The recent heart-rending article on Health Central, ‘Our hearts are broken as much as our son’s brain’, must not go unanswered.
In her impassioned statement, this mother and grandmother shows exactly where our treatment of mental illness has gone wrong over this last half-century. For 150 years we had an easily understood policy of simple, human charity towards our fellow human beings. Our first mental health legislation was enacted in 1846; this simply aimed to “provide safe custody and the prevention of offences by persons dangerously insane and for the care and maintenance of persons of unsound mind”. Compare the simplicity of that brief synopsis with the vague, utterly unreal (and cynical) nonsense we meet with in the Mental Health (Compulsory Assessment and Treatment) Act 1992.
In the 1846 Lunatics Ordinance we see no ifs or buts or maybes: Government undertook to provide for “care and maintenance of persons of unsound mind” – and this for their lifetimes. In all civilised Western nations, asylums were built to accommodate the many people “of unsound mind”. It was a tall order indeed, and an extremely expensive one – but successive governments, for ethical, charitable reasons alone, did this for 150 years – until 1992.
Last year a Coroner’s Inquest heard how in 2013 Neil Jones was discharged from a Christchurch hospital with diagnoses of alcohol addiction, alcoholic brain damage, liver damage and having defecated in his pants on purpose. A hospital security guard took him to the nearest bus stop and placed on the footpath in his hospital pyjamas. Incredulous passers-by wanted to get help for him but were told that he had been medically discharged and he was only “putting it on”. He lay there for six hours. The doctor who ordered this treatment was not censured – in other words, we no longer have legislation which obliges us “to care for persons of unsound mind”.
Already in the 19th century there were differing opinions of how our insane people should be treated in asylums. There was quite a debate whether ‘moral treatment’ (Google it) or medical treatment was the right way to go. In those days, medical treatment included whipping, beating or blood-letting. The moral treatment was slowly accepted by everybody and later improved on by the medical profession. In the 1950s, medication appeared that proved to be an effective means of treating human insanity.
However, medication never, ever cured anybody of chronic schizophrenia. But somehow, in the following decades, we began to feel less charitable towards our chronic schizophrenic population – and the notion arose that they were being mistreated by the mere fact that they lived in institutions.
Well-meaning ideologues, completely ignorant of the nature of human insanity, worked diligently to rectify things. In 1992 they won the day – new legislation was enacted which made possible the cynical discharge of the many insane people (who were, in effect, lifelong wards of the state) to live without proper supervision in the community.
Worse, the new legislation also made it illegal to force patients to accept medication – unless placed under a temporary or indefinite compulsory treatment order. This in spite of clinical evidence that acutely ill, insane people are simply unable to know what is in their best interest – and can be quite unpredictable and may need to be protected from their own actions. Jo Pert, out jogging in Auckland in 2016, was killed by a man suffering from acute schizophrenia. But for our 1992 legislation, I believe she would still be alive – and he would not be a murderer.
However, the complete lack of ordinary charity and compassion is what characterises our mental health authorities and our psychiatrists today.
The article by this mother and grandmother makes this so painfully obvious. Our mental health authorities and our psychiatrists are simply unable to see past their ingrained ideology about human insanity. Like staff at Christchurch Hospital who discharged Neil Jones to lie on a footpath in his soiled pyjama pants, they just don’t get it: “What do you mean? Charity! Am I my brother’s keeper?”.
We can blame the ideologues of the late 20th century who, so full of ‘well-meaningness’, managed to seduce us (yes, I was actually one of the mental hospital staff who eagerly went along with them in the early 1960s and ’70s).
But today I blame our psychiatrists, NGOs like our Mental Health Foundation and our top academics, who haven’t got the intellectual guts or honesty to admit openly that in the 1990s we threw out a baby (namely, simple human charity) with the bathwater. Firstly by cancelling our previous realistic and humane legislation; and secondly, by wantonly destroying our well-functioning, nationwide chain of residential psychiatric hospitals with their thousands of psychiatric in-patient beds and their cohesive staff of specialist doctors, nurses, social workers and occupational therapists who personally knew, and kept a record of, all their chronic schizophrenic patients, whether living in the institutions or out with their families.
May this mother’s heartfelt statement not be in vain.
Andy Espersen is a retired psychiatric nurse who believes that the changes brought about by the Mental Health (Compulsory Assessment and Treatment) Act 1992 and the closure of residential psychiatric hospitals in the 1990s have harmed people with schizophrenia.