Pauline Savy

In sight, in mind: mental health policy in the era of deinstitutionalisation

Abstract This paper outlines the key goals of Australia’s National Mental Health Strategy in attempting to persuade state governments to pursue the progressive deinstitutionalisation of Australia’s stand alone public psychiatric hospitals and the mainstreaming of inpatient psychiatric care in wards of general hospitals. It utilises Goffman’s (1961) critique of asylums and the comprehensive audit of Victoria’s public psychiatric services in 1992 to illustrate some important deficiencies in the old asylum system of mental health care. The paper argues that, though the process of deinstitutionalisation in Australia is incomplete and there are many problems, sufferers from mental illnesses are now in a very real sense ‘in sight’ and ‘in mind’. The paper concludes with proposals for sociological research in the mental health field.

Workforce Crisis in Residential Aged Care: Insights from Rural, Older Workers

In Australia, workforce shortages in residential aged care present a significant challenge for the aged care industry. The growing demand for workers in aged care, combined with the shrinking supply of younger workers entering the field, highlights a future workforce crisis. The current shortfalls are set to worsen with the retirement of a generation of women who have provided the backbone of the workforce. Although targeted retention of this group may alleviate this issue, few studies have explored the retirement decisions of this cohort. This paper reports on a qualitative study of this cohort of Victorian public sector residential aged care staff. Although current government rhetoric promotes intrinsic rewards (altruism, moral fulfilment) over extrinsic rewards (excessive workload, pay and conditions), a combination of these factors was associated with job satisfaction. It would seem timely to revisit some of these concerns to ensure an adequate and sufficiently skilled workforce.

Using Mixed methods to develop and implement a work sampling tool in residential aged care

Abstract Despite chronic workforce problems associated with recruitment and retention of care staff in rural residential aged care facilities, there are few research studies that provide methodological guidance on how to investigate care practices. Developing an understanding of workflow and work practices is core to providing solutions in an environment of complexity and change. Based on the authors’ experiences, the purpose of this paper is to document an embedded mixed methods design providing an example of how to best capture the multi-focused work practices in residential aged care. Detail is provided on the development and implementation of a work sampling tool, along with the collection of qualitative contextual data. Processes and challenges involved are highlighted to offer a way forward for future research.

Toward the Development of a More Integrated Aged Care Assessment Process for Rural Older Australians: Practitioners’ Perspectives

There is an identified need for more effective assessment processes in rural Australia, with prior research revealing little knowledge sharing and even duplication across existing services. This article aims to explore the challenges to more closely integrated assessment processes, drawing on interview data with practitioners from three agencies located in the same rural region. Findings highlight the challenges of rural assessment, both demand-driven (more older people with complex needs, geographic isolation) and supply issues (time and distance, funding formulae, workforce shortages). The need for closer collaboration is recognized but significant systemic issues require addressing if it is to be achieved.

Introduction: Longevity and sociology

Population ageing is an historically unprecedented global phenomenon. The (World Health Organization [WHO], 2013) reports that, in almost every country, the proportion of people aged over 60 years is increasing faster than any other age group. It predicts that between 2000 and 2050 this proportion of the worlds population will double from about 11 to 22% or, in absolute terms, increase from 605 million to 2 billion (WHO, 2013). The ageing of populations around the world is clearly a cause for celebration. Longevity reflects human success in instituting effective public health measures, dealing with killer childhood diseases, significantly reducing maternal mortality, and producing the means of effective fertility control. Yet, many people around the world are not advantaged by this progress: they do not expect to make old bones. Such groups as Indigenous populations, people with disabilities and those with serious mental illnesses lag behind others in terms of health status and propensity for long life. It is estimated that Indigenous Australians, for example, have a life expectancy at birth of 59.4 years for males, and 64.8 years for females, some 16-17 years less than the overall Australian population (Australian Institute of Health and Welfare, 2013).

Summary: Broadening the evidence base of mental health policy and practice

Abstract This concluding paper draws together the dominant themes across the papers published in this issue. The majority of the papers clearly point to disparities between the aims of policy-makers and mental health workers. Using a variety of perspectives and methods, the authors of these insightful papers argue that modernist, rational approaches to structuring and evaluating services are at odds with the professional needs of mental health workers. At one level this critique is self-evident given the messiness and uncertainties inherent in working with service users whose individual problems require flexible approaches tailored from a broad and evolving practice-base. For some authors, the focus is epistemological and methodological; they offer much needed examples of analysing policy construction, interpreting statistics and the concurrent application of the widely used concepts of medicalisation and structural inequality. Together, the papers indicate that the progress of mental health reform in many western countries remains inconsistent and, in some cases, obstructive to effective professional practice.

Moving towards integrated aged care assessment: A comparison of assessment tools across three regional Victorian services.

Recent National Aged Care Policy Reforms are directed at streamlining entry into aged care services, building on the challenges associated with developing integrated assessment processes. Such reform is core to achieving a comprehensive, efficient process.