From the 1960s psychiatric patients were encouraged to take part in their own care and treatment. The general community also became more tolerant of the mentally ill. In this period many of the more manageable patients were discharged from hospital. Planning for new psychiatric hospitals ended in 1963 and no extra beds were provided from 1973. Instead, from the 1970s psychiatric services came to emphasise outpatient care, community-based treatment and more modern facilities. Every mental hospital patient was assessed, and 26% of psychiatric and 46% of mentally disabled patients were recommended for accommodation outside the major psychiatric hospitals.
Rise of community care
In the 1970s, under the umbrella term ‘community care’, most people with mental disorders now received support from a range of non-governmental organisations. These developed alternatives to institutional care, helped change public attitudes and built international links.
Other community organisations included the Schizophrenia Fellowship, formed in 1977, and the Richmond New Zealand Trust, formed in 1978. The Mental Health Foundation, also formed in 1977, concentrated on policy issues and advocacy to promote mental health and prevent or reduce the rate of mental illness.
The risks of community care
Psychiatrist Fraser McDonald served as the medical superintendent at both Carrington and Kingseat hospitals in Auckland. He warned of the risks, as well as advantages, of phasing out psychiatric hospital services in place of community care.
‘Let there be no misunderstanding, if these social structures are to be established and are seen as utterly essential for the proper healthy development of community psychiatry they … will need to involve at least as much money and as many people as have been involved in creating and maintaining the old institutions. To do anything less will be false economy of the cruellest kind.’1
Problems of deinstitutionalisation
Almost all psychiatric hospitals were closed or run down by the early 1990s. Some institutions abandoned their old buildings and constructed more suitable facilities on the same site, for example in the 21st century Hillmorton Hospital was one of several mental health facilities on the site of the former Sunnyside Hospital in Christchurch. The closure or rebuilding of traditional hospitals revealed that community care caused problems for some patients. Many did not have families or other people to support them, and some lived in boarding houses or other situations not suited to their needs. Many local initiatives for the mentally ill did not survive the reorganisation of the entire health sector in this period.
Mistreatment of patients
Sad stories emerged in this period of ill-treatment of patients in psychiatric institutions. A number of former patients at these facilities lodged legal claims of abuse by staff and doctors. In some cases, these patients received official apologies. Between 2005 and 2007 the Confidential Forum for Former In-Patients of Psychiatric Hospitals heard further stories of abuse and mistreatment.
The 1990s also saw a number of important advances in mental health treatment. These included more attention to the needs of Māori, who were over-represented in mental health statistics. Systems to encourage responses from consumers of mental health services themselves, and to act on those responses, also resulted in treatment gains.