Donald Scott-Orr, Consultant Psychiatrist
In an interview with psychiatrist Donald Scott-Orr for the Re;Minding Histories research project in 2020, Scott-Orr summed up his approach to mental health – and could have been describing the philosophy of this research project. He said:
[W]e really need to start where people are, and where they feel and where they relate and are engaged, when we’re dealing with mental health. And then work out from there … what people are exposed to, what they get in their gut. The practical situation, the people they meet, and what their interests are, their heroes[1]
Donald Scott-Orr (b. 1930) studied medicine at the University of Sydney in the 1950s. His first three years of medicine were “a science degree. We didn’t see any patients, we had no clinical input at all.” He confessed: “Actually, my main interest was sports. And I was a poor student”.[2] This changed when William Trethowan arrived in 1956 as the new Professor of Psychiatry. He came from the UK and had American experience.[3] Scott-Orr recalled: “[H]e gingered a lot of us; thirteen students in that fifth year became psychiatrists. Unheard of in Sydney.”[4] Trethowan also became president of the New South Wales Mental Health Association (MHA) and re-energised the organisation.
As Scott-Orr remembered, growing up, “our home was always a venue for troubled people; my parents were always trying to help them in various ways”.[5] Scott-Orr’s father was a doctor, and his uncle was a psychiatrist (Ralph Noble) involved in the Australian mental hygiene movement in the 1920s. This movement aimed to promote and improve people’s mental health, and study and prevent mental illness.[6] His uncle was involved in what Scott-Orr referred to as “the sort of forerunner of the Mental Health Association”, which became the NSW Mental Health Association after the end of World War II.[7] Scott-Orr has memories of going to MHA meetings in Sydney with his parents from this time.
The influence of his family, Trethowan, and his involvement in the Mental Health Association were important, as Scott-Orr stressed: “That’s an issue, what people are exposed to, what they get in their gut ... the modelling that we experience in our learning situation as well as the content.”[8] This shaped the broad understanding of mental health that he strove to promote throughout his career.
After residencies in psychiatry at Royal Hobart and Royal Perth Hospitals, Scott-Orr moved with his young family—his wife Sue and their two boys—to undertake postgraduate studies in psychiatry at McGill University in Montreal, Canada, in the early 1960s. They spent time in England before returning to Sydney in 1966, when he began work with the (then) State Psychiatric Services at North Ryde Psychiatric Centre. This period was the beginning of a decades-long shake-up that saw state psychiatric services shift from the institutional management of mental illness to the promotion of mental health and treatment beyond hospital settings.
Scott-Orr was one of the figures actively involved in bringing about change in support services for people with experience of mental distress. The Director of State Psychiatric Services, Bill Barclay, and the undersecretary of Health, Jimmy Rimes, were planning new health centres in Wollongong, Blacktown, and Gosford. Not keen on moving to Wollongong, as Scott-Orr told the latter: “I bought a house in Gosford and I said: ‘I’ve moved, I know you want to do something’ … then they had transferred my salary from North Ryde to Morisset Hospital. And as a result of that, I began to work in the Central Coast.”[9]
Despite his links with this psychiatric hospital, Scott-Orr spent much of his time outside the hospital, developing an early example of mental health support linking treatment with community involvement, utilising general practitioners, community nurses, and support groups.[10] He remembered when Barclay and Rimes were visiting, one of the nurses said, “‘If Dr Scott-Orr had his way he’d have 40 of us nurses working outside the hospital!’” He reflected: “Those were difficult days, in many ways, but there were also very exciting days.”[11]
Social attitudes towards people with experiences of mental distress were changing at the same time as mental health services outside of hospital settings were emerging. More people were coming forward for mental health consultations, though stigma around mental hospitals remained strong. Scott-Orr reflects:
I think the issue was really, how am I going to be viewed as a sufferer? Am I going to be viewed as a mental patient? Am I going to be viewed as belonging in that building? Or am I going to be seen as a person living in a house with a family and issues relating to my lifestyle and all the rest of it? And I think that was a transition period, to some extent. [12]
Scott-Orr maintained involvement with mutual support groups and the NSW Mental Health Association, and it too reflected the changing times. As he saw it: “Originally, the Mental Health Association was more of a thing that people belonged to … [people] who were all the powerful people in New South Wales, heading up departments and all the rest of it, and all the notable people … doctors and professors”.[13] Scott-Orr served as Chairman from 1969-72, and then as President from 1972-75. He was a delegate to the Australian National Association for Mental Health.
During this period, the culture of the Association changed:
Janet Meagher’s Green Esky was used in the early 1980s to identify public meetings of the Schizophrenia Self Help Group, open to anyone interested.
[U]p to that time, it had been, I think I could say it was a more rigid organisation. And in some ways, I guess I brought a certain amount of confusion into it. But we became a more egalitarian outfit, and the committee meetings were very lively. And we had some very interesting people who came and went from the committee at different times.[14]
Consumer activist Janet Meagher Joined the MHA board in 1983. To Scott-Orr, Meagher:
… didn’t come on board as a consumer. She had that in her history, but she long since had become involved in leadership, and she was a thinker, and an activator. And she was a pioneer … On her motorbike, as she was then … She was a real goer.[15]
Under Scott-Orr’s leadership, together with Professor Izzy Pilowsky, who also was president for a time, the MHA became “a sort of a ginger group”. He explained: “the Association had changed in its nature. It was becoming more focused on doing projects.”
And what we did was we had people on the Council, who headed up committees. One of these was the Group Leaders Committee, headed by social work academic Tony Vinson. And these group leaders were mainly women. And they set up a training program for group leaders. And then the group leaders took on projects … So that was the pattern that we tried to develop for the whole organisation; we tried to make it a pathfinding organisation.[16]
One of the projects Scott-Orr supported was led by social worker Margaret Lukes, who formed the Association of Relatives and Friends of the Mentally Ill (ARAFMI) in 1975.[17] Another was developed by Marjorie Bull, with Doris Hart: the Association for the Welfare of Children in Hospitals (later the Association for the Wellbeing of Children in Healthcare).[18]
In the MHA, Scott-Orr continued: “People became less oriented to mental health being to do with psychiatrists and that sort of thing, which is mental illness.” “You see, when I talk about mental health, I try to emphasise the health, and I try to emphasise the universality of it ... Mental illness is within that broader scope.”[19]
In 1979 Scott-Orr took on a new role in Agency Integration Development with the Department of Health, in the Sydney Northern Region, then as Mental Health Consultant, always trying to forge links between mental health, social, welfare, educational and other support services. In the early 1980s he was seconded part-time to the MHA, while also working in clinical services.
I think that that’s a key issue for dealing with mental health as an issue. That we can take a very broad view and see people where they are, whether in the home or a hospital or wherever, and we don’t divide things up and make it very doctor-oriented, or very hospital-oriented, or very outpatient-oriented, or very hostel-oriented. We seem to want to tie things down to institutions and things. And we really need to start where people are, and where they feel and where they relate and are engaged there, when we’re dealing with mental health. And then work out from there.[20]
He later moved and practiced in the mid-north coast area of NSW. Wherever he was, and whatever he was involved in, he continued to promote “a very broad view” of mental health. This view encompassed the community and favoured the involvement of lay people.[21] This vision continues to carry force today.
Written by Robyn Dunlop and Hans Pols
Footnotes
[1] Quotations are drawn from an interview with Donald Scott-Orr: “Interview,” by Robyn Dunlop and Hans Pols. Oral History Project on the History of Community Mental Health in Australia, 27 Oct 2020, 1:30:37.
[2] Scott-Orr, “Interview,” 1:17:42.
[3] William Trethowan had been trained in England and had taught at the Maudsley and Manchester University before working and studying in the United States (Massachusetts General Hospital and Harvard). Trethowan had extensive influence in NSW through the university, the Mental Health Association, and by co-writing new mental health legislation. Robert Cawley, “Obituaries: Professor Sir William Trethowan,” The Independent, 23 October 2011, https://www.independent.co.uk/news/people/obituaries-professor-sir-william-trethowan1527810.html.
[4] Scott-Orr, “Interview,” 1:17:42.
[5] Scott-Orr, “Interview,” 1:17:42.
[6] “Mental Hygiene,” Sydney Morning Herald, 7 September 1929, p. 21, http://nla.gov.au/nla.news-article16582044. Noble travelled to the USA in 1930 as Australia’s representative at the First International Congress of Mental Hygiene.
[7] This was the same time that the World Federation for Mental Health, the United Nations, and the World Health Organisation were founded.
[8] Scott-Orr, “Interview,” 1:31:18
[9] Scott-Orr, “Interview,” 4”40.
[10] For an outline of this work, see Robyn Dunlop. “Mental Health as History: Psychiatry, Community, and General Practice,” Health and History 21, no. 2 (2019): 1–22.
[11] Scott-Orr, “Interview,” 44:53. See also Donald Scott-Orr, “Tomorrow’s Imperatives – New Kinds of Care – Mental Health in the Community,” Mental Health in Australia 1, no. 7 (1978): 234-245.
[12] Scott-Orr, “Interview,” 1:09:26.
[13] Scott-Orr, “Interview,” 8:38.
[14] Scott-Orr, “Interview,” 12:06.
[15] Scott-Orr, “Interview,” 29:17.
[16] Scott-Orr, “Interview,” 8:38.
[17] Margaret Lukes, The ARAFMI Story: A Decade of Support 1975–1985 (Sydney: ARAFMI, 1985).
[18] See the Association for the Wellbeing of Children in Healthcare, https://awch.org.au/about/#history
[19] Scott-Orr, “Interview,” 20:24; 54:05.
[20] Scott-Orr, “Interview,” 1:30:37.
[21] See, for example, Donald Scott-Orr, Through Our Eyes: Changes in Mental Health: A History of the Association and of Mental Health in N.S.W.: A 60th Anniversary Celebration, speech given on 18 August 1992.