9. Mental distress means a mental or emotional state that disrupts daily life. How long the distress lasts and how intense it is can vary. People who experience mental distress include those who are seriously upset, people who are reacting naturally to a stressful situation, and people with mental illness (whether medically diagnosed or not).

10.  Mental distress is common among survivors of abuse and neglect in State and faith-based care. Of the 2,329 survivors who registered with the Inquiry, 83 percent reported experiencing mental distress at some point in their lives. Some survivors experienced mental distress before entering care. Many others reported suffering mental distress during or after their time in care. This summary focuses on the experiences of people who were in mental healthcare settings.

11.  During the early part of the Inquiry period, psychiatry was an emerging field, lacking many of today's diagnostic and treatment tools and an understanding of diversity and difference. Medical disciplines, including psychiatry, operated within a predominantly Western healthcare system, driven by a biomedical model that framed mental health and disability as problems to be fixed.

12.  For those experiencing mental distress, placement in mental healthcare settings was often compulsory, mandated by court orders, emergencies, or the criminal justice system. Some entered voluntarily or on advice from family or clinicians.

13.  The Mental Health (Compulsory Assessment and Treatment) Act 1992 brought significant changes to New Zealand's mental health system, emphasising patient rights and recognising the role of cultural factors in diagnosis and treatment, along with the right to appeal treatment. [2]

14.  Throughout the Inquiry period, people were admitted into mental healthcare settings for a variety of reasons, many of which were unrelated to psychiatric illnesses requiring hospital treatment. Factors such as societal prejudices, including sexist, homophobic, and racist attitudes, led to the inappropriate institutionalisation of people.

15.  A misunderstanding of behaviours due to a lack of knowledge about neurodiversity and sensory or learning disabilities also resulted in unwarranted admissions. The Inquiry saw evidence of children and young people being transferred between social welfare and psychiatric institutions as punishment. Gender norms and expectations, as well as discrimination against diverse gender identities and sexual orientations, were also significant factors driving admissions.

16.  Admissions to psychiatric hospitals surged in the 1940s and 1950s, peaked in the 1960s, and gradually declined in the 1970s. From 1960 to 1990, Māori first-time admissions to mental health facilities increased by over 200 percent, compared to a slight increase for non-Māori.[3] By the late 1990s, the high rates of mental distress among Māori were seen as a crisis of unprecedented proportions. ^[4]

17.  In 1999, Pacific Peoples made up seven percent of forensic inpatient users and five percent of community-based service users, indicating overrepresentation in mental health settings compared to the general population.[5]

18.  The Inquiry heard that mental health settings were environments of isolation, fear, violence and control. Almost all survivors of mental healthcare settings described abuse and neglect that stripped them of their personhood, identity, dignity, and autonomy. This abuse and neglect represented a disregard for the inherent human value of individuals, disrespect of their diverse identities and needs, and a failure to fulfil their rights to participation, inclusion and decision-making. It also represented a disregard for the collective whakapapa rights of survivors whānau.

19.  Survivors of mental healthcare settings experienced long-term isolation, segregation and severe neglect, and were subjected to regular control and restraint. This impacted their relationships, created fear of change or intimacy, and reduced survivors’ abilities to live independently or interdependently. For many, the medical abuse and neglect suffered resulted in long-term physical and mental conditions.

20.  Their ability to fit back into whānau life and with their communities was impacted. These impacts were compounded by discriminatory societal attitudes relating to ableism and disablism which limited lifelong opportunities. Some never left care, and the Inquiry heard evidence of unmarked graves on the grounds of some of the old institutions.

21.  Staff and caregivers in mental healthcare settings had almost total power and control over the lives of people in their care. Human rights were largely absent and the rights guaranteed to Māori under te Tiriti o Waitangi were not considered or upheld. The culture within mental healthcare settings discouraged intervention when abuse and neglect was happening, and in many places normalised abhorrent behaviour and practices. Serious abuse was almost never reported to police, and complaints and oversight processes offered little recourse or protection.

22.  Overcrowding was common in mental health settings.[6] Many institutions had substandard physical environments. Buildings were outdated, poorly designed and inappropriate. Overcrowding often led to compromised daily routines like reduced or absent oversight, lack of individualised care and limited activities. Many people in overcrowded and unsuitable environments suffered abuse and neglect.

23.  While many staff and carers in mental health settings genuinely approached their position to do the best they could for those in their care, poor employment policies combined with poor senior leadership and management practices made it difficult for individual staff and carers to safeguard people in care. This was summed up by staff from mental health settings who told the Confidential Forum for former in-patients of psychiatric hospitals about having “a lack of time for kindness”.[7]<

Footnotes