Housing and mental health: Living in a regional Australian community with a serious mental illness

In Australia, as a result of deinsitutionalization policy and legislative demands that insist that care and treatment is provided in the least restrictive way while undertaken within a framework of human rights, the majority of people with a mental illness live in their community. The closure and downsizing of psychiatric institutions, which commenced in the late 1970s and continues more than two decades later, was undertaken not only for fiscal reasons, but also in the belief that living in the community would provide people with more choice, increase their level of autonomy and ensure a better quality of life.

This research, a unique study conducted in regional Australia, provides an opportunity to reflect on past policies and examine current trends from a consumer perspective. A grounded theory methodology was utilised to explore the experiences of living with a mental illness and residing in a community in Central Queensland. Such an approach was used in the writings of Erving Goffman, particularly his seminal texts: Asylums (1961) and Stigma (1963).

Taking up the idea that there is an important relationship between wellness and housing, this research focussed on the place where people were living in order to explore issues of public policy, autonomy and service support. Fifteen people with a serious mental illness consented to an in-depth interview during which the relationship between where they lived and their quality of life was discussed.

An analysis of policy and legislative frameworks was also undertaken, and in particular the most recent changes to mental health legislation in Queensland. In this sense, examining the relationship structures of policy becomes a powerful way of linking the action of the state to the consequent reaction of the person who is living with a mental illness - in other words, who is 'living the policy'. 

The research concluded that the belief that being housed 'in the community' is 'better' for people with a mental illness should be challenged, most particularly for those who live outside metropolitan settings. The respondents to this study reported severe restrictions to their autonomy, continued stigmatisation within their community and the experience of on-going discrimination, with few available choices in their lives. In addition, they reported the anxiety associated with home visits by case managers and mental health professionals as 'checks' which, should they fail, might mean re-admission to hospital. Drawing on Goffman, the research concludes that living in 'an institution without walls' best describes their current circumstances.