This is an edited and abridged version of the submission Andy delivered to the Inquiry.
Let me first tell you my focus is schizophrenia. I understand your Inquiry wants to include a lot more illnesses and a lot more people – I do hope you are not casting your net too wide. You cannot be all things to all people.
Our new government initiated this inquiry in response to widespread public concern about mental health services – including the many suicides among clients of our mental health services and some murders committed by known mental health patients with schizophrenia. I believe if we solve the problems with chronic schizophrenia all the rest of our mental health problems will be much more easily dealt with.
I worked for nearly 40 years in psychiatric hospitals (between 1959 and 1997) as a psychiatric nurse and psychiatric social worker. In all those years I can’t recall having the specific mental health issues that lead to this inquiry – so I must ask, what has changed? This inquiry has stated that it would “look at the current approach to mental illness” – logically, therefore, we must ask the question: what has changed from our historical approach?
The crucial changes actually began with deinstitutionalisation of the large psychiatric hospitals worldwide, starting in the United States in the 1960s. Here in New Zealand that process began in the 1970s and 1980s and the Mental Health (Compulsory Assessment and Treatment) Act 1992 helped make that transformation possible, and the old psychiatric residential hospitals were all closed by 1999. And, as it turned out, we in New Zealand were more successful than Americans in caring for patients in the community.
You may think that all I want is to build residential hospitals again. Very many patients would certainly benefit from that – but my primary aim is to change the Mental Health Act 1992 so that anybody behaving ‘insanely’ will be uplifted by police and committed to an acute mental health inpatient unit or hospital.
I know that this sounds absolutely preposterous to modern ears. But we have forgotten that is how things were for 150 years, after the Colonial Government passed the Lunatics Ordinance in 1846 – and that in all those years every charitable and right-thinking citizen thought this was in the patients’ best interest.
Older police constables will remember that not only were they allowed to contain an insane person and place him or her in a mental hospital – it was their bounden duty to do so. They just needed the signatures of two medical practitioners which didn’t take them long (the whole operation took only minutes – a “mental health call-out” now takes police an average of five hours!).
Only few of our mentally ill meet the legal definition of ‘insane’. Schizophrenia is qualitatively different from all our other mental illnesses – and our problems caused by this illness alone dwarf all other mental health problems: the economic costs, and the amount of pain and sorrow inflicted on patients’ families by this one illness is enormous. Schizophrenia is an elephant in the room – and nobody these days seems able to quite comprehend just how big it is. Generally speaking, it is only in industrialised societies we get the social problems with ‘insanity’ because only here do we expect individuals to exist on their own and care for themselves – which is the one thing many people with chronic schizophrenia cannot do. This mental health problem is caused by our modern cities with their free, independent, ambitious citizens, all managing their own lives.
I suggest you read up on Dorothea Dix, the great 19th century American social reformer – and dreamer who tirelessly lobbied states and governments in America, Canada and Europe to build asylums. The social situation we now find here in New Zealand is very similar to what she found in the early 19th century – and which made her set out on her crusade :
- An huge number of mentally ill people are again in jail because of various offences, usually brought on by their illness.
- Many people with schizophrenia again drift aimlessly in our cities – the only difference from Dorothea Dix’s day is that we now pay them a small amount of cash and attempt to arrange board and housing for them (often quite unsuccessfully).
Dorothea Dix’s legacy to the Western World, namely residential mental hospitals, lasted over a hundred years. Then tranquilising medication made it possible for governments to renege on their promise to care for our ‘insane’ population.
In 1992 we made the legislative changes enabling our government to discharge chronic mentally unwell patients who up until then had been wards of the state – and to close our nationwide chain of psychiatric residential hospitals. That was a grievous mistake for which we, and our ‘insane’ population are now paying dearly.
This inquiry as early as December promised that “nothing would be off the table” when discussing our mental health problems. The promise was also that “the current approach to mental health” would be investigated. Logically you cannot investigate our current approach without comparing it with our historical approach. The two ideological corner stones for modern treatment of schizophrenia are de-institutionalisation and community care for all.
Events since the legislation changes have now made it obvious that this ideology has failed. It has become obvious that for very many people with chronic schizophrenia that institutionalisation is an outright blessing – and that it is a curse being forced to share in a community which is alien and irrelevant.
Nobody was ever forced to leave our old psychiatric institutions – patients were never under pressure to leave. But if you wanted to leave you would be discharged (unless deemed dangerous or obviously unable to cope). Governments were only too happy to let you go – because the institutions were very expensive to build and maintain.
It is a myth that people were “locked up and forgotten about, keys thrown away”. This system worked – simply because nobody in his/her right mind will ever wish to remain in a hospital. In my opinion chronic schizophrenia should be treated in specially designated hospitals – and the sufferers should never be forced to leave these institutions. And, unless they leave, they should remain legal wards of the state all their lives.
If you work in an acute mental health unit these days you will know it is common to discharge patients with schizophrenia against their wishes, even if they indicate they are suicidal. To follow the “recovery principle” for chronic schizophrenia is an abomination – it doesn’t even make sense. Yet we openly and proudly do it – we blindly and cruelly treat the sufferers of this illness according to our ideological beliefs – reality and simple human charity be damned.
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 has harmed people with schizophrenia.
This is an edited and abridged version of the submission he delivered to the Inquiry.
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