Professor David Castle, Chair of St Vincent's Mental Health Service, and his co-author, Professor Bruce Singh, Head of the Department of Psychiatry at The University of Melbourne, look at deficiencies in the current policy and possible solutions.
The authors say deinstitutionalisation has become the main focus of the policy and there is a difference in opinion between the public and mental health professionals on how successful it has been.
"We argue that the policy of deinstitutionalisation was fundamentally right in that it sought to treat people in an environment which is as 'normal' as possible," the authors say.
"The acid test is whether people with a mental illness are indeed happier under this new system compared with the old institutions, and the evidence suggests that this is the case."
They say the system needs to be refined and outlines several problem areas including:
· Difficulties with medication compliance,
· Continuing community stigma surrounding mental illness,
· A chronic shortage of appropriate housing provided for those not in long-stay institutions,
· Increasing numbers of people too ill for treatment by GPs or private psychiatrists.
The authors say that improvements to the policy should include increased funding, graded housing options, better continuity of care and integration of different components of the mental health system, enhanced programs for patients with complex disabilities, and better integration between drug and alcohol, mental health and legal sectors.
"A better working alliance between the State, Territory, and Federal Governments is needed to effect real change, and ensure more uniform approaches to the comprehensive treatment of a most vulnerable group within our society."
The Medical Journal of Australia is a publication of the Australian Medical Association.