Introduction

This special edition of Health Sociology Review has been prompted by ongoing claims about escalating mental health problems and their management in Australia and other western countries. It provides sociological discussion of the key issues and challenges currently confronting practitioners and service provision some two decades on from the closure of many asylums across Australia. This collection of papers follows an earlier special issue (Savy 2005) dedicated to the social implications of asylum closure in Australia and the transfer of care to community settings. Since this major shift in the location and philosophy of treatment, policy rhetoric has emphasised 'recovery' and 'consumer participation' as central to service provision. These elements are undoubtedly significant for the achievement of optimal and individualized care outcomes. At the same time, they assume the availability and readiness of service providers and professionals to establish and maintain the necessary, therapeutic relationships with clients.The earlier special issue was published in the wake of the release of Not for service: Experiences of injustice and despair in mental health care in Australia (Mental Health Council of Australia and the Brain and Mind Research Institute 2005). Many of the problems identified in this report through the voices of service users, family carers, mental health professionals and advocates have been echoed in subsequent government reports (Commonwealth of Australia 2006; Stolk et al. 2008), reports from peak bodies (e.g., SANE Australia 2010; VMIAC 2011) and frequently in media articles (e.g., Bender 2010; McGorry 2010). The Senate Select Committee on Mental Health (Commonwealth of Australia 2006:15-19) reported 'an urgent need for more mental health services' to meet demand; continued underfunding of community-based services; marked variation in the quality of care from place to place; 'a significant divide between rich and poor' in terms of access to care and treatment options; and the prevailing dominance of the medical model, which continues to sideline non-medical approaches to treatment and support, including recognition of the social causes and pathways of mental illness.Mental health policy development has been very progressive in Australia with its focus on the human rights and social inclusion of individuals with mental disorders, and endorsement of 'active' participation of service users and carers in treatment decisions and service planning (Commonwealth of Australia 2009; Victorian Department of Human Services 2009). Despite various advances in mental health service design since 2005, including the growth of anti-stigma campaigns, 'step up/step down' programs to support before and after admission to acute inpatient units, and early intervention services (e.g., Victorian Department of Human Services 2009:8), there is overwhelming consensus amongst many carers, service users, professionals and leading advocates of mental health care that these improvements do not go far enough (ABC Radio National 2010, 2011; Hagan 2010). Widespread dissatisfaction remains concerning the quality and availability of services. The principles of care are clear and well designed but, according to the above reports, their translation into practice is contentious.Similar concerns have been voiced in the United Kingdom. From their standpoint as both mental health practitioners and academic researchers, Lester and Glasby (2006:221) concluded that:Over time, mental health services have struggled to reconcile ongoing tensions between care and control, between community and acute care, and between user involvement and the regulation of potentially dangerous behaviour ... Although we seem to know what the key issues are, we also seem remarkably unable to solve them, as the same themes and concerns keep recurring throughout the history of mental health services.In considering possible explanations for the lack of positive change, Lester and Glasby (2006:221) identified 'the broad range of stakeholders involved in mental health services and the very broad views they have about the world and about what constitutes valid evidence'. …