From the 1950s new drugs became available and were widely used to treat psychosis, depression, anxiety and mania. These were supplemented by psychological treatments such as individual or group psychotherapy for some acute patients. As more effective treatments for mental illness were introduced, patients became more willing to enter mental hospitals voluntarily. Between 1935 and 1939 22.4% of patients were voluntary. From 1955 to 1959, when the first wave of new drugs became available, 47.5% of admissions were voluntary. This grew to 71.4% between 1960 and 1964.
Therapeutic developments, and the introduction in 1939 of free treatment in state mental hospitals, transformed psychiatric hospitals, as they were known from the 1950s. Patients’ behaviour could be stabilised, and they could often be discharged from hospital much sooner then in the past. This, however, created a ‘revolving door’ pattern of re-admission and trial leave. Psychiatric hospitals, however, were still home for large numbers of long-term and institutionalised patients.
In 1942 a major earthquake forced the evacuation of 800 patients from Porirua Hospital. Many were temporarily transferred to the country’s best-known tourist hotels: Chateau Tongariro, at National Park, and Wairakei Hotel near Taupō.
Significant changes to the cornerstone mental health statute in 1947, 1961, 1969 and 1992 gave effect to the policies of destigmatising and relaxing admission procedures, mandating extramural services and facilitating integration of mental health with broader health services administration.
Reforming the institutions
Most mentally ill people were still treated at specialist hospitals. In 1969 New Zealand’s 11 psychiatric hospitals and four 'psychopaedic' hospitals (for intellectually handicapped people) represented 43% of public hospital beds and 37% of all hospital beds. As these hospitals came to be seen as therapeutic communities, they were equipped with halls, libraries, canteens, chapels and swimming pools.
From the 1940s new types of professional staff, such as social workers and occupational therapists, were employed to prepare and support patients for life and work outside, and to liaise with community groups. Until the late 1960s able-bodied patients were still encouraged to help with daily chores around the hospital and grounds. This physical activity was justified therapeutically as providing stimulation and relief from boredom, but also provided the constantly overcrowded and underfunded facilities with a large labour pool of long-term patients for basic functioning.
The eternal now
Renowned author Janet Frame drew on her experience in mental hospitals in several of her books, both fictional and autobiographical: ‘There was a personal, geographical, even linguistic exclusiveness in this community of the insane who yet had no legal or personal external identity – no clothes of their own to wear, no handbags, no purses, no possessions but a temporary bed to sleep in with a locker beside it, and a room to sit in and stare, called a dayroom. Many patients confined in other wards of Seacliff had no name, only a nickname, no past, no future, only an imprisoned Now.’1
Short- and long-term patients
A growing gap developed between short-term psychiatric patients and long-term patients who had lost outside links and established a home in their hospital. The first group were cared for individually in ‘front’ wards, while the remaining patients were managed as efficiently as limited resources allowed. Internationally renowned author Janet Frame was a psychiatric patient in the 1940s and 1950s, and in her writing she vividly described the differences between front and back wards, and newer and older institutions.