Concern about the impact of the prolonged uncertainty created by the COVID-19 pandemic has generated new and poignant reflections on mental illness.

National survey data has also shown us that living through a global pandemic has the potential to change us. The pandemic shapes our thinking about mental health: our experiences of worry, fear, and our shared reactions to extreme stressors such as economic shock, job losses, isolation, and interrupted study.

For more than 20 years I have carried out research into mental illness, institutions, families and ideas about mental breakdown. This historical perspective on mental illness can add to our knowledge and understanding of mental health in these times. The past few months have reminded me that our society has a pattern of trying to solve the problem of mental illness. We have a history of innovative solutions to mental health care in communities, but these are perhaps not well known to the public.

These solutions include the creation of mental health 'aftercare' in Sydney in 1907. In 19th-century Australia, mental health institutions were overcrowded and run with custodial, rather than therapeutic, practices of restraint and seclusion. A person with experience of severe mental illness would typically be separated from society by being legally certified as insane and admitted as a residential in-patient to a state hospital for the insane. This took place under state lunacy acts, which saw significant amendments in the 1930s and at the end of the 1950s, when most states introduced mental health legislation.

Rates of recovery were low and stays were often long, though there was some movement in and out of institutions. Discharge of all but the sickest patients was one response to endemic overcrowding but it presented its own challenges in terms of ensuring patient wellbeing outside the institution.

From our current perspective, there was a lack of awareness of the effects of institutionalisation on those confined, and little organised assistance for people when they were discharged. One of my research interests lies in the many different extra-institutional solutions for the care of people with mental illness in different places around the world, and experiments with family care in Australia.

These included attempts at "boarding-out", trial leave and leave of absence from hospitals. Families have often struggled to engage with institutions and have always sought answers to their questions about mental breakdown and stress. I have written about these themes in my book Madness in the Family (2010), which tells the stories of families from NSW, Queensland and Victoria, and New Zealand, before 1910.

Closer to our own times, Newcastle was the hub for innovative out-patient care and community psychiatry from the 1970s. One of our history students, Robyn Dunlop, is undertaking a PhD on this topic. Robyn argues that innovation in Newcastle's mental health services and medical school in the period 1967-1980 was influenced by local and international networks. Her work shows the transformations that took place in social and medical understandings of mental illness.

An interdisciplinary ARC-funded research team based at Newcastle and the University of Sydney includes historians, a psychologist, a psychiatrist and mental health peer workers. We are looking at historical examples to plot the story of how community-based psychiatric services in Australia was driven by people passionate about alternatives to the large institutions for mental health that tend to loom large in the public imagination.

The project offers a richer understanding of our national history of mental health and care in the community at a time when mental health care is recognised as being in need of investment.

In my new book, Why Talk About Madness? Bringing History into the Conversation (2020), I argue that we need to embrace stories told by people with experiences of mental illness so that we can better appreciate its history, as well as its future.

I explain the way that the term "madness" has been reclaimed and used by advocates and activists in mental health. It is definitely a word that could seem uncomfortable or strange when we see it. It might not be for everyone, but it signals some connections between the past and the present, and also might help us to lessen the stigma around mental illness.

Professor Catharine Coleborne is Head of the School of Humanities and Social Science at the University of Newcastle.

Listen in to Professor Coleborne talk more about this subject and her research in the School of Humanities and Social Science podcast Our Human Experience

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