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ANDY ESPERSEN: Schizophrenic neglect must be addressed


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.


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.” 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 (as were 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.


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 however responded to my petition by saying that 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!  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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46 Comments


In Nelson in the 60s-early 80s he Mental Health facility at Ngawhatu comprised a total of 14 sturdy villas spread equally up two valleys reaching into the Stoke foothills, with one valley for men and one for women The villas were graded according to the severity of the occupants' mental illnesses; those in the lower villas stood a reasonable chance of release back to the community, while the severe cases were attended to in the upper valleys and were there for the long term, perhaps for life.

I attended various clients at one or other of the villas as a young lawyer ffor many years I observed the whole facility to be professionally and competently operated.

Thus I was mystified…

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Ian Boag
Ian Boag
Mar 25

All good about bricks and mortar and lock em up. The biggest problem is psychiatrists. We know a consultant psychiatrist (specialising in addiction as it happens). He works in the public system. He tells me that we need roughly 3x as many psychiatrists to get on top of the mental illness thing. I guess he would know.


It takes roughly 10 years to train a consultant. We need a whole lot - now.

Go figure.

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Ian Boag
Ian Boag
Mar 26
Replying to

I'm just telling it as it is. I have no idea what a "normal" contingent of nutters is.

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I have a brother in law with major bipolar, mild Schizophrenia and possibly several other conditions. He is unable to behave within the norms of society. for the past 10 years his condition has bee steadily deteriorating and he spends large amounts of time in prison on ridiculous disturbing the peace charges. His 70 year old parents can't deal with him, the police can't deal with him there is simply no answers to his condition beyond prison.


This problem is real and the community simply doesn't have the resources or knowledge how to deal with mentally ill people.

Who closed all the mental health facilities and why?

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An excellent article, that I totally agree with. I remember living in Australia when they closed down these hospitals and cast the unfortunates out into wider society to become victims of ruthless and unscrupulous landlords while the politicians were smug about the savings they had made!

Firstly, we need to differentiate between Mental Health (and types of mental health) and Behavioural Health. (Shoplifting because of work stress is NOT Mental, it is Behavioural Health!).

Secondly, those with real mental health issues need to be treated and cared for, in proper facilities. And there should be facilities for those needing short-term hospitalisation.

Thirdly, prisons are not those facilities - they are for the badly behaved who commit crimes!

Finally, GPs should…

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As a Christian minister working often in the mental health area I couldn't agree more with this assessment of our mental health facilities. They are completely overwhelmed and unable to cope with the number of people suffering from this condition. I have been personally turned away 3 times from EPS in Dunedin when presenting with a highly distressed mental health patient. I have seen so many examples of people being admitted far too late in the progression of their illness and having to spend much longer times as an inpatient when if they'd been admitted earlier their stay wouldv'e much shorter. I also believe many homeless people are suffering from treatable mental health conditions and could be helped by admission.

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