Unhealthy Acts: interpreting narratives of community mental health care inWaikato, New Zealand

This paper provides a regional commentary on the progress of deinstitutiona lization in an era of restructuring in New Zealand. The commentary focuses on the Waikato region, where the transition to community-based psychiatric care has been underway since the announcement of the closure of Tokanui Hos pital in 1993. We use media reports to construct a narrative illuminating t he distinctive threads of alternative discourse on the re-placing of people with mental health problems and sites of treatment 'into the community'. O ur interpretation of this local narrative is cast against a series of backd rops: firstly, we provide an abbreviated history of deinstitutionalization in New Zealand; secondly, we examine mental health care as a sector within a rapidly evolving health system; and, thirdly, we reflect on the implement ation of community mental health care in a re-regulated civil society. We a rgue that the effective implementation of community care has been hampered by the lack of concerted policy in the mental health care sector, by a fisc al squeeze on the health care system and by the impingement of non-health c are legislation (the Commerce Act, the Privacy Act and the Resource Managem ent Act) on the local expression and management of community care. In the W aikato narrative, we also identify administrative practices that have recas t people with mental health problems as criminals and reestablished prisons as the site of treatment. We conclude that the media in New Zealand have a role that extends beyond simply reporting on events. Indeed, the media act as a reflexive conduit; journalists interpret issues and through their 'st ories' help to shape the course of events.