Reflections on My Time at the Melville Clinic

by Bill Healy

Looking back almost fifty years to my involvement in establishing and working at the Melville Clinic, the first purpose-designed and built Community Mental Health clinic in Victoria, I am filled with a mix of thoughts and emotions. Thinking of those times, the 1960s and 1970s, one can readily slip into one cliché after another, yet these were exciting and turbulent times. As a young social worker, fresh out of postgraduate studies, I was able to see a once-in-a-lifetime opportunity to play a role in redefining the nature of mental health services. Our simple and straightforward purpose was to bring mental health services to the community instead of persisting with the established orthodoxy of removing individuals from their communities by admitting them to large institutions (psychiatric or mental hospitals), which were generally located in remote locations, far from the person’s family, friends, and community.

The Melville Clinic Annexe. Image courtesy Brian Stagoll

My enthusiasm for community-based services had several different motives; even, to some extent, from my family, and its specific class and cultural location. I grew up in a staunch Australian Labor Party family with a strong sense of class struggle, a commitment to social justice, and a dedication to sustaining the strengths of family and community. These sensibilities were continuously reinforced because we were Irish-Australian Catholics with an almost tribal identity, a sense of being outsiders—the other—whilst continuously experiencing the benefits of group cohesion and social support networks. My personal interest in mental health came sharply into focus when I failed every subject in my first year at university. There must be an explanation for this, I thought, and I hoped that I would find out by studying psychology. I was able to enrol in both psychology and social work a couple of years later. Not surprisingly, my return to university didn’t provide any simple answers. Instead, it set me on a trajectory that eventually led to a career in mental health.

Being a university student in the mid- to late 1960s was exciting—every day appeared to bring new insights from study, wider reading, endless conversations over coffee, pub talk, and the news. We were focused on challenging the power and authority of the status quo. New ideas were important and inspiring, including those of Goffman in his work on Asylums and several other social theorists who articulated the (then radical) idea that the walls around mental hospitals were not only designed to keep people inside but, equally important, to reassure the rest of society by reinforcing our sense of normality by removing potential threats to the social order.1 At the same time, literature on a range of community-based mental health programs was emerging from the US, part of the Johnson Administration’s war on poverty. These initiatives presented a stark contrast to the then-common asylum-centred Australian system. Suddenly, it seemed that there were viable alternatives in which mental health services could be located where people lived. These alternatives were inspired by notions of social justice, equity, and better access to services. Heady ideas of early intervention, even primary intervention, abounded. All this provided me with new ideas and ideals, which allowed me to imagine possible, new, and different ways of working in mental health.

Australia was changing. All around were the sounds of challenge and rebellion. Music, film, and literature all contained exciting challenges to the status quo. My childhood had been spent almost dreamily during the restrictive and conservative Menzies era. The 1960s were different: an electrifying sense of change was in the air. In 1972, with the election of the Whitlam Government, means became available to realise progressive policy ambitions. The prospect of providing better services appeared to be within reach. In 1973 the Sax Commission, the Health Commission appointed by the Whitlam government, released a path-breaking report entitled Towards a Community Health Program for Australia.2 It was a slim volume, short enough that a government minister told me to read it on the short plane ride from Melbourne to Canberra. It was short but powerful: it set out a model for health services to be in the community rather than in large public hospitals. It had the same spirit as the government’s commitment to universal health insurance.

The staff room at the Melville Clinic in the early 1980s: In the late afternoon, staff in exhausted collapse after a day on the community front-lines ... perhaps!! Courtesy of Brian Stagoll

In 1972 I was working as a social worker at the Parkville Psychiatric Unit (PPU), which was an informal hospital—it was not gazetted to accept involuntary patients, did not have locked wards, only had a small number of beds, and ran large day and outpatient programs. It was the main teaching hospital for trainee psychiatrists. It was located on the same grounds as the Mental Health Research Institute (MHRI) and the Mental Health Library. All were the legacy of the early Dax reforms of Victorian mental health services aimed at opening institutions to the wider world.3 Jerzy Krupinski, the director of the MHRI, convened a meeting of people interested in exploring the potential of the new community health plans for mental health. I was part of that meeting. We duly sent a submission to Canberra and soon received an enthusiastic response which included additional funds to establish community mental health services. My dreams were about to come true!

Soon after, however, we faced the challenge of turning these charming dreams into reality!

Many factors worked in our favour. Canberra was eager to get the program underway. The first staff group were keen to be involved and enthusiastically engaged in discussions on plans, means, and practicalities. Program objectives were articulated. Brunswick, an inner Melbourne suburb, was chosen as the location or our envisaged clinic. This suited our dreams perfectly as it was a former working-class suburb which had been populated by successive waves of immigrants. We accessed the relevant census data and started to develop plans to reach these migrants groups. We began to explore the suburb and immersed ourselves in the range and complexity of its people and institutions. We visited the area and held both formal and informal meetings. We sought out potential locations for our clinic. Support from the MHRI was strong and continuing.

However, there were difficulties and roadblocks as well. The first one was structural. Whilst we had the support of the MHRI and some of the senior clinicians at the PPU, our idea of a community-based centre was not adequately understood and appreciated by the Mental Health Authority (MHA) and the Health Department. There even seemed to be some suspicion towards an initiative that was supported by Canberra! Moreover, both institutions were still preoccupied with the demands of an asylum-based system; I suspect our initiative was seen as a way to divert funds from the large mental hospitals.

The second roadblock was the tedious pace of the state bureaucracy in general. A suitable building was soon found; it merely required a basic fit-out to suit our purposes. Despite that, endless delays occurred in our dealings with the Department of Public Works; progress was at a snail’s pace. It appeared that nothing could accelerate our plans as it was stuck in the labyrinth of bureaucratic processes, especially as we had no ‘champion’ at a sufficiently senior level within the Mental Health Authority and the Health Department. Finally, in desperation, the consultant psychiatrist in charge, Graham Mellsop, appeared on This Day Tonight (the predecessor of the 7.30 Report), where he was interviewed in our preferred building. He was frank about his frustrations about the endless delays, which was a courageous and potentially career-ending move. Fortunately, it worked. Soon the renovations of the building commenced.

In those early planning and preparation days, we were driven by the excitement of articulating new and radical ideas and putting them into practice. We worked in a remarkably collegial way. At the same time, our enthusiasm had a certain degree of naivety, perhaps a counterpart of our idealism, which limited our efforts later on. For example, I had been seconded from my position at the PPU to be the new clinic’s senior social worker on a part-time basis in anticipation of filling the role full-time once the administrative details had been finalised. Yet when these details were finalised, the senior social work position was set at a level lower than my current position. As I was married with three young children, I couldn’t readily take on the role anymore. I attempted to negotiate a joint lecturer position with the Social Work Department at the University of Melbourne where I had recently completed my postgraduate degree. I was unsuccessful in large part because of my naivety about negotiating with complex and hierarchical organisations like the Mental Health Authority. In the end I was appointed as a lecturer and received approval by the then chief clinical officer to work at the new program as well.

Finally, in 1974, the staff moved into the building at Melville Road, Brunswick. Soon we agreed to use our address as the name of the program, thus the Melville Clinic was born. A few staff members, from memory mostly myself, unsuccessfully argued for a more honest and transparent name: The Brunswick Community Mental Health Program. This, I thought, reflected the spirit and intent of the community mental health movement more accurately. My role, somewhat by default, was to be a senior employee as at that stage I had worked in clinical roles longer than any of the other staff except the psychiatric consultant. I worked full-time at the University and part-time at the clinic, juggling the demands of working more than full-time. I regularly worked at the clinic one afternoon a week, which often turned into a late night, with a mix of direct client contact and supervision. Whenever possible I would attend staff meetings and continue to establish and maintain contacts with community groups. Looking back, I am amazed at how I found the energy to effectively work one-and-a-half jobs while I was fully involved with my family as well. I suspect I was inspired by idealism and the experience of being part of creating a cutting-edge model of mental health services.

During the implementation of our plans, we mostly focussed on structure, means, and culture. The early days were characterised by idealism and a commitment to democratic decision making. We had extended opening hours, focused on client-based definitions of need and not merely clinical assessments, designed records that aimed to capture this goal, aimed to be the lowest prescriber of medications per head of all mental health facilities, attempted to recruit bilingual staff while supporting all staff members to learn the basics of one of the many languages spoken in the neighbourhood, and accepted that we would have to keep the Mental Health Authority less than fully aware of our practices as we feared head office would force us to conform with its outdated policies and procedures. This stance reveals both the strengths and weaknesses of our idealism. Soon we came under pressure to record client contacts on standard forms which required, among other things, a formal diagnosis. We regarded this as a diversion from our model: we were forced back into the limitations of a narrow medical model. Furthermore, we were reminded that the ultimate clinical authority rests with the ‘medico-legal’ requirements placed on the consultant psychiatrist.

Looking back today, I am convinced that those struggles were an important factor in sustaining our efforts. We were utterly committed to providing adequate responses to human needs deriving from the multiple contexts of everyday life rather than following the dominant medical model, which removed people from their contexts of relationships to hospitals to treat a narrowly defined psychiatric illness. We were eager to provide treatments to the people of Brunswick who, in large part, were neglected by the then-current mental health system apart from interventions targeting psychotic patients. I realise now that the experiment would inevitably be reined in as it was perceived as a threat to the good order of the existing mental health services. Eventually, after some years of struggle, the Melville Clinic lost its main protector, the MHRI, and came under the administrative control of the Royal Park Psychiatric Hospital. Gradually, we had to reduce our ambitions. Along the way, however, our program attracted many impressive workers who went on to play significant roles in mental health. When Victoria’s psychiatric and mental hospitals closed in the 1990s, many of the principles of community-based practices that we were just grappling with were reflected in the policies and new structures of the modern services.

For more about the Melville clinic see: Brian Stagoll.

Bill Healy is a social worker who has been involved in mental health throughout his career. In 1968 he was employed at the Travancore Developmental Centre, which provided treatment to children and adolescents. Three years later, he moved to the Parkville Psychiatric Unit and, later, to the Melville clinic, where he worked from 1974 to 1979. He taught social work at the University of Melbourne and Latrobe University, with which he is currently associated as adjunct professor of social work. His involvement with mental health also included many informal and formal memberships on boards, usually as chair: the Richmond Fellowship of Victoria/Mind; the Mental Health Legal Centre and Forensicare, and over 20 years as a community member of the Victorian Metal Health Review Board and its successor, the Mental Health Tribunal of Victoria.

This reflection first appeared in Health and History 25, no 1 (2023): 118-123.

Notes:

1. Eving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (Hammondsworth, UK: Penguin, 1968).

2. National Hospitals and Health Services Commission Interim Committee (chairman: Sidney Sax), A Community Health Program for Australia [The Little Green Book] (Canberra: National Hospitals and Health Services Commission Interim Committee, 1973).

3. For the reform program of Dax see: E. Cunningham Dax, Asylum to Community: The Development of the Mental Hygiene Service in Victoria, Australia (Melbourne: F.W. Cheshire for the World Federation of Mental Health, 1961).