27 Oct 2018

History repeating - New Zealand's mental health inquiries

From News Extras

New Zealand’s mental health system has been repeatedly pulled apart in major investigations, the latest of which is reporting back next month. Jess McAllen looks at the history and recurring themes of the past 30 years.

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Photo: RNZ / Richard Tindiller

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They say history never repeats, but mental health inquiries sure do.

Last year suicide emerged as a major election issue. The 2018 Mental Health and Addictions Inquiry, promised by Labour on the campaign trail, is finally set to report back at the end of November, a month after the initial deadline.

The panel is tasked with making a range of recommendations, including: the role of a re-established Mental Health Commission, ways to link up communication between different departments like health and justice, and increasing accountability in leadership positions.

It will be far from the first of these inquiries, although it will arrive into a very different landscape.

Previous major inquiries happened when psychiatric hospitals were in the process of shutting down. For the thousands discharged from such hospitals, alternative community services were sparsely resourced. Public attitudes to mental illness were still fear-based - people with mental health problems were no longer confined to remote asylums, they were in society’s own backyard.

The reasons for the regular groundswells of public concern vary - from former patients killing people in the 1980s, police killing young men with mental illnesses in the 1990s, to alarm about youth suicide today. But many of the key problems identified in the two big inquiries by former judge Ken Mason in 1988 and 1996 - and the dozens of reports and plans that followed - remain the same.

The 1988 Mason Report: “huge human cost”

The catalyst for the first Mason report was largely the case of John Papalii, a man who had a more than 20-year history with mental health services, and was in serious distress in June 1987. A social worker located Papalii for an application for committal to Oakley hospital under the 1969 Mental Health Act, but put off attending court until the next day as a judge was unlikely to be available. It would be too late.

That night, Papalii took a carving knife from the Auckland boarding house he was staying at and stabbed a man waiting at a bus stop. He then fatally stabbed another boarder and severely wounded two others.

The report, headed by Judge Ken Mason and commissioned by the then-Labour government, slammed the Auckland Health Board, saying it had “disgraced psychiatry”. But it did not centre on one case: Mason and his team had been tasked with investigating the treatment of patients who had a crossover with the justice system, particularly those with a history of violent offending.

Health officials brought in lawyers before the official release and 70 lines of the 231-page final document - sold for $20 a pop - were permanently deleted by the High Court.

References to previous reports are scattered throughout the document. One is the 1983 Gallen Inquiry which called for the merging of Oakley and Carrington hospitals and a secure unit for the treatment of mentally unwell prisoners. Following the death of a patient at Oakley, the Gallen Inquiry advocated better protection of patients' rights.

Among other things the inquiry revealed that Michael Watene died due to a lack of observation after Electroconvulsive Therapy (ECT). It also highlighted patients being over-medicated - with tranquilizers and anti-Parkinsonian medication - and a number of people who didn’t need to be in hospital at all.

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   The The 2018 Mental Health and Addictions Inquiry is launched in Palmerston North  Photo: RNZ / Richard Tindiller

Following this inquiry Oakley was keen to quickly discharge patients back into prison and only accept those with a concrete diagnosis. The Gallen inquiry vehemently opposed plans to build a prison hospital for psychiatric patients - similar to what Kelvin Davis announced this year for Waikeria prison - and this was highlighted in the 1988 Mason report.

“We do not believe that a hospital is compatible with a prison as such and we do not support any proposal to construct a hospital which is effectively a prison with hospital overtones,” the Gallen inquiry stated.

“...In our view prisoners requiring psychiatric treatment should receive it in a psychiatric hospital where security, though effective, is subordinate to therapy...it should be operated and controlled as a hospital and not subject to or incorporated in the prison system.”

The 1988 report said: “It is our firm belief that, if the recommendations of the Gallen Inquiry had been adopted by the board, there would have been no need for our inquiry”. This would become something of a running theme.

Carrington and Oakley hospitals were on the same grounds - now the Unitec campus in Mt Albert - but had very different attitudes to treatment. Oakley would take patients referred from prisons and those who other hospitals did not want.

Between 1983 and 1987, 13 prisoners killed themselves at Paremoremo. Mason rejected the view of senior Auckland Health Board staff that prisoners with severe mental health problems should be treated in prison.

On 15 March 1985 PSA members at Carrington and Kingseat hospitals passed resolutions banning the admission of “Oakley type” patients because of a lack of secure facilities and staff. But Mason did not blame the union, saying that security at Carrington had been run down to the extent it could no longer safely contain some prison inmates, so the ban was “hardly surprising”.

“It is clear to us that it was not the PSA’s ban which stopped inmates being admitted to hospital, but rather the failure of the board to provide a secure facility which would safely contain those psychiatrically disordered offenders requiring security.”

The report said the board’s superintendent in chief, Leslie Honeyman, chief nurse, Anne Murphy, and chief executive, Ian Campbell, had to take collective responsibility for events since 1983 which resulted in “huge human cost”. Mr Campbell resigned two weeks after the report’s release. Ms Murphy and Mr Honeyman were made redundant two months later.

Mason also called for integrated bicultural services to better deliver the needs of Māori, acknowledging that psychiatric assessments were mainly done via a western model that didn’t take into account the impact of family, culture and spiritual being on identity.

In a snap parliamentary debate after the report was released, then-National MP Don McKinnon said: “If anyone here had any relative they thought was going to go to Carrington, you would be horrified. Look, I wouldn’t tie up a neurotic dog in that institution”.

A country-wide network of regional psychiatric secure units - such as Auckland’s Mason Clinic - were established as a result. This is called forensic mental health. The role of these services is to assess, treat and rehabilitate people with a mental illness who have, or are alleged to have, committed a crime - as well as those who are deemed to be at risk of committing one.

The report heralded a new era, and the potential for a more empathetic approach in treating offenders with mental illness. That hasn’t necessarily followed through to 2018. Last year, an ombudsman investigation into care for prisoners at risk of self-harm or suicide discovered a prisoner was denied admission to the Mason Clinic and had spent 37 nights in a row on a tie-down bed.

The 1996 Mason Inquiry: “We have wasted our time”

The 1992 Mental Health (Compulsory Assessment and Treatment) Act prompted a fresh flurry of public outrage. The difficulty of getting someone committed to hospital was a constant complaint, along with the large decrease of inpatient beds without a corresponding increase in community services.

After a series of cases where men discharged from psychiatric hospitals sexually abused children, the government proposed lowering the threshold for compulsory care for people with mental health issues from posing a “serious danger” to health or safety to simply posing “a danger”. MPs on the social services select committee asked for this not to proceed.

In 1994 New Plymouth couple Janice and Lindsay Gibson killed their 12-year-old son in an exorcism ritual. Health workers and police had visited the family just days before the death. People with mental health problems were quickly being re-associated as dangerous in the mind of the public. This was a long time before John Kirwan.

Also that year, 22-year-old Matthew Innes died in a police car after a transfer to Kingseat psychiatric hospital. The official report - again chaired by judge Mason - said he suffocated after being placed face down, arms and legs handcuffed. It described the mental health system as operating at “number 8 fencing wire level”. These problems have not gone away. In July this year, Alo Ngata died in custody after being tasered by police when he attacked an elderly man. Ngata had a history of mental health problems according to a Stuff article, having spent time at a psychiatric facility a few years ago. In April this year,  29-year-old Jerrim Tomms was shot dead by police. His family said on the night he died they called mental health services but were told to ring police for a welfare check. Five weeks earlier he’d been hospitalised for Bipolar treatment. 

The Otago Daily Times reports in 1995

The Otago Daily Times reports in 1995 Photo: Otago Daily Times

Despite a widespread perception that our youth suicide rate was at its height last year, 1995 was actually the record - and our highest suicide rate per population was in 1998. It was a time of high unemployment, particularly among young people, and the 1991 “mother of all budgets” benefit cuts were in full swing.

Beyond the statistics, the crisis was very much in the public eye.  Politician Jim Anderton’s daughter killed herself in 1993. A month after her death, Mr Anderton wrote to Health Minister Jenny Shipley asking for more help for young people and offering to work together.

It all reached a crescendo when two men were killed by police in separate incidents. In September 1995, police shot 34-year-old Eric Gellatly dead, 21 hours after he broke into an Invercargill sports store at night and started firing.

In an editorial for the Otago Daily Times Labour MP Mike Moore suggested individualism was outweighing the public need. He lodged a private members’ bill calling for a general mental health inquiry. Mr Moore represented a certain mindset: some thought the pendulum had swung too far in favour of patient’s rights and wanted a return to the old lock and key.

“People who had been in places like Oakley, Sunnyside, even Templeton hospitals, sometimes for over 40 years, have found a better, more fulfilling life in the care of the community,” Mr Moore wrote.

“Community values have changed. The stigma of shame and embarrassment has thankfully changed. Perhaps 80 percent are better off, but not all.”

Then-Prime-Minister Jim Bolger took some convincing. An article in The Dominion on 28 October 1995 quoted him saying a mental health inquiry would delay improvements to the system and “we’re certainly not intending to go back, in locking up all those who have some mental illness for years and years as it was in the past”.

Two months after the Invercargill shooting, 37-year-old Barry Radcliffe was also shot dead by police. He was standing outside a Whangarei sports store with a gun. Both Radcliffe and Gellatly had interacted with specialist mental health services before their deaths. In the same week, the National government confirmed an official inquiry - again, headed by Judge Mason.

The 1996 inquiry had a wider brief into general mental health services in New Zealand and the failure to properly resource community care. The terms of reference even had a section dedicated to “the rights of family members”.

A handful of politicians objected, including Jim Anderton and then-Labour leader Helen Clark. Both said the problems with the mental health system were already well-known.

In an Otago Daily Times article, The Alliance’s deputy leader Sandra Lee was clear.

“They know what is wrong; 25 reports have said more resources are necessary; this (inquiry) is just another delay tactic, a smokescreen by a Government that has no intention of funding mental health adequately.” The National Party has said similar this year

The 1996 Mason report recommended the Commission have wide-sweeping powers including: responsibility for mental health purchasing, service provision and policy making. Instead the government opted to keep those functions within the Ministry of Health and the (then) Regional Health Authorities. The Commission, set up in 1996, was to evaluate delivery of mental health services and make recommendations to government.

Mason was annoyed by this, telling The Evening Post in August 1996 that the Commission was identical in name but completely different in concept to what the inquiry team had recommended.

“I believe to a substantial extent, we have wasted our time,” he said.

“In the sense that we yet again alerted the community to some of the grave deficiencies which exist out there in the mental health sector, it has not been a waste of time...But in the sense that we have achieved any significant change, apart from funding, then to a very large extent it has been a waste of time.”

In 2012 the Commission was disestablished. Its core functions were transferred to the role of Mental Health Commissioner, which sits under the umbrella of the Health and Disability Commissioner.

Health Minister David Clark and Prime Minister Jacinda Ardern announce an inquiry into mental health and addiction.

Health Minister David Clark and Prime Minister Jacinda Ardern announce an inquiry into mental health and addiction. Photo: RNZ / Richard Tindiller

Deja vu

The tragedies differed, but each report noted several problems that had been mentioned in earlier reports and not properly addressed. Often an inquiry had made concrete recommendations which were either ignored or only half-heartedly acted upon.

This was predicted in 1988 by a former medical superintendent at Carrington and Oakley hospitals, Dr John Radcliffe, who said there was a chance the 1988 report would have barely any recommendations implemented.

“The great risk,” he told the New Zealand Herald, “is that as soon as the public interest dies down, the report will be forgotten, with little being done.”

In other words, journalists and politicians were always very interested in fresh inquiries sparked by public scandals. But when it came time for the expensive and somewhat boring follow-through, interest waned.

A 1996 editorial in The Dominion, titled ‘Mentally sick will be losers’, expressed the same attitude after the second Mason inquiry.

“Their report cited 67 inquiries since 1987, including seven of national significance,” it said.

“It noted wryly that if their recommendations had been implemented, mental health services would not still be in a state of crisis.”

Last year, Ken Mason himself told Stuff he encouraged another inquiry, while the Mental Health Commissioner Kevin Allen disagreed when he appeared before the health select committee, stating an “urgent need for action” instead.  Last year the inaugural chair of the Mental Health Commission Barbara Disley, who is on the current inquiry panel, was unsure for similar reasons but this year said she changed her mind because of the government’s intention to have a “short, sharp review”.

There's that old line: the definition of insanity is doing the same thing over and over and expecting different results.

The value of these inquiries ultimately comes down to how the recommendations are acted on. In 2028 will New Zealand be on the verge of another inquiry into mental health and addictions? Or will we look back at 2018 as another lip service report?

* Jess McAllen is a freelance journalist based in Wellington who writes about social issues

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