Aftermath to Lattermath and the Iconomy of Psychiatry: Shifting from hospital-centric towards community-centric mental health-care ecosystems

Alan Rosen

doi:10.1921/swssr20252532

Authors

Alan Rosen University of Sydney https://orcid.org/0000-0001-5478-702X

DOI:

https://doi.org/10.1921/swssr20252532

Keywords:

aftermath, lattermath, iconomy, shifting centre of gravity, hospital-centric, community-centric, mental healthcare ecosystems

Abstract

Drawing on Professor Emeritus Terry Smith’s work on Aftermath Architecture, we reflect on how the world’s purportedly ‘eternal’ architectural icons can be transformed in the public consciousness, by terrorism and political intrigue, into impermanent ‘soft targets’. In parallel we explore the grandiose ‘Iconomy’ of Psychiatry, and the decay of its grandiose institutional icons into stigmatizing stereotypes of dysfunctional mental health services. Professor Smith also invoked a related concept: the ‘Lattermath’, a late 15th century term for the new shoots of grass growing after harvest, to make the case that a renewal of hope is possible for architecture, prioritizing domestic and communal living. To achieve an enduring ‘Lattermath’ in psychiatry requires us to shift the centre of gravity of mental health services from being so hospital-centric towards community living. It also entails rebuilding mental health-care eco-systems which integrate clinical, lived experience, and carer expertise, while optimizing mental health and wellbeing outcomes., It also entails heeding First Nations caring for nature and community, their climate change activism and their resilience, and operationalizing human rights and an ‘invisible village’ or a co-designed local community of ongoing mental health care and support for individuals and families while ever they need it.

Author Biography

Alan Rosen, University of Sydney

Professor Alan Rosen, AO, is Professorial Fellow, Graduate School of Medicine and formerly Australian Health Services Research Institute, University of Wollongong, and Clinical Associate Professor, Brain and Mind Centre, University of Sydney, Australia; Senior Consultant and Academic Psychiatrist, Far West NSW Mental Health Services 1985-present, specialising in Community, Urban, Remote, and Aboriginal Mental Health Services; Officer of Order of Australia, conferred 2014; Ian Simpson Award, Royal Australian & New Zealand (ANZ) College of Psychiatrists, 1994; formerly Psychiatrist/Director/Clinical Director of Royal North Shore Hospital and Community Mental Health Services 1979-2009; and inaugural Deputy Commissioner of the Mental Health Commission of NSW 2012-2015, Member Mental Health Working Group, National Independent Hospital Pricing Authority 2013- and NSW Mental Health Review Tribunal 2020-; International consultant in MHS system redesign; Visiting Professor, University of Wisconsin 1990; Senior Fellow, Medical Anthropology and Social Psychiatry, Harvard University, 2006; Member, Section of Leadership & Management 2021-, Aboriginal and Torres Strait Islander Committee, 2014-2024, Royal ANZ College of Psychiatrists. Presidential Invited Speaker at American Psychiatric Association Annual Meeting, San Francisco and at World Psychiatric Association Congress, Berlin 2017 & Lisbon, 2019. Author/co-author-editor of 170 academic articles and chapters, several published books/manuals/ reports and many public media articles. ORCID: https://orcid.org/0000-0001-5478-702X

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