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| These days Seacliff would be a resort for celebs and movie moguls |
40+years ago, the person/s who inflicted "horrific injuries" on those children in Wellington might have been safely confined, away from potential victims in a mental institution. Like Lake Alice for example - or Seacliff, notorious in the public mind for nearly lobotomising the celebrated Janet Frame.
The word asylum comes to mind. It means literally a place of safety, a refuge for sufferers from diseases like schizophrenia, which is incurable. These people can be capable of inflicting "horrific injuries" and their families live in dread of them doing so. Or a schizoid might himself be so afraid of that, he (or she) might commit suicide.
But there are no Seacliffs or Lake Alices any more. They were too expensive. Cheaper to get 'the community' to care for them - the very same community which knows small children are being tortured in their homes and does nothing to stop it. "Family harm is a challenge across the motu," say the police. Perhaps they employ Te Reo in the hope that Maori will get the message.
Many are the drivers for 'family harm'. But 40% of those presenting with first-episode psychosis are Maori, and mental illness affects 20% of (mostly Maori) Kiwis in prison. Retired mental health nurse Andy Espersen, a rare survivor of the old mental asylums, pleads for some old-fashioned charity - institutional care for schizophrenia sufferers who can never be cured. And for economy - it's cheaper than putting them in prison.
40 years ago New Zealand had a nationwide, coherent system of psychiatric hospitals – 8,000 psychiatric in-patient beds – each hospital fully staffed with psychiatrists, specialist psychiatric general practitioners, psychologists, trained psychiatric nurses, social workers, occupational therapists, etc.
Then, according to The Encyclopedia of New Zealand: “In response to a mix of ideological and fiscal imperatives, almost all psychiatric hospitals were run down, closed, repurposed or sold off by the 1990s.”
Prior to that, every mentally ill person had the legal right to be admitted into these hospitals immediately, day or night. Moreover, the hospitals were also residential. Patients had the right to remain in hospital for the rest of their lives, should they so desire. They could not be discharged against their wishes.
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| Does this look like such a terrible place to be? |
I am a retired mental health nurse and one of the very few surviving staff from the old Mental Asylums. As a 23-year-old I was first employed at Seacliff Hospital in January 1959 just a couple of years after Janet Frame’s last discharge from there. She was already quite well-known for her literary works. I clearly remember our tutor, Dawn Price, attempting to convey to us budding psychiatric nurses the importance of our job: “We saved her life! She would certainly be dead if it hadn’t been for us.”
Espersen seems to imply that the psychiatric nurses saved Frame from the doctors. And knowing what we do now about the medical experts, that's entirely credible.
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| Janet Frame |
Frame was very distressed in her early years – highly suicidal and mentally disturbed. And later in her life she occasionally admitted herself to these old-style asylums, both in Auckland and in the UK.
I (and most staff) was critical of some of the Mental Health (Compulsory Assessment and Treatment) Act 1992 legislation – but by and large thought that more Community Care would be a good thing. Throughout my working years I always thought many of our patients did not need to be in institutions. However, we didn’t quite realise that all the institutions would disappear completely.
This article deals only with schizophrenia - human madness, lunacy, insanity – call it what you will. Not until the 20th century did we begin to talk about depressions and neuroses as mental illnesses. The fact remains that there is a qualitative difference between schizophrenia and all other mental illnesses. Although many other mental afflictions may be even more cruel and crippling to an individual than schizophrenia, sufferers are not insane.
In New Zealand around 0.3-0.7% of the total population will suffer from schizophrenia at some point. An article published this year in Schizophrenia Bulletin states, “Māori represent 40% of those presenting with first-episode psychosis and also receive higher rates of schizophrenia diagnoses.” Twenty percent of the prison population is mentally ill, the majority of whom will probably be schizophrenia sufferers.
And Maori.
Mental Health Foundation chief executive Shaun Robinson says, “In many ways prisons have become our biggest residential mental health service. Because the other parts of the system are just failing so many people.”
This ‘failure’ brought about the 2018 Ron Paterson inquiry which, in turn created the He Ara Oranga report. One year earlier, in 2017, I had presented a petition to parliament: That the House recommend that the Government establish a Royal Commission to report on harm to our schizophrenic population from changes inherent in the Mental Health (Compulsory Assessment and Treatment) Act 1992, and on harm from the closure of residential psychiatric hospitals in the 1990s.
From my experience working in the mental health sector, I know that, in many cases, schizophrenia and psychosis cannot be cured. Many people living with these conditions will never be able to fully recover and think and act like people who are not living with this mental illness. For this reason, schizophrenics should be supported to control and live with their condition but should not be subject to the same expectations of independence as the general community.
The health ministry responded by saying it does not support increasing institutionalisation. Ron Paterson’s report likewise recommended that mental health care be provided in the least restrictive circumstances possible. The then Labour Government accepted 38 of its 40 proposals.
With astounding naivety Ron Paterson and his committee believe that legislation intended to replace the 1992 Act exists to protect patients against transgressions of their human rights when under compulsory assessment or treatment. But original ordinances set out to protect both society and patient from the sometimes terrible consequences of schizophrenia, and the sufferer from being held responsible for criminal action while acutely disturbed.
We must go back to the drawing board and conceive of mental health legislation from a different angle altogether - namely from the angle of simple human charity. Over the last 40 years the Health Ministry has shown a deplorable lack of proper understanding of our chronic schizophrenic population. In effect they have neglected them.
Ordinary hospitals are in the business of healing and curing their patients, but chronic schizophrenia is incurable, as all psychiatric textbooks will confirm. Under the Justice Department (1846 – 1948), the exclusive aim of psychiatric hospitals was to make life as bearable as possible for our schizophrenia sufferers. In fact, to provide hospice care for them. Under the NZ Health Ministry (since 1948) the aim has developed into an attempt to cure them.
Of course, we should never again build huge 19th century asylums in remote areas. I hd a lovely schizophrenic cousin (now deceased) in Denmark where I went to visit her once. She lived in a modern tastefully built institution (similar to a pleasant old people’s home) in a suburban setting, of course.
The cost would be prohibitive you say. But the cost of keeping a Correction’s inmate is $150,000 annually versus an aged-care resident at approximately $80,000 …
So where to now?
Since the election Matt Doocey has been made the first ever Cabinet Minister for Mental Health. But he is building a Ministry - a bureaucracy - which has no real-estate to go with it!
Get the bureaucrats to deal with it.
The Mental Health Ministry has no assets, owns no buildings, employs no staff, no doctors or nurses. All that is with the Ministry of Health.
Meanwhile the replacement legislation for the 1992 Act remains on the table.
ACT in fact has a well-thought-out Mental Health policy but van Velden fails to see (or perhaps she only omits saying so now?) that to succeed, institutions will be needed. Bricks and mortar will be needed – where all their envisaged specialists can be reached on site; institutions that do not discharge suicidal schizophrenics against their will.
I am all for that.
Andy Espersen is a retired mental health nurse, with decades of experience working in mental health institutions.
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| Christ driving the Moneychangers from the Temple Caravaggio |
Very insightful article.
ReplyDeleteYes. Charity and Lovingkindness has been replaced with Expediency and faux “kindness” (actually just narcissistic acting to mask a deep hatred of humanity - a la Jacinda Ardern).
It’s great to have this issue aired. And the benefit of this older nurses wisdom.
For two years, I worked in a mental health facility. While I agree that there is a need for better monitoring of individuals with mental health issues as it is I believe that large institutions are not the solution. Instead, there needs to be a major overhaul in the way these individuals are treated, with a focus on treating them as a whole mind body and spirit unit rather than labeling them as "mentally unwell, we found that some residents functioned better if we kept their minds occupied so little jobs and routines." We were able to pick up on warning signs that residents were becoming unwell and prevent it from worsening, such as changes in hormones and chemical imbalances, UTIs, and difficulty handling stressful situations like rejection, seclusion, or deaths. It is worth noting that the majority of our clients were not Maori, with only three out of 44 in a home. I believe this is due to their whanau (family) looking out for them.
ReplyDeleteIn situations where we needed crisis assistance, we often relied on the police due to a lack of manpower in crisis teams example the Taylors centre. This was exemplified by the tragic incident at Hillmortion in Christchurch a few years ago, where a man under our care was able to escape and fatally stab a mother. Before attempting to open large institutions, we need to strengthen our resources so that we are not simply shutting individuals off from society without a better alternative.
While a centralised health system may improve communication between specialists, doctors, and social workers, during my time there it was non-existent and everything felt disjointed.
Helen Clark created this mess when the b...... closed the mental establishments. She should have been in Oakly/ Carrington herself.
ReplyDeleteIndeed.
ReplyDeleteI have seen people with mental illness living in absolute squalor because they are unable to look after their own basic needs of hygiene and how to cook nutritional meals; it is ridiculous and naive to expect those with mental illness to live independently; we need facilities where they are monitored their medications provided with meals and hygiene services but have appropriate chaperoned freedom
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