Chapter 6: Nature and extent of abuse in mental healthcare settings

137. While all forms of abuse and neglect were experienced across most mental health settings, this chapter focuses on the most pervasive forms that the Inquiry heard about. The Inquiry heard that mental healthcare settings were environments of isolation, fear, violence and control for many survivors and witnesses. Features of these settings included:

• strict regimented routines
• people in care experiencing depersonalisation, for example people in care being processed in groups according to a fixed timetable, without consideration for individual privacy needs
• a one size fits all approach. Institutional care follows a uniform approach, providing the same services to all children, young people and adults in care regardless of their age, gender, abilities, needs, or reasons for separation from parents / caregivers
• children, young people and adults in care in institutions are often isolated from their whānau, support networks, hapū and iwi, and communities, far from their places of origin, and unable to maintain relationships with parents, whānau and support networks.

138. Counsel for the Crown Secretariat described the evidence presented at the Inquiry’s Ūhia te Māramatanga Disability, Deaf and Mental Health Institutional Care Hearing as “a shameful picture of inhumanity”.[123] This is an apt description of what was experienced in these settings.

Physical abuse

139. Children, young people and adults in mental healthcare settings experienced physical abuse that was violent, pervasive, and created a climate of fear for many survivors. Most of the abuse that occurred was perpetrated by staff, and in many instances the abuse was intentional. Survivors described being punched, kicked, held in painful restraint positions, dragged along the ground, sexually assaulted and raped by staff.[124] Chris Finan (Maori, Yugoslavian), who was diagnosed with ADHD as a child, spent time in mental healthcare settings as a child and young person in the 1980s and 1990s. As a child at Lake Alice in Rangitikei he received electric shocks from an electroconvulsive therapy (ECT) machine without anaesthetic:

“I was given ECT to get rid of my behavioural issues. I remember being shackled to the bed and the pain of the electric shocks feeling like thunder or fireworks. I did not get anaesthetic.”[125]

140. Many survivors told the Inquiry they were physically abused by other patients or residents at institutions. Peer abuse inside institutions was widespread, recurrent and often not dealt with by staff. Survivors described being hit in the head and knocked out by a cricket bat, bitten, stabbed in the stomach and thrown downstairs by their peers.[126] Some survivors described abuse by peers or others being allowed or facilitated by staff.

141. The Ministry of Health acknowledged the presence of physical abuse in mental healthcare settings from 1950 to 1999 and recognised that during this time, these care settings did not always adequately safeguard people from harm.[127]

People were neglected, dehumanised and degraded

142. Society’s devaluation of people experiencing mental distress was magnified within the confines of institutional settings. Staff viewed and treated individuals in their care as less than – many survivors talk about staff failing to provide residents with even a basic level of respect and dignity.[128] Survivors and whānau told the Inquiry that the most pervasive form of abuse in these settings was neglect,[129] with the denial of an individual’s personhood being an insidious and damaging feature of all mental health settings. Personhood has been described as the “essence of being human” and includes “choice, a sense of autonomy, being part of a loving family, the chance to labour, love and consume”.[130]

143. Survivor Carla Mann, who spent part of her pregnancy in Carrington Hospital in Tāmaki Makaurau Auckland said: “You weren’t treated like a person there, you were treated like a ‘thing’.”[131]

144. Survivor Denise Caltaux similarly described the lack of dignity and care afforded to patients at Tokanui Psychiatric Hospital, located south of Te Awamutu, in the early 1990s, describing it as “horrendous”.[132] Denise recalled that patients in the unit at Tokanui were “herded like animals” to be locked in a communal space during the day, showers were conducted communally by gender each morning, and there were no choices given around food and drink.[133]

145. In mental healthcare settings, people would live in pyjamas or dressing gowns issued to them upon arrival.[134] A report about Tokanui Psychiatric Hospital in 1985 concluded:

“Residents live as paupers, with no personal possessions and often no personal clothing. They are frequently dressed / undressed in the middle of a day room, bathed in large groups, toileted in hallways on potty trolleys, and generally treated with little respect for the dignity and privacy of each person. Staff have become insensitive to the dehumanising aspects of these care procedures.”[135]

Emotional, psychological and developmental neglect

146. Across large-scale institutional settings, the Inquiry was told of survivors’ emotional, psychological and developmental needs being neglected. Aroha, care, emotional support and attention were withheld from survivors, and they were not given opportunities to grow and learn through meaningful activities and stimulation.

147. Survivors of some mental healthcare settings did not feel emotionally supported to process earlier trauma and adversity they had experienced in their life, including in other State and faith-based care settings.[136] They believe trauma and adversity probably contributed to their mental and emotional state at that time. Survivor Ms SD said she did not receive support from staff in Sunnyside Hospital in Ōtautahi Christchurch to help her process grief she was experiencing alongside other challenges, and instead, “it was all just sort of brushed under the carpet.”[137]

148. Catherine Hickey, whose brother Paul “suffered prolonged and premeditated abuse [at Porirua Hospital] at the hands of the very people who were entrusted to protect him”,[138] told the Inquiry that:

“There was no value placed on his young life, and the very people who were put in that position of trust showed complete disregard for his wellbeing and safety.”[139]

149. A 1979 letter from the psychiatric medical officer at Hawke’s Bay Psychiatric Unit to Porirua Hospital states: “I wish [Paul] better luck with his mutilation … since the only real relief I can see for him is in his death.”[140] Paul took his own life nine months later.

150. Antony Dalton-Wilson (Samoan, Gypsy, German) who was in several mental healthcare settings as a child, told the Inquiry that:

“I sometimes went to Māngere Hospital in the holidays but I’m not sure why. I hated it and was treated really badly there. When I first went there, they put me straight in time out and told me to wait. I was yelling for somebody to get me out. I did not have any food or drink…The staff didn’t come and get me out until night-time.”[141]

151. Chris Finan described his entry into Lake Alice in Rangitikei at the age of seven:

“When I arrived, I was strip searched by the nurses…I was then hosed down in the communal shower area. The shower area was open and all sorts of people, of different ages, were in there.”[142]

152. The lack of activities within in-patient psychiatric units have been described by survivors as ‘intolerable’.[143] People’s need for meaningful activity and stimulation was neglected. Samoan survivor Rachael Umaga said that at Te Whare Ahuru at Hutt Hospital in Te Awa Kairangi ki Tai Lower Hutt:

“There was nothing to do at the unit. We just sat there all day and smoked. I felt neglected because there was nothing to do, except wait for 10 o’clock, 12 o’clock, three o’clock and five o’clock for our pills or for a cup of tea.”[144]

153. Rachael told the Inquiry that while there was a craft room, music room and room where you could cook or bake under the supervision of a nurse, no one could do these activities because the facilities were not adequately maintained or resourced with staff to supervise: “It really felt like the staff provided us all these things to show they care but it was all just surface level and for show.”[145]

154. Chris Finan told the Inquiry that he received no education or other activities as a child in Lake Alice and was medicated to control his energy levels.[146] He experienced a similar lack of meaningful activity at Kingseat (Karaka) in the mid-1990s:

“I would wake up at 6am and have a shower and then breakfast. We would only wear pyjamas, which had ‘patient’ labelled on them. Each day I sat around doing nothing.”[147]

155. The 1985 report on Tokanui Hospital concluded similarly, that there were many residents who received minimal personal attention or effort to stimulate them and “these residents spend their days virtually ignored by staff except for foods, fluids and baths”.[148]

Medical abuse and neglect

156. Medication was used to control, subdue or ‘manage’ people’s behaviours while they were in mental healthcare settings, often for the benefit of staff. ‘Overmedicalisation’ refers to the inappropriate application of medical analysis or diagnosis to non-medical situations, as well as the use of unnecessary treatments, which applies to many instances of medical abuse the Inquiry has heard about.[149]

157. The Inquiry heard evidence of medication being used in an experimental nature in psychopaedic and psychiatric settings. Former staff have used the term ‘medical experiments’ to describe the kind of trials that took place in these settings.[150]

158. Dr Enys Delmage, consultant in adolescent forensic psychiatry, told the Inquiry that caution should be exercised when “passing judgment on historical prescribing practices”. He said clinicians in those days “would not have had the benefit of decades of research and innovation that followed”.[151]

159. At the Inquiry’s State Institutional Response Hearing, Ministry of Health Chief Executive and Director-General of Health, Dr Diana Sarfati publicly acknowledged that:

“Much of the nature and standard of care and treatment provided in historical psychiatric or psychopaedic institutions would be unacceptable today and are now, rightly, reviewed as neglect or abuse.”[152]

160. Survivors often used the term ‘guinea pig’ to describe how they felt being given different medications, typically without their informed consent. Samoan survivor Leota Scanlon, who was placed in Lake Alice Child and Adolescent Unit at 13 years old, described how he “just felt like a guinea pig there” as “the staff spent their time figuring out what drug worked best to settle us down and to shut us up”.[153]

161. Chemical restraint is a type of restraint where medication is used to control a person’s behaviour, typically to sedate, subdue and encourage compliance. Chemical restraints can be proactive and used to stop an anticipated behaviour occurring. When it is used in this way it is called overmedicalisation, as a regular dose of medication is being given to maintain control over the behaviour. At other times, medication is used reactively to control or curb unwanted behaviour. The Inquiry has heard evidence of chemical restraint being used in care settings such as disability and mental health settings, as well as social welfare residences and institutions.

162. Survivor Robert Shannon (8 years old) was placed in an adult ward at Palmerston North Hospital for eight months in the early 1960s.He told the Inquiry he was sedated throughout his time at the hospital, and that it:

“Was only necessary because I was not in an appropriate facility and I was not receiving any treatment for my condition [paediatric behavioural challenges later diagnosed as Childhood Behavioural Disorder].”[154]

163. In a letter to a charge nurse at Alice Child and Adolescent Unit, Rangitikei, Dr Pugmire refers to both paraldehyde and Largactil (the brand name for antipsychotic medication, chlorpromazine) as “tranquilizers”.[155] Not only was this kind of medication used as a chemical restraint in care, but paraldehyde injections were often used as tools to inflict aversive punishment.

164. Medical abuse in the form of chemical restraint and over-medicalisation enabled other types of abuse to occur, particularly sexual abuse. Sexual abuse sometimes occurred while survivors were physically or chemically restrained (including being heavily medicated) in settings such as psychiatric hospitals.[156] Survivors spoke about how they were intentionally taken advantage of while in these states.

165. The Inquiry has also been told about punitive medicating. Dr Olive Webb, clinical psychologist specialising in intellectual disabilities and autism spectrum disorder, gave an example of the ward doctor at Sunnyside Hospital in Ōtautahi Christchurch who increased a patient’s medication as punishment. The patient had broken the antenna on his car in retaliation for something he had said that upset her.[157]

166. Medical neglect means the failure to provide or allow for adequate medical care that could be needed by children, young people and adults in any care setting. This includes injuries and illnesses being left unnoticed, untreated or caregivers or staff withholding access to medical treatment for any length of time.[158] Family members told the Inquiry that they brought injuries to the attention of staff, but they remained untreated.

167. Catherine Hickey told the Inquiry that when her family visited her brother Paul at Porirua Hospital they often found him with untreated injuries:

“[Mum found him} cowering in a corner in the ward, with fresh bruises, black eyes, swollen lips and cuts on his body…this happened more than once.”[159]

Aversion techniques to punish and control

168. Aversion therapy is a form of behaviour therapy where undesirable behaviour is matched with an unpleasant (aversive) stimulus and delivered in a measured, controlled way.[160] As unpleasant feelings or sensations become associated with that behaviour, the goal is for the behaviour to decrease or stop. Aversion therapy has been the focus of debate for many years among educators, medical professionals and practitioners.[161] Its use remains controversial on ethical grounds and because of concerns about its effectiveness and safety.[162]

169. The Inquiry has seen some evidence of aversion techniques being used on children, young people and adults across different care settings in an attempt by staff to reduce behaviours they viewed as ‘problematic’ or challenging. This was often done through the delivery of uncomfortable, sometimes intolerable medical stimulus such as electric shocks delivered through ECT machines and painful injections. Survivor Mr JJ said that he was given electric shocks on 12 occasions in one day after accidentally breaking a pot at Lake Alice Child and Adolescent Unit.[163] The Inquiry refers to these as aversive techniques, rather than therapy, as they represented medical abuse as a form of punishment and control.

170. The effects of medical abuse, such as electric shocks, could enable subsequent abuse to occur. As discussed in the Inquiry’s report Beautiful Children: Inquiry into the Lake Alice Child and Adolescent Unit, several survivors suspected they were raped while heavily sedated or unconscious after receiving electric shocks[164] Survivor Malcolm Richards, said he had no idea how long he had been unconscious after electric shocks, but he “came to back in the cell with a sore, sticky rectum" and believed he had been raped.[165]

171. The Inquiry has seen evidence of paraldehyde injections being used as aversive punishment. Paraldehyde is a hypnotic and sedative with anti-convulsant (anti-seizure) effects, known to have an extremely offensive taste and smell.[166] Administration by way of injection is understood to be extremely painful.[167] Following administration, people report being unable to use the part of the body that received the injection over a long period, until the effects have worn off.[168]

172. Medical abuse in the form of aversion techniques also commonly occurred consequently to children, young people and adults in care who were impacted by other types of abuse and neglect. Caroline Arrell, a former worker at two large-scale disability and mental health institutions, Tokanui Psychiatric Hospital near Te Awamutu and the Kimberley Centre near Taitoko Levin, said young residents’ ‘challenging behaviour’ was overwhelmingly caused by emotional and physical neglect and a lack of stimulus:

“I believe [residents] as demonstrated in their behaviour, were also responding to a wide variety of abuse. I believe that they were behaving in perfectly understandable ways in very abnormal environments.”[169]

Abuse and neglect experienced by different groups

173. For survivors who experienced mental distress, the most common abuse type in these settings was physical, which featured in 43 percent of accounts.

174. For Pākehā survivors of disability and mental healthcare settings, the most commonly experienced type of abuse was physical, at 44 percent.

175. Almost half of Māori survivors who went through disability or mental healthcare settings were physically abused (46 percent). There was also significant sexual (33 percent of accounts), and emotional abuse (31 percent of accounts) experienced by Māori.

176. For wāhine Māori who spent time in disability or mental healthcare or care settings, physical abuse was the most commonly experienced type (44 percent).

177. Of the Pacific survivors time in disability or mental healthcare settings, 36 percent said that they were neglected while they were there. This is a high proportion compared to other groups or settings. The next most common abuse type was physical abuse, which was experienced by 29 percent of survivors.

178. Takatāpui, Rainbow and MVPFAFF+ survivors experienced homophobic abuse that was sometimes couched within religious abuse and justifications. Takatāpui, Rainbow and MVPFAFF+ children and young people were targeted due to their sexuality, gender expression or sex characteristics, and were more vulnerable to abuse. Some were subjected to conversion practices in mental healthcare that were psychologically and often physically abusive. These experiences are set out in detail in the Inquiry’s summary of the experiences of Takatāpui, Rainbow and MVPFAFF+ people in state and faith-based care.

179. The Inquiry was told about forced and unconsented abortions happening in mental health settings. Mostly, the Inquiry heard of women who realised during or after the procedure that they had undergone an abortion. The Inquiry also heard that some of their pregnancies were a result of sexual abuse occurring whilst in care.[170]

Extent of abuse in mental healthcare settings

180. MartinJenkins estimated a total of 183,489 people in the identified health and disability care settings during the Inquiry period. The MartinJenkins report further estimates how many people probably experienced abuse in health and disability care settings. Their analysis of available data from international studies provided a low estimate of 22,153 survivors (10.5 percent of survivors who were in these settings from 1950 to 2019), and a high estimate of 72,422 survivors (34.2 percent).[171]

181. There has been limited research on the extent of abuse and neglect in mental healthcare settings. The Ministry of Health has never kept centralised records. As part of its Notice to Produce response, the Ministry of Health reported that any complaints of abuse that could have come to the attention of the Ministry and its predecessors over the scope period would not be held in a central location and would instead be held among records for the relevant directorate or business unit. The Ministry stated it was not a health provider and so was unable to answer questions relating to records.

Footnotes