|Description of this FunctionDescription of this Function|
Society's attitudes to and understanding of psychiatric illness has changed significantly since the 1840's and these changes have been reflected in the nature of the institutions established and in the policies and structure of the central administration.
What follows is an account of some of these developments. It is an outline only and further research is required.
To assist researchers to locate the records they require it is necessary that the historical terms for psychiatric illness be used in this account of the administration of mental health in Victoria. It is acknowledged that this decision has resulted in the inclusion of terms which today are considered most offensive.
Detention of Lunatics
Under the provisions of An Act to make provision for the safe custody of and prevention of offences by persons dangerously insane and for the care and maintenance of persons of unsound mind 1843 (7 Vic., No.14) persons certified as "dangerous lunatics" or "dangerous idiots" could be committed by warrant to a gaol, house of correction or public hospital until discharged on the authority of two Justices of the Peace or until, on the order of the Governor, they were removed to a colonial lunatic asylum. Prior to 1848 lunatics were either detained in gaols or transferred to the Tarban Creek Lunatic Asylum in New South Wales.
In 1848 the first permanent institution for the detention of lunatics within the Port Phillip District was established as a ward of the Tarban Creek Lunatic Asylum. Despite the establishment of this institution at Yarra Bend, the authorities continued to place lunatics in gaols.
Following the establishment of Victoria as a separate colony in 1851, the Colonial Secretary (VRG 16) became responsible for the Yarra Bend Lunatic Asylum (VA 2839). The Civil Establishments for 1851 and 1852 show John Sullivan as holding the posts of Colonial Surgeon, Medical Officer to the Lunatic Asylum and Surgeon to the Gaol. In 1853 Robert Bowie was appointed as Surgeon Superintendent of the Lunatic Asylum and William McCrea became Colonial Surgeon, later Chief Medical Officer. There is evidence in the Civil Establishment lists to suggest that the Chief Medical Officer had responsibility for the Asylum until at least 1856 and Appendix 14 of the Report of the Committee of Inquiry into Hospital and Health Services in Victoria (1975) suggests that this relationship continued until 1861 from which time the Superintendent of the Asylum was directly responsible to the Chief Secretary (VRG 26). From 1856 the Civil Establishment shows the staff of the lunatic asylums as part of the Chief Secretary's Department (VA 475).
Lunacy Statute 1867
In 1867, with the passing of the Lunacy Statute (No.309), the law relating to the treatment of lunatics was consolidated and significantly amended. The 1867 Act regulated the admission, detention and treatment of patients and established standards for the management of public asylums and institutions. The Lunacy Statute provided for the proclamation of public asylums which were institutions for the reception of lunatics and their detention at public cost. A distinction was apparently made between an "asylum" and a "receiving hospital", the latter being intended for the reception of patients prior to diagnosis and long term committal to an asylum. The Act also provided for the establishment of lunacy wards within public hospitals. These wards were intended to be reception centres for the short term treatment of those suffering from transient insanity, that is, those who might reasonably be expected to recover within a matter of days or weeks.The Act also provided for the licensing of institutions for the reception of lunatics and these were to be known as licensed houses. Licensed houses were required to meet standards of management and patient care and to maintain records comparable with those required of public asylums.
The Yarra Bend Asylum (VA 2839), the Collingwood Receiving Hospital (VA 2851) the Royal Park temporary Lunatic Asylum (all previously existing institutions) and the newly established Ararat Asylum (VA 2841) and Beechworth Asylum (VA 2842) were proclaimed as public asylums on 1 October 1867.
The Lunacy Statute also provided for the appointment of an Inspector of Lunatic Asylums and Licensed Houses and for the appointment of Official Visitors. The Inspector of Lunatic Asylums and Licensed Houses was required to visit every institution at least once in every three months. The Official Visitors were empowered to visit and report on the condition of the asylums and on the treatment of patients. These authorities were required to inspect the buildings; to see every patient and to inquire whether any patient was held under restraint; to inspect the orders and certificates authorising the reception of all patients admitted since their last visit and to prepare a report of their findings. They were also required "to inquire as to the care, treatment and mental and bodily health of the patients" and as to "the arrangements for their maintenance and comfort, ... what occupations or amusements are provided, ... whether there has been adopted any system of coercion or noncoercion ... and also as to the classification and the dietary of the patients". (See Lunacy Act 1867.)
Every institution was required to keep an Inspector's Book and a Patients Book in which the authorities were to record their observations and recommendations. The Inspector was also empowered to authorise visits to patients by relatives and medical personnel and to authorise the transfer of patients, their absence from an institution or their placement in the care of a relative or friend. However only the Chief Secretary could authorise the transfer of a patient from one institution to another. The Inspector could also recommend the discharge of a patient but all discharges required the consent of the Chief Secretary and were usually arranged by the person who signed the original admission order.
The Chief Secretary (VRG 26) was responsible for the administration of the granting of licences to licensed houses.
On 1 October 1867 Edward Paley, Superintendent of the Yarra Bend Asylum, was appointed to the position of Inspector of Lunatic Asylums and Licensed Houses. With this appointment a Hospitals for the Insane Branch (VA 2863) was established within the Chief Secretary's Department (VA 475). From this time the Civil Establishment lists show staff of the individual lunatic asylums as part of the Hospitals for the Insane Branch and a separate division for this Branch is found within the Appropriation Acts. However it is not until 1884 that a separate reference to the Inspector's Office is found in the Civil Establishment lists and this may be because the incumbent continued to be a Medical Superintendent of one of the asylums.
As the Hospitals for the Insane Branch was located within the Chief Secretary's Department, the Under-Secretary of that Department, as its permanent head, had responsibility for those officers employed within the Civil and later the Public Service. However, the Inspector of Lunatic Asylums and Licensed Houses appears to have exercised effective authority in matters of policy and the operation of institutions and was required to report directly to the Chief Secretary and thence to Parliament. The Inspector also made recommendations regarding the appointment and supervision of personnel, though many decisions required the approval of the Public Service Commissioner.
Royal Commission on Asylums for the Insane and Inebriates 1884 - 1886
The Royal Commission on Asylums for the Insane and Inebriate was commissioned on 17 May 1884 and presented its report on 29 April 1886. (See Papers Presented to Parliament 1886, Vol.2, p.271.)
Frequently referred to as the Zox Commission, the Royal Commission was required to inquire into and report upon the state and condition of Asylums for the Insane and Inebriates, both public and . Its inquiries were extensive and the Commission produced two progress reports prior to its final report in 1886. The Commission was empowered to inquire into the mode and management (of institutions), remedial treatment and results, the classification of inmates, the policy of continuing large metropolitan institutions, the advisability of licensing patients to individuals, the due classification of the imbecile and the insane, the proper position of medical officers in relation to the system of management, special qualifications necessary for all officers and employees before appointment and their mode of appointment, the system of official visitors and inspection, the mode of obtaining supplies and any further matter that appeared important to the Commissioners.
The Royal Commission made some sixty five recommendations in its final report. A number of the Commission's recommendations were implemented prior to the presentation of its final report, others were implemented through the Lunacy Amendment Act 1888 and some recommendations were not implemented until proclamation of the Lunacy Act 1903 in 1905.
The Commission recommended that criminal patients be kept apart from other patients and that an asylum for criminal lunatics be erected at Sunbury. In December 1886 the old gaol at Ararat was proclaimed as "J Ward" of the Ararat Asylum (VA 2841). It was intended to cater for the admission of the criminally insane. Prior to their transfer to "J Ward", patients had to be certified as insane by two medical practitioners and the Chief Secretary was responsible for the issue of a warrant authorising their transfer to "J Ward". The asylum at Sunbury was not completed until 1893 by which time the authorities decided to retain Ararat Gaol as an asylum for male criminal lunatics and use the new Sunbury ward for the detention of female patients considered dangerous to themselves or others.
Lunacy Amendment Act 1888
Provision for the detention of the criminally insane was formally introduced with the Lunacy Amendment Act 1888 (No.986). The criminally insane were defined as those persons detained in a gaol, reformatory or industrial school who appeared to be insane and those persons who had been ordered to be kept in safe custody under the provisions of the Criminal Law and Practice Act i.e. those who were to be detained during the "Governor's pleasure". The 1888 Act authorised the transfer of insane prisoners to an asylum for the criminally insane.
The Act also provided for the proclamation of receiving houses which were to be any asylum or portion of an asylum which was intended for the short term detention of patients. Orders for the initial committal of patients were to be made for a period not exceeding 28 days and patients were to be placed first in a receiving house for a period of observation. Patients were to be immediately examined and if they were found to be insane they could be transferred to an asylum. However if they were found not to be insane they were to be discharged.
The Act also required the annual examination of patients unless they were being detained at the Queen's pleasure and medical practitioners were required to report to the Inspector of Lunatic Asylums and to forward a copy of the report to the Chief Secretary. If the Inspector concurred that a patient was not insane, the patient could be discharged and in the event of a difference of medical opinion, the Chief Secretary was to determine the outcome.
The Act also authorised the establishment of separate accommodation for paying patients and the boarding out of patients in accordance with Governor in Council regulations regarding the class of persons with whom patients might reside, the distance from an asylum, standards of accommodation and diet and the treatment of patients, for example, permitted occupations and the degree of liberty or absence allowed.
licensed houses were to be phased out. No new licences were to be issued but the Governor in Council could authorise the renewal of existing licences for six months. The Act also authorised the licensing of philanthropic hospitals for the insane which were to be registered with the Master in Lunacy (VA 2611). No charge was to be made for the care and maintenance of patients. Requirements regarding inspection and visits to asylums, the admission and discharge of patients and record keeping were also to apply to these institutions.
Lunacy Act 1903 (No.1873)
With the proclamation of the Lunacy Act 1903 in 1905 major changes in the administration of mental health in Victoria were implemented. Some of these changes were in line with recommendations that had been made by the Royal Commission on Asylums for the Insane and Inebriate in 1886.
Under the Act, public asylums were renamed hospitals for the insane, a name change which reflected the increasing emphasis on treatment as opposed to detention. These institutions were for the care and control of long term patients and the Act required that each hospital for the insane maintain a Register of Patients, a Medical Journal and Case Books. The Act also provided for the proclamation of receiving houses where patients were to be admitted for diagnosis or temporary detention. The maximum period of detention was to be seven days unless the patients were certified as being dangerous. Extensions of the original order could be sought but no patient was to be held for more than two months. admissions to a receiving house could be made on the recommendation of two medical practitioners. Patients found to be insane were to be transferred to a hospital for the insane. The criminally insane were not to be admitted to receiving houses.
The Act also provided for the continuation of lunacy wards in public hospitals. These were to be known as receiving wards and were to be for the temporary reception of insane persons or persons presumed to be insane. The Act also authorised the establishment of separate accommodation for paying patients and the proclamation of hospitals for the criminal insane. The licensing of ly run institutions or licensed houses was re-introduced.
The Lunacy Act 1903 retained the system of Official Visitors to institutions, each of which was to be inspected at least once every three months and the Official Visitors were to inquire into the care and treatment of patients and inspect the records maintained by the institution. The Act amended the provisions regarding annual examination of patients so that the examination was only mandatory for each of the first three years and once every five years thereafter. Arrangements for the boarding out of patients continued to be authorised but were not implemented very extensively. The Act also provided for the appointment of a full time pathologist.
Under the provisions of the Lunacy Act 1903, the Inspector of Lunatic Asylums was replaced by an Inspector General of the Insane in whom were vested the powers of the Public Service Commissioner in relation to officers and employees of the newly created Lunacy Department (VA 2864). Previously the Hospitals for the Insane Branch (VA 2863) and the Inspector of Lunatic Asylums had been located within the Chief Secretary's Department (VA 475). Since the officers and employees of the Branch were employed within the Public Service, authority was divided between the Inspector, the Under-Secretary of the Department and the Public Service Commissioner. The inefficiencies of such a system were frequently complained of and in 1901, the Inspector of Lunatic Asylums reported that "the Inspector is an officer appointed under the Lunacy Act and has statutory duties and is granted statutory powers under the Act. Being the only available expert, he discharges the duties of a sub-permanent head of the Lunacy Branch under a general understanding with the Under-Secretary who is permanent head. In dealing with matters under the Public Service Act, the Inspector has really only power to recommend - any orders he issues are given on the understanding that his action will be approved of and supported by the permanent head.... The Public Service Commissioner has the final authority - he nominates for appointments, grants increments, has a potential voice in the rates of salary and in promotions and deals with all the important changes in staff". (Quoted in Early Victorian Psychiatry by C.R.D. Brothers.)
The Inspector General of the Insane thus assumed ultimate authority and responsibility for the administration of the Lunacy Department and its staff. However given that the Chief Secretary retained ministerial responsibility for mental health, it is likely that records relating to the administration of this function will be found within the records of the Chief Secretary's Department (VA 475).
In 1914 the Lunacy Act Amendment Act (No.2530) provided for voluntary admissions to any hospital for the insane, receiving house or licensed house. Persons so admitted were described as voluntary boarders and were not to be deemed lunatic patients.
In 1915 following the proclamation of the Mental Treatment Act 1915 (No.2600) a special Military Mental Hospital was opened at Royal Park by the military authorities who took over what had been the female division of the Receiving House. A ward at Mont Park was also established as a Convalescent Military Hospital and it was further agreed that the Defence Department would erect a Military Hospital at Mont Park and that subsequently the control of these premises would revert to the State. These institutions and others established subsequently were for the treatment of ex-service personnel who had developed a mental disorder as a consequence of their war service.
Mont Park Military Hospital for the treatment of ex-military personnel suffering from chronic psychiatric illness was returned to the State in 1924 for the use of civilian patients. In the same year an institution for the reception of ex-military personnel was opened at Bundoora and following a 1923 agreement with the Commonwealth, the Lunacy Department became responsible for their care.
Mental Hygiene Act 1933
Under the provisions of the Mental Hygiene Act 1933 (No.4157) proclaimed in 1934, the Inspector General of the Insane became the Director of Mental Hygiene and the Lunacy Department (VA 2864) became the Department of Mental Hygiene (VA 2865). Hospitals for the Insane were to be known as mental hospitals and licensed houses became mental homes. The Director of Mental Hygiene assumed the powers previously exercised by the Inspector General. These changes reflected changed community attitudes to mental illness and the development of new approaches to the treatment of those suffering from mental illness.
The Department of Mental Hygiene (VA 2865) was located within the Chief Secretary's Department (VA 475) as the Lunacy Department (VA 2864) had been. The Department was responsible for the development and direction of policy governing the treatment of the mentally ill and for the establishment and administration of institutions for their care and treatment. From 1937 two branches were established within the Department. The Mental Defectives Branch was responsible for the treatment of intellectually disabled adults and children and the Mental Hygiene Branch was responsible for the care of those suffering from mental illness.
In 1940, under the provisions of the Public Service Act (No.4751) the Director of Mental Hygiene ceased to exercise the powers of the Public Service Commissioner in relation to officers and employees of the Department of Mental Hygiene. The Commissioner had been replaced by the Public Service Board (VA 886) and the permanent officers of the Department elected one member of the Board who sat whenever matters concerning officers of the Department of Mental Hygiene were being considered. However the Director retained certain powers in relation to disciplinary and other matters.
Transfer of Mental Health from Chief Secretary to Minister of Health in 1944
In 1944 under the provisions of the Ministry of Health Act 1943 (No.4988) responsibility for the Mental Hygiene Acts and the Mental Deficiency Act was transferred from the Chief Secretary to the Minister of Health. The Department of Mental Hygiene (VA 2865) was replaced by the Mental Hygiene Branch (VA 2866), a division of the newly established Department of Health I (VA 695).
The Director of Mental Hygiene, as principal officer of the Branch continued to formulate policy and to exercise responsibility for the administration of the Mental Hygiene Acts. However for the purposes of the Public Service Act the Secretary of the Department of Health was ultimately responsible for the Branch. The Director retained the right of direct access to the Minister to whom he reported.
Establishment of the Mental Hygiene Authority 1952
In 1947 the Government appointed the Mental Hospitals Inquiry Committee, whose terms of reference included a review of the administration of Mental Hygiene.
The report of the Mental Hospitals Inquiry Committee, tendered on 9 March 1948, pointed out that the volume of work undertaken by the Director of the Branch was too great for one person. The Committee reported that many of the problems and inefficiencies encountered in the administration of mental hygiene stemmed from the fact that the Director had to rely on the Public Service Board for staff and the Public Works Department (VA 669) for any maintenance, repair or construction work. They concluded that "the well-being of the mentally sick...should not have to wait upon the pleasure of two Departments which are far removed from them, and are only remotely interested in their welfare".
The Committee recommended that the administration of the Mental Hygiene Acts and the Mental Deficiency Act including authority for the Mental Hygiene Branch should be vested in an independent board of three commissioners in whom would be vested responsibility for the complete control of buildings, equipment, staff and patients, and which would function as a self-contained unit.
The Committee also made recommendations as to the provision of improved hygienic conditions, diet and clothing, greater amenities for patients, increased inspection and improved staff conditions.
In 1950 the Kennedy Report on the Mental Health and Mental Hygiene Services in the state of Victoria was presented to the Minister of Health. Professor Kennedy had visited Victoria in 1949 and he recommended modifications and additions to the Mental Hygiene Bill; re-organisation of the Department; greater emphasis on early treatment and rehabilitation as opposed to custodial care; the provision of special services to mental defectives and improved training of personnel.
The new Authority was established under the provisions of the Mental Hygiene Authority Act 1950 (No.5519). The Act was not proclaimed until 31 January 1952 at which time the Authority became operative. The Mental Hygiene Authority was responsible for the development and direction of policy relating to the provision of services to the mentally ill, for the administration of the Mental Hygiene Branch, Department of Health I (VA 2866) and for the administration of and public mental health institutions.
The Authority consisted of three members appointed by the Governor-in-Council: an expert in psychiatry as Chairman; a medical practitioner with some experience in psychiatry as Deputy-Chairman and a person with skill and experience in administration. The members of the Authority were not subject to the provisions of the Public Service Act. The authority reported directly to the Minister for Health (VRG 39).
Powers of the Mental Hygiene Authority
It appears that only some of the recommendations of the Mental Hospitals Inquiry Committee were fully implemented. While the Chief Medical Officer, the Chief Clinical Officer and the Medical Superintendents of the institutions were also made exempt from the provisions of the Public Service Act, the staff of the Mental Hygiene Branch remained public servants within the Department of Health I (VA 695). As the 1953 Annual Report indicates, the Authority still had the problem of dealing with the Public Service Board for all staffing matters, except those relating to medical officers. Therefore technically the Secretary of the Department of Health I had control over the staff of the Mental Hygiene Branch.
However it appears likely that the Authority did have some effective control of the employees of the Mental Hygiene Branch (VA 2866) through the Secretary to the Authority, who was also to be the Secretary of the Branch (s.15 of the Act.) The Annual Reports of the Authority provide evidence of the Authority's high level of control and direction of staff.
The Authority was not empowered to purchase land and execute works as had been envisaged by the Mental Hospitals Inquiry Committee and section 10(h) of the establishing legislation makes it clear that the Authority was subject to the provisions of the Public Works Act 1928 (No.3758) when carrying out any maintenance or repair work on the institutions under its control.
Responsibilities of the Mental Hygiene Authority
The functions of the Authority were to formulate, control and direct general policy and administration relating to the Mental Hygiene Acts. The Mental Hygiene Branch (VA 2866), a division of the Department of Health (VA 695), implemented policy.
The Authority was required:
to make provision for the improvement of the treatment and measures for the prevention of mental defect, disorder and disease
to provide for the carrying out of research and investigations in relation to the causation and treatment of mental defects, disorder and disease
to arrange for the inspection and control of institutions licensed as mental homes
to furnish recommendations and reports to the Minister upon matters affecting the accommodation, maintenance, treatment and welfare of persons suffering from any mental defect, disorder or disease
to provide the Minister with copies of reports required under the Act
to publish reports, information and advice concerning mental illness and, with the approval of the Minister to arrange for the provision of places for the accommodation, maintenance, treatment and welfare of persons suffering from mental illness
to arrange for the provision of special accommodation for the treatment of ex-service people suffering from mental illness
to establish or assist in the extension or establishment of:
(a) outpatient clinics for advice and treatment in relation to mental or emotional disorder
(b) hostels for the welfare and rehabilitation of persons who are or who have been under the control of the Mental Hygiene Branch
(c) a preventative service, including clinics to deal with retarded, defective and problem children.
The Mental Hygiene Authority replaced the Director of Mental Hygiene and the Chief Medical Officer of the Mental Hygiene Branch (VA 2866) was given the statutory powers of the Director in relation to the admission, transfer, trial leave and discharge of patients. The Chief Medical Officer was also responsible for the physical well being of patients while the Chief Clinical Officer was responsible for the treatment of mental disorders, research and the training of staff.
Mental Health Act 1959 (No.6605)
In 1959 the law relating to mental health was consolidated and significantly amended. The Mental Health Act 1959 came into operation in 1962. This Act established a clear legislative distinction between patients who were mentally ill and persons who were intellectually defective. People previously known as criminally insane were to be known as security patients and mental treatment patients were to be known as repatriation patients.
Institutions for the long term treatment of patients suffering from chronic mental illness continued to be known as mental hospitals. Hospitals for the short term treatment of people suffering from acute mental illness and for the admission for observation and diagnosis of people apparently suffering from mental illness became known as psychiatric hospitals. They had previously been known as receiving houses. The former receiving wards in public hospitals became psychiatric treatment centres. Institutions for the treatment of ex-service personnel who were suffering from mental illness arising out of or aggravated by or contributed to by that service, were known as repatriation mental hospitals. Admission to these institutions was to be on the recommendation of a medical practitioner authorized by the Repatriation Commission of the Commonwealth of Australia.
The Act continued the licensing and registration of ly run institutions which were known as mental homes and training centres. Although the Minister of Health had become responsible for mental health in 1944, the Chief Secretary continued to be responsible for the admission, transfer and trial leave of security patients who had been admitted to a mental hospital or training centre.
As with earlier mental health legislation, the Act regulated the establishment of institutions, the admission, care, control and treatment of patients and intellectually defective persons, the inspection of institutions and patients, the annual examination, transfer and trial leave of patients and required that certain records including a Register of Patients and case records be maintained.
Central Administration 1962
The 1959 Act established the Mental Health Authority (VA 692) which, by virtue of the functions given to it under section 12, became the executive policy, planning and directing body for mental health activities in Victoria for the period 1962 to 1978. The Authority was appointed by the Governor in Council and consisted of three members, namely a Chairman being a medical practitioner expert in psychiatry, a Deputy Chairman being a physician with experience in psychiatry and the Administrative Member who was to be a person with administrative skill and experience (Section 5, Mental Health Act 1959). All were appointed for a period of five years (Section 6 (1)) and were eligible for re-appointment and no person over the age of 65 could be appointed or continue as a member of the Authority (Section 5 (3)).
The Mental Health Authority's policies were implemented by officers and employees of the Mental Hygiene Branch (VA 2866) which was a division of the Department of Health I (VA 695). Within the Mental Hygiene Branch, medical officers were not members of the Public Service and their appointment to permanent positions was made by the Governor in Council on the recommendation of the Authority and with the approval of the Minister. Certain provisions of the Public Service Act applied and the powers of the Public Service Board in relation to such matters as leave, dismissal, incapacity and retirement etc. were exercised by the Authority.
Other personnel in the Branch were members of the Public Service but were subject to the disciplinary control of the Administrative Member of the Mental Health Authority in respect of minor matters and to the Authority in more serious matters. The permanent head of the Department of Health I continued to have overall responsibility for the administration of the Acts administered by the Department and to be responsible under the provisions of the Public Service Act for the general working of the Department and for the transaction of its business.
In practice the Secretary of the Authority, who was also Secretary of the Mental Hygiene Branch and subject to the Public Service Act, was under the control and direction