The Medico-Legal Society of Victoria was established in 1931. The objectives of the society are the promotion of medico-legal knowledge and the fostering of professional and collegiate scholarship and interaction among members of the medical and legal professions. This is achieved by facilitating the exchange of ideas and information at general meetings held about six times per year. Persons of eminence in their field are invited to the meetings to deliver papers of mutual interest to the two professions.
25 years ago Victoria led Australia, and arguably the world, as the 19th century asylums were swept away in the final phase of deinstitutionalisation. The land was sold and realised huge sums of money for government. We drastically reduced inpatient beds with were relocated to general hospitals, though typically squeezed into poorly designed and confined spaces. Victorians were promised this would work, provided we built strong community mental health services to allow us to cope with the loss of beds. There was initially great energy and innovation, with early intervention, dynamic and intensive home-based care and case management teams springing up. 20 years ago Victoria had the highest per capita spend of all States on mental health care, and was seen as the “jewel in the crown” of Australian and even global mental health care. Tragically over the past two decades, Victorians have seen this brave new world crumble and descend into an appalling crisis. I have characterised this decline as “Victoria’s Mental Breakdown”. The causes are clear. Firstly, the design of the new system was flawed with the governance and financing of the new system sitting unprotected within the major acute hospital networks, and the community mental health system, in which 95% of patients sit at any given moment, progressively neglected. Secondly, as stigma faded and the population surged dramatically, investment collapsed, and Victoria sank to the lowest level among the States. 3% of Victorians experience serious mental illness, which is the responsibility of State governments, yet only 1.1% are covered by current levels of expenditure. Hence, every day 2 out of 3 seriously ill Victorians are turned away from public mental health services. There is a rising tide, especially of young people, desperately seeking help in our emergency departments, widely acknowledged to be highly unsuitable venues for the care of distressed and suicidal people. Over 600 Victorians die annually from suicide. They don’t have terminal illnesses and their deaths are all therefore preventable. This collapse of public mental health care represents a “death of a thousand cuts”, and has happened in every jurisdiction where this careless and complacent approach to deinstitutionalisation has occurred. However, Victoria’s decline, her mental breakdown, is among the most spectacular and disappointing given such early promise. We cannot just blame governments, it is a collective failure of leadership and of our society that despite the dramatic rise of awareness and the decline of stigma, we have failed the severely mentally ill, and especially our young people in whom mental illnesses generally appear for the first time.
Membership of the Medico-Legal Society of Victoria is open to legally-qualified members of the medical and of the legal professions.