109. In the early part of the Inquiry period, psychiatry was still an emerging discipline. Psychiatrists lacked some of the tools and understanding of today, not only to diagnose and treat conditions, but also of difference and diversity.

110. Medical disciplines, including psychiatry, operated within a predominately Western healthcare system, driven by a biomedical model of understanding and approach to health, including mental health and disability.

111. Prejudice and a lack of knowledge and understanding of different behaviours or conditions saw some people admitted to mental healthcare settings for reasons that would be viewed as inappropriate today, including admissions based on punitive, sexist, homophobic and racist attitudes and misunderstood behaviours.[87]

112. During the Inquiry’s State Institutional Response Hearing, Director-General of Health Dr Diana Sarfati acknowledged:

“Societal stigma against people with mental health conditions and learning disabilities was a contributing factor to people being placed in psychiatric settings during the 1950s-1970s, and I acknowledge that people (including children and young people) were placed in psychiatric hospitals and facilities for reasons that would not be acceptable today.”[88]

Trauma and disadvantage

113. Survivors told the Inquiry that, before entering mental healthcare settings or engaging with mental healthcare services, they experienced trauma and adversity, including in childhood and adolescence.

114. Māori survivor Ms LW had been experiencing mental distress from the trauma of sexual abuse and was 18 when her mother took her to a doctor who sent her for assessment at Wellington Hospital; that same day she was placed at Porirua Hospital.[89] Māori survivor Ms OF (Ngāti Kahungunu) became “depressed and angry” after being sexually abused by a friend’s father and struggling with her sexuality. She was sent to Ward 12 Southland Hospital in Waihopai Invercargill after attempting to take her own life when she was aged 16.[90]

115. Most survivors who talked to the Inquiry about mental healthcare pathways also had a history of State or faith-based care.[91] The majority of these survivors experienced trauma in these care settings.[92]

116. NZ European survivor Robert Donaldson experienced sexual abuse by Father Magnus Murray from age 7 to 17 years old, whom he had met through his family's involvement with St Bernadette’s Church in Ōtepoti Dunedin.[93] After having a breakdown as an adult in the 1980s, Robert was admitted to Cherry Farm Psychiatric Hospital in Ōtepoti Dunedin, where he suffered further physical abuse.[94]

117. For some survivors admitted into mental healthcare, authority figures (including medical professionals) appear to have misdiagnosed their conditions due to a lack of understanding of the survivor’s experiences, behaviours, and emotions.[95] Māori survivor Terry King was admitted to Ngawhatu Hospital in Whakatū Nelson at 14 years old because he kept running away from his abusive home. He had suffered sexual and physical abuse from priests at St Joseph’s School in Waihi and St Mary’s School in Tauranga, as well as from his stepfather. His reports of abuse were not believed by medical staff, and instead Terry was diagnosed as “Feeble minded, with Schizoid Personality”[96] almost one month after being admitted.[97]

Behaviour, neurodiversity and disability

118. Neurodiverse children and young people and people with sensory or learning disabilities, traumatic brain injury or foetal alcohol spectrum disorder, often came to the attention of authorities because of their behaviours. These behaviours could be wrongly labelled as naughtiness, delinquency or even contribute to diagnosis of a mental health condition, which could increase the likelihood of an individual being placed into a mental healthcare setting.[98] This was particularly the case for tamariki and rangatahi Māori, who were often placed into mental healthcare from home or social welfare residences where authorities took a racist approach and so were less tolerant with their behaviour. As described in the Inquiry’s final report, Whanaketia – Through pain and trauma, from darkness to light, discriminatory and racist attitudes contributed to tamariki and rangatahi Māori being considered deviant and criminal.

119. Porirua Hospital set up a unit for autistic people in the 1970s as this diagnosis began to increase.[99] Tāngata Turi Māori survivor Mr LF (Ngāti Maniapoto) who had Asperger’s syndrome was admitted to Sunnyside Hospital in Ōtautahi Christchurch when he was 21 years old. He stayed at the hospital on and off over a period of approximately 11 years:

“I was visually misdiagnosed with schizophrenia and medicated accordingly. At no time was an interpreter used to ask me how I felt and what was happening to me. There was no support in terms of information and discussions with family at all.”[100]

120. In a paper prepared for the Inquiry, Dr Olive Webb explained that until around 1980, children and young people with autism were often diagnosed with a psychiatric condition, “childhood schizophrenia”:

“The expected mode of intervention was medical, and that means, during these times, antipsychotic, sedating medication. The intense anxiety experienced by people with ASD would not be recognised as such, and escalations of behaviour would be seen as manifestations of psychosis. In keeping with treatment of people with psychiatric conditions, restraint and seclusion would occur to manage out-of-control behaviour.”[101]

Young people transferred from social welfare settings

121. The State sometimes transferred children and young people from social welfare residences into mental healthcare settings. This was in response to actual or perceived mental, emotional, and / or behavioural issues. Sometimes this was for short periods of observation.[102]

122. Pākehā survivor Beverly Wardle-Jackson, who was placed into girls homes and experienced physical abuse in care, was later placed in psychiatric care. Beverly told the Inquiry:

“Like a lot of girls who went into care, I ended up in psychiatric hospital care – first Ward 27 at Wellington Hospital and then Porirua Hospital, where I stayed on and off from 1967 to 1973, and later Oakley Hospital. In between admissions, I went to other places – often back to various girls homes. Each time, I was returned to Porirua Hospital when my behaviour was perceived to be ‘difficult’. I was just a lonely, isolated teenage girl.”[103]

123. In the late 1960s between 20 and 30 percent of girls discharged from Fareham House in Pae-Tu-Mokai Featherston were transferred directly to psychiatric hospitals.[104] Admissions of girls into mental healthcare settings were often influenced by gendered discrimination, including being demonised for not living up to societal expectations of girlhood and womanhood. This is discussed further in Part 4 of the Inquiry’s final report, Whanaketia – Through pain and trauma, from darkness to light.

124. By the 1970s, some social welfare residences had regular visits from psychological services, which could prompt assessment, referrals, and transfer of children and young people to other psychiatric or psychopaedic settings such as hospitals.[105] A 2006 Ministry of Social Development report, Social Welfare Residential Care (1950-1994) examined the departmental and institutional practices in social welfare residences. This report noted a small but significant group of children and young people in social welfare residences that had either come from, or went on to, a psychiatric hospital.[106] Examples given of this connection between social welfare and psychiatric institutions included:

1. Hokio Beach School near Taitoko Levin, Holdsworth Boys’ Home in Whanganui and Lake Alice Child and Adolescent Unit in Rangitikei
2. Allendale Girls’ Home in Tāmaki Makaurau Auckland and the psychiatric ward at Auckland Hospital
3. Kohitere Boys’ Training Centre in Taitoko Levin, Epuni Boys’ Home in Te Awa Kairanga ki Tai Lower Hutt, Miramar Girls’ Home in Te Whanganui-ā-Tara Wellington and Porirua Hospital.[107]

125. This pattern was also clear in the evidence survivors gave to the Inquiry. As discussed in the Inquiry’s report, Beautiful Children: Inquiry into the Lake Alice Child and Adolescent Unit, the Inquiry found the Department of Social Welfare paid insufficient attention to whether it had lawful authority to consent to the informal admission of children and young people to a psychiatric hospital.[108]

126. Survivors believed they were sometimes admitted from social welfare residences to nearby psychiatric or psychopaedic settings as punishment for unwanted behaviour, especially running away.[109] Survivor Alan Nixon, who had been running away from Kohitere Boys’ Training Centre in Taitoko Levin, was sent to Lake Alice and placed into the adolescent ward for observation when he was aged 16. Alan told the Inquiry he received ‘two jolts’ of electric shocks without muscle relaxant or anaesthetic “as punishment for not telling the Lake Alice staff the reasons why I kept running away”.[110] After a month at Lake Alice, where he experienced further abuse and neglect, Alan was sent back to Kohitere Boys’ Training Centre.[111]

127. Former psychiatrist Dr Ken Bragan described how the courts sent “delinquent adolescents” to Sunnyside Hospital in Ōtautahi Christchurch.[112] Māori survivor Susan Kenny (Ngāti Apa) had already been labelled as delinquent due to her behaviour following sexual abuse and other trauma. She was placed at Sunnyside after a minor incident at Kingslea Girls’ Home in Ōtautahi Christchurch:

“One day at Kingslea, I can remember exercising in the courtyard and a shuttlecock went on the roof. I got up on a chair to get it. A staff member came and grabbed me, and I kicked back. I remember getting an injection. I think it was after that I went to Sunnyside.”[113]

128. The Inquiry also heard from a clinical psychologist, and former staff member at Holdsworth School in Whanganui, that boys were transferred from the school to Lake Alice Child and Adolescent Unit in Rangitikei as punishment for misbehaviour.[114]

129. Retired police aid youth worker Mr LX recalled a points system at Holdsworth School, which determined whether boys were sent home or released. He asked the principal what the negative points on the board meant and was shocked with the response: “Oh then that inmate goes to Lake Alice for treatment and let me tell you he comes back with a much better attitude.”[115]

130. Some former staff of psychiatric institutions told the Confidential Forum for former in-patients of psychiatric hospitals that, on occasion, people with no diagnosed mental health conditions ended up in psychiatric hospitals due to capacity pressures in other care settings, including social welfare residences. [116]

Gender discrimination

131. Pathways into mental healthcaresettings could also be gendered. Women and girls’ admissions sometimes reflected prevailing societal norms and attitudes about women's gender roles, mothering, pregnancy, miscarriage, childbirth, sexuality and marital difficulties.[117] The Confidential Listening and Assistance Service found that young women admitted to psychiatric hospitals for post-partum depression often stayed for many years.[118]

132. Discrimination against women and girls could also intersect with racism. Young girls at Fareham House in Pae-Tu-Mokai Featherston, who were predominately Māori, were given medication in an effort to “establish acceptable patterns of behaviour.” [119] As discussed above, the Inquiry heard that 20 to 30 percent of girls at Fareham House went on to be admitted to mental health hospitals.[120]

133. The Inquiry’s summary report on the experiences of women and girls in State and faith-based care has more detail on the gendered reasons for entries into mental health settings.

Homophobia and discrimination

134. Discrimination towards people with diverse gender identities and/or sexual orientation resulted in people from the Takatāpui, Rainbow and MVPFAFF+ communities being admitted to mental health settings.[121] Until 1973, the Diagnostic and Statistical Manual of Mental Disorders categorised homosexuality as a mental health disorder. This, coupled with the criminalisation of homosexuality (until homosexual law reform was passed in New Zealand in 1986), established a pathway for Takatāpui, Rainbow and MVPFAFF+ communities into mental healthcare settings.[122]

135. Religious attitudes that conceptualised homosexuality as a mental health issue also forced Takatāpui, Rainbow and MVPFAFF+ to engage in mental healthcare and treatment, particularly for Pacific Peoples.

136. The Inquiry’s summary report on the experiences of Takatāpui, Rainbow and MVPFAFF+ people in State and faith-based care has more detail on homophobic and other discriminatory reasons for entries into mental health settings.

Footnotes