The Digital Pre-Clinic: Governmentality and Expertise in Australian Mental Healthcare

Abstract

Over the past decade, digital peer support services have become a vital element of Australia's mental health system. Promoted by the non-profit organisations that provide them as a way of connecting people with "shared experiences" of mental ill-health, these services have emerged within Australian public health as a key intervention in the management of the emergent category of "mild mental illness"; a state of minor mental ill-health conceived by public health authorities as a state of ill-health preceding clinical pathology. Employing a governmentality approach, this thesis analyses the efforts of Australian public health and digital peer support service providers to shape, guide and regulate the conduct of Australians through these digital services.

To do so, this thesis draws on qualitative research into two Australian digital peer support services: the Beyond Blue forums and Canteen Connect. Conducted throughout 2020-21, I undertook semi-structured interviews with lead moderators of these services and two Australian epidemiologists working in the field of digital mental health. Alongside this, I analysed key documents produced by Beyond Blue and Canteen, government authorities and epidemiologists.

Through analysis of this material, I argue that in response to the problems of the deinstitutionalisation of mental healthcare and the internet, Australian public health authorities transformed online health forums into mental health services that provide "digital peer support". I contend that this transformation produced these peer-to-peer sites as delivering what I term 'pre-clinical care', a form of support aimed at those who are constituted as not sick enough to require clinical care but could become sicker if left unattended. Following this, the thesis examines how these service providers attempt to deliver this pre-clinical care and the consequences of these practices. In this section of the thesis, I illustrate how these sites construct mild mental illness as a state of risk and ill-health, manageable through monitoring one's own and others' emotional states, productivity, and concentration; how the 'person with lived experiences' emerges within through sites as an 'expert healthcare consumer', operating to legitimise medical authority; and the ways in which these sites participate in processes of territorialisation, resulting in the formation of distinctly Australian online mental health forums.

In this way, this thesis is not only a critical investigation of digital peer support services, it is also an examination of peer expertise, mental healthcare, the internet and government in contemporary Australian society. Ultimately it argues that minor mental ill-health has become a central site of concern and intervention for Australian public health, one in which authorities seek to manage populations through the production of a subject who acts to protect and secure both their own mental health and that of others.