Physical health

182. Survivors placed in mental healthcare spoke of the immediate and ongoing physical impacts from receiving electric shocks as punishment, such as electrode burns, tinnitus and memory loss.

183. Medication was administered to many survivors in these settings to control their behaviour. Since then, these survivors have developed chronic health conditions related to direct physical impacts like bowel damage.

184. The neglect experienced by survivors in institutional care exacerbated other impacts of abuse. Some survivors who suffered physical abuse were medically neglected and their injuries not treated, which made the injuries they suffered worse and the damage lifelong.

185. Women were denied reproductive rights during and after their time in institutional care, meaning many were unable to have their own children.

186. Engagement with survivors and their whānau or support networks, during the Inquiry and previous inquiries, revealed that people died while in care. These deaths seemed more likely to occur in disability and mental healthcare settings where people experienced gross neglect.

Mental health and emotional wellbeing

187. The Inquiry received evidence that solitary confinement (also referred to as seclusion) was prevalent in mental healthcare settings. Research demonstrates that solitary confinement can have lasting physiological impacts on survivors’ intellect and behaviours, social and emotional regulation, mental and physical health, and memory, and on brain structure and function. This impact is especially likely when solitary confinement (seclusion) is experienced frequently, for longer durations, and at a younger age when the brain is still developing. Chemical restraint was also used in combination with solitary confinement (seclusion). Survivors remember this as a double form of punishment and that its impact was felt acutely.

188. Social isolation and separation had detrimental impacts on children, young people and adults in mental healthcare settings. Institutionalisation separated many survivors from their whānau, hapū, iwi, language, culture and wider communities for decades, and in some cases, for life. This separation had traumatic and far-reaching consequences for survivors and was particularly acute for Māori and Pacific survivors.

189. Research shows that placing people into institutional care – where they experience strict routines and restricted autonomy – has detrimental impacts to many aspects of their lives. For children, being placed into regimented institutional care impacts their intellectual, behavioural, social and developmental development, including their attachments.

190. Like many in residential institutions the experience for mental health residents was dehumanising. There are a number of impacts that are unique to these survivors. Many survivors of these institutions don’t like locked doors or the sound of heavy keys. All survivors were prescribed medications while in an institution and many are still using similar regimes. Many survivors experience negative impacts of long-term use of these medications.

191. Survivors of mental healthcare settings experienced long-term isolation, segregation and severe neglect, and were subjected to regular control and restraint. These 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.

192. Almost every survivor the Inquiry heard from still experiences stressful and disruptive anxiety disorder challenges and many continue to experience ongoing mental distress or live with diagnosed mental health issues. This includes suicide and suicide ideation and attachment disorders. Attachment disorders are mental health conditions that affect how people form and maintain relationships. They often develop in early childhood if the caregiver is neglectful, abusive, or not consistently available.

193. People with attachment disorders might struggle to trust others, manage their emotions, and build healthy relationships. They might seem withdrawn, anxious, or overly dependent on others.

Impacts on life after time in mental healthcare settings

194. Survivors of mental healthcare settings were subjected to extreme abuse and severe neglect, including segregation and isolation. Many survivors were denied personhood and autonomy, independence, and were not given the opportunity to learn basic life skills. Their ability to fit back into whānau life and with their communities, having been in institutions with strict regimented routines, was impacted. These impacts were compounded by discriminatory societal attitudes relating to ableism and disablism which limited lifelong opportunities.

195. From 1988, large mental health institutions started closing down without infrastructure in place to support transition back into the community. No aspect of institutional care had prepared survivors for this and adjusting to community life was challenging. Survivor Sunny Webster, who was placed in a mental health institution, explained that she lacked the basic skills necessary for everyday life and had to teach herself “how to live from scratch.”[172]

196. Another survivor, Toni Jarvis, said he cannot understand how the State expected him to “go to Cherry Farm and then at a later stage manage to fit back into the community”.[173]

197. Māori survivor Sidney Neilson (Ngāpuhi, Ngāti Porou) was diagnosed with schizophrenia at 19 years old and told the Inquiry that he spent almost 50 years in and out of Porirua Hospital. In a joint witness statement with his sister, Sidney explained that he and his whānau felt unsupported in his pathway into community-based living, after he was discharged around 1989, due to deinstitutionalisation:

“There was limited offer of help or support for me or my whānau, I felt like I just thrown into the community and told to survive. I moved from an open ward at the hospital to a halfway house. There were whānau hui, and meetings with a psychologist and psychiatrist in preparation for my release, but all my family knew was that the hospital wanted to discharge me.” [174]

198. Sidney initially had some negative experiences with community-based living, such as moving from flat to flat with different mental health community services, dealing with poor living conditions such as mould and being taken advantage of by a previous landlord. However, Sidney told the Inquiry that he now enjoys the independence:

“I love my life. It is good living alone, cooking, shopping, keeping my flat clean and tidy, keeping myself clean and tidy and doing my own things”.[175]

199. Survivors of abuse and neglect in mental healthcare settings have also experienced difficulties with employment. Survivors said the emotional and psychological impacts affected their ability to retain employment in a range of ways including how they respond to or interact with others, feelings of inadequacy or unworthiness, and the impact of alcohol or substance misuse. Other employment difficulties stemmed from the prejudice and discrimination of having been in care, including being seen as less trustworthy than other people.

200. Societal attitudes towards mental distress and people who have been in mental healthcare settings has meant that the negative impacts of abuse and neglect in care have contributed to further adverse outcomes for many survivors experiencing mental distress. This includes fewer employment opportunities, often meaning survivors require long-term income support that is often inadequate for their additional needs.

201. Some survivors of mental healthcare had no pathway after care. Some survivors have spent much of their lives in institutional care, shifting to smaller care settings where features of institutional care still exist. These include regimented routines, one-size-fits-all approaches to care, lack of individualised care responding to each person’s unique needs and circumstances, isolation from whānau, depersonalisation and may be excluded from communities.

202. The Inquiry has not only received evidence of people dying in care, but also of people in care being buried in unmarked graves.

Impacts on particular groups

203. Disconnection from te ao Māori was often compounded for survivors who were tāngata whaiora. Tāngata whaiora Māori in mental healthcare settings were denied opportunities to connect with their whānau and their Māori identities. The care and treatment they received often did not reflect holistic approaches to health and wellbeing, including kaupapa Māori models of care.

204. State and faith-based institutions generally denied tāngata whaikaha and tāngata whaiora Māori the ability to express themselves as Māori and become or develop their cultural competency. Many lost their identity as Māori and their connection to their whānau. Māori survivor Joshy Fitzgerald told the Inquiry that he wished he had more opportunity to learn te reo:

“[te reo Māori] would at least give me a feeling of belonging. I don’t feel like I belong anywhere.”[176]

205. Separation and lost connection to kainga (family) impacted disabled Pacific survivors’ ability to also keep connected with their ethnic and faith-based communities and maintain their cultural identity.

206. At the Inquiry’s State Institutional Response Hearing, Geraldine Woods, then Acting Chief Executive of Whaikaha, said:

“Between 1950 and 1999, Health and Disability care settings failed to consistently and meaningfully support the cultural needs of tāngata whaikaha Māori. I acknowledge that this caused tāngata whaikaha Māori to be disconnected from their culture, identity, language and communities. These impacts are ongoing and have impacted whānau, hapū and iwi.”[177]

207. The segregation of survivors in institutional care settings and restricted contact and separation from whānau caused acute pain and lifelong negative impacts. This separation also denied Māori and Pacific survivors access to their cultural beliefs, values and practices.

208. Survivors with diverse sexuality or gender identity spoke about how homophobic abuse impacted their self-worth, and feelings of safety about their identity.

209. Takatāpui, Rainbow and MVPFAFF+ survivors in disability and mental health settings were sometimes physically and sexually abused and neglected because of their gender orientation or sexuality. As well as the life-long impacts shared by many other survivors they experienced gender dysphoria and intimacy avoidance, struggling with emotional closeness and connecting on a deeper level.

Footnotes