Beyond the "Standard Patient": Deinstitutionalisation, Relational Care, and the Structural Barriers to Hepatitis C Elimination for People with Serious Mental Illness

Bradley Underhill, Carolyn Holbrook, Alison R. Yung and Carl I. Moller
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Alison R. Yung: Deakin University

No xuepm_v1, SocArXiv from Center for Open Science

Abstract: Australia’s 2016 introduction of subsidised Direct-Acting Antiviral therapy was celebrated as a biomedical milestone, yet treatment commencements have dropped 84 percent, creating an elimination plateau that disproportionately impacts people living with severe mental illness. Drawing on thirteen oral history interviews with policy architects, researchers, and outreach clinicians, this study examines the structural mechanisms driving this gap. Applying an intersectional policy analysis and historical-institutionalist framework, we show how deinstitutionalisation legacies, state-federal funding divides, and rigid inpatient pharmacy subsidy rules sustain the "Standard Patient" fallacy. Furthermore, attitudinal stigma and diagnostic overshadowing lead clinicians to deprioritise viral clearance in psychiatric settings. We argue that reaching elimination requires moving beyond population-level biomedical targets toward a rights-based model of "relational delivery" anchored by peer outreach workers.

Date: 2026-10-22
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Persistent link: https://EconPapers.repec.org/RePEc:osf:socarx:xuepm_v1

DOI: 10.31235/osf.io/xuepm_v1

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