Over the period since 1900 a number of approaches have been adopted to manage and provide treatment to problematic users of alcohol in Western Australia (WA). The term ‘treatment’ is used loosely to refer to the broad conceptual approaches for managing problematic users in WA over the period.
However, our contemporary understanding of the term ‘treatment’ is an inaccurate characterisation of punitive practices accepted in the earlier part of the period, even though these were referred to as ‘treatment’ in official accounts of that time.
This page is concerned with the genesis and the application of models of civil commitment in WA over the period from 1900 involving the mental health system.
At this time two approaches of civil commitment have operated in WA specifically concerned with problematic users of alcohol –
- commitment of an ‘inebriate’ under mental health legislation
- commitment of a ‘convicted inebriate’ to a prison-based rehabilitation regime, under the Convicted Inebriates Rehabilitation Act 1963, for the offence of public drunkenness
There is the possibility of the reintroduction of a variant of civil commitment, involving compulsory treatment, apparently to specifically target problematic users of amphetamine type substances.
The Mental Health Commission (MHC) released a proposal for compulsory treatment of alcohol and other drug users for public comment in September 2016.
Click here to view or download a copy of the MHC background paper.
Inebriates – Mental health system (1900 – 1974)
This model of civil commitment relied on provisions in inebriates legislation, coupled with mental health legislation, to compel ‘inebriates’ to undertake detoxification and supervised rehabilitation in ‘asylums’ and other mental health facilities.
This approach was not supplanted until the early 1970s, when the Alcohol and Drug Authority (ADA) was established, marking the development in November 1974 of a system of specialist treatment services in WA, separate from the mental health system.
In the colonial era, before 1900, in WA, the ‘insane’ were initially managed under the UK statute, the Lunacy Act 1845, which had been adopted when the Swan River Colony was established in 1829, and which was replaced by a local statute, the Lunacy Act 1871.
The Fremantle Asylum was opened in July 1865 and operated on a custodial basis staffed by warders, along similar lines to the Fremantle Prison, as destination for those formerly would have been confined in Fremantle Prison, for alcohol-related disorders, as well as other types of mental illness.
The role of the Fremantle Asylum was supplanted by Claremont Asylum, which opened in 1903, after the construction of a number of temporary buildings. Most of the patients were progressively transferred from Fremantle Asylum as buildings were constructed on the Claremont site, except for female patients who were the last to be transferred in 1908.
After the departure of female patients the former Fremantle Asylum in 1908 it was declared a Poor House, known as the Women’s Home. The Women’s House was finally closed in 1941.
Although officially known as the Claremont Hospital for the Insane, the facility was commonly referred to as the Claremont Asylum and housed the majority of the State’s patients with mental illnesses requiring institutional management. There were separate wings for male and female adult patients and children, with the majority of patients admitted by certification under the Lunacy Act 1903, which included provisions for the detention of ‘habitual drunkards’ in Part IV.
Part IV of the Lunacy Act 1903 was repealed and re-enacted in the Inebriates Act 1912, which sought to reflect a less restrictive approach for committing inebriates, compared to arrangement in the Lunacy Act 1903. The 1912 legislation permitted that either a Magistrate or a Judge could make an inebriate order, whereas in the 1903 legislation only a Judge was able to make an order.
The Inebriates Act 1912 provided in Section 6(3) that the inebriate was to be ‘afforded an opportunity of being heard in objection’ – a provision that was not included in the 1903 legislation and the possibility of extensions of the original order could be obtained, for additional periods of up to 12 months, whereas the 1903 legislation did not permit an extension beyond 12 months.
Before the commencement of the ADA in November 1974, which was established by the Alcohol and Drug Authority Act 1974, there were two hospital-based options for short-term management of those suffering from acute effects of alcohol or other drugs in WA.
One option was confinement, an approach which had existed from colonial times, in relation to those acutely affected alcohol, as this approach regarded acute intoxication as a temporary form of insanity to be managed by committal and confinement. This approach, which originated from colonial times, was continued at Claremont Asylum from 1903.
The committal of intoxicated persons and those with other forms of alcohol-related mental disorders to the Claremont Asylum occurred up to the mid 1960s through powers under the Lunacy Act 1903 and the Inebriates Act 1912. This approach continued until the mid 1970s, even though the inebriates legislation was repealed by the Mental Health Act 1962, who did not come into effect until July 1966.
This meant the mental health system was for a substantial period of time the key provider of services for those experiencing acute effects from alcohol use, drugs (eg drug induced psychoses), as well as those affected by mental disorders associated with longer term chronic use of alcohol, such as dependence, delerium tremens (DTs) or Korsakov’s psychosis.
There was sub-group of those affected by alcohol and other drug-related mental disorders who could be treated without the process of committal at Claremont Asylum (which was renamed Graylands Hospital in the early 1970s) were in some circumstances able to receive treatment through avenues at other hospitals.
One such avenue was available through the Mental Treatment Act 1927, which had originally been used to provide a separate treatment facility for service men returned from World War I who had significant impairment from post traumatic stress disorders, described at that time as ‘shell shock’ and were hospitalised at Lemnos Hospital.
The Mental Treatment Act 1927 included provisions for voluntary admission to the State’s other major mental health facility, Heathcote Mental Reception Home (HMRH). The introduction of the Mental Treatment Act 1927 paved the way for the establishment of HMRH, which operated to distinguish from those certified as being insane and committed to Claremont and those who were considered as being mentally ill (ie not suspected of being insane), who could be admitted as a ‘voluntary boarder’ under the 1927 legislation.
HMRH was opened in February 1929 and operated as a facility for people with a range of mental disorders until its closure in 1994. This name continued to be used until 1948 when it was renamed the Heathcote Reception Hospital. The inclusion of the term ‘reception’ as part of the title was to distinguish that, unlike the Claremont Asylum, that Heathcote was a short term facility intended as a place the treatment of mental illness for voluntary patients.
Another option, which had existed since colonial times and continued into the 1900s, was admission of those suffering from acute effects of alcohol or other drugs to a mental health ward at Royal Perth Hospital (RPH), the major adult metropolitan public hospital. This hospital was originally called the Colonial Hospital established in 1855, which was subsequently renamed the Perth Public Hospital, the Perth Hospital and since 1946 has been known as RPH.
Therefore, by 1930s there were at least three pathways for the institutional management of mental illness (which included alcohol-related disorders) in public hospitals in WA –
- certification which meant a person would have been committed to Claremont
- admission to a small number of ‘reception homes’ which had been gazetted as places where a person with mental illness could be admitted as a ‘voluntary boarder’
- admission to the Mental Health Ward at Perth Hospital
There was also a limited role undertaken by emergency departments at the other major adult metropolitan public (teaching) hospitals of Fremantle Hospital and Sir Charles Gairdner Hospital. Problematic users were also able to obtain treatment at regional hospitals outside the Perth metropolitan area, especially at Kalgoorlie Regional Hospital, for short-term admission management and detoxification for acute alcohol-related conditions when they may also have had co-occurring other medical conditions.
The formal separate administrative responsibility for mental health services occurred in January 1950, with the establishment of the Mental Hospitals Department. In 1954 it was renamed the Mental Health Services (MHS) and its function was to provide a free comprehensive psychiatric service and was responsible for the prevention and treatment of mental illness throughout WA.
The MHS also provided facilities for the assessment and care of the intellectually handicapped. The department operated under the Lunacy Act 1903 to June 1966 and then under Mental Health Act 1962 from July 1966.
In May 1984 the Public Health Department, the Department of Hospital and Allied Services and the Mental Health Services were amalgamated into a single department, the Health Department of Western Australia. The MHS ceased to operate as a separate entity as a result of this amalgamation.
Convicted inebriates: Prison system (1963 – 1975)
The passage of the Convicted Inebriates’ Rehabilitation Act 1963 (CIRA) enabled Magistrates to formally commit ‘convicted inebriates’ to a low security farm-based prison, Karnet Prison, for periods of enforced detoxification and rehabilitation.
Responsibility for the administrative oversight and disposition of convicted inebriates was placed with the Convicted Inebriates Advisory Board, which was established under the Convicted Inebriates Rehabilitation Act 1963.
The Board employed a welfare officer and at least one sessional medical practitioner who provided opinions to the courts at the time of committal regarding suitability in terms of a history of serious problematic alcohol use, which made an order with conditions for compliance. The Board also provided advice to the court for extensions and discharging orders.
The Karnet Inebriates Section opened in March 1963, prior to the commencement of the CIRA arrangements. This operated as an informal process within the prison system as part of a pre-release program for prisoners with prior histories of problematic alcohol use, until the formal operation of the CIRA in December 1963.
The CIRA commenced December 1963 until the Convicted Inebriates’ Rehabilitation Act Amendment Act 1974, which came into effect in November 1974. The Prisons Department acquired a separate farming property in Byford, which was expanded into the Byford Inebriates Centre, which opened in March 1972.
The functions of the Convicted Inebriates Board were transferred to the ADA and the Byford Inebriates Centre continued to operate when the property was transferred to the ADA in November 1974, who renamed it Quo Vadis Hospital in May 1975.
The CIRA was repealed by Convicted Inebriates’ Rehabilitation Repeal Act 1989.
This system of prison-based commitment operated separately and in parallel and in addition to the Inebriates Act 1912, which supported the system of asylum-based commitment of those with alcohol-related mental disorders, as described earlier.
‘Where a person is convicted summarily, or on indictment, of an offence and drunkenness is an element, or was a contributory cause, of the offence, the court, if satisfied that the offender is an inebriate, may order him to be placed in an institution, for a period not exceeding twelve months.’ Section 4(1)
It is debatable that CIRA system was ‘treatment’, as a committal order under the CIRA, was a term of imprisonment to Karnet Prison. An attraction for policy makers for the CIRA model was that it was a perceived solution to a law and order problem, involving a small but visible group of ‘alcoholics’ or ‘public drunkards’.
Similar legislation had been adopted in other jurisdictions, which also targeted chronic public inebriates (CPIs).
Sources of data: Annual reports
Official publicly available detailed statistical information about operation of services to manage problematic users of alcohol can be found in a number of different sources, the primary source until the 1970s being annual departmental reports of the Mental Health Services (MHS).
A standard feature of annual reports was the inclusion of information in a summary form about those admitted to inpatient facilities, as well as other information about changes in organisational arrangements, developments in services and policies and renaming of departments.
This means annual reports can potentially be a rich source of statistical data contained in appendix tables of breakdowns of data about utilisation of services and other measures, such as sub-categories of admissions, appended to annual reports.
It should also be noted that –
- annual reports were issued under the title of departmental CEO’s, Inspector General of the Insane (1903 – 1945/1946), Inspector General of Mental Hospitals (1946/1947 – 1952/1953), Inspector General of Mental Health Services (1953/1954 – 1960/1961), and from 1961/1962 under the departmental name of MHS
- reporting related to patient utilisation of services was published on a calendar year basis from 1900 to 1963, then switched to a financial year basis from 1963/1964. (Note: Annual reports published income and expenditure data on a financial years basis from 1909/1910.)
- some annual reports have been lost or were not produced
Statistical information about the operation of the Convicted Inebriates Board are contained within annual reports of the prisons department over the period of the operation of the CIRA.
Annual reports: Fremantle Lunatic Asylum (1899 – 1900)
- 1899 [1.1MB]
- 1900 [911k]
Annual reports: Inspector General of the Insane (1903 – 1945/1946)
- 1903 [8.3MB]
- 1904 [853k]
- 1905 [3.4MB]
- 1906 [6.5MB]
- 1907 [6.5MB]
- 1909/1910 [736k]
- 1910/1911 [1.2MB]
- 1911/1912 [1.2MB]
- 1912/1913 [980k]
- 913/1914 [943k]
- 1914/1915 [927k]
- 1915/1916 [1.8MB]
- 1916/1917 [2.0MB]
- 1917/1918 [983k]
- 1918/1919 [1.1MB]
- 1919/1920 [4.3MB]
- 1920/1921 [1.1MB]
- 1921/1922 [1.1MB]
- 1922/1923 [1.2MB]
- 1923/1924 [976k]
- 1924/1925 [1.2MB]
- 1925/1926 [1.3MB]
- 1926/1927 [945k]
- 1927/1928 [1.1MB]
- 1928/1929 [1.0MB]
- 1929/1930 [920k]
- 1930/1931 [1.4MB]
- 1931/1932 [1.3MB]
- 1932/1933 [2.3MB]
- 1933/1934 [1.6MB]
- 1935/1936 [1.1MB]
- 1936/1937 [1.1MB]
- 1937/1938 5.9MB]
- 1938/1939 [1.2MB]
- 1939/1940 [1.6MB]
- 1940/1941 [1.5MB]
- 1942/1943 [1.4MB]
- 1943/1944 [1.3MB]
- 1944/1945 [1.1MB]
- 1945/1946 [1.2MB]
Annual reports: Inspector General of Mental Hospitals (1946/147 – 1952/1953)
- 1946/1947 [1.6MB]
- 1947/1948 [2.0MB]
- 1948/1949 [975k]
- 1949/1950 [1.4MB]
- 1950/1951 [10.5MB]
- 1951/1952 [1.6MB]
- 1952/1953 [1.3MB]
Annual reports: Inspector General of Mental Health Services (1953/1954 – 1960/1961)
- 1953/1954 [1.6MB]
- 1954/1955 [1.6MB]
- 1955/1956 [1.8MB]
- 1956/1957 [1.9MB]
- 1957/1958 [2.1MB]
- 1958/1959 [2.0MB]
- 1959/1960 [2.7MB]
- 1960/1961 [2.3MB]
Annual reports: Mental Health Services (1961/1962 – 1978/1979)
- 1961/1962 [3.1MB]
- 1962/1963 [2.7MB]
- 1964/1965 [5.6MB]
- 1965/1966 [3.9MB]
- 1966/1967 [9.5MB]
- 1967/1968 [7.3MB]
- 1968/1969 [3.9MB]
- 1969/1970 [2.8MB]
- 1970/1971 [7.3MB]
- 1971/1972 [6.5MB]
- 1972/1973 [2.5MB]
- 1973/1974 [1.1MB]
- 1974/1975 – Excerpt [419k]
- 1975/1976 – Excerpt [445k]
- 1976/1977 – Excerpt [227k]
- 1977/1978 – Excerpt [240k]
- 1978/1979 – Excerpt [395k]