Bernie Goldie

Book debunks myth behind ‘deinstitutionalisation’ of mental patients

The deinstitutionalisation of people from mental hospitals in Australia and the US over the past 50 years has cost the community dearly, according to the author of the aptly titled new book, Penny Wise, Pound Foolish.

Dr Ciorstan Smark’s book highlights how growing expenses in keeping mental institutions open made ideas of community care attractive to governments footing the bills for mental institutions.

However, Dr Smark, a Senior Lecturer in the University of Wollongong’s School of Accounting and Finance, points out that funding for appropriate levels of community support have never been forthcoming.

“Costs have fallen instead on people with mental illness, on their families and carers and on other institutions such as homeless shelters and jails,” she said.

“The costs have wound up being heavier than the savings.”

Dr Smark argues that the term ‘deinstitutionalisation’ is simply misleading.

“The assumption under which the mental health industry has operated for many years is that patients were transferred from institutional care in state mental hospitals to ‘the community’, where they would presumably receive ‘treatment’ and ‘services’.

“The myth in this instance is not that the state hospital census decreased, which it did, but that patients left institutional settings for the community, where they benefited from a change in the form in which publicly supported care was provided to the chronically mentally ill.

“The professionals’ and the public’s folly has been to assume that once patients were outside mental hospitals they were outside institutions. Nothing could be further from the truth,” Dr Smark said.

Her book is based on her PhD studies. She completed her PhD in the area of accounting's role in the deinstitutionalisation from mental hospitals in NSW. Dr Smark’s late uncle, John Gordon Collins, lived bravely with schizophrenia for many years.

Penny Wise, Pound Foolish is published by VDM which can be reached via email at Dr Smark researches in the areas of finance, cost shifting, accounting, business ethics and financial planning.

Sections of her book form part of the studies for third year financial accounting students at UOW.