Two lawyers who have represented more than 1000 abuse survivors have told the Royal Commission no victim has ever received adequate compensation for what they suffered.
The inquiry into abuse in state and faith-based care has entered its second week of hearings in Auckland.
Law firm Cooper Legal is one of only a few involved in helping survivors of institutional care take civil claims against the state and churches for abuse they suffered as children and vulnerable adults.
The firm represents 1250 clients, aged 18 to 80 and has 1400 open files, a number now growing.
About 1100 claims have been settled with the ministries of Social Development, Health and Education, as well as faith-based institutions, with payments so-far totalling nearly $23 million.
Sonja Cooper said the vast majority of her clients were beneficiaries or low wage earners in precarious economic circumstances.
"We would say that no survivor to date has received adequate compensation for the harm that has been done to them and say that unapologetically."
Ms Cooper said by far the most common complaints in psychiatric hospitals were severe physical assaults at the hands of staff and other patients and sexual violation and abuse.
She quoted a young boy who was a patient at Porirua Hospital in the 1970s and a punishment called the concrete-pill.
"And this is where four staff members would hold a teenage boy by each of their limbs, pull them up and then drop them on the concrete."
Ms Cooper said many young people were given unmodified electro-convulsive treatment as a punishment, without any anaesthetic to dull the pain.
"Teenagers again mainly but this also happened to our vulnerable adult clients were pulled into the ECT room to watch the patients being given ECT to frighten them and were told this is what will happen to you if you don't do what we tell you."
She said complaints were not dealt with properly, which exposed vulnerable children to further abuse.
Ms Cooper said other assaults took a more insidious form under the cover of medical examinations.
She gave the example of a doctor nicknamed Dr Cough.
"He would make the boys remove their clothes, line them up and see them individually and he would make them remove their clothes and he would touch their genitals."
Amanda Hill, also a partner in Cooper Legal, said there was an ongoing culture of violence, coupled with an environment that prohibited narking or snitching.
She said the culture of violence included initiation beatings, which occurred at virtually every residence in the country.
"We talk a lot about physical and sexual abuse because these are what people understand more about what abuse really means but psychological abuse and emotional abuse were just has harmful and just as prevalent."
She said children in care were constantly taunted by staff members.
"We were told that they were useless, that they would end up in prison, that they would never amount to anything, that their parents didn't love them, that nobody wanted them, that they were worthless and nobody cared what happened to them."
The lawyers' said a reckoning with the truth and a commitment to both healing the past and changing the future will take more than legal action, as structural, long-term change and commitment will take many generations.