the recruitment and allocation of staff.

Chapter Five charts the period which I have called ‘The Honeymoon Period’, extending from 1973 until 1983. In 1973 a decision was made by the Commonwealth Government to establish a number of universal programmes to benefit the community.30 The MHS, as a provider of community based mental health facilities, became a recipient of the new funding arrangements, and embarked on an expansion programme. However, the lack of co-ordination in social welfare activities which existed within these mental health services was no longer feasible or tolerable. In order to overcome this difficulty, the MHS appointed a Principal Social Worker to coordinate all matters relating to social welfare decisions. I was heavily involved in the activities that led to this change and have documented it in more detail later in this chapter. At this time social work within the MHS became recognised as an independent profession. Activities were extended into community clinics and facilitated the establishment of a hierarchical social work administrative structure and an associated extension of career possibilities for social workers.

30 P. Mendes, Australia’s Welfare Wars Revisited: The Players, the Politics and the Ideologies, Sydney, UNSW Press, 2008, pp.27-29. 10

Chapter Six titled ‘Professional Humpty Dumpty’ discusses how social workers fell off the pedestal on which, I suggest, they had been placed. It covers the period 1984- 1999 and describes how yet another political decision became responsible for a major reorganisation of the health services. The redirection overturned the aspirations of social workers to cement and secure their professional standing. ‘Pandemic management reforms’ became the catchword for events as the administrations of allied government departments were amalgamated into mega entities. Government departments began modelling themselves on the private sector in an attempt to reduce costs. The MHS was incorporated into the Health Department of WA. Mental health social work became part of a generic social work department, which then became absorbed by the Allied Health Division of the Health Department. Into the 1990s government services were increasingly outsourced, and government departments became purchasing authorities. New conceptualisations regarding the treatment of mental illness which accepted the management approach of the government, saw priorities revert back to the old medical model, which was incompatible with social work practice. Social workers endeavoured to negotiate with members of the Health Department bureaucracy, but their efforts were unsuccessful. By the end of the 1990s the profession faced significant challenges.

In each of the analytical chapters (Four, Five and Six) I tease out the core themes that are present in the observations made by the interviewees about their experiences and the events surrounding them, and integrate these with themes from the literature and what documentary evidence was available. I then pull these together in Chapter Seven to formally summarise the findings of the research.

11

Chapter 1

The Research Journey

The broad aim of this research is to examine the historical contribution that social work has made in the Mental Health Services of Western Australia (MHS) and in so doing to add to the understanding of the potential of the profession in this important area of practice. The chosen methodology was to review the history of social work by studying the changes in conceptualisations of mental illness, government health policies, composition of the health work force, and gender relationships from 1959, when the first qualified social workers were employed by the MHS, to the end of the 1990s by which time a large number of organisational changes had occurred. The aim was to identify the factors underlying the development of social work services, and the responses of social workers to these developments over the forty year period of the research. Of particular interest were the factors that inhibited social workers from achieving the goals they set themselves.

1.0 RESEARCH QUESTIONS

How did mental health social work in Western Australia develop from its introduction in 1959, when it was shaped by the ideologies around nineteenth century charitable organisations, to its position in 1999 when it became shaped by a popularist neo- liberal managerialist reform agenda?

The four sub sections that arose from this question are:

(i) What were the functions of social work in the Mental Health Services in Western Australia between 1959 and 1999, how were they defined and how did they change?

(ii) In what way, if any, did social work give evidence that it differed from other professions involved in the care of the mentally ill in the MHS?

(iii) What has been the historical place of social work in the mental health hierarchy?

12

(iv) In what way did the fact that social work was a predominantly female profession influence the development of social work in the MHS?

The research is informed by a qualitative research methodology whereby multiple paradigms combining objectivist and constructivist epistemologies are bound together to provide an interpretive framework.1 Denzin and Lincoln are among a number of authors who consider that research in this style is constantly evolving as the data takes research in new directions, and they refer to the qualitative researcher as a bricoleur or maker of quilts, or a ‘do it yourself’ person, which puts the spotlight on the multiple skills and resourcefulness of the individual. The bricoleur is described as one who is knowledgeable about the many interpretive paradigms (including feminism, Marxism, cultural studies and constructivism) contained in qualitative research and who deploys whatever strategies, methods or empirical materials that appear to be suitable. The solution is then pieced together as an emergent construction and takes different forms as new tools and methods of representation are added to the puzzle. In this approach the bricoleur- the researcher- is always in the material world of values and material experiences, and the world is constituted through the researcher’s interpretive perspective.2 The research is also informed by Crotty’s concept of ‘scaffolding’, which allows the researcher to move through a number of elements including epistemology, theoretical perspective, methodology and methods, each of which inform one another and provide a sense of direction as the particular purposes of the study are examined.3 Utilising a social constructionist method, Crotty argues:

all knowledge and therefore all meaningful reality as such, is contingent upon human practices, being constructed out of interaction between human beings and their world, and being developed and transmitted within an essentially social context. 4

It follows that, in the view of social constructionists, people do not create meaning, rather they construct meaning by engaging in the world they are interpreting and the way it is interpreted by others. In this way, they suggest, objectivism and subjectivity are brought together and held together. Taylor and Bogdan argue that qualitative

1 Denzin & Lincoln, Handbook of Qualitative Research, Introduction. 2 Denzin and Lincoln, Handbook of Qualitative Research, p.2. 3 Crotty, The Foundations of Social Research, Introduction. 4 Crotty, The Foundations of Qualitative Research, p.42. 13

research, based on interpretive or phenomenological perspectives, is committed to understanding social phenomena from the perspective of those experiencing it: the important reality is how and what people perceive it to be.5

Following this brief introduction, this chapter now moves to an analysis of historical approaches and outlines the particular historical approach that is employed to address the research questions posed. It then moves on to discuss four perspectives used in this approach: hermeneutics, the post-structuralism of Michel Foucault, feminism and critical inquiry. Then it describes the sampling methods, data collection instruments, and analytical tools that were used concluding with a discussion of the issues arising from the research questions.

1.1 History and historical controversies.

Increasingly in the last twenty years, the assumptions upon which historical research and writing have been based since the emergence of history as a professional discipline in the nineteenth century have been questioned.6 Many of the assumptions go back to the beginning of a continuous tradition of Western historiography in Classical antiquity. What was new in the nineteenth century was the professionalisation of historical studies and their concentration at universities and research centres. Central to the process of professionalisation was the firm belief in the scientific status of history. However the concept science was understood quite differently to that understood by natural scientists who sought knowledge in the form of generalisations and natural laws. For the historians, history differed from nature in that it dealt with meanings as they expressed themselves in the intentions of men and women who made history and their values and mores. But both shared the optimism that methodologically controlled research makes objective knowledge possible. George Iggers notes that for historians, as for other scientists, truth consisted in the correspondence of knowledge to an objective reality that, for the historian, constituted the past as it had actually occurred.7 He adds that historians often denied the extent to

5 Taylor & Bogdan, Introduction to Qualitative Research Methods, pp.3-7. 6 G.G.Iggers. Historiography in the Twentieth Century from Scientific Objectivity to the Postmodern Challenge, Hanover and London, Wesleyan University Press, 1997, pp.1-17. 7 Iggers, Historiography in the Twentieth Century, p.2. 14

which their research rested on assumptions about the course of history and the structure of society that predetermined the results of their research.

The most noted proponent of ‘objective’ history is the English historian, Geoffrey Elton, and I will use Elton’s work as a way of setting out the principles of this school of history. Elton argues that historians, by examination of the choices and actions of people in the past and by translation of the past ‘as it actually happened’, can represent reality objectively.8 He sees some ways of dealing with history as being intrinsically different to others by distinguishing between the inside knowledge of the professional historian ‘who has assimilated the various and often very tiresome relics of the past and can also judge it’ and ‘the amateur who shows a tendency to find the past, or parts of it, quaint’, and considers that although amateur history might be entertaining it cannot deepen the understanding because it is written from the outside.9 Further, although acknowledging that the historian can profit from insights provided by related discipline areas such as the social sciences, he comments that one of the main dangers to which modern society is exposed lies in ‘the rashness of the social scientist, treating his theories as facts,’ and then proceeding to apply them in practice.’10

Elton considers that truth can be extracted by a critical examination of the evidence, including the reasons why it came into existence, why events of the past occurred, why people lived and died and whether or not historians were interested in writing about them.11 They had an independent reality, and the historian’s job was to analyse them through the traces they left behind. Thus no matter how difficult it might be, historians were required to understand in a cognitive sense the actions, ideas and motives of people in the past without direct reference to their own beliefs in the present.

Elton divides evidence into two categories, that which was produced specifically for the attention of the researcher, and that produced for some other purpose.12 The first is mainly comprised of evidence of a literary and often secondary nature: chronicles, memoirs, letters for publication, and notes of self justification. The second comprises

8 G.R. Elton, The Practice of History, London, Sydney University Press, 1967. 9 Elton, The Practice of History, p.17. 10 Elton, The Practice of History, p.39. 11 Elton, The Practice of History, p.65. 12 Elton, The Practice of History, pp.76-84. 15

all documents and records, most, but not all, letters and state papers, official memoranda whether published or not, reports of commissions and law suits, and also all the material relics of past societies such as buildings or artifacts. He adds that these lists are not exhaustive, and the historian should always first make it clear which one is being dealt with, and the purpose of the research is therefore identifiable. Truth then emerges from a double process of understanding what the evidence really was, and understanding how it fits together. This objectivist view of history, however, came under attack on many fronts.

The historiography of the nineteenth century rested on the tradition of the classical Greeks that history was always written as a narrative. Hayden White and other theorists of history have argued that while it appears to proceed from empirically validated facts or events, it actually requires imaginative steps to create a coherent story.13 Therefore, they suggest, a fictional element enters into all historical discourse. ‘Scientific’ historical discourse involves the literary imagination while the older literary tradition also sought truth in the reconstruction of the real past. This conviction that history is connected more closely to literature than to science has challenged the very assumption on which modern historical scholarship had rested; the idea that objectivity in historical research is not possible because there is no object of history, has gained increasing currency. The ‘scientific’ orientation shared basic assumptions with this literary tradition that history portrayed people who really existed and actions that really took place.14 However for historians who rejected White’s arguments, assumptions of reality, intentionality and temporal sequence determined the structure of historical writing.15

In the 1950s another critique developed when the French structuralists, Claude Levi Strauss and Jacques Lacan, working in cultural anthropology and psychoanalysis respectively, began to develop scientific approaches to the study of human society and behaviour based on the pioneering work in structural linguistics of the Swiss linguist Ferdinand de Saussure, who studied language as a system whose properties did not

13 H. White, Metahistory: The Historical Imagination in Nineteenth Century Europe, Baltimore, The John Hopkins University Press, 1973. 14 Iggers, Historiography in the Twentieth Century, p. 3. 15 D. Beran, Early British Romanticism, the Frankfurt School, and French Post-Structuralism: In the Wake of Failed Revolution, New York, Peter Lang Pub. Inc. 2001. 16

rely on external referrants.16 What they considered to be important were the relationships between elements of language or signs. Structuralist linguistics posited a closed system of signification which could be observed and understood by an external observer; language became the focus of study and the means by which external reality was constructed. Many believed that the human sciences, which had up to this point been regarded as pseudo-sciences, could now achieve the status of ‘true’ sciences.17 Levi Strauss in his 1962 discussion of history in The Savage Mind describes the effects of structuralist methods in the human sciences as placing sign systems as the centre of attention and reducing ‘man’ (the subject) to the secondary status of being merely an effect of the system: they were leading to the ‘dissolving of man’ from epistemologies in the human sciences. Moreover, if there were deep structures in language that were amenable to observation, then there must be deep structures in other aspects of social life which could similarly be discovered.

Debates have long gone on about whether history texts should contain more fact or more interpretation. In the early 1960s, E.H.Carr in his What is History contended that the facts of history cannot be truly objective, since they become facts only because of the significance given to them by the historian, and commented on how closely the works of historians mirror the society in which they live. Thus, he claimed, in his most famous statement, history is ‘an unending dialogue between the present and the past’.18 Richard Evans agrees, arguing that there is more than one way to read a document, and all of them, theoretically, are equally valid; our way of reading a source derives principally from our present-day concerns and the questions that current ideas and theories lead us to formulate.19

G. Himmelfarb writes that today’s New History has become ‘the accepted shorthand term for postmodernist modes of history that may not be consistent with one another, but that represent, singly and collectively, a challenge to traditional history’.20 The

16 A. Green & K. Troup. The Houses of History: A Critical Reader in the Twentieth Century History and Theory, New York, New York University Press, 1999, pp. 297-298. 17 Green & Troup, The Houses of History, pp. 117-128. 18 E. H. Carr, What is History? London, Penguin, 2nd edition, 1987, p. 30. 19 R. Evans, In Defense of History, London, Granta Books, 1997, p.84. 20 G. Himmelfarb, The New History and the Old, Harvard, Cambridge, Mass., The Bellenap Press of Harvard University Press, 1987. See also J. Appelby, L. Hunt and M. Jacob, Telling the Truth about History, New York, Norton, 1994, p.16, who argue that scientific writing, with its encoded values, only makes sense when placed in a social context. 17

proponents of New History argue that social phenomena need to be studied in their historical contexts, which incorporate social relationships between people and cultural groups. Postmodernism also utilises the concept of historical contingency whereby the political economy of truth is determined by the political discourse of the institutions which produce it, and is subject to constant political and economic movements. 21

The English postmodernist historian, Keith Jenkins, in his discussion of the problems faced by those who attempt to record history, argues that no matter how verifiable or acceptable the methodology, history continues to represent a personal construct and manifestation of the perspective of the narrator who acts as interpreter between past events and our reading of them.22 He comments, ‘perhaps we are now in a postmodern moment when we can forget history’.23 As Munslow puts it, ‘facts’ are never innocent because historians invest them with meaning, correlate and place them within a context, which then leads the historian to generate the ‘facts’.24 However Helene Raddeker argues that the fact that a social event or an occurrence, broadly interpreted as a revolution, happened, does not mean that we can adequately describe what it means, and that the modern historian’s stock in trade is meaning, not facts.25

Arthur Marwick disagrees with the approaches taken by those post-modernist writers and argues that they are unfamiliar with the modes of explanation historians actually use.26 He argues that historians are always seeking corroboration and qualification, involving a balance between short-term agency, contingency and convergence, and longer-term structural, ideological and institutional movements. Consequently the production of history is very much an iterative activity demanding further research.

To this point I have presented the two extremes of the arguments between earlier historians and their postmodern critics and some replies by historians to those criticisms. I will now return to, and discuss what is sometimes referred to as the way

21 Himmelfarb, The New History and the Old, p. 203. 22 K. Jenkins, Rethinking History, London, Routledge, 2003, See also K. Jenkins, On What is History: From Carr and Elton to Rorty and White, London, Routledge, 1995. 23 Jenkins, Re-thinking History, p.7. 24 A. Munslow, Deconstructing History, London, Routledge, 1997, p.178. 25 H. B. Raddeker, Skeptical History: Feminist and Postmodern Approaches in Practice, London and New York, Routledge, 2007. 26 A. Marwick, ‘Two approaches to Historical Study: The Metaphysical (Including ‘Postmodernism’) and the Historical’, in Journal of Contemporary History, No. 30, 1995, pp.5-35. 18

most working historians work - the ‘perspectivism’ as set out by the English historian Edward Carr and his later followers such as Richard Evans.

Carr argues that a past event does not become a fact until it has been accepted as such by historians who decide not only on the choice of facts, but also in what order or context they are used.27 He adds:

The facts of history are indeed facts about individuals, but not about the actions of individuals performed in isolation, and not about their motives, real or imaginary, from which individuals suppose themselves to have acted. They are facts about the relations of individuals to one another in society and about the social forces which produce…the results they themselves intended.28

Distinguishing between fact and evidence, Carr tells us that an event is something that happened, but a fact is something constructed by the historian, or existing in the remains of the past, in documents. He argues ‘before we take up a work of history our first concern should be not with the facts it contains, but with the historian who wrote it before you study the historian study his political and social environment.’29 He sees the historian as being engaged in a continuous process of melding together interpretation and facts between the present and the past, and from these, draws conclusions that may serve as a guide to action. Carr comments, ‘History is therefore a selection in terms of historical significance’.30

Commenting that history begins with the handing down of tradition; and carrying the habits and lessons of the past, and into the future, Carr did not see progress as having a finite end, but as an infinitely slow progress of development, although with occasional ‘leaps’ from time to time, with the historian as interpreter of these actions.31 However as Evans notes, the gaps in a document (what it does not mention) are often just as interesting as what it contains, and what the historian writes and what the documents

27 Carr, What is History, p.11. 28 Carr, What is History, p.52. 29 Evans, In Defense of History, mentions the English liberal historian G.M. Trevelyan, whose work was written against his background of landed gentry, hence his paternalistic stance towards the lower orders, p.163. 30 Carr, What is History p.105. 31 Carr, What is History, p.108. 19

say are often two different things.32 He adds that many sources are not written at all, and ‘getting inside the head’ of someone who buried treasure in a grave in the fourth century or who made a newsreel in the twentieth century, is far from easy. Although suggesting it is possible to isolate words and concepts in terms of the overall linguistic and conceptual system being employed, Evans questions the manner in which the historian of today can convey the meaning that words from the past had for contemporary historians.33

Evans discusses the emergence of the political history of the nation state and its relation with other nation states during the professionalisation of history in the nineteenth century.34 Indeed, writing in 1997 he comments that the two world wars reinforced rather than undermined the hegemony of the ‘kings and battles’ approach, and the view that history is essentially political history remains widespread. He quotes Carr’s comments made in 1961 that it was only over the last two hundred years or so that ‘the mass of people enter fully into history’, because it was only in this period that ‘social, political and historical consciousness had begun to spread to anything like a majority of the population.’35 Carr’s concern is that historians, by treating ‘the history of the English speaking world as the centerpiece of universal history, and everything else as peripheral, is an unhappy distortion of perspective’, and that it is the duty of schools of modern history in universities to correct such popular distortions.36 Evans reminds us that despite the fact that both Carr and Elton advocated a return to traditional political history, virtually everything of meaning or importance to all kinds of people (not just to a small elite of educated and powerful people) has a written history, for example social history, quantitative history, cultural history and women’s history.37

1.2 History and hermeneutics Utilising Carr’s approach to history opens up a range of perspectives. Denzin and Lincoln describe the work of the historian William Dilthey as one such perspective.38

32 Evans, In Defence of History, p.92. 33 Evans, In Defence of History, p.90. 34 Evans, In Defence of History, pp.161-162. 35 Evans, In Defence of History, p.163, quoting Carr, p.149. 36 Carr, What is History?, p.150. 37 Evans, In Defence of History, p.164. 38 W. Dilthey, Selected Writings, Cambridge, Cambridge University Press, 1976. quoted in Denzin 20

They suggest that in the process of generating “facts” Dilthey argued that natural reality and social reality are different kinds of reality, each of which require different kinds of investigation involving “grasping the subjective intent of the person (actor) from the inside” to understand behaviour in terms of motives, beliefs and desires through the process of hermeneutic inquiry. Thus, he writes:

We are enabled to move away from the inadequacies of thin descriptions of de-contextualised facts… to produce ‘thick descriptions of social texts characterised by the context of their production, the intention of their producers, and the meanings mobilised in the process of their production’.39

Crotty suggests that much hermeneutic theory contains the prospect of uncovering meanings and intentions that are hidden in the text, as quite often the intention of the authors remains implicit and may be unrecognised by the authors themselves, and that interpreters may end up with meanings and assumptions that the authors themselves would have been unable to articulate.40 Therefore, he argues, in order to understand a text about human beings in a particular culture one needs to understand the relationship between human affairs and the culture that guided their lives. He concludes that ‘in this process no final interpretation is sought’.41 Understanding the meaning of historical texts to include more than their semantic significance is based on a centuries-old disciplined approach referred to as hermeneutics, which was adopted by the early Greeks.42 They authenticated texts by examining the consistency of the grammar and style of the author throughout a particular text, and related part to whole and whole to part as an interpretive practice. Hermeneutics was also applied to the realm of biblical exegesis (critical analysis of texts) which demonstrated the different literal and spiritual interpretations given to texts. This led to significantly different theologies by the Christians and the Jews.43

Dilthey, one of the earlier proponents of hermeneutics, believes that life and history are intertwined.44 He argues that the source of historical understanding for an author is

& Lincoln, Handbook of Qualitative Research, p.192. 39 Dilthey quoted in Denzin & Lincoln Handbook of Qualitative Research, p.286. 40 Crotty, The Foundations of Social Research, p.91. 41 Crotty, The Foundations of Social Research, p.91. 42 Crotty, The Foundations of Social Research, p.89. 43 Crotty, The Foundations of Social Research, p. 89 44 Dilthey, quoted in Crotty, The Foundations of Social Research, pp.92-93. 21

derived from a two-fold knowledge of the historical and social context of lived experience as is reflected in language, literature, behaviour, art, religion or laws, and explains that in this way hermeneutics can be understood as the link by which we, as historically and culturally located beings can communicate our experiences and values to others and the world in general. Crotty identifies the concept of the ‘hermeneutic circle’ based on ‘understanding the whole through grasping its parts, and comprehending the meaning of parts through divining the whole circle’, as a consistent theme in the literature.45 He notes that the human sciences and the natural sciences have different subject matters, and that the understanding exercised in the human sciences is not required in the natural sciences.

1.3 History, post-structuralism and Michel Foucault

Post-structuralism is described by Robert Young as an epistemological method which, by embracing a number of approaches through its abstract thinking, argues that all meaning and truth are provisional and constantly shifting, thereby frequently escaping the limits of disciplinary boundaries: it is the theoretical critique of the assumptions of modernity.46 He suggests that where historians have commonly based their analyses on material facts, such as documents, art and architecture and archaeological remains which they have labelled as source ‘texts’ and assumed that each has a single meaning, post-structuralists have enlarged the field of texts and argued that each can be read in many ways through the process known as deconstruction. 47 Anna Green and Kathleen Troup see post-structuralism as self-referential, not necessarily and certainly not entirely taking its meaning from the context in which it was produced or from authorial intent.48 Consequently each text’s lack of an external referent leads us to a multiplicity of histories, and voices from the past. Basically, post-structuralism supports a relativist position, and contests any claim to historical objectivity or a single historical truth.

45 Crotty, The Foundations of Social Research, p.92. 46 R.J.C. Young, Torn Halves: Political conflict in literary and cultural theory, Manchester, Manchester University Press, 1996, pp. 67-83. 47 Young, Torn Halves, pp.67-83. 48 Green & Troup, The Houses of History, p.299. 22

For historians, many poststructuralist topics and methods of investigation are a legacy of Michel Foucault and his followers. No historian of mental health can fail to have read his famous book in the history of insanity, Madness and Civilisation: A history of insanity in the age of reason, which, in its argument that insanity has no ontological trans-historic reality but is profoundly historical, not only influenced anti-psychiatry but also shaped the direction post- structuralism developed.49 Reibling argues that to Foucault, ‘truth’ is comprised of the interplay of power relations and sustains social systems to which all people, including those holding power, are subjugated; it is not an instrument of individual or collective agency.50 Wolin writes that Foucault has a special genius for ferreting out manifestations of power in organisations such as hospitals and asylums.51 Megill suggests that critics of Foucault’s work, and there are many, fail to understand that his work is not an ordinary historical project.52 Foucault studied what he termed to be the ‘history of systems of thought’ in an endeavour to discover who we are in the present and how we got to be that way.53 He broke from earlier histories in his rejection of meta-narratives, and did not regard historical change as cumulative or progressive, nor guided by a fixed underlying principle.54 Foucault, in an interview with Eribon, commented,

All my books…are little toolboxes if you will. If people are willing to open them and make use of such and such a sentence or idea, of one analysis or another, as they would a screwdriver or monkey wrench, in order to short-circuit or disqualify systems of power, including even possibly the ones my books come out of, well, all the better.55

Utilising the term discourse, which he refers to as the general framework or perspective within which ideas are formulated and includes ways of seeing, categorising and reacting to the social world in everyday practices, Foucault argues

49 Green & Troup, The Houses of History, pp. 300-301. See also M. Foucault, Madness and Civilisation: A history of insanity in the age of reason, London, Tavistock, 1969 50 B. Reibling., ’Remodeling Truth, Power and Society: Implications of Chaos Theory, Non-equilibrium Dynamics, and Systems Science for the Study of Politics and Literature’, in N. Easterlin and B. Reibling (eds.), After Poststructuralism: Interdisciplinary and Literary Theory, Illinois, Northwestern University Press, 1993, pp.178-179. 51 R. Wolin., The Terms of Cultural Criticism, New York, Columbia University Press, 1992, pp. 170- 193. 52 A. Megill, ‘Recent Writing on Michael Foucault’, in Journal of Modern History, Vol.56, No.3, 1984, p.507. 53 Green & Troup, The Houses of History, p.301. 54 Green & Troup, The Houses of History, p.301. 55 D. Eribon, Michel Foucault, Originally published in French, 1989, translated by Betsy Wing. London, Faber and Faber, 1991, p.237. 23

that all power is enacted through systems of language, and exercised every time someone speaks a discourse, and that people are inevitably part of the discourse of power.56 All of Foucault’s work examines the operations of power in its different forms. He regards the operation of power within societies as tending to reinforce the dominant discourses of that society. Consequently he regards power as operating not from above through a single agency (for example the government) but diffusely, locally while resistance, with which power is in constant interplay, occurs in a series of local disruptive struggles rather than a mighty dialectical engagement.57 The corollary to this is that working to change the discourse can lead to changes in power relationships.

Thus for Foucault, power is not a negative thing which is exercised by the powerful over the weak, telling them ‘no’! Rather, power is productive. As he says:

We must cease once and for all to describe the effects of power in negative terms: it ‘excludes’, it ‘represses’, it ‘censors’, it ‘abstracts’, it ‘masks’, it ‘conceals’. In fact power produces; it produces reality; it produces domains of objects and rituals of truth. 58

Thus, for Foucault, power and knowledge are intertwined. Producing knowledge means producing domains of truth and it is in the creation of knowledge, the regimes of truth, that power lies.

Jupp identifies three features of discourse analysis: discourse is social and meanings vary according to social and institutional settings, there are different discourses that can be in conflict with one another; and, discourses may be viewed as being arranged in a hierarchy.59 He argues that in this way discourse analysis, as it involves the concept of power, may be seen as a method of examining the theoretical connection between the production of discourses and the production of power.

The legitimacy of Foucault’s apparently historical works has often been questioned in debates that can only be touched on here. For example, Marwick comments that,

56 V. Jupp, ‘Documents and critical research’, in R. Stapford & V. Jupp (eds.), Data Collection and Analysis, London, Sage, 1996, pp.298-316. 57 Green & Troup, The Houses of History, p.302. 58 Quoted in McHoul & Grace, A Foucault Primer, p. 64. 59 Jupp, Documents and Critical Research, pp. 298-316. 24

although his books have historical dimensions, they are manifestly not those of a professional historian.60 Evans considers that Foucault saw truth and knowledge as the products not of cognition, as most historians would, but of power.61 Barbara Reibling argues that Foucault’s method, although it appears to be dynamic, is essentially static and deterministic, in that the system under review always remains in equilibrium, power circulates, and nothing changes.62

Having discussed Foucault’s approach to discover ’who we are in the present and how we got that way’, I find myself agreeing with Megill’s argument that there are two ways of using Foucault’s work.

On one level, the task confronting historians is to take up and pursue the specific historical problems that Foucault has managed, through his new perspective, to unearth. On another and very different level, the task is to examine this perspective itself. Foucault claims to be giving us a historical ontology of ourselves.63

Then, referring to the eye-opening character of this ontology Megill asks ‘To what extent is this ontology true?’ While addressing the questions posed by this research project, I will not attempt to examine Foucault’s ontological approach. However, in line with Megill’s suggestion that historians can and should investigate empirically the subjects of Foucault’s histories, I have no hesitation in utilising one of his ‘little toolboxes’, because it is the manifestations of power in mental health social work in Western Australian that is the basic subject of this thesis. This thesis, then is premised on the belief, shared by Megill, that it is possible to explore the kinds of discourses, power relationships that Foucault posits, empirically.

1.4 History and Feminism

Since the 1960s one of the most profound developments in historical writing has been the advent of feminist history; however, like the study of history itself, feminist history

60 Marwick, Two approaches to Historical Study, p. 16. 61 Evans, In Defense of History, p.195. 62 B. Reibling, ‘Remodelling Truth, Power and Society: Implications of Chaos Theory. Non-equilibrium Dynamics, and Systems Science for the Study of Politics and Literature’, in N. Easterlin and B. Reibling (eds.), After Postructuralism: Interdisciplinary and Literary Theory, Illinois, Northwestern University Press, 1993, pp.178-179. 63 A, Megill, ‘Recent Writing in Michel Foucault’, p. 511. 25

has split into several competing schools. Generally, however, the shifts from histories which were essentially descriptions of women’s lives to historico/political agendas that were concerned with understanding and alleviating women’s oppression have been the concern for feminist researchers.

Sex role theory has been used in the study of Australian society by Anne Summers and other writers to demonstrate the way in which behaviour of men and women is dependent on notions of behaviour learned in the private sphere 64 Anne Weick is another scholar who supports the view of the importance of the social environment in shaping lives.65 She describes family membership as the beginning of a socialisation process that works symbiotically with systems of sanctions found in society’s institutional structures often in subtle but nevertheless coercive ways. Education, politics and social welfare, which are often seen as forms of social determinism stress the way individuals are trapped in stereotypes of the ‘male role’ and the ‘female role’. Bob Connell, however, in his study of the theory of gender relations disagrees, and contends that sociologically based sex-role theories ignore the changing definitions of male and female roles that had been the central theme in academic social science’s response to feminism.66 Pointing to developments in the family arising from second wave feminism and the gay liberation movement, he demonstrates that the division of labour and the distribution of power are not dependent on biological sex, but on gender based characteristics associated with the roles played by individuals themselves. He argues that sex role theories miss the realities on which attitudes to various situations are built, and play down the economic, political and domestic power that men have over women.67

64 See A. Summers, Damned Whores and God’s Police, Ringwood, Victoria, Penguin, revised edition, 1994, and M. Stevens, ‘The Gendering of Anthropological Knowledge’, in P. Grimshaw, R. Fincher & M. Grieve (eds.), Studies in Gender, Melbourne, Equal Opportunity Unit, Melbourne University Press, 1992, pp.188-197. 65 A. Weick ‘Overturning Oppression: An Analysis of Anticipatory change’ in L. Davis (ed.), Building on Women’s Strengths: A Social Work Agenda for the Twenty-first Century, New York, Haworth Press, 1994, pp.221-228. 66 R. Connell, ‘Theorising Gender’, in N. Grieve & A. Burns (eds.), Australian Women: New Perspectives, Melbourne, Oxford University Press, 1986, pp.342-357. 67 See also C. Weedon’s Feminist Practice and Post-Structuralist Theory, London, Basil Blakewell, 1989, who examined patriarchal power relationships in which power was seen to rest on the social meanings given to biological sex differences, and also J. Mitchell in Women’s Estate, Harmondsworth, Penguin, 1971, Chapter 9, who describes how mechanisms of power, which are at the levels of the unconscious, become patterns of male dominance. 26

Anna Green and Kathleen Troup identify two major definitions of gender that have led to different strands of feminist analysis: ‘the cultural definitions of behaviour defined as appropriate to the sexes in a given society at a given time’ and ‘a constitutive element of social relationships based on a perceived difference between the sexes, and… a primary way of signifying relationships of power’.68 They argue that one thread of gender history reflects the course of the feminist movement in general which lobbied for equal rights, and the historians who adopt this approach tend to focus on examining women’s status and experience in the past. Historical analysis of patriarchy gave a strongly political edge to the writing of women’s history, arguably raising the “consciousness” of the historical profession regarding the status of women’s history and women historians. In this second set of approaches Green and Troup, drawing attention to the historical dualism between men and women, and the analytic potential of other dualisms such as work/family, nature/culture, and public/private, note that research concerning the sexual division of labour has suggested that the value of women’s work decreased when the workplace became separated from the home and men were perceived as ‘workers’ while women were merely concerned with the family, an activity not labeled as ‘work’.69

Other theorists have suggested that, due to the fragmentary nature of identity ‘woman’s’ subjectivity is divided and conflicting. Sally Alexander argues that psychoanalysis offers a reading of sexual differences rooted, not in the sexual division of labour nor within nature, but through the unconscious and language.70 Thus she argues psychoanalysis can contribute to the understanding of power relations in society. Joan Scott contends that historians need to examine ways in which gendered identities are substantively constructed, and relate their findings to a range of activities, social organisations, and historically specific cultural representations.71

The move away from theorizing an essential feminine and the fragmenting of the subject has convinced some gender historians of the necessity of studying men and masculinity. On this issue Baron comments that gender is present even when women

68 Green & Troup, The Houses of History, pp.253-260. 69 Green & Troup, The Houses of History, p.255. 70 S. Alexander, ‘Women, Class and Sexual Difference’, History Workshop, No. 17, 1984, pp.125-149, quoted in Green & Troup, p. 257. 71 J. Scott, ‘Gender a Useful Category of Historical analysis’ in J. Scott, Feminism and History, New York, Oxford University Press, 1996, p.169. 27

are not, and that the changing definitions of masculinity over time have also altered the power differentials between men.72

The welfare industry has always been associated with women, at least at the service delivery level. Wilson, one of the writers on this subject, contends that social work in statutory settings has shown that the domestic motif has reinforced the role of women as carers irrespective of its effects on their welfare, stigmatising them if they ‘fail’.73 Finch agrees and states that the promotion of ‘community care’ policies have placed increasing demands on women’s capacity as carers of the young, the old and the infirm.74 In terms of employment practices, Dominelli and McLeod argue that social work has become a field characterised by hierarchical employment in which men are located at the top, primarily in management positions, while women occupy the ones on a lower scale with direct client contact.75 Audrey Bolger, in a study of social work employment prospects in Perth Western Australia in the early 1980’s, notes that divisions in this field were becoming more rigid, with women losing ground as more men became available to fill a shrinking shortage of senior jobs.76

The fields of management and organisation theory have also been the focus of feminist study. Although it is too extensive a list to analyse here, two studies are particularly relevant. Research into the Australian experience by Collinson and Hearn suggest that such studies were particularly valuable in revealing the way male bonding occurred and masculine values predominated.77 Benshop and Doorwaad in their study of management styles observed that women’s styles differed from those of men, and that they did not possess the highly competitive approach, qualities necessary to produce

72 A. Baron, ‘On Looking at Men: Masculinity and the Making of a Gendered Working Class History’, in Anne-Louise Shapiro (ed.), Feminists Revision History, New Brunswick, NJ., Rutgers University Press, 1994. 73 E. Wilson, Women and the Welfare State, London, Tavistock, 1977. See also L. Dominelli, ‘Father- Daughter Incest: Patriarchy’s Shameful Secret’, in Critical Social Policy, No.16, pp.8-22, and H. Marchant & B. Waring (eds.), Gender Reclaimed, Sydney, Hale and Ironmonger, 1986. 74 J. Finch, ‘Community Care: Developing Non-sexist Alternatives’, in Critical Social Policy, No.9, pp.6-18. 75 L. Dominelli & E. McLeod, Feminist Social Work, Basingstoke, Macmillan Education, 1989, p.36. 76 A. Bolger, ‘Status in a Female Profession: Women Social Workers in Perth’, Australian Social Work, Vol. 34, No. 2, pp.3-9, 1981. 77 D. Collinson & L. Hearn, ‘Naming Men as Men: Implications for Work, Organisation and Management’, in Gender, Work and Organisation, Vol.1, No.1, January 1994, pp.1-21. 28

maximum efficiency.78 These findings are particularly relevant in social work services where female staff predominate.

1.5 History and Critical inquiry

There are many versions of critical inquiry. Michael Crotty describes this perspective as focussing on power imbalances and structural inequalities in society, and states:

It is a contrast between research that seeks merely to understand and a research that challenges…between a research that reads the situation in terms of interaction and community and research that reads it in terms of conflict and oppression …between a research that accepts the status quo and a research that seeks to bring about change.79

Kincheloe and McLaren argue that ‘criticalist’ researchers and theorists who use their work as a form of social or cultural criticism accept the basic assumptions, that all thought is fundamentally mediated by power relations that are social in nature and historically constituted. Certain groups are privileged over others and oppression is particularly forceful when those who are subordinated accept their position as inevitable or natural. Language is central to the formation of subjectivity, both conscious and unconscious awareness, therefore mainstream research practices are generally implicated, although often unwittingly, in the reproduction of systems of class, race and gender oppression.80 Such theorists argue that, as a result, oppressed people need help in order to participate in the struggle for their own liberation.

Two approaches to empowerment of this kind have been identified by Jim Ife: the individual approach, which seeks to empower people to take control of their lives, to have access to resources and to articulate and achieve their ambitions, and the structural approach, directed at oppressed groups such as Aborigines and those with disabilities.81 In this way, by incorporating their own stories of oppression, the

78 Y. Benshop & H. Doorwaad, ‘Covered by Equality: The Gendered Subtext of Organisation’, in Organisation Studies, Vol. 19, No. 5, 1988, pp. 787-805. 79 See Crotty, The Foundations of Social Research, pp.112-146 for a discussion of the Marxist and Frankfurt School’s development of crtitical inquiry. 80 J.L. Kincheloe & P.L. McLaren, ‘Rethinking critical theory and qualitative research’, in Denzin & Lincoln, Handbook of Qualitative Research, pp.139-140. 81 J. Ife, Rethinking Social Work: Towards critical practice, Melbourne, Longman, 1997, pp.127-151. 29

experiences of these groups are validated. Ife argues that critical theory is integrative and that an approach based on critical theory must include both approaches to empowerment. This, he suggests, would not be possible without links being made to empowerment at the structural level. Consequently he sees critical thinking as seeking to break down many of the dualisms in Western thought, making it compatible with the feminist notion of ‘the personal is political’. A critical inquiry approach, he says, must lead to action. 82

1.6 Holding the perspectives together

This analysis will use Carr’s approach and deal with a ‘multiplicity of causes’ to establish some hierarchy between them. In this research I identify the ‘multiplicity of causes’ and their relative importance to the research topic as the social, political and economic factors which impinged on the development of social work for the mentally ill in Western Australia. The following perspectives each provided alternative ways of gathering and interpreting the data:

 Hermeneutics focuses on our understanding of the individual in the social and psychological forces that shape him or her. It is based on the notion that in order to understand the part (the specific act or sentence) the inquirer must, as far as possible, grasp the whole (the institutional context, form of life, language games and so on). An important implication of hermeneutics for this study is the interpretation by the researcher regarding social and cultural and political changes that occurred and their impact on social work development.

 Poststructuralism moves away from the study of apparent objective reality, to uncover meanings and intentions that are either hidden or not articulated in texts. Foucault’s poststructuralist approach utilises discourse analysis to demonstrate the way in which different discourses have constructed regimes of power and, although I have not utilised Foucault’s post structuralist method, I will be using his analysis of power to examine the way power worked in the field of mental health in WA empirically.

82 Ife, Rethinking Social Work, p. 136. 30

 A feminist perspective has made it possible for the ‘voices’ of female social workers to be legitimately included within the research framework and for the largely oppressive social relationships, in which they are situated, to be analysed. Female dominated occupations such as social work have remained firmly ensconced on lower rungs of the ladder of professional hierarchy and this study will use feminist insights to examine this situation in the case of mental health social work.

 A critical inquiry approach focuses on power imbalances and seeks to change the status quo by promoting dialogue and new levels of learning to those who are subordinated and who seek to control their own lives. The approach aims to demystify power and show how the nature and effect of power reverberates through organisations and institutions.

1.7 Methods

This thesis uses three analytical methods. The first is a detailed contextual analysis of the history of social work and mental illness, both in Australia and Britain and these are found in chapters Two and Three. The object of these chapters is to provide the necessary context for the later analysis of the mental health social work in Western Australia. The second method is a detailed analysis of what historical documents were found in various archives in Western Australia. The third is a programme of semi- structured interviews with twenty five individuals who worked in mental health services in WA during the period under examination in this research. In the final section of this chapter I provide a summary of the way that I analysed all of the data to develop the themes.

Analysis of the literature

My contextual analysis of social work and mental health takes the approach that virtually everything has an identifiable history. Most of the literature focused on the United Kingdom (UK) and the United States of America (USA), there is limited

31

literature describing the developments of social work in mental health in Australia. This brief excursion into the literature sets out the general themes as I see them.

Social work was first identified as a field of employment in the 1880’s and 1890’s in the work of the Charity Organisation Society, when trained volunteers introduced a case-by case approach to assist those needy individuals who complied with strict behavioral guidelines. Mary Richmond’s seminal social work text Social Diagnosis (1916) developed from practice based on these guidelines; it became the first social work textbook.83 Later writers such as Gordon Hamilton, Helen Perlman and Florence Hollis identify themes of diagnosing and providing practical help within the existing system for welfare recipients as prominent features in social work methodology.84 However Richard Kennedy in an historical analysis of social work development in Victoria argues that social work, based on principles of the COS, was and is more concerned with disciplining the poor than with providing genuine relief.85

Rose and Miller argue that, following the establishment of the welfare state in Britain in the post World War period, social work practice was regarded with optimism, but that this situation changed when economic difficulties occurred in the 1960s. 86 Prior discusses the criticism of social work practices in the UK at this time and suggests that these criticisms were a motivating factor in implementing recommendations of the 1968 Seebohm Report, which withdrew specialised training for social work and significantly changed the organisation of social work services to the mentally ill.87

A number of writers discuss the treatment paradigms that dominated social work theory in the years following the 1980s. Parton and O’Byrne examine the changing meaning of the term the ‘social’, as it became increasingly dependent upon its relationship with the welfare state, and attempt to articulate the various elements that

83 M. Richmond, Social Diagnosis, 1st edition 1917, New York, Russell Sage Foundation, 1945. 84 See G. Hamilton, Theory and Practice of Social Casework, New York, published for the New York School of Social Work, Columbia University, by the Columbia University Press, 1951, H. Perlman, Social Casework: a problem solving process, Chicago, University of Chicago Press, 1957, and F. Hollis, Casework: a psychosocial therapy, New York, Random House, 1964. 85 R. Kennedy, Charity Warfare: The Charity Organisation Society in Colonial Melbourne, Melbourne, Hyland House, 1985, pp. 45-47. 86 N. Rose & P. Miller,‘ Political power beyond the state: problematics of government’, in British Journal of Sociology, Vol. 43, No. 92, 1992, pp. 173-205. 87 L. Prior, The Social Organisation of Mental Illness, London, Sage, 1993, p.92. 32

characterised social work, pinpointing the difficulties of those searching for definitions of truth in social work practice. 88 Clarke discusses the processes of ‘marketisation’ and ‘contracting out’ that had become a central feature of service provision by public welfare agencies, while Howe describes the limitations imposed on social workers delivering personal and welfare services initiated by the consumerist ideology of the 1980s in the UK.89 However all these authors write about generic social work and ignore the existence of specialised knowledge or skills that are required in mental health social work practice.

In Australia the history and development of social work has yet to be fully studied and the work of J. R. Lawrence remains the seminal text. Among other things, Lawrence demonstrates the significant role played by Britain and the USA in providing the foundations on which Australian social work practice was developed. Robert Bland is another prominent scholar of social work who examines social work practice and focuses on the role of carers and consumers.90 The influence of gender in the development of social work profession in Australia has also been important, especially recently, and is approached in several ways. Elaine Martin and Susan Brown both discuss the way gender is involved in the construction of the profession and the demand for its services, while Crawford and Leitman examine the role gender and power relations played in the career paths of social workers in the early years of the profession in WA.91

There is a considerable literature on the history of insanity in England, the USA and Australia and the means by which it was both conceptualised and treated. The way insanity became defined as an illness under the jurisdiction of the medical profession is contained in the writing of Scull, who also described the development of asylums

88 N. Parton & P.O’Byrne, Constructive Social Work: towards a new practice, London, Macmillan Press, 2000. 89 See J .Clarke (ed.), A Crisis in Care: A Challenge to Social Work, London, Sage, 1993, and D. Howe, ‘Modernity, Postmodernity and Social Work’, in British Journal of Social Work, Vol. 24, No. 5, 1994, pp. 513-532. 90 Bland, Renouf &Tullgren, Social Work Practice in Mental Health. 91 E. Martin, Gender, and Domain: The Social Work Profession in South Australia 1835-1980, Doctoral Thesis, Department of History, the University of Melbourne, 1990, Susan Brown, ‘A Woman’s Profession’, in H. Marchant and B.Waring (eds.), Gender Reclaimed: Women in Social Work, Sydney, Hale and Ironmonger, 1986, and F. Crawford and S. Leitman, ‘The midwifery of power? Reflections on the development of professional social work in Western Australia’, in Australian Social Work, Vol. 54, No.3, 2000. 33

for the mentally ill.92 Showalter discusses the representation of women as inmates of asylums in England during this period, while Matthews identifies the influence of gender in the construction of mental disorder in women inmates of an Australian psychiatric institution.93 Lefley identifies several models of mental illness, all of which involve social issues in their etiology, and discusses theorists such as Goffman and Maxwell Jones, suggesting that such writings accelerated the policy of deinstitutionalisation in the 1960s. 94

Australian psychiatrist and historian, Dr E. Cunningham Dax, traced the treatment of mental illness at the time of Governor Phillip, while Kirkby overviewed the administrative differences between institutional care in England and those that were developed by Australian psychiatric practices and examined law reform in Australia.95 The growth of psychiatry as a profession, and the way gender influenced the asylum population in NSW in different periods from 1840, is discussed by Stephen Garton.96

Changes in organisational and institutional structures overseas and within Australia, which ultimately affected the organisation of mental health in WA, are discussed from a number of approaches. Among them are Weller and Davis, who overview the way in which governments have attempted to manage change97, O’Faircheallaigh and Wanner who discuss the introduction of generic management techniques98, Hood who examines the impact of de-bureauracratisation policies on the human services99, and

92 Scull, Decarceration: Community Treatment and the Deviant - A Radical View, New Jersey, Prentice Hall, 1977. 93 J. Matthews, Good and Mad Women: The Historical Construction of Femininity, Sydney, George Allen and Unwin, 1984, and E. Showalter, The Female Malady: Women, Madness and English Culture, 1830-1980, New York, Pantheon, 1985. 94 H. Lefley, Family Caregiving in Mental Illness, Family Caregiver Application Series, vol.7, Thousand Oaks, California, Sage Publications, 1996. 95 See E. C. Dax, ‘The first 200 years of Australian Psychiatry’, Australian and New Zealand Journal of Psychiatry, Vol. 23, No. 1, pp.103-110, 1989, and K. Kirkby ‘History of psychiatry in Australia pre- 1960’, in History of Psychiatry, Vol. X, 1999, pp. 191-204. 96 S. Garton, Medicine and Madness: A Social History of Insanity in NSW 1880-1940, Sydney, NSW University Press, 1988. 97 P. Weller & G. Davis, eds., New Ideas, Better Government, St Leonards, NSW, Allen and Unwin, 1996. 98 C. O’Faircheallaigh, J. Wanna & P. Weller, Public Service Management in Australia: New Challenges, New Directions, 1st edition 1976, South Yarra, Macmillan Education, 1999. 99 C. Hood, The Tools of Government, London, Macmillan, 1983. 34

Duckham, writing of WA experiences describes administrative changes that occurred in the 1980s across a whole range of government departments and instrumentalities.100

A.E.Ellis has written the only comprehensive history of mental health services in WA, in an account which begins in 1829 and concludes in 1974.101 More recently the collection edited by E. Cocks and others, has comprehensively analysed the history of intellectual disability in WA from a number of perspectives, while scattered historians such as Virtue and Harman have looked at topics as diverse as women in the Fremantle asylum and the general history of nineteenth century asylums.102 These and other texts are explored in some detail and themes extracted in Chapters Two and Three.

Analysis of historical documents

I had originally aimed to base this thesis on an examination of a range of public documents. After finding as wide a range of documentary evidence as possible, I approached them with questions in mind, largely around the questions set out in the early part of this chapter. I followed the usual route of historians when engaging with written sources: ascertaining their provenance; situating them in their intellectual and administrative contexts; looking for self-interest or bias; examining them for what they do or don’t say; casting them against each other; and finally reading them with close attention for what they are trying to say.103 The fact that so many documents that I wanted to look at had been destroyed, made a detailed examination of the existing sources all the more important, however the fact that such rich pickings were to be found in my oral histories leavened my disappointment over the relative lack of sources.

100 I. Duckham, Serving the Servants, Serving the State: a brief history of the Institute of Public Administration of Australia, Western Australian Division, 1945-2005, Institute of Public Administration Australia, Western Australia, in association with the Centre for Western Australian History, 2005. 101 A. S. Ellis, Eloquent Testimony: The Story of the Mental Health Services in Western Australia 1830- 1975, Nedlands, University of Western Australia Press, 1984. 102 R. Virtue, ‘Lunacy and social Reform in Western Australia, 1886-1903’, in Studies in Western Australian History, No. 1, 1977, and B. Harman, ‘Women and Insanity: the Fremantle Asylum in Western Australia, 1858-1908’, in P. Hetherington and P. Maddern (eds.), Sexuality and Gender in History, Perth, Centre for Western Australian History, 1993. 103 On the way historians use written sources see G. Elton, The Practice of History, S. Davies, Empiricism and History, London, Palgrave, 2003 and J. Tosh & S. Lang, The Pursuit of History; Aims, methods and new directions in the study of modern history, London, Pearson Longman, 2006. 35

Acts of Parliament

Information concerning mental health legislation was obtained from Statutes of WA, the Mental Health Act. 1962, in the Acts of Parliament of Western Australia, 1962, Vol. 2 Part 6, Section 125, Mental Health Review Board, and Vol.3 1998. Act of 1996. Information concerning mental health regulations was obtained from the WA Government Gazette November 1997 No. 193 Special Edition. Mental Health Act 1996, Mental Health Regulations 1997, p.6109, and No. 1007.7 November Special. Hospital Regulations, 1997, Licensing and conduct of Private Psychiatric Hostels (under the Hospital and Health Services Act 1927).

Annual Reports

Annual Reports of the Directors of MHS of the years 1959-1984, held by the State Records Office of Western Australia (SROWA) in Perth proved to be an invaluable source. These included a 1959 decision by the MHS to employ a qualified social worker, and the year 1984/85, which included establishment of the Health Department of Western Australia following amalgamation of the Public Health Department, the Department of Hospital and Allied Services and the Mental Health Services. From 1984-1988 the Annual Reports of the Commissioner for Health included the work of the MHS. Reports of the social work section and those of other allied health disciplines were not included. To illustrate the sorts of information which is carried in these reports, the 1959 Annual Report contained an account by the superintendent, Dr Moynah, of the appointment of the first qualified social worker by the Day Hospital at Graylands.

Social Work

Whilst the following records were located, it proved impossible to access any records about direct social work services in the MHS. MHS Annual Reports during the years 1975-1983 included generic accounts of Social Work activities. The Government Gazette 1 Feb.1974, no.9, p.267 contained State Public Service Salaries Determinations and details of MHS salaries. The names, qualifications and dates of all 36

social work appointments by the WA government are contained in annual Public Service Lists from 1959.

The Battye Library Archives provided Western Australian Parliamentary Debates, Legislative Council, Hansard Parliamentary Papers 1960, Volume 157, p.3233, which contains material concerning accommodation provided for psychiatric prisoners. Volume 161, 1962, pp.874-998, gives an account of the second reading of the Mental Health Bill. Volume 162, 1962, p.1194 contains information concerning the appointment of a Director of Mental Health. The 1995 Vol. 328, p11186 and 1116 Vol. 335, pp.5623-7042 contains information concerning the Mental Health Act of 1996. Details of a decision in 1972 to reorganise the administration of Swanbourne and Graylands Hospitals were also obtained from the State Records Office of Western Australia (SROWA) as was information concerning social work appointments.

Further information relating to the development of social work in WA was obtained in material provided by the office of the WA Branch of the Australian Association of Social Workers (AASW) and included in the Battye Library Archives. This included:

 A report of the PEAK Committee of the AASW, March 1973 “Measures to increase the quantity and quality of social work services available to the Australian community”.

 A 1969 recommendation of social work staff at the UWA for future social work courses and a discussion concerning cessation of specialist training in social work education.

 Reports of the Federal Council of the AASW 1969-1973 concerning establishment of a registration board for professional social workers.

 1969 salaries rates for social work grades and qualifications.

 A study of social welfare manpower in WA, 1974, and a Report of a Working Party on Community Studies in 1985.

Unfortunately, my endeavours to find trade union records came to nought. I was advised by staff members at the archival section of the Civil Service Association

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(CSA), which covered mental health social workers, that ‘unnecessary details’ concerning staff and industrial conditions had been destroyed. When I attempted to access MHS administrative records at the SROWA I was informed that, since the departmental restructure in 1984, these records were centralised in the Health Department of WA. However, I was subsequently informed that all ‘non-essential’ material had been destroyed. This included information relating to the Social Welfare Department of the MHS, the names and responsibilities of employees, staff budget allocations, industrial details, and the location of staff. In addition a number of submissions from social workers with direct patient contact, which included statistical information and recommendations relating to social issues had also been destroyed. I discovered that the records of other professional groups had also been dealt with similarly.

Analysis of semi-structured interviews

Colin Robson describes interviewing as a method widely used in social research, and formulated according to the ‘depth’ of response sought.104 He considers that face-to face interviews offer the possibility of modifying a line of inquiry, following up interesting responses and investigating underlying motives in a way that postal and other self- administered questionnaires cannot. He notes that, despite concerns about reliability concerning the lack of standardisation and the possibility of bias, interviewing methods lend themselves well to use in combination with other methods; for example a case study might be used to complement participant observation.

Acknowledging that when used as a social science tool, the interview is a complex and involved procedure, Minichiello, Aroni and Hayes identify three interviewing models that fall on a continuum along which can be found fully structured interviews at one end and unstructured or loosely structured in-depth interviews at the other.105 They all propose that different ontological and epistemological positions generate different methodologies, that is, different models of reality lead to different propositions about what reality really is, and different ways of collecting data. Hence structured or

104 C. Robson, Real World Research: A Resource for Social Scientists and Practitioner Researchers, first published 1993, Oxford, Blackwell Publishers, 2002, pp.268-291. 105 V. Minichiello, R. Aroni & T. Hayes, In-Depth Interviewing: Principles, Techniques, Analysis, 3rd edition, Sydney, Pearson, Prentice Hall, 2008, pp.46-49. 38

standardised interviews are based on the assumption that researchers can generate data that is valid and reliable. Further, they argue that if we believe that social reality exists, some form of qualitative data collection method such as less structured types of interview may be used which is geared to the interviewer’s interests, which often takes on the appearance of a normal conversation, because the element of control is minimal.

In this study the primary method of obtaining information from interviews was that of semi- structured interviews in which the content of the interview was focused on issues central to the research questions. Essentially this method enables the researcher to guide the interview and develop a schedule around a list of topics without fixing the order in which they appear. Minichiello, Aroni and Hayes all concur that loosely structured and semi-structured interviews can involve an in-depth examination of people and topics, and that they are the most widely used format of qualitative interviewing.106

Sampling

Attempts were made to contact as many senior professionals as possible who might be able to comment on their experiences during the period in question. Due to the passage of time a large number had either died or moved interstate, or simply were not contactable. The twenty five interviewees that were located and appeared to be interested were all people who had held senior positions in the MHS during the period focused in this research. Twenty two interviewees were personally known to me and were relatively easily located. The names and contact details of the remaining three were suggested and provided by a member of the Australian Association of Social Workers (AASW). A total of twenty six people were approached, and one, a psychiatrist, declined to be interviewed. The interviewees consisted of:

Social Workers - 10 females and 3 males Psychiatrists - 6 males Allied Health - 2 males and 1 female Nursing- 2 males and 1 female

106 Minichiello, Aroni & Hayes, In-Depth Interviewing, p.52. 39

Of the social work sample, three had held executive positions in the MHS and Health Department of WA, and at the time of interviews were semi-retired, four had fully retired after being employed in hospital or community clinics, and two were current employees of the MHS Division of Health Department of WA. One of the male social workers had left employment with the MHS after working in a near city clinic, one was in charge of a social work service in a psychiatric hospital, and two were in managerial positions in regional areas. The six psychiatrists were all males and were all retired from the workforce. One had been Director of the MHS, three had been Superintendents of clinics or hospitals, and two had been Consultant Psychiatrists. In the allied health group both clinical psychologists were male - one was retired. The occupational therapist was a female, and had also retired. All had been in senior positions during the period covered by this thesis, after being promoted from ‘hands on’ experience throughout the department. The three nurses - two male and one female - had been employed as community care nurses when a social welfare service was first established in the MHS; they were all retired.

The following chart presents the chronological ordering of the interviews and identifies them by occupation. Interview No Date Occupation 1 23/03/2001 Social worker 2 26/05/2001 Social worker 3 04/04/2001 Psychiatrist 4 05/04/2001 Nurse 5 09/04/2001 Nurse 6 10/04/2001 Psychiatrist 7 17/04/2001 Nurse 8 22/08/2001 Psychiatrist 9 28/08/2001 Social worker 10 24/05/2001 Psychiatrist 11 08/11/2001 Social worker 12 31/10/2001 Social worker 13 22/10/2001 Social worker 14 14/11/2001 Social worker 15 12/11/2001 Social worker 16 14/11/2001 Occupational therapist 17 16/05/2001 Psychiatrist 18 07/12/2001 Social worker 19 28/05/2002 Psychologist 20 11/11/2002 Social worker 21 28/11/1002 Social worker 22 17/02/2002 Social worker 23 26/02/2002 Social worker 24 16/06/2003 Psychologist 25 17/04/2008 Social worker

40

Several informants expressed doubt about their ability to recall details of their experiences because of what they perceived to be the problematic nature of long-term memory. This was a particular concern for the more elderly of them. In considering this issue I note that oral historians have devised strategies to enable interviewers to achieve more accurate recall of the past.107 These strategies utilise a number of different perspectives. For example oral historians suggest that power structures, gender, myth, and popular culture are possible origins of the way individuals interpret events, and which form the bases of cultural stereotypes of masculinity and femininity, becoming internalised and then passed on unconsciously.108 Kate Van Heugten argues that although the question of recall may become a factor in assessing the validity of such information, the postmodern view is that different contexts evoke different representations of self, and that the shift in focus to context and process has powerful implications for qualitative analysis.109

The semi-structured interviews were conducted with the aim of stimulating, through the use of a semi-structured schedule of prompts, the informant’s memory of experiences in the MHS. For social work interviewees this included personal background information, motivation to become a social worker, qualifications, places of employment, professional responsibilities, practice methods, relationship with other professionals, orientation to psychiatry, career expectations, job satisfaction, fulfillment of personal expectations, and significant personal experiences. For interviewees from associated professions it included professional responsibilities, orientation to psychiatric practice, positions held and their location, contact and length of association with social workers, and expectation of social work functions.

In order to maintain as relaxed an atmosphere as possible, I intended that all interviews would be held at the residence or office of each interviewee. However on three occasions this was not possible so an alternative location was chosen. All participants were given the information sheet and consent form (Appendix 1 and

107 J. Neuensehwander, ‘Oral Historians and Long-Term Memory’, in D. Dunaway & W. Baum, (eds.), Oral History: An Interdisciplinary Anthology, Nashville, American Association for State and Local History in Cooperation with the Oral History Association, 1984, pp. 324-332. 108 J. Sangster, ‘Telling our stories: Feminist debates and the use of oral history’, in R. Perks & A. Thomson (eds.), The Oral History Reader, London. Routledge, 1998, p. 82. See also P. Hamilton, ‘The knife edge: debates about memory and history’, in K. Darien-Smith & P. Hamilton, (eds.), Memory and Myth in Twentieth Century Australia, Melbourne, Oxford University Press, pp.21-26. 109 K. Van Heugten, ‘Managing Insider Research: Learning from Experience’, in Qualitative Social Work, 2004, Vol. 3, No. 2, p.211. 41

Appendix 2) and this generally facilitated a valuable easing into each interview. But because permission was not obtained to identify their specific contribution, I have used interview numbers rather than their names; these numbers do not coincide with the chronological order of the participants listed in the bibliography. I recorded the interviews on audio-tapes, with the duration varying between forty-five and sixty minutes, and manually transcribed them as close to the time of recording as possible. I also recorded subjective aspects including the attitude of the interviewee, non-verbal communication, any unaccounted pauses in the dialogue, and the various nuances of speech.

I turn now to the question of the applicability of ethics in two areas of this research- interviewee privacy and the use of insider knowledge. The first refers to what Robson describes as the balance between the ‘right to know’ and the participant’s right to privacy.110 All agreed to participate and that their observations would be included in this thesis. I made no attempt to obtain permission to identify participants and so without this permission have used Interview numbers rather than names in the analyses.

The Australian Association of Social Workers (AASW) Code of Ethics, is based on a commitment to social justice, and includes the principles of meeting social and personal needs of individuals and enabling them to develop potential abilities.111 It contains a number of challenges including ‘raising awareness of structural inequalities’ and ‘promoting policies and practices and social conditions that uphold human rights and that seek to ensure access, equity and participation for all’.112 Further, it asserts that the obligation of social workers is “to advance the knowledge base of social work by facilitating and contributing to evaluation and research, and sharing research knowledge and practice wisdom with colleagues”.113 In this research I felt this latter issue was important as social workers, particularly since the introduction of privatisation policies, faced the possibility of marginalisation of their services due to major changes in health and administrative ideologies.

110 Robson, Real World Research, p.65. 111 AASW Code of Ethics, Section, 1999 edition, section 3.1.1. 112 AASW Code of Ethics, Section 4.1.2 a. 113 AASW Code of Ethics, Section 4.1.5 f. 42

Before proceeding with interviews, it was necessary to obtain approval from two University of Western Australia committees, the Human Research Ethics Committee (HREC) and the Ethics Committee of the Department of Social Work and Social Policy. Of particular importance in relation to these two committees were the issues of anonymity and confidentiality. Denzin and Lincoln along with all other researchers consider that research subjects have the right to be informed about the nature and consequences of projects in which they are involved, and must agree voluntarily to participate and their agreement must be based on full and open participation in the research.114 This was done in conformity with the NHMRC guidelines which inform all university ethics committees in Australia.

Oral historians recognise the use of audio-taped testimony as a valid source of historical information so I was guided by Paul Thompson’s Voice of the Past: Oral History in the Construction, Transcribing and Editing of Interview Material, and Valerie Yow’s Recording Oral History, both of which identify the important role played by the researcher in selecting and interpreting such information.115 Editing the information included allocating a number to each interviewee together with personal details, time and place of interview, attitude of interviewee together with my own reactions to the interview. Information from the tapes was used to describe the contribution made by individual social workers.

Two very important questions for this project concern my own place in the research. The term ‘insider research’ is used to describe projects where the researcher has direct involvement or connection with the research setting.116 Such research contrasts with the positivist’s concern where objectivity and detachment predominated. Reinharz suggests that human research (such as social work research) should use human tools, and should use the researcher as a research instrument.117 The validity of insider research is discussed among others by Pauline Rooney who argues that insiders have a wealth of knowledge which the outsider is not privy to, for example an awareness of

114 Denzin, & Lincoln, The Landscape of Qualitative Research, p.217. 115 See P. Thompson, The Voice of the Past: Oral Information from the tapes history, Oxford, Oxford University Press, 1978, pp.196-229, and V. R. Yow, Recording Oral History: A Practical Guide for Social Scientists, Thousand Oaks, California, Sage Publications, 1994, p.177. 116 K.Van Heutegan, Managing Insider Research p. 207. 117 S. Reinharz. On Becoming a Social Scientist, San Francisco, Jossey-Bass, 1979, quoted in Van Heutegan, Managing Insider Research, p. 207. 43

internal politics and of legitimate/taboo subjects, and can use this knowledge to obtain richer data; from such a perspective the insider position could be viewed as potentially enhancing the validity of the research.118 She adds that validity could be threatened if the researcher’s politics, loyalties or hidden agenda lead to misrepresentations or the distortion of data. However Andrea Fontana and James Free point out all interviewees have the ‘power’ to choose how to respond to questions and therefore may give a ‘socially desirable’ answer.119

My twenty-five years of experience as both a mental health practitioner and manager (Deputy Principal Social Worker of the MHS) provided me with first hand knowledge of the aspirations and challenges confronting social workers in the face of conflicting ideological and funding constraints, together with knowledge of the complex and mostly unarticulated relationships between social workers themselves and with other professional staff. Referred to in the literature as ‘insider information’ I utilised this knowledge in the development of the research methodology. As a former employee of the MHS I utilised whatever insider information I could identify as having particular significance in developing the research topic.

1.8 Data Analysis

Wolcott distinguishes between the terms ‘analysis’ and ‘interpretation’ of data.120 He reserves the term ‘analysis’ in the narrower sense following standard procedures for measuring and communicating with others about ‘what is out there’ and amenable to statistical treatment. By contrast ‘interpretation’ refers to ‘our efforts at sense-making; a human activity that includes intuition, past experience, emotion’. For example, while the basis of symbols of behaviour can be derived by anthropologists and examined analytically, discerning the patterns themselves is a matter of interpretation. He also writes that ‘qualitative researchers need to be storytellers’.121 To be able to tell a story

118 P. Rooney, ‘Researching from the inside- does it compromise validity? A discussion in Level 3, DIT online publication, issue 3, May 2005, Learning Technology Team, Supporting e-learning throughout DIT, at http://itt.dit.ie/html.elearning/tesearch.htm. Viewed on 26/08/2006. 119 A. Fontana, & J.H Free, ‘Interviewing: The Art of Science’, in Denzin & Lincoln (eds.), Handbook of Qualitative Research, pp.364-376. 120 H.F.Wolcott, Writing up Qualitative Research, 2nd edition, Thousand Oaks, Sage Productions, 2001, p.33. 121 H.F. Wolcott, Transforming Qualitative Data: Description, Analysis and Interpretation, Thousand Oaks, Sage Publications, 1994, p.17. 44

well is crucial to the enterprise. He adds: ‘Regardless of the topic… qualitative researchers of analytical or interpretive bent are nevertheless expected to ground their reflections on observed experience’.

Following the recommendation of Wolcott, I make sense of the data by utilising the ‘observed experience’ of interviewees and I incorporate with this, reflections on my own observations and experiences. In then placing this within a context of the time that uses secondary analysis of documents and literature, and using the ‘scaffolding’ approach outlined by Crotty122, I create a bricolage123 that hopefully tells a strong story.

The data were examined by establishing three time frames within the forty-year period of the research, each representing an identifiable period of social work development. The first period commenced in 1959 with the first appointment of a qualified social worker in the MHS. The second period began in 1973 when social work became recognised as an independent professional service. The third period commenced in 1984 when the MHS became incorporated as a member of the Health Department of WA. Dominant issues were identified and examined relative to the archival, documentary and interview material that was collected.

1.9 Summary

In this chapter I have described the methodology undertaken to achieve the broad aim of this research, namely to examine the contribution social work has made to the Mental Health Services of Western Australia. In order to identify the factors underlying this development I first discussed the positions taken in arguments between objectivist historians and post-modern critics, and located my own research perspective on historical research. I then described my chosen qualitative research methodology which enables multiple paradigms to be bound together in an interpretive framework. Utilising this methodology enabled the research material to be approached from a number of differing perspectives–hermeneutics, feminism, critical analysis, and

122 Crotty, The Foundations of Social Research. 123 Denzin & Lincoln, Handbook of Qualitative Research. 45

the work of Michel Foucault. I next described the methods whereby these approaches were incorporated in the research material.

The documentary evidence used in this thesis has come from a necessarily restricted range of public documents, restricted because so many relevant records have been destroyed. Fortunately I was able to interview 25 invaluable mental health service staff who worked during most of the period under review. Together they give a comprehensive picture of the period I wish to analyse. The next chapter, on the development of social work in England, America, Australia and Western Australia, is the first of two broadly contextual chapters. It is followed by a chapter on the history of mental illness and mental health service provision in those same places.

46

Chapter 2

Social Work and Social Policy: An Overview

In this chapter I provide an account of the emergence of social work in England, the USA and Australia. Perusing the literature I was initially confronted with an extensive international history extending back beyond the first European settlement on our shores. By comparison there is very little Australian scholarship on the history of social work; indeed Philip Mendes comments on the ‘historical vacuum’ facing Australian researchers who seek to study the place of social work practice in the human services in this country.1 The core text on this topic remains the 1965 work of R. J. Lawrence in his study of the development of the Australian Association of Social Workers (AASW), but it is now 44 years old.2 Similarly there is still only one published academic study of social work development in Western Australia, which is by Frances Crawford and Sabina Leitman, who demonstrate the influence of class and gender on the profession in the early decades of the twentieth century.3 Writing the story of social work in WA then, involves bringing together disparate sources to create the broad outlines of a history rather than a detailed historical analysis. Nevertheless certain core themes do emerge: the inter-relatedness of gender and political, social and cultural power, and the vulnerability of social work to political change.

As much of this inter-relatedness involves the professionalisation of social work, this chapter makes use of the work of the sociologist of professions, Eliot Freidson and his followers, to help understand the characteristics of professional power. In this way of thinking, professions continually engage in ways to assert and organise exclusive power over specific fields of knowledge, by excluding others from practising that knowledge and persuading lay people and clients that the professions’ interests in practising that knowledge are altruistic, not self-interested, and that only they can lay

1 P. Mendes, ‘The history of social work in Australia: A critical review’, in Australian Social Work, Vol.58, No. 2, 2005, pp.121-131. 2 R. J. Lawrence, Professional Social Work in Australia, Canberra, Australian National University, 1965. 3 F. Crawford & S. Leitman, ‘The midwifery of power? Reflections on the development of professional social work in Western Australia’, Australian Social Work, Vol. 54, No. 3, 2001, pp. 43-53. 47

claim to legitimately practise in that field.4 As Charlie Fox suggests, in their search for power and legitimacy they appear to follow a similar path:

Typically a profession on the make will strive to exclude those with contiguous knowledge from operating in its field, much as orthodox medicine tries to deny alternative therapies the right to practise their profession, or lawyers fight off paralegal occupations like property conveyancers. A would-be profession will form an association to represent its interests and perhaps seek patronage from powerful or prestigious people to give it legitimacy and cachet (the monarchy is very useful for this purpose). It will set up codes of ethics to protect its reputation. It will agitate with disinterested educational organisations to provide courses that practitioners must do and will then allow only those who have done these courses to become members of the association. Finally, it will use its influence to have government pass regulations to allow only duly registered practitioners to practise and to use the title of the profession, that is to forbid anyone using the relevant title - - - unless they had been duly registered. This represents the big prize for a profession, a law denying all those whose qualifications it doesn’t recognise the right to practice.5

As it will become evident in the analysis much of the conflict around mental health matters was between the traditional professions of psychiatry, psychology, social work, occupational therapy and nursing.

This chapter begins in England and the USA in the nineteenth century and concludes in 1959 with the appointment of the first mental health social worker in WA.

2.0 EMERGENCE OF SOCIAL WORK

2.1 International

It is generally agreed that social work emerged from philanthropic activities directed at poor people living in the slums of rapidly industralising cities of Europe and North America in the mid nineteenth century and that the precise ways this happened provide

4 E. Freidson, The Profession of Medicine: A study of the sociology of applied knowledge, New York, Dodd, Mead and company, 1970. See also P. Boreham, A. Pemberton and P. Wilson (eds.), The Professions in Australia: A Critical Appraisal , Brisbane, University of Queensland Press, 1976, pp.7- 8. B. Probert, Working Life: Arguments about Work in Australian Society, Melbourne, McPhee-Gribble, 1989, chapter 4, and C. Fox, Working Australia, Sydney, Allen and Unwin, 1990, chapter 5. 5 C. Fox, ‘The Regulation of Women’s Hairdressing in Western Australia, 1926-1946’, Papers in Labour History, forthcoming, 2010. 48

identifiers for the differences between the Anglo/American, northern European and third world approach to social work.6 In many northern European countries, attempts to provide help for individuals and families more economically have encouraged the promotion of self-help and self-reliance, family based informal services and voluntary rather than state activities.7 England and America addressed similar categories of problems according to their existing cultural ideologies and resources, which differed from those in northern European and third world countries. In this chapter I first provide a brief overview of social work developments in England and the United States, whose cultures and practices may be compared to those of Australia, and where the profession was already established, before focusing on Australia and Western Australia.

2.2 British social work

In the nineteenth century British welfare services were provided by voluntary organisations. Jane Lewis is among the writers who describe the establishment of social work services in England.8 In the late nineteenth century the activities of philanthropic and state funded welfare organisations became incorporated into the Charity Organisation Society (COS). Women were employed to dispense material relief to individuals whose lives were disrupted by the industrial revolution and rapid urbanisation.9 The society adopted the landmark graphic representation prepared by social worker Mary Richmond, showing social forces surrounding the family in the form of kin, neighbours and civic, charitable and public relief agencies on which the

6 G. Hutchenson, L. Lund, R. Lyngstad & S. Oltedal (eds.), Social Work in Five Countries: A Report, Bodo, University of Bodo, 2001, and J. Midgley, Social work in a Global Context, Thousand Oaks, Sage Publications, 1997, pp.74-79. 7 P. Niemela & J. Hamalainen describe three basic forms or models of a developed welfare state system: the Nordic or Scandanavian model which aims to provide social welfare for each individual citizen according to individual needs: The Anglo/American where the provision of social security is primarily organised through the market or private insurance: The Continental Europe where social benefits are determined according to people’s status within the labour market. See ‘The role of social policy in social work’, in A. Adams, P. Erah & S. Shardlow, (eds.), Key Themes in European Social Work; Theory, practice, perspectives, Lyme Regis, Russell House Publishing, 2001, pp. 5-8. 8 J. Lewis, The Voluntary Sector, the State and Social work in Britain: The Charities Organisation Society/Family Welfare Association since 1869, Aldershot, England, Edward Elgar Publishing Company, 1995. This gives detailed accounts of the interwoven voluntary and statutory movements in the UK from 1869 until the 1990s. 9 A.E. Fink, J.H. Pfouts & A.W. Dobelstein, The Field of Social Work, 8th edition, New Delhi, Sage 1985, p.82. 49

helper might draw for assistance.10 Techniques were codified and monitored through the maintenance of individual written reports and records. Caseworkers were then referred to as ‘social workers’.11

Influenced by the English Poor Law of 1845, separation of the ‘deserving’ from ‘undeserving’ applicants became the bedrock of assistance to those in need. Jane Lewis is among the historians who suggest that this distinction represents a way of disciplining working class applicants for charity.12 This ‘deserving’-‘undeserving’ distinction became basic to the establishment of private philanthropic societies such as the COS in England, America and Australia. The COS considered that teaching habits of thrift and sobriety to applicants for charity would prevent them from becoming a charge on public resources. Mary Richmond’s pioneering work in the early twentieth century formalised forces surrounding the applicant and family and became a universal guide for social work services.13

By 1913 medical authorities in Britain accepted that social workers could enhance the work of other health providers by assisting families to cope with problems accompanying hospitalisation and discharge.14 Almoner training programmes in British hospitals and a mental health course at London University were introduced.15 In the early decades of the twentieth century when insights from psychological research suggested that early childhood experiences were significant in the development of adult personality disorders, social workers were employed to assist psychiatrists in hospitals and child guidance clinics by obtaining information concerning personal and family backgrounds.16 Norma Parker, one of the pioneer social workers in Australia, observed that the integration of social casework principles

10 J. Lewis, The Voluntary Sector, the State and Social Work in Britain: The Charities Organisation Society/Family Welfare Association since 1869, Aldershot, Edward Elgar Publishing Company, 1995, p.72, quotes the chart that was reproduced in Progress, No.2, April, 1906. 11 J. Hopkins, ‘Social work through a looking glass’, in N. Parton (ed.), Social Theory, Social Change and Social Work, London, Routledge, 1996, pp.22-28. 12 Lewis, The Voluntary Sector, pp.10-12. 13 M. Richmond, Social Diagnosis, New York, Russell Sage Foundation, 1917. Lawrence, Professional Social Work in Australia, p.11, writes that in 1915 an article by Abraham Flexner appeared in America in the Proceedings of the 42nd National Conference on Charities and Corrections, claiming that ‘social work had not become a profession as it lacked transmittable professional techniques’, pp.576-90. Mary Richmond’s book was a response to these assertions. 14 L. Prior,. The Social Organisation of Mental Illness, London, Sage, 1993. 15 R.J. Lawrence, Professional Social Work in Australia, Canberra, Australian National University Press, 1965, p.6. 16 Fink, Pfouts & Dobelstein, The Field of Social Work, pp.86-87. 50

with psychological and psychoanalytic theories marked the beginning of professional social work in mental health internationally.17 They became part of the treatment team of psychiatrist, clinical psychologist and psychiatric social worker.

In 1946, the COS changed its name to that of the Family Welfare Association (FWA), and introduced a psycho/dynamic approach to family casework, replacing the traditional problem solving approach.18 Then in 1954, in an effort to unify social work around the concept of casework, training programmes were transferred to the London School of Economics. 19 However criticism arose on the grounds that casework was seen to be class-based as social workers were predominantly middle-class, and welfare administrators were considered to come from lower middle and working classes.20 Divisions within social work were also gender based. When the psychological approach led by female social work leaders in the 1950’s was adopted, it was opposed by males employed in social administration who objected to the ‘psychologising’ and ‘inward looking’ nature of social work and believed the profession to be in danger of ignoring both wider social problems and social realities.21

The Beveridge Report of 1942 recommended that British welfare services, previously the preserve of the voluntary sector, should be transferred to statutory authorities, thus heralding the establishment of the British Welfare State. 22 Jane Lewis, commenting on the report wrote:

Voluntary organisations were still perceived as supplementary or at best complementary to the state, and the possibility of direct provision by the state was not questioned. During the period of the classic welfare state the relationship between economic growth and state provision was believed to be positive… social services were regarded as a social investment.23

17 N. Parker, ‘Early social work in retrospect’, Australian Social Work, Vol.32, No.4, December 1979, p.13. 18 Lewis, The Voluntary Sector, pp.112-113. 19 Lewis, The Voluntary Sector, pp.112-113. 20 Lewis, The Voluntary Sector, p.116 quoting R. M. Titmus ‘The administrative setting of Social Service’, Case Conference, 1954. 21 Lewis, The Voluntary Sector, p.114. 22 W.H. Beveridge, Full employment in a free society: a report, 2nd edition, London, Allen & Unwin, 1960. 23 Lewis, The Voluntary Sector, p.17. 51

Included in this social investment was the National Insurance Act of 1946 whereby an employed man could receive entitlement to sickness, unemployment, and retirement benefits. This legislation was later criticised by Nancy Hardstock and other feminist writers who considered that it legitimised discriminatory attitudes towards women whose demands were often different from those of men, and placed them in a subordinate position.24 Further measures introduced in 1946 by the National Health Service Bill withdrew from local authorities their responsibility for hospitals, and set up hospital boards appointed by the government.25

When the economy was strong, as it was in the 1950’s, social work became increasingly organised and became part of the statutory government sector, resulting in the setting up of unified social services departments. By the 1960’s qualified social workers had taken the opportunity to move into the organisational hierarchies as team leaders.26 But in the 1970’s faced with rising costs and increasing levels of poverty, demands on government increased and welfare services were threatened. A key strategy of the government then became reduction of welfare services.27

The influence of the social work profession on shaping social welfare provisions in the UK is demonstrated by the introduction of a policy of community based services in 1968 (referred to as the Seebohm Report) initiated by the National Institute of Social Work (NISW).28 Recommendations, based on the fragmentation that had occurred in social work in so-called professional settings, included establishing unified social service departments in each local authority and replacing specialist social work with generically based training programmes.29 Consequently medical and psychiatric services were placed alongside child and family welfare and others under the authority of local social service departments, and domiciliary care services such as home help and meals on wheels were transferred from their former position

24 N. Harstock, The Feminist Standpoint Revisited and Other Essays, Colorado, USA, and Oxford, UK, Westview Press, 1998, pp.22-23. 25 K .Laybourne, The Evolution of British Social Policy and the Welfare State, 1800-1933, Keeled, Staffordshire, Keeled University Press, p.228. 26 J. Hopkins ‘Social work through a looking glass’ in N. Parton, Social Theory, Social Change and Social Work, London , Routledge, 1996, p.26. 27 Beveridge, Full Employment in a Free Society. 28 Report of the Committee on Local Government and Allied Personal Services, London, HMSO, 1968 29 Lewis, The Voluntary Sector, pp.124-126. 52

in health departments.30 The overall impact of these recommendations was a rapid growth of statutory personal social services. This marked a development for generic social work and, arguably, the loss of the chance for specialisms such as mental health social work.

Welfare services were restructured again when the Thatcher government gained office in 1979 and introduced restrictions in public spending, particularly in welfare services.31 Several features of this restructuring were:

 Marketisation, involving the sponsored development of competition in the provision of welfare services by the introduction of ‘internal markets’.

 The development of mixed economies of welfare, promoting the independent sector of private and voluntary providers.

 The introduction of care by the community, as part of the wider privatisation of welfare responsibilities.

 A new managerialism, consistent with the view that many state functions could be better performed by the private sector.32

Adoption of these principles led to innovations such as quasi-markets whereby local authorities could contract for services provided by a range of private and voluntary sector providers. Social workers created ‘packages of care’, in which services were tailored to defined needs, rather than being delivered as a comprehensive service, thus reducing the interpersonal aspects of practice.33

30 Lawrence argues that social work had become fragmented in so-called professional settings that were administratively not professionally determined, in ‘Australian Social Work in Historical, International and Social Welfare Context’ in P J. Boas and L. Crawley (eds.), Social Work in Australia: Responses to a Changing Context, Australian International Press in association with Australian Association of Social Workers, 1976. 31 J. Clarke, ‘After Social Work?’ in N. Parton (ed.), Social Theory, Social Change and Social Work, London, Routledge, 1996, pp. 44-48. 32 J. Clarke, ‘After social work?’, pp.44-48. 33 M. Sheppard, Care Management and the New Social Work: A Critical Analysis, London, Whiting and Birch, 1995. 53

In the 1990s, massive changes, initiated through the British National Health Service and Community Care Act of 1990, took place in the area of personal social services. This Act required compulsory competitive tendering of local government services and the creation of internal markets in the health and social services involving the freedom for providers to develop services, and maximized choice among service users; they were thus ‘quasi-markets’. The immediate impact of the creation of quasi-markets and the ‘contracting out’ of personal social services was to encourage the proliferation of small providers, especially in the voluntary and private sectors. Along with these changes was the development of an advocacy movement involving volunteers and specialist organisations including people with learning disabilities, mental health users, children and young people who had grown up in care services, and various ethnic groups.34 This individualist version of self help rested on the view of users and carers in the health and welfare sector, where individual consumers were able to make rational choices via a process of utilising care-managers. At this time, as a direct result of research and feminist analysis of the effects of caring on women’s lives, a carers’ movement campaigned successfully for legislation to require social service assessments of carers’ needs alongside the assessment of clients.35

In reviewing the development of social work in England from what she calls its individual approaches to welfare problems in the closing years of the nineteenth century to the neo-liberal ideology of the late twentieth century, an observation by Lena Dominelli provides an interpretation which is worth noting. She argues that social work became de-personalised during the eighties and nineties due to a number of factors including the fragmentation of neo-liberal thought in a post-modern society. She concludes that discriminatory practices associated with social work decisions reinforced the male domination of management, and increased the high proportion of women in untrained roles in social care.36

34 R. Adams ‘Empowerment, marketisation and social work’, in B. Lewis (ed.), International Perspectives and Social Work: Change in Social Work, Aldershot, England, Ashgate Publishing Company, 1997, pp.71-76. 35 L. Dominelli, ‘De-professionalising social work: anti-oppressive practice, competencies and post- modernism’, British Journal of Social Work, Vol. 26, No. 2, 1996, pp. 153-175. 36 L. Dominelli, Feminist Social Work Theory and Practice, Basingstoke, Palgrave, now Palgrave Macmillan, 2002. 54

2.3 The United States

As with historical developments in England, social work in America emerged from the activities of voluntary organisations but, apart from a relatively brief period associated with the depression of the 1930s, remained largely outside the parameters of government bureaucracies.37 Trattner documents the establishment of the nation’s first important national public health activity - the US Sanitary Commission - as occurring during the American Civil War, which was financed and directed solely by private means.38

Following the war the growth of private philanthropy, notably by the US Charity Organisation Society (COS) which began in 1877 in Buffalo, New York, employing women to assess the eligibility of applicants for welfare assistance, and the Settlement House movement, helped lay the groundwork for progress in public health.39 This procedure was systematised in 1917 by Mary Richmond in her book Social Diagnosis which was the first and only social work text for many years. It described social diagnosis as a definable method whereby clients were dealt with on a case-by-case approach that became known as ‘social case work’. The Settlement House movement in the form of urban missions, was developed in Chicago, focusing on the environmental causes of poverty and on expanding working opportunities for the poor.40 One of its leaders, Jane Adams, was also actively involved in social reform at the national level where she encouraged the adoption of social policies that would address problems through government intervention.41 While Settlements focused on what later became group work and community organisation, social work in the COS’s focused on casework with individuals and families.42 Widespread education also set

37 W. Trattner, From Poor Law to Welfare State: A History of Social Welfare in America, 6th edition, first published 1974, New York, The Free Press, 1999, pp.78-87. 38 Trattner, From Poor Law to Welfare State, pp.78-87. 39 J. Axinn & M. J. Stern, Social Welfare: A History of the American Response to Need, Fifth Edition, Boston, London, Allyn and Bacon, 2001, pp.97-101. 40 M. Payne, The Origins of Social Work, continuity and change, New York, Palgrave Macmillan, 2005, pp. 38-41. 41 Payne in The Origins of Social Work, states that Jane Adams is the only social worker to have received a Nobel Prize for her peace campaigning in the 1920’s. She saw her pacifism as a logical extension of her community practice, p.40. 42 N. Cohen, Social Work in the American Tradition, New York, Holt, Reinhart and Winston, 1958, pp.68-69. 55

the stage for strong alliances between educated professional women and married housewives scattered across the nation.43

In 1905 Dr Cabot, a member of the hospital staff in the Massachusetts General Hospital took leadership by creating the Social Services Department to provide a link between the patient and all available sources of help in the community; he envisioned ‘the social worker as an interpreter of the hospital to the patient, and of the patient to the hospital’.44 Opportunities for social work involvement were further extended in the 1920s by two separate but associated developments - the mental hygiene movement, which both advocated a Eugenic version of sex education and helped educate the public about mental illness, and the introduction of the psychodynamic approach to casework, which was utilised in newly developed Child Guidance Clinics and resulted in the integration of psychiatric social workers as member of the mental health treatment team.45 These initiatives in medical care and treatment of the mentally ill in the early decades of the twentieth century, and the absence of consistent state provisions for the relief of poverty in the USA reinforced an extension of the activities of voluntary organisations and increased the demand for social work staff.46

When F. D. Roosevelt became president in 1932, he introduced the New Deal which initiated the entry of Federal statutory authorities into the health and welfare industries, establishing, among a range of financial reforms such as anti-trust suits to regulate competition, regulations for public utilities, protection of bank deposits, and controls for the stock market, as well as the nations first system of social security.47 In 1935 the Federal government introduced the Social Security Act which guaranteed minimum financial security as a matter of right and made federal funds available for contracting its services. The entrance of government into the social welfare field on a large scale produced an immediate demand for social workers; many of whom obtained high positions shaping policy in social insurance schemes and resettlement

43 T. Skocpol, Social Policy in the United States: Future Possibilities in Historical Perspective, New Jersey, Princetown University Press, 1995, pp.27-28. 44 Fink, Pfouts & Dobelstein, The Field of Social Work, p.82. 45 Payne, The Origins of Social Work, pp.38-39. 46 Payne, The Origins of Social Work, pp. 38-39. 47 Trattner, From Poor Law to Welfare State, pp.273-274. 56

programmes, all of which resulted in social work assuming an unprecedented authority.48

In the years following the depression and World War Two, poverty which had become almost invisible in the fifties, became increasingly prominent in the sixties. The civil rights demonstrations of 1966 and President Johnson’s ‘war on poverty’, which set up the Office of Equal Opportunity, added new grants and subsidies for poor and black groups while further subsidising locally-based interests.49 The new programmes also sought to employ indigenous social workers and para-professionals in the new public and voluntary services.50 An administrative decision ordering the restructuring of state and local welfare departments led to the separation of financial assistance from the requirement of casework services.51 The thrust of the ‘war on poverty’ brought social workers into community action programmes as private organisations and moved many of them from a therapeutic to a reform and advocacy role, pushing for consumer and community participation in decision- making.

During the 1970s, the nature of service delivery was transformed by the concept of revenue sharing and direct aid to local communities leaving the states free to support whatever social services they considered appropriate.52 The consequent development of quasi-government organisations meant the contracting-out of federal welfare services to voluntary agencies left America with a ‘semi’ welfare state, and reinforced the growth of private practice among social workers.

As was the case in Britain, neo-liberal policies based on the privatisation of services and the elimination of large welfare bureaucracies were adopted by the Republican, Ronald Reagan, when he was appointed president in 1980.53 Based on the premise that the forces of the free market place would best ensure the general welfare he urged, not only the cutting back of welfare but also that responsibility for the needy would be

48 P. J. Day, A New History of Social Welfare, Third edition, Boston, MA, Allyn and Bacon, 2000. 49 Skocpol, Social Policy in the United States, p.247. 50 Trattner, From Poor Law to Welfare State, p.344. 51 Trattner, From Poor Law to Welfare State, p.251. This was supported in a policy statement of the NASW on June 29, 1967. 52 M. Katz, In The Shadow of the Poorhouse: A Social History of Welfare in America, New York, Basic Books, 1999, pp.259-300. 53 Trattner, From Poor Law to Welfare State, pp.363-385. 57

transferred from the federal bureaucracy to the states and that private foundations and churches should then provide for victims of change in programmes such as childcare, public and mental health services and subsidized housing.54 Consequently those who had benefited from changes to social security in the previous era, which incorporated the middle-class into the welfare state, became vulnerable to policies of retrenchment. Assimilation of social services by the market and the growth of for-profit firms appeared in nearly all social welfare fields.55 Another development was the introduction of greater administrative control over remaining social programmes through the application of sophisticated managerial techniques, and the use of empirical tests to “measure” results.56 Demand for public accountability of internally derived data was not shared among institutions, and was believed to be a department’s private concern.

Federal demand for utilization and public accountability changed that belief and many felt that their autonomy was threatened. Like other health care professionals, many social workers viewed the requirement for professional accountability as a political attack on their services, while others sought the greater professional status they believed it would help them achieve.57

By the 1990s a new process - that of continuous quality improvement - had evolved. For social work in health care the intention was to integrate medical and nonmedical services and ‘provide opportunities to review who is being served, what services they are getting and whether the best clinical care is being given’.58 A further set of indicators involved the development of specific packages that measure cost- effectiveness or the outcomes of specific programmes, as well as the lack of service.

The commercialisation of the non-profit sector was continued by George Bush when he became president in 1988, and by the early 1990s the number of people officially listed as “poor” had risen to 36 million.59 In 1994, when Bill Clinton was elected, he

54 Trattner, From Poor Law to Welfare State, pp.363-385. 55 Katz, In the Shadow of the Poorhouse, p.312. 56 Trattner, From Poor Law to Welfare State, p.371. 57 H. Rehr, N. Showers, A. Young & S. Blumenfield, ‘Professional Accountability and Quality Improvement Through Practice-Based Studies’, in Creative Social Work in Health Care: Clients, the Community and Your Organisation, New York, Springer Publishing Company, 1998, p.65. 58 Rehr et al, Professional Accountability, p.65. 59 Trattner, From Poor Law to Welfare State, pp 378-385. 58

believed he needed to revamp welfare policies.60 In 1996 he signed a welfare reform bill which replaced the Aid to Families with Dependent Children (AFDC) with a programme called Temporary Assistance for Needy Families (TANF) under which block grants to States were to include time limits and conditions on the receipt of cash assistance. This measure reversed six decades of federal social policy- that of guaranteeing at least a minimum level of financial assistance or some kind of safety net to the nation’s destitute and dependent citizens, especially its young people.61 Welfare, then, had come to be seen as a project that caused more problems than it solved, rather than the solution to the problem of poverty. A further result of the legislation was the continuing devolution of welfare programmes to the states, and an increase in the roles of private sector and faith-based organisations. Consequently as public welfare departments were restructured greater pressure was placed on non- profit organisations to fill the gaps in services.62

Professional social workers in America are employed in both statutory and voluntary systems and are required to be registered in many American states.63 This requirement applied to individuals employed to fill these gaps in organisations following recommendations of the 1996 legislation, and was defined in 1955 by establishment of the National Association of Social Workers (NAASW).64 Registration ensures that practitioners who plan on doing independent clinical work with clients must provide evidence of their ability to perform such work by satisfying a board of highly experienced, licensed social work practitioners. Acknowledgement of differing levels of expertise was introduced during the period of the New Deal when schemes of national insurance were introduced, resulting in social workers moving from government employment to the field of private practice. Subsequent privatisation of state welfare functions has meant that this process continues.

60.Trattner, From Poor Law to Welfare State, pp. 378-385. 61 Trattner, From Poor Law to Welfare State, pp.397-400. 62 N. Tannenbaum & M. Reisch, ‘From Charitable Volunteers to Architects of Social Welfare: A Brief History of Social Work,’ in Ongoing Magazine, School of Social Work, Michigan University, at http://www.ssw.umich.edu/ongoing/fall2001/briefhistory.html 63 M. D. Glicken, Social Work in the 21st Century: An Introduction to Social Welfare, Social Issues and the Profession, Thousand Oaks, Sage Publications, 2007, pp.60-61. 64 Tannenbaum and Reisch. From Charitable Volunteers to Architects of Social Welfare. 59

2.4 Australia

Social work in Australia is relatively new and its development quite understandably adopted and incorporated much of the existing knowledge available from England and America. Although each country has comparable institutions, there are some significant differences that make for interesting contrasts. R.J Lawrence comments:

In many aspects the first thirty years of the training movement in America recalled the British development. The growth in the large cities, the connection with the rise of social science, the majority of women students, the early reliance on welfare agencies, the growth of full-time social work and the leading position of medical social work and the early Australian training demonstrates the same features. But there were important differences arising mainly from the size and strength of the social agencies in the much larger American society, and from its more democratic tempo.65

Social work in Australia is also new compared to the more established professions of medicine, law and the clergy. The definition of ‘profession’ is a complex issue that has evolved over the last century.66 According to a report of the Commonwealth Statistician in 1921, membership of the professions was confined to those ‘mainly engaged in government or the defence of the nation, and in satisfying the moral, intellectual and social wants of its inhabitants’ suggesting the importance of education and obligation to the community.67 Lawrence considers that, as a profession, Australian social work in its broadest definition is synonymous with social welfare work or social service work that is done by organisations or individuals who share common knowledge, skills and values, and that such

65 Lawrence, Professional Social Work in Australia, p.7 66 E. Freidson in his early study of the medical profession argues that autonomy and a legitimate control over work are the only true criteria for distinguishing professions. See E. Freidson, The Profession of Medicine: A study of the sociology of applied knowledge, New York, Dodd, Mead and company, 1970, p.82. Conversely, Anderson and Western, ‘The Professions: Reason and Rhetoric’, suggest that such groups are enabled to use their considerable economic and political influence to legislate social policies that affect their life chances in a positive way, and unfavorably influence the social conditions of the powerless. In Boreham, Pemberton & Wilson, (eds.), The Professions in Australia, pp.7-8. 67 R. J. Lawrence, Australian Social Work in Historical, International and Social Welfare Context, quoted in P. Boas & J. Crawley (eds.), Social Work In Australia: Responses to a Changing Context, Melbourne, Australian International Press in association with the Australian Association of Social Workers, 1976, p.1. 60

characteristics are developed through professional association and learning, and are reinforced through membership of a professional community.68

Research suggests that in colonial Australia there was general distrust of direct government assistance based on migrant memories of harsh English Poor Law regulations.69 A mixture of private charity and government relief developed, the inadequacy of which was demonstrated by the depression of the 1890’s. Then, when the Commonwealth Federation was established in 1901 and government powers were divided between the Commonwealth and the states, the only welfare policies that remained with the Commonwealth, were those relating to invalid and old age pensions, the rest were left to individual states. In 1904, and building on colonial and state arbitration systems, compulsory arbitration was introduced by the Commonwealth government. In its most famous judgment, the Harvester Judgment of 1907, Judge H.B. Higgins determined that ‘a fair and reasonable wage’, a ‘family wage’, which would enable him to support a wife and children ‘in Spartan comfort’, should be paid to male workers. Clearly the male worker was seen as the head of the family. 70 Consequently Australia developed a unique work/welfare state model which was concerned primarily with the protection of wage earners and which left welfare as a residual category of support for those who had slipped through the cracks of the wage system. Indeed, some historians have called this model the ‘residual welfare state’.71 Additionally the first decade of the twentieth century saw the introduction of old age and invalid pensions but, in general, welfare assistance was regarded as demeaning and able-bodied men were expected to support themselves by their presence in the labour market.

Prior to the 1950s, expectations that the man would be breadwinner and head of the family and that his wife would remain at home caring for him and the children, drastically reduced the range of jobs that women could enter in Australia.72 These

68 Lawrence, Professional Social Work in Australia. 69 R. Kennedy, Charity Warfare: The Charities Organisation Society in Colonial Melbourne, Melbourne, Hyland, 1985, pp.45-47. See also Mendes, Australia’s Welfare Wars Revisited, J. Roe (ed.), Social Policy in Australia: Some Perspectives, Stanmore, N.S.W, Cassell Australia, 1976. 70 Mendes, Australia’s Welfare Wars Revisited, pp.17-18. 71 Mendes, Australia’s Welfare Wars Revisited, pp.17-18. 72 J. Roe ‘The end is where we start from: women and welfare since 1901’ in C. Baldock & B. Cass (eds.), Women, Social Welfare and the State, Sydney, Allen and Unwin, 1988, pp.6-11 61

expectations were reinforced by both state and federal government marriage bars, which required women employees to resign their jobs when they married. Middle- class single females who sought employment chose socially acceptable fields, such as those offered by the ‘helping professions’ of nursing, teaching and social work, while working class women went into domestic, factory and shop work.73 By this time there was still a very rigid sexual division of labour in Australia.

Social work was described by Susan Brown as being seen to be particularly suitable for women as it was consistent with the accepted sequence of a brief period in the workforce followed by marriage and possibly voluntary charitable work as a nurturing occupation ‘caring for others’.74 Eileen Martin considered that, as with teaching, nursing and other paramedical occupations, it was seen as the extension of the domestic sphere of women, although the status and rewards were lower than those of males in comparable occupations.75 Norma Parker, one of Australia’s foundation social workers, also considered that a medical or almoner qualification was ‘a highly desirable qualification to possess, not because it led to an understanding of the medical settings and medical problems, but because it confirmed a higher status on those who had it and opened the door to good jobs, some of which had no medical connection.’ 76 Medical social work, or almoning as it was then known, became an acknowledged and popular specialty for women. On the other hand psychiatry, which as a profession did not develop in Australia until 1936 when a Diploma in Psychological Medicine was set up at the University of Melbourne, was heavily masculine, but it was a field that had little appeal for doctors, as mental illness was stigmatised and psychiatrists had yet to achieve the respectability attributed to other medical specialties.

This working out of gendered power relations can be demonstrated by the manner in which the powerful medical profession dominated the decisions of the almoners in

73 Roe, ‘The end is where we start from: women and welfare since 1901’, pp.17-18. 74 S. Brown, ‘A Woman’s Profession’, in H. Marchant and B. Waring (eds.), Gender Reclaimed: Women in Social Work, Sydney, Hale and Ironmonger, 1986, p.82. 75 E. Martin, Gender, Demand and Domain: The Social Work Profession in South Australia 1935-1980, Doctoral Thesis, Department of History, The University of Melbourne, 1990, p.13. 76 Parker, Early Social Work in Retrospect, pp.13-16. See K. Russell, The Melbourne Medical School, Carlton, Victoria, Melbourne University Press, 1977. In Western Australia according to the University of WA Calendar the Medical School was established in 1965. 62

New South Wales hospitals.77 Although training programmes in social work were first introduced by almoners, the medical profession promoted hospitals exclusively as the most appropriate places for training social work students, rather than having them follow the training programmes that were undertaken by welfare organisations and hospitals overseas.78 Despite the gendered inequities, social workers were able to carve out an autonomous place for themselves through various initiatives, especially when individual treatments implied in the medical, hospital model were found to be ineffective when the problem was one of family dysfunction. 79

One such example was the adoption of the work of the American social worker, Virginia Satir who introduced the practice of Family Therapy in the 1970s.80 This was a treatment methodology conceptualising the family as a social system that had become unbalanced as the result of unresolved interpersonal conflicts. Satir believed that this method was particularly useful to social workers, with their interest in interpersonal relationships. Her approach to social work was broadly adopted by social workers in Western Australia, particularly in the 1970s, because they were uniquely placed to apply their social work skills to working with families.

Elaine Martin in her study of professional social work developments in South Australia examines ‘the domain of social work’.81 She found that because agencies were community funded, social work practice was determined accordingly, and as funding agencies became more diverse, the particular domain of social work became more difficult to identify. Martin describes the way gender was involved in the construction of the profession and the demand for its services, and identifies two features in the 1940s and 1950s that induced scepticism from employers about social work practice in such settings. These were the predominance of women in social work, especially the implications when family responsibilities were secondary to

77 H. Marchant, ‘A feminist perspective on the development of the social work profession in New South Wales’ in Australian Social Work, Vol.38, No.1, 1985, pp.35-43. 78 E. Martin, ‘Social Work and Social Services’ in B. Dickey, Rations, Residences and Resources: A History of Social Welfare since 1836, Adelaide, Wakefield Press, 1986, pp.226-284. 79 R. W. Rieler (ed.), The Individual, Communication, and Society: Essays in Memory of Gregory Bateson, Cambridge, 1984. 80 V. Satir, Conjoint Family Therapy: A Guide to Therapy and Technique, Palo Alto, Science and Behavior Books, 1967. 81 Martin, Gender, Demand and Domain. 63

professional careers, and the dependency of social workers on communally- resourced organisations for both employment and as a practice base.

The growth of social work in Australia was influenced by successive stages of social policy development. Inspired in part by the widespread misery and hardships suffered during the Great Depression, between 1941 and 1945 basic components of the welfare state were introduced by the Curtin and Chifley governments to rectify the inadequacies of the earlier legislation concerning basic wage levels and the existing state and Federal systems of relief.82 By the end of World War II, the Commonwealth government had assumed responsibility for all major income security benefits as a bulwark against poverty, and by introducing a policy of full employment, as a bulwark against unemployment. It referred explicitly to its welfare initiatives as a safety net which would catch those who had fallen through the cracks of presence in the workforce, due to unemployment sickness or injury. The Commonwealth has come to provide income security payments while the states and private social security sector provided the remainder of welfare services through tied grants.

Following the welfare initiatives of the Labor government, when the Liberals came to power in 1949 they de-emphasised the welfare state although they never attempted to abolish it. Instead they favoured the provision of welfare by the self-reliance of members of families and private charities. Spending on welfare programmes was extremely low by international standards.83 However, the late 1960’s saw the ‘rediscovery’ of poverty. Pressure built up to increase social security benefits following the Commonwealth Government Commission of Inquiry into Poverty (the Henderson Report) reports of 1966 measuring the incidence of poverty, and the final report of 1973.84 The election of the Whitlam Labor government in 1972 initiated a series of macro-reforms reflecting the influence of a structural model of welfare, rather than limiting social policy to minor incremental changes in social security payments. The 1973 Australian Assistance Plan to coordinate federal, state and local organisations established a network of community services which aimed to achieve greater accessibility of social welfare services for individuals and families.

82 Mendes, Australia’s Welfare Wars Revisited, p.19. 83 Mendes, Australia’s Welfare Wars Revisited, p.23. 84 See Jones, The Australian Welfare State, pp. 46-47, and Mendes, Australia’s Welfare Wars Revisited, pp. 24-25. 64

Markiewicz suggests that due to the advent of the 1973 recession and the Government’s inability to control unemployment, inflation and improve the economic situation, a serious lack of confidence occurred in the Federal government and Whitlam’s vision of an integration of welfare services seemed no longer feasible.85 In 1976 when the Fraser Liberal government came to power it introduced a policy based on cutting the public sector and providing incentives for private expenditure, but the level of welfare spending decreased only slightly, due to a series of recessions in the late seventies and early eighties and a rise in unemployment benefits.

Philip Mendes writes that after the defeat of the Fraser government in 1983, Liberal free marketeers, assisted by international think-tanks particularly in Anglo Saxon countries, formed links with a variety of government and business supporters and gradually assumed control of the political agenda of the Liberal party.86 The neo- liberal takeover was assisted by the Valder Report, ‘which attributed Australia’s economic problems to increased government spending in the 1970s. According to the report Australia suffered from a welfare mentality in both corporate and individual terms’.87 It also called for restrictions of welfare benefits to the most needy, and the privatisation of some welfare services. Corporatising organisational structures became the goals of most new government initiatives, leading to a reversal of state-guaranteed income and a return to the provision of welfare by private charities and churches. Governments then began to claim that the welfare state was controlled by self- interested welfare professionals in non-government organisations whose main concern was their own advancement rather than the relief of poverty. For example, in 1991 the Australian Council of Social Services (ACOSS) was accused of being more interested in building large welfare bureaucracies than in helping the poor.88 Subsequent policies of the Liberal Party recommended restriction or termination of government welfare benefits. Mendes suggests that the aim of these reforms was ‘to

85 A. Markiewicz, ‘Panacea or scapegoat: The social work profession and its history and background in relation to the State Welfare Department in Victoria’, Australian Social Work, Vol.49, No.1, September 1996, pp.25-31. 86 Mendes, Australia’s Welfare Wars Revisited, pp.123-129 87 Mendes, Australia’s Welfare Wars Revisited, p.127. 88 J. Hewson, ‘De-regulate the labour market, re-examine service delivery’ Victoria Council of Social Service Policy Issues Forum: November 2-8, quoted in Mendes, Australia’s Welfare Wars Revisited, p.128. 65

end welfare dependency, and promote a transfer of responsibility from the government to families and the individual’.89

The Howard coalition government, which governed Australia from 1996 to 2007, continued the process of marketising welfare, for example by dismembering and privatising the employment-finding services of the Commonwealth Employment Service (CES), one of the Chifley government initiatives during World War II. It tightened the criteria and level of payments for welfare benefits, and sought to displace ACOSS as the representative of the welfare sector with a group of agencies who mainly worked within a religious or moral framework.90 As occurred in the UK and USA throughout the 1990s there was a shift towards contracting-out of government services which brought with it significant changes in the content and delivery of services and of social work activities.91 Social work positions were transferred from senior management and administration to those of “non human service”, and replaced by staff with specific management training backgrounds. What followed was a declassification of positions previously tagged “social work”. Social work positions were then open to those with what were considered to be ‘appropriate’ qualifications. Further difficulty occurred when the Government drew back from direct service delivery leaving social workers with case management roles only, and little opportunity to extend into wider aspects of casework.92 Karger reports that there was a strong view at that time that the values and philosophy of the social work profession were at odds with the values of technological rationalism and makes the following observation concerning social work policy:

It should aim to highlight the capacity of the social worker to perform a professional role within a complex and demanding organisational structure amidst a population of service users whose needs span structural, environmental and individual issues and whose consent to interventions is not always voluntary.93

Early accounts of professional social work in Australia describe its dependence on overseas sources. Lawrence reports that medical social work was the first area to be

89 Mendes, Australia’s Welfare Wars Revisited, p.129. 90 Mendes, Australia’s Welfare Wars Revisited, p.132. 91 Osborne & Gaebler, Reinventing Government, New York, Penguin, 1993. 92 Osborne & Gabler, Reinventing Government, p.109. 93 Quoted in Markiewicz, ‘Panacea or Scapegoat’, p.11. 66

developed as a specialty.94 In the early decades of the twentieth century, as training was unavailable in Australia, a “significant handful” of Australians travelled overseas to obtain social work education. Norma Parker was one of those. She explained that, before the publication of the first textbook on social casework, the teaching of social work methods resembled a trade apprenticeship where young workers learned skills on the job with some general supervision. She considered that the integration of casework principles in Australia marked the beginnings of professional social work development.95

By the 1930s medical social work courses were established in Victoria and NSW and trained social workers were employed in hospitals and voluntary organisations where the primary function was that of medicine.96 However Helen Marchant identifies the work of female activists in the early 1920s as the ones who were actually responsible for the introduction of medical social work.97 She argues that the contribution of the activists was taken over by the male-dominated medical profession who, backed by the hospital social workers, gradually dominated the course content of training programmes to the detriment of groups concerned with family and child welfare. Nevertheless Elspeth Browne argues that, given the nature of the times, had it not been for these affiliations with male academics, it would have been highly unlikely that social work training would ever have been established as a university course.98

Changes brought about by World War 11, including extension of the Commonwealth’s role in rehabilitation and welfare fields, all increased the demand for qualified social workers.99 Even at this stage, hospitals in Melbourne and Sydney employed dedicated

94 Lawrence, Professional Social Work in Australia, p.5. See also T. Kewley, ’Social work and training in Australia’ in Social Welfare, January, 1952. 95 N. Parker, ‘Early Social Work in Retrospect’, in Australian Social Work, Vol.32, No.4, December 1981, p.16. 96 L. O’Brien and C. Turner, Establishing Medical Social Work in Victoria: Discussion and Document, University of Melbourne Press, 1976, p.14. 97 H. Marchant, ‘A Feminist Perspective on the Development of the Social Work Profession in N.S.W.’, Australian Social Work, 1985, Vol. 38, No. 1, pp. 35-43. 98 E. Browne, Tradition and Change: Hospital Social Work in NSW, AASW, New South Wales Branch, 1996, p.4. 99 E.M.W. Martin, ‘Social Work and Services 1935-1965’, in B. Dickey, Rations, Residences and Resources: A History of Social Welfare Since 1836, Adelaide, Wakefield Press, 1986, pp.226-284. 67

psychiatric social workers although they were dependent on the importation of overseas trained staff as there was no specific training for them in Australia. 100

Writing in 1986, Healy, Rimmer and Ife discussed the growth and change in social work education over the two preceding decades. They comment:

There has been a structural transformation of the social work/knowledge enterprise in Australia, that this transformation has involved a marked differentiation of the knowledge education process from the world of practice, and that in the course of instutionalising social work education there has been a double process of cultural imperialism, on the one hand from foreign (largely United States and United Kingdom) social work education sectors, and on the other hand from newly institutionalised local academic institutions. This double process has de-legitimised and rendered dependant the indigenous knowledge and indigenous social work practice. 101

Another form of cultural imperialism, the masculinisation of social work education leadership in Australia which, they argue, was initiated when males were recruited from overseas, some of whom were unqualified or under-qualified by Australian standards.102 From a total number of thirteen, eight heads of social work departments in higher education were reported to be unqualified or under-qualified by Australian criteria. Whether the emphasis was on higher degrees rather than social work qualifications and experience, a practice culture imported from overseas was established within Australian social work departments and a growing gap between academia and fields of practice was noted.103 Elspeth Browne commented on the significance of this gap.104 She pointed to those who had graduated from departments in Sydney, Melbourne, Brisbane and Adelaide Universities by the end of the period of rapid expansion in the 1970s, all of whom were women, who were vigorous in social work education and practice and in the emergent professional association of the time.

100 See B. Healy, J. Rimmer & J. Ife ‘Cultural Imperialism and Social Work Education’, in Advances in Social Work Education, The Heads of Schools of Social Work in Australia in Association with the University of New South Wales, 1986, for their discussion of the influence of sources from the United States and the United Kingdom on indigenous knowledge and practice. However since then Australian writers have done much to provide the profession with the information lacking in previous years. 101 Healy and others, Cultural Imperialism, pp 92-93. 102 Healy and others, Cultural Imperialism, p. 94. 103 E. Browne, ‘Cultural Imperialism in Australian Social Work Education? Patriotism, Patronage and Professionalism (A Response to Healy, Rimmer and Ife)’, Advances in Social Welfare Education, October, 1988. 104 E. Browne, ‘Cultural Imperialism in Social Welfare Education.’ 68

She referred to these women, such as Norma Parker, Amy Wheaton, Hazel Smith, Alison Player, Mary Mclelland and Kate Ogilvie as “our founding mothers”. She also pointed out that at that time social work departments only offered sub-degree programmes, and as late as 1974 they had only produced eight graduates with higher degrees in social work. The first doctorate in social work was awarded in 1978. Of necessity academically trained staff had to come from overseas until Australian institutions could produce a supply to meet the demand.105

Not surprisingly there was some loss of confidence on social work education amongst the practicing professionals and the heads of new schools that were developing criteria. Healy, Rimmer and Ife referred to ‘marked differentiation of the knowledge- education processes from the world of practice’.106 They suggested that the problem was not so much the cultural imperialism of foreign academics, but whether the emphasis on higher degrees rather than social work qualification and experience had colonised the practice culture within Australian social work departments. In this period social work was not considered to be alone in the masculinisation of its leadership. As Cass, et al, point out, the case of social work was different and distinct because social work was predominantly female, and that the numbers of Heads of Department who were unqualified by Australian criteria would have been unthinkable in the more established professions. 107

In 1946 the Australian Association of Social Workers (AASW) was formed, and became registered with the Commonwealth Arbitration Court.108 The AASW determines entry qualifications and standards for the social work profession. In order to deal with the expressed need for professional support from colleagues in like areas, special interest groups have been established in a number of fields of practice in a number of states and territories.109 As well as this, a large number of Schools of Social Work have developed specialist postgraduate courses. As an example, a postgraduate

105 E. Browne, ‘Cultural Imperialism in Social Welfare Education.’ 106 B. Healy and others, Cultural Imperialism. 107 B. Cass, M. Dawson, D. Temple, S. Willis & A. Winkler, Why So Few? Women Academics in Australian Universities, Sydney, Sydney University Press, 1983. 108 N.S.W. Branch Newsletter, Fifty Years of the National AASW, AASW, N.S.W. Branch March, 1996, vol. 1. 109 AASW Mental Health Interest Group, AASW New South Wales Branch, November 1996, p.10. 69

Certificate has been established by the Discipline of Social Work and Social Policy at The University of Western Australia in 2009.

2.5 Western Australia

Social work in Western Australia had a slow start compared to what occurred in other parts of Australia. A branch of the AASW, which was formed in Perth in 1946, contained only a handful of members as professional training was unavailable in WA; those aiming for qualifications were required to travel to the Eastern states or overseas.110 However the shortage of qualified social workers did not become a critical issue until the end of World War II when efforts began to establish a tertiary training programme. This was finally achieved in the mid sixties. A trickle of graduates then began employment in government agencies. Prior to that, due to a limited amount of government involvement in welfare, members of private philanthropic agencies mainly supplied welfare services.

Unlike the situation in New South Wales and Tasmania, where the British government established convict colonies, Western Australia was the first colony to be founded exclusively as a private concern.111 The conditions of settlement at the Swan River colony placed responsibility for colonisation in the hands of private individuals with the condition that the government would incur no expense other than the provision of a small military guard and limited civic facilities to deal with administrative and social needs. When the British settlers first arrived in 1829, they carried with them traditions, some of which, although appropriate in their homeland, fitted uncomfortably into the exigencies of a very different new life. One of the traditions that did fit comfortably was the minimal provision of government welfare, while another was private philanthropy and the participation of upper and middle class women in it.

In the beginning, few philanthropic organisations existed to help the poor in the Colony; ‘charity’ was left to individuals, church orphanages and, as a last resort, to the

110 Crawford & Leitman, The midwifery of power?, pp.43-54. 111 P. Statham, ‘Swan River Colony 1829-1850’ in C.T. Stannage, (ed.), A New History of Western Australia, Nedlands, WA, University of Western Australia Press, 1981, pp.181-188. 70

colonial government.112 The Poor Relief Act of 1845 distinguished the ‘thriftless and unworthy’ from the ‘needy and unfortunate’, effectively minimizing the financial responsibilities of the authorities.113 Only after comprehensive inquiries into the bona fides of applicants for relief, did the government provide indoor and outdoor relief; widows and deserted wives were more likely to be given relief than able-bodied men who were regarded with suspicion.114 Abbott and Chesney write that destitute men and women were housed in poorhouses, and lunatics and other ‘incompetents’ were housed in an institution in Fremantle.115 Beyond this, charity was largely in the hands of ‘ministers of various denominations, ladies and others who took an interest in the sick, infirm and indigent poor’.116

Due to agitation by wealthy farmers over an apparent shortage of labour in the 1840s, food shortages and delays in the allocation of arable land, and despite an explicit foundation condition that no convicts would be introduced, the colonial government requested of the British government, convict labour, and in 1850 the colony became a penal settlement.117 Eighteen years later, with improved rates of economic and demographic growth, transportation finally ceased. The gold boom from 1893-1896 brought prosperity to the colony but due to the sudden increase of population and totally inadequate facilities, it also brought immense difficulties, placing a strain on both public and private charity.118

In the 1890s there was a change from the existing personal forms of charity to a system whereby charity was largely channelled through an organisation, committee or institution, many of which were local copies of parent bodies in England, often

112 E. Willis, ‘Protestants and the Dispossessed in Western Australia 1890-1910’, in J. Tonkin (ed.), Religion and Society in Western Australia, Studies in Western Australian History, No. 9, October 1987, pp.31-44. 113 Poor Relief Act of 1845, Vic. No.2, Statutes of Western Australia, 1842-1853. 114 Willis, Protestants and the Dispossessed, p.32. 115 K. Abbott & C. Chesney, ‘ I am a poor woman: gender, poor relief and the Poor House in early twentieth century Western Australia’ in C. Fox (ed.), Social Policy in Western Australia, Studies in Western Australian History, Centre for Western Australian History, 2007, pp.24-39. 116 Willis, Protestants and the Dispossessed, p.32. 117 R.T. Appleyard, ‘Western Australia: Economic and Demographic Growth’, in C. Stannage (ed.), A New History of WA, Nedlands, University of Western Australia Press, 1981, pp.211-212. 118 V. Whittington, Gold and Typhoid, Two Fevers: A Social History of Western Australia 1891-1900, Nedlands, University of Western Australia Press 1988. See also M. Tauman, The Chief: C.Y.O’Connor, Nedlands, WA, University of Western Australia Press, 1978, for a detailed account of the public works programme 1881-1896. 71

connected with a particular church.119 These committees were able to obtain government support, and provided the opportunity for women who had contacts among the well-to-do to take a public role in charitable organisations. These included a convalescent home for adults and homes for single expectant mothers, the blind, and the deaf.120 Among these were both charitable and early feminist organisations, such as the Ministering Children’s League (1891) Women’s Service Guild, (1891) The Women’s Christian Temperance Union, (1897) and the Children’s Protection Society (1906).121

While the broad parameters of state welfare continued, during the first two decades of the twentieth century one of the growth areas in state involvement in welfare was in the regulation of children and families. Governments gave strong support to philanthropic welfare organisations interested in child protection that were influenced by environmental theories of child rearing.122 As child cruelty and neglect became a social problem, a network of child protection agencies emerged in WA; the Children’s Protection Society (CPS) was one of them.123 The achievements of the CPS led the State Government to pass the State Children’s Act 1907 and later the Child Welfare Act of 1927, which enabled Inspectors of the Society to visit homes of people reported to be neglecting or treating their children cruelly, and remove the children if necessary.124 In effect the CPS had become a de facto state welfare organisation.

Rosemary Kerr writes that the Western Australian State Children’s Department (SCD), known as the Child Welfare Department from 1907, supported a medical model of intervention in cases of juvenile delinquency.125 Integral to this was the creation of Children’s Courts and the use of medical experts to guide the bench in determining sentences. A system based on ‘valid scientific examination’ to separate

119 See P. Hetherington, ‘Baby Farming in Western Australia’, in Fox (ed.), Social Policy in Western Australia, pp.75-97 for a discussion of facilities provided by church run organisations to help unmarried mothers and their babies. 120 Willis, Protestants and the Dispossessed, p.34. 121 Willis, Protestants and the Dispossessed, pp.40-41. 122A. Davis, ‘Infant mortality and child saving: The campaign of women’s organisations in Western Australia’, in P. Hetherington (ed.), Childhood and Society in Western Australia, Nedlands, University of Western Australia Press with Centre for Western Australian History, 1988, p.161. 123 L. Rowe, ‘The Children’s Protection Society: Child Protection in Western Australia, 1906-1930. Towards a Medical-Welfare Model’, in C.Fox (ed.), Social Policy in Western Australia, pp.116-131. 124 Rowe, The Children’s Protection Society, p.120. 125 R. Kerr, ‘Inefficients at best, and criminal at worst’: Juvenile Delinquency in Western Australia during the interwar years’, in C. Fox (ed.), Social Policy in Western Australia, p.100. 72

the intellectually disabled, the delinquent and the normal child was introduced following World War I in which psychologists, psychiatrists and educators became increasingly influential in the diagnosis of the social and psychological conditions leading to offences and the subsequent classification of young offenders.126 The quality of home life became a factor in the assessment of juvenile delinquency, and parents were repeatedly targeted for failing to control their children.

In 1940 a group of upper and middle class women established the first Lady Gowrie Centre in Victoria Park, a working class suburb of Perth, with the objective of providing an environment in which children might flourish, and which others could copy; other centres soon followed.127 Patricia Crawford suggests that their underlying ethos was that mothers should be responsible for the daily care of children within a context of male authority. The Centre staff kept records of each child which came before it. A social worker provided a family background report on home conditions, a medical worker provided details of the child’s physical condition and eating habits, and a teacher provided observations of the child at play.128 She notes that there was a class component in the functioning of the Centres.129 The Centres were built in inner- city suburbs so that the children would come from working class families where many of the working class women supplemented their income with work, often as domestics. Staff members were especially critical of mothers who joined the paid workforce, and attributed children’s behavioural problems to working mothers. There was also a gendered component at the Centres.130 This was demonstrated in the first instance by the composition of the staff, in which a male director was assisted by female employees. At the end of the Second World War the Centre staff typically consisted of a male director, a nurse, a social worker, teachers, a part-time medical superintendent and a cook, whose salaries were funded by the Commonwealth Health Department. Encouraged by the possibilities for teaching and observation, many people visited the Gowerie Centres to study their methods.131

126 Kerr, Inefficients at Best, p.101. 127 P. Crawford, ‘Early Childhood in Perth, 1940-1945: From the Records of the Lady Gowrie Centre’ in P. Hetherington (ed.), Childhood and Society in Western Australia, pp.187-207. 128 Crawford, Early Childhood in Perth, p.188. 129 Crawford, Early Childhood in Perth p. 196. 130 Crawford, Early Childhood in Perth p.200. 131 Crawford, Early Childhood in Perth p.204. 73

Although there already existed a welfare culture, maintained for the most part by the voluntary services of women, there was only one professional social worker in Western Australia until the Second World War.132 The period of reconstruction following the war, together with social problems arising from its aftermath, initiated a demand for welfare provisions and for the services of qualified social workers such as those already employed in the Eastern states. An attempt had been made in the late 1920s to establish a government Child Guidance Clinic along the lines of existing establishments in England and the USA, based on the newly introduced concepts drawn from Freudian psychology. Norma Parker, who was one of the first West Australians to obtain social work qualifications, hoped to work at the clinic.133 After completing an Arts Degrees at the University of Western Australia in 1928, she and Constance Moffitt studied at the National School of Social Services in Washington D.C in the USA, as social work training was unavailable in Australia.134 A year later they were joined by Eileen Davidson. However when they returned to WA three years later, no jobs were available due to the economic depression of the 1930s. They then found work in the Eastern states where Norma Parker became employed as the first almoner in St. Vincent’s Hospital, Connie Moffitt in the Melbourne Child Guidance Clinic and Eileen Davidson set up the Almoner Department in Sydney.135 None of the three returned to Perth to practice. The ensuing years were ones of reorganisation and reintegration for the profession, and as Norma Parker commented, ‘we did what was close at hand and calling out to be done’.136

During the depression of the 1930s and World War Two, economic development in Western Australia remained slow or non-existent.137 Where private philanthropy was active in other Australian states, this was not so in Western Australia and so philanthropy provided few, if any, avenues for employment for new social workers and neither did the new relief measure put in place to assist workers who lost their

132 F. Crawford & S. Leitman, ‘The midwifery of power? Reflectionss on the development of professional social work in Western Australia’, in Australian Social Work, 2001, Vol.54, No. 3, p.45. The social worker was Aimee Eakins at Royal Perth Hospital. 133 Parker, Early Social Work in Retrospect p.16 134 This was due to the influence of Dr. J. McMahon, Director of Catholic Education in Western Australia, who had studied there for his Ph.D. and had retained many linked with the USA. 135 Parker, Early Social Work in Retrospect, p.19. 136 Parker, Early Social Work in Retrospect, p.19. 137 R. N. Ghosh, ‘Economic development and population growth in Western Australia since 1945’ in Stannage (ed.), A New History of Western Australia, pp.267-293. 74

jobs during the Great Depression. Until the late 1960s the only avenues of social work employment were the Department of Social Services, Royal Perth and the Children’s Hospitals, the Navy, and the Red Cross Society.138 As we shall see later, the Mental Health Services were added to this list when the first mental health social worker was appointed in 1959.

Indeed Mental Health social work is extremely important to the professionalisation of social work in WA. During the forty-year time frame of this research, the WA Public Service Board (WAPSB) determined industrial conditions for employment in the state public service by a system of individual categorisation based on qualifications and experience. Under this system the category of profession required membership of a professional association, and acknowledgement of expertise in a specific area. In 1959, the outcome of an appeal to the state Industrial Court by Mrs M. Stockbridge, the first mental health social worker to be appointed to the area of mental health services, resulted in social work being transferred from the classification of General Division to that of Professional Division in the state public service.139 This was a landmark decision for all social workers employed by the state government. It meant that they were granted professional status and a salary and career range comparable to other professional groups; it was one of the milestones in its development in WA.

2.6 Core themes

In this survey and analysis of the history of social work in England, the USA, Australia and Western Australia, two core themes emerge: the inter-relatedness of gender and power; and the vulnerability of social work to political change. This section overviews some aspects of these two countries in very broad outline.

The inter-relatedness of gender and power

The significance of gender in the construction of social work and the delivery of services is a core theme that is interwoven with the establishment and maintenance of power structures and relationships in each of the countries under discussion. In

138 Crawford & Leitman, ‘The Midwifery of Power?’, p.46. 139 M.E. Stockbridge in WA Public Service Lists, 1959, p.150. 75

charitable organisations women usually appear in two ways. Firstly they almost universally appear as the front line of assistance, visiting the poor, investigating their bona-fides, often heading the philanthropic organisations which provided the relief but more often being under the control of males. They also appear as wives and mothers in the home. The dominant ideology about the importance of mother and child was the initiative for actions taken by many middle-class women who perceived working class women to be in need of help to properly care for their children and fulfill their family duties. Gender was also used to maintain social policies that reinforced the dependent status of women on a male breadwinner by dividing ‘productive’ from ‘unproductive’ welfare recipients.140 The most obvious inheritance philanthropy gave to social work was a feminised workforce, in which women formed the bulk of social workers. This is not unusual in the histories of the three countries studied. A range of feminised professions (social work, occupational and physiotherapy) are all seen to have their origins in the caring role of women in the family, hence these professions can be seen as families with men usually at the head of social work organisations and women at the bottom.

According to Hearn most of the writing about the professions does not identify gender as a central organising concept in this way, although it seems blindingly obvious. But Hearn uses another example to press home the point. Using the medical profession as an early example, he argues that professionalisation was essentially a patriarchal process through which men controlled reproduction and emotionality, taking over an occupation, midwifery, first performed by women in medieval times.141 Helen Marchant, commenting on these early events and also on the experience of the medical social workers, warned of the dangers of social workers seeking alliances with male dominated professions.142

140 For example, Lewis in her book The Voluntary Sector, the State and Social Work in Britain, pp.56- 58, describes the policy and gendered nature of relief giving by the COS in late 19th century England. This same focus can be noted in the account of Western Australian experience by L. Rowe, The Children’s Protection Society describing conditions and experiences in the early decades of the twentieth century. 141 J. Hearn, ‘Notes on Patriarchy: Professionalism and the Semi-professions’ in Sociology, Vol.16, No.2, 1982, pp.184-222. 142 Marchant, A Feminist Perspective, p.42. 76

The vulnerability of social work to political change

It is clear from the literature that the impact of government policies determined the boundaries of social work services in each of the three countries. In Britain, for example, the wholly inadequate attempts to relieve the severe poverty caused by the Great Depression led to the establishment of the Beveridge Report which recommended the establishment of the welfare state. Following World War II this was achieved, and the focus of the relief of poverty shifted from privately funded organisations to the establishment of government departments responsible for welfare. This was the moment of greatest growth for the profession of social work. The increase in the number of employees engaged in social welfare and in the number of social work specialties involved led to publication of the Seebohm Report of 1968 and the introduction of generic training and facilities to replace those that were specialist based. Then in 1970 the Local Authority Service Act provided for the transfer of all health and medical services from institutional to community based locations. A change of government in 1979 accompanied by political decisions based on ideologies of the New Right led to the restructuring and marketisation of welfare services. Further legislation in the 1990s led to the competitive tendering out of government services and the proliferation of small providers in the voluntary and private sectors. Social workers were intimately involved in these processes, being moved from public to private employment and sometimes back again, as the winds of change blew through social welfare, frequently dealing with the casualties of these restructurings.

American social workers in the twentieth century experienced a similar trajectory. In The New Deal, legislation during the depression of the 1930s, particularly the National Recovery Act of 1933, shifted responsibility from private to public relief and this initiated the widespread increase of employment of social workers in welfare and policy areas. However, as the need for financial relief lessened after the Second World War, the employment of social workers by the Federal government declined. During the 1960s and 1970s and the Federal government’s ‘war on poverty’, another expansion of social welfare services began but this time it was accompanied by the concept of revenue sharing as federal government services were contracted out to local community organisations. As was the case in Britain the advent of neo-liberal policies introduced by President Reagan in the 1980s resulted both in an attack on welfare as a

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human right and in the marketisation of welfare itself. Once again social workers were involved in these processes, moving from public to private organisations and assisting those who were victims of the process.

In Australia, following Federation, most responsibilities for health and welfare were left to the States, which, together with private charities, had long provided for the relief of poverty. During World War II the basic components of modern welfare were established when the Commonwealth government set up the welfare state. However by the end of the 1960s the Henderson Report showed that certain groups were living dangerously close to the ‘poverty line’. The consequent introduction of the Australian Assistance Plan in 1973 established a network of community resources to achieve greater accessibility to social welfare services, and an associated increase in funds available to the states for the employment of social workers. This policy was modified and finally reversed by the election of subsequent governments. In 1983 the newly appointed Liberal government adopted the neo-Liberal ideologies from Britain and the USA as corporate organisational structures became the goal of government initiatives. Then in the 1990s legislation introduced by the Howard government resulted in a shift to contracting out services and, therefore, changes in the content and delivery of social work

The influence of government policy in welfare provisions is very evident in Western Australia and the consequences for social work are similar. Social work was established on the foundations provided by private organisations concerned with child and family welfare and modified within legislative parameters. Although Commonwealth funding was provided for defense and rehabilitation services from the 1940s, Federal finance for the extension of welfare and community services did not become available until the 1970s. Following that time the global reforms resulted in the amalgamation of a number of government bureaucracies, and the restructure of health and welfare bureaucracies to conform to corporate management ideologies during the 1980s and the contracting out of services in the 1990s.

While the vulnerability of social work to political change is demonstrated by its positive industrial position during the period of the Welfare State in England and the New Deal in America, is also observable, but in a negative way during the neo-liberal 78

changes that occurred during the latter decades of the twentieth century. In the competitive situation associated within a globalising market and neo-liberal politics and economics, social workers operating in the health and welfare fields were required to define the outcomes of the services they provided. The profession’s lack of ability to define the humanitarian aspects which are at the centre of its practice, within the quantifiable elements demanded by government bureaucracies, placed them in an extremely vulnerable position.

2.7 Summary

This chapter has provided a survey of the historical development of social work services in England, the USA and Australia. The discussion of how these services became established in Australia provides an opportunity to link the established historiography of social work in England and the USA with the largely unexplored Australian and particularly Western Australian experience. A key finding in this respect is that in broad terms the history of social work in all three places is similar and that Australia largely followed initiatives established elsewhere: social work’s origins lie in nineteenth century philanthropy; philanthropic methods powerfully shaped the way early governments conceptualised welfare and welfare recipients; state responsibility for welfare changed the meaning of welfare to the point where welfare became a right consequent on citizenship, as each country adopted its own version of the welfare state; neo-liberalism changed this relationship again by conceptualising recipients of welfare as consumers in a market of providers. With respect to social work in these contexts, several core themes emerge, the most dominant being the impact of gender in determining the position of social work within a network of political and personal power relationships and the impact of political decisions in shaping the way social work was organised, conceptualised and performed. In the next chapter, I focus the history of Mental Health Services in the same four places, finishing with the situation in Western Australia.

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Chapter 3

Mental Health: A Brief Overview

Services for the mentally ill constitute an essential but ever changing challenge to provisions for the maintenance of effective standards of mental health care. The historical literature on this topic is massive and comes from a number of different perspectives. Historians such as Scull, Porter, Showalter and Rothman focus on experiences of the insane and the establishment of asylums for their treatment.1 The historical and sociological research of others such as Foucault, Goffman and Szasz not only challenged the concept of mental hospital care but also challenged the very existence of mental illness itself and prepared the way for the deinstitutionalisation of patients into the community.2 As we have seen, Freidson discusses those characteristics that are required before an occupational group can claim professional status, an important approach in relation to the alienists (later psychiatrists) in their search for control over the definition and treatment of mental illness.3 Other issues were also influential in determining the development of mental health services, including those relating to government policies and to community attitudes. I reach into each of the above areas as the chapter progresses.

The chapter begins with an overview of the history of mental health services in England and the USA before moving to Australia and Western Australia. The section on Western Australia runs only until 1959 when the story will be taken up in Chapter Four. Overseas developments are included because of the influence they had on Australian developments, as their cultural patterns appear to sit most comfortably with our own. Because people with intellectual disabilities were often categorised under

1 See A. Scull, Museums of Madness, London, Allen Lane, 1979. and Decarceration: Community Treatment and the Deviant- A Radical View, New Jersey, Prentice Hall, 1977. Also R. Porter, Mind Forg’d Manacles: A History of Madness in England from the Restoration to the Regency, London, The Althone Press, 1987, E. Showalter, The Female Malady: Women, Madness and the English Culture, 1830-1980, New York, Pantheon, 1985, and D.J. Rothman, Conscience and Convenience: The Asylum and its Alternatives in Progressive America, Boston, Little, Brown and Company, 1980. 2 See M. Foucault, Madness and Civilisation, London, Tavistock, 1967, E. Goffman, Asylums, Harmondsworth, Penguin, 1961, and T.S. Szasz, The Myth of Mental Illness, New York, Secker and Warburg, 1962. 3 E. Freidson, Professional Dominance and the Social Structure of Medical Care, New York, Atherton Press, 1970. 80

lunacy acts and shared the asylums and hospitals for the insane with the mentally ill, this chapter will include their history as well, up until the moment where they became separated conceptually and administratively. This chapter forms part of the crucial background to the next three chapters, which deal with the history of mental health social work in WA. Throughout the chapter I highlight the different, perhaps even idiosyncratic, themes that are relevant for each jurisdiction. At the close of the chapter I identify a number of core themes that emerge across jurisdictions - themes which demonstrate some of the similarities as well as the complexity of the process of mental health development. In the final section of the chapter I summarise these themes, which are examined in greater details in the following chapters.

3.0 DEVELOPMENT OF MENTAL HEALTH SERVICES

3.1 England

In medieval and early modern England, those who were permanently insane did not pose a unique problem but were part of the larger class of the senile, incurably old, blind, crippled, intellectually disabled and ‘morally disreputable’ vagabonds who were either at large in the community, were dealt with under provisions of the Poor Laws, or unless they were of the propertied class, were isolated from the rest of society by being lodged in private mad houses run by medical men (the so-called ‘trade in lunacy’) or incarcerated in custom built asylums subsidised by the State such as London’s notorious Bethlem (Bedlam) Hospital.4 The motives of late eighteenth and early nineteenth century reformers of mental health services were, ‘in important measure’, therapeutic and humanitarian rather than custodial. As Andrew Scull has said, one of the distinguishing features of the lunacy reform movement at this time was its conviction about the redemptive power of the medical institution.5

3.1.1 Moral therapy In the eighteenth century the first major challenge to the existing situation was posed by reformers such as Samuel Tuke, who established the York Retreat, a small asylum

4 See R. Porter. English Society in the Eighteenth Century, London, Penguin, 1982, and A. Scull, The Most Solitary of Afflictions; Madness and Society in Britain, 1700-1900, New Haven, Yale University Press, 1993. 5 Scull, Museums of Madness. 81

on the outskirts of York, to hold from 100 to 120 ‘insane persons’. Tuke introduced the principle that moral treatment or management based on the doctor’s involvement with the patient’s “moral capacities” could help patients emerge from their madness, as self-reliant, responsible and sane beings and lead to recovery.6 John Locke’s writing on madness also helped establish the belief that “defective” human beings, at least those who were insane, could be repaired.7 Humanitarianism could then be introduced into medical treatment, and “moral therapy” could be combined with accurate classification of the disease and with competent and sympathetic medical care.

As the nineteenth century wore on and as the new methods of treatment were popularised, the number and size of asylums increased almost exponentially. By the 1840s, the average size of asylums in England was around 300 inmates. By 1870 it had gone up to 542, and by 1900 to 961, with the most significant increases being from the pauper population.8 Initially inspired by the ideas of moral treatment, they became closed institutions, more like warehouses for the chronically mad than asylums.9

3.1.2 Idiocy and Imbecility

Running somewhat parallel to the expansion of the asylum population was the growth in small schools for so-called ‘idiots’, inspired by the work of the French educators Seguin and Itard. Previously people with intellectual disabilities had been either provided for in families and communities, the Poor Law system or combined with the mad under lunacy acts, which, although recognising the difference between the two conditions, simply combined mental illness and intellectual disability and incarcerated such people together in asylums or later hospitals for the insane. It was not until 1886 that the British government passed its Idiocy Act which finally separated ‘idiots’ from

6 S. Tuke, Description of the Retreat: An Institution near York for Insane Persons of the Society of Friends, containing an account of the origins and progress of treatment and a statement of cases, (microfilm), published York, England, printed for W. Alexander, 1813, and D. Hume, Theory of Knowledge, Edinburgh, Nelson, 1951. 7 J. Locke, The Educational Writings of John Locke: a critical edition with introduction and notes, London, Cambridge, University Press, 1968. 8 A. Scull, Social Disorder/Mental Disorder, London, Routledge, 1989, quoted by P. Barham, Closing the Asylum: The Mental Patient in Modern Society, London, Penguin, 1992, pp.67-68. 9 P. Barham, Closing the Asylum, pp.65-78. See also R. Porter’s ‘The patient’s view: doing medical history from below’ in Theory and Society, Vol. 14, 1985, pp.175-198. 82

lunatics and a small number of ‘idiot’ asylums grew, nevertheless most people with intellectual disability remained where they had always been.

The final separation came with the 1913 Mental Deficiency Act. In part inspired by Eugenic beliefs in the power of heredity, by anxieties over the future of the British race and by attempts to remove ‘idiots’ and ‘imbeciles’ from hospitals for the insane, the Act set up a network of ‘idiot’ colonies and other institutions which separated and segregated people with intellectual disabilities across Britain, not just from people with mental illnesses but from Britain altogether. Henceforth intellectual disability had its own history. 10

3.1.3 New treatments in the nineteenth century

Following passage of the Lunacy Act of 1845, which established rules regarding certification and treatment and which restricted certifying the insane to qualified doctors, the state became increasingly involved in institutionalisation of the insane.11 Concentrating on the process of professionalisation of psychiatric services, Freidson describes the establishment of “alienist” doctors as they struggled to achieve a unique position in treatment of the insane.12 He notes that they were disclaimed by their medical colleagues and set apart from the ranks of the more respected physicians, and so initiated a long and contentious battle to achieve professional status in their own right

During the late nineteenth century the aetiology of insanity which was associated with moral factors gave way to new emphases on the physical basis of insanity in heredity and the idea of insanity as a disease of the brain. Conceptualisations of madness changed from moral to medical aetiologies and asylums slowly became re-branded as hospitals for the insane.13 The new emphasis on physical causes of insanity supported

10 These paragraphs are taken from M. Thomson, The Problem of Mental Deficiency: Eugenics, Democracy, and Social Policy in Britain, c. 1870-1959, Clarendon Press, Oxford, 1998, and D. Wright and A. Digby (eds.), From Idiocy to Mental deficiency: historical perspectives on people with learning difficulties, London, Routledge, 1996. 11 Barham, Closing the Asylum, pp. 65-78. 12 Freidson, Professional Dominance. 13 M. Lewis, Managing Madness: Psychiatry and Psychiatry in Australia 1788-1980, Canberra, AGPS publication, 1988, p.9. 83

the alienists’ claim to predominance because only they had the training and experience to deal effectively with physical diseases.14 But Lewis notes a darker side of this process:

It is just here perhaps that psychiatry came into its most notable and outstanding contribution, in helping to complete the process of sealing and closure in which insane people were enveloped, and to establish the hegemony of the psychiatric ‘difference’. Asylums became custodial rather than curative institutions and psychiatric ideologies provided a convenient shield to distract from searching moral questions about the social fate of vulnerable groups of people.15

Taking figures provided by the Lunacy Commission and Board of Control, Scull shows how fast the asylum system expanded in the nineteenth and early twentieth century.16 He provides the total number of patients in public asylums in England and Wales from 1850-1930, and the rates per 10,000. During 1850 the figures were 7,140 (4.03 per 10,000) rising to 15,845 in 1860 (7.96), 40,088 in 1880 (15.73), 74004 in1900, (23.05), 93,648 in 1920 (24.84), and 119,659 in 1930 (30.14). However these figures are probably an underestimate of the number of institutionalised insane people as they do not include those in wards or units of general hospitals and chronically ill patients in workhouses.17

3.1.4 Changing treatments of the insane in the twentieth century.

Historians have, by and large, identified the 1960s as the decade when the treatment of insanity came under the most sustained attack but moves to provide alternatives to hospitals had begun much earlier. The opening of the Maudsley Hospital to voluntary patients in 1923, the growth of the Mental After-Care Association, (the earliest of which was founded in 1879), and the Royal Commission of 1924-1926 were among those with far reaching results. As Jones notes,

14 Lewis, Managing Madness, p.10. 15 Lewis, Managing Madness, p.75. In 1914 one authority described patients in asylums as being divided into two groups, namely, those who have a reasonable chance of recovery forming about 10%, and the remainder being hopeless and chronic cases. In Closing the Asylum on p.69 Barham notes that a slow epidemic of schizophrenia was considered to be a causal factor for the increase in asylum populations in European countries and America. 16 A. Scull, Decarceration: community treatment and the deviant, a radical view, New Jersey, Prentice Hall, 1977, p. 65. 17 Scull, Decarceration, p. 65. 84

The Royal Commission on Lunacy and Mental Disorder was established in response to public uneasiness that people were being recklessly detained as insane, that the whole system of lunacy administration was wrong, and that widespread cruelty existed in public mental hospitals.

She further observes that mental illness was now defined as ‘the inability of the patient to maintain his social equilibrium’ and that its treatment ‘should be a community service based on the treatment of people in their own homes whenever possible, with a strong preventive element.’18 The Commission also recommended the abolition of the old Poor Law and of the distinction between pauper and private patients, with the provision of public funds for this work. These recommendations were incorporated in the Mental Treatment Act of 1930 which established out-patient clinics at general hospitals.

Changes were also taking place within mental hospitals. Occupational therapy was introduced in some hospitals as part of treatment. Out-patient clinic work was increased, and in 1928, following a recommendation from the Board of Control, arrangements were made to employ almoners whose task it would be to allay the patient’s anxieties about home conditions during treatments. Recommendations were made that future mental hospitals should be constructed on a villa system rather than a system of wards, and that they not contain more than a thousand beds. Nurses should be graded according to capability with training in both general and psychiatric nursing.19

There were also changes in the treatment of mental illness which promised both a conclusive cure for insanity and a greater presence of medical psychiatry in the world of the mental hospital. Electroconvulsive therapy (ECT) and a range of other physical interventions (insulin shock, metrazol and surgery), all based on the idea that insanity had an organic, bio-chemical base, were introduced in the 1930s to treat patents. In the 1950s the invention and introduction of narcoleptic drugs (commonly referred to as anti-psychotics or tranquillisers) were introduced and shortened the time chronically ill

18 K. Jones, Mental Health and Social Policy 1845-1959, London, Routledge & Keegan Paul, 1960, pp.106-114. 19 Further details concerning this decision are discussed in the previous chapter on social work development. 85

patients spent in hospital, enabling them to be discharged from crowded mental institutions. Barham observes that changes in the 1950s and early 1960s were based on the notion that mental patients, assisted by powerful medications, could once again become diligent citizens. To remind us that much preceded the new drug, he also points out that social and industrial therapies were introduced in mental hospitals well before the adoption of major tranquillisers.20

It is clear however, that the introduction of drug treatments played a major role in initiating the long-term decline in the population of England’s hospitals for the insane. Scull describes the trend.21 In 1951 the numbers resident in mental hospitals in England and Wales were 143,200, in 1955, 146,200, in 1960, 136,200, in 1965, 126,500, and in 1970, 103,500. 22 As the number of hospitals and patients fell away, the deterioration in the already squalid condition of many mental hospitals continued and calls grew for the phasing out of this ‘irredeemably flawed’ institutional system.23

3.1.5 Community care

In 1959 a new Mental Health Act announced a shift from specialised health services to a more diversified community service embracing a range of agencies. Community care facilities were regarded as transitional stepping stones between hospital and full integration into the community, yet a new, unforeseen problem arose. Kathleen Jones is one of a number of writers commenting on the problem in Britain of accommodation for the mentally ill after leaving hospital, arguing that treatment received by acutely ill psychiatric patients, in which they were admitted to hospital for a few days to adjust to medication and then discharged, was inadequate.24 Craig and Timms commented on findings that large numbers of people with chronic mental illness and multiple hospitalisations lived in institutions for the homeless, where psychiatric care was practically non-existent.25 Consequently, because of the policy of

20 Barham, Closing the Asylum, p.3. 21 Scull, Decarceration, pp. 66-68. 22 Scull, Decarceration, p.70. 23 Scull, Decarceration, p.71. 24 K. Jones, Asylums and After, London and Atlantic Highlands, New Jersey, Althone Press, 1993, pp.250-251. 25 T. Craig & P. Timms ‘Out of the woods and onto the streets? De-institutionalisation and homelessness in Britain’ in Journal of Mental Health, Vol. 1, 1992, pp. 265-275. Quoted in J. Hicks and 86

providing intensive but brief treatment for acute psychosis, very high occupancy rates occurred and patients frequently had to be discharged prematurely in order to admit others whose problems were more pressing or dangerous.26 By 1961, the new drugs, together with policies which did not divert money saved by closing mental hospitals to new community treatments, resulted in the running-down of hospitals without the provision of adequate community facilities.

3.1.6 Changes in the ideology of mental illness

New drugs were not the only cause of the decline in the number of mental hospitals in England. In the 1960s and 1970s, the publication of a range of books collected under the general rubric of ‘anti-psychiatry’ and including Asylums by Goffman, Folie et Deraison by Foucault, The Myth of Mental Illness by Szasz and The Divided Self by Laing represented a full-frontal intellectual attack on the institutions, treatments and understandings of mental illness. The publication of Maxwell Jones’s Social Psychiatry in Practice: the idea of the therapeutic community in 1968, which involved patients, families, significant other persons and professionally trained personnel in active roles, reinforced both the critiques of psychiatry and alternative treatments.27

The period from the 1960s also brought with it a variation in the occupations of mental health practitioners as the medically based ideology of mental illness was modified to include psychological, then social and cultural issues, thus opening up the treatment of mental illness to professions like psychology, occupational and physio-therapy and psychiatric social work.28 As these were female-dominated ‘caring professions’, they changed the gender characteristics of employees in psychiatric institutions.29

The issue of gender in mental illness was addressed by a number of second-wave feminist writers in the 1970s and after. Some were concerned with the over-

E. Hill, ‘WA Health Care in the New Millenium: Are We Going Forward, Backward or Round in Circles?’ Occasional paper, 1999, p.8. 26 Hicks & Hill, WA Health Care in the New Millenium, p.8. 27 M. Jones, Social Psychiatry in Practice: The Idea of the Therapeutic Community, Harmondsworth, Penguin, 1968. 28 E. Bates & P.Wilson, Mental Disorder or Madness, St.Lucia, Queensland University Press, 1979, pp.20-32. 29 These professional groups are discussed more fully later in this chapter. 87

representation of women as psychiatric patients and the ways in which women’s position in society might have been particularly conducive to madness and mental illness.30 Others addressed the relationship between constructions of mental illness, the economic situations that reinforced the caring roles taken by women and the rhetoric of motherhood.31 Still others argued, in accordance with the emerging ideas from anti-psychiatry, that psychiatry and its institutions oppressed women by punishing departures from orthodox motherhood and femininity.32

3.1.7 To the present

The Mental Health Act (MHA) of 1983 further emphasised the desirability of community over hospital-based services but insisted that deinstitutionalisation was not to be used to get people out of hospital and close down facilities, before another set of facilities had been established. Attention was drawn to experiences in the USA and Italy where thousands of mentally ill people lived on the streets and in emergency shelters. In a recognition of the wider fields involved in treatment, the Act redefined treatment to include nursing, care and rehabilitation, not confining it solely to medication.33 By 1998, and with many years of experience of deinstitutionalisation, the British Department of Health began to address the fundamental failure of the mental health system to provide effective services for people with long term mental illness, specifically targeting the provision of ‘better and faster treatment with more and better trained staff’.34 It seemed clear that the wholesale changes to the mental health system over the previous 40 years had delivered markedly mixed results. On the one hand, the big institutions with their legacy of cruelty and neglect had gone, but far too many vulnerable people had been left without adequate support.

30 See P. Chesler, Women and Madness, New York, Avon Books, 1972, and J. Busfield, Men Women and Madness: Understanding Gender and Mental Illness, London, Macmillan Press, 1996. 31 Foremost among these is C. Coleborne, ‘ “She does her hair up fantastically”: the production of femininity in patient casebooks of the lunatic asylum in 1860s Victoria’, in J. Long, J. Gothard and H. Brash (eds.), Forging Identities: bodies, gender and feminist history, Nedlands, University of Western Australia Press, 1997. 32 J. Matthews, Good and Mad Women: The Historical Construction of Femininity, Sydney, George Allen and Unwin, 1984. 33 C. Pritchard, Mental Health Social Work: Evidence-based Practice, London and New York, Routledge, 2006, p.201. 34 UK Department of Health, Modernising Mental Health Services, London, National Health Service Executive, 1998. 88

3.2 United States of America

In the USA the federal system shaped the development of mental health services in ways which were quite different to England. Two common themes are the roles played by state rather than federal governments until, in the 1960s, the federal government began to take a much greater interest in the matter, and the powerful role of private providers. In 1854 President Franklin Pierce, fearing that “the whole field of public beneficence” would fall under the influence of the Federal government, vetoed legislation that would have allowed the use of federal money to build asylums, thereby determining this to be a State responsibility.35 According to David Rothman, the leading historian of mental illness in America, these words encapsulate the prevailing religious teachings and secular definitions relating to the proper functioning of the social order at that time.36 Compared to the English equivalent, government investment in public workhouses and almshouses was extremely limited and the majority of the poor and disabled were given relief within the community, in private institutions, or were expected to make their own way.

3.2.1 Establishment of asylums for the insane

The origins of American hospitals for the insane lie at the beginning of the eighteenth century when many states introduced Settlement Laws to prevent strangers from endangering the town’s peace and security, and the local alms house was seen as a place of last resort for their apprehension.37 The alms house was also a place where the chronically sick gradually accumulated. Untrained physicians became regular salaried attendants and by the end of the colonial period the almshouse had become, in effect, a hospital for the poor.

Enlightenment ideas encouraged a belief that such ailments as insanity were essentially and broadly environmental and consequently were curable. Having located

35 K. J. Bentley & M. F. Taylor, ‘A context and vision for excellence in social work practice in contemporary mental health settings’ in Bentley, K .J. (ed.), Social Work Practice in Mental Health: Contemporary Roles, Tasks and Techniques, Pacific Grove, CA., Thomson Academic Resource Center, 2002, p.7. 36 D. J. Rothman, The Discovery of the Asylum: Social Order and Disorder in the New Republic, Boston, Toronto, Little, Brown and Company, 1971, and Rothman, Conscience and Convenience. 37 Rothman, The Discovery of the Asylum, pp.45-47 89

the aetiology of the disease, early proponents of asylums believed that ‘a setting that eliminated the irritants could restore the insane to health’.38 They would try and create a model society of their own that isolated the insane from the dangers in the community and alleviate their distress by a reform programme that would also educate the public.

The upshot of these ideas was that post Civil War reformers initiated the transfer of mentally ill persons from county almshouses to state facilitated insane asylums and the asylum system began to expand in much the same way as did its equivalent in England.39 By the 1870s, however, the same problems arose. Asylums became grossly overcrowded with a general breakdown in the capacity for treatment, all of which assisted in turning a system which began with profound optimism that insanity was curable in properly run asylums into a system where patients in effect became inmates and custody became the dominant rationale. The optimism which inspired the work of the early reformers, which was itself inspired by the well-known work of reformers like Tuke in England, proved to be short lived.

3.2.2 Intellectual disability

The situation for ‘idiots’ and ‘imbeciles’ in eighteenth and early nineteenth century USA matched Britain; they remained either in their families and communities, almshouses, jails and lunatic asylums, until the arrival of the educative ideas of Eduard Seguin in the 1840s and 1850s and the implementation of segregated ‘idiot’ schools where children would be educated and perhaps returned to their communities. Unlike Britain, however, the longer term fate of these schools was to become large custodial institutions which matched and ran parallel to the system of hospitals for the insane and which took inmates from them (the movement for specialist institutions ran parallel to the movement in Britain). When Eugenics arrived in the US in the early twentieth century and classified intellectual disability as a menace from which the whole population needed to be protected, segregation was already the dominant form of treatment; the US did not need specific legislation to set up a new infrastructure for secluding its disabled population. The numbers of asylums and the

38 Rothman, The Discovery of the Asylum, p.129. 39 Rothman, The Discovery of the Asylum, pp.265-295 90

number of inmates was growing. What was different though, was that whereas Britain had never adopted sterilisation as a solution to the host of imagined Eugenic problems, several US states did and thousands of people with intellectual disabilities were sterilised. But this is part of another story.40

3.2.3 Changes in the twentieth century

While much of the early twentieth century history of the US system matches the English (the medicalisation of madness, the changing nomenclature from asylums to hospitals for the insane, the introduction of physical treatments and so on) there were peculiarly American initiatives that should have revolutionised the kind and quality of care available to mentally ill patients.41 The mental hygiene movement, initiated by Adolf Meyer in the early twentieth century, his focus on individualised study and treatment, the collection of factual information and the delivery of after-care services, was one such initiative.42 Rothman identifies tensions that were associated with these reform programmes in America in the twentieth century.43 He describes what he calls the Progressivist conscience originating in the Jacksonian era, ‘the ideological formulations’ of humanitarian and philanthropically minded people to cure insanity and crime, with the intention of reversing intolerable conditions.44

Rothman argues that during the 1920s and 1930s the Progressives intended to introduce a case-by-case system of caring for the mentally ill and to concentrate on better programmes and training, but they never considered the underlying causes of insanity.45 The Progressives were not so much concerned with the institutions of insanity but tried to understand the life history of each patient and then devise a remedy specific to the individual during, and following, hospital treatment. Based on the case by case approach introduced by Mary Richmond, progressives were not so much struggling to return patients to the community, as attempting to individualise

40 J. W. Trent, Inventing the Feeble Mind: A history of mental retardation in the United States, University of California Press, Berkely, 1994. 41 A.E. Fink, J.H. Pfouts & A.W. Dobelstein, The Field of Social Work, 8th edition, New Delhi, Sage, 1985, pp. 84-89. 42 Rothman, Conscience and Convenience, p. 309. 43 Rothman, Conscience and Convenience, p.5. 44 Rothman , Conscience and Convenience, p.327. 45 Rothman, Conscience and Convenience, pp.44-78. 91

treatment.46 According to Rothman however, institutions dominated the system to such an extent that other options became almost impossible to implement; in essence the reformers never perceived a conflict of interest between the keeper and the kept.

3.2.4 Deinstitutionalisation

Figures of residents in mental hospitals in the USA from 1950-1974 show a staggering decline in numbers as American governments adopted the process of deinstitutionalisation with alacrity. In 1950 there were 512,500 residents, in 1955, 588,900, in 1960, 535,500, in 1965, 504, 000, in 1970, 339,000, and in 1974 there were just 215,000 residents.47

As was the case in England, one impetus for deinstitutionalisation was associated in the 1960s and 1970s with the writings of Goffman, Foucault, Szasz and Laing but had built on earlier writers and, of course, the introduction of drug treatments.48 In terms of community care, far-reaching effects on the design and establishment of community services were initiated by Gerald Caplan’s 1960s work in the field of community psychiatry. Caplan saw his task as investigating harmful factors affecting the mental health of the community and he planned community-based federal preventative and treatment programmes.49 Facilities established following the Community Mental Health Centers Construction Act of 1963 were intended to achieve these aims. However, although the number of centres increased, they did not replace traditional hospitals; most of these resources went to people experiencing less serious psychological disturbances or simply having problems in living.50 A new emphasis was placed on psycho/social interventions as a primary goal for treatment of the long-term mentally ill, but the training of medical and psychiatric staff did not

46 This is described more fully in the previous chapter on social work. 47 ‘N.I.M.H, ‘Trends; resident patients: State and country mental patients, 1950-1968’, quoted in Scull, Decarceration, p.68. 48 W. R. Breakey, ‘The Rise and Fall of the State Hospital’ and ‘Developmental Milestones in Community Psychiatry’, in W. R. Breakey (ed.), Integrated Mental Health Services: Modern Community Psychiatry, New York, Oxford University Press, 1996, pp.22-25. 49 G. Caplan, An Approach to Community Mental Health, London, Tavistock, 1961. See also R. B. Caplan, in collaboration with Gerald Caplan, Psychiatry and the Community in Nineteenth Century America; The recurring concern with the environment in the prevention and treatment of mental illness, New York, Basic Books, 1969. 50 G. N. Grobb, From Asylum to Community: Mental Health Policy in Modern America, Princeton, Princeton University Press, 1991, pp.245-255. 92

prepare them for providing community based services. Professionals from other services associated with medicine, psychologists, social workers and occupational therapists, then became involved.51

The subsequent evolution of the centres during and after the 1970s fulfilled few of the expectations of their founders. Although community care was the ideal it did not generally provide an alternative to mental hospital care. At best, available data suggests that centres which coordinated their activities with state hospitals played a role in reducing admissions to hospitals.52 Breakey notes that despite the benefits that accrued to many patients, a return to the community meant for many more ‘a return to jails and homeless shelters, institutions intended not for the care of the ill, but for the custody of criminals and support of the poor’.53 For many in other countries, the US became an example not to follow.

3.3 Australia

The development of mental health services in Australia emerged from the convict settlement when the mentally ill were incarcerated in large purpose-built asylums situated in quiet areas away from centres of population. This system was to change after the 1940s when new attitudes and treatments enabled patients to attend out patient facilities and clinics in general hospitals, and then changed dramatically after the 1960s and 1970s, when deinstitutionalisation was introduced to reorganize mental health services away from the institutions and into the community.54 Associated with deinstitutionalisation were two related policies, those of community care, which centered on ongoing funding being made available to support people with mental illnesses in the community, and mainstreaming, which aimed to provide services in general hospitals for mentally ill patients, so ending the isolation of existing psychiatric services.55

51 Grobb, From Asylum to Community, p.15. 52 Grobb, From Asylum to Community, p.261. 53 Breakey, The Rise and Fall of the State Hospital, pp.22-25. 54 D. McKinnon & C. Coleborne, ‘Introduction: Deinstitutionalisation in Australia and New Zealand’ in Health and History, Vol. 5, No. 2, 2003, pp. 1-16. 55 McKinnon & Coleborne, Introduction. 93

3.3.1 Colonial origins

Pargiter considers the development of mental health services in Australia to be unique, as ‘no other modern nation had its origins as a penal colony in a land which had for many thousands of years been occupied by people with a culture many thousands of years old’. Indeed he continues, the European colonists failed to appreciate that the Aboriginals’ mental and physical health depended on their relationship with their environment and was governed by their sophisticated and complex systems of beliefs.56 Lewis writes that when New South Wales was established in 1788 as a penal settlement, lunacy law and systems of care were originally imported from England.57 Together with practices characteristic of Eighteenth Century medicine (bleeding, emesis and blistering) new ways of dealing with the insane, such as moral management were introduced by philanthropically minded persons who envisaged a retreat or asylum where the insane could be treated with dignity.58 Thus the establishment of Australian colonies in the late eighteenth and early nineteenth centuries was contemporaneous with this major shift in thinking about madness in England, and this was therefore the prime influence on mental health services in nineteenth century Australia. 59

3.3.2 Establishment of asylums

The authority of the Governor was absolute in the new colony of New South Wales, and was the legal foundation on which lunacy administration rested.60 Although humanitarian concerns were incorporated into the administration of lunacy when Governor Philip took charge of the colony’s “idiots and lunaticks”, it was Governor

56 R. Pargiter, ‘A Brief History of Mental Health Services in Australia and New Zealand,’ in R. Kosky, H. Eshkevari, & V. Carr (eds.), Mental Health and Mental Illness: A Textbook for Students of Health Sciences, Sydney, Butterworth-Heinemann, 1991, p.3. See also J. Cawte Medicine is the Law, Adelaide, Rigby, 1974, for further discussion of this topic. 57 M. Lewis, Managing Madness p.1. 58 Pargiter, A Brief History of Mental Health Services , p.4 59 S. Garton, ‘Asylum histories’, in C. Coleborne & D. MacKinnon (eds.), ‘Madness’ in Australia: histories, heritage and the asylum, St Lucia, Queensland, University of Queensland Press in association with the API Network and Curtin University of Technology, 2003, pp.12-21. See also R. Porter’s Mind Forged Manacles, London, the Althone Press, 1987. For an account of moral therapy see Tuke’s York Retreat, pp.222-234. 60 C. J. Cummins, A history of Medical Administration in New South Wales 1788-1973, Sydney, Health Commission of NSW, 1979. 94

Macquarie who took the major interest in them and opened the first asylum in 1811.61 The keepers, who were mostly convicts, were given instructions by Macquarie ‘not to exercise unnecessary severity to the mentally deranged’ and to ‘treat them with kindness and humanity at all times’.62 When in 1838 the new Tarban Creek Asylum was opened in NSW housing both bond and free patients, the first Superintendent, who was a lay person assisted by his wife, attempted to establish the asylum along the lines of the York Retreat in England.63 However by 1848 a series of complaints about conditions at the asylum questioned his lack of qualifications and training, the upshot of which was his replacement by a doctor, Francis Campbell, a medical graduate from Edinburgh. Campbell established a system of meticulous clinical notes and medical and nursing systems, and his approach to asylum management became standard practice as other colonies built their own asylums.

Growth of asylums

In Tasmania, the second colony to be founded, asylums developed along similar lines to NSW with the same problems, lack of funds, the absence of segregation of criminals from the insane and the long legacy of convict transportation. In Tasmania, convict lunatics were first sent to Sydney then to the Hobart Hospital until, in 1832, Governor Arthur opened the existing New Norfolk Hospital to ‘lunatics’. From then, female ‘lunatics’ remained at New Norfolk with free men while male convict ‘lunatics’ journeyed through the several institutions of the convict system. In Victoria, Yarra Bend Lunatic Asylum took patients from 1848 but the rapid increase of population in the 1850s gold rush brought greater overcrowding and poorer conditions. The establishment of asylums at Ararat, Beechworth and Kew in Melbourne followed.64 More asylums were built in the other colonies from 1860 to 1890: Woogaroo (renamed Goodna) and others at Queensland, Fremantle Asylum in Western Australia, Parkside in South Australia, and Callan Park in Sydney. About the

61 E. C. Dax, ‘The first 200 years of Australian Psychiatry’, ANZJP, Vol. 23, No.1, March, 1989, pp.103-110, E. C. Dax, Asylum to Community: the development of the mental hygiene service in Victoria , Melbourne, Cheshire, 1961, and ‘The evolution of community psychiatry’, Australian Journal of Psychiatry, Vol. xxvi 1992, pp.295-301. See also the account of the work of Dax by B. Robson, ‘He Made Us Feel Special’, in Australian Historical Studies, Vol. 122, pp.271-289. 62 C. J. Cummins, A History of Medical Administration in New South Wales 1788-1973, Sydney, Health Commission of NSW, 1979. 63 Pargiter, A Brief History of Mental Health Services, pp.3- 5. 64 Dax, The first 200 years of Australian psychiatry, p.104. 95

same time receiving homes or early treatment centres were opened, out-patient clinics were begun, and some general hospitals began to take psychiatric patients.65

In NSW, Frederick Norton Manning, who succeeded Campbell as Superintendent of Tarban Creek Asylum (later renamed Gladesville Hospital for the Insane) was appointed as Inspector General of Lunacy in 1887 and seems to have become the major figure in Australian lunacy reform, developing an extensive system of asylum care and administration.66 Committed in the main to a medical model of insanity, Manning described the term ‘insanity’ as referring to ‘a disease of the brain’ and not ‘a disorder of the intellect’. 67 In addition to physical and medical factors, however, he did consider other influences peculiar to the Australian physical and social environment to be part of the aetiology of mental illness. These included the isolation and harshness of the environment, the impact of sunstroke on those of ‘nervous debility’ and the ‘possessed and excited state of the gold miner’ in individuals with a ‘pre-determined moral weakness’ 68

From the 1880s the history of mental health services matched that in England and, in part, the USA. Institutions expanded in size as asylums became hospitals; patients becoming inmates in increasingly custodial settings as moral management was replaced by medical models of insanity which divided patients into curable and incurable. While new surgical and other procedures were applied to the former, the latter were left largely, to rot. As Stephen Garton observed, new frames of reference had appeared: a language of hospital, patient and illness that specified a medical discourse producing new figures - the incurable, the curable, the neurotic and the mental defective, who in turn reshaped medical practices and opened new avenues for treatment.69

65 J. W. Springthorpe, ‘The treatment of early mental cased in a general hospital’, Intercolonial Medical Journal of Australasia, Vol. 7, 1902, pp. 187-202, and D. McDonald, ‘A village full of occupants. The Kenmore Hospital for the Insane 1895-1900.’Canberra Historical Journal, September1973, pp. 10-24, quoted in E.C. Dax, ‘The first 200 years of psychiatry’, p.104. 66 Dax, Asylum to Community, p.104. 67 G. Edwards, ‘Causation of insanity in the nineteenth century’ ANZ Journal. Psychiatry. Vol. 16, 1982, pp. 53-62. These views were articulated in the provisions of the Lunacy Act of 1818. 68 D. Goodman, Gold Seeking: Victoria and California in the 1850’s, Sydney, Allen and Unwin, 1994, pp.197-212. Here he uses lunacy as a lens for exploring deeper cultural anxieties. 69 S. Garton, ‘Asylum Histories’, in Coleborne, & MacKinnon (eds.), Madness in Australia, pp.20-21. 96

3.3.3 Intellectual disability

Historically in Australia, intellectual disability and mental illness were part of the same system of committal and treatment with both conditions incorporated in lunacy legislation.70 However colonies took their own journeys with regard to treatment. NSW set up special institutions for its intellectually disabled population early on, as did Victoria late in the nineteenth century. Western Australia and Tasmania did not until the late twentieth century, when they established specific separate administrative arrangements as part of the process of deinstitutionalisation and normalisation. Until then people with intellectual disabilities were mixed in with the ordinary asylum / hospital for the insane populations, universally classified as incurable and condemned to a life of custody.

By the late nineteenth and early twentieth centuries, as the winds of Eugenics began to blow across Australia, doctors began to construct these populations in different ways, matching the re-conceptualisations apparent in Britain and the USA. The Eugenic belief that hereditary weakness was at the basis of many instances of insanity and idiocy, which often became worse with each succeeding generation, meant that idiocy and imbecility were the last link in the chain of heredity transmission.71 Consequently, as the intellectually disabled came to be regarded as examples of racial degeneration, the idea of physical degeneracy easily merged with wider ideas of social degeneracy and moral decline.72 Yet, the life of those who Eugenics had re-classified as a ‘menace’ did not materially change. Whether in institutions for the insane or in those for the intellectually disabled, they were still segregated from the rest of society. Attempts to provide separate institutions in Queensland and Tasmania failed and in

70 Garton, Asylum Histories. 71 Edwards, Causation of insanity in nineteenth century Australia, p.57. 72 See A. Williams’ study of the Newcastle Asylum for a detailed account of conditions within the asylum - overcrowding, poor conditions, declining rates of recovery- undercutting much of the psychiatric rhetoric about the ‘advances’ of eugenic policies, in Managing the Feebleminded: Eugenics and the Institutionalisation of People with Intellectual Disabilities in New South Wales 1900-1930, PhD Thesis, University of Newcastle, 1999, and the work of L. Monk, Attending Madness: At Work in the Australian Colonial Asylum, Amsterdam and New York, Rodopi, The Wellcome Series in the History of Medicine, 2008, for a study of the attendants who mediated the struggles between different groups over government of the asylum. 97

these states, therefore, they remained part of the history of mental health services.73 Except in the cases taken up by the parent’s movement of the 1950s.

From the 1950s a movement among parents and certain experts began to provide facilities in the community for intellectually disabled children and then to demand that governments do it.74 Driven partly by a wholesale hostility to the institutionalisation of their children, voluntary bodies like the Aid Retarded Persons, NSW, provided schools, training occupations and eventually accommodation for intellectually disabled people.75 And, like the Queensland Sub-normal Children’s Welfare Association, they tried to change attitudes. Parents formed State Councils for the Mentally Retarded, and subsequently a national body of this organisation was established.76

Voluntary associations at both State and Federal levels pressed governments to provide and improve facilities and where they would not, they provided them themselves. In NSW, under the influence of community psychiatry the role of the state services in relation to the intellectually disabled began to change. In 1962 the Health Advisory Council, created by the Labor Government, established guidelines for a range of services for the intellectually disabled including prevention, diagnosis, education, training and various types of residential facilities. By the mid 1960s a new approach to the treatment of the intellectually disabled in mental hospitals was beginning. However in some states, people with intellectual disabilities remained in the hospitals for the insane until the advent of the normalisation and deinstitutionalisation movements of the 1960s and 1970s. 77

3.3.4 Psychiatric treatments

In the first years of the twentieth century, Australian psychiatric practice was assisted by the influx of overseas trained doctors and medical practitioners who retained

73 Lewis, Managing Madness, pp. 151-170. 74 Lewis, Managing Madness, pp.151-170. 75 T. R. Bryceson, Aid Retarded Persons NSW Branch: A short history 1959-1966, Newcastle, NSW, Aid Retarded Persons, NSW Branch, 1967. 76 C. Fox, ‘Parent’s Groups and the history of intellectual disability. Australia in the 1950s’, unpublished paper, 2009. 77 C. Fox, ‘Debating Deinstitutionalisation: The fire in Kew Cottages in 1996 and the idea of community’, Health and History, Vol. 5, No. 2, 2003. 98

contacts with England and the British Commonwealth and whose professional associations were branches of British parent bodies. Psychiatrists’ methods of treatment were shaped by the shift from a belief that moral failure caused insanity to a conviction that it was determined by physical causes.78 While the works of Jung and Freud were discussed in Australia in the 1910s, and despite the effectiveness of psychoanalysis in treating diseases like shell shock in the First World War, psychoanalysis was received with general scepticism by most Australian psychiatrists. In any case the majority of Australian mental hospitals were overcrowded and little ‘treatment’, let alone the individual conversations of psychoanalysis, was available or possible.

In the late 1920s it was generally believed that mental illness was the result of a physical injury, disease or malformation.79 Therefore it was reasonable to expect that it could be cured by physical treatments, the same treatments that were being used in England and the USA: malarial therapy for illnesses related to syphilis; insulin and cardiazol to treat schizophrenia and depressive psychosis; electro-convulsive therapy and psychosurgery in the 1940s; Cade’s lithium treatment for manic depressive illness in 1949; and in 1952 the introduction of chlorpromazine the first antipsychotic drug.80 Pargiter suggests that these treatments fitted well with the medical model of mental illness dominant at the time and those psychiatrists, who regarded themselves as part of scientific medicine, believed that the cause of mental illness was organic, not psychogenic.81 Moreover he believes that the introduction of these rationally based treatments raised the morale of doctors and nurses treating the mentally ill.82

When it was formed in 1901 the Commonwealth Government had no direct responsibility for health matters other than quarantine, so funding for mental health services remained a state matter. A national health service was established by the Menzies’ Liberal-Country Party Government in the 1950s, involving voluntary insurance and non-contributory benefits; payment of medical benefits was dependent

78 C. Smark & H. Deo, ‘ Social and Historical Power Plays: A Foucauldian Gaze on Mental Institutions’, in Faculty of Commerce Papers, College of Business Symposium, University of Wollongong, 7-8th November 2006, pp.2-3. 79 Smark & Deo, Social and Historical Power Plays, pp.2-3. 80 Lewis, Managing Madness, pp.43-44. 81 Pargiter, A brief history of mental health services, p.7 82 Pargiter, A brief history of mental health services, p.7 99

on membership of a registered voluntary society, but psychiatric disorders were not included as they were not rated as part of general medical conditions.83 In the decade following World War II new concepts concerning the organisation of psychiatric care both in hospital and in the community initiated changes in established patterns of mental health care and organisation. However drugs alone did not produce large movements of patients out of hospitals. The impetus which operationalised the philosophical movement that became deinstitutionalisation, was neither wholly altruistic nor pharmaceutical, it was partly fiscal, as state governments saw that there were savings to be made in health budgets by running down old hospitals and transferring patients to cheaper community options.84

By the 1950s overcrowding and poor conditions in State mental hospitals were well known. They were reported on by the Australian Association of Psychiatrists85 and following the well-known report by Stoller and Prescott, the States Grants (Mental Institutions) Act of 1955 was introduced to provide Commonwealth grants to the States to improve the worst of them; unfortunately the Act removed payments for ongoing maintenance costs.86 Funding was greatly expanded when the Federal Labor government was elected in 1972 with a policy of withdrawing funding for capital works for hospitals, to be replaced by increased funding for community services. The rate of development of community services then increased dramatically. In 1974/75 this involved 90% of operating costs for funding. However the figure was cut back by the Liberal Country Party government to only 50% by 1978/79. 87 It was clearly in the interests of the State governments to move patients out of State-funded mental hospitals and onto other benefit schemes funded by the federal government, such as disability pensions or unemployment benefits. 88

83 M. Harries & G. Smith, ‘Trends in Mental Health Policy Development and Implementation in Australia’, in Community Care- New Partnerships and Perspectives, ACOSS Conference Paper, 27 October, 1994. See also the report Not for Service: Experiences of injustices and despair in mental health care in Australia, Mental Health Council of Australia, 2005. 84 Harries & Smith, ‘Trends in Mental Health Policy Development and Implementation’. 85 Pargiter, A Brief History of Mental Health, pp.4-5. 86 Lewis, Managing Madness, p.78. This required the states to spend money on capital works in mental hospitals in order to receive the grant money, some of which was still unspent in 1964. By then the full costs of maintaining patients were being borne by the states. 87 Lewis, Managing Madness p.78. 88 Lewis, Managing Madness p.33. 100

3.3.5 Deinstitutionalisation

The radical changes in mental health services which began in the 1960s can best be described under the rubric of community care and deinstitutionalisation.89 However, as Dolly MacKinnon and Catherine Coleborne argue, “deinstitutionalisation” is a highly contested label; it can also involve re-instutionalisation as some people with physical and mental disabilities who have been removed from one kind of incarceration tend to end up in another; sufferers of mental illness and intellectual disability commit crimes and find themselves in the prison system, which does not have the institutional mental health facilities to deal with their needs. 90

The changes associated with deinstitutionalisation occurred during the second half of the twentieth century when the number of patients discharged annually from receiving homes and mental hospitals in Victoria, for example, rose from 1,531 to 6,646.91 WA showed a similar pattern. There were 1350 patients receiving in-patient treatment in Claremont Hospital in 1964, with the number of patients discharged to the community reducing the total to 1000 in 1967, and to 900 by 1970.92

An important part of the process of deinstitutionalisation was the relationship which developed between mental hospitals and voluntary community groups, as institutional services were replaced by those in community settings. To take Victoria as an example, two individuals prominent in the introduction of community services in the area of mental health were Eric Cunningham Dax, Chairman of the Mental Hygiene Authority (MHA) from 1952 to 1969 and Edith Pardy, President of the Victorian Mental Hospitals Auxillary from 1933 to 1983.93 Dax’s work both in England and Victoria involved re-organising hospitals, developing a network of community services and supporting greater levels of community education about mental health. When he arrived from England to take up his position with the MHA he was struck by

89 A.Stone, ‘Psychiatric abuse and legal reform: Two ways to make a situation worse’, International Journal of Law and Psychiatry, Volume 5 1982, quoted by M. Harries, Honours Dissertation, ‘Deinstitutionalisation of the Chronically Mentally Ill’, Flinders University, 1983, pp.33-34.. 90Coleborne & MacKinnon, Deinstitutionalisation in Australia and New Zealand, pp. 1-16. 91 Dax, Asylum to Community, pp.222-223. 92 Ellis, Eloquent Testimony, pp.98-99. 93 B. Robson, ‘He made us feel special: Eric Cunningham Dax, Edith Pardy and the reform of the Mental Health Services in Victoria, 1950s and 1960s’, Australian Historical Studies, Vol.34, No.2, 1992, pp.278-289. 101

the filth and brutality at Kew Hospital and Kew Cottages, the home for intellectually disabled people in the grounds of the Kew Hospital, and began a campaign to draw attention of Members of Parliament and the public to the problem. Dax also advocated a rebuilding programme, or what he referred to as ‘slum clearance’ in order to create centres where patients could receive rehabilitation and, hopefully, return to the community. His concept of community care, articulated in the 1950s and 1960s, was informed by the earlier work of voluntary groups whose aim was to increase community understanding and tolerance of mental illness.94

Voluntary organisations aimed at increasing understanding of mental illness and removing injustices of asylum-based care, had begun in Victoria in 1933, when Edith Pardy mobilised a number of women to join a ‘lay’ auxilary of visitors and helpers to patients at mental hospitals. She set up the Mental Health Auxilary in Melbourne with branches being formed throughout suburban Melbourne as well as in country regions, together with specific branches established to run hostels for patients after leaving hospital. The voluntary groups, dominated by women, and influenced by new philosophies of care for the mentally ill and by newspaper reports of neglect and cruelty, saw institutions as symbols of an out-moded era of psychiatry.95

By the time Dax arrived, the Association of Relatives and Friends of the Mentally Ill (ARAFMI) had joined the significant group of volunteers who were intent on reforming the mental health services. Pardy became a member of the advisory committee to the MHA on its inception in 1952. She made direct appeals to the social conscience of women to become volunteers within the parameters of localised community groups attached to mental hospitals like Larundel and Mont Park in Melbourne, and forged a collective identity critical to the work of the voluntary organisations.96 Plans for regionalisation of services were developed and psychiatric units began to be developed at various places. Victoria was the first state to come to grips with the legacy of neglect.

94 Robson, He made us feel special, pp. 278-289. 95 Robson, He made us feel special, p.280. 96 Robson, He made us feel special, p.283. 102

The approaches of both Pardy and Dax typify the early models of medico-social care in which prevention, rehabilitation and treatment occur at psychiatric units in general hospitals and in conjunction with social services in the community. As such they represent an early departure from the medical model of mental illness, which places psychiatry and psychiatric hospitals as the principal centers for treatment.97

3.3.6 Changing faces of mental health delivery

The 1983 NSW Richmond Report into Health Services for the Psychiatrically Ill and Developmentally Disabled put more nails in the coffin of institutionalisation. Although deinstitutionalisation had been under way in NSW since the 1960s the Richmond Report consolidated and advanced it by recommending the continuing diminution of reliance on mental hospitals and advocated that money from the sale of hospitals be put towards more community based treatment facilities for people with mental illness.98 Then in 1984 proposals were made to the Commonwealth Labor Government to develop a national mental health policy.99 The National Mental Health Policy of 1992 advanced the view that the mental health services should be part of the mainstream health system and promoted the provision of acute inpatient care within the general hospital setting.100 This was followed by a five year Mental Health Plan to which all States and Territories became signatories.101 The Commonwealth agreed to additional funding for mental health and an annual reporting system about outcomes and activities across Australia.102 Implementation of the Policy and Plan included:103

 Development of a set of policy indicators.  Development of a data base set of services.  Identification of consumer outcome goals.  Identification of national goals and targets.

97 MacKinnon & Coleborne, Deinstutionalisation in Australia and New Zealand, p.3. 98 Smark & Deo, Social and Historical Power Plays, p.4 99 Included were proposals made by The Australian National Association for Mental Health (ANAMH) and the Royal Australian and New Zealand College of Psychiatrists (RANZCP). 100 National Mental Health Policy, 1993. 101 Harries & Smith, Trends in mental health policy development, p.5. 102 K. Richmond & R. Savy, ‘In sight in mind: mental health policy in the area of deinstutionalisation’, Health Sociology Review, Vol. 1, 2005. 103 H. Whiteford, ‘The Australian Health Ministers’ Advisory Council (AHMAC) and the National Mental Health Reforms’, Australasian Psychiatry, Vol. 2, No.3, pp.101-104, quoted in Harries &. Smith, Community Care. 103

 Establishing of service standards for mental health service delivery.  Development of alternative funding models for service.  Development of guidelines for national mental health legislation.  Developing an understanding of the specific needs of Aboriginal and non English speaking people.  Workplace reform, including an analysis of services provided by non- government agencies.

Importantly, in 1994 and 1996, there were two relatively contemporaneous inquiries by the Industry Commission into charitable organisations in Australia, specifically recommending that all government community services should be subject to competitive tendering.104 Mental health services, as part of state government expenditure, were included in this decision which was anticipated to provide considerable savings. As early as 1991, Rimmer, the then Assistant Director of the Research Unit of the Industry Commission in Australia, estimated that there had been a dramatic increase in contracting by all three levels of government in Australia, and that $20 billion was being allocated in this way annually at a saving of approximately $5 billion.105

Several writers have commented on these changes. Harries argues that the substantial re-orientation of vast sums of money from government into private hands and from public ownership to shareholders, converted the role of most State governments from primary providers to direct purchasers of services.106 Smark and Deo refer to the difficulties of accurate measurement that arise when measures from accountancy are applied within health organisations.107 Julie Henderson argues that the National Mental Health /Strategy created a neo-liberal understanding of individuals and families, which viewed the family as an autonomous unit responsible for its own maintenance and allowed for the regulation of the family by professional carers in the provision of mental health services. She notes that while the early consumer movement of the 70s and early 80s sought to challenge medical power, the advent of

104 M. Harries, Privatisation of Human Services, PhD. Thesis, Murdoch University, 2004, pp.97-98. 105 Harries, Privatisation of Human Services p.98 106 Harries, Privatisation of Human Services p.98. 107 Smark & Deo, ‘ Social and Historical Power Plays’, p.7 104

neo-liberalism had subjected consumers and carers to the language of economics and the market. Thus, the State, through the National Mental Health Strategy, distanced itself from service delivery, and established mechanisms for increasing reliance on non-government and private sources of care. As a result, families of the mentally ill were being asked to take ever-more responsibility for family members.

3.3.7 Significance of gender in treatment of the mentally ill in Australia

A good deal of recent historical analysis has concentrated on the way gender relates to mental health and mental health services. As several Australian historians have noted about the nineteenth century, once admitted to an asylum patients were examined and then turned over to the gendered prescriptions for their behaviour, with separate spaces for men and women, while clothing and uniforms differentiated inmates from attendants and the outside community.108 Garton in his analysis of shifts in the asylum population of NSW from 1840-1940 demonstrates the way changes in gender ideologies affected the treatment of the mentally ill as moral therapies became a determining feature of colonial manhood.109 Matthews in her study of a South Australian mental hospital, views mental illness as a cultural struggle imbricated in networks of gender and power, where the typical female lunatic was a suicidally depressed housewife or domestic servant.110 Coleborne writes that the Victorian asylum was organised along gendered lines. For example, the laundry was characterised as a ‘female’ space where lunatics appeared calm and well behaved; doctors’ perceptions were that ‘good’ behaviour and hard work were evidence that female lunatics were either good women or were, in the context of contemporary ideas about femininity, cured.111 She relates this dichotomy of sickness and wellness to the medical discourses employed at the time. Thus ‘the madwoman was ascribed an identity that had its own set of postures and poses and these were opposite to the desired poses of the ideal woman.’112 Fox observes, though, that ‘women who were

108 C. Coleborne, ‘Space, power and gender in the asylum in Victoria 1850’s to 1870’s,’ in Coleborne and MacKinnon, eds., Madness in Australia. 109 Garton. Medicine and Madness. 110 Matthews, Good and Mad Women. 111 C. Coleborne, ‘“She does up her hair fantastically”: The production of femininity in patient case- books of the lunatic asylum in 1860s Victoria’, in Forging identities: bodies, gender and feminist history Nedlands, University of Western Australia Press, 1997, pp. 47-68. 112 Coleborne, ‘She does up her hair fantastically’, p.57. 105

classified as “idiots” or “imbeciles” in Tasmania were subject to the belief that they were incurable and incurably “different” and consequently were subject to a lifetime of incarceration.113

Gendered prescriptions also applied to those who worked in the asylums. In Victorian times, as males assumed a dominant role in the family, a family structure was imposed on the administration of asylums, a benevolent male at the head assisted by his wife as matron and together they controlled their ‘children’, both inmates and attendants, who were subject to patriarchal discipline.114 Lee-Ann Monk argues that as asylums grew in size and became more bureaucratically organised, asylum attendants constructed their sense of themselves from the outside world.115 Thus men supervised male inmates, and women supervised females, and while men did not wish to exclude women from working, they demanded a more strictly sex-segregated workplace where they were not required to work with either female patients or attendants.116 She also suggests that when nursing became a profession, the transforming of attendants into nurses reinforced the status of asylum doctors.117

In the 1960s and 1970s this gendered model of asylum administration was challenged on two fronts, from the social sciences, as new information was incorporated into the traditional medical model of illness, and from the second wave of the women’s movement. Although exact figures are not available, existing information suggests that disciplines evolving from the social sciences, and the occupations which arose from them, namely psychology, social work and occupational therapy, were comprised mainly of females. 118

It is likely that a gendered discourse also developed within the predominantly male profession of psychiatry and that the history of the profession has matched that in the

113 C. Fox, ‘Exploring “Amentia” in the Tasmanian Convict System’ in Tasmanian Historical Studies, Vol.13, 2008, p.152. 114 Garton, Medicine and Madness, p.5. 115 L. Monk, Attending Madness: At Work in the Australian Colonial Asylum, Amsterdam, New York, Clio Medica 84, The Wellcome Series in the History of Medicine, Radopi, 2008, p.13. 116 Monk, Attending Madness, p.73. 117 Monk, Attending Madness, p.220. 118 On psychologists, see for example A. Turtle, ‘The first women psychologists in Australia’, Australian Psychologist, Vol. 23, No. 3, 1990, and A. Gaynor and C. Fox, ‘The Birth and Death of the Clinic: Ethel Stoneman and the State Psychology Clinic, 1927-1930’, in Studies in Western Australian History, No. 14, 1993. 106

UK. Writing in 2005 Rosalind Ramsay argues that, while there has been an increase in the number of women psychiatrists in the UK and Ireland, professional barriers, including the so-called glass ceiling, still exist. She warns that within a decade women doctors could outnumber men, and its “feminisation” could lead to the profession losing status, as occupations that become “feminised” seem always to do.119 Tait and Platt’s findings seem to support the point. They found that women were more likely to be working in a specialty such as psychiatry as the hours and working conditions were more compatible with family commitments.120

In this section I have briefly described the influence of British, American and Australian experiences on developments in mental health provisions. The influence of Poor Law legislation in Britain governed attitudes to those in need of material help. The medicalisation of services for the mentally ill in Britain, together with changing attitudes to mental illness, the establishment of combined health and welfare community services and deinstitutionalisation policies were accomplished within the bureaucratic structure of statutory services. The American influence was different. Where British focus was on the importance of environmental issues affecting mental health, in America the focus was on psycho/social issues. Community clinics were established for specific treatment of patients with psycho/social mental disorders compared to the generalised community services of the British. In both countries the closure of mental hospitals occurred prior to the establishment of suitable follow-up facilities in the community. The Australian experience, based as it originally was, according to British tradition, retained the same bureaucratic organisation of services. But in terms of individual treatment procedures Australian services followed the American psycho/social orientation.

3.4 Western Australia In this section a short historical study of mental health services in Western Australia until 1959 will be provided. This will serve as context for the next three chapters, the analysis covering the years from 1959 to 1999.

119 R. Ramsay, ‘Women in Psychiatry’ in Advances in Psychiatric Treatment, vol.11, 2005, pp. 383- 384. 120 A. Tait & M. Platt, ‘Women consultants, their background and training: some myths explored’, in Medical Education, No. 29, pp. 372-376. See also A. Wilson and J. Earles ‘The feminization of psychiatry: Changing gender balance in the psychiatric workforce’, Psychiatric Bulletin, No. 30, 2006, pp. 321-323. 107

3.4.1 Early developments

The development of mental health care in Western Australia began with the arrival of the fleet at the Swan River colony in 1829.121 Two years later the first mentally ill person was transferred from detention on the ship, Marquis, docked at Fremantle, to the Round House, which also served as a goal and administrative centre. Megahey in his account of the early years of mental health services has divided colonial WA into two periods: 1829 to 1857, which covered the period between the first settlement and the establishment of the Fremantle Asylum, and 1857-1900 which covered the life of the asylum to the end of the colonial period.122 He reports that during this early period the presence of “lunatics” in gaol and the Colonial Hospital was reported in the Blue Books, and “idiocy” and ‘insanity’ were considered to be aspects of the same disorder. There were probably not more than two or three mentally disturbed persons in a total population of about fifteen hundred immigrants and they were housed in the punishment cells of a warehouse, which served as the temporary asylum. It was not until the arrival of the convicts in 1850 that accommodation proved a problem.123 Ellis considers that the official birthday of asylum care of the insane in Western Australia came in 1857 when ten insane convicts who were confined in this warehouse were moved to the newly constructed Fremantle Asylum. He comments: ‘Thus was the State Mental Health Services in Western Australia born from the Convict Establishment’. 124

In 1871 a new Lunacy Act, modelled on the British Lunacy Act of 1845, was introduced in WA, and conditions established under which inmates were to be detained and treated. A lunatic was defined thus: ‘Lunatic shall mean and include every person of unsound mind and every person being an idiot’. 125 This Act was

121 Ellis, Eloquent Testimony. A later article by P. Skerritt, A. Ellis, F. Prendergast, C. Harrold, H. Blackmore and B. Derham, ‘Centenary of Federation: Psychiatry in Western Australia: An eloquent testimony’ in Australian Psychiatry, Vol. 9, No.3, September 2000, refers to the end of the MHS and its merger with the Health Department, of WA. 122 N. Megahey ‘Living in Fremantle asylum: the colonial experience of intellectual disability 1829- 1900’, in E. Cocks and others (eds.), Under Blue Skies, pp.17-26. 123 Ellis, Eloquent Testimony, pp. 10-13. 124 Ellis, Eloquent Testimony, p.25. 125 Lunacy Act. 34 Vict. IX, Act no.7, Sect2, 1871. Statutes of Western Australia 1832-1882, Volume 1 pp. 432-465. 108

intended to provide for the ‘safe custody’ of those thought to be a risk to others, and the ‘care and maintenance of persons of unsound mind’, and no distinction was made between persons who were ‘of unsound mind’ and ‘idiots’; both were included in the term ‘lunatic’.126 And both groups were housed together in the Fremantle asylum.

In 1903 the Lunacy Act was revised and the term ‘lunatic’ was replaced by ‘Insane Patient’, which still included both the mentally ill and the intellectually disabled. Megahey has commented that, unlike the practice elsewhere in Australia, WA experience did not acknowledge differences in the needs of each separate group. He suggests that an explanation for this may be found in the power structure of the colony, particularly the Convict Establishment. When the convict system ended in 1886, the administration of the asylum remained administered by the Colonial Secretary, and it was not until 1895 that the medical Department was established and the post of Principal Medical Officer was created.127 Virtue points out the difficulties associated with this new position; it was part-time, and because of Western Australia’s isolation there was little capacity to follow developments in other parts of Australia. Further, he considered that the 1903 Act served to perpetuate the system of custodial care.128 There were, however, big changes in the air.

Chronic overcrowding and understaffing at the Fremantle asylum resulted in a public inquiry in 1900, which led to the appointment of a medical specialist in the treatment of the ‘insane’ to head it. Dr. S. Montgomery was appointed from Britain as Superintendent in 1901. Carmen-Brown and Fox describe Montgomery as ‘the first of the specialist alienist administrators to administer the new hospital for the insane’ and it is to Montgomery that the credit goes for establishing Claremont as an Hospital for the Insane and setting up the new Lunacy Act in 1903.129

Claremont Hospital was completed in 1907 and such was the combination of architecture, location, facilities and new conceptualisations of mental illness, that one

126 M. Rayner & J. Cockram, ‘The response of the law to Intellectual Disability in Western Australia 1929-1993’, in Cocks and others (eds.), Under Blue Skies, pp.137-166. 127 N. Meaghey, Living in Fremantle Asylum, in Cocks and others (eds.), Under Blue Skies, p.47. 128 R.Virtue, ‘Lunacy and social reform in Western Australia 1886-1903’, in Studies in Western Australian History, No. 1, 1997, pp. 33-37. 129 K.Carman-Brown & C. Fox, Doctors, Psychologists and Educators in Cocks and others (eds.), Under Blue Skies, p.210. 109

local newspaper referred to it as ‘eloquent testimony to the humanity of the Government and people of Western Australia’.130 The use of the words ‘hospital’ and ‘insane’ were an expression of the international trend toward the medicalisation of both mental illness and intellectual disability.131

3.4.2 Legislation

In Western Australia an emphasis on legislation has been a major aspect as a means of implementing changes in services for the mentally ill and consequently needs to be viewed in historical perspective. We have seen how changes to the lunacy laws in the late nineteenth and early twentieth century reflected changes in the way mental illness was conceptualised. The optimism of nineteenth century liberal thinkers who believed the human condition could be improved by education or environmental reform was challenged by anxiety around apparently increasing political conflict, the social problems of poverty, illness, and crime, and a declining birth rate.132 Consequently a search began to find new ways of overcoming these problems and answers were increasingly found in hard-edged biological explanations.

The Western Australian Lunacy Act was amended in 1915 but did nothing to highlight the different care required by the ‘insane’ and the ‘feeble-minded.133 Then, in 1917, in order to minimise the public stigma attached to certification in a mental institution, the Mental Treatment Act was passed, which provided that those suffering from a mental disorder brought about by wounds, shock, stress or exhaustion could be received for treatment without being ‘certified’ under the Lunacy Act.134 But nothing could be done for people who were considered ‘incurable’; they would spend the rest of their life in mental hospitals.

In the 1920s, growing concern over the process of admission, detention and treatment at Claremont Hospital for the Insane, allegations of ill-treatment by staff and of overcrowding, resulted in the establishment of a Royal Commission into Lunacy in

130 The West Australian newspaper, quoted by Ellis, Eloquent Testimony, p.46. 131 Carman-Brown & Fox, Doctors, Psychologists and Educators, pp.205-247. 132 Carman-Brown & Fox, Doctors, Psychologists and Educators, pp.205-247. 133 Rayner & Cockram, Responses of the Law to Intellectual Disability in Western Australia, p.148. 134 Rayner & Cockram, Responses of the Law to Intellectual Disability in Western Australia, p.149. 110

1922 to report on the administration of accommodation and treatment of people in hospitals for the insane.135 Recognising that there was a stigma attached to Claremont Hospital, and in order to remove this stigma, the Mental Treatment Act of 1927 was passed, recommending that a Reception Home be established for ‘recoverable’ patients away from Claremont, and stipulating the conditions on which patients could be detained and discharged.136 The Act introduced a new concept ‘mental disorder’ into legislation and recommended hospitals for the treatment of patients who had not been found to be ‘insane’ but could be treated without acquiring the stigma of lunacy. Following this, Heathcote Reception Home in Applecross was opened in 1929 for patients who were considered to be ‘curable’. This made it possible to treat mentally ill persons as voluntary boarders as distinct from the certified insane, and avoid the stigma of certification.137 Unfortunately for those still in Claremont, the clear implication was that they were ‘incurable.138 Ellis commented that the stigma attached to people admitted to Claremont, had an adverse effect on the hospital for the next 50 years.139

New treatments were continually introduced, reflecting the continued salience of the belief that mental illness was a physiological condition, a disease of the brain. As was the case elsewhere, insulin coma treatment, ECT and psychosurgery were introduced in the 1930s. From the 1950s the major tranquillisers were introduced, enabling patients who previously needed to be kept under restraint to be discharged into the community. 140 Yet, overcrowding remained a continuous problem at Claremont Hospital despite these apparent advances in psychiatric treatment.

Eugenics and after

The arrival of Eugenics in Western Australia, which recommended segregation and social control of so-called ‘mental defectives’ resulted in heated debates in Parliament

135 Rayner & Cockram, Responses of the Law to Intellectual Disability in Western Australia, p.150. 136 Mental Treatment Act. 18 Geo V, Act No. 13, 1927. In The Statutes of Western Australia, 1927, pp. 16- 21. Mental Health Department, File no 85/01179, Dobis 5957, AN 200/3 acc 1374, 1926/61. 137 R. Virue, ‘Lunacy and Social reform in Western Australia 1866-1903’, in Studies in Western Australian History, No. 1, 1977, pp. 33-37. 138 A. S. Ellis quoted in C, Gillgren, Once a defective, always a defective, p.69. 139 Ellis. Eloquent Testimony, p.84. 140 Ellis, Eloquent Testimony, p.119. 111

and the general population. The eugenist programme advocated state intervention in encouraging the breeding of the ‘fit’, and stopping the ‘unfit’ from breeding through a policy of locating, registering and segregating or sterilising them. These ideas were promoted assiduously by people like Ethel Stoneman, the State Psychologist in the late 1920s, who was the inspiration behind the Mental Deficiency Bill of 1929. In the event this Bill, designed to set up an infrastructure of surveillance, segregation and seclusion, did not proceed because of the financial stringencies caused by the worldwide Great Depression in the 1930s. Little money was available for mental health services of any kind, so nothing was done to further Stoneman’s plans and people with intellectual disabilities remained mixed promiscuously with other inmates of Claremont Hospital. 141

Public unease about conditions at Claremont and reports of cruelty by nursing staff resurfaced in the 1950s and resulted in investigative press reports which described the intermingling of violent, mentally ill and intellectually disabled patients, overcrowding, and lack of activities.142 Another Royal Commission was set up which concluded that the system of record keeping and communication between the nursing and medical staff was inefficient, that extra medical officers (bringing the total to six psychiatrists and two medical officers) and three welfare officers at Claremont Hospital were needed and that security needed to be tightened.143 Ellis scathingly refers to Claremont Hospital at the time as ‘the poor relation’ in the Western Australian hospital system, where ‘there was little attempt to maintain ordinary human dignity’, which in turn did much to perpetuate both mental illness and the stigma attached to it.144

The outstanding national feature of the Stoller Report in 1955 on mental health facilities and needs was the identification of the shortage of approximately 10,000

141 The Birmingham Report of 1911, quoted by C. Gillgren, Once a defective, always a defective, on p.65 prefigured this belief, and divided the mentally defective into three categories - idiot, imbecile and feebleminded, and that segregation in institutions was necessary to prevent them breeding. On Stoneman see Gaynor & Fox, The Birth and Death of the Clinic. 142The Sunday Times, 12 and 19 Feb. 1950. 143 1950 Report of the Royal Commission to inquire into alleged cases of brutality at the Claremont Mental Hospital Western Australia. SROWA. 144 Ellis, Eloquent Testimony, p.96. 112

beds throughout Australia.145 Federal government funds of 10 million pounds to the States were ultimately provided in order to bring standards of mental hospitals at least to the level of the general hospitals, and recommendations made that outpatient services should be established.146 As far as Western Australia was concerned, the other outstanding feature of the report was a scathing account of the deplorable conditions at Claremont Hospital. Let us leave this account of the history of mental health in WA with an account of the 1950s by Guy Hamilton, the senior medical officer appointed in 1962 at Claremont, which personalises the Stoller report:

The care was appalling. In the male children’s ward, J Block, there were people who lay in bed with bed sores until they died; there were cot cases for whom little but basic nursing was provided; there was no policy of training and the care of 40 people in a ward by two or three rostered staff was inadequate. At meal times, they were seated at arms length to each other, so that they couldn’t grab each others food, which I suspect that they did simply because they were hungry. Many who were incontinent were hosed down outside, even in winter in the so-called airing courts. There was no individuals care, there was no love, there was no care at all and all bad behaviour was coped with in the medical fashion, using what some used to call ‘chemical warfare’against them. This was a medical response to abnormal behaviour; there was little psychological training or treatment. It was the only place in the world where I have found children as young as two years being simply referred to by their surnames. … they were receiving worse treatment than animals and most were certainly not being treated as children.147

The more recent history of mental health services in WA will be taken up in the next three chapters.

3.5 Core themes

Despite some local variation there is a thematic consistency in the development of mental health services across the countries discussed. I have identified four particular themes that are relevant to this research.

145 A. Stoller & K. Arscott, Report on Mental Health Facilities and Needs of Australia, Canberra, Commonwealth Government of Australia, 1995. 146 Gillgren, Once a defective, always a defective, p.79. 147 Gillgren, Once a defective, always a defective, pp.78-9. 113

3.5.1 Changing community responses to the mentally ill

Throughout each of the countries under review, mental illness was and is defined according to what members of the community considered to be ‘normal’. In England the ‘pauper lunatics’ who could not find refuge under provisions of the Poor Laws were transferred to private mad houses run along commercial lines, or incarcerated in asylums built by the state where moral treatments would supposedly cure them of their affliction. In the USA, the majority of people with mental illness were cared for in the community until, as in the UK, asylum care was introduced. Despite the intention of reformers, however, asylums were quickly transformed into large, overcrowded institutions in which patients became inmates and were effectively ‘warehoused’. In the meantime, changing conceptualisations of mental illness from a ‘moral’ to a medical question meant that mental illness had become medicalised and asylums became hospitals for the insane and psychiatric medicine took an ever greater role in treatment.

The mental hygiene movement led by a group of volunteers prior to World War I was among the forces initiating the move to deinstutionalisation of asylums in the latter half of the century. Volunteer groups were also responsible for developing community awareness of the mental health needs of asylum patients and of facilities needed to assist rehabilitation. However, new ideologies from anti-psychiatry, the invention of new drugs which enabled treatment to be given outside the hospital setting, growing concern with the stigma and failures of mental hospitals and the desire of governments to save money, all led to the twin projects of deinstitutionalisation and community care and large numbers of the formerly impregnable hospitals were closed down. Whether the ‘community’ in the countries covered in this chapter have adopted the tenets of community care, however, is another matter, as too many people with mental illness were and are re-institutionalised in prisons, or live out their lives in boarding houses and on the streets.

3.5.2 The changing definitions of mental illness.

As Foucault argued and as this chapter shows, mental illness is historical and, in the period covered here, has been conceptualised as a ‘moral’, environmental, physical or

114

psychological disease. In the nearly nineteenth century the etiology of mental illness was broadly environmental or, in the language of the day, it was thought that ‘moral’ treatment could lead to cure. In the later nineteenth century, together with the growing dominance about the deterministic powers of biology in a range of intellectual movements, it moved from this broadly social to a biological model, a disease of the brain, to be cured by purely medical interventions. In the mid to late twentieth century, it moved back from the medical model to one that involves the biological/ psychological/ social/ cultural elements of human experience. Although separate facilities were provided in Britain and the US for care of people with intellectual disability in the nineteenth century, and later in several states in Australia, intellectual disability remained classified with insanity under the same lunacy acts until well into the twentieth century. In the 1970s and beyond, mental illness and intellectual disability parted company both conceptually and administratively in all states.

3.5.3 Effect of government policies.

Government legislation in the countries under discussion was influenced by the system of Poor Laws introduced in 1845 in England based on the premise that the government had a responsibility for the poor and indigent. While provision for the care of the mentally ill was undertaken largely by the states and private philanthropy in the US until the New Deal of the 1930s, responsibility in England and Australia remained with governments. People with mental illnesses were provided for with large, purpose-built asylums, which became hospitals for the insane, the administration of which was set out under successive lunacy Acts, which also set out the admissions and discharge processes.

Of significance in the development of mental health services were the introduction of community care policies associated with deinstitutionalisation, which occurred throughout the US, England and Australia during the 1960s and 1970s, resulting in a major relocation of both patients and resources in mental health services away from large institutions to regular hospital systems, from exclusion from, to inclusion “in the community”. New community-based services were introduced in varying degrees of effectiveness, but they seem least effective in the USA. In the 1980s and beyond, neo- liberal policies, introduced by the Thatcher and Reagan governments in Britain and the 115

USA, were adopted throughout Australia, and the privatisation of many health and mental health services followed as governments became purchasers rather than providers of such services.

3.5.4 Influence of gender

Services for the mentally ill throughout each of the countries studied have demonstrated the influence of gender among patients, administrations and in the composition of staff. A division of labour surfaced early where male doctors headed asylum and hospital administrations, overseeing systems where male attendants supervised male inmates and females supervised females. The traditional hierarchical pattern of early asylum administration, continued until the 1960s, supported by policies that excluded married women from paid work, often excluded women from medical training at universities, and reserved the jobs at the head of hospital hierarchies for males. When government marriage bars were abolished in the 1960s women entered universities in greater numbers and broke the stranglehold of men on the medical profession. At the same time, new modes of thinking from the social sciences began to create new knowledge about mental illness, and new professions, which had been constructed as female, entered the field: psychologists, occupational and other therapists and social workers. Whether this made a difference to the established hierarchies in the field is a central part of the investigation which follows.

3.6 Summary

In this chapter I have surveyed the development of services for the mentally ill in England, the United States and Australia until 1999. It is a crucial background to understanding the history of mental health in Western Australia as it is perceived by people who had a significant role to play in mental health services over a 40 year period. The section on Western Australia stops in 1959, but discussion of later developments - the thrust of this thesis - is contained in the next three chapters: 1959- 1973, 1974-1984 and 1985-1999.

The chapter takes a rather winding road to traverse all the aspects of a topic as many facetted as mental health. It first described conditions in medieval England where 116

vagabonds and the intellectually and physically disabled were dealt with under provisions of the Poor Law, and individuals rather than the social system were held to be responsible for their own misfortune. With the commencement of the “trade in lunacy” in the late eighteenth and early nineteenth century, pauper lunatics were accommodated in private madhouses run by medical men or in asylums built by the state. The belief that “defective” human beings could be repaired was one factor leading to the increase in the number and size of asylums in England. Compared to the English equivalent, government investment in asylums in America was extremely limited. The poor and disabled were given relief within the community, or managed to fend for themselves. New ways of dealing with the insane, such as moral management, were introduced in England in the late eighteenth century. This corresponded to the establishment of the Australian colonies, and was a major influence on the development of mental health services here.

Intellectual disability and mental illness historically were incorporated in lunacy legislation in both England and Australia and people with intellectual disabilities were incarcerated with the mentally ill. By the early twentieth century the Eugenics movement in Britain and America initiated the belief that hereditary weakness was the cause of many instances of insanity and idiocy. In America segregated ‘idiot’ schools were established, which ran parallel to the system of hospitals for the insane. In Australia, conditions for those who were intellectually disabled were modified by voluntary organisations from the 1950s, but until late in the twentieth century they were universally classified as incurable and condemned to a life of confinement.

In England in the early twentieth century, the Poor Law system of the relief of poverty was abolished and in 1928 out-patient clinic work was established at general hospitals and almoners were increasingly employed, to allay the fears of patients concerning their treatment. By this time as well, medical models of mental illness had overtaken the remnants of environmental etiologies. Based on the idea that mental illness had an organic base, a range of new physical, medical procedures were introduced and in the 1950s this was followed by the introduction of neuroleptic drugs that shortened the time patients needed to spend in hospital, enabling them to be discharged into the community.

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Moves to provide alternatives to mental hospitals were well under way by the 1960s. The period brought a change in the medically-based ideology of mental illness to include psychological and social issues. The radical changes that began in the 1960s, known as deinstitutionalisation, changed the face of the treatment of people with mental illness completely. In America the establishment of community psychiatry had far reaching effects on the design and establishment of community services. The establishment of community health centres was meant to diminish the harmful factors affecting the mental health of the community. Federal funding was available for the centres which placed psycho/social intervention as a primary aim, but it did not replace care in mental hospitals. Community care ideology spread to England and was subsequently introduced to Australia by the Mental Health Authority of Victoria in 1952, and then to Western Australia. The characteristic forms of treatment in Australia continued to follow those from England and the USA, with many of the same problems. Hospitals for the insane closed, to be replaced by community-based treatments in mainstream hospitals and community clinics. But funding always remained problematic and, as was the case in the USA particularly, many people with mental illnesses were left to fend for themselves or were re-incarcerated in the criminal justice system. As we have seen, the results of the process of deinstitutionalisation were mixed.

In the next chapter, I commence my detailed analysis of the data obtained from both a search of the published and unpublished record and a series of semi-structured interviews with 25 mental health practitioners who worked in the MHS of Western Australia during the period under review.

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Chapter 4

The Establishment Years 1959-1972

Introduction

In 1959 the establishment of ‘an important new service’- Graylands Day Hospital- was announced by Dr D.W. Moynah, Inspector General of the Mental Health Service (MHS).1 The treatment of patients during the day, and their return home at night time, was considered to be a revolution in care of the mentally ill in Western Australia, as psychiatric patients had always been treated as inpatients at Claremont or Heathcote Hospitals.2 The introduction of qualified social workers ‘to assist in the admission, discharge and after-care difficulties of patients’ was a landmark decision of twofold importance: it acknowledged the significance of social and environmental factors in the ideology of mental health, and was the first social work appointment made by the State Government.3

Despite the efforts of members of the WA branch of the Australian Association of Social Workers (AASW) and a concerted media campaign, qualified social workers were in scarce supply. Training facilities were not yet established in Western Australia, and students wishing to enrol in social work courses were required to travel interstate or overseas. Consequently when three English social workers arrived in Perth they were quickly approached by representatives of the MHS, and subsequently became the first social work appointments made by the State government of Western Australia. The new appointees were Mrs M.E. (‘Teddie’) Stockbridge, a qualified psychiatric social worker (PSW), Miss Sylvia Cresswell who had a background in social welfare, and Mr Gill Walters who was experienced in management and industrial rehabilitation. At the same time a new category of employment, with the title of Mental Health Officer (MHO) was created to complement the all too scarce social workers.

1 Annual Report of the Inspector General of the Mental Health Services, 1959, Mental Health Library. 2 Participant No 6. Interview with author on 10/04/2001. 3 Annual Report of the Inspector General of the Mental Health Services, 1959. Mental Health Library. 119

The experiences of each of the new arrivals varied considerably. Sylvia Cresswell became Principal Social Worker for the MHS in 1973, but Gill Walters remained at Claremont Hospital for only a short time before moving to become manager of the newly established Mental Health Services Industrial Rehabilitation Centre.4 However, the most significant appointment for the future of social work was that of Teddie Stockbridge (later became Dr M.E. Stockbridge) who, after working at the Child Guidance Clinic until 1964 was seconded to the University of Western Australia (UWA) to prepare for the establishment of a new social work course. By 1972 the Director of Mental Health announced that the number of social workers employed by the department had increased from the original three in 1959 to twenty two, who were located in a number of different sections of the department.5

4.0 Development of social work services

The period 1959-1972 saw major changes in the organisation and delivery of mental health services. Claremont Hospital, which had been built in 1903 to house 700 psychiatric and intellectually disabled patients, had become grossly overcrowded by the 1950s. Following a series of complaints from the public, the outmoded legislation regarding treatment of the mentally ill was revised in 1962, separating the mentally ill from intellectually disabled patients and establishing a system for the aftercare of patients in the community. In 1973 Claremont Hospital was divided into Swanbourne Hospital for psycho-geriatric patients and Graylands Hospital for psychiatric patients. Heathcote Hospital continued to provide treatment for acutely ill patients. The 1959-73 period was a time when social work in the mental health services took its first tentative steps towards full professional recognition, which seemed to have arrived when the position of Principal Social Worker was established for the first time.

In this chapter I document the early years of mental health social work in Western Australia by utilising data from secondary sources and the interviews with social workers and other professionals who were employed during this time, and drawing

4 A.S. Ellis, Eloquent Testimony, p. 127. 5 Annual Report of the Director of Mental Health Services 1971-1972, Mental Health Library, These social work figures do not represent the total welfare work undertaken by the department, as contributions of the Mental Health Officers (MHOs) are not included. 120

heavily on my own experiences of events. Data is limited because there were only five senior staff from this period available for interview. Their important observations augment, wherever possible, my own memory of events. From this analysis I suggest that developments in mental health social work practice in Western Australia between 1959 and 1972 were contingent on changes in the conceptualisation of mental illness, particularly its aetiology and treatment. I also suggest that as mental health social work was regarded as a predominantly female occupation because of the traditionally caring roles of females, gender played a significant role in the location, distribution and content of social work development, despite the fact that some of the early social workers were males.6 The chapter first describes the changing conceptualisations that enabled social work to be included in Mental Health Services. It then deals with the new knowledge that was involved. Finally it examines the manner in which this knowledge was applied in social work practice in mental health hospitals, disability services and outpatient clinics in the MHS between 1959 and 1973, paying particular attention to the way in which gender shaped this practice.

4.1 Conceptualisations of mental illness

The advent of the anti-psychiatry movement has been addressed in some detail in the previous chapter. Historians of psychiatry have identified a number of changes in the conceptualisation of mental illness in the twentieth century.7 In the early twentieth century a biological model of mental illness dominated, based on a positivist/medical ideology in which hereditary factors were of prime importance. In the 1920s when Freud’s followers suggested that adult personality disorders were related to the timing and consequent arrest of maturational processes, the psycho/dynamic model of mental illness, which took account of both the individual and of interactions between individuals, came into play. A biological/psychological/social (bio-psycho-social) model was introduced when social factors became associated with the development of several categories of

6 See for example S. Browne, ‘A Woman’s Profession’, in H. Marchant & B. Waring (eds.), Gender Reclaimed: Women in Social Work, Sydney, 1986. 7 H. P. Lefley, Family Caregiving in Mental Illness, Thousand Oaks, Sage Publications, 1996, pp.33-46. 121

neurotic disorders such as depression.8 In England in the 1940s, Maxwell Jones introduced a new concept to psychiatric treatment - the therapeutic community. This was a community-based model of care for the mentally ill based on the principle that the community, not the hospital should be the main source of treatment.9 The introduction in the 1950s of long-lasting drugs to treat depressive and psychotic disorders reduced the need for patients to remain hospitalised. The patient, family members, friends, and outside supportive facilities were to be involved, and Jones envisaged that the social worker rather than the psychiatrist would be the most appropriate professional involved in mental health care.

4.1.1 Anti-psychiatry movement

By the 1960s, new ideas and processes had changed the face of treatment of mental illness. In the 1960s and 1970s criticisms of hospitals for the insane and psychiatry by the new movement known as anti-psychiatry were also significant in promoting changes to the treatment of the insane. Indeed some questioned the very existence of insanity itself. Thomas Szasz regarded psychiatry as a specialty not of psychiatry but of mythology, and postulated that terms such as ‘illness’ and ‘disease’ applicable to physical ailments could not be applied to the phenomenon of mental dysfunction. He argued that in mental illness no such anatomical or physical abnormalities could be identified, and therefore any diagnosis or treatment was invalid.10 Another strain of thought championed by the Scottish psychiatrist, R.D. Laing questioned whether mental illness (typically, schizophrenia) was really an illness at all. He regarded the medical model, with its assumptions of the doctor’s scientific objectivity, as preventing rather than facilitating his understanding of the patient, and argued that people with schizophrenia would recover providing that medical interference did not suppress or sidetrack, what at one stage in his thinking, was a voyage of inner discovery.11 He wrote, ‘Sanity today appears to rest very largely on a capacity to

8 L. Webb, C. DiClemente, S. Johnstone, J. Saunders & R. Perley (eds.), DSM III Training Guide, New York, 1981. 9 Jones sets out his concepts in M. Jones, Social Psychiatry in Practice: The Idea of the Therapeutic Community, Harmondsworth, Penguin, 1968. 10 T. Szasz The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement, New York, Harpwer Row, 1970, and The Myth of Mental Illness: Foundation of a Theory of Personal Conduct, London, Paladin, 1972 11 R. Laing, The Politics of Experience, New York, Pantheon, 1967. Quoted by H. Ruitenbeek, Going Crazy, New York, Bantam Books, 1972, p.162. 122

adapt to the external world- the interpersonal world and the realm of human collectivities’.12 But individuals were necessarily ambivalent about this as there were no safely prescribed guidelines of behaviour, so he asked: ‘Adjust to what’? 13 Paul Laffey argues that anti-psychiatry is a slippery term associated with the stronger emergent critiques, yet many of these had evolved from ideas that had existed for years.14 He notes that the more vocal proponents of deinstitutionalisation tended to walk hand in hand with those who had called for the reconfiguration of psychiatric epistemology and practice. For example some psychiatrists and allied health professionals who worked with mentally ill patients found themselves wondering whether psychiatric illnesses were as immutable as previously thought. Correspondingly, learning to communicate with patients ‘ in ways that did not belittle the patient’s “voice”, encouraged reflection on the hierarchical nature of the hospital’s moral structure; consequently, rather than demanding the end of psychiatry, many anti-psychiatrists asked for its review’.15 While there was increasing public apprehension concerning the incarceration of mentally ill patients, at the same time governments saw the prospect of cost savings in closing hospitals for the insane.16 In the 1960s and 1970s all these issues accelerated the adoption of the policy of deinstitutionalisation that was to revolutionise the treatment of the mentally ill.

4.1.2 International Classifications of mental illness

The changing face of mental illness and the realisation that factors other than purely medical ones played a part in both its cause and cure presented a problem of classification for psychiatry. The International Classification of Disease (ICD), which was introduced in 1940, grouped all mental and intellectual disorders together. Forty years later it was sub-divided to include seven main categories.17 It was not

12 Laing, The Politics of Experience, p 162. 13 Laing, The Politics of Experience, p 162. 14 P. Laffey, ‘Anti-psychiatry in Australia: Sources for Social and Intellectual History’ in Health and History: Deinstitutuinalisation Special Issue, Journal of the Australian Society of Medicine, Vol.5, No.2, 2003, pp. 17-19. 15 Laffey, Anti-psychiatry in Australia, p.18. 16 See Goffman, Asylums and M. Foucault, Madness and Civilisation. 17 Webb and others, (eds.), DSM II Training Guide, noted that the International Classification of Disease in 1880 categorised mental disorders into seven groups: mania, melancholia, monomania, paresis, dementia, dipsomania and epilepsy. 123

until 1952 that the Diagnostic and Statistical Manual of Mental Disorders (better known as the DSM I), was published as an alternative to the ICD, providing sub- categories of mental illness. However Clasen argued that these could not adequately describe the significant social, cultural and biological issues that had by then become involved in mental illness, and considered that a more authoritative nosology was required.18 The sub-categories were again revised, and by 1980 the DSM III contained more than 200 distinguishable disorders associated with major psychiatric illnesses.19

Whereas psychiatry focused on the diagnosis and treatment of disease, and psychology on the identification of emotional and intellectual factors in personality development, it was social work that focused on interactions between individuals within the institutional framework of a specific society and the organisations that supported its effective functioning. Social work was the first profession to incorporate insights from the social sciences into its mental health practice, and its role in relation to psychiatry enabled these insights to be incorporated into psychiatric classifications.

4.1.3 ‘Mental Deficiency’

Social workers featured prominently in the recently created Mental Deficiency Division (MDD) of the MHS in 1965.20 As we have seen, the treatment of mental illness in Australia was medically oriented with its roots firmly established in the tradition of British psychiatry. Studies in England, however, had demonstrated that psychiatric hospitals, institutions for people with intellectually disabilities, and the then dominant medical model of care, were unsuitable for such people.21 In addition, the idea of normalisation, which had been developed in Denmark and other

18 J. A. Clasen, ‘Some implications of classification in sociology for problems of classification in Psychiatry and Psychopathology’, in M. Katz, J. Cole & W. Barton (eds.), The Role and Methodology of Classifications in Psychiatry and Psychopathology, Washington, US Department of Health, Education and Welfare, 1965, pp.169-170. 19 Webb and others, DSM III Training Guide. In 1980 the DSM III was extended to include a number of V codes - borderline intellectual functioning, child abuse and others - that might otherwise require evaluation or treatment. 20 Ellis, Eloquent Testimony, p.156. 21 N. Megahey, ‘Making a New Profession: Social Trainers and Intellectual Disability’ in E. Cocks, et al, eds., Under Blue Skies, p.257. 124

Scandinavian countries in the 1960s, came to inform the policies regarding intellectual disability. The growing commitment of the Western Australian government to develop a service for people with intellectual disabilities separate from the existing service for mental illness showed that Western Australia had learned from these experiences.

In 1965 Dr. A. Ellis, who had been appointed Director of the MHS in 1964, separated it into two sections: the Mental Health and the Mental Deficiency Divisions (MDD), thus recognising that the intellectually disabled needed different treatment from the mentally ill.22 To head the new MDD he chose a physician rather than a psychiatrist, Dr G. Hamilton, who had worked at Claremont Hospital since 1962 and had a special interest in individuals with intellectual disabilities, having a son with an intellectual disability.23 Hamilton’s aim was to replace the medical model of treatment with a developmental model and provide appropriate support services in the community. 24

Researchers assert that social work principles espoused during the 1960s dovetailed well with the spirit of normalisation.25 With emphasis of the MDD on social needs Hamilton pushed hard to expand residential and domiciliary services in the community. He established a programme that utilised newly trained social trainers in addition to the existing professional staff of social workers and psychologists. Psychologists brought a new technology, behaviourism, (based on aversion therapy, operant conditioning and reinforcement) to the MDD, and they were well qualified to assist in the process of normalisation. Because of the new emphasis on the social problems of people with disabilities, social work was an essential ingredient, but the shortage of social workers was a great concern. Hamilton believed that, because of the emphasis on social issues in intellectual disability policy, only social workers could consider the true nature of the problem. He did, however, suggest that the focus of social workers on individuals and families, together with the relative

22 Ellis, Eloquent Testimony, p.156 23 Ellis, Eloquent Testimony, p.156. 24 Carman-Brown & Fox, Doctors, Psychologists and Educators, p.228. 25 B. Logan & D. Chung, ‘Current social work values in the fields of mental illness and intellectual disability: changing service approaches to people with a disability’, in Australian Social Work, Vol.54, No.3, September 2001, pp.37-41. 125

newness of social work as a profession, were factors that militated against them becoming leaders in the field. 26

4.2 Social Work Education

In her book Looking Back: Reflections on 25 Years 1964-1990 Jenny Gardner tells of the establishment of a social work training course at the University of Western Australia (WA).27 She writes that when the Western Australian branch of the Australian Association of Social Workers (AASW) was formed in 1946 with seven members, one of its stated aims was to establish a school of social work at UWA. In 1957 a committee to achieve this goal was formed, chaired by Professor Walker, Professor of Psychology, and including Professor Saint, Dean of Medicine. The University Senate gave approval, but it was not until 1961 that a decision was made for the course to be at post-graduate diploma level. Provision was made to appoint a Reader in Social Work, but this proved difficult to fill so ad hoc arrangements were necessary in order for the course to commence in 1965. The Psychology Department became administratively responsible for the course, assisted by an Advisory Board. Dr Walter Tauss, a member of the Psychology Department, was appointed as Executive Officer, ‘Teddie’ Stockbridge was transferred from the MHS Child Guidance Clinic to become Lecturer in Social Work, and Jean Teasdale was appointed on a part-time basis as Visiting Lecturer. Both women were only given temporary positions because of the marriage bar, that government policy which prohibited the appointment of married women. In ‘Midwifery of Power? Reflections on the development of professional social work in Western Australia’, Frances Crawford and Sabina Leitman point out that similar gendered staffing occurred in other Australian university social work departments, where in nearly every case, heads of departments were male, and few had experience in social work.28

26 Guy Hamilton, quoted by K. Carman-Brown and C. Fox, ‘Doctors, Psychologists and Educators: The Professions and Disability’, in Cocks and others Under Blue Skies, p.229. 27 J. Gardner, Looking Back: Reflections on 25 Years 1965-1990, Nedlands, Department of Social Work and Social Administration, University of Western Australia, 1990. 28 F. Crawford & S. Leitman, ‘The midwifery of power? reflections on the development of professional social work in Western Australia’, Australian Social Work, Vol.54, No.3, 2001, p.47. 126

The Diploma in Social Work was a seventeen-month course under the administration of the Department of Psychology.29 Admission was available to graduates who had completed a number of prerequisites or their equivalent. Selection of applicants depended on acquisition of units in psychology, economic history, public administration, politics and anthropology or other approved units, as well as personal suitability. The University of WA Handbook of Social Work Regulations described the course as offering a generic training for all phases of social work.30 Candidates were required to study: definitions; fields and objectives of social work; casework as a basic method; community organisation for social work; advanced theory of social case work with analysis of case material; government and social legislation; social factors in physical and mental health; the structure of society; and research methods. Candidates were also required to complete not less than 180 days of practical training in a social work agency approved by the Head of the Department of Psychology. The state public service offered a number of traineeships.

During 1965 the West Australian Institute of Technology (WAIT, later to become Curtin University) announced that a second school of social work was to be established.31 Because of a lack of qualified practitioners, difficulties occurred in obtaining fieldwork placements for students from both courses. Furthermore, only six candidates had enrolled in the first UWA course and the intake at the University remained disappointingly small. The UWA Senate was concerned that the WAIT course could represent a wasteful duplication of courses. Then in 1969 a press announcement was made regarding the likely discontinuation of the UWA course. Considerable debate arose between members of the profession and employers of social workers, and a committee was set up to address concerns.32 Finally it was decided to establish a Department of Social Work at UWA and a two-year postgraduate Master of Social Work degree. The department was directly responsible to the Professorial Board, which contained representatives of the major employing agencies and the AASW. Shortly before his death in 1971 Dr Tauss, who had completed his social work qualification at the University of Sussex in 1967, was

29 Department of Social Work Regulations, University of Western Australia Faculty Handbook, 1965, p.131. 30 Department of Social Work Regulations, University of WA Faculty Handbook, 1965, p.131. 31 Gardner Looking Back, p.10. 32 Gardner Looking Back, p.11. 127

appointed as the first Head of the Social Work Department. ‘Teddie’ Stockbridge then took the position of Acting Head until 1974 when Professor L. Jayasuriya was appointed to the foundation Chair of Social Work and Social Administration at UWA.33 The second School of Social Work was announced only months after the first had commenced. The Associateship in Social Work, which commenced at the WAIT in 1967 was a full-time course and took three and a half years full-time study to complete, and stressed the application of practical techniques based on social and psychological theories.34 Candidates for the course were required to have passed five subjects, including English, at the Leaving Certificate Examination of the Public Examinations Board of Western Australia or the equivalent mature age matriculation exams, and to have satisfied the Head of Department of their suitability for the work.

The course had been submitted to the Australian Association of Social Workers (AASW) for approval, but no decision had been given. However the Public Service Commissioner recognised the Associateship as a sufficient qualification for appointment as a Social Worker, and offered cadetships for the course. It was structured as follows: the first year was theoretical, and subjects especially concerned with social work were taught in the second and third years. Subjects were grouped into themes: human behaviour and social control; psychology, sociology and anthropology, human physiology, medicine and psychiatry; social welfare and social policy; background theory of social welfare policy, supportive and restorative services within the community; social work method and practice; overview of social work, history and philosophy, relatedness of social work to various activities, voluntary work, government and religious organisations and social services. This included methods of social casework, group work and social organisation.35

Students were required to undertake and complete a series of supervised practical work placements totalling 183 days in the second and third years, to the satisfaction of the Head of Department and a supervisor of professional training, who was to be appointed by the Institute. Some social work practitioners thought that the second course was technically rather than professionally based and many believed the course

33 Gardner Looking Back, p.15. 34 Western Australian Institute of Technology Handbook, 1967, pp.89-92. 35 Western Australian Institute pf Technology Handbook, 1967, pp.89-92. 128

would detract from the reputation of social work. Consternation arose between members of the AASW, staff at the tertiary institutions and administrators of the state funded employing agencies.36

Importantly none of the social workers graduating from either UWA or WAIT were trained specifically in psychiatric social work, as the universities taught only generic social work. However, both courses included a lot of material on mental health and psychopathology. The social workers who entered the MHS at Heathcote Hospital were essentially trained on the job by both the MHS psychiatrists and the English psychiatric social workers. They were trained in group and marital therapy as well as psychiatric symptomatology and its impact on the social functioning of patients. There were no psychiatric social workers at Claremont Hospital, or later at Graylands or Swanbourne Hospitals, until the appointment of Margaret Aylen at Claremont Hospital in 1968. Consequently no training of local social workers in psychiatric social work took place in these facilities until then. On the other hand, Heathcote Hospital was seen to be a place where the more ‘curable’ psychiatric patients were treated. Social workers were employed there and social work students were taken. The impression I gained at the time was that social work students were reluctant to do their fieldwork at a psychiatric hospital.

4.3 Establishment of social work in the MHS

4.3.1 The Child Guidance Clinic

The Child Guidance Clinic was the first section of the MHS to employ qualified psychiatric social workers. It was a training facility for students of child psychiatry, clinical psychology and social work, and focused on children with behaviour disorders. When ‘Teddie’ Stockbridge left in 1965 to assist in the establishment of a social work course at the University of WA her place was taken by another English trained social worker whom I was able to interview.37 She did not have specialist psychiatric social work (PSW) training, but had qualified as an Almoner in England,

36 Western Australian Institute of Technology Handbook, 1967, pp.89-92. 37 Participant no. 11, interviewed by author on 08/11/01. 129

and had recently migrated to Perth with her young family. Concerning her decision to do social work she explained:

I wanted a profession and I didn’t like the idea of teaching or nursing, so I think that was how I drifted towards this. You could enter either a two year course in social studies. Not long after the war, 1949-1951, it was a two year course at London University. Then students could apply to be probation officers, members of the police, almoners or PSW’s…. I got the idea that I wanted to be a hospital almoner rather than a social worker. In those days you used to be called Lady Almoners, so they put you through various tests and you had a number of placements. First you had a basic one with the Family Welfare Association, that was the original COS, which was really the beginning of professional social work…. you got a very strict training in one of the family welfare agencies in London, then there were placements in hospitals.

Five years later after having emigrated to Perth and working in a children’s hospital she changed her mind:

I came to the conclusion that being in hospital was not for me any more. There were certain things I found difficult in connection with working with doctors- chasing after doctors. I didn’t really feel that there was quality teamwork in the hospital setting… it was very much better in mental health, but there was still a hierarchy, the doctors were still on top. I think the psychologists and social workers were fairly level pegging. Staff were organised into multi-disciplinary teams in which the role of the psychiatric social worker was to contribute information concerning the personal, family and interpersonal background of the child, which was gathered in addition to information given by the psychiatrist and psychologist. This became the basis for the establishment of the more permanent multidisciplinary treatment teams.

She saw her role as:

Very much a clinical one, home visiting was not encouraged at all. Part of it would be discussing the handling of the child; we’d go into the family dynamics to help the parents get some insight about what was going on between them and the child, and between the child and the siblings….I always felt that with a lack of specialised training I wasn’t properly prepared, but the social workers didn’t have specialist training with generic courses, did they? 38

38 Participant no.11, interviewed by author on 08/11/2001. 130

Another social worker who joined the clinic in 1965, and subsequently left for an academic career commented:

We had a case conference every Thursday morning. A team of psychiatrist, psychologist and social worker saw all referrals. Each member would offer their assessment of what they found in contact with the family and a teaching-learning exchange followed, with each member of the team cross-questioning each other, and open discussion being encouraged from all who attended on the interpretation being offered. An intervention plan followed from these discussions. These were enriching case conferences, often talked or written about, but rarely experienced consistently. Clients received a systematic, disciplined and expert service, and the team developed a level of mutual respect for one another based on the special expertise each offered. 39

These case conferences were also regarded as teaching sessions, and were attended by visiting allied health professionals and students. Other than that, and attendance at AASW meetings, there was no professional contact with other social workers. ‘It [the number of social workers] was very small, we could all sit around one table’

4.3.2 Claremont Hospital

The situation at Claremont Hospital for the Insane was in direct contrast to the Child Guidance Clinic, and was significant in that changes initiated there would lead to an enhanced role for social workers throughout the MHS. By the 1950s the hospital consisted of a number of wards extending over several acres of land. One section (which was later to become Swanbourne Hospital) was built on relatively high land while the other (which was to become Graylands Hospital) was built on lower lying land. All buildings were designed along the principles of recognised asylum architecture: long wards with locked doors and airing courts; the total complex surrounded by high brick walls. A prominent feature of the buildings was their tall chimneys which proclaimed their presence from some distance away. According to

39 R. Baker, in J. R. Lawrence (ed.), A Career in Social Work: Seven Personal Accounts, Sydney, UNSW School of Social Work, 1978, p.50. 131

information from psychiatric nurses employed there at the time, the role of doctors and ‘mental nurses’ was one of containment, not treatment.40

By the beginning of the 1950s, Claremont had room for 800 chronically mentally ill and intellectually disabled patients. However many of these had been admitted as children or young adults and were now elderly. By 1960 accommodation at the hospital had been stretched beyond capacity to provide accommodation for 1400 patients, which made the task of providing appropriate patient care extremely difficult. Institutional inertia and the dominance of the custodial model of care ensured that they remained in hospital and none had any concerned relatives or friends prepared to take them home or look after them. It was not until a series of complaints occurred regarding patient care and overcrowding at the hospital, that new legislation in the form of the Mental Health Act (1962) was introduced.41

4.3.3 Graylands Day Hospital

The development of Graylands Day Hospital, made it possible for people to receive daily psychiatric treatment while remaining in their own homes, and provided an alternative to the ageing Claremont Hospital for the Insane which had been in operation since early in the century.42 At that time there were 300 what were sometimes called ‘mentally defective’ and 100 senile patients in Claremont Hospital. 43 It was agreed that overcrowding at Claremont was a major problem but conflict arose between the Inspector General and a State Government planning committee that had been set up to submit plans for future development fourteen years previously.44 Dr Moynagh utilised an existing ward of Claremont Hospital to immediately establish the Day Hospital rather than defer this until a new building could be erected nearby at the Shenton Park Lemnos Hospital, as proposed by the committee. The committee also intended that a site that had been acquired earlier at Guildford on the northern outskirts of Perth (and what six years later would become

40 Participant no. 4 interviewed by author on 05/04/2001 and participant no. 7 interviewed by author on 17/04/20011. 41 Mental Health Act, 1962-64, Statutes of Western Australia, 1962. 42 D.W. Moynagh, Annual Report of the Inspector General of the Mental Health Services, 1959, Mental Health Library. 43 A. S. Ellis, Oral History Transcript p.222. 44 Ellis, Eloquent Testimony, p.123. 132

Pyrton Training Centre for children with intellectual disabilities) would be established as ‘a mental defectives colony.’ Criticism was made of Dr Moynagh’s plans for reducing overcrowding at Claremont by providing residential care facilities in the community, rather than providing new hospital buildings in close proximity to wards of the old hospital housing chronically ill patients.45

In an oral history interview with Ronda Jamieson, Dr Ellis, who succeeded Moynagh as Director of Mental Health, commented that although Moynagh had a lot of good ideas he overlooked the realities of the political situation; it was essential that any new plans to extend services were not only financially, but also politically viable. He added: ‘Moynagh had a lot of new ideas, and they were new ideas, but he wanted them done now, and it just wasn’t on’.46 Apparently there was another election due in 1962, and the government wanted to show that, by providing new buildings, they were taking some positive action. However Moynagh’s ideas clashed with those of the committee responsible to the Under Secretary of the Department. 47 Then in 1962 amidst a highly politicised dispute with this same Under-secretary, Moynagh resigned 48 Ellis commented on the necessity for an astute political awareness by the person administering the department, thus. ‘If you don’t work within the system, you’ll never change the system’.49 Then when the appointment of a successor to Moynagh was discussed in Parliament, F. Lavery (Minister for Local Government) recognised the difficulty inherent in the situation, and remarked, ‘I am hoping that when he is appointed, whoever he may be, will be responsible to the Minister, not to some under-secretary or other department head’.50 However Moynah’s influence continued after his resignation, in the adoption of his community-based approach to new legislation; the separation of the mentally ill and intellectually disabled, and rehabilitation and residential services that had already been established.

45 Ellis Eloquent Testimony, p.123. 46 Ellis, Oral History Transcript, p.224. 47 WAPD, Vol. 2, 1962, p.1207. 48 WAPD, Vol. 2, 1962, p.1208. 49 Ellis, Oral History Transcript, p.227. 50 WAPD, Vol. 2. 1962, p.1208. 133

4.3.4 Heathcote Hospital

Established in 1928 as a reception home in the then outer suburb of Applecross, Heathcote Hospital catered for 90 patients with acute psychiatric illnesses.51 Patients remained for comparatively short periods until they ‘recovered’ or, alternatively, were transferred elsewhere. While I was employed at Heathcote Hospital from 1966 – 1970, a van, cryptically referred to by some staff as ‘the tumbrel’, would park each week outside the discharge doors. It would remain there while patients who had been unresponsive to treatment and required long-term care were shepherded into it, destined for Claremont Hospital. Heathcote Hospital was a recognised training facility for psychiatrists and maintained an active research programme. The Superintendent, Dr R.Ellison, having trained and practised in English hospitals, was familiar with the training and capabilities of psychiatric social workers. In 1964, Helen Jaspan, who was newly arrived in Western Australia and possessed these qualifications, was appointed to the staff.52 She was also experienced in family centred and marital casework, and participated in group-work and research and training programmes for social workers, psychiatrists and allied health practitioners. In the two years she worked at Heathcote she identified a number of issues: the social work role as part of the interdisciplinary team dealing with mental illness; the introduction of the patients’ social history as a diagnostic tool in mental treatment; and recognition of the families of patients and their support networks as an integral concern in psychiatry.

It had been the practice for the admitting doctor to concentrate on obtaining the patient’s psychiatric symptomatology, but this information from the patient or relative concerning events precipitating hospital admission was often incomplete and unreliable. When a social work service became available it included visiting the patient’s home whenever possible to obtain details of personal and family background, significant relationships, cultural issues, education, employment, and behaviour.

51 Ellis, Eloquent Testimony, p. 84. 52 Social Welfare, WA Public Service List 1965. H. Jaspan was appointed 22 February 1965. 134

During the early days of my employment at Heathcote, I learned how to conceptualise the social and environmental issues associated with a patient’s psychiatric illness.53 The information would be recorded and possibly questioned at twice-weekly meetings in the psychiatrist’s office attended by medical, psychological, social work, occupational therapy and senior nursing staff. Each team member contributed to the discussion and a provisional diagnosis would be made. In this way it became established that the social work role extended beyond the relief of psychiatric symptoms. However, it was always the psychiatrist who made the final decision about treatment and the destination of the patient.

The Superintendent at Heathcote also introduced a series of amateur one-act plays by local playrights; each play demonstrated an aspect of psychiatric illness and its effect on the individual and on family members. The social worker played a prominent role as member of a panel of professional staff who would reply to questions from the audience following the performance.54 That social workers were regarded highly at Heathcote is illustrated by the fact that in certain ways they were treated equally to other professionally qualified staff. Each had a separate office and enjoyed the facilities of a staff common room and separate dining room.

In the late 1960s ‘Bridgewater’, a residential institution of the then Child Welfare Department (CWD) was established in Applecross on a site directly opposite Heathcote Hospital. At that time the hospital contained a number of female patients whose young children needed to be placed temporarily in care, plus a number of adolescent girls who had both behavioural and psychiatric disorders. As treatment at Heathcote was limited to those with acute psychiatric illnesses, all patients requiring longer-term care were transferred to Claremont Hospital. The close location of Heathcote to Bridgewater made it much easier to initiate communication between them. A series of interdepartmental case-conferences to discuss management plans was commenced. These proved successful in some cases but in others the outcome

53 The author was employed as a social worker by the MHS from 1966-1984, then intermittently until 1989. 54 Informant no. 6 interviewed by author on 10/04/2001 135

was hindered by the strict observance of confidentiality requirements by both agencies.55

A particular sexual division of social welfare services developed at Heathcote hospital where relationships between psychiatrists and social workers differed according to long established medically oriented traditions. Social workers on the female wards of the hospital joined male psychiatrists in joint marital therapy and post-graduate clinical research presentations, but this was not so on the male wards. What was said at the time was that psychiatrists preferred to work with the male welfare officers as they had done for several years prior to the appointment of social workers.

4.3.5 Allied Health Professions

During the period of de-institutionalisation, social and cultural factors were recognised as part of the aetiology of mental illness, and members of associated professions, referred to as ‘allied health professionals’ were included with doctors as part of the treatment team. These professions comprised psychology, social work, occupational therapy, and to a lesser extent physiotherapy, podiatry and speech therapy. Consequently psychiatry, rather than being the sole occupant of the mental health field, became only one of the disciplines involved. This change in orientation rendered what was seen as the purely medical model of mental illness that had traditionally been used, to be no longer viable. Nevertheless psychiatrists retained the leadership position, indeed the presence of social workers and others was not acknowledged except in the clinical notes. Psychiatric reports to outside agencies included allied health material subsumed under the medical summaries and consequently these remained invisible beyond the walls of the hospital. The following sections will discuss the development of these professional groups and the manner in which they varied in response to political and ideological changes.

55 Ailsa Smith, formerly Superintendent of Bridgewater Reception Centre, Phone interview with author, 2007. 136

Clinical Psychology

Ross Smith defines clinical psychologists as having ‘a basic training in the science of human behaviour and its application to management, prevention and treatment of mental and emotional disturbances’ whereas the psychiatrist has ‘a basic training in medicine and later goes on to study the application of medicine to the prevention and treatment of mental disturbances’.56 In Western Australia psychologists were the first professions after psychiatry to be associated with mental illness. Psychology was first taught in the Department of Philosophy at the University of Western Australia when it was established in 1913. The entry of psychologists to the mental health field was precipitated in the 1920s by an expanding interest in Eugenics and the establishment of the State’s first children’s adolescent clinic.57 This led to the identification of standards of intellectual ability and the separation of those with intellectual disability from the population classified as insane. The clinic closed during the depression years of the 1930s.

It was during the 1940s that psychologists first entered the psychiatric field. Initially it was almost exclusively in the assessment of intelligence and personality, then in the role of non-directive therapy. In 1949 a course in Clinical Psychology was established at the UWA and in the following year the Department of Health opened a Child Guidance Clinic. At that time psychological practice was influenced by Freudian psychoanalysis, and much of the succeeding work was based on the principles it embraced. The following year the first psychologist was appointed to the Claremont and Heathcote Mental Hospitals. In the following years the creation of the Mental Deficiency and Forensic Divisions increased the demand for psychological services and saw the appointment of Ross Smith as Principal Clinical Psychologist in 1969. Then in the 1960s the principles of behaviour modification were applied, both to the inmates of hospitals and to institutions catering for the intellectually disabled.

It was in the Mental Deficiency Division of the MHS that psychologists became prominent, not only due to their behaviour modification programmes, but also because of their interest in administration and the additional qualifications that were involved.

56 R. Smith, Reflections of a Clinical Psychologist, Perth, Hesperian Press, 1999, ‘Introduction.’ 57 Smith, Introduction: Reflections of a Clinical Psychologist. 137

The appointment of Errol Cocks as Deputy Superintendent of the Mental Retardation Division was the highest yet given to a psychologist, and the first to a non-medical person to a position of that kind.58

The Department of Psychology at the UWA reinforced the participation of psychologists in the area of research. Not only did it provide professional education for its students in psychopathology, but also for trainee psychiatrists in the MHS. It is interesting to note the growing respect given to the profession in the expanding health and welfare services of the Whitlam years. During this time Ross Smith was appointed to a committee set up by the Australian Psychological Society to provide national inputs to the Federal Government on the role of psychologists in community health care. He also held a similar appointment for a three year term on the National Health and Medical Research Council Mental Health Committee.

Occupational therapy

In the 1950s occupational therapists began to enter the employ of the MHS. Ellis reports that work commenced on a Social and Occupational Therapy building at Heathcote; appointments were made there and at Claremont Hospital.59 The occupational therapy departments provided a wide variety of craft and other activities and conducted work on the wards including sport, play reading, current affairs, discussions and outings in the community. As the number of admissions rose at Heathcote Hospital, group therapy techniques were introduced. Professional boundaries expanded in 1966 when occupational therapists were employed in the Pyrton Training Centre when they were employed in connection with the policy of normalisation, and at Irrabeena, the testing and diagnostic centre which had been set up by the Slow Learning Children’s Group in the 1950s but which had been taken over by the MDD in 1964 where they worked in the area of assessment. Services were extended later to the metropolitan clinics. There, occupational therapy skills were utilised to introduce patients to provide educational and diversional therapy programmes.

58 Carman-Brown and Fox, Doctors, Psychologists and Educators, P.230. 59 Ellis, Eloquent Testimony, pp.181-183. 138

4.4 Mental Health legislation

A new Mental Health Bill was introduced into parliament by the Hon Ross Hutchinson, Minister for Health in 1962, which aimed to remove existing certification procedures in mental health hospitals, make them compatible as far as possible with those of general hospitals and introduce new trends in rehabilitation.60 In effect this was the first piece of legislation which promoted the process of de-institutionalisation, so its importance to my story cannot be over-estimated.

Among its many clauses, words such as lunacy, insanity, license, trial leave and escape were to be dropped in order to remove the stigma of mental illness; children under 16 were no longer to be certified but would be provided for in the future under the new Child Welfare Act; and a Board of Visitors (as was already in existence) was to be given wider powers of investigation. The new Act was to replace the existing Lunacy Act, the Mental Treatment Act, the Mental Treatment (War Service) Act and the Inebriates Act. It was to have a profound impact on both the treatment of the mentally ill and the employment of mental health social workers. In the parliamentary debate that followed the introduction of the Bill, a number of amendments were made. The Hon L. A. Logan argued that it was necessary to define mental illness more precisely:

(in) treatment of the mentally ill we should be ending the feeling of despair that affects patients when they are transferred from one hospital to another…one of the outstanding features of the present time is the reluctance of people to seek medical advice at an early stage of an illness, they will wait until the condition has deteriorated so much that it takes long treatment to bring them back on the road to happiness.61

John Brady (Member for Swan) pointed out the problems arising from committal of people to asylums who were not insane. He quoted the case of a woman who had contacted him after having been admitted first to Heathcote then to Claremont

60 WAPD, Vol. 1, 1962, p.874. 61 WAPD, Vol. 2, 1962, p.1194. 139

Hospital when she was not insane in any way. Under the new Act it was intended that patients could be admitted to a mental hospital after the appropriate referral forms had been filled in, but no such procedure was necessary for voluntary patients. Provision was also made for private hospitals to treat psychiatric patients on a voluntary basis. Other matters for debate concerned the protection of individual rights of patients who had property, but were considered to be incapable of handling their affairs. Previously such property had automatically been placed under the care of the Public Trustee, and a payment of 5 % of the income of an insane person made to the Public Trustee. The introduction of a Public Trustee Amendment Bill required a set charge to be made for each person, together with a psychiatric assessment before this was done.

Treatment of the intellectually disabled was addressed by replacement of the term ‘mental disorder’ by ‘mental incapacity’. The Hon. Ruby Hutchinson described the horror of some parents at the poor conditions of children at Claremont Hospital, where girls and boys with intellectual disabilities were treated in large wards by male attendants and asked the Minister to consider the separation of ‘mental defectives’ from the mentally ill.62 A change in the conceptualisation of mental illness from a psychological and medical approach to one that involved social and environmental aspects of patient care was reflected in attempts to introduce changes in legislation, whereby intellectual disability was no longer classified as a mental illness.

The Mental Health Act 1962-1964 passed through the Legislative Council with the introduction of amendments concerning the estates of incapable persons, the qualifications of the Director and his deputy, and the rights of patients to contact their members of parliament. A department known as the Mental Health Services was established to be administered by a Director directly responsible to the Minister. The methods of admission to approved hospitals were:

62 WAPD, Vol. 2, 1962, p.1198. Mrs Ruby Hutchinson was a member of the Legislative Council and Chairman of the Mental Health Committee of the Western Australian Branch of the Labor Party. 140

 Division 1 Informal Admission A person who in the opinion of the superintendent was, or appeared to be, suffering from a mental illness could be admitted to an approved hospital.63

 Division 2 Admission by referral

A person could be received into an approved hospital by the production of a referral from a medical practitioner, based on his personal examination of that person for a period not exceeding 72 hours. During that period the person had to be examined by a psychiatrist and if necessary, admitted as a patient.64

 Division 3 Admission following Reception Order

A person could be received for a period of 72 hours on application in the prescribed manner by a Justice, when the Justice was satisfied the person was suffering from a mental disorder, and if necessary the person could be conveyed by the police, or some person authorised by the minister, to an approved hospital. Persons on remand could also be admitted for observation for a period not exceeding 28 days.65

 Division 4 Detention of patients

Unless his or her status was extended, a patient should be discharged after a period of six months from the day of admission as a patient.66

 Division 5 Leave of Absence and After Care

The key point of the legislation for the process of deinstitutionalisation lay in the clauses relating to After Care. The Superintendent or any medical officer of the department could discharge a patient admitted under the status of Divisions 2 and 3 to After Care status ‘under the supervision of a medical practitioner or any suitable

63 11 Elizabeth 11 1962 Vol 1 Acts nos. 1-90, The Mental Health Act 1962 Part 1V sect. 27(1), Statutes of Western Australia, 1962, p. 250. 64 Mental Health Act, 1962, Part 1V Section 28(1), Statutes of Western Australia, 1962, p.251. 65 Mental Health Act Part 1V Sections 29-36, p.251-252. 66 Mental Health Act Section 38. 141

person willing to undertake it’. After Care status could, however, be rescinded and the patient recalled to hospital. 67 If it appeared to be in the interest of the patient to remain on After Care status, the superintendent could require him to be examined by a medical practitioner nominated by him. The patient could then remain on after care for a further 12 months.68 Crucially too, the old title of Inspector General was abolished, and Dr A Ellis, was appointed as Director of the MHS in 1963.69 He had joined the Department in 1963 after previously being employed by the Victorian Mental Hygiene Authority, where an active programme of rehabilitation and the return of patients to the community had already replaced the old concept of custodial care. He was to play a leading role in the history of mental health for many years.

One of the difficulties associated with administration of the Act was the shortage of social workers to provide background information concerning patient admissions, and support when they were discharged. The initial influx of social work staff from overseas had not continued, and the Hon. Ruby Hutchinson suggested a solution to the problem.70 She referred to a newspaper article by the journalist Athol Thomas which commented on the grave shortage of social workers at that time.71 The writer of the article described one of the popular descriptions of image of social workers as ‘do- gooders who handed out tea, bread and sympathy, and not much else’. He contrasted this with the actuality of the situation as the value of social work was now recognised by the State in a number of specialised agencies, including mental health. Mrs Hutchinson added that this shortage was probably much worse now. She had been informed that social work employers preferred middle-aged women as they had the necessary understanding that only came with experience. In order to overcome this in the future she suggested that adolescent girls should be given some social service training as they left school, which would help them become better wives and mothers, as well as open up a new field of employment. When they were middle-aged women this training and experience would enable them to work in the mental health field. She commented, ‘it must be remembered that the medical profession is recommending that

67 Mental Health Act Section 43. 68 Mental Health Act Section 45. 69 Ellis, Eloquent Testimony, p 138. 70 Mental Health Bill, Second reading resumed 25 Sept 1962. WAPD, Vol.162, New series 1962, p. 1196. 71 The West Australian, 1 December 1961. 142

people could be cared for at home, but this is rarely possible because help is not available’.72

In 1967 a conference of State and Commonwealth health ministers in Perth took another step which underpinned deinstitutionalisation when they established a Charter for Mental Health Services. This event had a significant impact on services for the mentally ill in WA. At that time, members of the public were unaware that when age and invalid pensioners were referred to approved mental hospitals, their pensions were cancelled by the Commonwealth Government.73 This practice, which resulted in hardship for families, was justified on the grounds that, as recipients were not being charged fees, they did not require pensions. Following recommendations of the Charter to redress this situation, pensions were granted to all patients with ‘a reasonable hope of recovery’. The Charter also pointed out that differences existed between the mentally ill and the intellectually disabled patients, and recommendations were made that both categories should receive similar benefits and subsidies. And, importantly, the Federal Minister for Health confirmed that the Commonwealth would stimulate the introduction of accommodation hostels and sheltered workshops on the basis of a $2 for $1 subsidy.74

4.5 Deinstitutionalisation

When Dr H. Blackmore was appointed as Physician Superintendent of Claremont Hospital in 1967, the new Mental Health Act permitted him to reorganise the hospital and establish a policy of de-institutionalisation.75 There were then 1400 hundred in- patients, 400 of whom had remained in hospital because they had become unable to care for themselves and had no concerned relatives or friends prepared to take them home. They were considered to no longer require inpatient care and were transferred to hostels in the community. This decision was strongly criticised at the time by some employees of the MHS.76 Four nurses, who were given the title of After Care Nurses, were transferred from the wards, relocated upstairs in a back section of the hospital

72 WAPD, Vol.162, New Series 1962, p.1196. 73 Ellis, Eloquent Testimony, p. 142. 74 Ellis, Eloquent Testimony, p.142 75 Annual Report of the MHS, 1968. 76 In R. Jamieson’s oral history transcript Dr Ellis describes the departmental criticism surrounding these events. 143

that had been nurses’ quarters77 and were required to find hostels and nursing homes so patients could be discharged.78

One of the nurses who began working on the Claremont Hospital wards in 1954 commented that Dr Blackmore improved the conditions, particularly in the children’s wards where there was no segregation.79 He explained:

Dr Blackmore separated the wards into mental disorders, and pushed the people who should not have been there into hostels. He called for volunteers from among the ward staff for community care nurses… there were four of us - two male nurses and two females. Dr Blackmore said ‘open the doors’, and I said ‘ but all the people will escape’- he was right and I was wrong…We would go into C Class Hospitals, nursing homes and private residences in the metropolitan area to try and keep the patients out of hospital. Until the social workers came we were directly responsible to Dr Blackmore… We overlapped into each others’ boundaries….At the weekly team meetings we would decide what action would be taken, but there was a bit of professional jealousy from the nursing staff because we were ‘outside’.

It appears that social workers were not always welcomed by members of the hospital based nursing staff, according to a comment:

‘What the blazes do we need these people for?’ This attitude changed when they found out what they did. …We would point out that social workers looked after pensions. They would take a lot of pressure off the patient, and if the patient wanted advice about getting money the social worker would have this advice at their fingertips. 80

Approximately 400 patients were discharged in this way during the next eighteen months, to privately owned hostels and nursing homes.81 Another of the nurses commented:

77 This was to become the location of the social work department. 78 Section 43 of the Mental Health Act of 1962-64 provided for patients to be discharged on after care for a limited period. This was intended for their own protection as they could be re-admitted when necessary without the need for further certification. 79 Participant no. 4 interviewed by author on 05/04/2001. 80 Participant no. 4 interviewed by author on 05/04/2001. 81 H. Blackmore, ‘De-institutionalisation: Claremont to Graylands’, in Western Australian Psychiatry Since Federation, Perth, 2001, p. 3. 144

When I started at the job it was new. I was so full of it. I’d never seen or heard anything like it. When I first began nursing we had no helpful psychiatric medication. When these came out you could see the change in a patient from being confused to coming back to reality, in particular the lady who would not go (from Claremont Hospital) because she feared a relapse…. We were on After Care, going to hostels and private homes to visit and talk to them. Private homes I preferred because you could talk to the relatives and take some of the stigma away. I was very happy that I could ease some of that stigma to a degree by explaining to the relatives what was happening. 82

In 1967 the position of Senior Social Worker was created in order to help coordinate the deinstitutionalisation process and supervise a potential staff of social workers, mental health officers and after-care nurses.83 It was advertised in the press for over twelve months, but local social workers familiar with the situation at Claremont were daunted by what appeared to be the enormity of the task. British-trained Margaret Aylen finally accepted the position.84 The function of the department was to arrange the transfers and continue their supervision after discharge when this was necessary. Such patients retained the status of After Care patients for their own protection, rather than being discharged outright.85 Those discharged in this way were moved to hostels in the community under the supervision of the nurses. However, little could prevent many of the hostels from becoming, in effect, the ‘back wards’ of the old mental institution and complaints proliferated about the conditions and overcrowding.86

Weekly ward meetings were introduced at Claremont during which the doctors would determine those patients no longer requiring in-patient care.87 Social work staff, in addition to providing background information, had to find accommodation for patients so that discharges could be made, and to assist those who had difficulty managing their own affairs. Although the Public Trustee assumed care of the estates of patients deemed ‘incapable of handling their own affairs’, day-to-day expenses and those relating to transfer to hostels and nursing homes were handled by social workers and

82 Participant no, 5 interviewed by author on 09/04/2001. 83 Participant no.8 interviewed by author on 22/08/2001. 84 M. Aylen was appointed to the position of Senior Social Worker Claremont Hospital, WA Public Service List 13, January 1969, Item 1185, Level 4, P. 33. 85 Mental Health Act 1962. 86 Participant no.9 interviewed by author on 28/08/2001. 87 Participant no.5 interviewed by author on 09/04/2001. 145

mental health officers.88 Teamwork was essential in this situation as social work tasks often overlapped with those of other workers. Resentment occurred between mental health officers who had been employed on welfare duties in Claremont Hospital and the newly appointed social workers.89 One of the psychiatrists employed at the time observed in an interview that these tasks sometimes involved interviewing relatives, assisting with discharge and care of patients, and occasionally picking up luggage and taking care of patients’ possessions.90

Social Work Administration came to be situated in the rooms previously allocated to the After Care Nurses (the former nurses’ quarters) in Claremont Hospital, and because of this location, which was upstairs and at the back of the hospital, communication and consultation between staff was difficult. This situation continued until 1972 when Claremont Hospital was divided into two sections: Graylands Hospital for the treatment of psychiatric patients and Swanbourne Hospital for psycho/geriatric patients.91

4.5.1 Outpatient clinics

As part of the process of deinstitutionalisation, outpatient clinics were established to monitor the progress of discharged and After-Care patients and offer an outpatient service to the public. Two of the social workers first employed at the clinics were male. A social worker employed at the main clinic, Havelock Clinic, which was situated near the city of Perth, commented in an interview:

I used to get everyone who was young- a lot of young people who were wrestling with their identity. I also saw a lot of homosexual clients when that was very much unacceptable. I did a lot of follow up for people who were being treated for a psychiatric disorder… a lot of people came back to be managed by Havelock Clinic before they had psychiatric emergency teams. …my job was to see that people functioned as well in the community as possible. That’s always been my orientation as a social worker, that’s how it was at Havelock Clinic. I would use the system to benefit the person who finished up being my client. We were all brought up on that psychosocial stuff; I

88 Participant no.22 interviewed by author on 17/02/2001. 89 Participant no.21 interviewed by author, 28/11/2002. 90 Participant no.8 interviewed by author on 22/08/2001. 91 Ellis, Eloquent Testimony, p.141. 146

very much used that model in that clinical setting. We had a lot of work interfacing with the family, a lot were for intensive counselling, especially young males. They (the doctors) weren’t going to pump them full of psychotropic drugs because they were wrestling with their sexual identity.92

He then related the story of a man whose paranoia concerned a fear of people about to kill him. A visit to the man’s workplace revealed a middle-aged man of European descent with little understanding of English. His experience illustrates other aspects of the work of social workers.

They were certainly waging a war against this man. They would drop lumber near him and would run a front-end loader near him because they didn’t like him. They weren’t trying to kill him they were just ‘creating’, as guys do in the workplace. It was a reality, and here we were treating him as a paranoid schizophrenic. He was a man with a very difficult personality. We found a few of those when we went out to discover what the actual behaviour was.93

He then described the case of a ‘little old lady’ in her late eighties who was being treated for paranoid delusions:

She used to wake her husband up in the middle of the night and say ‘they’re putting insects into my bed, let’s change beds’. Then she’d wake up again and say the same thing. She’d get water from Langley Park because she thought they were poisoning the water. What were we going to do with this lady because there was no way any nursing home would take her? She rang the police every day. It would have been tragic to separate them after many years of marriage. A decision was made to give her shock treatment. I discussed this with her husband and he wanted it. He just wanted her behaviour to change, it was wearing him down. Well, it knocked out the delusions, they just disappeared.

After working for two years at Havelock Clinic he felt it was time to move on. He added:

Men either gravitate or seek out management positions, but those opportunities never existed in mental health in those days- you had to be a member of a clinical team. It depends where you are. Havelock

92 Participant no 15 interviewed by author on 12/11/ 2001. 93 Participant no.15 interviewed by author on 12/11/2001. 147

Clinic was very interesting- we had a tremendous amount of freedom. It was an interesting job.94

The other male social worker was employed at Bentley Clinic. At the time, he explained to me, there were a number of patients, many who had been hospitalised in Claremont Hospital for years, who had multiple social and interpersonal problems; they were the cases that no one else wanted to touch. In his opinion their problems were compatible with the principles of family therapy that had only recently been introduced. He subsequently became one of the pioneers in this methodology in the MHS.95

Although treatment was supposedly organised on multi-disciplinary principles, when I worked at Bentley Clinic it was the Psychiatrist Superintendent who determined all professional roles. He had embraced the concept of community psychiatry, and the clinics had become involved in attempts to treat patients at home rather than admit them to hospital. The superintendent was against the labelling of people by placing them in diagnostic categories and argued that people responded in an ideocentric manner to stresses that others were unable to understand. He believed that personal guidance and family support could modify the impact of such delusions. A number of women patients, who had been discharged after a prolonged period of hospitalisation, were placed in hostels, while others, whose families had long ago given up hope of their release, were returned home. When these women first presented at the clinics, their bewilderment at being confronted with a completely new lifestyle was dramatically exposed.

The gender relations in the clinic had less to do with the structures of services and more to do with the interpersonal dynamics of case conferences. Those present at case conferences were the superintendent, nurses, clinical psychologist, social worker, three mental health voluntary workers and the clinic secretary. The superintendent distributed new cases according to the social and medical background data provided by patients on arrival at the clinic and assessments made by the psychiatrist. Patients requiring ‘psychotherapy’ for individual or marital stresses were referred to the

94 Participant no.15 interviewed by author on 12/11/2001. 95 Personal communication from Karlos (Charlie) Raduzis, undated. He was a graduate of the UWA, Dip. Social Work Course in 1966. 148

clinical psychologist. The social worker was referred “social problems” which consisted mainly of visiting the patient’s home to check the situation, finding accommodation for women fleeing from domestic violence, placement of children, and “supportive work” with the families. The nurses, who were mainly clinic based, would be called on to visit the patients in “emergencies”. The nurses often said to me that it felt like being seated around a table with father at the head, and being allocated the weekly family tasks. Clearly the superintendent occupied the most powerful position at the clinics, not only because of the traditional authority of psychiatry in mental health but also because of the masculine character of the psychiatric profession.

4.6 Core themes

Changing conceptualisations of mental illness

A core theme of the chapter is the impact of the introduction of social science ideology into what had traditionally been a medical model of illness. In 1959 the Inspector General Dr D.W.Moynagh established ‘a revolutionary new innovation’- Graylands Day Hospital as an alternative to the overcrowded Claremont Hospital making it possible for patients to receive day psychiatric treatment while remaining living in their own homes. In doing so he introduced social and environmental factors into what had previously been a medical model of mental illness. It was also revolutionary in that for the first time in WA qualified social workers were employed to participate in treatment of the mentally ill. Psychological factors were already added to medical ones in diagnostic procedures at Child Guidance Clinics overseas, and the availability of qualified psychiatric social workers in WA enabled the treatment team of psychiatrist, psychologist and social worker, which was to become standard practice in psychiatric institutions, to be established.

The realisation that factors other than the medical played a part in the cause and treatment of mental illness led to the introduction of an International Classification of Disease in the 1940s, which was revised in 1952 and subsequently adopted in WA throughout the MHS. The invention of psychotropic drugs, the advent of the anti- psychiatry movement, together with apprehension regarding conditions at Claremont Hospital, accelerated the adoption of deinstitutionalisation in the 1960s. With this 149

came the introduction of a community-based model of mental health care, based on the principle that the community, not the hospital should be the main source of treatment. This was to revolutionise once again facilities for the care of the mentally ill in WA. The extension of community psychiatric clinics in Perth suburbs was the outcome of this changing concept of mental health services.

Influence of legislation

Mental health legislation, which prepared the way for the deinstitutionalisation of hospital patients and extension of social work activities is another core theme. Social work establishment and development is closely linked to legislation contained in the Mental Health Act of 1962/64. The Act aimed to remove existing certification procedures based on the old 1905 legislation, to incorporate changes that had been made in the conceptualisation of mental illness to make them compatible as far as possible with general hospitals, and to introduce trends in rehabilitation. A department known as the Mental Health Services was established, to be administered by a Director directly responsible to the Minister. It also provided safeguards to protect the compulsory admission and treatment of patients in mental hospitals. And, what was of special significance to the development of social work services, the Mental Health Act of 1962/64, provided after-care provisions for patients when they left hospital. However one of the difficulties was the shortage of social workers to supply background information concerning admissions and support for patients when discharged.

When Dr H. Blackmore was appointed Superintendent of Claremont Hospital in 1967 the legislation permitted him to utilise the newly established category of After Care, and discharge patients who no longer required hospital treatment, but remained there as they had nobody to care for them in the community. He transferred four nurses from the wards and established a Social Welfare Department under the supervision of an experienced social worker, comprising social workers, mental health officers and community care nurses to assist in the transfer of patients to hostels and nursing homes. Teamwork was essential. This became the prototype for the social welfare teams in other mental health units.

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Gender and power relationships

A further theme is the influence of gender in the hierarchy of power relationships in the mental health system. From 1959, when social workers became established in Western Australia, they fell into a secondary role to the primary profession of psychiatry. Although social workers, psychologists and occupational therapists were included as part of treatment teams, it was the psychiatrist who always had the last word. Psychiatry, which developed as a male profession in the nineteenth and early twentieth century, retained this position as the female-dominated professions of nursing and social work entered the mental health field.

Male, Psychiatrist-Superintendents of hospitals and clinics were responsible for the appointment and supervision of social work and other professional staff, consequently social work activities were dependent on the orientation (and sometimes the good will) of particular individuals. Mental hospitals, which were the point of origin of social work practice in WA, followed the British tradition of hierarchical organisation, headed by a superintendent and structured according to the importance ascribed to other employee groups. Because, at Claremont Hospital, a traditional hierarchy was established and social work was placed in the hierarchy at a subordinate level, the gendered structure of the institution significantly shaped the roles of the largely female social work workforce.

4.7 Summary

This chapter has examined the legislative structure and ideological basis on which mental health social work in Western Australia developed in the years between 1959 and 1973. It describes the entry of social work from the time when the first qualified social workers were appointed in Western Australia in the mental health services until 1973 when administrative decisions affected the profession. During that time a number of changes occurred in the conceptualisation of mental illness in which the established medical model was replaced by others which included psychological, social and environmental factors. Following this, the dominant medical model of mental illness was modified as social work and other mental health professions were

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included as members of the treatment team. In this process gender played a pivitol role, as the male dominated psychiatric profession retained supremacy.

Mental health legislation of 1962/64 was a significant feature in the establishment of social work in the MHS. This was made possible by the introduction of After Care as a category, whereby patients could retain mental health services while residing in the community, accelerated deinstitutionalisation of mental health hospitals, which had been occurring since the introduction of new psychiatric drugs and treatments from the 1950s. This policy established a need for the employment of additional social workers, and the formation of the Social Welfare Department at Claremont Hospital headed by an experienced social worker. Among the many functions of social workers, perhaps the most important was the placing of patients who had no family to care for them, in community hostels and nursing homes.

Running through the chapter are a number of core themes in which issues of power and gender are interwoven with political issues and with changes in the concept of mental illness. The following chapters describe social work’s journey from 1974 until the end of the 1990s. The next chapter which I have titled ‘The Honeymoon Period’ covers the period between 1974 and 1983.

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Chapter 5

The ‘Honeymoon’ Period

1973 to 1984

This chapter follows a historical journey that begins in 1973 with the appointment of a senior social worker to the position of Principal Social Worker, which recognised social work as an autonomous profession within the MHS and ends when the department became amalgamated as a member of the Health Department of WA in 1984.1 The intervening years represented a ‘honeymoon period’ for social workers who enjoyed a sense of jubilation at the newly acquired independence of professional practice. As the journey progresses it encounters some of those who were employed by the department and is informed by the challenges and ethical questions which arose along the way. However developments during the 1973-1983 period were not dependent solely on social work’s position in the mental health professional hierarchy but were associated with a number of inter-related professional, political, social and administrative issues which I discuss in the following sections of the chapter.

5.0 Development of social work services

5.1 Political influences

We now turn to the political influences that impacted on the development of social work as a profession. The states had traditionally been responsible for funding public health services until the Commonwealth began to fund primary care, private psychiatry, medication and income maintenance, while non government (for profit and not for profit) organisations began to provide other community health services.2 Elliott and Graycar demonstrate that during the era preceding the 1970s the approach of conservative governments in social policy was one of ‘cautious, regulatory

1 Social work was transferred from the General to the Professional Division in 1964 but a Principal Social Work position was not established until 1973 for the MHS. Ross Smith in his Reflections of a Clinical Psychologist, Victoria Park, Hesperian Press, 1999, writes that a Principal Psychologist had earlier been appointed. Similar appointments were made shortly afterwards for Occupational Therapists and Nurses. 2 M. Harries and G. Smith, ‘Trends in Mental health Policy and Implementation in Australia’, Community Care: New Partnerships and Perspectives, ACOSS Conference Paper, 27 October 1994. 153

administration of incremental change’ and that while economic expansion was slow and unemployment was rising rapidly the overriding impression was that there were few major social policy initiatives during that time.3

When the Whitlam Labor government took office in 1972 it developed a clearly articulated reformist policy that involved greater commitment to the underprivileged by the redistribution of power through a system of participatory planning.4 The policy resulted in the expansion of Commonwealth money by a system of ‘matched grants’ to the states for the establishment of community mental health clinics. However the policy terminated in 1981, after which there was no direct Commonwealth funding of State mental health services. During the intervening ten years the new ideology of community care, coupled with the efforts of consumer groups to improve the quality of care to the mentally ill, led to a period of substantive reform.5 Late in 1975, however, when the Liberal and Country parties were returned to government these programmes were cut back in an effort to reduce government spending.

One of the first initiatives of the Whitlam Government was the establishment of the Hospitals and Health Services Commission, an independent statutory authority responsible to the Minister for Health and chaired by Dr Sidney Sax.6 The government proposed establishing a National Hospitals Commission to promote the modernisation and regionalisation of hospitals, and extend the support of community based health services and preventive health programmes.7 It also proposed replacing the existing health system in which health services were funded by voluntary health insurance, with Medibank, which was funded by a levy proportionate to the income of each taxpayer.8 Palmer in his examination of the politicisation of health funding in the 1970s, noted that the government’s intention was that financing of medical and hospital services should lie outside the operation of the market, and this was consistent

3 G. Elliott, & A. Graycar, ‘Social Welfare’, in A. Patience & B. Head (eds.), From Whitlam to Fraser: Reform and reactions in Australian politics, Melbourne, Oxford University Press, 1979, pp.88-102. 4 Elliott & Graycar, Social Welfare, p.88. 5 Elliott & Graycar, Social Welfare, p.3. 6 Elliott & Graycar, Social Welfare, p.120. 7 Address by Mr. Hayden to the 1972 national conference of the Australian Hospitals Association, quoted by Patience & Head, in From Whitlam to Fraser, p.119. 8 G. Palmer, ‘Health’, in A. Patience & B. Head (eds.), From Whitlam to Fraser: reform and reaction in Australian politics, Melbourne, Oxford University Press, 1979, pp.103-124, contains a detailed analysis of the Medicare provisions. 154

with the opinions of trade union supporters and members of welfare organisations.9 He also noted that the policy favoured the employment of persons such as social workers and teachers whose salaries were entirely financed through government expenditure, an opinion that was not shared by doctors who were employed on a fee-for-service basis.10 Another Whitlam government initiative was the 1972 Australian Assistance Plan (AAP) which established a system of regional organisations comprising representatives of all Australian and State Government departments, trade unions, employer and non- government groups associated with social welfare, for the purpose of identifying ‘target groups’ that had specific funding needs; Western Australia was one of the States in which these regional organisations were set up. 11 This influx of federal funding enabled community-based projects to be established by the West Australian MHS, and promoted a need for additional social work staff and those with competence in health-related areas of the social sciences. The employment in these projects of individuals who had not been trained in the rigidly hierarchical medical settings of a mental hospital was accompanied by their expectation that they would participate in discussion and decision-making.12 Consequently significant challenges were presented to hospitals and other mental health organisations that had developed on authoritarian and hierarchical principles.

Following its victory in the 1975 elections, Malcolm Fraser’s Liberal and National Country Party coalition, supported by the Australian Medical Association, decided to maintain Medibank, but reduce its impact on Federal Government funds by preserving the private fee-for-service practice in hospitals.13 Among its new initiatives was the imposition of a levy of 2.5% of taxable income on all taxpayers having incomes above certain exemption levels. The Hospital and Health Services Commission was then taken over by a bureau responsible to the Director General of Health, a move that was representative of the distinct differences of emphasis between the Labor party and the

9 Palmer, ‘Health’, p.104. 10Palmer, ‘Health’, p.104. 11 P.D. Groenewegen, ‘Federalism’ in Patience and Head (eds.), From Whitlam to Fraser, p.61. The other States in which such organisations were set up were Queensland. New South Wales and Victoria. 12 Participant no.16 interviewed by author on 13/11/01. Similar experiences can be found in other countries. See for example the USA. R. Rubenstein.and H. Lasswell, The Sharing of Power in a Psychiatric Hospital, New Haven, Yale University Press, 1966. The authors describe the functions and interactions of staff and patients in the Yale Psychiatric Institute. 13 Health Insurance Commission, Second Annual Report 1975-1976, Canberra, quoted by G. Palmer, ‘Health’, in A. Patience & B. Head (eds.), From Whitlam to Fraser, p.110. 155

Liberal-National Country Party coalition. Although the community development programmes were continued as part of its ‘new federalism’ policy, responsibility was given to the states for most of the programmes previously undertaken by the Commonwealth.

5.2 Feminist influences

The impact of the burgeoning second wave feminist movement in the 1960s and 1970s was increased when Labor came to power. Early in 1972 the Women’s Electoral Lobby was formed to push for reforms in such areas as women’s employment, sexuality and childcare. Commonwealth government finance was provided for the appointment of an Advisor on Women’s Affairs to the Prime Minister’s office, and following an application to the Arbitration Commission to open the National Wage Case, on December 13th 1972, the establishment of ‘equal pay for work of equal value’ was handed down and the wages of 50,000 women, including transport drivers, hospital workers and Commonwealth public servants, were increased.14

In March 1973, Elizabeth Reid was appointed to the position of Advisor to the Prime Minister and submissions on a wide range of women’s issues were presented to the Government. However her duties were not clearly defined and she was given no staff. Indeed, the Whitlam Government was criticised for ‘throwing a few sops’ to women, and failing to increase the numbers of representitatives on the bench, on boards of public authorities and in the top echelons of the Public Service.15 All these government community programmes required massive expenditure. Further, the ad hoc manner whereby the National Advisory Committee, which represented members of government and non-government bodies, allocated funds to women’s refuges, rape crisis centres and a number of health and welfare projects was criticised by opponents of the government. In the experience of the author this criticism was exaggerated at the time by unsympathetic coverage by the media because important changes were initiated which affected the status of women employed in the health services of WA.

14 A. Summers, ‘Women’, in Patience and Head (eds.), in From Whitlam to Fraser, p.191. 15 Financial Review, October 1973, quoted in Summers, Women. P. 193. 156

Ambitious women increasingly entered the upper levels of the state public service.16 An increase in the demand for social workers accompanied this and presented them with an opportunity to develop an independent administrative career structure and the opportunity for personal advancement within it.

5.3 New mental health facilities

I now discuss the establishment of a career structure within the mental health hierarchy and implications it posed for the position of the profession and for individual social workers. Most of this information comes from an interview with Dr A. S. Ellis, the then Director of MHS, and his book Eloquent Testimony. In an interview he described to me the role of the social worker in the MHS:

They were more or less the eyes and ears of the examining psychiatrist, they were a great help. We couldn’t be everywhere. The social worker’s job was to give the medical officer in charge of the case more background because it’s very difficult to rely on what patients say or what relatives say. If the MO didn’t want a social worker- “helping” or “interfering” they called it- then they didn’t. Some of them saw it like that. You need an outside assessment of the situation, and that’s where I find social workers most useful and good at… all I can say is they’ve grown up and we know their value, but that wasn’t always so. A lot of people said ‘ they’re interfering bloody females, they’re no help’, but they did help when you knew how to work with them… it was usually a personality problem, the psychiatrist feeling insecure and the social worker feeling insecure too. Some of the psychiatrists were very anti social work interference, and they were even anti feminist, I can’t think why, but they were.17

In his book Dr Ellis describes the separation of Claremont Hospital into two separate units, Swanbourne Hospital and Graylands Hospital, the growth of community clinics, and of services for the intellectually disabled.

16 I.Duckham, Serving the Servants, Serving the State: A Brief History of the Institute of Public Administration of Australia, Western Australian Division 1945-2005, The Western Australian Division of the Institute of Public Administration, Perth, 2005, Ch. 1. 17 Interview with Dr. Ellis on 04/04/2001. 157

5.3.1. Establishment of Swanbourne/Graylands Hospitals’ Administrations

By 1970 the policy of deinstitutionalisation initiated by Dr H. Blackmore in 1967 had reduced the number of in-patients in Claremont Hospital from 1400 to less than 1000.18 Dr Ellis considered that Claremont was “beyond patching up”, that it should be closed and replaced by two separate institutions, Swanbourne and Graylands Hospitals.19 Members of the public were notified of the functions of each new hospital by the following media report:

Graylands will provide a full range of psychiatric services, in-patient, day-patient and out-patient treatment and rehabilitation programmes, with improved short-term accommodation. Swanbourne will care primarily for psychiatric cases among the aged and a number of adult mental defectives.20

A departmental circular from the Director Ellis to staff of the MHS stated that Graylands Hospital would take acutely ill psychiatric patients from the North-West region of the city, and Heathcote Hospital would take those living in the South East region, and have the same facilities as Graylands Hospital.21 These changes would be accompanied by expansion of in-patient, out-patient and day-treatment programmes, which would make it possible for patients to be treated by the same doctor and ‘team’ for the whole period of treatment. Swanbourne Hospital would look after elderly people with psychiatric illnesses - referred to as psycho-geriatric patients - and intellectually disabled adults; the latter group would be accommodated in the original wards of the old Claremont Hospital. Children with intellectual disability had already been moved to places like Pyrton Training Centre, a process which had begun in 1966.22 The hospitals were ultimately separated in 1972.

18 Ellis, Eloquent Testimony, pp. 98-99. 19Annual Report of the Director of Mental Health Services, 1971/72, p.7. 20 Sunday Times, 27 August 1972. 21 Ellis, Eloquent Testimony, p. 204. 22 L. Stella, ‘Normalisation and Beyond: Public Sector Residential Care, 1965-1990’, in Cocks et al (eds.), Under Blue Skies, p.110. 158

5.3.2. Community clinics

In the mid 1970s, clinic facilities at Havelock St, Bentley and Fremantle were expanded and, following the establishment of out-patient clinics at Kalgoorlie and Geraldton Regional Hospitals, new ones opened at Armadale (1976) and Midland (1977).23 During the 1960s and early 1970s the Director had visited doctors throughout the metropolitan and regional districts to assess the feasibility of extending services provided by the department.24 Treatment teams, in which social workers joined psychiatrists, psychologists, occupational therapists and community care nurses, ensured continuity of care for patients from Heathcote Hospital who attended Bentley or Fremantle clinics. These were functioning successfully and following the Director’s policy of continuity of care, a similar service was envisaged from Graylands Hospital. Each of the four treatment teams was allocated a specific geographic area, and a series of regular consultative visits by psychiatrists was arranged. However, as will be discussed later, this plan, although consistent with social work practice, was not welcomed by the consultant psychiatrists at Graylands.

A new Community Psychiatric Division was established in 1974 to supervise the admission and continued care of patients resident in privately owned hostels, and to monitor the conditions under which these hostels operated.25

5.3.3. The Mental Deficiency Division

The early failure of the authorities to recognize the difference between mental illness and intellectual disability, together with the advent of eugenics, had, by the 1930s, resulted in the presence of a substantial number of intellectually disabled patients in Claremont Hospital. Occasional forays into new methods of treatment from within the field of Eugenics came to nothing, albeit that eugenics was particularly strong in WA in the years before World War II. In 1911 Dr W. Birmingham of the Lunacy Department produced a classically Eugenist report establishing the ‘incurable’ and ‘genetic’ basis of ‘mental deficiency’, suggesting a system of cottage homes and

23 Ellis. Eloquent Testimony, p.152. 24 Participant no 3 interviewed by author on 4/4/2001. 25 Ellis, Eloquent Testimony, p.182. 159

industrial workshops where residents could be graded according to their abilities and placed in appropriate work. Typically, he classified people with intellectual disabilities as ‘mentally incurable’, ‘mentally retarded’ or ‘idiots’, and finished his report thus.

I cannot conclude without urging with all the power that is in me, the adoption of the only effective means of dealing with the feeble-minded and epileptic by compulsory and permanent segregation. The evil arising from the unchecked increase in defectives is growing and spearing throughout the civilized world, forcing its way into all classes of society and vitiating the health of the nation. We are careful that no black skins be found in our white Australia but we are doing nothing to protect the transmission of degenerate brains to those who come after us.....We have amongst us those, who, for no fault of their own, are unfit for the battle of life and lead a wretched existence..…We can place these poor people where their feeble minds can be guided along lines that they can follow, and where they will be safe from pitfalls of life and crime that are so thick along their pathway and that their poor, half-blind intellects cannot see to avoid.…Knowing as I do the benefits that would follow the introduction of proper institutional treatment of feeble-minded and epileptics I have no hesitation in urging our legislators to grapple with the imminent danger to our future greatness as a nation and wipe out this dark blot on our civilization. 26

Although Birmingham’s report had absolutely no influence in government and people with intellectual disabilities remained in Claremont Hospital, the belief, “once a defective, always a defective”, that people with disabilities were unable to contribute to life or to participate actively in society, lingered on.27 Throughout the post-war years this firm belief continued among professionals and others in the community that nothing constructive could be done for (particularly) severely intellectually disabled people, other than the provision of kind and competent custodial care. That is until the 1950s, when a group of children was transferred to the Mentally Incurable Children’s Association’s residential home, Nulsen Haven. In the 1960s and more rapidly, in the 1970s, with the introduction of social and environmental factors into the conceptual construction of intellectual disability, the policy of deinstitutionalisation was also applied to the group of child patients who remained in Claremont Hospital and were regarded as either too disabled to care for

26 Quoted by Gillgren, Once a defective, always a defective, pp. 65-66. 27 Gillgren. Once a defective always a defective, pp. 53-91. 160

themselves or who had no-one in the community to care for them. The first step was the establishment of Pyrton Training Centre in 1966, followed by the establishment of hostels and group homes. 28

In 1974 members of the Parents and Relatives Group that had existed for many years at Claremont Hospital, voiced their opposition to the policy of deinstitutionalisation as it related to their intellectually disabled children, most having been admitted as babies with assurances to their parents that lifetime care would be provided, but now mostly adults.. They were now of victims of neglect remaining confined to their beds or cots. Only those exhibiting symptoms of a psychiatric disorder in addition to intellectual disability were to remain in hospital.29 Members of the group had not previously been informed of the decision to transfer their ‘children’ and were notified of a meeting to discuss the situation.

At that time I was the Swanbourne/Graylands Social Work Supervisor, and was requested by Dr P. Reid, the Superintendent of Swanbourne Hospital, to act as chairperson of a meeting called to consult/ inform these parents of the changes that were about to take place.30 Most of those present were devastated to hear that their children were to be discharged from the hospital and placed in accommodation in the community, and voiced their strong disapproval. Some parents wept, demanding reasons why the assurances they had received earlier from Claremont Hospital were being dishonoured. It was altogether an intensely emotional situation, as there was no way the parents could envisage an alternative future for their children, especially one in the community where, although they would be supervised by specially trained staff, these would be strangers.31 The outcome was that despite the hostility expressed by the opponents of de-institutionalisation, they were compelled to recognize the power of the politicians and service providers. Consequently social workers were directed to arrange for the assessment of intellectually disabled patients by Irrabeena, the Mental Deficiency Division’s assessment and treatment centre in

28 D. Davidson, Nulsen Haven (Inc) A History, Faculty of Health and Human Sciences, Centre for the Development of Human Resources, Social Research and Development Monograph no.5, Edith Cowan University, Western Australia, 1993, pp. 3-11. See also Stella, Normalisation and Beyond. 29 Ellis, Eloquent Testimony, p.156. 30 The incident occurred in 1975 during the period that I was Social Work Supervisor of Swanbourne- Graylands Hospitals, and Dr P.Reid was Superintendent of Swanbourne Hospital. 31 Megahey, Making a new profession: Social trainers and intellectual disability, pp.248-281. 161

Ord Street, West Perth.32 Irabeena had its own problems. In 1977 Sue Harris, a social worker who previously worked at Gladesville in NSW, was appointed to the staff of Irrabeena. She was critical of the shortage of professionally qualified social work and psychology staff at Irrabeena compared to that in other childcare institutions such as Parkerville Homes.33 Nevertheless, despite this highly stressful situation, the transfers were completed and 200 patients were transferred.

5.3.4. Community Placements

Social workers were also concerned with a group of patients who were referred for placement in the community. This group consisted of ‘bad girls’ who had been transferred to Claremont Hospital from the Home of the Good Shepherd, a religious, custodial institution which provided care and employment for borderline intellectually disabled girls who had committed offences under the Child Welfare Act.34 However the institutional staff, whose good intentions were directed to the wellbeing of the residents, was untrained and unable to cope when confronted with the girls’ behavioural problems. A social worker at Swanbourne Hospital commented:

If the girls had any kind of behavioral problem, they’d be shot up [to Swanbourne] …I think that a lot of people were just put there because there was nowhere else to go, and the tragedy was that it was supposed to be that people didn’t stay long term, it was happening all over the world. There’s just so many people out there but it’s just for a few people out of hundreds, it’s wrong because this was the big thing for the future- get them out into the community… where did people go when they had no home to go to? 35

Behavioural problems in the community brought MHS staff into contact with the Community Health Nursing division of the WA Health Department. In 1975 the community health nurses at Balga and Lockridge, two outer-suburban areas of Perth, reported that these areas contained a number of under-privileged Aboriginal and non- Aboriginal families, and that nursing staff were constantly confronted with a multitude of social and welfare problems including delinquency, alcoholism,

32 Stella, Normalisation and Beyond, p.115. 33 Stella, Normalisation and Beyond, p.115. 34 Participant no. 22 interviewed by author on 17/02/2003. 35 Participant no. 22 interviewed by author on 17/02/2003. 162

aggression and vandalism.36 They requested that psychiatric consultation be made available. Dr Ellis in an interview with Rhonda Jamieson explained:

About sixty or seventy percent of their work was dealing with emotional problems, you see, and so I got together with the Community health people and said ‘Is that so?’ and they said ‘Yes’, so I sent Frank Faralley [a psychiatrist] and a psychiatric nurse out to Balga, and that’s how they got started. 37

One of the important questions to be asked was what kind of environment these people would be returning to if they had to go to hospital, and it was here that social workers came to the fore. In response to Rhonda Jamieson’s question of decisions concerning returning people to the environment Dr Ellis replied:

We had social workers to do that… one would have hoped that the medical officer or psychiatrist responsible for the patient would have made at least some token attempt to find out what sort of place they were going back to. But that was not always possible of course because we had patients from the north- west for example. We did send Dr Bignold at one time to the North-west to have a look at what sort of situation for example the aborigines who’d been in hospital were discharged to, and what sort of hope they had of the illness recurring. But you see, psychiatry as you probably realize is a middle- class or upper middle-class luxury, and many of us tend to think that everyone comes from the same class. 38

In the 1960s, hostels and boarding houses to accommodate de-institutionalised patients had been established. Social workers were aware of overcrowding and dehumanising conditions in some of these places. Because of this, hostels had come under public scrutiny and in 1974 the Community Psychiatric Division (CPD) was established to co-ordinate the admission of discharged psychiatric patients to privately-owned hostels in the suburbs and supervise their conditions. Dr R. Ellison was appointed as Superintendent. 39 The social worker for the Division developed a programme whereby all requests for placements to MHS-subsidised hostels were to be directed through a supervising social worker with a report giving the social and medical details of each patient who applied for a place in a hostel.40 This information

36 Ellis, Eloquent Testimony, p.152. 37 Dr A. E. Ellis, Oral History Transcript. 38 Dr A. E. Ellis , Oral History Transcript. 39 Ellis, Eloquent Testimony, p.182. 40 Participant no.23 interviewed by author on 20/2/2003. 163

included the patient’s approval for the transfer, contact with the patient’s family if possible, and assurance that the patient had sufficient funds to pay for accommodation in advance. A quantity of clothing as specified in a list would be provided. The combined information was then submitted to the CPD staff who did not give approval until all requirements were satisfactorily met. Few patients had the necessary funds to comply with these conditions, so delays occurred while social workers in the hospitals arranged for amounts paid for board by pensioner patients to be waived, and clothing purchases completed. These requirements, although justifiable, were time consuming for an already heavily overloaded staff and progress was slow. At the time I was Social Work Supervisor at Graylands Hospital. Social workers were severely criticised by medical staff, whose attempts to ‘clear the beds’ and discharge patients were hampered. It must be remembered that Graylands Hospital, unlike Heathcote, provided services for chronically mentally ill patients who required constant readmissions41. The result was ongoing, serious conflict between the social workers and doctors. Some patients were surreptitiously discharged ‘by the back door’ to unregistered hostels and boarding houses, and no longer received supervision by MHS staff. 42

The tense relations between the social work and medical staff was reinforced by a series of scandals concerning conditions faced by mental health patients in the community which, as I recall, were given wide coverage by the press and television. Dr Ellis responded by visiting the hostels facing criticism. On the front page of one publication was a photograph of him examining a barred cage in the grounds of a hostel. The cage was used to restrain a psychotic male patient who had a tendency to wander away. In his own defence the manager of the hostel claimed that it was especially constructed to give the man time to enjoy the fresh air! 43 Dr Ellis then ordered all transfers to hostels were to cease and that an inquiry on conditions in hostels was to commence immediately. Coincidentally the CPD Director was away from the department, and the task of conducting the inquiry fell to the social worker. The inquiry revealed considerable overcrowding throughout the hostels, where in

41 These were patients discharged on After Care who remained the responsibility of the MHS. This is described in more detail in Chapter 4. 42 Participant no.4 interviewed by author on 05/04/2001 and participant no. 7 interviewed by author on 17/04/2001. 43 Participant no.5 interviewed by author on 09/04/2001. 164

some cases there was barely sufficient room for patients to move between beds, poor and insufficient food, the sharing of personal clothing, and inquiries over the handling of residents’ money, and inadequate supervision by staff.

The order forbidding the discharge of patients continued for fifteen days, until a decision was made to prepare legislation to provide the CPD with the authority to grant licences for the operation of hostels and supervise their operation. The Mental Health Act 1976 Amendment Act, which was assented to in June 1976, required an appropriate licence approved by the Minister to be held by any person conducting a private hostel, day activity centre or private sheltered workshop.44 It also provided for the granting of subsidies towards the cost of maintenance of approved hostels, demanded that satisfactory arrangements existed for the upkeep of such hostels, and provided for the appointment of a Board of Visitors to check on their suitability. Under terms of this legislation the responsibility of assessing the personal suitability of the owners, examining the physical presentation of each hostel, and of forwarding a report to the MHS Director was allocated to the social worker. Dr Ellis commented, ‘with her feminine eye she could spot things…she was a great help, a very valuable team member, an experienced female’.45 When Dr Blackmore, another psychiatrist, was interviewed concerning this period he commented, ‘I don’t know whether she put any of it into print. Very little was recorded, I leant very heavily on her ability - a very capable person, very effective’. 46 Despite the heavy workload and after requests for additional staff had been refused, she continued to be the only social worker employed by the CPD, and despite her efforts a number of patients did not meet or wish to comply with CPD standards. Hospital social workers throughout the MHS, therefore, were faced with the difficulty of locating accommodation in unlicensed hostels or in boarding houses.

5.4 Establishment of a career structure for social work.

The report of an AASW (WA branch) sub-committee set up in March 1973 to advocate for a voice in government policy formulation, stated that the recruiting,

44 Mental Health Act Amendment Act, 1976, Division 1 section 6, subsections a, to d, 26b. 45 Dr A. Ellis interviewed by author on 4/4/01. 46 Dr H. Blackmore, interviewed by author on 22/8/01. 165

education and deployment of social work manpower by all levels of government and non-government agencies were of strategic importance in formulating social welfare policy on a national level.47 A working party of which I was a member was formed to enquire how these statements could be communicated by mental health social workers. Although we were acutely aware of some of the social problems associated with mental illness, we had no pathway through which this material could be forwarded to the policy section of the department as public servants were debarred from making public statements. We recognised that the ad hoc methods that had been operating since the first social work appointments in 1959 had by now become ineffective and we now needed a senior representative as spokesperson. Whoever was appointed would determine the future development of social work in the MHS - a decision that would no doubt affect each of us individually. We then prepared a report requesting the appointment of a Principal Social Worker with a classification similar to that of the Principal Psychologist who had been appointed in 1969.48

Social workers were still regarded as ‘paramedicals’, which inferred that their role in relation to the medical profession was an appendage. Following the announcement that continuation of the UWA social work course was in doubt after 1970, Ron Moffatt, a senior social worker with the Child Guidance Clinic who was convener of the working party, wrote a paper titled ‘The need for a university education in the social work profession’ which was presented to the Senate of the University of Western Australia:

Categorization as ‘paramedical’ is quite ludicrous, as the majority of social workers are not only independent of the medical profession but of any other profession, and in both statutory and voluntary agencies are not only responsible in their own right for their own professional practice, but actually hold senior administrative positions in which they are responsible for directing the agencies’ policies.49

The working party’s request was granted and the Director announced that the position of Principal Social Worker would be established.

47 AASW (WA Branch) sub-committee, AASW Archives, Battye Library. 48 Smith , Reflections of a Clinical Psychologist, p.76 49 AASW (WA Branch) sub-committee, AASW archives, Battye Library. 166

This key moment in the history of mental health social work arrived when, in 1974, Sylvia Cresswell was appointed as Principal Social Worker, Mental Health Services of WA, with duties that were broadly defined as coordination of social work activities throughout the department.50 The terms of employment, however, contained no mention of research or of contribution to departmental policies. She was given a centrally located office, adjacent to those of other senior administrators. She commented in an interview:

When I first arrived being a social worker was different, and nobody knew anybody else’s salary. I got to know about salary structure- the Public Service Act became my bible- and found social workers on different salaries. I formed a little group of social workers employed elsewhere called ‘the salaries group’ (within the Public Service)- - - - we got some sort of equilibrium between social workers and other professional groups- lengths of training to use as a yardstick.51

Apparently discussing financial concerns was considered to be extremely ‘unladylike’, an opinion that was consistent with the recorded views expressed in a survey of WA pioneer social workers that reported that salary was a secondary consideration when choosing a social work career.52 However, this was not the case for individuals taking advantage of the government subsidised bursaries and training allowances from 1966, when education programmes were introduced at WA universities, the attitude was unmistakably demonstrated by one woman who stated simply, ‘Salary was important to me’. 53

One of the first actions of the Principal Social Worker was to examine the employment conditions relating to social workers and mental health officers from 1959 when she first joined the department. At that time social work appointments across the public sector were made on the basis of seniority, but the system lacked any mechanism whereby increased expertise or specialist knowledge beyond the base grade level could be acknowledged. Conditions of employment for social workers were determined according to negotiation between the Civil Service Association,

50 Mental Health Department files, file no. 1974/1323, AN 163/1 to AN 169-14, Acc. No.54, The position was titled Senior Social Work Supervisor at L.5 when it was listed in the Government Gazette, but was changed by the MHS to Principal Social Worker. 51 S. Cresswell interviewed by author on 28/8/01. 52 Crawford & Leitman, The midwifery of power? p.50. 53 Participant no.1 interviewed by author on 25/3/01. 167

representing government employees, and the Public Service Board appointed by the WA government.

Social work salaries were classified according to salary ranges agreed by representatives of the Professional Division of the Public Service.54 When vacancies occurred the required qualifications and duties were first listed in the Government Gazette, and then advertised in the press. Once appointed to a position, a social worker then signed a Duty Statement defining the standard professional qualifications required. Promotions within a salary range or to a higher classification level were dependent on a positive evaluation of professional competence by the Principal Social Worker. Appeals against such promotions and classification levels could be made by application to the Public Service Board.

Two successful social work appeals to the Public Service Board against existing classification were then conducted on behalf of ‘Teddie’ Stockbridge and Syliva Cresswell. The position of Principal Social Worker was upgraded, and, at the same time, a Senior Social Work position was established at Bentley Clinic, acknowledging the specialist nature of the work. Both decisions were significant as they prepared the way for establishment of yet another hierarchical structure within the MHS.

According to Duty Statements signed by each employee social work activities were bound by two different areas of responsibility: to the Superintendents of hospitals and community based units in accordance with mental health legislation, and to the Principal Social Worker for professional matters. Referring to these statements Sylvia Creswell commented:

In the hospitals these activities mainly involved information gathering, working to some degree with patients but mainly with relatives and a certain amount of after-care work…but the out patient clinics had a different orientation.55

These formal duty statements were signed by the Director. However, Dr Ellis added:

54 Western Australian Government Gazette 1965. 55 Sylvia Cresswell interviewed by author on 28/08/2001. 168

I never wrote one. I think that was better left to the social work family. There was nothing in their duty statement to say they had to do therapy, but in their contact with families. They weren’t very skilled in that area, [therapy] and I’m not quite sure when it became a degree or diploma… Occasionally they might have stepped out of line and tried to do some therapy but it would have been unauthorised. 56

Mental health officers, who had no formal training but were chosen because of their life experience and mature personalities, had first been appointed in 1959 to Claremont Hospital and assisted social workers in their duties. Similar appointments followed at Heathcote Hospital. The duties involved: transporting selected patients and their luggage to and from hospital, assisting with applications for social security benefits and purchasing suitable clothing prior to discharge. In 1968 the mental health officers had launched a successful appeal to the Western Australian Industrial Court, which had jurisdiction over their working conditions, claiming parity of duties with those of social workers and therefore, similar salary levels. Although the overlap of duties had given rise to a certain amount of rivalry, this salary determination caused considerable resentment among social workers. Gender was a significant factor here, as the mental health officers were male and subsequently received a larger salary than the female social workers. (Men still received higher wages than women at this time). Further, social workers who were married women were ineligible to be classified as permanent employees and therefore unable to participate in the generous Government superannuation scheme that was available at the time.57

5.5 Social work functions

In this section I describe how the way in which social workers pursued their activities varied according to the interpretation of social work duties in the various mental health units, and then discuss some of the professional tensions arising from these activities.

56 Dr A. Ellis Interviewed by author on 04/04/2001. 57 Married women did not become eligible for classification as permanent government employees and for superannuation entitlements, although a voluntary savings scheme was operative. 169

5.5.1 Graylands Hospital

Graylands Hospital accommodated approximately 400 patients which included those who were acutely ill, a proportion of whom were chronically ill individuals who were regarded as incurable with episodic occurrences, entrapped in the ‘revolving door syndrome’.58 A social worker at Graylands Hospital, described her interpretation of the role of social workers in a hospital setting:

My mother was a nurse, and saw hospitals as treating illnesses, and the people responsible for diagnosing and treating illness and management were the doctors…whenever I had any difficulty having my role accepted I felt it was a function of their personality rather then their profession having more status than mine. I can’t recall having a problem with most of the doctors over the time, it was always a matter of negotiation….except for one psychiatrist of the older school, many of those who saw him as being difficult were younger women, such as being ‘patted on the head’. We developed a mutually respectful relationship. I was just old enough not to fall into the younger woman category… I didn’t see gender as an issue, but some people perceived it to be.59

She described the different social work methodologies that were necessary for patients with short-term treatable conditions compared to those suffering from long- term mental illnesses, describing the social assessment of newly admitted patients as the major part of her work from 1975. She considered that her casework with patients and relatives differed from the approach taken by psychologists and psychiatrists in that it aimed to provide information and insight rather than psychotherapy. She also differentiated her approach from that of the mental health officers who were employed in MHS hospitals to address the immediate material needs of patients, and commented that the immediacy of their assistance made them more popular with patients than were the social workers.

Another social worker who began social work employment at Graylands Hospital in 1973 adopted a different emphasis which involved problem-centred casework.60 This included financial counselling of people who sometimes required renegotiation of

58 J. Hicks & E. Hill, WA Health Care in the new Millennium. Are We Going Forward, Backward or Round in Circles?, Occasional paper, 1999. 59 Participant no. 2 interviewed by author on 26/3/01. 60 Participant no.22 interviewed by author on 17/2/03. 170

their outstanding loans or a request to the hospital administration to waive board payments in order to accumulate enough funds to cover advance rental in order to obtain accommodation before discharge, or to outfit them with suitable clothing before being admitted to a hostel. She recalled her work with community agencies. An example concerned an Aboriginal woman admitted from an outer metropolitan suburb who was married with a young baby, and had who been admitted with a queried provisional diagnosis of drug addiction/ manic depressive illness and lost custody of her child. She faced an indefinite stay in hospital. This interviewee said:

The fellow didn’t want her back and his parents wanted to look after the child. They were granted custody. She had periods when she was dreadfully upset. [The hospital staff] kept giving her drugs and I felt that she would never recover while she was in hospital. It was my job to arrange a place for to live when she was ready for discharge. I found her a place, and she got good access to the child. I followed her up at the clinic and she’s done extremely well, actually.61

5.5.2 The Multicultural Centre

The Multicultural Centre, which was situated in Newcastle Street in the city, was established in 1978 to cater for the number of mainly European migrants in the inner city areas and Aboriginal patients, including some from isolated communities. Usually these patients had been admitted to a general hospital but were transferred to Graylands Hospital because they had failed to respond to psychiatric treatment. One such patient, an emaciated Aboriginal woman who spoke no English, was transferred from one of the missions in the north of WA to the local hospital. She was in a catatonic state, and was referred to Graylands Hospital with a provisional diagnosis of paranoid schizophrenia. The admitting psychiatrist requested that enquiries be made by a female social worker, as this may have been more culturally acceptable to the mission staff. Enquiries from the mission staff revealed that the woman had given birth to twins, and their existence was associated with some kind of tribal taboo. Since the birth she had become mute and had refused all offers of food. The psychiatrist made a conditional diagnosis of puerperal psychosis. Concerning the babies, no further information could be elicited, but it was suggested that the father was from a prohibited blood group, and that the patient was the victim of ‘bone

61 Participant no.22 interviewed by author on 17/2/03 171

pointing’.62 The social worker requested that an anthropologist be consulted, as the case had cultural components, but funding for this was not approved by the hospital administrator. At that time little attention was paid to the findings of cultural anthropologists who often pointed out the futility of treating indigenous patients according to the ideologies of western medicine. Eventually the woman was discharged and escorted back to the mission by a member of the nursing staff. Three months later she was readmitted with the same symptoms then discharged again. This happened on two more occasions. In the meantime the social worker had corresponded with representatives of social agencies in the area from which the patient was resident, but no further information concerning her condition could be obtained. She died about eighteen months later. Voluntary workers from the mission who visited Perth at a later date explained that once ‘the bone’ had been pointed at her, nothing more could be done. The response of the MHS medical administration to addressing the problems presented by indigenous patients was to arrange for a psychiatrist to visit the north-west and southern regions of WA on a consultative basis at monthly intervals.63 Until the establishment of the Multicultural Centre there was no acknowledgement of Aboriginal culture by the MHS. Aboriginal welfare officers were appointed to a special service established for liaison people with tribal communities to cater for indigenous patients with apparent psychiatric symptoms, but the practice of transferring such individuals to Graylands Hospital continued.

5.5.3 Swanbourne Hospital

A number of changes occurred in 1973 when Swanbourne Hospital became designated as a treatment centre for psycho/geriatric patients. The Superintendent, Dr Reid, had introduced a system of community medical assessments by a psychiatrist and community nurse following referral by a GP.64 A change of policy occurred in 1976 when Dr N. Hills was appointed as Psychiatrist Superintendent of Swanbourne Hospital. He modified the existing medical approach in patient care to one that required social workers to assess social supports patients had in the home and

62 J. Cawte, Medicine is the Law: Studies of Psychiatric Anthropology of Australian Tribal Communities, Adelaide, Rigby, 1974 further discusses the implications of Aboriginal culture concerning illness. 63 Participant no. 3 interviewed by author on 04/04/2001. 64 Participant no 21 interviewed by author on 28/11/2002. 172

elsewhere which would affect their ability to remain independent. Social work then took a more active role, including liaising with general practitioners, accommodation services, home nursing organisations and social agencies that could provide support in the home for both the patient and his or her family. A Senior Social Work position was established, acknowledging the specialist nature of psycho/geriatric work. The social worker appointed to the position remarked:

He (Dr Neville Hills) was, I think, the start of Swanbourne waking up from a gigantic slumber, and he came in with fresh ideas to do, things I thought were very good. Because before that nobody really wanted to do anything new. I thought there were lots of things that could be done- it was really hard. The doctors had a lot of control because there were a lot of the old medical officers there, and their word was sort of law. Once Neville came in there was someone more powerful who could start directing, and that’s the way we went…one of the things we were doing there was stopping Swanbourne from becoming a dumping ground, because in those days when other hospitals had someone difficult, it was “let’s put them into Swanbourne”. 65

Before the new system could be set up, one of the community care nurses suggested ‘why don’t one of you social workers come out with us’? 66 From then on the referrals were directed to the Senior Social Worker instead of going straight to the nurses. The home assessments were then undertaken by a nurse and a social worker, a practice that was criticised by other doctors outside Swanbourne Hospital, who believed that social workers weren’t qualified to do the job. The social workers, however, were supported by Dr Hills, who considered he had a lot of respect for staff from other disciplines. The following comment by a social worker demonstrates this point:

We went out with one of the nurses and saw this old lady who had been referred by a doctor at ‘Charlies’ (the Sir Charles Gardiner Hospital) to come to Swanbourne for admission. This lady was in a ‘high’, I don’t know what it was called, but it was a great volume of talk. She talked, and talked and talked and talked, but apart from that she was quite normal and she really didn’t fit into Swanbourne. In a way, if she had to be treated at all she’d have been better off at Graylands or at a clinic, so we refused (to have her admitted to Swanbourne Hospital). The doctor was very angry and rang Neville

65 Participant no.21 interviewed by author on 28/11/2002. 66 Participant no.4 interviewed by author on 05/04/2001. 173

Hills, and told him he should have gone out there himself. And so he did go out, and came back agreeing with us that there was no place for that lady in Swanbourne. We had a similar thing happen a couple of times with other doctors. If the patient was accepted they wouldn’t say anything, but Neville always said that most of the assessment was social, not medical. 67

In 1976, following the appointment of a Deputy Principal Psychologist, the position of Deputy Principal Social Worker was established, to which I was appointed, and was located at Graylands Hospital. This job entailed supervising the social work staff at the hospital, overseeing the community social work programmes in the psychiatric division of the MHS and acting as Principal Social Worker in the absence of the Principal. Similar positions were then established in occupational therapy and nursing. This structure was consistent with the organisation of the MHS, and practicable on the assumption that consensus existed concerning departmental policies. However this did not always occur between professional disciplines or at times within them.

5.6 Relationship of social work with other disciplines

The appointment of Principals as representatives of the allied health professions, and the introduction of line management led to a contentious situation at Graylands Hospital in the late 1970s. I was Deputy Principal of the Social Welfare Department at the time and in this capacity attended the monthly Heads of Department meetings chaired by the Graylands Superintendent and held in his office. Those at the meeting included representatives from psychiatry, nursing, psychology, social work, occupational therapy, administration and representatives of domestic and outdoor services. Disagreement arose over the departmental policy of continuity of care for psychiatric patients, which entailed being treated by the same psychiatric team in hospital and the community. This policy was consistent with the ideological basis of social work and was supported by other members of the allied health team: psychology and occupational therapy. Social work practice had extended beyond the walls of the hospital and a network was being built up between social workers and community groups which supported people with mental illness.

67 Participant no. 21 interviewed by author on 28/11/2002 174

The superintendent raised objections to this development, claiming that psychiatrists alone were legally responsible for patient care under terms of the Mental Health Act. He argued that psychiatrists were the ones who were obliged to go to Court after a patient had committed suicide, and the legislation did not cover involvement in social work activities away from the hospital. This decision would confine social work intervention to social welfare problems concerned with the patient’s admission and discharge, similar to the circumstances in the late 1950s. I strongly opposed such a policy reversal. Apart from the professional implications, this was also contrary to the regionalisation and extended care policies being promoted by the MHS at the time. Personally I did not communicate well with this superintendent, but endeavored to approach the situation as professionally as I could. However the issue became a major source of contention and hostility while I remained as senior representative of the social work profession at the hospital. When I left in 1984 this hostility was directed, but with greater intensity, towards my successor. The avowed purpose of the psychiatric decision was to make Graylands Hospital a ‘centre for excellence’ for the profession of psychiatry. This apparent reversion to a medical model concept was reinforced by consultant psychiatrists in charge of the treatment teams and also by a senior consultant in charge of the programme for trainee psychiatrists

5.7 Variations in the concept of mental health

Commitment to the concept of psychiatric treatment involving an inter-disciplinary professional team of psychiatrist, psychologist and social worker varied throughout the MHS. When it was first introduced by child guidance clinics, the concept was quite specifically based on the principles of Freudian psychology: the psychiatrist focusing on symptoms of psychiatric disorder, the psychologist on intellectual development and associated symptoms of emotional disorder, and the social worker providing a social history of personal and interpersonal development. A treatment was then prepared; the child would be treated by either the psychiatrist or the psychologist, while problems concerning management of the presenting problems would be referred to the social worker.68 This system involved very little overlap

68 Ron Baker describes the role of the social worker at the Child Guidance Clinic in Perth while he was employed as a Psychiatric Social Worker in the 1950s in R.J. Lawrence A Career in Social Work: Seven Personal Accounts, Sydney, UNSW School of Social Work, 1978, p.50. 175

between the disciplines. However this was modified when social workers whose training comprised input from the social sciences, adopted a more holistic approach, taking account of environmental and other social, rather than narrowly management issues.

5.7.1 Psychiatry

Boundaries that were clearly delineated by the medical model of health then became diffused as social and environmental factors were incorporated into the etiology of illness. Because of these changes, psychiatrists, who formerly had been recognised as the sole determining voices in patient management, found their position under challenge. This was demonstrated by the difficulties that arose between psychiatrists and social workers in the documentation of background information. Initially the task of information gathering on arrival at hospital had previously been the responsibility of the admitting doctor. It consisted of medical and basic personal information, which was only one aspect of that required for psychiatric disorders. Social workers were now available to provide more appropriate and comprehensive information, but limitations occurred due to their limited availability and the circumstances of admission. It was not always possible to link together the psychiatric, psychological and social aspects of the patient’s situation

In-service teaching

Heathcote and Graylands hospitals were both teaching centres for psychiatric and allied health professionals and nurses, and it was customary for in-service training to be provided by senior members of different professional groups. Medical students comprised the largest group and underwent an intensive six month internship and had a separate induction period including sessions with representatives of the members of different disciplines. The medical trainees already had previous experience in general hospitals and with medical social workers, so the social work component of these sessions was aimed at demonstrating the different requirements of social work with mentally ill patients and their families, particularly the social problem spanning

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hospital and community. The team meetings appeared to present an ideal opportunity.69

An incident occurred during one such a meeting which showed how some parts of the psychiatric profession viewed the team meetings and this became common throughout the MHS teaching hospitals. One of the consultant psychiatrists, after hearing presentations of allied health staff, gathered around him the group of doctors currently enrolled as trainee psychiatrists, and ignoring others in the room raised his voice and remarked, ‘Well gentlemen, let us now proceed to practice psychiatry!’ After that he directed all discussion to the medical and pharmaceutical aspects of the case under review and ignored everyone else in the room. No time was left for further discussion! Despite the efforts of allied health staff they were unable to prevent a re- occurrence of incidents of this kind.

Relationships between social workers and psychiatrists were clearly not always amicable. Dr Ellis’s opinion that the main role of social workers was essentially an information-providing one was widely held by other psychiatrists in the MHS. 70 Considering the therapeutic role of social workers to be an incidental one related to members of the patient’s family, one psychiatrist commented:

In the clinic there was the initial interview with the patient, and family assessment was done at some stage…initial work was information gathering, but also therapeutic as well…they were more information- gatherers than therapists (with a small t), certainly the information and opinions they gave were very helpful in the counselling of family members.

5.7.2 Psychology

It was in this area of ‘counselling’- a blanket term- that indecision over the boundaries of social work and psychologists occurred. A senior Clinical Psychologist who had worked in both hospital and community settings of the MHS, clearly differentiated the psycho/pathological based approach of his profession from the

69 The author was in charge of the Social Welfare department at Graylands Hospital from1974-1984. 70 Participant no.6 interviewed by author on 10/04/2001, and participant no.10 interviewed on 24/05/01. 177

‘here and now’ focus of social casework.71 In the experience of the researcher other psychologists, particularly those who adopted a family therapy methodology, referred to this as ‘psycho-therapy’, and consequently within the exclusive province of clinical psychology

5.7.3 Community care nursing and occupational therapy

Differing perceptions of social work in relation to nursing also occurred at this time. Since the Social Welfare Department was first established at Claremont Hospital in 1969, community care nurses had been designated as part of the department, and competition for selection existed among ward-based nurses when a vacancy occurred in the Social Welfare Department. This system changed in the late 1978 when a notification was issued from Head Office that these nurses were to be transferred back to the nursing staff. A new Community Care Nursing section was then established. Under the new system nurses would supervise the progress of medical treatment and provide ‘counselling’ to patients discharged form the hospital and their families, replacing the existing social casework service. Community care nurses would attend the early morning ward round and be informed of intended discharges. They would then contact families and other supportive community facilities. When necessary, they could refer back to the treatment team for advice. The plan was to locate nurses at community clinics where they would act as liaison between the clinic and the referring hospital. Needless to say social workers at the hospitals were incensed at these changes, which not only curtailed their professional practice, but restricted it almost to the boundaries of the hospitals. A certain amount of overlap also occurred between social work and occupational therapy.72 A senior Occupational Therapist commented on changes in practice methods:

It has moved a lot... you were supposed to use craft as the medium for working with people, and the best thing that happened, I think, was the move away from that to dealing with people with problems. We had quite a lot of contact with social workers- even in those days there was beginning to be the ‘crossing’- it really was looking at issues in people’s

71 Participant no.19 interviewed by author on 29/05/2002. 72 The 1977/78 Annual Report of the MHS acknowledged the appointment of a Principal Nurse and Principal Occupational Therapist. 178

lives. Because of the group approach we had far more idea of what was happening than previously.73

The experiences of social workers and others employed by the MHS between 1973 and 1983 suggest that social workers underwent a period of personal and professional achievement when they achieved independent status with medical colleagues in the hierarchy of the MHS. However, according to some interviewees, this sense of achievement was not universally experienced and social workers often found their professional practice demeaned and contested.

5.8 Core themes

Throughout this chapter a number of core themes have emerged as the events of the 1973-1983 years unfolded. These themes are now discussed.

The importance of political decisions and occupational disputes

In 1973 the decision of the Whitlam Government to grant money to Australian States for the establishment of community mental health development affected the social work profession for the next decade. It required the coordination of all social and welfare services throughout the MHS. Previously staff selection and supervision had been somewhat of a haphazard arrangement between the superintendents of various sections of the department. Following this decision a Principal Social Worker was appointed to undertake this responsibility, resulting in the establishment of social work as an independent professional group in the medically dominated hierarchy. Social workers were jubilant, as for the first time they were able to choose the most appropriate methodology for the practice and the administration of their services without seeking psychiatric approval to do so. The existing administrative structure of the Social Welfare Department at Claremont Hospital following the deinstitutionalisation policy of the 1960s served as a benchmark for social work services throughout the MHS.

73 Participant no. 16 interviewed by author on 13/11/2001. 179

Running through the chapter is information from social work interviewees which demonstrates the way in which policy changes affected both the services they provided and the recipients of these services. A positive outcome of such changes occurred when in 1973 Swanbourne Hospital became designated as a treatment centre for psycho/geriatric patients, and pre-admission assessments were introduced enabling community services to be utilised and patients to be treated at home. Another positive outcome was the opportunity for social workers in community psychiatric clinics to initiate family therapy programmes in an effort to combat unnecessary hospital admissions. Less positive was the political decision, which was strongly opposed by the parents of intellectually disabled patients placed there at birth, to transfer them to community hostels.

On the other hand, there are enough examples of disputes between social workers and other professions over matters like therapy and counselling to show that contests over professional knowledge were rife in the MHS and that these represented the kinds of contests that fit into the power, knowledge relationship described in the methodological chapter. Demarcation disputes between psychiatry and social work, psychology and social work and social work and mental health nursing are, at their core, disputes over the possession and legitimacy of mental health knowledge.

The significance of gender

Because the makeup of the ‘caring professions’ of social work, occupational therapy and nursing was still largely determined by gender in this period, their membership remained predominantly female, while membership of psychiatry and to a lesser extent clinical psychology, remained predominantly male. Gendered family backgrounds also influenced the choice of occupation. Freidson argued in 1970 that potential social workers and doctors were mainly recruited from the middle and upper middle class families and in the process of professional socialisation each individual acquired the appropriate ethical and behavioral standards of the group.74 Evidence from the interview material suggests that middle class social expectations about gender were absorbed equally by social workers and members of other professional

74 E.Freidson, Professional Dominance and the Structure of Medical Care, New York, Atherton Press, 1970. 180

groups. Consequently the hierarchical nature of this socialisation, consistent as it was with that of contemporary society at the time, facilitated the smooth individual internalisation of these values and expectations.

Although the title ‘Principal’ established a nominal equity between each profession in the MHS, any such equity was quite illusory in terms of salary. MHS professional employees were members of the Civil Service Association (CSA), a union that negotiated salary levels, which were determined according to a work value assessment, and comparison with other groups of similar levels of training and with salaries of private practitioners. Psychologists were established as registered private practitioners, whereas social workers and occupational therapists at that time were not, and were almost solely employed by government or voluntary organisations. Salary levels, which articulated the marketplace position of occupations, ensured that doctors and clinical psychologists, whose monetary value was based on length of training and comparison with private practitioners, headed the list of salaried professional employees. Social workers, who were predominantly government employees, had no such benchmark. Indeed, discussions of salary were, in the words of one interviewee, ‘extremely unladylike’, a comment consistent with views uncovered by Frances Crawford and Sabina Leitman in their study of pioneer social workers in West Australia.75 However this is just one area where gender impacted on mental health social work. Because of the gendered nature of the mental health professions, the conflicts over social work and other occupational knowledge, described in the first section, also took on a gendered inflection.

Changes in the conceptualisation of mental illness

Consistent throughout the chapter were the impact of changes in the conceptualisation of mental illness, in essence the growing recognition of social and environmental factors in the production and treatment of mental illness. The introduction of Commonwealth funding in 1973 to provide community services for Australian states acknowledged public acceptance of this and initiated the establishment of social work as an independent profession in the MHS. Analysis of

75 Crawford & Leitman, The Midwifery of Power? p.50. 181

individual interviews demonstrates that methodological approaches to treatment involving interpersonal and family relationships formed a central part of social work practice, particularly in community mental health clinics.

The advent of community psychiatry, in tandem with the policy of deinstitutionalisation, initiated a need for hostels and rehabilitation facilities for patients’ no longer requiring hospital care, but unable to function independently in the community. The establishment of a Community Psychiatry Department coordinated the transfer and supervision of patients to hostels and nursing homes in the community. An amendment to the Mental Health Act of 1976 granted licences and financial subsidies to approved hostels and specified the conditions under which they operated.

The growing importance of social and environmental factors in the conceptualisation of mental illness also impacted on inter-professional relationships. One example of such changes was the incorporation of these factors into the traditionally based medical model of psychiatric nursing. In the late 1960s, community care nurses had become members of the Social Welfare Department at Claremont Hospital to assist placing and supervising patients in community hostels. But in the late 1970s a Community Care Nursing Division was established and its members became reinstated as part of the nursing staff. Under the new system nurses were to replace social workers in the care of patients discharged from Graylands Hospital, and to assume responsibility for their ongoing social and medical supervision. This decision caused considerable uncertainty between the two professions, confining social work intervention to the period of hospitalisation, and initiated a blurring of professional boundaries, which became increasingly evident in community psychiatric clinics.

5.9 Summary

This chapter continues the historical journey during the crucial 1973-1983 period, which began with the Federal government’s decision to develop a system of mental health community services, and ended when it was replaced by another which was

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initiated by a WA government-commissioned review of the functions of the MHS.76 Across these years, mental health social work grew in confidence as a profession and achieved recognition that it was entitled to a similar status, at least to the non- psychiatric professions, as an independent profession within the department. Power relationships continue as a dominant feature in the interpersonal and organisational relationships and dynamics in the development of social work.

What is very apparent from the oral histories herein is that changing concepts of mental illness further established the ubiquity of power issues. The growing acceptance of the need to include social and environmental issues in the understanding and treatment of mental illness further consolidated the influence of social work to the point where the allied health professions of psychology, social work and occupational therapy, challenged the power of the psychiatric profession by being admitted as ‘equal’ members of the treatment team. In turn, however, the power of each of these groups was threatened as the boundaries of their own practice and professional knowledge blurred. The fact that the roles of all the professions were in flux proved to be problematic for mental health social work.

76 C.M. Campbell and Associates, Health Services and Facilities for the Mentally Ill in Western Australia: A Plan for Their Organisation and Further Development, West Perth, 1982 183

Chapter 6

Professional Humpty Dumpty

1984 -1999

In the last chapter I analysed changes in the administration of social work services in the MHS following political decisions of 1973. It proved to be a ‘honeymoon period’ as it is very apparent that social workers were accepted during this time and for the first time as independent professionals and legitimate members of the mental health treatment team. In the 1970s and1980s neo-liberal policies were imported from Britain and the USA, posing cuts to government funded services and threats to job security and income maintenance.1 As will become apparent from the data presented in this chapter, social work, as part of government services, was one of the casualties of new policies. The ‘honeymoon period’ was over.

This chapter begins with an overview of the organisational and administrative changes that occurred in Government departments Australia-wide at this time and which provide a context for the analysis of the interviews and other evidence. I then describe how the development of social work as a profession as the MHS changed from a separate department in 1984 to that of the larger structure of the newly formed Health Department of WA. The accounts of social workers who were employed in different divisions of the department at that time demonstrate the human face of government policy of the time and enable me to identify some of the issues that were significant to social work development during the 1984 -1999 period.

6.0 DEVELOPMENT OF SOCIAL WORK SERVICES

6.1 Organisational change

It is generally noted that the history of Australian social welfare is largely patterned on the British experience. As I have described in Chapter 3, the 1830s Poor Law legislation was designed to create a ‘free’ labour market and facilitate

1 C.Johnson, Governing Change: From Keating to Howard, Brisbane, University of Queensland Press, 2000, p.3. 184

industrialisation through the implementation of a harsh system of poor relief based on the principles of less eligibility. John Harris and Catherine McDonald note that the establishment of the post-war Keynsian welfare state in Britain was an attempt to create ‘state-guaranteed citizenship rights’ irrespective of a citizen’s standing in the market.2 From 1945 to 1976 the distinction between the operation of the market on one hand and the Keynsian welfare state on the other, enjoyed a broad spectrum of support in politics under which the state assumed major responsibility for dealing with all different types of social problems facing individual citizens. State power was seen as ‘the caretaker of social existence’ 3

In the immediate post-war period Britain’s centrally planned services were located in the main in different branches of local government. From 1976 due to cuts in expenditure, the requirements of the International Monetary Fund, and in response to economic globalisation and New Right monetarist policies, the British welfare state was subjected to a neo-liberal agenda of privatisation, liberalisation and de- regulation. Values associated with the Keynsian welfare state were to be avoided, and the theme of empowering individuals against the dominance of the state was advanced.4

6.2 Change in the Australian public sector

In Australia, although a similar policy to that of Britain was pursued in the post World War II period, there were different institutional arrangements which were mediated by political decisions between the states and the Commonwealth. Initially the administrative structure of the MHS was fashioned according to requirements of the 1904 WA Public Service Act. Then in 1948 the National Assistance Act encapsulated the recommendations of the Beveridge legislation concerning reforms to the complex collection of income maintenance schemes in existence in 1944.5 Although appropriate for conditions at that time the structure was unable to sustain

2 J. Harris and C. McDonald, ‘Post-Fordism, the Welfare State and the Personal Services’ in British Journal of Social Work. Vol. 30, 2000, p.54 3 M.A. Jones examines implications concerning the transformation of Australia into a welfare state in the 1970s in M. A. Jones, The Australian Welfare State: Origins, Controls and Choices, Third edition, Sydney, Allen and Unwin, 1990. 4 Brown, The British Welfare State. 5 Beveridge, Full Employment in a Free Society. 185

the rapid economic growth associated with the period of reconstruction following the Second World War. Predictions were made of a ‘banana republic’ if the necessary economic changes were not implemented. This system remained basically unchanged until the 1980s when private, neo-liberal agendas of profit-oriented companies played a greater role in the provision of welfare in every area of service delivery.6

6.2.1 Public sector management reforms

At this time new ‘pandemic management reforms’ initiated sweeping changes in the relationship between capital accumulation and the welfare state.7 An articulated goal of this era was for the governments to become more efficient by modelling themselves on the private sector, which identified costs and measured objectives by giving priority to economic over social and managerial considerations, and included putting as many services as possible out to contract. These ‘new’ public management reforms became established in federal and state bureaucracies in Australia as ‘old’ administrative structures of traditional bureaucracies were replaced by the generic management techniques of corporate entities.8

Chris Hood describes these de-bureaucratisation doctrines as representing a ‘paradigm shift’ whereby threats to job security, income maintenance, upheaval in the family, changing moral values and sex roles, and an increased concern over ethnicity and racial violence had a massive impact on the composition and delivery of human services.9 Paul Kelly considered that these changes initiated ‘the end of certainty’.10 These changes were particularly significant for those at the ‘coalface’ who were closely affected by the greater focus on results and the professional

6 C. Pollitt and G. Bouckaert, Public Management Reform: A Comparative Analysis, 2nd ed. Oxford, UK, Oxford University Press, 2004, p.1 7 T. Gabler “Reinventing Government” and Patrick Weller “The Universality of Public Sector Reforms” in G. Davis (ed.), New Ideas, Better Government, St.Leonards, NSW, Allen and Unwin, 1996 8 C. O’Faircheallaigh, J. Wanna and P. Weller, Public Sector Management: New Challenges, New Directions, Second Edition, Brisbane, Macmillan Education, 1999, pp.8-20 9 C. Hood, “Contemporary public management: A New Global Paradigm?” in Public Policy and Administration, Vol. 10, No. 2, 1995, pp. 104-117. 10 P. Kelly, The End of Certainty: The Story of the 1980’s, St.Leonard’s NSW, Allen and Unwin, 1992 186

evaluation of programmes.11 Critics from the neo-liberal right increasingly contended that the state had overextended itself and government became too big and unresponsive, thus reducing private initiative and freedom of choice; critics on the left also responded to the rising tide of individualism and were concerned about both ‘welfare dependence’ and the capacity of the state to deliver real improvements in welfare.12 Consequently despite differences of viewpoints a substantial consensus emerged that the nature of many government services and the method of their delivery should be reshaped.13

6.2.2 Privatisation of services

By the 1990s Government services were increasingly being outsourced; the private- for-profit sector was encouraged to compete for government funding for the delivery of human services, re-labelling clients as customers, and statutory departments had increasingly become purchasing authorities.14 Privatisation was the umbrella term applied to these changes. In 1993 the WA government’s publication of Agenda for Reform, referred to as the McCarrey Report and, premised on the conviction that modern management procedures were more efficient than those existing in the public sector, recommended a review of the finances and operations of public sector management. The report was strongly criticised by academics and members of non- government human services on the grounds that it provided no evidence that the authors had any understanding of social policy issues, and that its sole rationale was based on issues of financial management. Maria Harries commented:

11 I. Duckham, Serving the Servants, Serving the State: A Brief History of the Institute of Pubic Administration of Australia, Western Australian Division 1945-2005, The Western Australian Division of the Institute of Public Administration, Perth, 2005, p.42 12 M. Keating, “Reshaping service delivery” in G.Davis and P. Weller (eds.) Are You Being Served: State, Citizens and Governance, Crow’s Nest, Australia, Allen and Unwin, p.98 13 Keating, Reshaping Service Delivery, Keating also noted that in 1996 the OECD Ministerial Symposium reformed their public services because of concerns about economic performance, the changing needs or demands of citizens and institutions, and a decline in confidence in government., p.99 14 See O’Faircheallaigh and others, Public Sector Management, p.27 for a discussion of the 1993 Hilmer Report and the associated Special Premier’s Conferences and the Council of Australian Governments, which progressively urged the adoption of a national policy as a step toward an efficient national market and as a contribution to economic integration. Following delivery of this report the Competition Reform Bill 1995 took effect, foreshadowing the way most government services would be put out to tender. 187

There was a sense amongst people in the human service area at this time that something important was being left out of the economic equation. One of the consistent references was to problems with ‘the new language’. What was said was that the new language ignored the ‘soft’ language of community, values, social contracts and civic responsibility… the sector struggled to engage with the possibilities in the new privatised economic environment at the same time as it tried to articulate a values framework that respected the deep commitment to those whom it saw as the casualties of the new market systems that were being introduced. 15

6.2.3 Disciplinary approaches to public sector management

A number of different disciplinary approaches have been taken regarding the nature of the deficiencies of public sector performance, and the alternative ways of addressing them in the closing decades of the twentieth century. The most persistent research theme concerns the requirements for different types of management structures for different sectors in government and non government. O’Faicheallaigh and others dispute the arguments that organisational forms and solutions to organisational problems drawn from an analysis of private sector firms can be applied extensively to the public sector.16 They argue that the assumption that they can be accommodated has important implications in terms of the value placed on different types of qualifications and expertise. They query the number of ‘layers’ that need to be involved in the construction of an organisational hierarchy, suggesting there should be a ‘flat’ structure in which few management levels intervene between operational levels at ground level and senior managers, and ask whether there should be an extended chain of command travelling through a series of management levels. Further, they note that a distinction between the ‘old type’ public administrator and the modern ‘can-do’ public sector manager exists. They argue that the traditional duties of a public servant were to conduct administrative tasks and regulatory functions according to the policy of the executive branch of the elected government; they were judged by their ability to perform directed tasks and utilise resources. By contrast the new breed of public officials are regarded as managers or directors and

15 Harries Privatisation of Human Services, p.113. Harries describes the views expressed by members of the Australian Association of Social Workers (AASW) 1995, the National Council of Social Services (ACOSS) 1996, and those of Eva Cox in her Boyer lecture in 1995, revealing their struggle to articulate a ‘values’ framework that would describe their deep commitment to those who they saw as casualties of the new market system.. 16 O’Faicheallaigh and others, Public Sector Management, pp.43-46. 188

are given more operational autonomy for implementing vision statements and meeting declared objectives. Such skills are seen as related to demands for accountability and political demands for electoral support but also to the historical patterns of operation within the public service and the nature of internal control mechanisms. A different focus is taken by Amanda Sinclair who considers that the debate of the ‘what and ‘why’ of administration was superseded by another with a fixation on the ‘how’ and comments:

In the remaking of public sector management, the linking of social ideals with institutional purposes and personal values and aspirations has become largely undiscussed and undiscussable. One of the legacies of the new hegemony of generic management models in administration is a language and discourse which casts public sector management as a technical rather than a social commitment or moral practice. 17

She argues that public sector management had to face problems concerned with issues such as the provision of services without fees, the enforcement of laws and regulations, the responsibility of protecting the needy and the helpless and the lack of an effective means of evaluating these services, making the application of generic management ideas limited. 18

6.2.4 Gender-based management cultures

Numerous studies illustrate how groups operate in various work settings.19 While Anne Oakley’s work in 1974 differentiates between ‘sex’ and ‘gender’ in reference to the biological differences and social roles of men and women, gender concerns were

17A. Sinclair ‘Leadership in Administration: Rediscovering a Lost Discourse’, in P. Weller and G. Davis (eds.), New Ideas, Better Government, St.Leonards, NSW, Allen and Unwin, 1996, p.229. 18 For a discussion of the differences between administration and management see O.E. Hughes.1994, Public Management and Administration, London, St Martin’s Press, also D. Shand “Are We Reinventing Government?” and A. Sinclair “Leadership in Administration: Rediscovering a Lost Discourse” both in Weller and Davis (eds.), New Ideas, Better Government. 19 R.M.Kanter, Men and Women of the Corporation, New York, Basic Books, 1977 and W.A. Ouchi, Theory Z, How American Business Can Meet the Japanese Challenge, Reading, MA, Addison Wesley, 1981. R.K. Merton, Social Theory and Social Structure, New York, Free Press of Glencoe, 1957, was a forerunner of later management theories in recognising the power of sub-cultures on the dynamic between employees and managers. 189

mainly ignored in organisational analysis until the 1980s.20 Sue Maddock, who studied the influence of gender cultures on organisational behaviour and management, notes that deeply embedded in the cultural context of such work particularly in the health field, were the expectations that employment experiences were similar for all employees. She contends that for many years organisations were regarded as ‘closed systems’ run on military and authoritarian patterns where employees obeyed the bosses.21 Ferguson describes this bureaucratic style of corporate culture as ‘feminizing’ because it disempowers individuals, and bureaucrats, like women, are expected to be conforming.22 Instead she argues that the passivity of women is a result of the lack of power and authority within public sector bureaucracies particularly in the health field where female professions tended to have less status than male professions.23 She argues that as subcultures developed the impact of authoritarian work cultures on staff relations and productivity became more apparent. However this situation was not seen to be a problem to those employed in the health field until the 1980s when the market demanded diversity and innovation.

Researchers into aspects of Australian experience propose that cultural studies concerning the influence of gender are particularly valuable. An Australian study by Collinson and Hearn described the different types of bonding that could occur in an organisation, and identified the way male bonding and masculine values could predominate.24 Benshop and Doorwaad in their study of the effect of managerial approaches on levels of productivity, found that women’s styles differed considerably

20 A. Oakley, The Sociology of Housework, Oxford, Martin Robinson, 1974 first distinguished between ‘sex’ and ‘gender’. The theme was continued in her article “Interviewing women: a contradiction in terms” in H. Roberts (ed.), Doing Feminist Research, London, Routledge. 1983. 21 S. Maddock, Challenging Women: Gender, Culture and Organisation, London, Sage.1999, pp.84- 110. 22 C. Ferguson, The Feminist Case Against Bureaucracy, Philadelphia, Temple University Press, 1984. There are numerous studies which illustrate how groups operate in various work settings. R.K.Merton’s Social Theory and Social Structure, New York, Free Press of Glencoe, 1957, was one of the first to notice that oppressive sub-cultures were both the product and cause of conflicts within corporations and bureaucracies. Post-structuralists such as Foucault in his 1972 work The Archeology of Knowledge, London, Tavistock Publications, stated that bureaucratic systems caused not just behavioural conformity but also alienated employees, and concluded that employees familiar with such rules considered them to somehow be natural and therefore preordained. 23 Veiled references made by male informants indicated that the lack of assertiveness by WA female social workers was a major factor in the dominance of males in areas of administration and policy. 24 D. Collinson and J. Hearn, 1994, ‘Naming Men as Men: Implications for Work, Organisation and Management’ in Gender, Work and Organisation, Vol.1, No.1, January 1994 190

from men’s, in that they did not possess the competitive qualities to produce maximum efficiency.25 A study by Audrey Bolger concerning the availability of employment for social work graduates in Western Australian noted that career opportunities available to women in this field were diminishing as more men were becoming available.26

6.2.5 Closed shop cultures

Although managerial methods concerning the delivery of government policies were significant in the delivery of services to the community, equally so, but less widely acknowledged in this area, was the impact of a number of ‘closed shop’ cultures. For example, Weller and others drew attention to the system in the old Australian Government Department of Foreign Affairs that encouraged a rigid distinction between different ‘casts’ or ‘streams’ - ‘policy’ or ‘diplomatic’ officers at the top and ‘administrative’, ‘consular’ and ‘keyboard’ officers and others at the bottom.27 They noted that the culture reinforced a rigid closed shop where ‘policy’ officers were shielded to a large extent from issues of resources and financial management; ‘administrative’ officers were encouraged simply to process and not to ask difficult questions about the fundamentals of the system or how things could be improved. The cultural change brought about by multi-skilling policies and the introduction of training programmes then became a prerequisite for setting in place better management systems for improved service delivery in the organisation.28

6.2.6 Commonwealth government accountability measures

When the Labor Party came to power in the Commonwealth in 1983, its intention was to bring the public service and public sector into line with the new non-

25 Y. Benshop and H. Doorwaad, 1988, ‘Covered by Equality: The Gendered subtext of Organisations’, in Organisation Studies, Vol. 19, No. 5, 1988, pp.787-805 26A. Bolger, ‘Status in a Female Profession: Women Social Workers in Perth’, in Australian Social Work, Vol. 34, No. 2, 1981. pp.3-9. 27 P. Weller, J. Forster and G. Davis (eds.), Reforming the Public Service: Lessons from recent experience, Crows Nest, Victoria, Macmillan Education Australia, 1993, p. 63. 28 The paradigm informing public service reform, of business organisation and market rationality provides a wide range of options; the creation of a new culture is one of these. See D. Mildern ‘The experience of amalgamation: The Department of Transport and Communications’ in Weller and others (eds.), Reforming the Public Service, pp.88-96, in which she emphasizes the need for clarity in corporate goal setting. 191

conservative ‘economic’ management.29 Based on the need to reduce public expenditure and a belief that ‘ossified’ hierarchical, rule-driven bureaucracies’ with stated outcomes, should be replaced, ‘a competitive mission-driven government that focused on results and outcomes rather than processes’ became the catalyst for future reforms.30

The Public Service Reform Act of 1984 introduced a system of ‘generic classifications’ and multi-skilling and included provisions for Senior Executive Service officers to be recruited from inside and outside the service.31 This involved an increasing reliance on employment contracts and performance pay. In 1986 the Public Service Legislation-Streamlining Act collapsed hundreds of classifications into eight bands in the Commonwealth sector, and defined job performance expectations across a wide range of criteria based on an agency specific basis.32 These important changes to internal personnel administration were not introduced by legislation, but by negotiation with representatives of staff associations

Wilenski is one of a number of writers who were critical of these developments.33 He drew attention to the complexity inherent in determining job classifications, and the clash of values that frequently occurred between the cost-cutting approach of technical management cultures and the traditions of public service with its fundamental ethical concerns. Yeatman argued that while the complex reporting chains between ‘super-ordinates’ and ‘subordinates’ were flattened out to replace the old authoritarian culture of ‘command and deference’, the introduction of task- centred and results-oriented performance agreements was incompatible with the long term strategic policy and planning needed for the benefit of society.34 Consequently professional groups such as engineers, doctors, lawyers and social workers may find that the discretionary authority they require to interpret their task and respond to needs has been seriously circumscribed.

29 Gaebler, Reinventing Government p. 17 30 Duckham, Serving the Servants, p.31 31 O’Faircheallaigh, and others, Public Sector Management in Australia, pp.148-161 32 O’Faircheallaigh and others, Public Sector Management in Australia, p.148. 33 A. Wilenski, ‘Administrative Reform -General principles and the Australian experience’, in Public Administration, Autumn 1986, and M. Considine & M. Painter, Managerialism: The Great Debate, Melbourne, Melbourne University Press, 1997. 34 A. Yeatman, Bureaurcrats, Technocrats, Femocrats; Essays on the Contemporary Australian State, Sydney, Allen and Unwin, 1990, p.25. 192

6.2.7 Australian government structural reforms

Michael Keating identifies a number of changes that were made at the centre of government by Prime Minister Hawke in 1987 with the expectation of achieving better coordination in policy advice and economies of scale.35 One of the measures to prevent duplication of functions was the abolition of the Public Service Board and the establishment of an Australian Public Service Management Board chaired by a Commissioner. The Senior Executive Management Programme was introduced to segregate an upper echelon of senior staff and provide them with the necessary management and negotiating skills to enable sweeping administrative reforms in the spirit of scientific management.36 Premised on the view arising in the United States that management consisted of generic skills that could be applied across most portfolio areas the Australian Government established the Australia Senior Executive Service (SES), which covered deputy secretaries, specialist advisors, heads of divisions and regional directors.37 Appointment to the SES rested on selection criteria based on generic skills and management orientation stressing personal achievements, creativity and conceptual or analytical skills, which were personal qualities differing greatly from those applying to other classifications evaluated for individual officers according to formal results-based performance appraisal schemes usually devised on agency specific criteria It was envisaged that such managers would be more mobile and that there would be regular interchange between the public and private sectors. Consequently the transfer of decision-making powers and responsibilities to lower levels of the organisation would grant more discretion in decision making to front- line managers, although some overall control remained with the central office. A further reform at the centre of government was the merging together of closely related policy and programme areas into mega-departments in order to remove

35 M. Keating ‘Mega-departments: The Theory, Objectives and Outcomes of the 1987 Reforms’ in, P.Weller, J.Forster, and G. Davis , (eds.) Reforming the Public Service: Lessons from Recent Experiences, South Melbourne, Macmillam Education Australia, 1993. 36 Executive Management Programme 1987, Design Specification, Senior Executive Development Branch, Public Service Board, February 1987. See also B. McCallum, ‘Managing Senior Public Sector Managers’, in A. Peachment, ‘Reforming the Public Sector: Global Trends, Local Action’, in A. Peachment (ed.), The Business of Government: Western Australia 1883-1900, Annandale, NSW, The Federation Press, 1991. 37O’Faircheallaigh and others, Public Sector Management pp.151-152. 193

overlap and duplication of functions between departments.38 This was expected to lead to broader based and more integrated policy advice becoming available to portfolio ministers and the cabinet.

6.2.8 Enterprise bargaining

In 1996 the Federal Government Coalition ministry initiated further reforms by the introduction of the Workplace Relations Act of 1996 which, by introducing individual workplace agreements, provided for agency specific bargaining including job classifications, entitlements and the removal of restrictions on part-time work, thus bringing public sector workplace relations into line with the private sector.39 Then in 1997 a revised Public Service Act was introduced whereby Secretaries were given wide managerial powers as heads of agencies and designated as employers of staff and as such they could assign duties to staff and determine their remuneration.40 Additional services had to be funded both at the expense of other services and by improving efficiency in the delivery of services, so reducing the type of work involved to technical input and output measures.41 As a result, with regard to social workers, the discretionary activity of casework intervention and treatment was de- emphasised for social workers in health and welfare areas in favour of the number of cases they processed, assessed and referred on to other agencies. Simms and Stone commented that although such reforms effecting bureaucratic improvements in the position of women were successful, they also noted that such reforms were contentious as they challenged existing power arrangements and consequently were marginalised or deprived of resources.42 As agendas for departments were made more explicit, departments increasingly chose to ‘mainstream’ equity measures and devolve responsibility to operational managers.

38 M. Keating, “Mega-departments: The Theory, Objectives and Outcomes of the 1987 Reforms”, in Weller and others (eds.), Reforming the Public Service, pp.1-13. See also H. Williams, ‘The impact of Changes at the Centre of Government’ in Weller and others (eds.), Reforming the Public Service, p.38, who noted that reform of the estimated process also occurred, whereby under the reformed cabinet guidelines forward estimates for three years became continuously updated due to the effect of parameter changes and government decisions. 39 B. Yates, Workplace Relations and Agreement Making in the Australian Public Service’ in Australian Journal of Public Administration Vol. 57, No. 2, 1998, pp.86-88. 40 Excerpts from the Senior Executive Management Programme 1987, quoted in Yates p.179. 41 Yeatman, Bureaurcrats, Technocrats, Femocrats, pp.13-21. 42 M. Simms and D. Stone ‘Women’s Policy’, in C. Jennett and R. Stewart,(eds.), Hawke and Australian Public Policy, Melbourne, Macmillan, 1990 194

In summary, changes introduced during the 1980s into the Australian public sector services, which had grown in size but remained basically unchanged since federation, shifted the focus from ‘administration’ to ‘management’, and were consistent with trends occurring in bureaucracies in other parts of the world.

6.3 Western Australian Government reforms

Industrial conditions applicable to WA public servants were set down by the Public Service Act of 1904 whereby terms and conditions of employment and promotion were routinely chosen on the basis of seniority; decisions could be challenged by lodgment of an appeal with the Western Australian Industrial Court. Traditionally WA public service career professionals were trained for specific occupations and independent of the government of the day, were accountable for their performance through the responsible minister, and remained anonymous. The system continued until it was replaced by the Public Service Act of 1978 which introduced promotion by ‘merit and efficiency’ rather then seniority.43 Further, as politics was virtually a part-time occupation, politicians relied heavily on the advice of these senior administrators. 44

6.3.1 Structure of the WA Public Service

During the initial period, the State Public Service was structured into a number of Divisions. The position of Permanent Head - a very powerful one- was characteristic of the paternalistic ‘gentleman’s club’ philosophy that existed at the time. Under that came the following- Special (heads of departments, inevitably occupied by a male) Administrative, (usually without management training), Professional (tertiary trained specialists), Clerical (clerks and typists) and General (technical and non-professional staff which fostered ‘an old-fashioned, authoritarian, and conservative culture’.45 At that time the Commonwealth Government provided most of the funds for social security but state governments were responsible for organising services and

43 Duckham, Serving the Servants, pp. 9-11 44 Duckham, Serving the Servants, quoting an interview with D. Black, p.10 45 Duckham, Serving the Servants, p.11 195

distributing funds which included health and mental health services.46 This was the situation following World War II when the return of service personnel and the influx of migrants in the post war period resulted in an expansion of numbers in both the State and Commonwealth public services.

In October 1944 a small group of senior state and commonwealth public servants, local government employees and academics in Perth made a decision to study the problems of public administration, and established a branch of the British Institute of Public Administration, later to become the Institute of Public Administration (WA Division).47 The decision was said to be characteristic of the strong bond of allegiance to the British Empire that still existed among some members of the Perth community at the time, and a portend of the continuing influence that English political and public policies were to maintain in the future. However, in the initial stages, participation was mainly confined to heads of Commonwealth and State departments. Despite many efforts membership lagged as it was felt that the meetings were more academic than practical.48

Administration of the Public Service continued with little change until the 1960s and 1970s when, influenced by the Keynsian ideology that the state assume responsibility for dealing with all types of social problems facing individual citizens, state power was seen as ‘the caretaker of social existence’.49 During this period referred to by Groenewegen as ‘the new federalism’ a strong growth in government expenditure occurred and a number of welfare based policies were introduced.50 By early 1973 the Australian economy was enjoying buoyant conditions which were accompanied by a rise in average weekly earnings, mounting industrial unrest; a boom in mining shares in WA and a rapid increase in capital inflow were factors associated with acceleration in the growth of the money supply.51

46 S. Garton, Out of Luck: Poor Australians and Social Welfare 1788-1988, Sydney, Allen and Unwin, 1990, pp.141-145 47 Duckham Serving the Servants, p.7. 48 Public Administration was introduced as a compulsory unit of study conducted by Professor F. Mauldon and Dr M. Harris (later Tauman) for students of economics and law as early as 1942 by the UWA. 49 J. Keane, Democracy and Civil Liberty, London, Verso, 1988 p.4 50 P. D. Groenewegen, Federalism, in Patience and Head (eds.), From Whitlam to Fraser, pp.55-57. 51 Groenewegan, Federalism, pp. 55-57. 196

When the Whitlam government came to power in 1973 the largest growth in Commonwealth outlays occurred in areas formerly regarded as state functions - education, health, urban and regional developments. This was a policy which resulted in an increase in community funded facilities for health services in WA. However this rapid increase in Commonwealth intervention in traditional state responsibilities led to bitter inter-governmental financial relations, as the rise in specific purpose grants appeared to indicate reduced state independence in budgetary decision- making. Further, the public became incensed as increased levels of taxation were required to finance government policies. There is considerable discussion in the literature concerning the growth of the bureaurcracy at the time, and the inability of the Weberian patterned administrative structure to cope with the influx of changes.52 Whitwell, one of the many writers who commented on the trend argued that it was difficult to disentangle the actions of the government from the broader changes in the domestic and international economies, and that from the 1960s there were numerous signs of changed economic circumstances and the onset of economic instability. 53

In 1975 the Fraser government claimed that a major cause of the economic crisis was the cost of the ever-growing public sector. In 1981, following the Review of Commonwealth functions (known as the ‘razor gang’) staff ceilings were introduced as an effective way of halting the growth of the Commonwealth Public Service. 54 The Fraser years were characterised by a decline in infrastructure investment, and withdrawal of the Commonwealth from almost all the initiatives of the Whitlam period.55

6.3.2 Western Australian public sector management In Western Australia the election of the Burke government in 1983 continued the larger task of relating the West Australian bureaucracy to reforms initiated by the

52 M. Keating and P. Weller, ‘Rethinking government’s rules and operations’, in Davis and Weller (eds.), Are You Being Served. Jones The Australian Welfare State, pp.62-64 suggests that Keynes theory was intended to present only a short-term solution for the world to revive the depressed economies of the 1930s. 53 G. Whitwell ‘Economic Affairs’, in H.Emy, O. Hughes and R. Matthews (eds.), Whitlam Revisited: Policy Developments ,Politics and Outcomes, Leichart, NSW, Pluto Press, 1993, p.33. 54 E. Van Acker, ‘Women’s policy activism and changing relations with the state’, in Davis and Weller, Are you being served? p.65. 55 P. Troy, ‘Love’s Labor Lost: Whitlam and Urban Regional Development’ in Emy, et al, (eds.), Whitlam Revisited, p.159. 197

Thatcher in the UK and Regan in the USA by focusing public sector management on results and outcomes rather than processes.56 Emphasis was re-directed from a concern for individual rights to prioritising economic and administrative issues. 57 Ian Duckham notes that publication of the policy document Managing Change in the Public Sector changed forever the life of public administrators in WA by announcing that the job of the public service was to follow policy directions of the government rather than make the policy.58 He argues that by stating in forthright terms that the job of the public service was to carry out the government’s instructions, the former cosy relationship that had existed between ministers and senior bureaurocrats was destroyed. Dr Ellis mentions this ‘cosy relationship’ during his period as Director of the MHS:

The main thing was in those days I had direct access to the Minister. I wouldn’t have taken the job if I hadn’t been given that. I didn’t go over the head of the Public Health Commissioner. I’d let him think it was his idea. He was a very good support of my policy of establishing clinics in country areas.59

6.3.3 Functional Review Committee

At this time the government also established the Functional Review Committee which resulted in the downsizing of a number of departments in order to make them more efficient or cost effective; additional services were to be funded by improving the efficiency of existing services The medical, mental health and community health departments were among those that were amalgamated into a single department. In order to ensure the effectiveness of these reforms a Senior Executive Service was established.60 A further innovation was the replacement of the former ‘Gentleman’s Club’ by a group of aspiring women who were appointed to leadership positions

56 A. Peachment, ‘Reforming the Public Sector: Global Trends, Local Action’ in A. Peachment (ed.), The Business of Government: Western Australia 1983-1990, Annandale, NSW, The Federation Press, 1991, p.33. 57 E. Cocks and M. Allen, Discourses of Disability in E. Cocks et al. (eds.), Under Blue skies. Writing about people with disabilities, they suggest that the discourse underlying these changes moved away from a concern for the individual, arising from an understanding of their lives and needs, to a much broader debate about the economic and political needs of society, and that such a move may be as threatening to vulnerable people as was the period of indicment in the early twentieth century. 58 Duckham, Serving the Servants’, p.18. 59 Interview with A. S.Ellis on 04/04/2001. 60 Duckham, Serving the Servants, pp. 20-22. 198

both in the public service and the Institute of Public Administration. However the structure of many public sector agencies was such that, unlike businesses whose managers were close to customers and staff, they were unable to respond quickly and efficiently to changes.61 Vardon and Morley argue that such a shift away from the structure and traditions of an existing culture requires understanding of the beliefs and values about work that are deeply ingrained and easier to identify than achieve; the fast-moving culture of competitive industries was particularly inappropriate for slow-moving bureaucracies.62

6.3.4 Mental illness and the Amalgamation of departments

In 1982 in order to comply with the government’s aim of achieving increased efficiency of services for the mentally ill in WA, the government commissioned an investigation to be made by the management consultants, C.M.Campbell and Associates.63 Their report recommended that the psychiatric services be given responsibility for all community, outpatient, day patient and outpatient care, together with a comprehensive range of facilities, and psychiatric services should be integrated with general health services. Further developments should be on the basis of a partnership between the MHS and the general hospitals including the teaching hospitals, and that the facilities locally based with facilities in country areas. In 1984 the reform agenda of the Burke government utilised recommendations of the Campbell Report by amalgamating the medical, mental health and community health departments to form the Health Department of WA, and creating a new facility - the Department for Intellectual Disabilities - which enabled intellectually disabled individuals to be separated from the mentally ill. The new administrative structure provided a hierarchical network of regional services that were coordinated by a central administration responsible to the Commissioner for Health, and located in the offices of the former Medical Department of WA. A similar policy in the eastern states had resulted in the removal of direct ministerial responsibility but it was feared by representatives of the MHS that by catapulting the department from its position as

61 Yeatman, Bureaucrats, Technocrats, Femocrats, pp.19-21. 62 S. Vardon and K. Morley, ‘ Creating successful change in public organisations’ in Weller and Davis, (eds.), New Ideas, Better Government, pp.138-141. 63 C. M. Campbell and Associates Health Services and Facilities for the Mentally Ill in Western Australia: A Plan for their Organisation and Further Development, West Perth, Campbell and Associates, 1982. 199

an autonomous organization, a similar move would result in a downgrading of services. Dr Ellis who was Director of the MHS from 1963 until 1977 wrote:

Free and informed discussion between these departments enabled appropriate advice to be presented to the Minister, but it is doubtful if the proposed monolithic structure will improve or maintain the quality of the State Mental Health Services, and whether the minister would continue to be adequately informed about the functions of this highly specialized area. 64

His comments reveal the disparate conceptualisations that existed between the medical and mental health administrators, and suggest that the age-old antipathy felt by medical to psychiatric practitioners was far from eradicated. 65

6.3.5 Health Department of WA

At this time a Management Committee was formed in the Health Department of WA whose function was to formulate policy and forward recommendations to the Minister for Health representing the separate areas of departmental professional activities- psychology, social work, occupational therapy, physiotherapy, speech therapy, dietetics and podiatry with the responsibility of coordinating recommendations of the combined professional groups and forward them for approval first to the Commissioner then to the Minister for Health.66 Implementation of this policy was inconsistent with the practice of a psychiatrist as leader of the treatment team. However it was consistent with government strategies to reduce the size of the public sector and to make the process more transparent, and included the requirement that psychiatrists explain the outcomes of their government funded programmes.

Further changes in the 1990s followed the election of the Howard government.67 These included a move back to state rights by contracting out of services provided by the Commonwealth, and an inquiry into charitable organisations.68 The Agenda for

64 Ellis, Eloquent Testimony, p.185. 65 The ANZCP was not established until 1944. This is discussed more fully in Chapter 5, 1959-1973. 66 Participant no.9 interviewed by author on 28/02/2002 67 Osborne and Gaebler Reinventing Government, New York, Penguin, 1993. 68 M. Harries, Privatisation of Human Services, PhD Thesis Murdoch University, 2004, p.96. 200

Reform in 1993 (known as the McCarrey Report) found serious deterioration in the State’s financial position and explicitly promoted privatisation of most government assets and services. Following that, the Competition Policy Reform Bill 1995, enacted by the Federal Government, authorised almost total dismantling of existing welfare structures and arrangements with the promise of economic benefits, resulting in contracting out of government services including those providing social welfare. 69 This decision was considered by David Hayward to be by far the most far-reaching of the government’s privatisation initiatives.70

From 1996 performance indicators of program efficiency and effectiveness were required when services were purchased by the WA Treasury Department. In addition each government department established its own set of guidelines for contracting. A new funding arrangement was announced in which the peak body for the not-for-profit community services sector, The Western Australian Council of Social Services (WACOSS) lost its grant from the government as did all services previously funded by the Minister.71 Changes in employment conditions across the human service sector were associated with these changes whereby the content and delivery of social work activities enjoyed by social workers and associated professional groups were placed under serious challenge.

6.3.6 Effects of Commonwealth Policies on WA

While the 1983-1992 Labor government reformed the century-old public service structure, the 1993-2000 Court Coalition Government of WA used these new structures to deliver results in terms of accountability and outcomes for customers.72 On the national scene the introduction of enterprise bargaining and workplace agreements represented a huge paradigm shift for public servants both in federal and state tiers of government.73 By continuing to utilise the Commonwealth Government’s policy of replacing large public utilities that had became cumbersome in the changing global market, with smaller and more motivated work teams with less management

69 Harries, Privatisation of Human Services, p.99. 70 Harries, Privatisation of Human Services, p.103. 71 Harries, Privatisation of Human Services, p.105. 72 Duckham, Serving the Servants, p.33. 73 J. Halligan, I. Mackintosh, and H. Thompson, The Australian Public Service: The View from the Top, Belconnen, ACT, Coopers and Lybrand and the University of Canberra, 1996. 201

control, the focus on outcomes rather than processes was retained. The shift away from the mono-corporations towards a system of flatter, decentralised units co-coordinated by a central corporate body involved a networking form of administration away from the bureaucracies to enable new alliances to be established within the organisation and with external stakeholders in the voluntary sector. Maddock argues, however, that managers and management writers have tended to ignore the impact of social conditions and corporate values on the motivation of the workforce, concentrating on external incentives such as pay and empowerment strategies, and considers that the development of trust necessary for such networking to occur is dependent on the growth of new relationships and communication between those who have been separated in the past by power struggles.74

Associated with the focus on outcomes and the move towards decentralised units, the Ministerial Task force on Mental Health was commissioned in 1996 by the WA government. 75 It recommended the establishment in the central office of the Health Department of WA of a separate branch to undertake management of the State’s Mental Health Programme, the appointment of a Chief Psychiatrist to the Health Department Executive, and the adoption of a team-based service delivery approach with a clinical team responsible to the team leader who must be a psychiatrist, rather than a member of their professional hierarchy. It also recommended that the department recognize the role of private practitioners and non-government agencies in implementation of the plan.76 Legislation, which included the formation of a group to draft new mental health legislation, was subsequently introduced.77

In 1996 a new Mental Health Act changed the definition of mental illness to: ‘For the purposes of this Act a person has a mental illness if the person suffers from a disturbance of thought, mood, volition, perception, orientation or memory that impairs judgment or behaviour to a significant extent’.78 A Mental Health Review Board was established to examine complaints that a person was being improperly detained in a

74 S. Maddock, Challenging Women, pp.15-.31. 75 Report of the Ministerial Task Force on Mental Health, Vol.2, March 1996. Held at the Battye Library, Perth. 76 WAPD, 1996, vol. 332, 2 May-19 June 1996, pp.1389-2794. 77 Mental Health Act 1996, No. 68 of 1996, Statutes of Western Australia, 45, Elizabeth 11, 1996, Vol.2, Acts Nos. 42-82, pp. 1969-2091. 78 Mental Health Act 1996, Part 1, Section 4 (1). 202

psychiatric hospital. In making a decision consideration was given to the medical, psychiatric and social circumstances of the person.79 The Mental Health Act also considered the treatment of involuntary patients in the community, stating that a psychiatrist was to consider whether a person could be better treated by making a community treatment order than by detention as an involuntary patient in hospital. Application for a review of a detention order could be made. Appeals against a decision or order could be made to the Supreme Court.80

The focus of this chapter has been on the impact on Western Australia made by Commonwealth Government public sector reforms which prioritised economic and administrative issues rather than individual rights. A prominent feature of these reforms was an attempt to achieve efficiency by the amalgamation of departments. Amalgamation of the MHS into the newly established Health Department of WA was included in this policy.

6.4 Social Work Services in the Health Department of WA

In this section I describe the administrative structure of the Health Department of WA and the position and responsibilities of social work services within it. I then describe administrative features of newly coordinated social work services in the department. Attention is then turned to the experiences of individual social workers within hospital, community and rehabilitation areas.

6.4.1 Head Office Administration

The organisational reform changes of 1984 were significant in the development of social work services in the field of mental health in WA as they were modified to conform to policies of corporate management and the new generically based concept of service delivery. A new position, that of Principal Social Worker, WA Health Department was created.81 The social worker, who had been responsible for the organisation and supervision of social work services in the MHS, then became Assistant Principal Social Worker, WA Health Department. She commented:

79 Mental Health Act 1996, Part 6, Section 125. 80 Mental Health Act 1996. 81 Public Service List 1985. 203

Instead of identifying with the Mental Health Services, (social work) staff had to identify with Health Department social work. We had the largest staff. We were still keeping a social work group together, I was rather proud of it. It was a good pattern, and it meant that people who were isolated were drawn into a professional framework.82

However former MHS social work staff, whose supervisory and specialist positions came under review due to the new administrative structure, expressed less enthusiasm especially concerning the loss of specialist identities through the merger of departments. One commented:

Everything was recorded in writing. I felt that social work in the MHS had just been swallowed up.83

Another explained:

I had quite a bit of trouble at first because I collected quite a few people from community health and the general hospitals who felt their way of working was vastly different from mine, and I wouldn’t understand their way of working… I explained that I’m not going to stand on over the top of you. Even the ones in my group were a little bit ‘narky’ as they thought theirs was a specialized type of work.84

Under the new system, referred to as ‘line management’ all social workers were professionally responsible either directly or through Social Work Supervisors to the Principal Social Worker, but administratively responsible to the Superintendent of their particular area. A system of Monthly Reports was introduced whereby each social worker was expected to calculate the number of interviews, mileage travelled and comments on the type of cases and social problems encountered. Additional Senior Social Work positions were established at the major medical and psychiatric hospitals and centres in specialist practice areas such as psychiatry, child health and geriatrics. These positions were made possible by an earlier 1973 benchmark decision by the Industrial Tribunal. A new position, Level 2, on the Social Work Salary Determination, was created in a reclassification appeal made by the Civil Service Association on my behalf when I was employed as a Level 1 social worker at Bentley Clinic, to the Industrial Tribunal, claiming that specialist social work expertise was

82 Participant no.9 interviewed by author on 28/08/2001. 83 Participant no.1 interviewed by author on 23/03/2001. 84 Participant no. 21 interviewed by author on 28/11/2002. 204

required in a psychiatric setting. This acknowledged that specialist expertise was necessary for social work practice in psychiatry and that supervision of professional practice in this area was no longer required.85 Four Assistant Principal Positions were established to provide supervision of social workers employed in nominated areas of specialist practice: general hospital, mental health, geriatrics, and community health.

Several social work staff acted in the position until the appointment of a new Principal Social Worker in 1987.86 In her co-coordinating role she was responsible under provisions of the 1986 Financial Administration and Audit Act, and in the interview commented that she felt that for the first time the government was looking at the achievement of objectives by government departments as opposed to the amount of money being spent. She added:

It seems to me it was twofold. One was co-ordination of social work services throughout the State, including community health and country hospitals, the other part was a policy advisory role to advise the Director General, Dr Roberts at the time, and the Minister on matters of social policy that were relevant to social work where we had some expertise to offer; partly co-coordinating and partly advising. Shortly after I arrived the Financial Administration and Audit Act was introduced. I found it quite exciting because for the first time the government was looking at performance of a government department in achieving objectives, as opposed to how much money it had spent on it. It was a good position because you had knowledge of social workers from throughout the whole State system and you could pull it all together. Sometimes it would be particular research issues, but very likely it would be based on the practice experience of social workers…Conceptually the work was interesting, but you really had to think about just what you were trying to achieve, how you were going to go about it, and measuring what you were achieving… accepting that sometimes it’s going to be qualitative and sometimes subjective, it can rarely be quantitative.87

To illustrate the nature of her advisory role as Principal Social Worker she described two of her responsibilities - as chairperson of a departmental Domestic Violence Committee and as Health Department representative on a parliamentary Domestic Violence Committee. Recommendations of this committee were then incorporated in a protocol for dealing with situations of domestic violence on a State wide level. The

85 Public Service Notices 1974, Mental Health Services Section. 86 Participant no. 20 interviewed by author on 11/11/2002. 87 Participant no 20 interviewed by author on 11/11/2002. 205

amalgamation of community health, mental health and hospital social workers initiated practice problems between social work specialists within the department.88 One of the Assistant Principal Social Workers with extensive experience in both hospital and community settings, was involved in a number of issues which turned out to be highly contentious. Social workers in the areas of community health and public health considered their way of working differed from hospital work, and became concerned that their specialist areas would not be properly understood by a person located at Head Office, who was unfamiliar with their specialty. They asserted that someone who worked in a hospital would not understand, for example, that sometimes it was necessary for them to work at night. They wanted someone who had worked in Community Health to be in charge of their section. The Principal Social Worker responded that ‘there was no way that would happen: they just had to come in line’. It was the beginning of a rather unpleasant series of confrontations in which definitions of ‘community work’ and ‘community action’ were hotly debated.89 From the interview material I am unsure of the outcome. The social worker who was directly involved in the situation commented:

I was direct supervisor of all those people, but I couldn’t really supervise them all. A lot of them were very senior, and I had the idea that if somebody’s very senior you should act as consultant on an ongoing basis not like this idea that a lot of supervisors have that senior people need that you see them on a fortnightly or monthly basis. Social work shoots itself in the foot because people say ‘Why do you need all that supervision? Aren’t they capable?’ I believe that with students and new graduates, yes, but after that you get people to go longer, and stand on their own feet. 90

6.4.2 Hospital administration

Until the mid 1990s there were two dedicated psychiatric hospitals in Western Australia servicing the entire state – Graylands Hospital and Heathcote Hospital. In this section I first describe the administrative structure at Graylands Hospital before moving on to discuss individual social work experiences in mental health clinics, and specialist services.

88 Participant no.21 interviewed by author on 28/11/2002. 89 Participant no 21 interviewed by author on 28/11/2002. 90 Participant no 21 interviewed by author on 28/11/2002. 206

Graylands Hospital

Despite the introduction of centralised administrative and reporting procedures very little change was directly experienced for social workers at practitioner level.91 Prior to that time under ‘line management’ professional heads of departments were no longer responsible to Superintendent of each unit but to their respective Principals in Head Office. At Graylands Hospital a monthly Heads of Department Management Team Meeting was held, chaired by the Superintendent and attended by representatives of each professional and administrative section. As the hospital was the largest unit of the MHS it was also where office accommodation for senior allied health staff was situated. Consequently the Management team included the author and the heads of occupational therapy, and psychology. Together we represented members of the Allied Health treatment teams.

Recommendations from the Management Team were forwarded to the monthly Superintendents’ meeting and to the policy planning section at Head Office. However before a decision was reached it was the practice for each allied health representative to refer the matter to the appropriate Principal in Head Office. The departmental policy was that of establishing community based mental health facilities utilising the services of allied health professionals in addition to medical professionals. In direct contrast was the declared agenda of the Superintendent, namely, to maintain Graylands Hospital as a ‘centre of excellence’ for WA psychiatry. It would have an administration completely separate from any regionalisation programme being introduced by policy makers at Head Office. This situation was, to use a hackneyed phrase ‘a disaster waiting to happen’.

When the Principal positions were abolished in 1996 the Graylands Hospital Superintendent reconstructed the Management Team. Instead of having a representative for each profession the allied health component (social work, psychology and occupational health professions) was reduced to include only one representative chosen by the entire group who would attend in rotation with others. A

91 Participant no 1 interviewed by author on 25/03/2001. 207

similar arrangement concerning staff selection was introduced whereby an interdisciplinary committee replaced the previous selection process undertaken by individual professions. The social work representative commented – ‘the medical staff felt they had all the knowledge and we worked through their courtesy- typifies the social work response at the hospital to these changes’.92 Graylands Hospital remained the only centre which provided treatment in a secure (locked ward) environment and provide a range of assessment and comprehensive treatment services for patients who were severely mentally disturbed or who required intermittent periods of hospitalisation when Heathcote Hospital closed in 1996 as its functions as a centre for acutely ill psychiatric patients were dispersed to general hospitals.

One of the interviewees, who had been a Social Work Supervisor at Graylands Hospital in 1993, commented on the changes in practice that had occurred during the decade of the 1990s.93 During that time the length of stay of patients, which had averaged twenty eight days, was reduced to fourteen days, during that period it took about a week and a half to allow medication to take effect, after which time the patient was expected to be discharged. Consequently it was not possible to undertake the psycho/social interventions which had traditionally formed part of social work practice at the hospital. This interviewee commented:

The sort of social work proper in terms of dealing with families, counselling, couples work, has tended to drop away because the patients are either too disturbed, or haven’t families. In my time here the level of chronicity for the average patient has resulted in a reduction in the number of patients that are amenable to counselling and therapeutic interventions and that feedback has come from occupational therapy and psychology as well.

The social workers interviewed indicated that these changes meant that it was possible for the social workers to address only the more basic welfare and financial issues; there was an assumption that the psycho/social issues would be picked up in the community.

92 Participant no. 1 interviewed by author on 23/03/2001 93 Participant no. 13 interviewed by author on 22/10/2001 208

We don’t have the time to follow up other peoples’ responsibilities other than the discharge process that outlines areas that still require input, after that, it’s up to the clinics…the discharge summary, well it’s medical, but it may or may not contain our recommendations. 94

Heathcote Hospital

The closure of Heathcote Hospital in 1996 added further to the already intense competition for beds at Graylands Hospital. Although the Health Department made attempts to increase the number of beds for psychiatric patients in metropolitan and regional general hospitals, this increase did not include persons referred from the courts and awaiting trial for criminal offences, some of whom had previously been detained at Heathcote.

6.4.3 Forensic Psychiatry, Frankland Centre

When a new assessment and treatment facility for forensic psychiatry was established in the grounds of Graylands the resident forensic team was readily available. A senior social worker from Graylands Hospital was appointed as Project Officer of the unit until her retirement in 1990, when another social worker also from Graylands Hospital, joined the unit.95 She was acutely aware of social action and social justice issues as part of a multi-disciplinary treatment team and it was her role to provide information concerning the psycho/social background, and ensure the patient had legal representation. Describing her experiences she said:

Certainly when we look at mental health patients we really do recognise that if you don’t look at the psycho/social context within which the mental illness occurs the patient will relapse very quickly back to hospital and you can’t do any meaningful rehabilitation without addressing those issues. That philosophy is accepted by the rest of the team, very much so. Medication is a component of the treatment, but everything is aimed at treating people decently and honestly.

94 Participant no. 13 interviewed by author on 22/10/2001 95 Participant no.12 interviewed by author on 31/10/2001 209

Important also was the provision of education concerning the patient’s mental illness by the social worker, and the provision of support for family members who were at times distressed and felt responsible for precipitating the illness and its consequences. She described an example of her interaction with the parents of a patient who had been informed their son was diagnosed as having a major psychotic disorder:

Women, I think, invest a lot of themselves in their children, nurturing them to grow up and be happy and successful. Being able to relate to parents of a child with a mental illness is I think a very useful vehicle. To be able to reach out to mum and dad and say ‘that’s not the case, this illness occurred because of fate and bad luck, it’s got nothing to do with you as a parent’. I think that’s quite a useful thing. I think too that as women we’re more content to be working at the grass roots, and we’re not particularly- for myself- ambitious. I wish I was at Royal Street telling them ‘This is what it’s like at the grass roots, listening to parents telling me they have to padlock their bedroom door because of the policies you’re implementing’.

She referred to the number of submissions, requests and recommendations that had gone to Head Office of the Health Department over the years, but had been ignored, and explained that she now assists families to become more politically motivated. They are urged to see their member of parliament. If this approach is unsuccessful a letter is sent to the Minister, the Ombudsman or the Office of Health Consumers. However these families were often very tired and dispirited, and this was not always possible. Discussing the social work role as a therapist with long term patients at the Centre she explained this involved the following:

Talking to them and letting them talk about issues that are on their mind. For instance some-one or two here- have actually murdered someone and they do need to talk about that being on their conscience. I try to provide an opportunity for patients to talk about those issues.

The transfer of patients with chronic mental illnesses from the Frankland Unit to the community was seen to have been hampered by the reduction in the number of supported beds and the consequent placing of long term patients in charity institutions and private hostels of dubious quality. Once patients had left the Frankland Centre, depending on the legal status, they were to be followed up at the

210

Community Forensic Out patient Centre in Perth, or at one of the autonomously administered clinics. In the latter case contact ceases with the Centre, and attendance becomes voluntary.

6.4.4 Community clinics

As well as the two psychiatric hospitals, there were and continue to be a number of clinics in the Perth metropolitan and regional areas of Western Australia. In the following section I describe social work experiences in the modified administrative structure in which the position of Clinic Managers replaces that of Superintendent.

In 1987 I returned to the Health Department as locum Social Work Supervisor at Swan Clinic, which was part of the Swan Districts Division of the WA Health Department, where I remained until 1989.96 It was a refreshing and challenging experience, and totally different from my time at Graylands Hospital. Headed by a Superintendent the staff consisted of allied health professionals, community nurses and administrative staff. Bi-weekly meetings and case discussions ensured an inter- disciplinary approach. Situated at Midland, an outer Perth suburb, the geographic areas (Balga and Mirrabooka) surrounding the Clinic contained an amount of government-funded housing together with established statutory and voluntary agencies in an effort to confront a complexity of social and environmental problems. Facilities for the provision of health, social and welfare facilities were uncoordinated and thinly distributed throughout the region. Consequently mental health social work practitioners at the clinic, in addition to casework with clients involving long-term unemployment, sole parenthood, child abuse and those arising from cultural and ethnic issues, also became involved in a considerable amount of community liaison and development issues, and enabled inter-professional contacts to be established and extended. Liaison with Community Health nurses was an essential role for social work. Perhaps the most important of these contacts was the establishment of an Allied Health Group. When I first arrived the allied health professionals from the Swan Districts Hospital and Swan Clinic functioned in relative isolation to one another. An Allied Health Committee was established, which initiated effective

96 I was acting in the locum position of Social Work Supervisor at Swan Clinic during 1987-1989 and Chair of the Swan Districts Coordinating Committee 211

liaison between the groups, and commenced interdisciplinary presentations. Recognition by the committee of the medical and social needs of the district, and uncertainty concerning future plans of the Health Department initiated the establishment of a Coordinating Committee. This consisted of representatives from each medical, allied health and administrative area to formulate future plans for the area. In 1989 a research document titled ‘Proposal for Services in The North Eastern Division of the Health Department of WA’ was prepared and forwarded to the policy division of the department.97 But communication links between the Health Department and the outer reaches of the metropolitan area were extremely tenuous. Shortly afterwards a Divisional Manager was appointed, and the Coordinating Committee disbanded. No response was received from Head Office, and the document was apparently lost in the labyrinth of intra-departmental mail. For me, although at the time I was extremely disappointed at the lack of response by the Health Department, the experience serves as a renewal of hope in the ability of medical, allied health and administrative staff to work constructively together.

We turn now to discuss social work at Avro Clinic, which is situated in a location close to the city of Perth, adjacent to a rehabilitation and drop-in centre, replacing the old Havelock Clinic. It is an example of the impact of regionalisation policies and the amalgamation of health services becoming part of the newly established North Metropolitan Health Region with the administrative centre at Osborne Park Hospital.98 The position of Clinic Superintendent was replaced by Clinic Manager in charge of all administration and staffing. Ten social workers were employed throughout the North Metropolitan Region, and only one was located at the clinic. She commented:

I do a lot of assessment work with new clients referred to the clinic, to assess their psycho/social circumstances and mental state, and then to discuss my impressions with the team, and work out who would work with that person. This includes a lot of initial assessment, because Avro Clinic tends to cater for people with chronic mental illnesses; many are single and live alone. The other end of the spectrum is

97 The paper prepared by the Coordinating Committee in 1989 titled ‘Proposal for services in the North Eastern Division of the Health Department’ remained unpublished 98 Participant no.14 interviewed by author on 14/11/2001.The mental health clinics were at Subiaco, Mirrabooka, Osborne Park and Joondalup. 212

family work, family therapy, and education work with people with mental illnesses. The rehabilitation aspect of it is in terms of understanding what the resources are, and referring people to day activities and so forth.

A large component of her role was welfare work - accommodation and material resources for clients. Avro Clinic, in partnership with Homeswest and a non- government organisation was part of an Independent Living Programme. The clinic received an allocation of available housing, and the social worker maintained a housing list, assisted in prioritising referrals and helped people settle down in accommodation. The social worker considered that maintenance of professional standards was a significant problem for social workers. Before amalgamation with the Health Department MHS social workers had regular supervisory sessions and met regularly on a rotating basis at different clinics in the metropolitan area to share information concerning mental health issues. These meetings together with professional consultation were now difficult to arrange. She commented:

When I started there was really good access, so now we’re kind of starving, you know, to get that kind of support, and you very much have to create it yourself. I’ve even had instances where I’ve been particularly concerned about a client I’ve gone and purchased private supervision because there just isn’t anyone around … I think its just a sign of the general erosion and drying up of resources.

She linked the difficulty of maintaining professional standards with the introduction of generic classifications in the mid eighties. Consequently a second designated Social Work position at the clinic was cancelled and renamed Accommodation Support Officer.

In smaller clinics in regional centres the policy of generic classifications posed difficulties for social work in the area of adult psychiatric services. Although professional opportunities for promotion still existed a social worker who was regional manager of a mental health clinic, considered that social work opportunities were complicated by the establishment of Mental Health Practitioner positions. 99 Due to the difficulty of attracting highly skilled staff to country areas, what were

99 Participant no.18 interviewed by author on 07/12/2001 213

previously social work positions in regional areas had been converted to generic positions, although there was a degree of risk due to the lack of available support for allied health groups, all of which regarded supervision as part of a professional culture. Concerning the interdisciplinary nature of this culture he commented:

The medical person is clearly an essential component of the team. There is a clear delineation of roles and responsibilities. The psychiatrist is extremely supportive of other professions… so there’s a hierarchy in that they’ve got clinical leadership, but in terms of managing other staff and telling them what to do, that doesn’t exist. My experience is that in the larger clinics there’s more tension on that level. But in the rural areas they tend typically to attract psychiatrists who are very keen about community practice, very keen about working in teams. And there is more need to work in strong partnerships with the community than perhaps there is in the metropolitan area.

The manager of the Rockingham/Kwinana Child and Adolescent Centre and an experienced mental health social worker, considered that an important aspect of his responsibilities was to support and maintain the specialist role of each profession in the multi-disciplinary team.100 Situated south of Perth in a fast growing industrial and residential area, the Centre was part of a chain of facilities that included the former Child and Adolescent Services and the Child Guidance Clinics. He commented that when the departments were amalgamated in 1984 the roles of each profession which were determined according to the tradition of earlier classical child guidance teams (psychiatrist, psychologist and social worker) were already well established. He also commented on the importance of establishing partnerships with other organisations in the community.

6.4.5 Functional Reviews

Information from the interview material reveals that a series of Functional Reviews were held to decide on the structure of the Health Department, and the heads of each profession were required to prepare submissions concerning the essential nature of their positions. It was a time of uncertainty and tension for the individuals whose

100 Participant no. 25 interviewed by author on 17/04/2008. 214

positions were being examined.101 The seriousness of the matter escalated when a request by the Assistant Principals to be considered as Specialist Consultants remained unanswered. The unspoken message was: ‘You’re not needed; therefore what you do is not valued’.102 Social workers developed a number of strategies, some of them comical, to deal with this.103 For example, ‘spreading rumours that social workers were to be granted senior positions, then waiting to see how long this would take to get back to us’:

There was quite a strong gossip mill. Silly stuff I guess, but we felt so powerless in the situation. We did all the rational things, collecting data and talking about roles, how we could maintain that position in head office. But there was also the sense of trying to move things along on a lighter note.104

A deputation to the Commissioner for Health in 1996 by three representatives of the Allied Health Services (occupational therapy, speech pathology and social work) to discuss the benefits of retaining the Consultant positions proved disastrous. Principal and Assistant Principal Social Workers, after having been valued for their skills and knowledge, were criticised for adopting a negative approach to the new administrative arrangements, and for refusing to accept change. As a consequence each position was made redundant. Similar decisions were applied to other Allied Health Principals.

Looking back at the Health Department I have a mixture of emotions. From the voices of those who experienced the changing conditions of employment I am convinced that the experiences of social work and of other professions are only a minute part of a more serious and encompassing political process that was being enacted underground and which will probably never be unearthed. When the MHS became amalgamated as part of the Health Department in 1984 the long established isolation of mental and physical health services came to an end, which was consistent with the social science ideology sustaining allied health based professions. However neo-liberal based decisions eroded any enthusiasm that was engendered at the time,

101 Participant no 20 interviewed by author on 11/11/2002, and participant no. 21 interviewed by author on 28/11/02. 102 Participant no. 21 interviewed by author on 28/11/2002. 103 Participant no. 21 interviewed by author on 28/11/2002. 104 Participant no. 21 interviewed by author on 28/11/2002. 215

particularly in the area of services for the mentally ill. As a researcher I find that the decades at the end of the twentieth century provide a challenging study of the impact of political decisions on the delivery of health services. As a social worker I look back with sadness at the opportunities that appeared to exist for the profession at the beginning of the period, but which were unceremoniously withdrawn later. As a woman I am saddened by the devastating, emotional intensity as these events unfolded, but full of admiration for the social workers in all sections of the department on whose shoulders fell the onerous task of maintaining professional services

6.5 Core themes

In this section I identify the two core themes that have emerged from the analysis of the literature and the interviews that covered this period. They are, the influence of legislative decisions and the importance of gender.

Influence of legislative decisions

Of major significance through the chapter are the introduction of neo-liberal policies which initiated ‘pandemic management reforms’ throughout Australia’ in the 1970s and 1980s. An articulated goal of the era was for governments to become more efficient by modelling themselves on the private sector, giving priority to economic over social and managerial considerations. This paradigm shift resulted in the replacement of ‘old’ administrative structures of traditional bureaucracies, with others in which costs and measurement of objectives became identified as the focus of management. This had an impact on the composition and delivery of welfare services, where one of its legacies was the transfer from a model of social commitment to a different technically based model.

Although studies such as those by O’Faircheallaigh and others identify organisational change arising from government legislation as one of the key issues in the area of organisation and management, and help us to understand the ‘how’ of administrative framework within which social work was located in the newly established Health Department, they do not offer an explanation of the ‘why’ these changes took place, 216

or why social work was redefined when health services were amalgamated or when privatisation policies were introduced in the 1990s. Neither does Sinclair’s differentiation between hierarchical and ‘flat’ administrative structures assist in identifying the conflicting organisational ideologies involved.

Associated with the 1984 amalgamation of hospital, mental health and community services departments in WA were a mixture of reactions. Psychiatric staff expressed doubts concerning the ability of the new monolithic structure to adequately address the requirements of a highly specialised area like mental health.105 On the other hand newly appointed social work administrative staff were more ambivalent, and while being gratified by the decision to maintain the existing hierarchical structure that enabled isolated staff to be drawn into a professional framework, considered that the introduction of quantitative methods lacked a means of identifying the qualitative aspects which were an essential component of social work practice, and failed to reflect fundamental ethical professional concerns.106 In the 1990s these concerns were voiced again in WA when statutory departments became purchasers of services rather than service providers. This was strongly criticised by members of non- government services on the basis that its sole rationale was financial.

During the 1980s and 1990s ‘generic classifications’, ‘multi-skilling’ and the introduction of individual workplace agreements placed social work services at a disadvantage as job performance became equated with costs, and did not include the widespread interpersonal skills involved in family therapy or in the establishment of networks essential to the development of essential community resources. These ‘undiscussible’ factors removed the capacity of social work staff from achieving an economic return for their services.

Under this system the government-funded ‘fee for service’ system, which provided doctors and psychiatrists with a similar compensation to those in the private sector, was extended to registered psychologists. Although registration for professional practice and the exclusive usage of social worker as a title had been discussed

105 Participant no 3 interviewed by author on 04/04/2001. 106 Interviews with participants refer to the amalgamation of health, mental health and community social work services. 217

periodically by practitioners and members of the AASW, difficulties surrounding the definition of social work resulted in no action being taken. Psychology as a profession then became established as one of the new growth industries.

Gender

The influence of gender is another core theme in the organisation of the health services and the administration of social work. In the broad Australian experience, despite the efforts of the Women’s Electoral Lobby, organisational and administrative changes did little to modify the impact of the ‘closed shop’ paternalistic type culture that characterised social work and medical professional relationships. After the health services were amalgamated in 1984, Ferguson noted that such trends tended to be related to those existing in the outside world, particularly those in the health field, and resulted in women feeling de-skilled and powerless.107 The influence of the Women’s Electoral Lobby was more successful in Western Australia where, according to Ian Duckham a number of ‘aspiring women’ acquired leadership positions in the government bureaucracies, thus threatening the survival of the long established ‘gentlemen’s club’. But, as he notes, their influence was modified by their inability to respond quickly and effectively to change. Comments made ‘off the cuff’ by male social work informants suggested that male domination in the areas of WA health services administration and management was the result of a lack of assertiveness by female social workers. A senior female social worker commented that decisions to replace the system of line management with one of regional managers evolves as much from these features as from the impact of organisational change.108

The significance of gender based power relationships is demonstrated by events occurring at Graylands Hospital in the 1990s. In response to difficulties associated with bed shortages and reductions in the length of stay, quantitative assessments of objectives and outputs consistent with the former medical model of care were introduced. While this method was consistent with the quantitative methodological

107 C. Ferguson, The Feminist Case Against Bureaucracy, Philadelphia, Temple University Press, 1984, p.89. 108 Participant no.21 interviewed by author on 28/11/2002. 218

approaches adopted by psychology and occupational therapy, this was not possible in the qualitative approach taken by social work which included social and interpersonal factors in the assessment process and in social work interventions. A consequence of this was the abrogation of the traditional role of social work in the Graylands Hospital.109

6.6 Conclusion

In this chapter I have examined the organisational changes during 1984-1999, first in those arising from decisions of the Commonwealth Government, then of the WA government, and finally in relation to developments in social work services which occurred in the same period. Although the data provides the framework within which these developments occurred, social work’s individual experiences give a powerful indication of the effect they produced both professionally and personally. The chapter describes the way the MHS changed from being an autonomous professional service to one in which this autonomy was removed. Earlier developments in social work in the MHS from 1959 until the 1980s gave little indication that the profession was sufficiently prepared to confront the challenges that lay ahead.

During the 1980s, in the wake of decisions by the Commonwealth government, Western Australia introduced neo-liberal policies revolutionising the organisational structure of bureaucracies and the industrial conditions of its employees. Policies concerning the amalgamation of services resulted in the MHS becoming incorporated as part of a state wide Health Department of WA. Mental health social work then ceased to be a specialist professional occupation and became part of a generic health service. Earlier concepts of social work in mental health, which included interpersonal and environmental issues, were not compatible with Government policies of economic rationalism and the introduction of private sector management practices. The establishment of regional management teams initiated the withdrawal of the system of line management, and correspondingly, of the Principal Social Worker and similar positions. The chapter demonstrates that while social work developed within a politically formulated framework, this development alone was not

109 Participant no. 13 interviewed by author on 22/10/2001. 219

sufficient to influence social work practice: issues of power and gender were equally significant. Conclusions from the literature and the interview material concur with the suggestion by Denzin and Lincoln that hermeneutic inquiry (understanding behaviour in terms of motives, beliefs and desires) is an important element of any analysis, and in this instance, one that relates to the redefinition of social work services in the area of mental health.110

110 Denzin and Lincoln, Handbook of Qualitative Research. 220

Chapter 7

Conclusion

This research is offered as both a contribution to the future of social work and the first study of social work development in the mental health services in an Australian state. The topic has previously failed to attract the attention of historians and researchers in social work. The inter-relatedness of political, social and economic factors presented a methodological challenge concerning the extrication of social work as a research topic. A qualitative research approach enabled a multi-method methodology and multi-perspective approach to be utilised to identify the development of mental health social work during the 1959-1999 period in the context of these broad social, political and economic changes and to develop a useful interpretive framework. The research methodological and theoretical frameworks were set out in chapter 1. Because I wanted to listen to the voices of the participants in this story so as to understand it from their perspective, I chose to seek out ‘voices’ of social workers and others involved. I believe that these voices have been heard for the first time. Because the research is an historical examination of social work over a fifty year time span in Western Australia it was necessary to discuss the particular historical methodological and theoretical frameworks I wanted to use, thus the thesis is shaped by the complex contemporary debates in historiography. The thesis is informed then by the perspectivism of E. H. Carr and Richard Evans which argues that there is no single historical reality, instead, history is written from the perspective of the historian in a complex relationship with the past, just as events are interpreted from the perspective of the observer. It used hermeneutics to uncover the relationship between events and their broader contexts and the inner meanings of those events. It used the work of Michel Foucault to understand that power runs everywhere through the social body, and can therefore be found in the institutions dealing with mental health. It also took from Foucault, the idea that power is productive of truth and meanings through the construction of expert knowledge. In the case of mental health in Western Australia, Foucault’s work helps us understand how different conceptualisations of insanity constructed both the definitions of the disease, the types of treatments proposed and the relationships between those professions with an interest in shaping the mental health system. It used feminism to

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understand the position of women in social work and the gendered dynamics of the mental health system in which women social workers found themselves. Finally, and it is here that I hope this research may have a political use; it was inspired by critical inquiry to seek out the core themes that have characterised the history of mental health social work in WA. It is these core themes that provide the lessons from the history of mental health social work for future members of the profession. The interrelatedness of gender and power, the vulnerability of social work to political and legislative change, the place of mental health social workers in changing community responses to mental illness and changing conceptualisations of mental illness, all present ongoing challenges to the future of the mental health social work profession.

The history of social work development in mental health in WA somewhat resembles a roller-coaster ride in a vehicle imported from overseas. It began its journey slowly with a small number of passengers, but gained size and momentum as others came aboard. The course was enlarged as still more vehicles entered, some had been used before, but others, like the social work vehicle, were untried for what proved to be an experience of unprecedented difficulty. The ride stopped suddenly when the track changed direction and the occupants of the vehicle lost control. Out spun the social workers who shook their heads and contemplated how it all had happened. This metaphor encapsulates a half-century of social work development in Western Australian mental health services. It began in 1959 with the appointment of the first mental health social worker, grew rapidly in the years between 1973 and 1983, then in new contexts, lost its way as broad administrative changes pushed it to the margins of the delivery of mental health services.

My approach to the research has been influenced by Edward Carr’s observations that history begins with the handing down of tradition. He perceives progress as not having a finite end, but as an infinitely slow progress of development with the historian as interpreter of this progress. Denzin and Lincoln argue that no single person can claim a privileged position in this process, as each researcher must always analyse from within the framework of their own experience. Acting as ‘historical interpreter’ gave me the incentive to link together the events that occurred during the forty year time-frame of the study. These ‘imaginative steps’ enabled me to focus on 222

the years 1959-1999. I divided the forty year period into three time-frames, each initiated by a political decision affecting social work administration and practice: the first employment of a social worker in 1959; the decision in 1973 by the federal government to fund community developments and the consequent employment of a principal social worker in MHS, and the decision in the 1980s to adopt neo-liberal policy frameworks and to apply them to the organisation of the health services. An analysis of the information from the literature, legislation, and from interviewees revealed the influence of political change; changing definitions of mental illness, and the influence of management policies, all of which are interwoven with issues concerning power and gender relationships.

My main research question was, how did mental health social work in Western Australia develop from its introduction in 1959, when it was shaped by the ideologies of nineteenth century organizations, to its position in 1999 when it became shaped by a neo-liberal version of what a mental health facility of 1999 should look like? The inquiry posed a number of subsidiary questions. The first was: what were the functions of social work in the MHS of WA between 1959 and 1999, how were they defined and how did they change?

As the medical model of illness was modified in the 1950s to include social and environmental factors, social work services were needed, hence that first appointment. Then, for the first time, social workers became members of the psychiatric treatment team of the MHS joining representatives from medicine, psychology and social work, headed by a psychiatrist. The hierarchical nature of relationships within the team echoed the power relationships existing at the time. The 1962-64 Mental Health Act prepared the way for social workers to move from their hospital base and focus on assisting patients to be cared for in the community. It introduced provisions for After Care programmes in which the supervision of patients continued after they had been discharged from hospital to their homes or to government supervised hostels. In the late 1960’s social work’s role was defined by a policy of deinstitutionalization introduced by Claremont Hospital. A Social Welfare Department was established consisting of social workers, mental health officers and community care nurses, which became a benchmark for developments throughout the MHS when, in 1973, professional status was granted to mental health social work . 223

This situation continued until 1984 when the profession became incorporated into the wider structure of the Health Department of WA. Then in the 1990s social work functions were marginalized as privatisation and outsourcing policies were introduced. While information from annual reports of the director of the MHS provide passing references to social work services, this research clearly indicates that political decisions determined the organizational structure and administration of social work services in the MHS. However social work practice within this framework was influenced by the impact of changes in social work methodology.

The second research question asks ‘In what way if any, did social work give evidence that it differed from the other professions involved in the MHS?’ In an early chapter I overviewed the origins of services for the mentally ill and noted the reaction of the medical profession as psychology, social work and occupational therapy ‘invaded’ their territory. Freidson’s identification of characteristics required by a group for recognition as a profession in the mental health services includes the search for control over the definition and treatment of mental illness. When Freudian psychiatry, for example, became one source of treatment for mental illness, it further solidified the power of psychiatry and, even though insights from the social science based ‘caring professions’ modified this, psychiatry remained the dominant profession. The introduction of the DSM3 as a nosology for psychiatric disorders included the influence of social and environmental issues but still placed them firmly under medical control.

When social work was first introduced into the MHS in 1959 its functions in the area of assessment concerning patient rehabilitation and child psychiatric disorders were quite specific. Not so specific was the area of casework with individuals and families, often referred to as ‘counselling’, and it was often confused with the psycho-therapy of clinical psychologists. While these functions were modified by hospitals and clinics the roles of each associated profession remained fairly stable. The introduction of community based care in the 1960s as an alternative to hospital care provided an area in which the focus of social work practice could differ from other professions, in that the supervision of hostels for mentally ill individuals and other rehabilitation resources in the community were allocated specifically to the social work services administered from Claremont Hospital. This was not so in other 224

MHS units where social work appointments and duties remained under control of the various superintendents. In 1973 when a Principal Social Worker was appointed by the MHS to coordinate all relevant departmental activities, a considerable variation in social work practice was observed. This was demonstrated in the descriptions of duties obtained in the research interviews. What remained constant was the role of the social worker in providing information concerning the patient’s personal and family background and including a professional psycho/social assessment to members of inter-disciplinary teams. At the same time the introduction of medico/psycho/social/cultural factors as explanatory factors in diagnosis extended the conceptualisation of mental illness and resulted in the blurring of professional boundaries. Generic professional practices were introduced in community based mental health services which some interpreted as negating the special skills of social work along with other professional groups. However interviewees from Graylands Hospital and from the Frankland Centre for forensic psychiatric services reported the retention of specific functions for social work during the 1990s. During the forty year period of the research the profession moved from having an identifiable independent professional role in the mental health field to one which was confronted by the multiple challenges introduced by generic practice and, as we have seen in other contexts, neo-liberal policies.

The third question was ‘What has been the historical place of social work in the mental health hierarchy?’ This question has partly been answered in considering the role played by social work in relation to the dominant medical profession. While social workers employed in MHS hospitals, community clinics and, until 1973, in services for the intellectually disabled, were recruited and supervised by superintendents of various sections of the department, their position in the hierarchy was partly dependent on the personal relationships of social workers with members of the medical profession. Information from interview material describes the retention of the psychiatrist as leader of the other ‘equal’ professionals of social work and psychology in the inter-disciplinary teams.

Chapter five, the ‘Honeymoon Period’, describes the jubilation of social workers as they were granted professional autonomy over their work to replace the existing domination of Psychiatric Superintendents. While the attainment of professional 225

independence may have been a source of jubilation for the social work profession with an apparently valued position in the mental health hierarchy, social workers remained subject to the provisions of the mental health legislation and to psychiatric surveillance. This was a source of contention, particularly in the 1990s, as was reported by a social work supervisor at Graylands Hospital. The outcome of the neo- liberal policy initiated in the 1980’s, referred to by Chris Hood as ‘a paradigm shift’ and which resulted in the de-bureaucratisation of federal and state organizations, had a massive impact on the delivery of human services in general and social work services in particular. Ian Duckham reports the downsizing of government departments in WA at this time to make them more cost efficient. The appointment of regional managers who would supervise all staff, together with the introduction of generic treatment practices, served to shatter the concept of a professional hierarchy in the mental health services.

The fourth question is ‘In what way may the fact that social work was a predominantly female occupation influence the development of social work in the MHS?’ From its origins in England and America this research has demonstrated that social work is a predominantly female occupation. A small number of males were members of the profession in the early years, and this trend has continued. However most of the literature does not identify females directly but utilises the term gender as a central concept. This research demonstrates that organisational and political changes did little to modify the sex differentiated relationships that characterised social work and the medical profession within the mental health services in WA until the 1990s. That social work is predominantly female dominated was a feature which facilitated its establishment as a ‘caring profession’ in tandem with the medical model with its patriarchal basis. The image described in chapter three was one in which early institutions for mentally ill ‘children’ were established, with a benevolent male in charge, assisted by his wife. In early social work itself, the great bulk of early practitioners were middle-class women. The introduction of social science insights and the consequent extension of the domestic role of the wife and mother in the ideal bourgeois family to ‘caring’ jobs which included nursing and social work, provide a point of departure from this domestic vision. The research indicates that the boundaries of social work functions were determined by masculine political decisions, and mainly females undertook social work practice. Crawford and 226

Leitman in their study of female pioneer social workers in WA refer to them as ‘our founding mothers’. A similar description may also be applied to Norma Parker and the group of women who pioneered medical social work in Victoria and New South Wales. Regarding social work as a female dominated profession, these researchers made it possible to hear the ‘voices’ of women legitimately acknowledged as part of the research process.

Information from interviewees demonstrates that during the 1959-1973 period the medical model was placed under pressure by the emerging social science-based professions. Feminist challenges to male authority were also noted by Helen Marchant when she wrote of New South Wales experiences.1 Ian Duckham describes the arrival of ‘a group of ambitious women’ in senior government positions in the 1990s but he does not specifically refer to the WA health services.2 Nevertheless women were prominent in social work management positions in WA during that time. Currently social work as a profession seems to be contemplating its next move. Renouf and Bland see the path ahead for social workers who work with people with mental illnesses and with their families and carers as being full of challenges and opportunities as a consequence of the national mental health agenda of the last two decades.3 These opportunities have enabled social workers to be included as part of a General Practice Care Plan and to receive Medicare rebates for people with complex conditions being treated by general practitioners. Opportunities for future specialisation in the field of mental health were also provided when the AASW revised its Social work Education and Competency requirements to include mental health content. Future social work researchers have rich pickings from which to demonstrate the effectiveness of their practice.

Now that I have come to the end of this research journey I have a greater appreciation of the contribution made by individual social workers in establishing and developing services in the field of mental health in Western Australia. Members of the social work profession generally are unaware of these contributions and the

1 Marchant, A Feminist Perspective on the Development of the Social Work Profession, pp.35-43 2 Duckham, Serving the Servants: Serving the State. 3 Renouf & Bland, Navigating stormy waters: Challenges and opportunities for social workers in mental health.

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many factors involved in the establishment and development of mental health social work in the second half of the twentieth century. Listening to the ‘voices’ of pioneer social workers in this study has made it possible to ‘humanise’ the impact of individual endeavours which otherwise would be obscured by statistically-based methodologies. Remaining aware of the messages being transmitted by these ‘voices’ is a task awaiting social work historians of the future. As discussed at the beginning of this conclusion, remaining alert to the problems and possibilities thrown up by the core themes analysed in this thesis is another, perhaps more important task.

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Appendix I

Information Sheet

PhD. Thesis, ‘A Feminist Study of the Development of Social Work in the Mental Health Services of Western Australia 1959-1999’.1

I am preparing the above thesis as a requirement for the Doctor of Philosophy (PhD) qualification from the University of Western Australia.

The aim of this thesis is to study the historical process of social work over the forty year period from 1959 when the first psychiatric social worker was employed by the department, until 1999. It will critically examine the origins and development of the profession, and question its ability to identify social welfare measures necessary for the maintenance of mental health in our community.

Social work is recognized as one of the allied health professions, and as such its contributions are an integral part of care for the mentally ill. Today we are experiencing changing attitudes to mental health and the imposition of financial constraints. As a result it is essential that members of the profession engage constantly in a critical analysis of their work and its potential to identify significant trends.

A number of social workers and others associated with them over the period of the study will be interviewed in order to obtain as wide a variety of opinions as possible. Because of your extensive experience in the field of mental health I look forward to your contribution. It is anticipated that each interview will take approximately one hour.

Marcia Foley, PhD. Candidate, the University of Western Australia.

1 Title of thesis changed to the current one in 2009 229

Appendix II

Consent Form

PhD.Thesis, ‘A feminist Study of the Development of Social Work in the Mental Health Services of Western Australia 1959-1999’.1

I ……………………………….…….. have read the information above and any questions I have asked have been answered to my satisfaction. I agree to participate in this activity, realizing that I may withdraw at any time without reason and without prejudice.

I give permission to Marcia Foley to use the interview/s, or part of the interviews given by me for research or publication and for copies to be lodged in the appropriate archival collections and specialist libraries, including the J.S. Battye Library of Western Australian History for the use of bona fide researchers.

The Human Ethics Committee of the University of Western Australia requires that all participants are informed that, if they have any complaint regarding the manner in which the research is conducted it may be given to the researcher or, alternatively to the Secretary, Human Research Ethics Committee, Registra’s Office, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009 (Telephone number 93803703). All participants will be provided with a copy of the Information Sheet and Consent Form for their personal records.

Signed

Date

1 Title of thesis changed to current one in 2009 230

BIBLIOGRAPHY

This bibliography is arranged in the following categorisations:

Primary Sources

1. Government legislation

2. Parliamentary debates

3. Government publications

4. Professional associations

5. Conference Papers

6. Newspapers

7. Research interviews

Secondary Sources

1. Journal articles

2. Books

3. Theses

231

Primary Sources

1. State Government legislation

Poor Relief Act of 1845, Vict. No. 2, Statutes of Western Australia, 1845.

Lunacy Act 34, Vict. 1X, Act No.7, Sect. 2, 1871, Statutes of Western Australia, Vol. 1, 1871.

Lunacy Act 3, Edw.VII, Act No.15, 1903, Statutes of Western Australia, 1903.

Mental Treatment Act.18. Geo.V, Act No.13, 1927, Statutes of Western Australia, 1927.

Mental Health Act 1962, Vol. 1, Act No. 46, Part 1V, Sections 27, 28 and 29, Elizabeth 11, Statutes of Western Australia, 1962.

Mental Health Act 1962-1964, Vol. 1, Act No. 92, Elizabeth 11, Statutes of Western Australia, 1964.

Mental Health Act 1996, Vol. 2, Part 1, Act No. 68, Section 4 (1), Elizabeth 11, Statutes of Western Australia, 1996.

2. Parliamentary Debates

Western Australian Parliamentary Debates, Vol. 82, No. 1, 1929.

Western Australian Parliamentary Debates, Vol. 161, No. 1, 1962.

Western Australia, Parliamentary Debates, Vol. 162, No. 2, 1962.

Western Australia, Parliamentary Debates, Vol. 332, No. 2, 1996.

3. Government publications

State Government

Report of the Royal Commission to inquire into allegations of brutality at the Claremont Mental Hospital of Western Australia, 1950, State Record Office of Western Australia (SROWA).

Ministerial Task Force on Mental Health, Vol.2, March 1996, SROWA.

Western Australian Government, Public Service Lists, 1959, 1965, 1985, SROWA

Western Australian Government, Public Service Board Notices, Mental Health Services Section, 1974, SROWA

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Commonwealth Government

Rights and Responsibilities. Commonwealth of Australia, Mental Health Statistics, 1991.

Stoller A. & Arscott, K. Report on Mental Health Facilities and Needs of Australia, Canberra, Commonwealth of Australia, 1955.

Through a Glass Darkly; Evaluation in Australian Health and Welfare Services, Canberra, Standing Committee on Social Welfare, Australian Government Publishing Services, 1979.

National Mental Health Policy, 1996.

British Government

U.K Department of Health, Modernising Mental Health Services, National Health Service Executive, London, 1988.

4. Professional Association Collections

Australian Association of Social Workers (AASW), Battye Library, Perth, Western Australia.

AASW Mental Health Interest Group, AASW New South Wales Branch, 1996.

AASW Code of Ethics, Australian Association of Social Workers, Canberra, 1999.

AASW Working Party Report, Australian Association of Social Workers, Canberra, July, 1973.

AASW: Social Work Principles in Health, Australian Association of Social Workers, NSW Branch, August, 1999.

NSW Branch Newsletter, Australian Association of Social Workers, NSW Branch, March, 1996, Vol.1.

Development of Competency Standards for Mental Health Social Workers, AASW Finch Report, Barton, 1999.

General Meeting, International Federation of Social Workers, Montreal, Canada, July, 2000.

Policy and Procedures for Establishing Eligibility and Membership of the AASW, Australian Association of Social Workers, Canberra, 1998.

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5. Conference and Occasional Papers

Annear, D. ‘Single Women and Mental Health Disorders’, National Conference on Homelessness, Melbourne, Victoria, 1996.

Coopes, C. & Carberry, P. ‘Reaching out to the mentally ill’. Paper delivered to the Australian Association of Social Work Conference, Newcastle, 1993.

Harries, M. & Smith, G. ‘Trends in mental health policy developments and implementation, in Community Care: New Partnerships and Perspectives, ACOSS Conference paper, 27 October 1994.

Metcalf, L. ‘Public Management: From Imitation to Innovation’, European Institute of Public Administration Conference, Maastricht, the Netherlands, 1991.

Hicks, J. and Hill, E. ‘WA Health Care in the New Millenium: Are We Going Forward, Backward or Round in Circles?’ Occasional Paper, 1999.

Hicks, J. and Hill, E. ‘Deinstutionalisation or Transinstitutionalisation’ Paper presented at the ANZAPPL Conference, Auckland, New Zealand, August, 2000.

Thompson, I., Hanley, J., Harries, M., Smith, G. & Cook, H. ‘Mental Health Ethics Debate’, Australian National Association for Mental Health Conference, Perth, 1992.

6. Newspapers

Financial Review.

Sunday Times.

The Australian.

The West Australian.

7. Research interviews

Dr A. S. Ellis interviews by R. Jamieson, between June 1979 and May 1980, held at the Battye Library, Perth, WA.

Pam Evans, interviewed by author on 23/03/2001. Elizabeth (Lizzie) Hill, interviewed by author on 26/05/2001. Dr A. Ellis, interviewed by author on 04/04/2001. John Kinnear, interviewed by author on 05/04/2001. Erica Sorel, interviewed by author on 09/04/2001. Dr R. Ellison, interviewed by author on 10/04/2001. Andy Fleming, interviewed by author on 17/04/2001. Dr H. Blackmore, interviewed by author on 22/08/2001.

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Sylvia Cresswell, interviewed by author on 29/08/2001. Dr T. Matthews, interviewed by author on 24/05/2001. Roma Lewi, interviewed by author on 08/11/2001. Janet Hicks, interviewed by author on 31/10/2001. Mark Sachmann, interviewed by author on 22/10/2001. Julie Fraser, interviewed by author on 14/11/2001. Brian Wooller, interviewed by author on 12/11/2001. Joan Anniere, interviewed by author on 14/11/2001. Dr F.Bell, interviewed by author on 16/05/2001. Anthony Collier, interviewed by author on 07/12/2001. Robin Christophers, interviewed by author on 28/05/2002. Margaret Stockton, interviewed by author on 11/11/2002. Maxine Lawn, interviewed by author on 28/11/2002. Elizabeth White, interviewed by author on 17/02/03. Noreen Paust, interviewed by author on 26/02/2003. Bruce Dufty, interviewed by author on 16/06/2003. Warrick Smith, interviewed by author on 17/04/2008.

235

Secondary sources

Journal Articles

Abbott, K. ‘Producing men? Masculinities, Boys’ Employment and Farm Labour in Early Twentieth Century Western Australia,’ Limina, No. 9, 2003.

Abbott, K. & Chesney, C. ‘ “I am a poor woman”: Gender, poor relief and the Poor House in late nineteenth and early twentieth century Western Australia’, C. Fox (ed.), Social Policy in Western Australia, Studies In Western Australian History, No. 25, 2007.

Arian, U. ‘Social work in mental health’, Social Work, Vol. 25, No.3, 1997.

Avery, L. ‘A feminist perspective in group work with mentally ill women’, Women and Therapy’, Vol. 21, No. 4, 1988.

Bacchi, C. ‘The Nature-Nurture Debate in Australia 1900-1914’, Historical Studies, Vol. 19, No. 75, 1980.

Barber, J. ‘Science and social work: are they compatible?’ Research in Social Work Practice, Vol.6, No.3, 1996.

Bashford, A. ‘Female bodies at work: Gender and reforming of colonial hospitals’, Australian Cultural History, No.13, 1994.

Benshop, Y. & Doorwaad, H. ‘Covered by equality: the gendered subtext of organisations’, Organisation Studies, Vol. 19, No. 5, 1988.

Berkman, A. ‘The emerging health care world: Implications for social work practice and education’, Social Work, Vol.41, No.5, 1996.

Bland, R. & Neill, M. ‘Rediscovering welfare concepts in social work practice in community mental health’, Australian Social Work, Vol.43, No.4, December, 1990.

Bolger, A. ‘Status in a female profession: women social workers in Perth’ Australian Social Work, Vol. 34, No. 2, 1981.

Bolzan, N. Heycox, K. & Hughes, L. ‘From pillar to post: women and social work studies in the 21st century’, Australian Social Work, Vol.54, No.1, 2001.

Bransford, C. & Baaken, T. ‘The evolution of mental health care policy and the implications for social work’, Social Work in Mental Health, Vol.1, No.1, 2002.

Brennan, J. P. & Kaplan, C. ‘Setting new standards for social work case management’, Hospital and Community Psychiatry, Vol. 44, No.3, 1993.

Busfield, J., ‘Men, women and madness in nineteenth century Britain’, Sociology, Vol. 28, No. 1, 1994.

236

Child, N. ‘The limits of the medical model in child psychiatry’, Clinical Child Psychology and Psychiatry, Vol.5, No.1, 2000.

Coleborne, C. & MacKinnon, D. ‘Deinstitutionalisation in Australia and New Zealand’, Health and History, Vol. 5, No. 2, 2003.

Collinson, D. & Hearn, L. ‘Naming men as men: implications for work, organisation and management’, Gender, Work and Organisation, No.1, January, 1994.

Crawford, F. & Leitman, S. ‘The midwifery of power? Reflections on the development of professional social work in Western Australia’, Australian Social Work, 2001, Vol. 54, No.3, 2001. . Crisp, B. ‘A History of Social Work Practice’, Research in Social Work Practice, No. 2, 2001.

Dax, E. C. ‘The first 200 years of Australian Psychiatry’, Australian and New Zealand Journal of Psychiatry, Vol. 23, No.1, 1989.

Dax, E. C. ‘The evolution of Community Psychiatry’, Australian Journal of Psychiatry, Vol. 26, No. 2, 1992.

Dibden, W.A. ‘In the Looking Glass’, ANZ Journal of Psychiatry, Vol. 1, No. 7, 1967.

Dominelli, L. ‘Father-daughter incest: patriarchy’s shameful secret’, Critical Social Policy, Vol.6, No.16, 1986.

Domenilli. L. ‘De-professionalising social work: anti-oppressive practice’, British Journal of Social Work, Vol. 26, No. 2, 1996.

Edmond, M. ‘Brief Casework: Effectiveness, Methods and Values’, Australian Social Work, Vol. 43, No. 2, 1990.

Edwards, G. ‘Causation of insanity in the nineteenth century’, ANZ Journal of Psychiatry, Vol.16, No. 1, 1982.

Foley, M. ‘The origins of mental health social work in Western Australia: a “psychiatric re-conception” ’, C. Fox (ed.), Social Policy in Western Australia, Studies In Western Australian History, No. 25, 2007.

Fox, C., ‘Debating deinstitutionalisation; the fire at Kew cottages in 1996 and the idea of community’, Health and History, Volume 5, No. 2, 2003.

Fox, C. ‘Exploring “Amentia” in the Tasmanian Convict System 1824-1890’, Tasmanian Historical Studies, Volume 13, 2008.

Hearn, J. ‘Notes on Patriarchy: Professionalism and the Semi-professions’, Sociology, Vol.16, No.2, 1982.

237

Hetherington, P. ‘Baby farming in Western Australia’, C. Fox (ed.), Social Policy in Western Australia, Studies in Western Australian History, No. 25, 2007.

Hogson, G.M. ‘Economics and Systems Theory: Essays in Political Economy’, Journal of Economic Studies, Vol. 14, Issue 4, 1987.

Horwood, B. A History of Social Work in Mental Health Services, AMHS Newsletter, 1996.

Howe, D. ‘Child abuse and the bureaucratisation of social work’, The Sociological Review, Vol. 40, No. 3, 1992.

Howe, D. ‘Modernity, Post-modernity and Social Work’, British Journal of Social Work, Vol. 24, No.5, 1994.

Jones, K. ‘The Mirage of Reform’, New Society, October, 1984.

Johnson, Y. M. ‘Indirect Work: Social Work’s Uncelebrated Strength’, Social Work, Volume 44, No.4, 1999.

Kager, H. J. ‘Science, Research and Social Work: Who controls the Profession?’, Social Work, Vol. 28, No.2, 1983.

Kerr, R. ‘Inefficients at best, and young offenders at worst: Juvenile delinquency in Western Australia during the Inter-war years’, C.Fox (ed.), Social Policy in Western Australia, Studies in Western Australian History, No. 25, 2007.

Kirkby, K. ‘History of Psychiatry in Australia pre-1960’, History of Psychiatry, Vol. X, 1999.

Laffey, P. ‘Antipsychiatry in Australia: Sources for Social and Intellectual History’, Health and history: Deinstitutionalisation Special Issue, Vol. 5, No.2, 2003.

Leech, M. ‘Long-term intervention in social work: Implications for the person, the profession and the practice’, Australian Social Work, Vol. 49, No. 2, 1996.

Leiby, J. ‘Social work and social history: Some interpretations’, in Social Services Review, Vol. 43, No. 3, 1969.

Logan, B. & Chung, D. ‘Current social work values in the fields of mental illness and intellectual disability: Changing service approaches to people with a disability’, Australian Social Work, Vol. 54, No.3, 2001.

Mc Donald, D. ‘A village full of occupants, the Kenmore Hospital for the Insane 1895-1900’, Canberra Historical Journal, September, 1973.

Maddison, D. ‘Psychiatry’s liaison with medicine: bride or mistress?’, Australian and New Zealand Journal of Medicine, Vol.15, No. 3, 1981.

238

Maddison, D. ‘The changing responsibility of the psychiatrist’, Medical Journal of Australia, Vol. 2, No. 7, 1966.

Marchant, H. ‘A Feminist Perspective on the Development of the Social Work Profession in N.S.W’, Australian Social Work, Vol. 38, No.1, 1985.

Markiewicz, A. ‘Panacea or scapegoat: The social work profession and its history and background in relation to the State Welfare Department in Victoria’, Australian Social Work, Vol.49, No.1, 1996.

Marwick, A. ‘Two approaches to historical study: The metaphysical (including postmodernism) and the historical’, Journal of Contemporary History, Vol. 30, 1995.

McKinnon, D. & Coleborne, C. ‘Introduction: Deinstitutionalisation in Australian and New Zealand’, Health and History, Vol. 5, No. 2, 2003.

Megill, A. ‘Recent writing on Michel Foucault’, Journal of Modern History Vol. 56, No.3, 1994.

Mendes, P. ‘Public attacks on social work in Australia: The two Bulletin affairs’, Australian Social Work, Vol. 54, No.3, 2001.

Mendes, P. ‘The history of social work in Australia: A critical review’, Australian Social Work, Vol.58, No.2, 2005.

O’Brien, J. ‘The Founding and Early Years of the Convent of the Good Shepherd, Leederville’, Religion and Society: Studies in Western Australian History, No. 9, 1987.

O’Brien, L. & Turner, C. ‘Hospital Almoning: Portrait of the First Decade’, Australian Social Work, Vol.32, No 4, Dec.1979.

Parker, N. ‘Early Social Work in Retrospect’, Australian Social Work, Vol.32, No. 4, 1979.

Parkinson, J.P. ‘The Castle Hill Lunatic Asylum (1811-1826) and the origins of elective pragmatism in Australian psychiatry’, Australian and New Zealand Journal of Psychiatry, Vol. 15, No. 4, December, 1981.

Porter, R. ‘The patient’s view: doing medical history from below’, Theory and Society, Vol. 14, No.2, 1985.

Ramsay, R. ‘Women in psychiatry’, Advances in Psychiatric Treatment, No. 11, 2005.

Rein, M. & White H. ‘Knowledge for Practice’, Social Service Review, Vol. 55, No. 1, 1981.

Renouf, N. & Bland, R. ‘Navigating stormy waters: Challenges and opportunities for social workers in mental health’, Australian Social Work, Vol. 58, No. 4, 2005.

Richmond, K. & Savy, R. ‘In sight in mind: mental health policy in the area of

239

deinstitutionalisation’, Health Sociology Review, Vol. 14, No. 3, 2005. . Robson, B. ‘He made us feel special: Eric Cunningham Dax, Edith Pardy and the reform of the Mental Health Services in Victoria, 1950’s and 1960’s’, Australian Historical Studies, Vol. 34, No.122, 2003.

Rose, N. and Miller, P. ‘Political power beyond the state: problematics of government’, British Journal of Sociology, Vol. 43, No.2, 1992.

Rowe, L. ‘The children’s Protection Society: Child protection in Western Australia, 1906-1930. Towards a medical-welfare model’, C .Fox (ed.), Social Policy in Western Australia, No. 25, 2007, Centre for West Australian History in association with the University of Western Australia, 2007.

Stockbridge, M.E. ‘Seventeen Months’, Australian Journal of Social Work, Vol. 21, No. 3, Sept. 1968.

Stoller, A. & Arscott, W. ‘The first tranquilliser decade’, Australian Journal of Pharmacy, Vol. 47, No. 2, 1955.

Stone, A. ‘Psychiatric abuse and legal reform; two ways to make a situation worse’, International Journal of law and Psychiatry, Vol. 5, No. 1, 1982.

Tait, A. & Platt, M. ‘Women consultants, their background and training: some myths explored’, Medical Education, Vol. 29, No. 5, 1995.

Tannenbaum, N. & Reisch, M. ‘From charitable volunteers to architects of social welfare: A brief history of social work’, University of Michigan, School of Social Work, May 2005, online publication, tttp://www.ssw.umich.edu/ongoing/ fall2001/briefhistory.html.

Tesoriero, F. ‘Will social work contribute to social development into the new millennium?’ Australian Social Work, Vol. 52, No.2, 1999.

Van Heugten, K. ‘Managing insider research: learning from experience’, Qualitative Social Work, Vol.3, No. 2, 2004.

Virtue, R. ‘Lunacy and Social Reform in Western Australia 1886-1903’, Studies in Western Australian History, No. 1, 1977.

Weller, P. & Wanna J. ‘Departmental Secretaries: Appointment, Termination and their Impact’, Australian Journal of Public Administration, Vol. 56, No. 4, 1997.

Whiteford, H. ‘The Australian Health Ministers’ Advisory Council (AHMAC) and the National Mental Health Reforms’, in Australian Psychiatry, Vol. 2, No.3, 2002.

Wilenski, A. ‘Administrative reform: general principles and the Australian experience’, in Public Administration, Vol.64, No. 3, April, 2007.

240

Wilson, A. & Earles J. ‘The feminisation of psychiatry: changing gender balance in the psychiatric workforce’, Psychiatric Bulletin, Vol. 30, 2006.

Wooton, B. ‘The Law, the Doctor and the Deviant’, British Medical Journal, Vol. 2, No. 5351, July 27, 1963.

Yates, B. ‘Workplace relations and agreement making in the Australian Public Service’, Australian Journal of Public Administration, Vol. 57, No. 2, 1998.

Books

Adams, A. Erath, P. & Shardlow, M. (eds.), Key Themes in European Social Work: Theory, practice, perspectives, Dorset, Russell House Publishing, 2001.

Adams. R., ‘Empowerment, marketisation and social work’ in Bogan Lewis (ed.), International Perspectives and Social Work: Change in Social Work, Aldershot, England, Ashgate Publishing Company, 1997.

Alperin, S. 120 Carers in the Health Care Field, New York, Ballinger, Publishing Co. 1980.

Alston, M. & McKinnon, J. Social Work Fields of Practice, 2nd edition, South Melbourne, Victoria, Oxford University Press, 2005.

Anderson, D.S. & Weston, J. ‘The Professions; Reason and Rhetoric’, in P. Boreham, A. Pemberton & P. Wilson (eds.) The Professions in Australia: A Critical Appraisal, Queensland, University of Queensland Press, 1976.

Appleyard, R.T. ‘Western Australia: Economic and Demographic Growth’, in C.T. Stannage (ed.), A New History of Western Australia, Nedlands, Western Australia, University of Western Australian Press, 1981.

Atkinson, A. Social Justice and Public Policy, Brighton, Wheatsheaf, 1983.

Australian Department of Labor and Immigration, Survey of Four Paramedical Professions, Australian Government Publishing Service, 1975.

Axinn, L. and Stern, M.J. Social Welfare: A History of the American Response to Need, 5th edition, Boston, Allyn & Bacon, 2001.

Baker, R. ‘The role of social workers in the Child Guidance Clinic’ in R.J. Lawrence, A Career in Social Work: Seven Personal Accounts, Sydney, UNSW School of Social Work, 1978.

Baldock, C.V. & Cass, B. (eds.), Women, Social Welfare and the State, Sydney, Allen and Unwin, 1988.

Banton, R. Clifford, P. Frosh, S. Lousada, J. & Rosenthal, J. The Politics of Mental Health, Houndsmills, Macmillan Publishers, 1985.

241

Barham, P. Closing the Asylum: The Mental Patient in Modern Society, London, Penguin, 1992.

Barker, R. L. Social Work in Private Practice: principles, issues and dilemmas, Silver Spring, Maryland, National Association of Social Workers, 1984.

Baron, A. ‘On Looking at Men; Masculinity and the Making of a Gendered Working Class History’, in Anne-Louise Shapiro (ed.), Feminist Revision History, New Brunswick, Sage, 1994.

Barrett, M. Women’s Oppression Today: The Marxist/Feminist Encounter, London, New York, Verso, 1980.

Barrett, M. & Phillips, A. (eds.), Destabilising Theory: Contemporary Feminist Debates, Cambridge, Polity Press, 1992.

Bates, E. ‘Alternative Theories of Madness’, in E. M. Bates, & P. Wilson (eds.), Mental Disorder or Madness, St Lucia, Queensland, University of Queensland Press, 1979.

Bates, E. and Wilson, P. Mental Disorder or Madness? Alternative Theories, St. Lucia, Queensland, University of Queensland Press, 1979.

Beers, C.W. The Mind that Found Itself, New York, Longmans, Green, 1908, cited in F. Fink, J. Pfouts & A. Dobelstein, The Field of Social Work, 8th Edition, New Delhi, Sage, 1985.

Bentley, K. J. & Taylor, F.M. ‘A context and vision for excellence in social work practice in community mental health settings’, in K.G. Bentley (ed.), Social Work Practice in Community Roles, Tasks and Techniques, Pacific Grove, CA., Thomson Academic Resources Centre, 2002.

Beran, D. Early British Romanticism, the Frankfurt School and French Post- structuralism: In the Wake of Failed Revolution, New York, Peter Lang, 2001.

Berrios G. & Freeman, H. 150 Years of British Psychiatry 1841-1991, London, Gaskell, 1991.

Beveridge, W. H. Full employment in a free society: a report. 2nd edition, London, Allen and Unwin, 1960.

Bland, R. ‘Social work practice in mental health’, in M. Alston and J. McKinnon (eds.), Social Work: fields of practice, 2nd edition, South Melbourne, Oxford University Press, 2005.

R. Bland, N. Renouf & A. Tullgren, Social Work Practice in Mental Health: an introduction, Crows Nest, N.S.W. Allen and Unwin, 2009.

242

Boas, P. & Crawley, J. (eds.) Social Work in Australia: Responses to a Changing Context, Melbourne, Australia International Press in association with the A.A.S.W, 1976.

Boreham, P. Pemberton, A. & Wilson, P. (eds.), The Professions in Australia: A Critical Appraisal, Brisbane, University of Queensland Press, 1976.

Breakey, W.R. ‘The rise and fall of the State Hospital’, in W. R. Brekey (ed.), Integrated Mental Health Services: Modern Community Psychiatry, New York, Oxford University Press, 1996.

Bricker-Jenkins, M. Hooyman, N.R. & Gottlieb, N. (eds.), Feminist Social Work Practice in Clinical Settings, Newbury Park, Sage Publications, c. 1991.

Brown, C. ‘Body Work’, in Grbich, C. (ed.), Health in Australia: Sociological Concepts and Issues, Sydney, NSW, Prentice Hall, 1996.

Brown, E. ‘Cultural Imperialism in Social Work Education’, in R. Birren, D. Grace, P. James, P. & T. Vison, (eds.), Social Welfare Education, Sydney, University of New South Wales Press, 1988.

Brown, J. The British Welfare State: A Critical History, Oxford, Blackwell, 1995.

Brown, S. ‘A Woman’s Profession’, in Gender Reclaimed: Women in Social Work, H. Marchant & B. Waring, (eds.), Sydney, Hale and Ironmonger, 1986.

Browne, E. Tradition and Change: Hospital Social Work in NSW, Australian Association of Social Workers, NSW Branch, 1996.

Busfield, J. Men, Women and Madness: Understanding Gender and Mental Illness, London, Macmillan Press, 1996.

Callicutt, J. & Lecca, P. Social Work and Mental Health, Collier Macmillan, London, 1983.

Campbell C. and Associates, Health Service and Facilities for the Mentally Ill in Western Australia: A Plan for their Organisation and Further Development, West Perth, Campbell and Associates, 1982.

Cannon, I. M. On the Social Front of Medicine, Cambridge, Harvard University Press, 1952.

Caplan, G. An Approach to Community Mental Health, London, Tavistock, 1961.

Caplan, R. & Caplan G. Psychiatry and the Community in Nineteenth Century America, New York, Basic Books, 1969.

Carman-Brown, K. & Fox, C. ‘Doctors, Psychologists and Educators: The Professions and Intellectual Disability’, in E. Cocks, C. Fox, M Brogan & M. Lee, (eds.), Under Blue Skies: The social construction of intellectual disability in Western Australia,

243

Edith Cowan University, Centre for Disability Research and Development, Faculty of Health and Human Services, 1996.

Carr, E.H. What is History? London, Penguin, 2nd edition, 1987.

Carney, T. & Tait, D. The Adult Guardianship Experiment: Tribunals and Popular Justice, Annandale, Sydney, Federation Press, 1997.

Carter, J. (ed.), Postmodernity and the Fragmentation of Welfare, London and New York, Routledge, 1998.

Cass, B. Dawson, M. Temple, D. Willis, S. and Winkler, A. Why so Few? Women Academics in Australian Universities, Sydney, Sydney University Press, 1983.

Cawte, J. Medicine is the Law: Studies in Psychiatric Anthropology of Australian Tribal Communities, Adelaide, Rigby, 1974.

Chamberlain, E. (ed.), Change and Continuity in Australian Social Work, London, Longman, 1988.

Chesler, P. Women and Madness, New York, Avon Books, 1972. Christie, A. (ed.), Men and Social Work: theories and practices, Houndsmills, Palgrave, 2001.

Colborne, C. ‘ “She does up her hair fantastically”: The production of femininity in patient case-books of the lunatic asylum in 1860s Victoria’, in J. Long, J. Gothard & H. Brash (eds.), Forging identities: bodies, gender and feminism, Nedlands, University of Western Australia Press, 1997.

Clarke, J. ‘After social work’, in N. Parton (ed.), Social theory, Social Change and Social Work, London, Routledge, 1996.

Clasen, L. A. ‘Some implications of classifications in Sociology for problems of classification in Psychiatry and Psychopathology’, in M. Katz , L. Cole, and W. Barton (eds.), The Role and Methodology of Classifications in Psychiatry and Psychopathology, Washington, US Department of Health, Education and Welfare, 1965.

Collicutt, J.W. and Lecca, P.J. Social Work and Mental Health, New York, Free Press, c.1983.

Close, D. Neglect and Violence: A Mental Health Nurse’s Training Manual, Whittlesea, Victoria, Wombat Publishing, 1979.

Cocks, E. Fox, C. Brogan, M. & Lee, M. (eds.), Under Blue Skies: The social construction of intellectual disability in Western Australia, Edith Cowan University, Centre for Disability Research and Development, Faculty of Health and Human Services, 1996.

244

Cohen, N.E. Social Work in the American Tradition, New York, Holt, Rinehart and Winston, 1958.

Coleburne, C. ‘She does up her hair fantastically: the production of femininity in patient casebooks of the lunatic asylum in 1860’s Victoria’, in J. Long, J. Gothard & H. Brash, (eds.), Forging Identities: bodies, gender and feminist history, Nedlands, University of Western Australia Press, 1997.

Coleborne, C. ‘Space, power and gender in the asylum in Victoria 1850-1870’ in C. Coleborne and D. MacKinnon (eds.), Madness in Australia: histories, heritage and the asylum, St Lucia, Queensland, University of Queensland Press, 2003.

Coleborne, C. and MacKinnon, D. Madness in Australia; Histories, heritage and the asylum, St Lucia Queensland, University of Queensland Press, 2003.

Connell, R.W. ‘Theorising Gender’, in N. Grieve & A. Burns (eds.), Australian Women: New Feminist Perspectives, Melbourne, Oxford University Press, 1986.

Connell, R.W. Gender and Power: Society, the Person and Sexual Politics, Sydney, Allan and Unwin, 1987.

Connolly, M. and Harms, L. (eds.), Social Work: Contexts and practice, 2nd edition, South Melbourne, Oxford University Press, 2009.

Considine, M. and Painter, M. Managerialism: The Great Debate, Melbourne, Melbourne University Press, 1986.

Crabbe, G.M. History of Lachlan Park Hospital, Hobart, Tasmanian Government Printer, 1966.

Crawford, P. ‘Early Childhood in Perth 1940-1945’, in P. Hetherington (ed.), Childhood and Society in Western Australia, Nedlands, University of Western Australian Press in conjunction with the University of Western Australia, 1988.

Crotty, M. The Foundations of Social Science Research: Meaning and Perspective in the Research Process, Crows Nest, NSW, Allen and Unwin, 1998.

Cummins, C.J. A History of Medical Administration in New South Wales 1788- 1973.Sydney, Health Commission of NSW, 1979.

Dalton, T. Draper, M Weeks, W. & Wiseman, J. (eds.), Making Social Policy in Australia: An Introduction, Crows Nest, NSW, Allen and Unwin, 1996.

Daly, K. Gender, Crime and Punishment, Yale, Yale University Press, 1994.

Davis. A. ‘Infant Mortality and Child Saving: The Campaign of Women’s Organisations in Western Australia 1900-1922’, in P. Hetherington (ed.), Childhood and Society in Western Australia, Nedlands, University of Western Australian Press in conjunction with the University of Western Australia, 1988.

245

Davidson, D. Nulsen Haven (Inc.): A History. Faculty of Health and Human Sciences, Centre for the Development of Human Resources, Social Research and Development Monograph No. 5, Edith Cowan University, Western Australia.

Davis, L.V. Women’s Strengths: A Social Work Agenda for the Twenty First Century, New York, Haworth Press, 1994. . Dax, E. C. Asylum to Community: The Development of the Mental Hygiene Service in Victoria, Australia, Melbourne, F.W. Cheshire, 1962. , Day, P.J. A New History of Social Welfare, third edition, Boston, MA. Allyn and Bacon, 2000.

Dean, A. Lin, N. & Encel, W. (ed.), Social Support, Life Events and Depression, New York, Academic Press, 1986.

Denzin N. K. & Lincoln, Y.S. (eds.), Handbook of Qualitative Research: Theories and Issues, Thousand Islands, Sage, 2000.

Department of Social Work Regulations, University of WA Faculty Handbook, 1964.

Dickey, B. Rations, Residences and Resources: A History of Social Welfare Since 1836, Adelaide, Wakefield Press, 1986.

Dickey, B. No Charity there: A Short History of Social Welfare in Australia, Sydney, Allen and Unwin, 1987.

Digby, A. Madness, Morality and Medicine: A Study of the York Retreat, Cambridge, Cambridge University Press, 1985.

Dilthey, W. Selected Writings, Cambridge, University of Cambridge Press, 1976.

Dominelli, L. Feminist Social Work, Basingstoke, Macmillan Education, 1989.

Dominelli, L. Feminist Social Work: Theory and Practice, Basingstoke, Palgrave, now Palgrave Macmillan, 2002.

Doel, M. & Shardlow, S. The New Social Work Practices, Aldershot, England, Ashgate Publishing Co. 1988.

Doener, K. Madmen and the Bourgeoisie: A Social History of Insanity and Psychiatry, Oxford, Basil Blackwell, 1981.

Dok, J. The Reflective Researcher: Social Worker’s Experiences with Theories of Practice Research, Sydney, Allen and Unwin, 1996.

Douglas, L. Roberts, A. & Thompson, R. Oral History: A handbook, Sydney, Allen & Unwin, 1988.

246

Duckham, I. Serving the Servants: Serving the State,: A Brief History of the Institute of Public Administration of Australia, Western Australian Division 1945-2005, The Western Australian Division of the Institute of Public Administration, Perth, 2005.

Dunaway, D. K. & Baum, W. K. (eds.), Oral History: An Interdisciplinary Anthology, Nashville, Tenn., American Association for State and Local History in Cooperation with the Oral History Association, 1984.

Edington, J. Law for the Nursing Profession and Allied Health Professionals, 3rd edition, North Ryde, NSW, CCH Australia, 1995.

Elliott, G. and Graycar, A. ‘Social Welfare’ in A. Patience and B. Head, (eds.), From Whitlam to Fraser: Reform and Reactions in Australian Politics, Melbourne, Oxford University Press, 1979.

Ellis, A. S. Eloquent Testimony: The Story of the Mental Health Services in Western Australia, 1930-1975, Perth, University of Western Australia Press, 1984.

Elton, G. R. The Practice of History, London, Sydney University Press, 1967.

Emy, H. Hughes, O. & Mathews, R. (eds.), Whitlam Revisited: Policy Developments, Politics and Outcomes, Leichart NSW, Pluto Press in association with the Public Sector Management Institute, Monash University, 1993.

Eribon, D. Michael Foucault, Translated by Betsy Wing, London, Faber and Faber, 1991.

Evans, R. In Defence of History, London, Granta Books, 1997.

Everingham, C. Social Justice and the Politics of Community, Aldershot, England, Ashgate Publishing Company, 2003.

Everitt, A. Hardiker, P. Littlewood, J. & Mullender, A. Applied Research for Better Practice, Basingtoke, Macmillan Press, 1992.

Family Support Services Association of NSW, Volunteers in Home Visiting Programmes; Concord West NSW, Family Support Association of NSW, 1995.

Farganis, S. Situating Feminism: From Thought to Action, Thousand Oaks, USA, Sage Publishing Inc., 1994.

Ferguson, C. The Feminist Case Against Bureaucracy, Philadelphia, Temple University Press, 1984.

Ferguson I. Lavalette M. & Mooney G. Rethinking Welfare: a critical perspective, London, Sage Publications, 2002.

Finch, J. Research and policy: The use of qualitative research in social and educational research, London, Palmer, 1986.

247

Finch, J. ‘Feminist Research and Social Policy’, in McLean, M. and Groves, D. (eds.), Women’s Issues in Social Policy, London, Routledge, 1991.

Finch, J.D. Aspects of Law Affecting the Paramedical Professions, London, Faber, 1984.

Fineman, S. (ed.) Emotion in Organisations, London, Sage Publications, 2000.

Fink, A. E. Pfouts, J. H. & Dobelstein, A.W. The Field of Social Work, 8th Edition, New Delhi, Sage, 1985.

Finnane, M. ‘From dangerous lunatic to human rights? The law and mental illness in Australian history’, in C. Colebourne & D. MacKinnon (eds.), Madness in Australia: histories, heritage and the asylum, St. Lucia, Queensland, University of Queensland Press, 2003.

Fitzpatrick, M. ‘Preventing the Unfit from Breeding: The Mental Deficiency Bill in Western Australia’, in P.Hetherington (ed.), Childhood and Society in Western Australia, Nedlands, University of Western Australia Press in conjunction with the University of Western Australia, 1988.

Fontana, A. and Free, J. ‘Interviewing: The Art of Science’, in N. K. Denzin & Y. S. Lincoln, (eds.), The Landscape of Qualitative Research: Theories and Issues, London, Sage, 1994.

Foucault, M. Madness and Civilization: A History of Insanity in the Age of Reason, London, Routledge, 2001.

Foucault, M. Discipline and punish: the birth of the prison, Harmondsworth, Pelican, 1979.

Foucault, M. A History of Sexuality, Harmondsworth, Penguin, 1979.

Foucault, M. The Archeology of Knowledge, London, Tavistock, 1972.

Fox, C. Working Australia, Sydney, Allen and Unwin, 1991.

Freidson, E, The Profession of Medicine: A Study of the Sociology of Applied Knowledge, New York, Dodd, Mead and Company, 1970.

Freidson, E. Professional Dominance and the Structure of Medical Care, New York, Atherton Press, 1970.

Gaebler, T. ‘Reinventing Government’, in P. Weller & G. Davis (eds.), New Ideas, Better Government, St Leonards, NSW, Allen & Unwin, 1996.

Gardner, J. Looking Back: Reflections on Twenty Five Years 1965-1990, Department of Social Work and Social Administration, University of Western Australia, 1990.

248

Garton, S. ‘Freud and the Psychiatrists: The Australian Debate 1900-1940’, in Head, B. (ed.), Intellectual Movements in Australian Society, Melbourne, Oxford University Press, 1988.

Garton, S. Medicine and Madness: A Social History of Insanity in NSW 1880-1940, Kingston, NSW, Australia, NSW University Press, 1988.

Garton, S. Out of Luck: Poor Australians and Social Welfare, 1788-1988, Sydney, Allen and Unwin, 1990.

Garton, S. ‘Asylum Histories’ in C. Coleborne & D. McKinnon (eds.), Madness in Australia: histories, heritage and the asylum, St Lucia, Queensland, University of Queensland Press in association with the API Network and Curtin University of Technology, 2000.

Gershon, M. & Biller, H. The Other Helpers: Paraprofessionals and Nonprofessionals in Mental Health, Lexington, Mass., Lexington Books, 1977.

Gilgren, C. ‘Once a Defective Always a Defective’ in E. Cox, C. Fox, M. Brogan and M. Lee (eds.), Under Blue Skies: The social construction of intellectual disability in Western Australia. Published by the Centre for Disability Research and Development, Faculty of Health and Human Sciences, Edith Cowan University, 1996.

Gilligan, C. In a Different Voice: Psychological Theory & Womens’ Development, Cambridge, Harvard University Press, 1982.

Glicken, M. D. Social Work in the 21st Century: An Introduction to Social Welfare, Social Issues and the Profession, Thousand Oaks, London, New Delhi, Sage Publications, 2007.

Ghosh, R.N. ‘Economic development and population growth in Western Australia since 1945’, in T. Stannage (ed.), A New History of Western Australia, Nedlands, University of Western Australia Press, 1981.

Goffman, I. Asylums: Essays on the social situation of mental patients and other inmates, Harmondsworth, Penguin, 1961.

Goodman, D. Gold Seeking: Victoria and California in the 1850’s Sydney, Allen and Unwin, 1994.

Graycar, A. & Jamrozik, A. How Australians Live: Social Policy in Theory and Practice, South Melbourne, Macmillan Publishing Company of Australia, 1989.

Grbich, C. (ed.), Health in Australia: Sociological Concepts and Issues, Sydney, NSW, Prentice Hall, 1996.

Green, A. & Troup, K. The Houses of History: A Critical Reader in the Twentieth Century History and Theory, New York, New York University Press, 1999.

249

Gregory, J. (ed.), Western Australia Between the Wars 1919-1939, Studies in Western Australian History X1, Centre for Western Australian History, Department of History, University of Western Australia, 1990.

Grimshaw. P, Lake, M. Mcgrath, A. & Quartly, M. (eds.), Creating a Nation, Ringwood, Victoria, Penguin, 1994.

Grobb, G.N. From Asylum to Community: Mental Health Policy in Modern America, Princetown, New Jersey, Princetown University Press, 1991.

Groenewegen, P.D. ‘Federalism’ in A. Patience & B, Head (eds.), From Whitlam to Fraser: Reform and Reaction in Australian Politics, Melbourne, Melbourne University Press, 1988.

Halligan, J. Mackintosh, H. & Thompson, H. The Australian Public Service: The View From the Top, Belconnen, ACT, Coopers and Lybrand and the University of Canberra, 1996.

Hamilton, G., Theory and Practice of Social Casework, New York, New York School of Social Work, Columbia University, Columbia University Press, 2nd edition, 1951.

Hamilton. P. ‘The Knife Edge: Debates about Memory and History’, in K. Darien- Smith & P. Hamilton (eds.), Memory and History in Twentieth Century Australia, Melbourne, Oxford University Press, 1994.

Harries, M. and Smith, G. ‘Community Psychiatry’, in R. J. Kosky, H.S. Eshkevari & V. J. Carr (eds.), Mental Health and Illness, Sydney and Oxford, Butterworth- Heinemann, 1991.

Hartstock, N.C.M. The Feminist Standpoint Revisited and other Essays, Oxford, Westview Press, 1998.

Hasley, A.H. (ed.), Traditions of Social Policy: Essays in honour of Violet Butler, Oxford, England, Blackwell, c.1976.

Hay, J. R. The Development of the British Welfare State 1880-1975, London, Edward Arnold, 1978.

Healy, B. Rimmer, J. and Ife, J. ‘Cultural Imperialism and Social Work Education in Australia’, in Advances in Social Work Education, The Heads of Schools of Social Work in Australia and the University of New South Wales, 1986.

Healy, K. Social Theories in Context: Creating Frameworks for Change, Houndsmills, Basingstoke, Palgrave Macmillan, 2005.

Henriksen, L. Norreklit, L. Jorgensen, K. Christensen, J. & Connell, D. Dimensions of Change: Conceptualising Reality in Organisational Research, Denmark, Copenhagen School Press, 2004.

250

Hetherington, P. (ed.), Childhood and Society in Western Australia, Nedlands, University of Western Australia Press in conjunction with the Centre for Australian History, Department of History, the University of Western Australia, 1988.

Hetherington, P. & Maddern, P. (eds.), Sexuality and Gender in History, Nedlands, Centre for Western Australian History, University of Western Australia, 1993.

Hill, M. The Welfare State in Britain: A Political History since 1945, Aldershot, England, Edward Elgar Publishing Company, 1993.

Hollis, F. Casework: A Psychosocial Approach, New York, Random House, 1964.

Hollis, F. A Typology of Casework Treatment, New York, Family Service Association of America, 1968.

Hood, C. The Tools of Government, London, Macmillan, 1983.

Hooyman, N.R. ‘Supporting Practice in Large Scale Bureaucracies’, in Hooyman, N.R. (ed.), Feminist Social Work Practice in Clinical Settings, Newbury Park, Sage Source Books, 1991.

Hopkins, J. ‘Social work through the looking glass’, in Parton, N. Social Change and Social Change and Social Work, London, Routledge, 1996.

Horobin, G. (ed.), Responding to Mental Illness, London, Kogan Page, 1985.

Howes, M. Politics and the Environment: Risk and the role of government and industry, London, Sterling, VA, Earthscan, 2005.

Hudson, B. Social Work with Psychiatric Patients, London, Macmillan, 1982.

Hutchenson, G. Lund, L. Lynsgstad. R. & Oltedal, S. (eds.), Social Work in Five Countries: A Report, Bodo, University of Bodo, 2001.

Huxley, P. Social Work Practice in Mental Health, Aldershot, England, Gower, 1985.

Ife, J. Rethinking Social Work: Towards Critical Practice, Melbourne, Longman Cheshire, 1997.

Iggers, G. G. Historiography in the Twentieth Century: From Scientific Objectivity to the Postmodern Challenge, London, Wesleyan University Press, 1997.

Ingleby, D. (ed.), Critical Psychiatry, Harmondsworth, Penguin, 1981.

Jaggs, D. Asylum to Action: Family Action 1851 – 1951, Melbourne, Victoria, Family Action, 1991.

Jamrozik, A. The Chains of Colonial Inheritance: Searching for identity in a subservient nation, Sydney, University of New South Wales Press, 2004.

251

Jenkins, K. ‘On “what is history”: from Carr and Elton to Rorty and White, London, New York, Routledge, 1965.

Jones, G. S. Outcast London: A Study in the Relationship between Classes in Victorian Society, Oxford, Clarendon Press, 1971.

Jones, K. Mental Health and Social Policy 1845-1959, London, Routledge & Keegan Paul, 1960.

Jones, K. Asylums and After, London and Atlantic Highlands, New Jersey, Althone Press, 1993.

Jones, M. Social Psychiatry in Practice: The Idea of a Therapeutic Community, Harmondsworth, Penguin, 1968.

Jones, M.A. The Australian Welfare State: origins, control and choices, 3rd edition, North Sydney, NSW, Allen and Unwin, 1900.

Jones, N. ‘Institutions and the Ultimate Experience’, in Scull, A. (ed.), Madhouses, Mad-doctors and Madmen: A Social History of Madness in the Victorian Age, Philadelpia, Pa., University of Pennsylvania Press, 1981.

Julian, R. ‘Ethnicity, Health and Multiculture’, in Gernov, J. (ed.), Second Opinion: An Introduction to Health Sociology, 2nd edition, Melbourne, Oxford University Press, 2002.

Jupp, V. ‘Documents and critical research’ in R. Stapford & V. Jupp (eds.), Data Collection and Analysis, London, Sage, 1996.

Kanner, B. Women in English social history 1800-1914: a guide to research, Cambridge, Mass., Garland publisher. 1990.

Kanter, R.M. Men and Women of the Corporation, New York, Basic Books, 1977.

Karapanagottidis, K. & Kilkeary, S. Influencing Outcomes Conference, Canberra, Australian National University, 1977.

Katz, D. & Khan, R. The Social Psychology of Organisations, New York, Wiley, 1966.

Katz, M.B. In the Shadow of the Poorhouse: A Social History of Welfare in America, New York, Basic Books, 1986.

Keane, J. Democracy and Civil Liberty, London, Verso, 1988.

Keating, M. ‘Mega-departments: The Theory, Objectives and Outcomes of the 1987 Reforms’, in P. Weller, J. Foster & G. Davis (eds.), Reforming the Public Service, South Melbourne, Macmillan Education Australia, 1993.

252

Keating, M. & Weller, P. ‘Rethinking government’s rules and operations’, in Davis, G. & Weller, P. (eds.), Are You Being Served: State, Citizens and Governance, Crows Nest NSW, Allen and Unwin, 2001.

Kelly, P. The End of Certainty: The Story of the 1980’s, St Leonards, Allen and Unwin, 1992.

Kennedy, R. Charity Warfare: The Charity Organisation Society in Colonial Melbourne, Melbourne, Hyland House, 1985.

Kevles, D. In the Name of Eugenics: Genetics and the use of human heredity, Cambridge, Mass., Harvard University Press, 1995.

Kincheloe, J .I. & McLaren, P.I. ‘Rethinking critical theory and qualitative research’, in N. K. Denzin & Y. S. Lincoln (eds.), Handbook of Qualitative Research, Thousand Oaks, Sage, 1994.

Kittrie, N. The Right to be Different: Deviance and Enforced Therapy, Baltimore, John Hopkins University Press, 1971.

Kravetz, D., & Jones, L. ‘Supporting Practice in Feminist Service Agencies’, in Bricker-Jenkins, M. & Hooynan, N. (eds.), Feminist Social Work Practice in Clinical Settings, Newbury Park, Sage, 1991.

Krupinski, J. ‘Epiderminology and Social Psychiatric Research’, in J. Krupinski, A. Mackenzie & R. Bancheveska. (eds.), The History and Achievements of the Mental Health Institute Research Institute of Victoria, 1956-1981, Melbourne, Health Commission of Victoria, 1981.

Laidlow, T.A. & Malms, C. Healing Voices: Feminist Approaches to Therapy with Women, San Francisco, Jossey-Bass Publishers, 1990.

Laing, R.D. The Self and Others, New York, Tavistock, 1961.

Laing, R.D. The Politics of Experience, New York, Pantheon, 1967.

Lask, J. & Lask, B. Child Psychiatry and Social Work, New York, Tavistock, 1981.

Lavalette, M and Pratt, A. (eds.), Social Policy: A Conceptual and Theoretical Introduction, London, Sage Publications, 1998.

Lawrence, M. and Maguire, M. (eds), Psychotherapy with Women: Feminist Perspectives, New York, Routledge, 1999.

Lawrence, R.J. Professional Social Work in Australia, Canberra, Australian National University Press, 1965.

Lawrence, R.J. ‘Australian Social Work in Historical, International and Social Welfare Context’, in P. J. Boas & J. Crawley, (eds.), Social Work in Australia: Responses to a

253

Changing Context, Melbourne, Australian Associated Press in association with the Australian Association of Social Workers, 1976.

Lawrence, R. J. A Career in Social Work: Seven Personal Accounts, School of Social Work, Sydney, University of New South Wales. 1978.

Laybourne, K. The Evolution of British Social Policy and the Welfare State: c 1800- 1933, Keeled, Staffordshire, Keeled University Press, 1995.

Learner, E. Education and Training for Social Work Personnel in Australia, Cambridge, Australian Publishing Services, 1979.

Lederman, E. Health Career Planning, New York, Human Sciences Press, 1988.

Lefley, H. Family Caregiving in Mental Illness, Family Caregiver Application Series, Vol. 7, Thousand Oaks, California, Sage Publications, 1996.

Leonard, P. Postmodern Welfare: Reconstructing an Emancipatory Project, London, Sage Publications, 1997.

Lewis. J. The Voluntary Sector, the State and Social Work in Britain; The Charities Organisation Society/Family welfare Association since 1869, Aldershot, Edward Elgar Publishing Company, 1995.

Lewis, M. Managing Madness: Psychiatry and Society in Australia, 1788-1980, Canberra, AGPS Press, 1980.

Lewis, M.A. & Tamparo, C.D., Law and Ethics in the Medical Office, Philadelphia, F.A.Davis, c.1993.

Liberman, F. Clinical Social Workers as Physiotherapists, New York, Gardner Press Inc., 1982.

Lindert, P. A. A Macro Game of Growth and Policy, New York, Holt, Reinhart & Winston, 1970.

Locke, J. The Educational Writings of John Jocke: A critical edition with an introduction and notes, Cambridge, Cambridge University Press, 1968.

Long, J. Gothard, J. & Brash, H. (eds.), Forging Identities, Nedlands, WA. University of Western Australia Press, 1997.

Maddock, S. Challenging Women: Gender, Culture and Organisation, London, Sage, 1999

Mantkelow, R. Paths to Psychiatric Hospitalisation: A Sociological Analysis, Aldershot, England, Avebury Publishing Co., 1994.

Marchant, H. & Waring, B. (eds.), Gender Reclaimed: Women in Social Work, Sydney, Hale and Ironmonger, 1986.

254

Martin, M. Colleagues or Competitors? A Study of the Role of the Five Professions Supplementary to Medicine, London, Bell, 1969.

Martin, E.M.W. ‘Social Work and Services 1935-1965’, in B. Dickey, Rations, Residences and Resources: A History of Social Welfare since 1836, Adelaide, Wakefield Press, 1986.

Matthews, J. Good and Mad Women: The Historical Construction of Femininity, Sydney, George Allen and Unwin, 1984.

McConagy, M. (ed.), Liberation Movements and Psychiatry, Geigy Psychiatric Symposium held at the Clinical Services Building, Prince Henry Hospital, Australia, Biba-Geigy, 1974.

Mc Glashan, T.H. ‘Schizophrenia: Psychodynamic Theories’, in H. I. Caplan and B.J. Sadock (eds.), Comprehensive Textbook of Psychiatry, 5th edition, Baltimore, Williams and Wilkin, 1989.

McLean, M. & Grove, D. (eds.), Women’s Issues in Social Policy, London, Routledge, 1991.

Megahey, N. ‘Living in Fremantle Asylum: The colonial experience if intellectual disability1829-1900’, E. Cox, C. Fox, M. Brogan and M. Lee (eds.), Under Blue Skies: The social construction of mental disability in Western Australia, published by the Centre for Disability Research and Development, Faculty of Health and Human Sciences, Edith Cowan University, 1996.

Mendes, P. Australia’s Welfare Wars Revisited: The Players, the Politics and the Ideologies, first published 2003, Sydney, University of New South Wales, 2008.

Merton, R.K. Social Theory and Social Structure, New York, Free Press of Glencoe, 1957.

Midgley, J. Social Work in a Global Context, Thousand Islands, Sage Publications, 1997.

Mill, J. S. On Liberty, Oxford, Oxford University Press, 1912.

Minichello. V. Aroni, R. and Hayes, T., In-depth –interviewing: Principles, Techniques, Analysis, 3rd edition, Sydney, Pearson Prentice Hall, 1995.

Mitchell, S. The Matriarchs, Ringwood, Victoria, Penguin Books, 1987.

Monk, L. Attending Madness: At Work in the Australian Colonial Asylum, Amsterdam, New York, Clio Medica 84, The Wellcome Series in the History of Medicine, Radopi, 2008.

Moussaieff-Masson, J. A Dark Science, Women, Sexuality and Psychology in the Nineteenth century, New York, Farrer Straus and Giroux, 1986.

255

Munslow. A. Reconstructing History London, Routledge, 1997.

Nester, E.W. The Microbial Perspective, Philadelphia, Saunders College Publishers, 1982.

Netting, F.E. Kettner, P. M. & McMurtry, S. L. Social Work Macro Practice, New York and London, Longman, 1993.

Neunensehwander, J. ‘Oral Historians and Long Term Memory’, in D. Dunaway, K. Baum, and K. Willa (eds.), Oral History: An Interdisciplinary Anthology, Nashville, Tenn., American Association for State and Local History in Cooperation with the Oral History Association, 1984.

Nile, R. (ed.) Governing Change: From Keating to Howard, St Lucia, Queensland, University of Queensland Press, 2000.

Oakley, A. The Sociology of Housework, Oxford, Martin Robinson, 1974.

Oakley, A. ‘Interviewing women: a contradiction in terms’, in H. Roberts (ed.), Doing Feminist Research, London, Routledge, 1983.

Obrien, L. and Turner, C. Establishing Medical Social Work in Victoria: Discussion and Document, Melbourne, University of Melbourne, 1976.

O’Faircheallaigh, C. Wanna, J. & Weller, P., Public Sector Management in Australia: New Challenges, New Directions, 1st edition 1976, South Yarra, Macmillan Education Australia Pty Ltd. 1999.

Olsen, M. & Marger, M. (eds.), Power in Modern Societies, Boulder, Western Press, 1993.

Osborne, D. & Gabler, T. Reinventing Government” New York, Penguin, 1993

Ouchi, W.A. Theory Z: How American Business can meet the Japanese Challenge, Reading, MA, Addison Wesley, 1981.

Page, K. Research Highlights in Social Work. II: Responding to Mental Illness, London, Kogan Page, 1985.

Palmer, G.R. ‘Health’ in A. Patience & B. Head (eds.), From Whitlam to Fraser, Melbourne, Oxford University Press 1979.

Parry, S. Frances, A. & Clarkin, J. DSM Casebook of differential therapeutics: a treatment guide to treatment selection, New York, Brunner/Mazel, 1985.

Pargiter, R. ‘A Brief History of Mental Health Services in Australia and New Zealand’, in Kosky, R. Eshkevari, H. S. and Carr, V. (eds.), Mental Health and Mental Illness: A Textbook for Students of Health Sciences, Sydney, Butterworth- Heinemann, 1991.

256

Parton, N. Social Theory, Social Change and Social Work, London, Routledge, 1996.

Parton, N. & O’Byrne P. Constructive Social Work: Towards a New Practice, Houndsmills, Macmillan, 2000.

Parton, N. Thorpe, D. and Wattan, C. Child Protection: Risk and Moral Order, Macmillan, London, 1997.

Pateman, C. & Gross, E. (eds.), Feminist Challenges: Social and Political Theory, Sydney, Allen and Unwin, 1986.

Payne, M. The Origins of Social Work, Community and Change, New York, Palgrave Macmillan, 2005.

Peachment, A. ‘Reforming the Public Sector: Global Trends, Local Action,’ in A. Peachment (ed.), The Business of Government: Western Australia 1983-1990, Annandale, NSW, The Federation Press, 1991.

Perrini, F. (ed.), The New Social Entrepreneurship: What Awaits Social Entrepreneurial Ventures? Cheltenham, UK, Edward Elgar, 2006.

Pilgrim, D. (ed.), Competing Histories of Madness in Bentall: Reconstructing Schizophrenia, London, Paperback, 1990.

Pinker, R. Social Theory and Social Policy, London, Heinemann Educational, 1971.

Porter, R. English Society in the Eighteenth Century, London, Penguin, 1982.

Porter, R. Mind Forg’d Manacles: A history of madness in England from the Restoration to the Regency, London, The Althone Press, 1987.

Porter, R. (ed.), The Faber Book of Madness, London, Faber and Faber, 1991.

Poynter, J.R. Society and Pauperism, English Ideas on Poor Relief 1798-1834, Carlton, Victoria, Melbourne University Press, 1969.

Prior, L. The Social Organisation of Mental Illness, London, Sage, 1993.

Pritchard, C. Mental Health and Social Work: Evidence-based Practice, London and New York, Routledge, 2006. Punch, K.F. Developing Effective Research Proposals, London, Sage Publications, 2000.

Putnam, L.L. & Mumby, D.K. ‘Organisations, Emotion and the Myth of Reality’, in Fineman, S. (ed.), Emotion in Organisations, London, Sage, 2000.

Quartly, M. ‘Making Male and Female Worlds’, in P. Grimshaw, M. Lake, A. McGrath & M. Quartly (eds.), Creating a Nation, Ringwood, Victoria, Penguin, 1994.

257

Raddeker, H.B. 2007, Sceptical History: Feminist and Postmodern Approached in Practice, London and New York, Routledge.

Rathbone - McCuan, E. Tebb, S. & Harbert, T. ‘Feminist Social Work with Older Women’, in M. Bricker-Jenkins & N. Hooyman (eds.), Feminist Social Work Practice in Clinical Settings, Newbury Park, Sage Source Books, 1991.

Rayner, M and Cockram, J. ‘The Response of the Law to Intellectual Disability in Western Australia 1829-1993’, in E. Cox, C. Fox, M. Brogan and M. Lee (eds.), Under Blue Skies: The social construction of intellectual disability in Western Australia, published by the Centre for Disability Research and Development, Faculty of Health and Human Sciences, Edith Cowan University, 1996.

Rees, S. and Rodley, G. (eds.), The Human Costs of Managerialism: Advocating the Recovery of Humanity, Leichardt, NSW, Pluto Press Australia, 1995.

Rehr, H. Rosenberg, G. and Blumenfield, S. (eds.), Creative Social Work in Health Care: Clients, The Community and Your Organisation, New York, Springer Publishing Company, 1998.

Reibling, B. ‘Remodelling Truth, Power and Society: Implications of Chaos Theory, Non-equilibrium Dynamics, and Systems Science for the Study of Politics and literature’, in N. Easterlin & B. Reibling (eds.), After Poststructuralism: Interdisciplinary and Literary Theory, Illinois, Northwestern University Press, 1993.

Reisch, M. & Gambrill, E. (eds.), Thousand Oaks, California, Pine Forge Press, 1997.

Richmond, M. Social Diagnosis, First published 1945, New York, Russell Sage reprint 1973.

Robertson, B. Oral History Handbook, 5th edn. Unley, South Australia, Oral History Association of Australia (Sth. Aust. Branch) 2006.

Robson, C. Real World Research: A Resource for Social Scientists and Practitioner Researchers, Oxford, Blackwell Publishers, 2002.

Rodger, J. J. From a Welfare State to a Welfare Society: the changing context of social policy in a postmodern era, Houndsmills, Macmillam Press, 2000.

Roe, J. (ed.), Social Policy in Australia: Some Perspectives 1901-1905, Stanmore NSW, Cassell Australia, 1976.

Romaine, S. Communicating Gender, Marwar, Erlbaum Associated Inc., 1999.

Rosenberg, G. & Clarke, S.S. (eds.), Social Workers in Health Care Management: The Move to Leadership, New York, London, The Hayworth Press, 1987.

Rothman, D.J. The Discovery of the Asylum: Social Order and Disorder in the New Republic, Boston, Toronto, Little, Brown and Company, 1971.

258

Rothman, D.J. Conscience and Convenience: The Asylum and its Alternatives in Progressive America, Boston, Little, Brown and Company, 1980.

Rubenstein, R. & Lasswell, H. The Sharing of Power in a Psychiatric Hospital, New Haven, Yale University Press, 1966.

Ruble, D. Constanto, P. & Oliveri, M. The Social Psychology of Mental Health: Basic Mechanisms and Applications, New York, Guildford Press, 1992.

Ruitenbeek, H. (ed.), Going Crazy: The Radical Therapy of R.D. Lang, 2nd edition, New York, Bantam Books Inc., 1972.

Sangster, J. ‘Telling our stories: Feminist Debates and the Use of Oral History’, In Dunaway, D.K. & Baum, W.K. (eds.) Oral History: An Interdisciplinary Anthology, Nashville, Tenn., American Association for State and Local History in Cooperation with the Oral History Association, 1988.

Saulnier, C.F. Feminist Theories and Social Work, New York, Haworth Press Inc., 1996.

Scott, J. ‘Gender a Useful Category of Historical Analysis’, in J. Scott, Feminism and History, New York, Oxford University Press, 1996.

Scott, J.W. ‘Retrieving Women’s History: Changing Perceptions of the Role of Women’, in S.J. Kleinbury (ed.), Politics and Society, Berg, UNESCO, 1988.

Scull, A. Museums of Madness, London, Allen Lane, 1979.

Scull, A. (ed.), Madhouses, Mad-doctors and Madmen: A Social History of Psychiatry in the Victorian Era, Philadelphia, Pa., University of Pennsylvania Press, 1981.

Scull, A. Decarceration: Community Treatment and the Deviant – A Radical View, New Jersey, Prentice Hall, 1977.

Scull, A. Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective, Berkley, University of California Press, 1989.

Scull, A. The Most Solitary of Afflictions: Madness and Society in Britain 1700-1900, New Haven, Yale University Press, 1993.

Sedgwick, P. Psycho Politics, London, Pluto, 1982.

Sheldon, B. ‘A Critical Appraisal of the Medical Model in Psychiatry, in Olsen, M. (ed.), Social Work and Mental Health, London, Kingsley Publishers, 1999.

Shepphard, D.L. ‘Organisations, Power and Sexuality: The Image and Self Image of Women Managers’, in Hearn, J. Shepphard, D. Tancred, S. & Burrell, G. (eds.), The Sexuality of Organisations, London, Sage, 1989.

259

Sheppard, M. Care Management and the New Social Work, London, Whiting and Birch, 1995.

Showalter, E. The Female Malady: Women, Madness and English Culture, 1830-1980, New York, Pantheon, 1985.

Simms, M. and Stone, D. ‘Women’s Policy’, in C. Jennett and R. Stewart (eds.), Hawke and Australian Public Policy, Melbourne, Mackinnon, 1990.

Skeet, M. & Elliott, K. (eds.), Health Auxiliaries and the Health Team, London, Croom Helm, 1978.

Skocpol, T. Social Policy in the United States: Future Possibilities in Historical Perspective, New Jersey, Princetown University Press, 1995.

Smallwood, G. ‘Turning History Around and Redefining Aboriginal Health by the Year 2000’, in Social, Religious and Spiritual Values of the Aboriginal People, Canberra, Australia, Council For Aboriginal Reconciliation, 1991.

Smark, C.J. & Deo, H. ‘Social and historical power plays: a Foucauldian gaze on mental institutions’, in Faculty of Commerce Papers, Wollongong, University of Wollongong, 7-8 November, 2006.

Spitzer, R.L. (ed.), DSM1V-TR Casebook: a learning companion to the diagnostic and statistical manual of mental disorders, Washington, DC, Psychiatric Publications, 2002.

Smith, R. Reflections of a Clinical Psychologist, Victoria Park, Perth, Hesperian Press, 1999.

Spitzer, L and Williams J. ‘The definition and diagnosis of mental disorder’ in W. Grove (ed.), Deviance and Mental Illness, Beverley Hills, Sage, 1982.

Stanley, L. and Wise, S. Breaking Out: Feminist Consciousness and Feminist Research, London, Boston, Routledge, 1991.

Statham, P. ‘Swan River Colony 1829-1850’, in C.T. Stannage (ed.), A New History of Western Australia, Nedlands, WA, University of Western Australia Press, 1981.

Stella, L. ‘Normalisation and Beyond: Public Sector Residential Care 1965-1990’, in E. Cox, C. Fox, M. Brogan & M. Lee (eds.), Under Blue Skies: The social construction of intellectual disability in Western Australia, published by the Centre for Disability Research and Development, Faculty of Health and Human Sciences, Edith Cowan University, 1996.

Stromberg, R. European Intellectual History since 1789, 2nd edition. New Jersey, Prentice Hall, 1975.

Summers, A. Damned Whores and God’s Police, (First edition 1986) Ringwood, Victoria, Melbourne University Press, 1994.

260

Szasz, T. Schizophrenia: The Sacred Symbol of Psychiatry, Oxford, Oxford University Press, 1979.

Szasz, T. The Myth of Mental Illness: Foundation of a theory of personal conduct, London, Paladin, 1972.

Szasz, T. The manufacture of madness: a comparative study of the Inquisition and the mental health movement’, New York, Harper & Row, 1970.

Tatam, D. ‘The Anti-psychiatry Movement’, in Berrios, G., and Freeman, H. (eds.), 150 Years of British Psychiatry, London, Gaskell, 1991.

Tauman, M. The Chief: C.Y. O’Connor, Nedlands, University of Western Australia Press. 1978.

Taylor, S. J. & Bogden. R. Introduction to Qualitative Research Methods: A Guidebook and Resource, 3rd edition, New York, John Wiley and Sons Inc, 1998.

Thompson, L. Perspectives on Life Threatening Illnesses for Allied Health Professionals, New York, Haworth Press, 1993.

Timms, N. The Language of Social Casework, London, Routledge and Keegan, 1968.

Trattner. W. From Poor Law to Welfare State: A History of Social Welfare in America, first published 1974, 6th edition, New York, the Free Press, 1999.

Trent, J.W. Jr. Inventing the Feeble Mind: A History of Mental Retardation in the United States, Berkeley, Los Angeles, London, University of California Press, 1994.

Troy, P. ‘Love’s Labor Lost: Whitlam and Urban Regional Development’, in H. Emy, O. Hughes, and R. Mathews (eds.), Whitlam Revisited: Policy Developments, Politics and Outcomes, Leichart, NSW, Pluto Press, 1993.

Tuke, S. Descriptions of the Retreat: An Institution near York for Insane Persons of the Society of Friends, containing an account of the origins and progress of treatment and a statement of cases. (Microfilm), York England, W.Alexander, 1813. Turner, C. ‘Feminist Practice with Women of Colour : A Developmental Perspective’, in Bricker-Jenkins, M. & Hooyman, N. (eds.), Feminist Social Work Practice in Clinical Settings, Newbury Park, Sage Publications, 1991.

Van Acker, E. ‘Women’s policy activism and changing relations with the state’, in G. Davis and P. Waller (eds.), Are You Being Served: State, Citizens and Governance, Crows Nest, NSW, Allen and Unwin, 2001.

Van Servellen, G. Communication Skills for Health Care Professionals: Concepts and Techniques, Gaithersburg, Md., Aspen Publishers, 1997.

261

Vardon, S. & Morley, K. ‘Creating successful change in public organisations’, in P. Weller and G. Davis (eds.), New Ideas, Better Government, St Leonards, NSW, Allen and Unwin, 1996.

Vias, M. & Connor, A. (eds.), Mental Health and Social Work, London, Kingsley Publishers, 1999.

West Australian Institute of Technology Handbook, 1967.

Walby, S. ‘Post-postmodernism? Theorizing Social Complexity’, in Barrett, M. and Phillips, A. (eds.), Destabilizing Theory, Oxford, Oxford Polity Press, 1992.

Walby, S. Theorising Patriarchy, Oxford, Blackwell, 1990.

Weller, P. Forster J. and Davis, G. Reforming the Public Service: Lessons from Recent Experience, Brisbane, Australia, Macmillan, 1988.

Wearing, M. ‘Medical Dominance and the Division of Labour in the Health Profession’, in Grbich, C. (ed.), Health in Australia: Sociological Concepts and Issues, Sydney, NSW, Prentice Hall, 1996.

Wearing, M. and Berreen, R. (eds.), Welfare and Social Policy in Australia: the distribution of advantage, Sydney, Harcourt Brace and Company, 1994.

Webb, L. DiClemente, C. Johnstone, Saunders, S. & Perley, J. (eds.), DSM 111 Training Guide, New York, Brunner/Mazel Publishers, 1981.

Weckowicz, T.E. Models of Mental Illness: Theories of Abnormal Psychology, Springfield, USA, Thomas, 1984.

Wedenoja, M. ‘Mothers are not to Blame: Confronting Cultural Bias in the area of Serious Mental Illness’, in Bricker-Jenkins, M. & Hooyman, N. (eds.), Feminist Social Work Practice in Clinical Settings, Newbury Park, Sage Publications, 1991.

Weedon, C. Feminist Practice and Post-structuralist Theory, London, Basil Blackwell, 1989.

Weeks, W. Women Working Together: Lessons from Feminist Women’s Services, London, Longman Cheshire, 1994.

Weick, A. ‘Overturning Oppression: An Analysis of Participatory Change’, in L. Davis (ed.), in Building on Women’s Strengths: A Social Work Agenda for the Twenty First Century, London, Haworth Press, 1994.

Weller, P. Are You Being Served? Crows Nest, NSW, Allen and Unwin, 2001.

Weller, P. Australian Mandarins: the frank and the fearless, Crows Nest NSW, Allen and Unwin, 2001.

262

Weller, P. Forster, J. & Davis, G. Reforming the Public Service: Lessons from Recent Experience, South Melbourne, Macmillan Education Australia, 1993.

Weller, P. & Davis, G. (eds.), New Ideas, Better Government, St. Leonards, NSW, Allen and Unwin, 1996.

White, H. Metahistory: The Historical Imagination in Nineteenth Century Europe, Baltimore, The John Hopkins University Press, 1973.

Whittington, V. Gold and Typhoid, Two Fevers: A Social History of Western Australia 1891-1900, Nedlands, University of Western Australia Press, 1988.

Whitwell, G. ‘Economic Affairs’, in H. Emy, O. Hughes & R. Matthews (eds.), Whitlam Revisited: Policy Developments, Politics and Outcomes, Leichardt, NSW, Pluto Press in association with the Public Sector Management Institute, Monash University, 1993.

Wiener, A. Mental Health for Non-Professionals, Springfield, Ill., Thomas, 1980.

Williams, L. & Martin, R. ‘Learning from Professional Community Based Psycho- social Services’, in Leeson, M. (ed.), The Mental Health Conference 1996 : There is a Person in Here, The Mental Health Services Conference Inc., of Australia and New Zealand, 1997.

Willis, E. ‘Protestants and the Dispossessed in Western Australia 1890-1910’, in J. Tonkin (ed.), Religion and Society in Western Australia: Studies in Western Australian History, Nedlands, Department of History, University of Western Australia, 1987.

Willis, E. Medical Dominance: The Division of Labor in Australian Health Care, Sydney, Allen and Unwin, 1970.

Wilson, E. Women and the Welfare State, London, Tavistock, 1977.

Wolfensberger, W. Normalisation: The Principles of Normalisation in Human Services, with additional Text by Bengt Nirje, Toronto, National Institute on Mental Retardation, 1972.

Wolin, R. The Terms of Cultural Criticism, New York, Columbia University Press, 1992.

Wright, D. & Digby, A. (eds.), From Idiocy to Mental Deficiency: Historical Perspectives on People with Intellectual Difficulties, London and New York, Routledge, 1996.

Yeatman, A. Bureaucrats, Technocrats, Femocrats: Essays on the Contemporary Australian State, Sydney, Allen and Unwin, 1990.

Young, R.J.C. Torn Halves: Political conflict in literary and cultural theory, London, Manchester University Press. 1996.

263

Younghusband, E. Social Work in Britain, 1950-1975: A follow up study. London, Allen and Unwin, 1978.

Zastrow, C. The Practice of Social Work, Homewood, Ill., Dorsey Press, 1985.

5. Theses

Barber, N. Civil Commitment and Review: Tensions in Law and Practice, PhD. Thesis, University of Western Australia, 2003.

Foley, M.C. Study of a Goldfields Sexual Assault Service, M.Phil. Thesis, University of Western Australia, 1993.

Hickey, B. The Development of Social Work in Western Australia 1946-1970, Master’s Thesis, University of Western Australia, 1971.

Harries, M. Deinstitutionalisation of the Chronically Mentally Ill, Honours Thesis, Flinders University, 1983

Harries, M. Privatisation of Human Services, PhD. Thesis, Murdoch University, 2004.

Hodges, J. Social Casework Management, Master’s Thesis, Department of Social Work and Social Administration, University of Western Australia, 1998.

Martin, E. Gender, Demand and Domain: The Social Work Profession in South Australia 1938-1980, Doctoral Thesis, University of Melbourne, 1990.

Williams, A, Managing the Feebleminded: Eugenics and the Institutionalisation of People with Intellectual Disabilities in New South Wales 1900-1930, PhD Thesis, University of Newcastle, 1999.

264