New families,new governance and old habits

In December 2011, the UK Government formally launched its ‘troubled families’ initiative. This is a focused programme of interventions, coordinated at local level and paid for by results. It has been described by the Prime Minister as a part of the ‘social recovery’ that has to be set alongside the economic recovery that is his government's priority. It is illustrative of a decisive shift in the nature of the welfare state as it reflects the neo-liberal political project. It also reflects a purposed shift in social attitudes towards troubled and troublesome families, driven to a considerable degree by a vicious popular press. It is indicative of a marked shift in the pendulum from ‘rehabilitation’ to ‘rescue’ as the focus of welfare practice with children and families. Recent developments in the promotion of adoption of children in the UK should be viewed in this light. This paper considers how those families with tense or divergent relationships with the state are to be governed in the context of a state and a set of social attitudes that represents a decisive break with the post-war welfare consensus.     

Psychotherapy, suicide and foreseeable risks of decompensation by the vulnerable

Utilising the findings and recommendations in a 2010 coronial inquest in New South Wales into the death of Rebekah Lawrence, a person who had recently completed a personal development course incorporating confronting techniques of regression, run by persons without formal psychotherapeutic skills, this column scrutinises issues arising in relation to unregistered therapies. The evidentiary bases upon which coronial findings of suicide can be made are also examined, along with the effects of the ancient presumption against findings of suicide. In addition, the existence of regulatory controls, as recommended by the New South Wales Deputy State Coroner, are discussed. The grim conclusion arrived at is that the potential exists for further deaths of vulnerable people in the aftermath of the wielding of powerful psychological techniques by persons ill equipped to do so and to identify and respond to the sequelae of their therapies.     

Centralisation versus regionalisation: Designing the Sixth National Mental Health Plan

In response to the recent Productivity Commission report into mental health, the previous Federal Government announced its intention to produce a new national agreement that lays the platform for Australia's sixth national mental health plan. It has been recommended mental health move to a more regional model of governance and planning, away from a centralised, top-down approach, partly in response to broader reforms affecting health care, and partly in direct response to consistent inquiry evidence that the mental health system remains in crisis. The past 30 years of mental health planning have been centralised. Successive national plans set a broad framework, with real decisions about mental health funding and service allocation made in the health departments of our capital cities. Will the next plan sponsor or inhibit regionality in mental health planning? This paper assesses Australia's historical approach to health planning particularly as it affected mental health and the costs arising. In learning these lessons, we propose the necessary ingredients to facilitate a regional, innovative, and effective approach to decentralised planning, for better mental health outcomes. We cannot afford to replicate the failed planning approaches of the past.