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History of the role of mental health services in Western Australia of managing problematic users of alcohol (draft)

byGregSwensen45thAnnualAlcoholEpidemiologySymposiumofKettilBrunnSociety

3-7June2019,Utrecht,Netherlands1 Keywords Alcohol;Mentalhealth;Treatment;WesternAustralia; 2 Background ThispaperpresentsfindingsfromanexploratorystudyofthehistoryhowthementalhealthsysteminWesternAustralia(WA)hasmanagedproblematicusersofalcoholandtheevolutionofitsroleovertheperiodfrom1900uptothepresentday.Theobjectiveofthepaperistoconsiderthelegislationthatestablishedtheframeworkforthementalhealthsystemtomanageso-called‘inebriates,’1supportedbyananalysisofarangeofinformationovertheperiodextractedfromdepartmentalreportsandotherarchivalrecords,complementedbytimeseriesdatacompiledfromadmissionstohospitalsandtreatmentservices,toidentifyhowinebriateshavebeenmanagedinthisState.Theexploratorynatureofthisresearchwillconsiderthefeasibilityoftheuseofarangeoflegislativetexts,historicalmaterials,officialrecordsandstatisticaldatatomaptheevolutionoftheroleperformedbythementalhealthsysteminmanagingproblematicusersofalcoholatdifferenttimesovertheperiod.Thepurposeoftheresearchistodeterminewhetherthisbodyofinformationwillsupportfurtherresearch,includingwhetherthedetentionandtreatmentofinebriateswasaformofmoralregulationthatassuagedcommunityconcernsaboutthesystemsofcontroltoregulatetheuseofalcohol.2Thispropositionthatregulationisnecessaryrestsonaconflictedunderstandingaboutalcoholthereisalimited‘freedom’todrink,whichoperatesthrougharegulatoryframeworkofliquorlicensingandotherlegislation,aswithoutcontrolsalcoholrepresentsarisktosocialorderandcommunitywell-being.Asystemofregulationisthereforeinevitable,asitisa‘manifestationofananxietyoffreedomthathauntsmodernliberalformsofrule.’3Aclearerunderstandingofhowcontrolsoperatedwillassisttoidentifychangesinattitudesandbeliefsaboutmanifestationsofproblematicuseofalcohol.Thiscasestudyofthehistoryofevolutionofthementalhealthsysteminmanagingproblematicusersofalcoholinvolvesanexplorationoftheconceptofself-governanceinrelationtothoseunabletoexercisetheirfreedomtodrinkwithoutharmtothemselvesorothers.

1Themeaningofan‘inebriate’isdefinedasexplicatedinthelegislativeframeworksection.2Theterm‘mentalhealthservices’isusedinthispaperasanoverarchingtermofconveniencetodescribethehistoryofpsychiatrictreatmentofproblematicusersofalcoholandismeanttoencompasshistoricaltermssuchas‘asylum’and‘mentalhospital’3AHunt,Governingmorals:asocialhistoryofmoralregulation(Cambridge,UK:CambridgeUniversityPress,1999),215.

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Thisexploratorystudywilldrawuponthepreceptsofself-regulatingandself-governingindividualsstemmingfromthewritingsofMichelFoucault.4Specifically,Foucault’sconceptofgovernmentalityandtheindividualhasbeenexpandedoninmorerecentresearch,suchasthatbyHunt5andWouters,6toexplainhowmechanismofcontrolevolve,‘fromthenineteenthcentury’spreoccupationwiththepromotionandformationof‘character’conceivedofassetofexternalvirtues...tobemasteredandincorporatedintotheself,(tothemidtwentiethcentury’s)…thepursuitof‘personality’…concernedwithpersonalself-formationthroughself-discovery.’7

Ithasbeenarguedtherehasbeenaninsufficientunderstandingofthelong-standingexistenceofmethodsofgovernance,whichhasitsrootsinthe‘sumptuaryimpulse’whichshowsthatwehavealwayssoughttoregulateconsumption,itbeing‘aubiquitousfeatureofsociallifeduringthelongroadtomodernity.(whichismanifested)inthelatetwentiethcentury(in)protractedstruggles…overtheconsumptionoftobacco,alcoholandfoodadditives…(which)usuallyinvolvesomecomplexmixofexternalgovernment,forexample,bylegislationandofself-government,whetheritbebydieting,quittingorjoiningaself-helpgroup.’8

3 Objectives and purpose TheanalysispresentedheresupportsandcomplementsotherresearchwhichhasexaminedthemanagementofproblematicusersofalcoholbytheWAcriminaljusticesystem,inrelationtopublicorderconsequences,especiallytheoffenceofpublicdrunkenness.9Thisresearchwillhaveanumberofobjectives.Aswellasexpandingourknowledgeoftheuniqueplacethementalhealthsystemhasplayedinprovidinginstitutionalcentrictreatmentandsocialcontrol,itwilloutlinehowbythe1970sthisapproachwassupplantedbyapublichealthfocussedapproach,whichhasevolvedintoamodelofstand-alonecommunity-basedspecialistserviceproviders.However,asthisresearchisconcernedwithonlypartofamuchlargerproblem,itshouldbeunderstoodasanincompletepictureofamuchgreatercompendiumofharmscausedbyproblematicuseofalcohol.

4MFoucault,Thebirthoftheclinic:Anarchaeologyofmedicalperception(London,UK:Tavistock,1976);MFoucault,"Abouttheconceptofthedangerousindividualin19thcenturylegalpsychiatry,"inMichelFoucault:Politics,philosophy,culture.Interviewsandotherwritings1977-1984,ed.LDKritzman(London,UK:Routledge,1978);MFoucault,Disciplineandpunish:Thebirthoftheprison(Harmondsworth,UK:Penguin,1979);MFoucault,"Governmentality,"inTheFoucaulteffect:Studiesingovernmentality,ed.BurchellG;GordonC&MillerP(London,UK:HarvesterWheatsheaf,1991);MFoucault,Thegovernmentofselfandothers,LecturesattheCollegedeFrance1982-1983,(NY:PalgraveMacMillan,2010);MFoucault,Thecourageoftruth:ThegovernmentofselfandothersII,LecturesattheCollegedeFrance1983-1984,(NY:PalgraveMacMillan,2010).5Hunt,Governingmorals:asocialhistoryofmoralregulation.6CWouters,"Howcivilizingprocessescontinued:towardsaninformalizationofmannersandathirdworldpersonality,"SociologicalReviewMonographSeries7(2011),http://dspace.library.uu.nl/bitstream/handle/1874/211510/SRM%20-%20HOW%20CP%27s%20CONTINUEDfinal.pdf?sequence=1.7AHunt,"Thegovernanceofconsumption:sumptuarylawsandshiftingformsofregulation,"EconomyandSociety25(3)(1996):410,https://doi.org/10.1080/03085149600000022.8Hunt,"Thegovernanceofconsumption:sumptuarylawsandshiftingformsofregulation."9GSwensen,"ThemanagementofpublicdrunkennessinWesternAustralia:policingtheunpoliceable?,"Limina:AJournalofHistoricalandCulturalStudies23(1)(2017).

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‘Alcoholuseisaleadingriskfactorfordiseaseburdenworldwide,accountingfornearly10%ofglobaldeathsamongpopulationsaged15–49years,andposesdireramificationsforfuturepopulationhealthintheabsenceofpolicyactiontoday.’10

Asalcoholuseisassociatedwithanarrayofprofoundsocial,health,lawandorderimpacts,inthisStateasinmanyotherEnglish-speakingcountries,amyriadofmeasureshavebeenadoptedovermanyyearstotryandregulateitsuseandameliorateitsharms,justifiablyitcanbedescribedasbeinga‘wickedproblem’.11Arecentpolicydevelopment,whichinvolvesproposalsinWAtotargetandcompelproblematicusersofalcohol,aswellasotherdrugs,toparticipateintreatmentthroughinterventionsandinterventionordersoverseenbyproblem-solvingcourts,willbealsoreferredto,asthisappearstobeareversiontoearlierpoliciesrelatedtoinebriatesandconvictedinebriates.12Whilstpolicymakershavecharacterisedtheserecentproposalsasinnovativeandcutting-edgeapproaches,itissuggestedsuchclaimsaremadeinignoranceofthehistoryofcivilcommitmentwhichoperatedinWAthatcompelledtreatmentofproblematicusers.Itisargued,therefore,theresearchpresentedhereisrelevanttoadebateabouttheroleofcompulsionintreatment,asoutlinedintherecentproposal,whichinvolvestheuseofjudicialauthority,referredtoas‘therapeuticjurisprudence’,whichgovernmentshavebeenresortingtosolvesocialproblemsinvolvingtheuseofdrugsandotherissues.13Itisimportanttorecognisethattheinstitutional-focussedsystemofmanagingproblematicusersofalcoholinthementalhealthsystem,evolvedfromearliestdaysoftheState’sestablishmentasaBritishcolonyin1829.InthecolonialperiodtheState’snascentmentalhealthsystemoperatedasacustodialsystemofcarebasedonasylumstorestrainandseparateproblematicalcoholusersandthosewithothermentaldisordersfromthebroadercommunity.14Fromthecolonialerauntilquiterecently,thementalhealthsystemrelieduponaperceivedadvantage,thatunlikethecriminaljusticesystem,itwasperceivedasbeingabletopotentially

10GBD2016AlcoholCollaborators,"Alcoholuseburdenfor195countriesandterritories,1990-2016:asystematicanalysfortheGlobalBurdenofDiseaseStudy2016,"Lancet392(2018):1026,https://doi.org/http://dx.doi.org/10.1016/S0140-6736(18)31310-2.11AustralianPublicServiceCommission,Tacklingwickedproblems-apublicpolicyperspective,AustralianPublicServiceCommission(Canberra,ACT,2007),http://www.apsc.gov.au/__data/assets/pdf_file/0005/6386/wickedproblems.pdf;JConklin,"Wickedproblemsandsocialcomplexity,"inDialoguemapping:buildingsharedunderstandingofwickedproblems,ed.ConklinJ(NY:Wiley,2005);AEPennay,"'Wickedproblems':thesocialconundrumpresentedbypublicdrinkinglaws,"Drugs:Education,Prevention&Policy19(3)(2012).12CorrectiveServicesMinister,"Firstofitskindalcoholandotherdrugtreatmentprisonannounced(Mediastatement),"(9March2018).https://www.mediastatements.wa.gov.au/Pages/McGowan/2018/03/First-of-its-kind-alcohol-and-other-drug-treatment-prison-announced.aspx.13AFreiberg,"TherapeuticjurisprudenceinAustralia:paradigmshiftorpragmaticincrementalism?,"LawinContext20(2002);MSKing,"Applyingtherapeuticjurisprudenceinregionalareas-theWesternAustralianexperience,"MurdochUniversityElectronicLawJournal10(2)(2003),www.murdoch.edu.au/elaw/issues/v10n2/king102nf.html;DBWexler,"Reflectionsonthescopeoftherapeuticjurisprudence,"Psychology,PublicPolicy&Law1(1995).14ASEllis,Eloquenttestimony:ThestoryofthementalhealthservicesinWesternAustralia1830-1975(Perth,WA:UniversityofWesternAustraliaPress,1984).

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rehabilitateandreform‘inebriates’,iethosewithalcohol-causedproblems.Thisbeliefinthesystemmayhaveconstrainedsupportfortheadoptionofnon-institutionalmethodsofmanagementinfavourofcontinuedrelianceontheasylum,untilcommunityattitudeschangedhereaswellaselsewhere,abouttreatingalcohol-relatedproblemsinthismanner.15Itwasonlysincethemid1970sthatpolicieshavebeenadoptedwhicheschewedtheroleofthementalhealthsystemandinsteadcreateaseparatepublichealthmodelofcarebasedonpreceptssuchasforindividualresponsibility,self-controlandself-regulationaswellaseducationprogramsemphasisingpreventionandearlyintervention.164 Note about methodological issues Thegrowinginterestinunderstandingtheharmsofalcohol,beyondthewell-knownlawandorderandcrimeconsequences,hasspurredthedevelopmentofmethodologiestoquantifyhealth-relatedconsequences.Anunderstandingofhowtheseoperateisavaluablerequirementinordertoidentifyandquantifyconsequencesfromproblematicuseofalcohol.Oneofthesehasbeenthedevelopmentofdiagnosticdescriptionsofalcohol-relatedmentaldisordersoveranumberofyears,sincethefirsteditionoftheAmericanPsychiatricAssociation’sDiagnosticandStatisticalManualofMentalDisorders(DSM)publishedin1952.17TheDSMhasbeenrefinedandnomenclaturehasbeenrevisedsinceitsformaladoptionin1952.Inthecurrentversion,DSM-V,thisincludesdisorderssuchasalcoholdependence,awithdrawalsyndromealsodescribedastheDTs(deliriumtremens),Korsakov’spsychosisandalcoholicpsychosis,whichnecessitatetreatment.18Inadditiontothegroupofalcohol-causedmentaldisordersasrecognisedbytheDSMsystem,thereareaspectrumotheradversehealtheffectsrelatedtotheproblematicuseofalcohol,identifiedbytheInternationalClassificationofDiseasesandCausesofDeath(ICD)system.19TheICDsystemoperatesinadifferentmanner,inthatitidentifiesabroadspectrumofconditionswhollycausedbyalcoholsuchasalcoholiccirrhosis,alcoholiccardiomyopathy,pancreatitisandalcoholicgastritis,aswellasaccidentsandotherconditionspartlycausedbyalcohol.20

15JBaumohl,"Onasylums,homesandmoraltreatment:thecaseoftheSanFranciscoHomefortheCareoftheInebriate1859-1870,"ContemporaryDrugProblems13(1986).16MJAshleyandJGRankin,"Apublichealthapproachtothepreventionofalcoholrelatedhealthproblems,"AnnualReviewofPublicHealth9(1988).17AmericanPsychiatricAssociation,"DSM:historyofthemanual."http://www.psychiatry.org/practice/dsm/dsm-history-of-the-manual.18Alcohol.org,"Alcohol-inducedpsychoticdisorder,"(8January2018).https://www.alcohol.org/comorbid/psychotic-disorder/;TChikritzhsetal.,Alcohol-relatedcodes:mappingICD-9toICD-10(Perth,WA:NationalDrugResearchInstitute,CurtinUniversity,2002).19IMMoriyamaetal.,Historyofthestatisticalclassificationofdiseasesandcausesofdeath,NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention(Washington,DC,2011),https://www.cdc.gov/nchs/data/misc/classification_diseases2011.pdf.20RoyalAustralasianCollegeofSurgeons,"Alcohol-relatedharm:Positionpaper,"(2016).https://www.surgeons.org/media/20784483/2016-08-02_pos_rel-gov-025_alcohol_related_harm.pdf;NationalHealthandMedicalResearchCouncil,"RevisionoftheAustralianguidelinestoreducehealthrisksfromdrinkingalcohol2009,"(2018).https://nhmrc.gov.au/about-us/news-centre/revision-australian-guidelines-reduce-health-risks-drinking-alcohol-2009;NationalHealthPreventativeHealthTaskforce,PreventingalcloholrelatedharminAustralia:awindowofopportunity,DepartmentofHealth&Ageing(Canberra,ACT,2008);ChikritzhsT;EvansM;GadnerC;LiangW;PascalR;StockwellT&ZeisserC,Australianalcoholaetiologicfractionsforinjuries

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5 Introduction Thecolonialeraofmanagingproblematicusersofalcohol,existedfromestablishmentofWAasaBritishcolonyin1829untilthelate1890sandwaspredicatedonaparticularnotionaboutthecausesandthereforeremediesforproblematicusersofalcohol:‘Untilthemid-nineteenthcenturyhabitualdrunkennesswascommonlyviewedasself-inflictedsinorvicepunishableasacrime.Bythe1860sanewview,ofhabitualdrunkennessasadisease,hademerged.’21

BythelatterhalfofthecolonialerathemanagementofinebriateshadbeenassignedtotheFremantleAsylumasaseparateinstitutionfromFremantlePrison.22TherewerealsodevelopmentsinotherAustralianjurisdictionswhichinformedpolicymakersinWAastothenatureofreformsthatwereadoptedinthisStateconcerninghowtodealwithproblematicalcoholuse.OnesuchexamplewastheRoyalCommissiononAsylumsfortheInsaneandinebriateinVictoriain1884-1886which‘concludedthatinebrietywasadisease–dipsomania–thatcouldbecuredbysubjectingtheinebriatetothedisciplineoftheasylum.Thelegalproblemwastodistinguishbetweenthosewhohadacravingfordrinkbutwereresponsiblefortheiractionsandthosedipsomaniacswhohadlostcontrolanddeservedhumanereformativeactionratherthanpunishment.’23

Amulti-layeredsystemofsocialcontrolsexistedfromtheinceptionoftheSwanRiverColonyin1829,wellbeforethecolonywasproclaimedaBritishpenalcolonyin1849.TherationaleforincreasedsocialcontrolswasespeciallydrivenbyconcernsaboutcrimeandsocialorderafterWAbecameapenalcolony,whichresultedinatotalof9,720convictsbeingtransportedfromtheUnitedKingdom(UK)between1851and1868.24FromitsinceptionWAhasbeencharacterisedasaplacewithhighlevelsofalcohol-relatedsocial,lawandorderandhealthproblemswhichthehospitals,mentalhealthservices,thepolice,prisonsandthecourtswereexpectedtoameliorateasbesttheycould.AnaccountinStannage’s1981seminalhistoryofWAgivesasenseoftheadverseimpactoftheheavylevelofalcoholconsumptionfromtheinceptionasaBritishcolonyin1829.

treatedinemergencydepartments,NationalDrugResearchInstitute,CurtinUniversity(Perth,WA,2011),http://www.dao.health.wa.gov.au/DesktopModules/Bring2mind/DMX/Download.aspx?Command=Core_Download&EntryId=701&PortalId=0&TabId=211;AVanDiemenetal.,MethodologyfordevelopingWesternAustralianspecificalcohol-relatedaetoiologicalfractions,EpidemiologyBranch,PublicHealthDivision,DepartmentofHealthWesternAustralia(Perth,WA,2017),https://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Population%20health/PDF/Specific-Alcohol-related-Aetiological-Fractions-Report.pdf.21SGarton,"Onceadrunkardalwaysadrunkard:Socialreformandtheproblemof'habitualdrunkenness'inAustralia,1880-1914,"LabourHistory53(1987):38.22SPiddock,"Aplaceforconvicts:theFremantleLunaticAsylum,WesternAustraliaandJohnConolly’s‘ideal’asylum,"InternationalJournalofHistoricalArchaeology20(2016);PMaude,"TreatmentofWesternAustralia’smentallyillduringtheearlycolonialperiod,1826-1865,"AustralaisanPsychiatry21(4)(2013).23Garton,"Onceadrunkardalwaysadrunkard:Socialreformandtheproblemof'habitualdrunkenness'inAustralia,1880-1914,"42.24JSBattye,WesternAustralia:ahistoryfromitsdiscoverytotheinaugurationoftheCommonwealth,Fascimileeditionreprinted1978,(Perth,WA:UniversityofWesternAustraliaPress,1924);AHasluck,Unwillingemigrants:AstudyoftheconvictperiodinWesternAustralia(Sydney,NSW:AngusandRobertson,1969).

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‘AlcoholandsocialreactiontoitwasattherootofthecrimeprobleminWesternAustralia.…Thiswasinnowayexceptional.Indeed,fromthe1830sdrinkhadbeenaseriouscommunityprobleminSwanRiver.Thecoroners’recordsshowthatmanyofthe“deathbydrowning”and“deathbymisadventure”casesoccurredasaresultofboutsofdrunkenness…Derelictwomenandmenwandereddrunkenandhomelessthroughthestreetsofthetownsbeforebeingarrestedandimprisonedovernight,tobechargedwithbeing“drunkanddisorderly”,“resistingarrest”andsoonthenextday.’25

Therewerethreetypesofinstitutionswhichcouldbeinvolvedinmanagingproblematicusersofalcoholinthecolonialera–FremantlePrison,FremantleAsylumandpoorhouses.Ashasbeensanguinelyobserved,‘(t)hestrugglingcolonycouldnotwastetimeonpeoplewhodidnotcontributetosocietyandtheabsenceoftreatmentoptionsorpeoplewhowereskilledtoprovidesuchtreatmentsresultedinrestraintandcustodialmanagement.’26

FromtheestablishmentoftheSwanRiverColonyin1829itwasevidenttherewasaneedforaseparatefacilitytomanagepeoplewithmentaldisorders,asthefirstrecordedaccountofamentallyillpersonrequiringtreatmentinvolvedDrNicholasLangley.DrLangleywastheappointedsurgeon,whoduringthecourseofthevoyageonashipwiththeconvoyoffirstsettlersin1829becameveryagitatedandondisembarkationbecamesoviolenthewasrequiredtobeconfinedonthehulkofawreckedmerchantshipatFremantle.27Therefore,FremantlePrisonperformedthefunctionofhousingpeoplewithmentalillnessuntiltheopeningoftheFremantleAsylumin1865.Theneedforapurposebuilt-facilitytomanageofmentallyillpeoplebecameamatterofgreaterconcerntothecolonyafteritwasproclaimedaBritishpenalcolonyin1849andstartedtoreceiveconvictsin1850,anumberofwhowere‘lunatics’,whosementalillnesssubstantiallyimpairedtheirsocialfunctioning.28Inthecolonialeraanumberofpoorhouseswereestablishedtoprovidesomeformofrelief,begrudginglyandonaveryrestrictivebasis,forhomelessandunemployedpeoplewhoweredeniedrationsor‘outdoorrelief’.Theprovisionof‘indoorrelief’involvedsubmissiontosystemsofdisciplineinboththemen’sandwomen’spoorhouses,refractedthroughgenderedarrangements,onthebasistheseindividuals’predicamentswereduetotheirlackofself-discipline,poorchoicesandweaknessofwill.29ThestimulusfortheFemalePoorhousecanbetracedtoeconomicfactorsandafterthecessationofthetransportationofconvictsin1868,whentheformerconvictdepotswereconvertedintoinstitutionstoprovideaplaceforhomelessindividuals.30Thepoorhouses,suchastheMountElizapoorhouseestablishedonasiteonMountsBayRoadwestofthecity

25JEThomas,"Crimeandsociety,"inAnewhistoryofWesternAustralia,ed.StannageCT(Perth,WA:UniversityofWesternAustraliaPress,1981),642.26Maude,"TreatmentofWesternAustralia’smentallyillduringtheearlycolonialperiod,1826-1865,"399.27PMaude,"TreatmentofWesternAustralia'smentallyillduringtheearlycolonialperiod,1826-1865,"AustralasianPsychiatiry21(4)(2013).28MMcPherson,"Aclassofutterlyuselessmen:ConvictlunaticsinWesternAustralia,"StudiesinWesternAustralianHistory24(2006).29KAbbottandCChesney,"'Iamapoorwoman':gender,poorreliefandthepoorhouseinlateninteenthandearlytwentiethcenturyWesternAustralia,"StudiesinWesternAustralianHistory25(2007).30PHetherington,Paupers,poorreliefandpoorhousesinWesternAustralia1829-1910(Perth,WA:UniversityofWAPress,2009).

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atthefootofKingsPark,werehighlyregulatedaccordingtorulesprescribedinregulationsunderan1882actconcernedwiththemaintenanceandrunningofpoorhouses.Theseregulationsweredesignedtodisciplinethoseindigentpersonswhosoughttostaytherebysettingoutinsomedetailtheamountoffood,dailyschedulesofactivitiesandthenatureofthework,punishmentsforfailureobserverulesetc.TheMountElizapoorhousewasreplacedbyapurpose-builtinstitutionfurtherawayatFreshwaterBay,whichopenedin1906.TheMountElizaandotherpoorhouseshousedasizeablepopulationofpooranddestitutepeople,whohadfoundthemselvesinthepredicamentofhomelessnessduetolong-standingsustaineduseofalcohol.‘TheMountElizabuildingsweresoldin1908withtheexceptionofonewoodenbuildingwhichwastransferredbyhorseanddraytothenewsite.Formanyyearsithousedalcoholicsandothernoisypatients.KnownasTheBungalow',itisnowthemainOccupationalTherapydepartmentandisallthatremainsoftheoriginaldepot.’31

Atthebeginningofthetwentiethcenturyastatutoryframeworkwasadoptedthatdefined‘inebriates’asapopulationofproblematicalcoholuserswhocouldbeconfined,whichemphasisedtheprimacyoftheasylumandsemi-ruralrecuperativefarmfortheirrehabilitation.Suchindividualscouldalsobecompelledbycourtasasentenceifconvictedofanalcohol-relatedoffence,to‘inebriatehomes’,whichemphasisedthevaluesofreform,rehabilitationandpunishment,asalsooccurredinotherjurisdictions.32Aseparateframeworkformanagingmentalhealthproblemsbegantoevolvefromthelate1920s,separatefromClaremontAsylum,resultedinanunusualbifurcatedsystemoftreatingmentaldisordersinWA,basedontwodifferentstatutoryprovisions.Thisarrangementisconsideredinmoredetailinthefollowingsection.ThisoccurredasareforminresponsetoaquitescathingreviewbyaRoyalCommissionin1922thathadidentifiedtheprofoundshortcomingsoftheasylum-centricsystemthatexistedforsometime:‘Thereisnomarkedlinedividingsanityfrominsanity;therearedegreesinterveningwhichmustberecognisedandprovidedfor.BeyondtheobservationwardsatthePerthandKalgoorlieHospitals(whichareinsufficientforthepurpose),thereisnoinstitutioninWesternAustraliawhichcandealeffectivelywiththisimportantquestion;thereis,sotospeak,nothingbetweensanityandClaremont.ThePerthandKalgoorlieobservationwardsmoreorlessfulfilthefunctionperformedbytheDarlinghurstReceptionHouseinSydney,whichdealsverylargelywithacutealcoholiccasesandacomparativelysmallproportionofcasesofearlymentaldisorder.’33

31ATWhyntie,"SunsetHospital:it'shistoryandfunction,"EarlyDays:JournalofRoyalWesternAustralianHistoricalSociety8(5)(1981):66.32VBerridge,"Punishmentortreatment?Inebriety,drinkanddrugs,1860-2004,"Lancet364,Suppl1(2004).33RoyalCommissionInLunacy,Reportandappendices(Angwinchairman),WesternAustralianParliament(Perth,WA,1922),7,http://www.parliament.wa.gov.au/intranet/libpages.nsf/WebFiles/Royal+Commissions+-+Report+and+appendices+of+the+royal+commission+in+lunacy/$FILE/Report+and+appendices+of+the+royal+commission+in+lunacy.pdf.

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Therewasamajorreforminthemid1970s,whichsupplantedthelong-standingrelianceoninstitutionalarrangementsintheformofthe‘asylum’or‘mentalhospital’byofentirelynewstructurecompletelyseparatefromthementalhealthsystem.Themid1970sreformwasamajorshiftintreatmentphilosophy,awayfromonelargelyconcernedwithofthemodelthathadoperatedforsomeyears,of‘dryingout’andrecuperationthroughmaintenanceofabstinence.Thisapproachhadprevailedbetween1900andthemid1970sandwastransformedintoamodelwhichchampionedearlyinterventionandrelianceoncommunity-basedorganisationstoengenderattitudinalandbehaviouralchangetowardslowerriskdrinking.Thiswasconceivedasmanagingallproblematicusersofalcoholoverseenbyastand-alonestatutorybody,theAlcoholandDrugAuthority.TheimpetusforthisreformwastriggeredbyaRoyalCommissionintheearly1970s,whichthoughcuriouslyitlargelyfocussedonconcernsaboutillicitdruguseandbarelyconsideredthemuchlargerprobleminvolvingtheuseofalcohol,includedcommentarythattreatmentfor‘alcoholics’optimallyshouldbebasedonvoluntaryadmission.34Anumberofdevelopmentssincetheearly1990swillalsobeconsidered.Oneofthesethedecriminalisationofpublicdrunkenness,areformthathadparticularrelevancetoIndigenouspeopleandwhichresultedinalongoverdueinvestmentinthegrowthanddifferentiationofIndigenousspecificservices.AnotherrecentdevelopmenthasbeenamajoradministrativereformwhichinvolvedtheabsorptionoftheADAbackintotheMentalHealthCommission.35Thismaymarkthebeginningofanewerawhichcouldagaincharacteriseproblematicusersofalcoholandotherdrugsashavingamentaldisorder.Ifthisisthecase,itcanbearguedthisisareversiontoelementsoftheadministrativearrangementsthatexistedpriortothemid1970s,asgovernmenthasrecentlyclaimedisapolicy,“thefirstofitskind”,thatwillinvolvecourt-orderedconfinementforthepurposesofprison-basedtreatmentrelatedtoalcoholandotherdrugs.36Wehavegoodreasontobeconcernedthismentalhealthservicescentricpolicywillunderminethekeyfeatureofvoluntarismthathasbeenakeyfacetofthesystemofspecialistalcoholanddrugservicesandhasbeenanintegralpartoftreatmentsincethemid1970s.Thispolicyalsoinvolvestheamalgamationofbothmentalhealthandalcoholandotherdrugtreatmentservicesintoonefunctionaldepartment,insteadoftwocompletelyseparatestatutoryorganisations.37

34RoyalCommissionIntotheTreatmentofAlcoholandDrugDependents,Report(WilliamsChairman),GovernmentPrinter(Perth,WA,1973),http://www.parliament.wa.gov.au/intranet/libpages.nsf/WebFiles/Report+of+the+Honorary+Royal+Commission+appointed+to+inquire+into+and+report+upon+the+treatment+of+alcohol+and+drug+dependents+in+Western+Australia/$FILE/Treatment+of+alcohol+and+drug+dependents+1.pdf.35MinisterforMentalHealth,"Agencytotackledrugissuesandmentalhealth(Mediastatement),"(1July2015).https://www.mediastatements.wa.gov.au/Pages/Barnett/2015/07/Agency-to-tackle-drug-issues-and-mental-health.aspx;HMorton,"DAOjoinsMentalHealthCommission(Mediastatement),"(10April2013).http://www.mediastatements.wa.gov.au/pages/StatementDetails.aspx?listName=StatementsBarnett&StatId=7287.36MinisterforCorrectiveServices,"Firstofitskindalcoholandotherdrugtreatmentprisonannounced(mediastatement),"(9March2018).https://www.mediastatements.wa.gov.au/Pages/McGowan/2018/03/First-of-its-kind-alcohol-and-other-drug-treatment-prison-announced.aspx.37Morton,"DAOjoinsMentalHealthCommission(Mediastatement)."

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6 Inebriates - Legislative framework Thissectionwillbrieflytracethelegislativearrangementsthatwereinstitutedtomanageproblematicusersofalcohol,fromthecolonialerauptotherecentpast,whoforasignificantamountofthisperiodwereeitherconfinedorinfrequentlyvoluntarilyadmittedtoamentalhospitalunderprovisionsrelatedto‘inebriates’orundermentalhealthlegislation.Insummarytherewereanumberoflegislativearrangementsfortheinstitutionaltreatmentofproblematicalcoholusersadoptedovertheperioduptothemid1970s-

• broaderprovisionsmentalhealthlegislationsuchastheLunacyAct1871,theLunacyAct1903andtheMentalHealthAct1962concernedwiththeadmissionofpeoplewithmentaldisorderstomentalhealthfacilities;

• provisionsintheLunacyAct1903andInebriatesAct1912concernedwith‘inebriates;’• theMentalTreatmentAct1927whichestablishedaframeworkforthevoluntary

admissionofindividualswithmentaldisorderswhichincludedthepossibilityofdetoxificationofalcoholdependentpersons;and

• undertheConvictedInebriatesRehabilitationAct1963tocommit‘convictedinebriates’toaprison-basedrehabilitationregime.

Theapproachsincethemid1970swillalsoconsideredseparatelyasthisinvolvedamajorshiftinapproach,withthementalhealthsystemlargelyceasingtomanageanyproblematicusersofalcoholasitwassupplantedbytheestablishmentofapublichealthapproachoverseenbytheAlcoholandDrugAuthority.Untilthemajorreformsinthe1970s,thementalhealthsystemlargelymanagedthosewithproblematicuseofalcoholbytwopathwayswhichinvolvedcoercion-

• asdeclared’inebriates’(definedasa“personwhohabituallyusesintoxicatingliquortoexcess”)whoweresentencedforupto12monthsbyacourtundertheInebriatesAct1912,eitherbyanapplicationbythepoliceorfamilymembers;or

• thosecommittedundereithertheLunacyAct1903ortheMentalHealthAct1962astheyhadanalcohol-relatedmentaldisorder.

6.1 Lunacy Act 1871 Thecolony’sfirstlegislativearrangementconcernedwithinebriateswastheLunacyAct1871whichestablishedaprocessforeitheramedicalpractitioner,ortwojustices,tocommita“lunatic”.Alunaticwasreferredtoasbeingeithera“personofunsoundmind”oran“idiot”andwhowas“notundercareandcontrol”toanasylumorproclaimedplacefor“treatment”asdeemednecessarybytheasylum’sSuperintendentMedicalOfficer.Problematicusersofalcoholweretherefore,likelytowithinunderthemeaningofbeinga‘lunatic’.Thepreambletothisactsuggestsitsprimaryobjectivewasnotsomuchabouttreatmentasformaintainingsocialorder,statingthelegislationwas‘toprovideforthesafecustodyof,andpreventionofcrimesby,personsdangerouslyinsane;forthecareandmaintenanceofpersonsofunsoundmind;forthecareandmanagementanddisposalofthepropertyandestatesofsuchpersons.’

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6.2 Lunacy Act 1903 ThefirstcomprehensivelegislativeframeworkfordealingwithmentaldisordersoccurredatthebeginningofthetwentiethcenturywiththeLunacyAct1903,TheActincludedprovisionsformanagingproblematicusersofalcohol,describedas‘habitualdrunkards’inPart4:Section26.ApplicationmaybemadetoaJudgeforanorderofApplicationfordetentionbythefollowingpersonsandinthefollowing,cases–(1) Bythehabitualdrunkardhimselfdeclaringthatheiswillingtosubmittocurative

treatmentundertheorderoftheCourt;or(2) Bytheparent,husband,wife,child,orfriendofsuchhabitualdrunkard,incases–

(a)Wheresuchpersonissufferingorhasbeenrecentlysufferingfromdeliriumtremensorotherdangerousphysicaleffectsofhabitualdrunkenness;or(b)Wheresuchperson,throughhabitualdrunkenness,hasrecentlybeenwastinghismeansandbeenneglectinghisbusinessorinsufficientlyprovidingforhisfamily,orawifehasbeenwastingthemeansofherhusband;or(c)Wheresuchpersonhasrecently,undertheinfluenceofdrink,usedorthreatenedviolencetowardshimselforanymemberofhisfamily.

TheundefinedreferenceintheLunacyAct1903to‘habitualdrunkard’suggeststhiswouldhavebeenunderstoodasthemeaningcontainedinthePoliceAct1892,beingsomeonewhohadmultipleconvictionsforpublicdrunkenness.Section27oftheLunacyAct1903providedcouldgrantanorderofcommittaltoahospitalofupto12months,inwhichcasetheywererequiredtohaveevidencefromnotlessthantwomedicalpractitionersandotherpersonsifnecessary,subjecttotheprovisotheywereheldin“award,division,orcompartmentthereofinwhichlunaticsarenotdetainedforcurativetreatment”.TheLunacyAct1903specifiedthatsomeonecouldnotremaininareceptionhomeformorethansixmonthsandthattheyneededtobeadmittedasa‘voluntaryboarder’.Foradmissiontooccurasavoluntaryborder,ietoafacilityotherthanClaremontHospital,“apersonhadtohaveenoughinsightintohisownbehaviourandfeelingstoknowthathewasillandneededtreatment,andtheabilitytodecideforhimselftoseekadmission.”38

6.3 Inebriates Act 1912 WhentheInebriatesAct1912waspassedwefindforthefirsttimeadefinitionofan‘inebriate’being‘apersonwhohabituallyusesintoxicatingliquororintoxicatingnarcoticdrugstoexcess.’(Section2).Thislegislationalsohadapotentiallyexpansivecoverage,inthatproblematicusersofalcoholwhoappearedbeforethecourts,whoarguablymaynothavebeenalcoholdependentnorexhibitedotheralcohol-causedmentaldisorders,butifalcoholwasafactorintheiroffending,couldhavebeencommittedfortreatmentinamentalhealthhospitalinsteadofbeingfinedorimprisoned.39

38Ellis,Eloquenttestimony:ThestoryofthementalhealthservicesinWesternAustralia1830-1975,84.39ThisprovisionwithrespecttooffenderswasreplicatedinthetheConvictedInebriatesRehabilitationAct1963.

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‘Whereapersonisconvictedsummarilyoronindictmentofanoffence,anddrunkennessisanelement,orwasacontributingcauseofsuchoffence,andoninquiryitappearsthattheoffenderisaninebriate,theCourtmay,initsdiscretion,ordertheoffendertobeplaced,foraperiodofnotexceedingtwelvemonths,inaninstitutionestablishedforthereceptionofconvictedinebriates’.Section7(1)

TheInebriatesAct1912inotherrespectsreplicatedsimilarprovisionsasinthe1903actofthethreepathwaysforcommittalforupto12months–

a) ontheapplicationbythepersonthemselves,orb) bythespouse,siblingsoradultchildrenorabusinesspartner,orc) byamedicalpractitioner.

ThelegislationalsopermittedunderSection12(2),thatapersonreleasedmayhaveconditionsonthelicenseofrelease,whichcouldbeforaperiodofupto12months,includingthatthepersonbe‘ofgoodbehaviour,andabstainfromtakingorusinganyintoxicatingliquororintoxicatingornarcoticdrug’.TheFremantleAsylumwasatthattimeandcontinuedtobetheprincipalplacewherethosewithamentalillness,aswellasthosefoundtobe‘inebriates’,wereconfinedfor‘treatment’.Theearlycolonialadministratorsappeartohaveregardeda‘lunaticasylum’intermsofhowtheRoyalBethlemRoyalHospitalinLondonconfinedandmanagedso-called‘lunatics’.40ThereweretwokeyinstitutionsthatloomedlargeinthecolonialerainWAtoenforcesocialorder,theFremantlePrisonandtheFremantleAsylum,openedin1859and1865,respectively.IthasbeenobservedfromitsearliesttimesthecolonyofWAreliedheavilyoncustodialarrangementstomanagesocialproblems,evidencedbyconstructionoftheRoundHousein1831,justtwoyearsaftersettlement.‘InWesternAustralia,thefirstpermanentbuildingwasnotachurch,notaninn,noraprivatehouse.Itwasagaol.Thisgaol,ostensiblydesignedforcriminals,alsoservedasaplaceforthecontainmentoflunatics.’41

Constructioncommencedin1903oftheClaremontHospitalfortheMentallyInsaneanditwasnotuntil1909whenthelastpatientsweretransferredtotheClaremontHospital,thattheFremantleAsylumceasedtooperateasaquasi-hospitalandreformatory.Theseearlylegislativemeasuressuggestpolicymakersinthefirstdecadeofthetwentiethcenturysoughttobringaboutsocialreform,evidencedbythepassageofthePrisonsAct1903whichtemperedtheharshnessofthePrisons’DisciplineAct1880relationtotheconductofprisonsandtoimprovethetreatmentofmentalillnessthroughtheLunacyAct1903.42TheClaremontHospitalfortheMentallyInsanewasrenamedtheClaremontMentalHospitalin1933andin1967aftertheword‘Mental’wasremovedfromitstitleitbecameknownastheClaremontHospital.40https://en.wikipedia.org/wiki/Bethlem_Royal_Hospital41NHudson-RoddandGAFarrell,"TheRoundHouseGaol:WesternAustralia'sfirstlunaticasylum,"AustralianandNewZealandJournalofMentalHealthNursing7(1998):154.42RVirtue,"LunacyandsocialreforminWesternAustralia1886-1903,"StudiesinWesternAustralianHistory1(1977).

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In1972ClaremontHospitalwaspartiallydecommissionedanddividedintotwoinstitutions,GraylandsHospitalwhichtreatedacutepatientsandSwanbourneHospitalwhichfocussedonpersonswithpsychogeriatricdisordersandadultpatientswithdevelopmentaldisabilities.6.4 Mental Treatment Act 1927 TheMentalTreatmentAct1927enabledaparallelsystemfortreatingalcohol-relatedmentaldisorderstoexistaftertheestablishmentofthe‘HeathcoteReceptionHome’inFebruary1929.Thisfacilitywasnotreferredtoasan‘asylum’becauseoftheperceivedstigmaofClaremontAsylum,butinsteadoperatedunderaseparatestatute,theMentalTreatmentAct1927,whichprovidedforthevoluntaryadmissionofpeoplewitharangeofmentalillnesses.ThegenesisfortheMentalTreatmentAct1927wasthedevelopmentofadifferentsystemforcareofwarveteranswithpsychiatricdisorders,whohadbeenadmittedinitiallytotheClaremontAsylumontheirreturnfromthewar,inaccordancewithprinciplesofdifferentcareintheMentalTreatmentAct1917,tomitigatecommunityperceptionsthatreturnedservicemenwerestigmatisediftheywerecommittedtoClaremontAsylum.Thisinvolvedaprevalentformmentalillness,nowunderstoodaspost-traumaticstressdisorder(PTSD),inreturningservicemenfromWorldWarI,whichatthattimewasreferredtoas‘shellshock’,althoughitwasrecognisedasaformofhysteria,adisorderconsideredasexclusivelyinvolvingwomen.43By1918aseparateinstitution,StromnessHospital,wasconstructedwithCommonwealthfundingprovidedtotheState,toonlytreatveteranswithmentalillnesses.StromnessHospitaloperatedfrom1918to1926andafteritsclosure,patientsweretransferredtoLemnosHospital,anewpurpose-builtfacilitywhichoperateduntil1995.AsthenumberofreturningservicemenshowingsignsofPTSDincreased,withpossiblyatleastoneinfivemenwhodevelopedthecondition,thisrequiredchangesinviewsaboutcausality,whichpositedthat‘shellshockwasadiseaseofmanhoodratherthananillnessthatcamefromwitnessing,beingsubjectedtoandpartakinginincredibleviolence’,becauseitwasheld:‘Soldierswerearchetypicallyheroicandstrong.Whentheycamehomeunabletospeak,walkorremember,withnophysicalreasonforthoseshortcomings,theonlypossibleexplanationwaspersonalweakness.Treatmentmethodswerebasedontheideathatthesoldierwhohadenteredintowarasaherowasnowbehavingasacowardandneededtobesnappedoutofit.’44

Thisduallegislativearrangementlinkedtospecifichospitalsmeantthatindigentandlesswell-offindividualswithalcohol-relatedandotherformsofmentalillnesswerelikelytobecommittedtotheClaremontAsylumunderLunacyActlegislation,whereasthoseadmittedtoHeathcotewerevoluntaryadmissionsundertheMentalTreatmentAct1927.6.5 Mental Health Act 1962 TheMentalHealth1962,whichcommencedinJuly1966,repealedtheInebriatesAct1912.However,wasreplacedbyasystemofcoercivemanagementofproblematicusersofalcohol

43MCMcDonald,MBrandt,andRBlum,"Fromshell-shocktoPTSD,acenturyofinvisiblewartrauma,"(4April2017).http://theconversation.com/from-shell-shock-to-ptsd-a-century-of-invisible-war-trauma-74911.44McDonald,Brandt,andBlum,"Fromshell-shocktoPTSD,acenturyofinvisiblewartrauma."

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wasestablishedundertheConvictedInebriatesRehabilitationAct1963,whichcommencedon18December1963.TheMentalHealthAct1962wasrepealedbytheMentalHealthAct1996,whichcommencedon13November1997.Thismeantthatin1997thefinalremnantoflegislationconcernedwith“inebriates”,whichhadexistedformorethan90yearsinmentalhealthlegislationinthisState,sincetheLunacyAct1903,wasfinallyremoved.TherewasaprovisioninwithinSection19oftheMentalHealthAct1962,whichauthorisedtheestablishmentofhospitalsandservicesforarangeoffacilities,oneofwhichinSection19(1)(f),involvedtheestablishmentof“centrestoprovidefortheinstitutionalcareandtreatmentofinebriatesanddrugaddicts”.ThereisnorecordofgazettalofsuchafacilitybeingestablishedorconductedforthepurposeofprovidingtreatmentascontemplatedinSection19(1)(f).6.6 Convicted Inebriates Rehabilitation Act 1963 Therewasafurthergroup,so-called’convictedinebriates,’whocouldiftheyhadbeenconvictedofaminor(iesummary)criminaloffencewhere‘drunkenness’wasanelementorcontributingfactorundertheConvictedInebriatesRehabilitationAct1963,besentencedto‘clinicaltreatmentandrehabilitation’:Section6(1).TheConvictedInebriatesRehabilitationAct1963establishedasystemtorehabilitate‘convictedinebriates’bytheimprisonmentofthosewhohadbeenconvictedofanoffencewhereacourthadfoundthatdrunkennesswaseitheracontributorycauseorelementoftheoffence.ThisresembledasystemofquasicivilcommitmentandrequiredtheseindividualstoserveaperiodaspecifiedperiodoftimeatKarnetPrison,alowsecurityfarm-basedprison.Eventhoughconvictedinebriateswerehousedinadesignatedfacilitywithintheprison,theyweretreatedasprisonersthroughanamendmentwasmadetothePrisonsAct1903bythePrisonsActAmendmentAct1962,whichaddedPartVIB,whichcommencedon25January1963.Thisamendmentenabled“convictedinebriates”,iethosesentencedundertheConvictedInebriatesRehabilitationAct1963,tobesubjecttotheprison’sdisciplinaryframework.45ItshouldbenotedthementalhealthsystemalsocontinuedtobeadestinationforproblematicusersofalcoholasinebriatesuntiltheintroductionoftheMentalHealthAct1962,whichcommencedinJuly1966.The1963reformmeantthatwhereasuptoDecember1963inebriateswereconfinedinamentalhealthfacilityorinadesignatedinebriate“receptionhome”underthetermsofacourtorder,from1964“convictedinebriates”weremanagedbytheprisonsystem.Thesystemofsentencingofproblematicusersofalcoholtodesignatedlowsecurityprisonfor“treatment”operatedbetween1964andNovember1974,untiltheAlcoholandDrugAuthorityAct1974waspassedbytheWAParliamentandcommencedon29November1974.

45ThisprovisionremainedinthePrisonsAct1903,untilitwasrepealedandreplacedbyanewpieceoflegislation,thePrisonsAct1981.

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7 The 1900s to mid 1970s Overtheperiodfrom1900untiltheearly1970s,theClaremontAsylumperformedapivotalroleinrelationtomanagingthoseacutelyorchronicallyaffectedbyuseofalcohol,by‘dryingout’suchpersons,involvingifnecessaryrestraintandcontrol.Becauseproblematicuserswerecommittedbyeitheranorderofacourtorbyamedicalpractitionertoamentalhealthfacility,thisresultedinsecondaryharmduetostigmatisationofthosetreated,whichmostlikelydeterredamuchlargerpopulationofproblematicusers,includingthosewithacutedisordersaswellasthosewhowerenotalcoholdependentfromseekingtreatment.ItislikelytherewasasimilaroutcomeinWAashasbeenreportedoccurredinotherAustralianjurisdictionsinthattheinebriatelegislationhadadisproportionateeffectonthelivesofworkingAustralians.‘BytheFirstWorldWartheeffortsofreformershadresultedinlongerperiodsofprisonandmentalhospitalincarcerationforthoseworking-classinebriatesdeemedtobesufferingthediseaseofhabitualdrunkenness.’46

Furthermore,aswellasthisclassbiasinrelationtothosewhomorelikelytobecommitted,itisalsoconceivablethatcommittalmayhaveservedotherpurposes,suchastoreformthoseseentohavefailedinothersocialresponsibilities.AsnotedinGreatBritain,‘(t)hepowertocommitoffenderstoinebriatereformatorieswasheavilyimplementedincasesofneglectandchildcruelty.’47Initially,from1914upuntil1918,maleinebriatesweresenttotheInebriateSectionestablishedaspartofafarm-basedfacility,WhitbyFallsAsylum,southofthePerthmetropolitanarea.However,itwasevidentfromearlyonfromcommentsinannualreportsoftheInspectorGeneraloftheInsane,thatthiswasnotfoundtobeasatisfactoryarrangementfromthementalhealthservicesperspective,suchasobservedinthe1917/1918annualreport:‘ThoseatWhitby,whowerecommittedUnderSections7and8oftheAct,usuallyadoptanattitudeofpassiveresistance,refusetreatment,and,generallyspeaking,aresubordinate,andIhavethroughoutfoundmyselfinanawkwardposition.’

FemaleinebriatesweresenttoGreenplace,ametropolitanfacilityforwomenwithmentaldisorders,whichopenedin1916.However,thisarrangementforwomeninebriatesalsoseemedtobeproblematic,asafterclosureoftheInebriatesSectionatWhitbyFallsinJuly1918,malesaswellasfemales,werecommittedundertheLunacyAct1903toeitherofthetwogazetted‘inebriatehomes’operatedbytheSalvationArmyortotheClaremontAsylum.However,inspiteearlierenthusiasm,bythelate1920sthesetwoinebriatehomeshadclosed.‘Onthe31stDecember1923,thereweresevenmaleinmatesresidentintheSalvationArmyHomeatClaremontand10femalesintheInebriatesHome,LincolnStreet,Perth.Duringtheyeartherewere49admissionstoClaremontand33toPerth.

46Garton,"Onceadrunkardalwaysadrunkard:Socialreformandtheproblemof'habitualdrunkenness'inAustralia,1880-1914,"53.47Berridge,"Punishmentortreatment?Inebriety,drinkanddrugs,1860-2004,"4.

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TheabovefiguresdiscloseaverymarkedincreaseinthenumberofinebriatestreatedattheSalvationArmyHomes.TheadmissionsattheClaremontHomeshowanincreaseof123percent,sandthePerthHome175percent.Thisincreaseisentirelyduetothemagistratessendingtothehomespersonsforonlyquiteshortperiods.TheInebriatesHomeswereprovidedforthetreatmentofinebriatesandtheobjecthaslargelybeendefeatedbytheshortperiodsordered,anditisobviouslyimpossibletotreataninebriateforashortperiodoftime,saythreeweeks.Itisveryevidentthataperiodofthreeweeksbyanystretchofimaginationcannotbeconsideredastreatment,butisintendedasapunishment.’48

Alongertermunderstandingofhowthementalhealthsystemmanagedproblematicusersofalcoholcanbegleanedfromtheannualnumberofinpatientadmissionstomentalhospitalsforalcohol-relatedmentaldisorders,asrecordedintheannualreportsofmentalhealthservices,49iscontainedinFigure1,whichhasabreakdownbygenderandshowsapredominanceofmaleadmissionsovertheperiod1904/1905to1977/1978.50Figure2showsthatalcohol-relatedadmissionstomentalhospitalsrepresentedasubstantialcomponentofalltypesofadmissions,constitutinguptoaboutoneinthreeofalladmissionsinthefirstdecadeofthetwentiethcentury,andfortheremainderoftheperiodrepresentingabout15%ofalladmissions.Figure3isconcernedwiththeannualcountsofadmissionsofinebriatestothe‘inebriatehomeswhichoperatedinthe1920sandsubsequentlytomentalhospitalsplusthecountsof‘convictedinebriates’whowerecommittedtotheKarnetPrisonundertheConvictedInebriatesRehabilitationAct1963.PeoplewithalcoholrelatedmentaldisorderscouldalsobeadmittedvoluntarilyorcommittedtothementalwardatPerthPublicHospital,whichprovidedinpatientshorttermstayandassessmentfacilityforthereceptionofthosesufferingfromavarietyofacutementaldisorders,until1929whenHeathcoteHospitalwasopenedanditassumedresponsibilityfordetoxificationofalcoholdependentpersons.51TheimpactontheadoptionoftheICD9CMandICD10classificationsystemsonannualcountsofalcohol-relatedmentaldisorderswillbeconsideredinthefollowingsection.ItshouldalsobenotedtherewereperiodsofincreasedrestrictivenessontheavailabilityofalcoholbecauseofperceivednationalsecurityandemergencyconcernsrelatedtoWorldWarI,theGreatDepressionandWorldWarII,whichprobablyreducedlevelsofalcoholproblems.

48AnnualreportofInspectorGeneraloftheInsane1925/192649Theterm‘mentalhealthservices’,isamorerecentterm,whichisusedforconvenienceandsimplicity.50Annualreportscontaindetailedappendixtableswithbreakdownsofadmissionsbyvariousmentaldisorders.However,somecautionneedstobeexercisedininterpretationofsomeofthesebreakdowns,astheWAmentalhealthservicesfollowedahybridsystemofclassificationofmentaldisordersupto1966/1967.Intheperiodfrom1967/1968to1969/1970theICD8classificationwasadopted,whichwassupplantedbytheICD9CMclassificationintheperiod1970/1971to1977/1978andsince1978/1979theICD10systemhasbeenused.Theincreasesinannualcountsofalcohol-causedmentaldisordersfromthemid1960sarerelatedtochangesinthewaythisdatawascapturedthroughtheintroductionoftheHospitalMorbidityDataSystem.Aswellasexpandeddiagnosticcategories,thedatareferstoadmissionsforthesedisordersinallpublicandprivatehospitals,comparedtotheapproachupto1966/1967,whichwasbasedonadmissionstojustmentalhospitals.51TheColonialHospitalwasestablishedin1855andrenamedthePerthPublicHospitalandthePerthHospital,beingrenamedRoyalPerthHospitalin1946.

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Theprisonsystem,likethementalhealthsystem,alsostruggledwithperformingitsroleasadestinationfortheinvoluntarydetentionofproblematicusersofalcohol,asobservedbytheDeputyComptrollerGeneralofPrisonsinthe1911annualreportwithrespecttotheimprisonmentoffemaleinebriates:‘VisitstotheFemalePrisonexemplifythefutilityofimprisoningtheinebriateforshortsentences.Experiencesuggeststhatthesystemisworsethanuseless–itisharmful.Theshortsentencemerelyaffordsameansofrecuperation,andtheprisonergoesoutoftheprisongatephysicallyfortifiedforfurtherdepredation.TheHomeoftheGoodShepherdandtheSalvationArmyauthorities,whichhavedonemuchtoassisttheadministration,havebeenapproachedwithaviewtoacceptingfortreatmentthisunfortunateclass,anditishopedshortlytorecommendyoutodeclarecertainportionsofthoseinstitutionsasprisons,wherefemaleinebriatescanbegivenreformativeopportunities.’52

Therewereprotractednegotiationsduringthe1920sbetweenthePrisonsDepartmentandtheInspectorGeneraloftheInsanewithrespecttowhichdepartmentshouldincurthecostofthosesentencedtotheSalvationArmyhomesforinebriates.53OneexampleisanextractfromcorrespondenceinafilenotetotheUnderSecretaryoftheColonialSecretary’sOfficefromtheInspectorGeneralofInstitutionsforInebriates:‘WearereceivingalargenumberofadmissionsundertheInebriatesActtotheSalvationArmyHomesforaperiodoftwenty-onedays.PatientssenttotheseHomesaresupposedtobesenttherefortreatment,buttwenty-onedaysdoesnotappealtomeasaperiodinwhichtreatmentcanbeofanyeffect.Itlookstomeasifitismoreapunishmentthantreatment,inwhichcasetheinebriateshouldbesenttoFremantlePrison.IdonotthinkthatourvoteontheEstimateswaseverintendedtoprovideforsuchshorttreatment.’54

Thispushbackbythementalhealthsysteminmanagingproblematicusersofalcoholundertheinebriateslegislationwasalsoechoedinhowthecourtsbecameincreasinglyreluctanttosupportcommittalexceptifithadsomedemonstrablebenefitfortheindividualconcerned.‘Amansufferingfromdeliriumstremensorotherwiseinamaniacalconditionfromthedirecteffectofalcoholisafitsubjectforadmissiontoaninstitution.Itiswellrecognised,andhasbeenjudiciallydetermined,that,sofarasinsanityisconcerned,amanmaybeinsanefromthetemporaryeffectsofalcoholaswellasfromothercauses.Hisreceiptintohospitalisaperfectlycorrectprocedure;butitisequallycertainthatthereisnothingintheLunacyActtojustifythedetentionofanymanmerelybecauseofawell-foundedbeliefthat

52Annualreportontheprisonsyear:ended31December1911,6.53Withrespecttomentalhealthservices,therewasnotadepartmentaladministrativearrangementuntiltheMentalHospitalsDepartmentwascreatedonJanuary1950,whichoperateduntilDecember1953,whenitwassupplantedbytheMentalHealthServicesDepartment.OnJuly1984theMentalHealthServicesDepartmentwasmergedalongwiththePublicHealthDepartmentandtheDepartmentofHospitalandAlliedServicestoformtheHealthDepartmentofWA.54StateRecordsOffice.InebriatesAct–increaseinthenumberofinebriatescommittedtoinstitutionsforshortperiods.Item1920-0234.

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hewillhaverecoursetoalcohol,eventhoughinallprobabilityhewillbecomeviolentandadangertohiswife.Theprotectionofawifeagainstadrunkenhusbandliesinthecriminallaw,andsuchprotectionasisgivenbyotherlegislationdirectedtothespecificpurpose.Sofarassuchcriminallawandotherlegislationmayprovetobeaninsufficientprotection,thereisnoreasontosupposethattheLegislaturewouldbebackwardinenlargingitsscope.ItisquiteclearthatthereisnothingintheLunacyActwhichwouldjustifythoseadministeringtheActindetaining,fromhumanitarianmotives,foranindefiniteperiod,amanwhoisnotinsaneaccordingtotheordinaryscientifictests,butwhomayandprobablywillbecometemporarilyinsaneifgivenaccesstoalcohol.Puttingitotherwords,mentalhospitalsarenotinstitutionsforpreventingalcoholicsfromhavingaccesstoalcohol.’55

Thechangesawayfrominstitutional-basedtreatmentofinebriateswhichhadstartedinthe1960s,parallelsthereformswhichhadoccurredinhowmentalillnesswasunderstoodwhichresultedinanemphaticshifttocommunity-basedapproaches.Thisreform,referredtoas‘deinstitutionalisation’ofmentalhospitals,commencedinearnestinthe1960soccurredbecauseofchangingattitudestowardsmentalillness,exemplifiedbytheanti-psychiatrymovement,whicheschewedthelabellingofsocialproblemsasmedicalproblemsandtheuseofinvoluntarytreatment.Thedeinstitutionalisationofthetreatmentofmentalillnesswhichstartedtooccurfromthelate1960swasfacilitatedbythedevelopmentofeffectivepsychotropicmedicationsthatbecamewidelyusedandlargelyobviatedtheneedforrestraintandconfinement.Therewereotherimpetusesfordeinstitutionalisation,suchastheexistenceofpopulationsofpatientswhohadspentmuchoftheirlivesinthehospital,thehighcostofinstitutionaltreatmentandgrowingevidenceofthebrutalisationanddegradationendemicininstitutionselsewhere.56Weshouldbecognisantthatthesubstantialpowerofcommittaltothementalhealthsystemdidnotoperateinisolationfromotherrepressivemechanismsthatenabledtheconfinementofawidegroupofindividuals,notjustproblematicusersofalcohol.Forexample,therewereasuiteofprovisionsinthePoliceAct1892,whichimposedescalatingtermsofimprisonmentforrepeatoffenders,socalled“habitualdrunkards.”Ineffectthismeantthepowersavailablethroughthecriminaljusticeandthementalhealthsystemsoverthe75-yearperiodtothemid1970ssustainedaframeworkofcoerciveandpunitivemeasureswhichtargetedproblematicusersofalcohol,predicatedonthebeliefthatwithoutstrictcontrols,theunfettereduseofalcoholposedaseriousrisktosocialorderandthestabilityofthefamily.Inadditiontotherepressiveprovisionsinbothmentalhealthandpolicelegislation,provisionswerealsopresentinotherlegislation,whichalsocontrolledtheuseofalcohol,suchasrestrictionsonSundaytradinghoursofhotels,theclosureofhotelsonholidaysinthe

55InreX(aninebriate),43295-96295(SupremeCourtofVictoria19March1937,1937).56SuchasthefindingsoftheChelmsfordRoyalCommissionchairedbyJusticeSlatteryinthelate1980s,whichexposedtheactivitiesoftheinfamousDrHarryBaileyandDrJohnHerronandtheiruseof‘deepsleeptherapy’overtheperiodfromtheearly1960stothelate1970satChelmsfordPrivateHospital:<https://en.wikipedia.org/wiki/Chelmsford_Royal_Commission>

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Christiancalendar,thecreationofextendedopeninghoursinminingregionsandextendedhoursoftradingthroughspecialclassesoflicenses.Theperceivedthreatofalcoholtosocialorderwasreflectedinotherpolicyareas,suchasinmatrimonialmatters,wherealcoholismwasagroundfordivorceundertheState’sMatrimonialCausesandPersonalStatusCode1948:‘Inthecaseofahusbanddefendant,habitualdrunkennessforfouryearsormoreandduringthatperiodhabituallyleavingtheplaintiffwithoutmeansofsupportorbeingguiltyofhabitualcrueltytowardsher;andinthecaseofawifedefendant,habitualdrunkennessforfouryearsormoreandduringthatperiodhabituallyneglectingherdomesticdutiesorrenderingherselfunfittodischargethem.’Section15(g)

Perhapsoneofthemostrestrictiveregimesrelatedtoalcoholoperatedthrough‘nativewelfare’legislation,whichtargetedIndigenouspeopleastheywereregardedasbeingespeciallysusceptibletoalcoholandincapableofusingitsafely.Thisinvolvedacombinationofmeasures,suchasthecreationof‘dryareas’toexcludeIndigenouspeoplefromgazettedtownsandprescribedzonesintheStatewhereIndigenouspeoplewerelegallynotabletoconsumealcohol.57AnespeciallyperniciousillustrationofcontrolsoverIndigenouspeopleinWAwereacollectionofso-called“nativecitizenship”laws,suchastheNatives(CitizenshipRights)Act1944,wherebyanIndigenouspersoncouldapplytoamagistratefor‘citizenship’.Thisnecessitatedrenunciationofindigenousassociationsandrequiredongoingcomplianceevidencedby‘adoptingthemannersandhabitsofcivilisedlife’,withtheever-presentthreatofrevocationofthecertificateofcitizenship,suchasifanIndigenouspersonwasconvictedofdrunkennessoroffencesundertheNativeAdministrationAct1905-1941.58TheAlcoholanddrugAuthority1974legislativereformmeantthatfromDecember1974problematicusersofalcoholinthisStatecouldnotbesentencedtoaregimeofcourtorderedrehabilitationinaprisonoranyotherfacility,eventhoughthepowerremainedintheConvictedInebriatesRehabilitationAct1963untilitwasrepealedinNovember1989.TheConvictedInebriatesRehabilitationAct1963,whichoperatedforadecade,untilthecommencementoftheADAin1974,soughttoestablishasystemofcivilcommitmentforthosechargedwithalcohol-relatedpublicorderoffencesforcompulsory‘treatment’inaunitwithinKarnetPrison,alowsecurityprison.TherehasonlybeenonereviewbytheConvictedInebriatesBoard,whichhadadministrativeoversightofthearrangement,whichina1969review,consideredthatofthe353‘patients’admittedtoKarnetprisoninthefirstsixyearsofoperation,therehadbeena‘successfulrecoveryrateof20%’.

57PBiskup,"White-AboriginalrelationsinWesternAustralia:anoverview,"ComparativeStudiesinSocietyandHistory10(4)(1968);EEgglestone,Fear,favororaffection:AboriginesandthecriminallawinVictoria,SouthAustraliaandWesternAustralia(Canberra,ACT:AustralianNationalUniversityPress,1976);AHaebich,Fortheirowngood:AboriginesandgovernmentintheSouthwestofWesternAustralia,1900-1940(Perth,WA:UniversityofWesternAustraliaPress,1988);PHasluck,AsurveyofnativepolicyinWesternAustralia,1829-1897(Melbourne,VIC:MelbourneUniversityPress,1942).58CTatz,"GenocideinAustralia,"JournalofGenocideResearch1(3)(1999):332,https://doi.org/https://doi.org/10.1080/14623529908413964.

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However,reservationswereexpressedabouttheco-locationoftheInebriatesSectionwithintheprison‘Duringthisperiodthepositionhasgraduallyarisenwheretherehabilitationandinterestinthe.alcoholicseemstohavebecometheworkoftheBoardanditsWelfareOfficer,withthestaffatKarnethardlybeinginvolvedinthisaspect;andagainthisseemstohavearisenfromthecircumstancesoftryingtorunaprisonrehabilitationcentreandanalcoholicsrehabilitationcentreunderthesameadministration,andtryingtoapplytheonesetofprocedurestobothsections;yettheneedsareextremelydifferent.’59

7.1 Statistical summary

Figure 1: Number of inpatient admissions for alcohol-caused mental disorders by gender, WA, 1904/1905 – 1977/1978

59InebriatesAdvisoryBoard,Areviewofsixyearsactivity(Perth,WA:InebriatesAdvisoryBoard,ChiefSecretary'sDepartment,August1969),15.

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Page20

Figure 2: Number of inpatient admissions for all mental disorders, alcohol-caused mental disorders & % of alcohol mental disorders of all mental disorders, WA, 1904/1905 – 1977/1978

Figure 3: Number of admissions & commitments of inebriates to mental hospitals & inebriate homes, WA, 1913/1914 – 1974/1975

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Mental health services 7 Apr 2018.xlsx: Cht Inebriates 1913- 1974 (11/5/19)

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Note: Salvation Army operated inebriate homes for men & women from 1920 - 1930

Inebriates Act 1912December 1912 - November 1962Convicted Inebriates Rehabilitation Act 1963December 1963 - November 1974

Page21

8 Mid 1970s – 1990s (ADA reforms) TheAlcoholandDrugAuthorityAct1974usheredintheabolitionoftheConvictedInebriatesBoardandcreationoftheADA.Thisframeworkrealizedalong-heldgoalforthetreatmentofproblematicalcoholusers,aswellasotherformsofdruguse,tobeundertakenbyaspecialistmulti-levelsystemofservices,focusingespeciallyonrecruitingearlystageproblematicusersofalcohol,comparedtotheapproachfoistedonthementalhealthsystemoftreatingindividualswhohadbeenlong-termalcoholusers.60TheformationoftheADAestablishedamedically-basedsystemtodetoxifyalcoholdependentpersons,whowereadmittedvoluntarilytometropolitanspecialistinpatientandoutpatientfacilitiesoperatedbytheADA.The1974reformcrystallisedareformbyMentalHealthServicesthatalcoholdependentpersonsshouldnolongertobeadmittedtoapsychiatricfacility,inlinewithashiftinmedicalopinioninAustraliaandelsewherefortreatmentofalcoholismasamentalillness.61ThismeantwiththeestablishmentoftheADAin1974,custodialfacilitiesceasedtoexistinWAtodetainanddetoxifyalcoholdependentpersonsthatpreviouslyoccurredundertheinebriatelegislativeframework.Anotherfactorwhichspurredthedevelopmentofaseparatespecialistmedically-orientedtreatmentsysteminWA,wastheelectionoftheWhitlamFederalLaborGovernmentinDecember1972.ThisresultedinadditionalfundingbeingprovidedbytheFederalGovernmenttoWAandtheotherStates,throughtheCommunityHealthProgramestablishedbytheHospitalsandHealthServicesCommissionAct1973(aCommonwealthpieceoflegislation).ThespecialistalcoholandotherdrugtreatmentsystemdevelopedbytheADArequiredthatanindividualneededtodemonstratesufficient‘motivation’tobeadmittedtoaprogram.Thisapproachmeantsomegroupsofalcoholdependentindividuals,suchashomelessandIndigenouspersons,werelikelytoexperiencedifficultyinbeingadmittedfortreatment,astreatmentwasdefinedinhealthandsocialobjectivestoimproveanindividual’scapabilitytohaveafunctionallife,ratherthantojustdetoxifyor‘dryout’asagoalofitself.TheADAestablishedaninpatientdetoxificationunit,AstonHospital,whichtheHon.RLJWilliamsMLC,thenChairmanoftheADA,describedintheseterms:‘Wedonotcureanybodythere;wedetoxifythem;thatis,weremoveallthetoxicsubstanceswhichmaybeintheirbodiesduetoalcoholordrugs.Thetreatmentmodalityisacuteclinical.’62

TheADAhadinheritedresponsibilityforthemanagementoftheByfordInebriatesCentrewhichhadpreviouslybeenoperatedbytheDepartmentofCorrectionsasa“prisonfarm”forthereceptionofinebriatessentencedbythecourtsundertheConvictedInebriates

60ASEllis,Investigationintodrugsandalcohol:Finalreport,HealthDepartmentofWesternAustralia(Perth,WA,1971);Ellis,Eloquenttestimony:ThestoryofthementalhealthservicesinWesternAustralia1830-1975.61BKissinandHBegleiter,eds.,Thebiologyofalcoholism.Volume5:Treatmentandrehabilitationofthechronicalcoholic(NY:PlenumPress,1977);LGKilohandBellDS,eds.,29thInternationalCongressonAlcoholismandDrugDependene,Sydney,February1970(Melbourne,VIC:Butterworths,1971).62WilliamsRLJ.MLC.‘DebateonAppropriationBill(ConsolidatedRevenueFund)(No.2)’.HansardLegislativeCouncil,25October1977,2534.

Page22

RehabilitationAct1963.TheADArenamedthefacilityQuoVadisandhaditclassifiedasahospital,sothatthecostofstayofpatientstobecoveredthroughtheState’sparticipationinnationalhospitalfundingarrangements.‘ThedevelopmentofQuoVadisisacomprehensiveoneandincludesupdatingoftheextensivepropertywhichconsistsof126acres.ThetherapeuticproceduresinforceatthishospitalareoflessintensitytothosewhichexistattheOrdStreetHospitalandaregearedtowardsthelong-termresocialisationofthepatientthroughgrouptechniquesandworkorientatedactivities.’63

InadditiontoestablishingAstonHospitalfortheexpresspurposeofshort-termdetoxification,theADAalsoopenedamediumtermstaylive-infacility,OrdStreetHospital,forthosewhohadcompleteddetoxificationandweredesirousofdevelopinglifeskillsandengaginginpsychologicalfocussedprograms.ThethirdlegoftheADA’sresidentialtreatmentoptionwasQuoVadisHospitalforlongertermrehabilitationcoupledwithdailyactivitiesrelatedtothefarm.WhereasoveraboutthefirsttenyearsoftheADA’sexistenceitactivelyexpandedandestablishedacomprehensivesuiteofclientservices,inthenatureofresidentialdetoxification,outpatientclinicsandregionalprograms,bythemid1980sthishadstartedtobedismantledwiththeprogressivedevolutionofservicestoarangeofnon-governmentorganisations(NGOs)andtheclosureofbothQuoVadisandOrdStreetHospitals.‘Anothereradrewtoacloseon29June1984whentheAuthorityofficiallyclosedtheQuoVadiscentreatByford.TheAuthorityconsideredthattheservicesprovidedatQuoVadiscouldbeprovidedmoreefficientlybyanon-governmentagencyandnegotiatedwithanumberofagenciestothisend.SuccessfulnegotiationshavebeenconcludedwiththeSalvationArmy,whichhasanAlcoholRehabilitationCentreatSeaforth(Gosnells).’64

TheADAexperiencedfiercelocalcommunityoppositionwhenitrelocateditsmainoutpatientservice,CarrellisCentre,fromWestPerthtoMountLawleyin1986,intherenovatedformerAnnexeofRoyalPerthHospital,basedonconcernsaboutillicitdrugusersattendingtheCentre.TheMinisterforHealthissuedadirectiveinresponsetothiscommunityopposition,suchthat‘usageofthefacilitywasrestrictedtotreatingonlythose‘personsaffectedbyalcoholproblems–whethertheybedependents,co-dependents,orpersonswithadrinkproblem.’65However,bythelate1990stheADAlocateditsremainingclinicalservicestothesiteoftheCentralDrugUnitinEastPerth,whichwasrenamedinApril1999NextStepSpecialistDrugandAlcoholServiceswasregisteredundertheBusinessNamesAct1962.ThischangesoughttorebrandtheADA'sresidualclinicalservicesinEastPerthasashortstayinpatientdetoxificationhospital,describedinthe2007/2008AnnualReportoftheDrugandAlcoholOffice.‘NextStepprovidesasupervised,medicaldrugandalcoholwithdrawalserviceforclientsrequiringwithdrawalfromlicit(includingalcohol)andillicitdrugsatMooreStreet,EastPerth.Thefacilityhas17beds,4ofwhicharededicatedfortheprovisionofservicestoAboriginalpeople.(page21)

63Annual report, Alcohol and Drug Authority, 1974/1975 (draft unpublished), 5.64Annualreport,Alcohol&DrugAuthority,1983/1984,5.65Annualreport,AlcoholandDrugAuthority,1985/1986,7.

Page23

Inthelatterpartof2007theADAcommencedtheimplementationofanewmodelofservicedelivery,wherebyitestablishedco-locatedservicestoprovidearegionaliseddeliveryofservices,brandedasCommunityDrugServiceTeams(CDSTs).ThisinvolvedtheADArentingtheactualpremisesandassumingoverallmanagementandresponsibilityofthefacilityandtheemploymentofmedicalandnursingpersonnel.ThemajorityoftheremainingofthestaffwhoprovidedcounsellingandwelfarerelatedserviceswereemployedbytheCDST.Thefirstsuchservice,theSouthMetropolitanCDST,wasdescribedasfollows:‘ImprovementoftreatmentservicesadvancedconsiderablywiththeestablishmentoftheSouthMetroCommunityDrugServicethatintegratedDAO’sNextStepmedicalserviceswiththecommunitydrugserviceteammanagedbyPalmerston.ThisenabledanewservicelocationtobeestablishedinRockinghamandacomprehensiverangeoftreatmenttobeofferedmoreeffectivelytoclientsthroughoutthesoutherncorridor.ThesuccessofthisapproachhasinformedplanningfortheintegrationofallmetropolitancommunitydrugserviceteamswithDAONextStepservicestooccurinthelatterhalfof2007andwillresultinseveralnewservicelocations.’66

However,inthisera,aspublicdrunkennessremainedanoffence,thecriminaljusticesystemcontinuedtobeanimportantresidualdestinationforthosearrestedforpublicdrunkenness.Thisresultedinatypeofa“revolvingdoor”,alsoidentifiedintheUnitedStatesandelsewhere,suchthatintoxicatedandalcoholdependentindividualsweredetainedovernightinpolicelockupanduntiltheirappearancethenextmorningbeforeaMagistrateonachargeofpublicdrunkennessandorcloselyrelatedpublicorderoffences.67WhentheseindividualsappearedbeforeaMagistratetheyusuallyreceivedasmallfineandifunabletopaythefine,theycouldservethetimeinprisoninlieuofpayingthefine.Anotherapproachfordealingwiththosechargedwithpublicdrunkennesswasafterbeingconveyedbythepolicetothelockup,thattheycouldbegrantedbailintheformofaself-recognizance.Thiswastypicallysetatlowtokenamountandiftheindividualfailedtoappearatcourtwhenthematterwaslistedforhearing,hisorherbailwasestreatedandthustreatedasdefactopaymentoftheoutstandingfine.TheselectiveadmissioncriteriausedbytheADAforentrytoitsspecialistalcoholandotherdrugtreatmentsystemmeantineffecttherewasatwo-streamapproachtomanagingproblematicusersofalcohol,thosewhowereperceivedasmotivatedandthosewhohadchronicandextendedhistoriesofalcoholuseandassociatedcomplexsocialandmedical

66Annual report, Drug and Alcohol Office, 2006/2007, 7.67RWFaganandALMauss,"Paddingtherevolvingdoor:aninitialassessmentoftheUniformAlcoholismandIntoxicationTreatmentActinpractice,"SocialProblems26(1978-1979);DMGallantetal.,"Therevolvingdooralcoholic:Animpasseinthetreatmentofthechronicalcoholic,"ArchivesofGeneralPsychiatry28(1973);KLovaldandHRStub,"Therevolvingdoor:reactionsofchronicdrunkennessoffenderstocourtsanctions,"JournalofCriminalLaw,Criminology&PoliceScience59(4)(1968);DJPittmanandCWGordon,Revolvingdoor:Astudyofthechronicpolicecaseinebriate(NewHaven,Connecticut:YaleCenterofAlcoholStudies,1958);PMSaetaandWMSmiland,"Publicinebriatehealth:thelegislatureandtherevolvingdoor,"PacificLawJournal1(1970).

Page24

problemsattendingasmallnumberofnon-governmentorganisations(NGOs)andprogramsrunbytheSalvationArmy.68Anumberofmajorreformssincethe1990shavereshapedtheroleoftheADA,whichhaveresultedinthewithdrawalofGovernmentasaproviderofservicesexceptinaroleasalimitedoperatorofashortterminpatientmedicaldetoxificationunit.Insteadgovernmenthasincreasinglyconcentratedontraining,fundingofservicesprovidedbyNGOsandoversightofcommunity-basededucationprogramsconcerningalcoholandotherdrugs(excepttobaccocontrol).8.1 Statistical summary Figure4referstotheperiod,from1967/1968to2009/2010.Itshowshowchangesinclassificationsystemsandtheintroductionofmorefine-graineddefinitions,mayhaveaffectedhowdifferentalcohol-causedmentaldisordersareidentified.Forinstance,itcanbeseenthatannualcountsforAcuteintoxication(F10.0),firstappearedintheyear1998/1999,eventhoughtheICD10systemhadbeenoperatingsince1978/1979.Figure4showswithrespecttoAlcoholdependence(303inICD9CMandF10.2inICD10)thattherewasamarkeddeclinefromanannualpeakofmore2,700admissionsin1976/1977and1977/1978,tonearly450in1994/1995,withsomegrowthsincetoabout1,700admissionsperyear.Abreakdownofthedataoverthisperiodbygender,whichisnotshownhere,indicatesthatwithrespecttobothmaleandfemaleadmissions,thegreatestgrowthappearstohaveinvolvedtwosub-groups–AcuteintoxicationandDependence.WhereasthetwolowestcountsforadmissionsinvolvingNon-dependentabuse(305.0–305.3andF10.1)andAlcoholicpsychosis(291andF10.3–F10.)haveremainedrelativelyconstant.Figure5isconcernedwithadmissionstotreatmentprogramsprovidedbyspecialisttreatmentagencies,coveringtheperiodfromthecommencementoftheADA,from1975/1976to2015/2016.Theinterpretationofthisdataisproblematicastheagencydidnotoperateacomprehensivedatasystem,nordidNGOtreatmentprovidersfundedbytheADAprovidedataconcerningadmissionsforsometime.Since2001/2002datahasbeenobtainedfromannualreportspublishedbytheAustralianInstituteofHealthandWelfare(AIHW)basedondataprovidedbyeachjurisdictionconcerningarangeoftreatmentagencies.Thealcoholandotherdrugtreatmentsystemdata(AODTS)reportscontainamixtureofbothinpatientandoutpatientdata,whereasthedatainFigure5fortheperioduptothelate1990sisADAonlydataconcerninginpatientstatistics.However,inspiteoftheselimitationstheimportanttrendinFigure6isofhowalcoholrepresentedintheorderof50%ofannualadmissionsforalltypeofdrugproblemsfortreatmentpresentationsattheADAupto1994/1995.Infact,inthefirstpartoftheperioduptotheearly1980s,alcoholproblemsrepresentedthreequartersormoreofalladmissionsattheADA.

68Notably,aPerth-basedresidentialprogramrunbyACRAH(theAssociationfortheCareandRehabilitationofHomelessPersons)wastheexceptiontotherequirementthatanindividualshouldengageinatreatmentprogram,asitpermittedactivelydrinkingalcoholdependentindividualstoliveatitsfacilityinMountLawley.

Page25

Althoughalcoholasaproportionofalladmissionsdeclinedtoaboutoneinthreeadmissionsby1999/2000,morerecentlythishasincreasedsomewhat.TherearealsoothercaveatsinrelianceondataintheAODTSannualreports,asinrecentyearsagenciesinWAandsomeotherjurisdictionshaverecordedincreasesincannabisrelatedadmissions,wheninfactthesehavemostbeenduetocourtdiversionprogramsforminorcannabisoffendersaspartofrequirementstoattendeducationalprograms.

Figure 4: Number of inpatient admissions for alcohol-caused mental disorders by ICD sub-groups, WA, 1967/1968 – 2009/2010

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Figure 5: Number of total admissions for treatment for alcohol, all admissions & % of alcohol admissions of total admissions, WA, 1975/1976 – 2015/2016 9 1990s to present: decriminalisation of drunkenness AshortcomingintheevolutionofmodeloftreatmentservicesestablishedandsupportedbytheADAfromthemid1970s,whichprogressivelydevolvedthemajorityoftreatmentservicestonon-governmentbodiesthroughtheseadministrativereforms,wasineffecttomarginalisethetreatmentofIndigenouspeopleandotherswithchroniclevelsofproblematicuseofalcohol.Thismeantsolongaspublicdrunkennessremainedanoffence,substantialnumbersofIndigenouspeopleinparticularcontinuedtobecaughtupintherevolvingdoorofthecriminaljusticesystem,iearrestforpublicdisorder,unabletopayfine,imprisonedanddischargedandreturntodrinkingandassociatedsocialandhealthproblems.ItwasnotuntilApril1990,withtherepealoftheConvictedInebriatesRehabilitationAct1963andthepassingoftheDetentionofDrunkenPersonsAct1989,thatpublicdrunkennesswasdecriminalisedinWA;areformwhichwasakeyrecommendationoftheRoyalCommissionIntoAboriginalDeathsinCustody(RCIADIC).69

69AboriginalAffairsDepartment,RoyalCommissionIntoAboriginalDeathsinCustody:GovernmentofWesternAustralia,implementationreport,AboriginalAffairsDepartment(Perth,WA,2001),www.daa.wa.gov.au/Documents/ReportsPublications/RCIADIC_Implementation_Report2000.pdf;JBrewer,"Publicdrunkenness-Australianlawandpractice,"inDeathsincustody:Australia,1980-1989.RoyalCommissionIntoAboriginalDeathsinCustody.ResearchPaperNo.3,ed.DBilesandDMcDonald(Canberra,ACT:AustralianInsituteofCriminology,1992);CCunneen,"ReflectionsincriminaljusticepolicysincetheRoyalCommissionintoAboriginalDeathsinCustody,"inReflections:40yearsonfromthe1967Referendum,Aboriginallegalrightsmovement,ed.GillespieN(Adelaide,SA:2007);RWHardingetal.,AboriginalcontactwiththecriminaljusticesystemandtheimpactoftheRoyalCommissionIntoAboriginalDeathsinCustody(Annandale,NSW:Hawkins

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Page27

Curiously,decriminalisationofpublicdrunkennesshadbeenresistedforsomeyears,evenbeingasserteditmaydepriveproblematicusersofalcoholwhocycledinandoutthecourtsandtheprisonsystemofsomeperceivedhealthandsocial‘benefits’whichtheyreceivedfrombeingincarcerated:‘Alcoholism…isaconditionwhichhasalwaysbeenthecauseofmanypeoplebeingimprisoned…InWesternAustraliathisproblemhasbeenaddedtobythepropensityofmanyoftheAboriginalpopulationforalcohol.Thereissomedangerthattheoptimismgeneratedbythedecriminalisationofalcoholicoffenceswillleadtoadeteriorationinthequalityofcareprovidedforalcoholics.…Whatprisonshavealwaysdoneforalcoholicsistocleanthem,feedthemandgivethemachancetorecuperate,ifonlyforashortperiod.Inthisrespectprisonhasbeenanasylum.’70

AspartofthisreformtheADAundertooktheprogressivefundingofsoberingupcentres(SUCs),oneofwhichwasinthePerthmetropolitanareaandtheremainderwerebasedintheNorthWestoftheState.71ThefunctionofSUCswastoprovidealow-costovernightnon-medicalservicealmostwhollyusedbyIndigenouspeople,thatprovidedpolicewithanalternativetolockupsasaplaceforshorttermprotectivecareofalcoholintoxicatedpeoplethattheyapprehended.Figure6referstotheperiod1963/1964to2010/2011andhasbeenincluded,eventhoughitcontainsdataconcernedwiththeoffenceofpublicdrunkenness,referringtotheperiodbeforeandafterdecriminalisationinMay1990.Thedatainthisfigureistodemonstratetheimpactofdecriminalisationofpublicdrunkennessandutilisesannualapprehensionsbypolicewhichresultedinanadmissiontoasoberingupcentre,asaproxymeasureofpublicdrunkennesssincedecriminalisation.Intheperiodpostdecriminalisation,theannualnumberofadmissionstoSUCsincreasedto2007/2008,supportingthebeliefthatdecriminalisationdidhaveanimportantimpactbyprovidingpolicewithanoptiontoconveyintoxicatedpeopletoasafeenvironmentotherthantoalockup.Therateofcharges/apprehensionsfordrunkennesshasremainedrelativelyconstantinWAsincetheearly1990s,thoughthedeclineinboththerateandnumberofadmissionstoSUCssince2008/2009appearstonotberelatedtoreductionsinalcoholintoxicatedpeople,butpossiblyduetochangesinfundingcriteriaandpriorities.Thesharppeakintheannualnumberofchargesoverthefour-yearperiodupto1975/1976requiresfurtherresearch,todeterminewhetheritwasaconsequenceoftheeffectoftheclosureoftheKarnetPrisonInebriatesSectionandtheestablishmentoftheADAintheearly

Press,1995);RoyalCommissionIntoAboriginalDeathsinCustody,RegionalreportofinquiryintoindividualdeathsincustodyinWesternAustralia,AustralianGovernmentPublishingService(Canberra,ACT,1991).70JEThomasandAStewart,ImprisonmentinWesternAustralia:Evolution,theoryandpractice(Perth,WA:UniversityofWesternAustraliaPress,1978),157-58.71GSwensen,UtilisationofsoberingupcentresinWesternAustralia,1990-1997,WADrugAbuseStrategyOffice(Perth,WA,1999);GSwensen,UtilisationofsoberingupcentresandtheirimpactondetentionsfordrunkennessinWesternAustralia,1990-2000,WADrugAbuseStrategyOffice(Perth,WA,2001);GSwensen,Utilisationofsoberingupcentres,1990-2002,DrugandAlcoholOffice(Perth,WA,2003);GSwensen,Utilisationofsoberingupcentres,1990-2003,DrugandAlcoholOffice(Perth,WA,2004);GSwensen,Utilisationofsoberingupcentres,1990-2004,DrugandAlcoholOffice(Perth,WA,2005);GSwensen,Utilisationofsoberingupcentres,1990-2005,DrugandAlcoholOffice(Perth,WA,2007);GSwensen,Utilisationofsoberingupcentres,1990-2007,DrugandAlcoholOffice(Perth,WA,2008).

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1970s,orotherreasons,suchasincreasedalcoholconsumptionfollowingtheloweringofthedrinkingageinWAfrom21to18in1971followingthecommencementoftheLiquorAct1970.9.1 Statistical summary

Figure 6: Number & rate of charges/apprehensions for drunkenness, WA, 1963/1964 – 2010/2011 InApril2013thegovernmentannouncedtheDAOwouldbecomepartoftheMentalHealthCommissionandthattheAlcoholandDrugAuthorityAct1974wouldberepealedsoastodissolvetheBoardoftheADA.Inaministerialstatement,theMinisterforMentalHealthstated:‘“TheStokesReporthighlightedtheneedforimprovedliaisonbetweenmentalhealthanddrugandalcoholservicestoco-operativelyprovidecareandinterventionforpatientswithdualconditions,”shesaid.“Thenewarrangementwillencourageculturechange,reducetheincidenceof‘silos’in-servicedeliveryandimprovethedeliveryofmentalhealthanddrugandalcoholservicesacrosstheState.”MsMortonsaidtheamalgamationwouldalsoensureintegrationofprofessionaleducationandtrainingandresearchactivitiesinthedrugandalcoholandmentalhealthsectors.

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ShesaidtheMHCandDAOcurrentlyoperatedprimarilyasthepurchaserofservicesacrossgovernment,andtheproposalwouldstrengthentheabilityofthedepartmentstonegotiateandmanagecontracts.”72

10 Discussion and conclusion Theresearchpresentedhereindicatestheprinciplesofgovernmentalityhasthepotentialtoassistinunderstandingwithrespecttotheuseofalcohol,ofhowatdifferenttimeperiods,policiesoperatedwhichdefinedandprioritisedtheregulationoftheuseofalcohol,tominimiseitsharmsandtomaintainsocialorder.Thesortofinformationrequiredtoidentifytheshiftsoveranextendedtimeperiodposedsomechallenges,suchasdeterminingimplementationoflegislativeprovisionsinaStatewhichcoveredanenormousgeographicalareaandsmalldispersedcommunities,reliabilityofandconsistencyintimeseriesdataconcerningutilisationofservicesandimpactofconstantcyclesofdepartmentalandadministrativechangeonqualityofrecords.Theemphasisonsocialorderunderpinnedthenecessityforsystemsofcomplianceandobservanceofrulesaboutappropriatebehaviourwasabletobeimplementedthementalsystemthroughtheconceptoftheinebriate,whichwassupportedbytheexistenceofabroaderframeworkwhichatdifferenttimesinvolvedarangeofdepartmentsandlegislation.Thismeansthatthementalhealthsystemshouldnotbeseenasactinginisolation,butthatitfunctionedasacomponentofabroaderframeworkofcontrols,includingthecriminaljusticesystemwhichenforcedaspectrumofoffencessuchaspublicdrunkennessandotheroffenceswhichcriminalisedpublicorderconsequencesassociatedwithalcohol,restrictionsonaccesstoalcoholinliquorlicensinglawsandprohibitionsthattargettedIndigenouspeopleinnativewelfarelegislation.Ofparticularinterestinthisregardishowtheframeworkofprovisionsininebriateandmentallegislationthatoperatedovertheperioduptothe1970senabledthealcoholindustrytobelightlyregulated.Thisoccurredasthecausesofalcohol-relatedmentaldisorders,aswellaspublicdrunkennessandotherconsequencesfromproblematicalcoholusewereseentobeafunctionofindividualshortcomings.‘Itwaslargelyamatteroftemperamentwiththeindividual,(which)becameadisease.Thisisanearlyexampleofthewayinwhichindividualisticbasisofthediseaseconceptfittedwellwiththeinterestsoftheliquortrade,unliketheprevention-oriented,consumptioncontrolaimsofthenineteenthcenturyTemperancemovement,andofthepublichealthlobbyofthe1980s.’73

Therewerealsolimitedinterestinreducingtheconsumptionofalcoholovertheperiodfrom1900tothe1940s,asoverthisperiodmilitaryregulationswereappliedtothetwoperiodsassociatedwithbothWorldWarsIandIIinrelationtoopeninghoursofhotelsnearportsandrailwaystationsandrestrictedservingofalcoholtoservicemen.PolicymakersinAustraliawerewellawareoftheexperienceintheUnitedKingdomintheWorldWarIperiodwhen

72Morton,"DAOjoinsMentalHealthCommission(Mediastatement)."73MLewis,"TheearlyalcoholismtreatmentmovementinAustralia,1859-1939,"DrugandAlcoholReview11(1992):79.

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accesstoalcoholwasheavilyregulatedtoensureproductionandefficiencywasnotadverselybyproblematicuseofalcoholwhichhadunderminedthewareffort.74However,overtheperiodafterWorldWarIItheconsumptionofalcoholinWAsubstantiallyincreased,from6.3litresofabsolutealcoholpercapitain1945/1946to10.8litresofabsolutealcoholpercapitain1977/1978,followedbyalevellingoffsince.Thislongertermofincreasingalcoholconsumptionismirroredintheincreaseintheratesofalcohol-relatedhospitaladmissionsincreasedtothelate1970s,thendecreasedtotheearly1990sandsincethenhaveincreasedmarkedly(Figure4).Theperceptionsofthevalueofappropriatebehaviourtowardsothershasbeenembodiedintheconceptofmanners,whichhasalongpedigreeandcanbetracedfromtheuseofsumptuarylawswhichutilisedexternalcontrolsandpunishmentsfortheeffectasnecessary,whichattheirheartwereconcernedwithconsumptionandregulationofimpulses.75Morerecentlygovernancehasevolvedtoanexpectationtheindividualshouldbeself-regulating,evidencedbyassumingandmaintainingresponsibilityfortheirownhealthandtomakeconsideredchoicestorationallyreducerisks,suchastodrinkalcohol‘responsibility’inaccordanceofrecommendedsafelimits.76Nudgetheoryhasalsobeenadvocatedasamechanismforpolicymakerstoeffectbehaviouralchangesfortheadoptionahealthierlifestyleinvolvingarangeofhealthissues,includingtheusealcohol.77Thisshifttoself-governanceisreliantonarationalconsumer,aspartofabroadergoaltocreateaneo-liberalopenmarket.Theopenmarketextollsareducedregularlyroleofthestatevisavistherelianceofself-regulationbyindustry,forinstancetheadoptionofindustry

74HCarter,Thecontrolofthedrinktrade:Acontributiontonationalefficiency1915-1917(London:Longmans,Green&Co,1918).75CIDick,"Sumptuarylawbyanyothername:manifestationsofsumptuaryregulationinAustralia,1901-1927(PhDthesis)"(UniversityofWollongong,2015),http://ro.uow.edu.au/theses/4490;AHunt,Governanceoftheconsumingpassions:ahistoryofsumptuaryregulation(London,UK:Hutchinson,1996);Hunt,"Thegovernanceofconsumption:sumptuarylawsandshiftingformsofregulation.";AHunt,Governanceoftheconsumpingpassions:ahistoryofsumptuarylaw(London,UK:MacmillanPress,1996).76HomeOffice,TheGovernment'salcoholstrategy,TheStationeryOffice(London,UK,2012),http://www.homeoffice.gov.uk/publications/alcohol-drugs/alcohol/alcohol-strategy.NationalHealthandMedicalResearchCouncil,Australianguidelinestoreducehealthrisksfromdrinkingalcohol,NationalHealthandMedicalResearchCouncil(Canberra,ACT,2009),https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcohol.pdf;NationalHealthandMedicalResearchCouncil,"RevisionoftheAustralianguidelinestoreducehealthrisksfromdrinkingalcohol2009.";HealthDepartmentofWesternAustralia,Alcoholuseandsocialdisruption:AnalcoholeducationcampaignforWesternAustralia,HealthDepartmentofWesternAustralia(Perth,WA,1993);HealthDepartmentofWesternAustralia,WesternAustralianHealthPromotionStrategicFramework2007-2011,HealthDepartmentofWesternAustralia(Perth,WA,2007);HealthDepartmentofWesternAustralia,"WesternAustralianHealthPromotionStraegicFramework2012-2016,"(2012).www.public.health.wa.gov.au/2/1588/2/health_promotion_strategic_framework.pm.77AArnoandSThomas,"Theefficacyofnudgetheorystrategiesininfluencingadultdietarybehaviour:asystematicreviewandmeta-analysis,"BMCPublicHealth16(2016),https://doi.org/10.1186/s12889-016-3272-x,http://download.springer.com/static/pdf/787/art%253A10.1186%252Fs12889-016-3272-x.pdf;NBiddleandKCurchin,"Thepromiseandperilsofgivingthepublicapolicy'nudge',"(1May2014).http://theconversation.com/the-promise-and-perils-of-giving-the-public-a-policy-nudge-24887;HTMeyer,"'Responsibilitydeal'announcedashealthgroupwithdraw,"(15March2011).http://www.alcoholpolicy.net/2011/03/respsonsibilty-deals-announced-but-health-groups-withdraw-.html;RHThalerandCRSunstein,Nudge:improvingdecisionsabouthealth,wealthandhappiness(Harmondsworth,England:Penguin,2009).

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overseencodesforalcoholadvertising.78Thishasbeenaparadigmshiftinhowhealthisviewedandunderstoodbyasthe‘Newpublichealth’,79which‘(w)hiletheemphasisisshiftedtosocialaspects,thestrategyalsofocusesonindividuals:ineffect,thebasisassumptionofthenewpublichealthistoincreasecitizens’responsibilityforrisksandpossibilitiesconcerningtheirbodiesandhealth.’80

ThisretreatbygovernmentfromdirectserviceprovisioninfavourofaregulatoryrolewascrystallisedintheadoptionandimplementationoftheNationalCompetitionPolicyinAustraliaovertheperiod1995to2005:‘TheNationalCompetitionPolicywasAustralia’slandmarkmicroeconomicreformprogram.Akeyprincipleoftheprogramwasthatcompetitivemarketswillgenerallybestservetheinterestsofconsumersandthewidercommunity.’81

Inadditiontothementalhealthsystem,repressivemechanismswereexercisedbythecriminaljusticesystemfromoffencesinthePoliceAct1892,whichimposedfixedtermsofimprisonmentforrepeatoffendersforpublicdrunkenness.Ineffectthismeantthepowersavailablethroughthecriminaljusticeandthementalhealthsystemsfromtheearly1900sestablishedaframeworkofcoerciveandpunitivemeasureswhichtargetedproblematicusersofalcohol.Thissystemwaspredicatedonthebeliefthatwithoutstrictcontrols,theunfettereduseofalcoholposedaseriousrisktosocialorderandthestabilityofthefamily.Inadditiontotherepressiveprovisionsinbothmentalhealthandpolicelegislation,provisionswerealsopresentinotherlegislation,whichsustainedanenvironmentofcontroloveralcohol,suchasrestrictionsonSundaytradinghoursofhotels,theclosureofhotelsonholidaysintheChristiancalendar,thecreationofextendedopeninghoursinminingregionsandspecifiedhoursoftradingthroughspecialclassesoflicenses.Otherexamplesoftheperceivedthreatofalcoholtosocialorderwereinmatrimonialmatters,wherealcoholismwasagroundfordivorceundertheState’sMatrimonialCausesandPersonalStatusCode1948.Therewerealsorestrictiveprovisionsin‘nativewelfare’legislation,whichtargetedIndigenouspeoplebyexcludingthemfromgazettedtownsandprohibitionofalcoholuseinprescribedzonesintheState,astheywereregardedasbeingincapableofusingalcoholsafelyduetosupposedracialandgenetic-basedfactorssuchasaldehydedehydrogenasedeficiency,82justifyingprohibitionuse.Allofthesemeasuresestablishedapervasivesystemofcontrolsovertheuseofalcohol,whichsharedapremisethegenesisofproblematicuseofalcoholwaslocatedintheperson.Thisperceptionwasusedtojustifytheuseofanarrayofpunitive,coerciveandpersuasivemeasurestoreform,correct,educate,treatandrehabilitatesuchindividuals.

78GSwensen,"Publicspaceandalcoholadvertising:exploratoryroleoflocalgovernment,"InternationalJournalofAlcoholandDrugResearch5(3)(2016).79APetersenandDLupton,Thenewpublichealth:healthandselfintheageofrisk(London:Sage,1996).80CTigerstedt,"Alcoholpolicy,publichealthandKettilBruun,"ContemporaryDrugProblems26(1999):212.81NationalCompetitionPolicy.<http://ncp.ncc.gov.au/pages/overview>82JGreeleyandWGladstone,"Alcoholandhumanbehaviour(ResearchpaperNo.14),"inDeathsincustodyAustralia,1980-1989:ResarchpapersoftheCriminologyUnitoftheRoyalCommissionintoAboriginalDeathsinCustody,ed.DBilesandDMcDonald(Canberra,ACT:AustralianInstituteofCriminology,1992).

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‘Theeffectsofalcoholicbehaviouronthebodyhavecometobeconsideredas’symptoms’ofa’disease’,butifalcoholismisconceivedasawayoflife,the’symptoms’wouldbebetterregardedasthesideeffectsoftheexcessiveconsumptionofalcohol.’83

Thisunderstandingcreatesapervasiveideologythateveryonehasafreedomtodrink,exceptthatthosewhoareproblematicusersofalcohol,forwhomtreatmentmayberequiredduetoaninabilitytoself-regulate,inspiteoftheexistenceofadversesocialandothercircumstances.ThisperspectivewasrecognisednearlythreedecadesagoinalandmarkreportbytheAmericanInstituteofMedicinepublishedin1990:‘Alcoholisadrug,anditsdirect,relativelypredictable,anduniformactionsonthehumanorganismhavebeenwelldocumented.Yetalcoholproblemsareexperiencedbyspecificindividuals,wholiveandmoveandhavetheirbeingwithinverydifferentsocial,psychological,andculturalenvironments.84

Theresurgenceinestablishingcourtadjudicatedprocessestocompelproblematicusersofalcohol,aswellasotherdrugs,toundergoaregimeofabstinencefocussed‘treatment’incustodialsettingscanbetracedfromthegrowthofDrugCourtsintheUnitedStates.Theuseofdrugcourtsandothercourt-overseencoercivemeasureshavesinceproliferatedinanumberofjurisdictions,includinginAustralia.Giventherecencyofstatementsbythegovernmentithasbeendifficulttoidentifythetypesofinstitutions,arrangementsandsupervisorystructuresthatwouldbeneededtoproducetheoutcomesexpected.However,inthelightoflittleevidencetosupportsimilarapproachesinthepast,itisarguedthesereformsmaybemostlyaboutpunishmentandnotmuchabouttreatment.

83MSargent,"Heavydrinkinganditsrelationtoalcoholism-withspecialreferencetoAustralia,"Australian&NewZealandJournalofSociology4(1968):146.84InstituteofMedicine,Broadeningthebaseoftreatmentforalcoholproblems(Washington,DC:NationalAcademyPress,1990),20.

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