For some time after the founding of the colony no special provision was made for the mentally ill. If these unfortunates had no relatives to care for them, or if they were too great a problem to their family, they could be cared for only in the nearest gaol. For some years successive Governments were slow to make adequate provision for the mentally ill and subnormal. Public opinion, and the numbers requiring attention, led to the establishment in 1853–54 of asylums in Auckland and Wellington, largely financed by public subscription. In Dunedin, within three years of the Scottish settlement, three mental patients were the first to occupy the small hospital in 1851, and an asylum was established in 1863. A year later a similar institution was set up in Christchurch and 17 patients were transferred to it from the gaol.
Responsibility for the asylums was vested in the Provincial Governments whose surgeon, as a rule, was the visiting medical officer. By good fortune the Otago Provincial Surgeon, Dr Edward Hulme, had studied mental diseases at the well-known Salpêtrire Hospital in Paris. Others were less well qualified. In 1876, with the abolition of the Provincial Governments, responsibility for the asylums reverted to the Central Government who appointed Dr F. W. A. Skae, Inspector of Asylums and head of the Asylum Service. By that time asylums were established at Auckland, New Plymouth, Napier, Wellington, Nelson, Hokitika, Christchurch, and Dunedin. By that time also the population was rapidly outstripping the capacity of the buildings which, in consequence, lacked space and many essential comforts and amenities. Whilst deploring this very serious difficulty, Dr Skae conceded that the wards were scrupulously clean and the patients treated humanely. There was, however, an unevenness in the standard of skilled medical treatment at the various asylums. In 1881, after Skae's death, Dr G. W. Grabham took over the duties of Inspector-General of Hospitals and Asylums until 1886. His successor was Dr Duncan MacGregor, until then Professor of Mental and Moral Philosophy at the Otago University, and one-time visiting physician to the Dunedin Asylum.
During his long and distinguished tenure of office, MacGregor had to face many serious problems arising out of the very heavy demands on the accommodation of the asylums, which in part he attributed to “the strong tendency which has risen to throw every case that can be brought within the definition of insanity off the local rates onto the general taxation of the Colony”. He was constantly urging Governments to increase the accommodation available, and as late as 1897 he referred to “the terrible conditions to which our asylums have been allowed to lapse owing to the overcrowding”. MacGregor was responsible for some remarkable improvements, both in the quality of medical treatment and the consideration given to the essential needs of rehabilitation. His superintendents were hampered in some institutions by overcrowding; his junior medical staff were poorly paid; and the regular and systematic instruction of the attendant staff was not provided for by any system of State examination. Yet, in his term of office, many far-reaching and important developments were pioneered. An obligatory course of lectures for nursing staff was instituted, meagre in the extreme by modern standards, but remarkable at the time, and even thought by some to be excessive.
In 1904, following upon the success of “The Cottage” and “Simla” wards at Seacliff, MacGregor authorised the newer development at Seaview Hospital, Hokitika, of what was to become the villa hospital pattern. MacGregor's successor in 1907, Dr Frank Hay, continued the development of the idea of the villa hospital, and since the early 1900s all new mental hospital development in New Zealand has been on villa lines. By 1924 New Zealand could show what was probably the only complete villa mental hospital in the world.
Formation of Mental Hospital Department
In 1908 a Mental Hospital Department was set up under its own Minister. The service continued as a separate Department until 1947, when it became the Mental Hygiene Division of the Department of Health with which it was joined. This union has proved fruitful.
In the intervening years a very great change has come about in the general attitude towards the mentally ill, and some corresponding improvement towards institutions devoted to their care. The present mental hospitals have developed a largely open policy. Restraints are minimal, and there is a major emphasis on treatment, rehabilitation, and development of abilities and assets. The institutions for the mentally subnormal have been differentiated from the mental hospitals, and are developing an advanced form of training programme. In addition to qualified nursing staff, many new categories of professional staff are included in the therapeutic team. Occupational therapists, whose training school was founded by the Division, social workers, clinical psychologists, and recreation officers – not to mention teachers and training officers in the hospitals for the mentally subnormal – have augmented the therapeutic agencies. There still remains in some areas, and in categories of accommodation, a residuum of the former problems of overcrowding. It is, however, confidently anticipated that this will be resolved within the next few years; for fewer patients are nowadays becoming chronic, and the length of stay in hospital after treatment is rapidly falling. Even more remarkable is the rapidly rising ratio of voluntary patients admitted. In 1954, 1,178 were admitted voluntarily and 1,928 admitted subject to reception order. In 1962 a Mental Health Amendment Act came into operation, which provided for the formal admission to mental hospital of certain types of patient who previously would have been admitted under a reception order. The procedure by which these patients are admitted is very similar to that for admission to public hospital on the recommendation of a medical practitioner. In the main these patients are mentally defective or mentally infirm (senile) patients. In 1964, the most recent year for which final figures are available, there were 4,244 voluntary admissions, 1,290 informal admissions, 1,429 formal (committed) admissions, and 351 Part IV admissions. (Part IV cases are referred from the Court or from prison. Some are eventually committed – some are referred back to the Court.)
There has been a progressive and steady reduction in the length of stay in hospital for first admissions. The latest available returns show that some 83 per cent of all patients admitted, including the mentally subnormal and the elderly and infirm, are discharged within less than one year: 57 per cent or more are discharged within less than three months. It is the aim and policy of the Mental Health Division to return the patient to his family and to the community as soon as the best interests of all concerned are served by so doing. In 1964 the average number of occupied beds was 10,489, including the hospitals and training schools for the mentally subnormal. During that period 7,314 patients were admitted and 7,273 were discharged.
The Division is alive to the need for developing close and intimate links with the community. For the past 30 years or more outpatient consultation services have been operated by mental hospital medical officers – many of them at nearby public hospitals. Out of this service has arisen the establishment of psychiatric wards in public hospitals, as part of the general hospital services, and the further development of psychiatric outpatient clinics at several of the larger public hospitals. Various patterns and ways of extending these services by way of psychiatric units and psychiatric wards in public hospitals are currently under examination, and further extension in this direction may be expected in the near future.
by Geoffrey Blake-Palmer, M.R.C.S., L.R.C.P., D.P.M., L.D.S., R.C.S., L.R.C.S., Director, Division of Mental Health, Department of Health, Wellington.
- Appendices to the Journals of the House of Representatives, Reports of the Inspector-General of Asylums (H. 7 of each year)
- Reports of Mental Hospitals Department (H. 7 of each year – to 1949)
- Reports of the Director-General of Health (H. 31 of each year).