108.    This section summarises the descriptions of the unit Dr Leeks gave in response to investigations and external scrutiny during the 1970s. We preface this summary by observing that Dr Leeks’ descriptions and accounts were not always fully transparent or accurate about the nature, extent and purpose of the unit’s activities. The accounts need to be read with that qualification in mind.

109.    As a starting point, Dr Leeks said the unit was set up as a back-up for children and adolescents who could not be treated in outpatient psychiatric clinics.^[198] He described the patients as including:^[199]

“Those young persons unable to respond [to treatment] on a once or twice weekly basis, and can no longer be controlled by parents, school, society or themselves. These will include the behaviour disorders merging with developing character disorders and those whose psychosis requires special surveillance, schooling and treatment, and who are not responsive in Outpatient facilities.”

110.    The unit became available in August 1972, and the first cohort of patients admitted included those Dr Leeks described as “uncontrollable or deemed to be improperly placed” at nearby welfare residences Kohitere, Hokio and Holdsworth.^[200] Dr Leeks said the children in the unit tended to be normal or better than normal in intelligence.^[201] But some of the children were, in his view, “bottom of the barrel kids … anti-social and destructive”.^[202] By 1974, it was decided to admit fewer “character disordered children and adolescents from welfare institutions”.^[203] He described about a third of the people at the unit as “behaviourally disordered”, a third as “in the neurotic realm”^[204] and a third who were “psychotic upon admission”.^[205] By 1976, the unit was receiving children from all over the country. Dr Leeks said it was common to be asked to take a child on the basis that “no other unit, school or institution [would] have him/her”.^[206]

Kāore i whai hua te huatau a Dr Leeks, arā, te “hapori whakaora” - Dr Leeks’ “therapeutic community” concept did not succeed

111.    Dr Leeks said his goal was to create “a therapeutic environment, not one based on punishment”.^[207] He said the unit provided individual and group therapy,^[208] medication and ECT within “the broader background, one always hoped, of a therapeutic community using mostly behavioural techniques”.^[209] He acknowledged the therapeutic community concept did not work well in the first few years, but he thought it was very good in the last three years (1974 to 1977).^[210] The aim, he said, was “to benefit the children in terms of psychological and emotional growth, and to help them to cope adequately with their environment outside the hospital setting”.^[211]

112.    Dr Leeks said the desired staff profile was “kindly, warm, understanding, intelligent with a sense of humour and a minimum of sentimentality”,^[212] although he admitted that was not always achieved. Sir Rodney Gallen later acknowledged that some staff treated patients with compassion and understanding.^[213] Patients referred to those staff members with affection and gratitude.^[214] But Dr Leeks said it was hard to attract staff to the unit. The work involved long hours (up to 12-hour shifts) and it demanded “total involvement”.^[215] He acknowledged some staff had to be moved on because they were unsuited for their roles and an assault by a staff member led to dismissal and imprisonment.^[216] He said staff were often affected by their experiences at the unit and they needed solid support systems.^[217]Having said that, he gave an example of a relatively senior nurse who described his two and a half years at the unit as the richest experience of his career.^[218]

113.    Dr Leeks acknowledged that some children perceived being put into a psychiatric unit as punishment.^[219] But for others, he said, it was “a welcome release from an intolerable situation”.^[220] Dr Leeks claimed that most children appeared to get a great deal out of being part of a community, despite the pain of examining their behaviour and their feelings.^[221] For some, he said, it was a painful process to leave the unit.^[222]Some children told Sir Rodney Gallen they enjoyed the sport and the facilities at the unit.^[223] Nurse Terrence Conlan said the unit was a relatively happy place for the children even in the early days.^[224] He said they were taken on outings, often spent a lot of time outdoors and in the gym, and often went to the sand hills behind the hospital to gather lupin seed to sell. When he left Lake Alice, he received many gifts and cards from the children in the unit.^[225]

Te whakamahinga o te haumanu whakahiko-hukihuki - Use of electroconvulsive therapy (ECT)

114.    Dr Leeks regularly prescribed and administered ECT at the unit. He stated it was always given therapeutically and was not a punishment.^[226]

115.    By way of context, properly administered ECT is now, and has been for many decades, a recognised and effective medical treatment in cases of major depression and sometimes for other mental illnesses such as bipolar disorder, schizophrenia, mania and catatonia.^[227] It is typically used when other treatments have not been successful.^[228] It involves passing an electrical stimulus through two electrodes placed on the head of a patient to cause a seizure. In 2019, 245 people received ECT in New Zealand.^[229] It is, however, a controversial treatment for some. A petition to the New Zealand Parliament Health Select Committee in 1999 from an opponent of ECT claimed ECT in any form is inhumane and degrading and always causes brain damage.^[230] For some, ECT in any form is regarded as torture.^[231]

116.    When ECT was introduced into Aotearoa New Zealand hospitals in the 1940s, the practice and recommendations for administering it were inconsistent. ECT was sometimes given ‘unmodified’; that is, without anaesthetic and muscle relaxant.^[232] This could cause fractures and dislocations as well as severe pain in the head or choking if the electric current did not immediately render the patient unconscious.^[233] For this reason, a general anaesthetic and muscle relaxant were commonly given from the late 1950s onwards to make ECT more comfortable for patients.^[234] An anaesthetic puts a patient to sleep before the electric current is delivered.^[235] A muscle relaxant prevents a patient from suffering fractures or dislocations if the body convulses as part of the induced seizure.^[236] ECT delivered in Aotearoa New Zealand now is always given with general anaesthetic and a muscle relaxant. ECT given this way is called ‘modified’ ECT.

117.    Best practice for administering ECT in the 1970s involved trained staff administering a general anaesthetic and muscle relaxant, after which they would place electrodes on a recognised location on the scalp before applying an electrical stimulus that would result in a generalised seizure. Medical and nursing staff would supervise the patient for a period afterwards.^[237]

118.    Properly administered, ECT, whether modified or unmodified, should be painless.^[238] In a letter to Dr Pugmire in 1976, Dr Leeks elaborated, “The process is explained to the child or adolescent; they are told they will be immediately unconscious and unable to feel anything, and would wake in a few minutes feeling considerably better”.^[239] Dr Leeks has stated that his method of ECT was generally painless and patients would have no memory of receiving
the treatment.^[240]

119.    Dr Leeks used what was called the glissando technique for ECT. The glissando technique was primarily employed before muscle relaxants were used as part of modified ECT. It involved increasing the current intensity from a very low level, when the patient was awake, to the chosen maximum strength, when the patient would be unconscious, over a period of about one to two seconds.^[241] Dr Leeks said this technique did the job of anaesthetic by producing a rapidly rising form of electric current that “put the patients out almost immediately but allowed the contraction of the muscles to happen slowly”.^[242] He said some patients experienced transitory headaches and nausea, but this resolved quickly.^[243] For these reasons, he said there was no need for to give an anaesthetic with ECT.^[244]

Te whakamahinga o te haumanu matakawa - Use of aversion therapy

120.    Dr Leeks said he introduced an aversion therapy regime towards the end of 1972 in response to violent and sexual misbehaviour by “a few of the more emotionally damaged” patients.^[245] He said his preference was to use therapy, medication and ECT as treatment, but for patients needing greater control he decided to try aversion therapy along with a reward system.^[246] Use of the technique increased in 1973 following violent incidents including an attack on a staff member with an iron bar.^[247] He said it was also used in an attempt to extinguish “homosexual and physically violent behaviours”.^[248]

121.    Aversion therapy as a technique was initially developed in the late 1920s to treat alcoholism but was later used for the purpose of modifying behaviours considered abnormal or challenging.^[249] It was used in 1935 to ‘treat’ homosexuality using an electric current.^[250] Other aversive stimuli have included nausea-inducing drugs and substances.^[251] It is based on Dr Ivan Pavlov’s theory of classical conditioning and aims to cause a patient to reduce or avoid undesirable behaviour by conditioning the person to associate the behaviour with an undesirable stimulus, such as an electrical or chemical stimulus. Dr Pavlov famously conditioned dogs to salivate to the sound of a bell by repeatedly pairing the bell with the presentation of food, which induced salivation, but subsequently the bell alone was sufficient to induce salivation.^[252] By the 1980s, the therapy had become controversial on ethical and humanitarian grounds and was largely replaced by other therapeutic interventions,^[253] although a form of aversion therapy using an electric shock device continues to be used at the Judge Rotenberg Educational Center in Massachusetts.^[254] The United Nations Special Rapporteur on Torture condemned this as torture in 2013.^[255]

122.    At Lake Alice, Dr Leeks primarily used electric shocks as negative stimuli to discourage unwanted behaviour. He maintained patients experienced these shocks only as ‘discomfort’,^[256] and they were below the pain threshold.^[257] He said this form of therapy was intended to make patients “think twice” about repeating the undesirable behaviour.^[258] He said it was devised by psychologists and used a great deal internationally for “sexual disorders or perversions, alcoholism, compulsive gambling” and “any behaviours, really”.^[259] In some cases, he said, it needed to be done daily – either at fixed times or after a particular behaviour had been carried out.^[260] He said the patients “all knew“ that if they carried out a particular unwanted behaviour, staff would “immediately take them and give them the treatment”.^[261] He claimed it could be done by virtually anyone, including psychologists or even family members.^[262] One or two sessions were usually enough, Dr Leeks said, although one boy needed about 10 sessions because of his violently assaultive behaviour.^[263] Dr Leeks did not disagree when NZ Police later said aversion therapy could be described as penalising patients for misbehaviour.^[264] Dr Leeks claimed to NZ Police he felt uncomfortable with aversion therapy and discontinued it after about a year.^[265] He also wrote in the late 1970s that he had some “doubt about the ethics and long-term results” of the aversion therapy regime.^[266]

123.    Dr Leeks used an older Ectonus electric shock machine for aversion therapy, using a different setting from that used in ECT.^[267] The model used had a variable current dial that could be used for the glissando technique or misused to deliver longer or painful shocks. It was not always clear between Dr Leeks and the nursing staff which treatment they were using on patients with the ECT machine. Dr Leeks occasionally recorded a patient as having received ECT when a nurse described it as aversion therapy.^[268] Regardless of the label used, survivors described electric shocks as causing similar levels of severe pain. Properly administered, neither therapy would cause pain of the type consistently described.

124.    Where possible, we draw a distinction between the legitimate use of electric shocks as a therapy (that is, ECT) and the use of an ECT machine to deliver electric shocks as aversion therapy or for punitive purposes. The use of unmodified ECT without anaesthetic or muscle relaxant or without following proper medical protocols is also discussed. Medications (primarily paraldehyde) were also used as aversive stimuli, particularly by the nursing staff.

Next page -->