469.    Te taha hinengaro in Te Whare Tapa Whā and the mental health pou in the Fonofale model both represent mental and emotional aspects of a person’s wellbeing. Here, we consider impacts on survivors’ cognitive and mental health. Cognitive health is an umbrella term for brain health and includes brain development and function (the ability to think, learn, remember and manage inhibition), emotional responses, social functioning and motor skills.^[1034] Mental health is “a state of mental well-being that enables people to cope with the stresses of life, realise their abilities, learn well and work well, and contribute to their community”.^[1035] The two are interconnected and greatly shaped by social and environmental factors.^[1036]

470.    Most survivors said experiencing and witnessing abuse in the unit had a severe and on-going impact on their mental health. Many survivors who told us they had no mental illness before their time in the unit have since been diagnosed with a mental health condition, which they attribute to their experiences in the unit. Most survivors shared long-term symptoms common to survivors of severe trauma, including shame,^[1037] anxiety,^[1038] guilt,^[1039] low self-esteem,^[1040] depression,^[1041] memory loss,^[1042] suicidal thoughts, dissociation, intrusive thoughts,^[1043] insomnia,^[1044] difficulty with relationships and attachment to others,^[1045] and extreme reactivity to stress.^[1046] 

471.    Survivors described a variety of emotions during their time at the unit in response to the abuse. Stress, anxiety, shame, guilt, fear and sorrow were commonly felt, as was anger. Ms Sharyn Collis said she and others “thought about running away, but we just couldn’t escape. We would get so angry – we would end up tearing our clothes and crying ourselves to sleep”.^[1047] Mr Charles Symes said he was told he was given electro-convulsive therapy (ECT) to stop his violent outbursts “but every time I got ECT it just made my anger worse. I got more and more violent. I hated it”.^[1048] Mr Pete Rose’s recurring emotion was fear, and he described the atmosphere at the unit as “fear-filled” and other patients’ attitude to Dr Leeks as “fearful”.^[1049]

472.    These emotions often did not fade with time and all could affect survivors’ interpersonal relationships. For many, these emotions persist strongly to the present day. Some survivors described uncontrollable outbursts of anger. One survivor said he had no partner or tamariki, and he put this down to his fear that he might repeat the cycle of violence and abuse: “I’m angry in my head, so I don’t want to repeat any cycle of any violence of any kind and I just refuse to because I can fly off … And it’s not like a build-up, it’s just bang like that, so I don’t trust myself.”^[1050]

473.    Survivors also described an intense, persistent fear of being sent back to Lake Alice, even though they knew the hospital had closed. For example, Mr Hendricks said the fear didn’t go away just because he had been released. “I have done my best to battle against that fear, but it comes back and haunts me every now and then.” He described how he would simply withdraw into himself and not communicate with anybody. He said he would, “become a robot, doing what people tell me to do, being where I am supposed to be and saying what I’m supposed to say because that’s how I had to survive in Lake Alice”.^[1051]

474.    Mr Bryon Nicol said he was still haunted by the trauma of Lake Alice.

“I live it in my mind and body daily. In particular, the memories of being raped, of the mentally disabled boy being injected in his penis, the sight and smell of urine and faeces swelling up in our pants and dripping down while waiting for ECT, and of begging for help from being sexually abused but being called a liar and being punished for it. These are the worse memories. They flash up daily.”^[1052]

475.    Survivors were aware the abuse had influenced their behaviour while at the unit and continued to do so in their adult life in the form of substance abuse and dependency, difficulty in regulating aggression and hypervigilance. One described how she was always hypervigilant. “If someone does a really loud laugh, then I freeze.”^[1053] Another, Mr Andrew Jane, described a trigger that prevented him from doing such an everyday thing as catching a bus. “I can’t even go on public transport because, if I see anyone with a beard, I just want to attack them. A man with a beard sexually and physically abused me in State care.”^[1054]

476.    Many survivors reported becoming dependent on alcohol and other drugs, sometimes from a young age, to numb the emotional pain and block out traumatic memories. Mr Scanlon had a succinct explanation for his dependency, which was typical. “I drank alcohol to try and kill all the bad memories I had of Lake Alice.”^[1055]  Some told us they had taken overdoses.^[1056] Some ended up in the criminal justice system because of substance dependency, often for drink-driving^[1057] and cannabis-related offences.^[1058]

477.    In their report, Ngā Wairiki and Ngāti Apa pointed out that for many tangata whaiora, their time at Lake Alice was a turning point for the worse.^[1059] Some young men never returned to their whānau, many developed alcohol and other drug problems, many lacked the support to develop basic life skills, and many went to live on the streets in different cities near and far from their whānau.^[1060] This institutionalisation stripped the mana and very essence of their people. The report noted that this institutionalisation increased the vulnerability of tāngata whaiora and, for many, increased the risk they would become part of the criminal justice system or would take their lives.^[1061] As one whānau member said:

“When he did leave, he went to Epuni Boys Home; he lived on the streets, he was a bit of a free spirit. He said to me, “I do not want anyone to control my life ever again.” So that’s why he lived on the streets, he did what he wanted to do. He gave everything to street people. He would busk and he would not worry about himself, feed himself, he had to feed everyone else. He was quite hard into the drugs though because that was the only thing obviously that would numb all the pain.”^[1062]

478.    Another whānau member said:

“They took away his rights to be a normal human being really, Māori man. They took away everything, they stripped him of everything so all he knew was trauma, he didn’t know anything else. So, obviously fear, there was so much fear about; what does that real world look like? He didn’t know what a real world was because he’d been abused from such a young age and he’s committed and then institutionalised … All he was interested in was surviving and how he could survive and what was the best way for him to survive.”^[1063]

479.    Most often survivors told us they lived with anxiety disorders, particularly post-traumatic stress disorder, and depression. Survivors, including those who had not been diagnosed with mental health conditions, often described symptoms such as memory loss, insomnia and hypervigilance. Depression, memory loss, mental confusion and stress affected survivors’ ability to work, as well as their personal relationships. Mr Kevin Banks said the quality of his life had suffered greatly, and he struggled to “be a good father and find happiness in everyday things”.^[1064] Mr Malcolm Richards described his memory as a “nightmare” for him.

“I lose my train of thought a lot and it is hard to keep a conversation or to concentrate on what I’m doing. I struggle every day. I can’t remember sometimes where my daughter lives and she is just down the street. Sometimes I drive and don’t remember how I ended up there. I run into people in the street that talk to me and I have no clue who they are.”^[1065]

480.    Insomnia was a common problem for survivors. Nightmares were another. Survivors reported waking up screaming, crying and in cold sweats. As a result, they feared sleep. Mr Banks, who suffered from these problems, said he was “always too tired to enjoy” his life.^[1066]

481.    Some survivors went into other State psychiatric institutions soon after their discharge from Lake Alice, while others did so later in life. Some remain in such settings today. The abuse has driven some survivors to harm themselves or to attempt suicide. Ms Robyn Dandy said she had “heard that a lot of the children who were in Lake Alice committed suicide in years after. I understand why they did this – the memories are so hard to live with”.^[1067]

482.    One survivor took his own life after his discharge from Lake Alice, and his parent and sibling told us about the days leading up to his death. They said he greatly feared being readmitted to the unit.

“[He] had been out of Lake Alice for just a few weeks when he killed himself. He killed himself on 16 August 1976. He had not been settled, and it was decided he needed more treatment. I was driving home to tell him that he was going to go to Manawaroa [health clinic] and be under the care of Dr Durie. When I got home, I found [him] in the shed.”^[1068]

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