554.    In this section, we consider how the wider social welfare and health system was shaped in the context of the ongoing impacts of colonisation; attitudes towards tamariki; systemic ableism, disablism and psychiatry; institutional racism; homophobia and transphobia; and power dynamics and trust in health care systems.

Ngā pānga mauroa o te tāmitanga - Ongoing impacts of colonisation

555.    The experiences of children and young people at Lake Alice must be seen within the wider context of Aotearoa New Zealand’s history as a settled colony and the enduring effects of colonisation. As we explained in He Purapura Ora, he Māra Tipu, over many generations the Government has pursued colonial and assimilationist policies to break down Māori authority and social structures and assert government control over Māori, their land and resources.^[1180]

556.    This colonial history, as well as ongoing structural racism, has led to high rates of poverty among Māori. The Crown’s failure to honour te Tiriti o Waitangi and, in particular, tino rangatiratanga, has undermined hapū and whānau structures and contributed to a disproportionate number of tamariki Māori and rangatahi Māori in care. The impact of this continues through multiple generations, and Māori are still over-represented in care today. Numerous reports, in particular Te Puao-te-Ata-Tu, have noted the State’s failure to involve Māori in developing and implementing care systems for tamariki.^[1181]

557.    Colonisation introduced a variety of Western beliefs and racist practices that devalued tamariki and justified their removal from their whānau, resulting in disproportionate harm to Māori. Our final report will examine this fully. For this case study, we note that these imported beliefs often understood wellbeing in terms of only physical health, with minimal focus on wider cultural, spiritual or social factors. Mental health was simply seen as a biological issue that required medical treatment. Māori, on the other hand, tend to view health in a holistic sense, encompassing cultural, spiritual, mental, emotional and physical dimensions.^[1182] In addition, the wellbeing of tāngata whaiora should be considered in the context of the health of whānau.

558.    Until about the 1970s, the dominant view was that psychiatric care should be delivered within institutions, which served to both remove tāngata whaiora from the community and place them where they could receive ‘necessary’ treatment.^[1183] Lake Alice Psychiatric Hospital was a product of this colonial mindset. In particular, the reasons often given to place children and young people at Lake Alice were based on colonial views and prejudices.

Ngā waiaro ki ngā tamariki me ngā rangatahi - Attitudes towards children and young people

559.    The placement of children and young people at Lake Alice was often based on misconceptions or prejudice arising from harmful societal views of the time, including unacceptable attitudes towards children and young people, racism, ableism, homophobia and transphobia. These prejudices were used to justify placing children and young people at Lake Alice.  It led to the abusive treatment they received there and devaluation of their lives and experiences.^[1184]

560.    During the 1970s, a widespread societal concern existed about rising rates of perceived youth ‘delinquency’.^[1185] Children and young people who ‘misbehaved’ or were thought to be ‘out of control’, were often seen as having moral, cognitive or character flaws. Authorities viewed State wards particularly negatively. Survivors told us about how they felt they were treated while in care and at the unit. For example, Mr Bryon Nicol said, “Being in care made me feel I was just a piece of shit to staff and authorities; there was never any caring environment, and I never felt cared for or that anyone valued me”.^[1186] These views were often further compounded by racist attitudes towards Māori and Pacific children and young people.

561.    Many of those at the unit came from already disadvantaged or marginalised parts of the community, and most children and young people were placed at Lake Alice for behavioural reasons. Often, this behaviour was the result of abuse or other challenges at home or at school. Sometimes, it came from a lack of appropriate support for the unique needs of an individual, such as those of neurodiverse children and young people as well as Māori and Pacific peoples. The root cause of the perceived ‘challenging behaviour’ was rarely examined or understood, and little professional support was provided.

562.    A report by Ngā Wairiki and Ngāti Apa found that many people sent to Lake Alice were quite young and showed a variety of behaviours that were difficult to understand or manage such as speech problems, developmental problems and trauma-oriented coping styles (acting out).^[1187] However, these were not necessarily symptoms of an acute mental illness requiring hospitalisation.^[1188]

563.    By the time children and young people were placed at Lake Alice, the perception was that they lacked self-worth and potential. Many of the children and young people had been involved with other institutions or State authorities and were viewed as ‘problems’ to be dealt with. When questioned by police, Dr Leeks described the children and adolescents in the unit as “bottom-of-the-barrel kids” (as discussed in chapter 2.4). Some staff shared this view. For example, a social worker, Mr Brian Hollis told us:

“There was a feeling I picked up about the Charge Nurse of the Adolescent Unit, Steve Hunt. He would make sarcastic comments such as ‘Social Welfare, you can’t control your kids, so you send them here, and we straighten them out’”.^[1189]

564.    Survivors also told us they felt they had been placed in the unit because they had misbehaved in their previous placement or there was nowhere else for them to go. Mr Walton Mathieson-Ngatai told us that children and young people from Kimberley who got up to mischief were dropped off at Lake Alice (as discussed in chapter 2.1).^[1190] A note on Mr JJ’s file confirms his second placement at Lake Alice was only because of a lack of other placement options.

“An earlier report suggests that [Mr JJ] was diagnosed as schizophrenic, but in fact this is not correct. This was a tentative diagnosis and had not been confirmed by Lake Alice … [Mr JJ] was re-admitted largely because of a lack of suitable alternatives.”^[1191]

565.    The perception that the children and young people had no other options appears to have contributed to the approach to treatment in the unit. An interview with Dr Leeks describes his view that, “He had an open hand to do what he could with them because they were too much for Social Welfare institutions and too destructive for the Education Department”.^[1192]

566.    Such views justified State actions to control and ‘correct’ behaviour. Where children or young people were considered ‘difficult’ or ‘unmanageable’, they were often criminalised or medically diagnosed. This then justified their placement within institutions, and the use of abusive practices as behavioural control such as electric shocks, paraldehyde, seclusion and restraint.

Te whakatoihara hauā, te whakahāwea hauā me te mātai mate hinengaro - Systemic ableism, disablism and psychiatry

567.    The perception that children and young people needed ‘correcting’ was supported by the ableist practices at Lake Alice. Ableist and disablist views consider people with mental health conditions are disadvantaged, leading to stigma, discrimination and exclusion (as discussed in Part 1). In particular, ableism and disablism view mental health conditions as something to be ‘fixed’ or ‘erased’.

568.    These views have influenced societal attitudes, laws and policies in Aotearoa New Zealand. The Ministry of Health has acknowledged that, “institutional and societal ableism in legislation, policy and systems has contributed to the abuse of disabled people and people with mental health conditions in health and disability care settings”.^[1193] The ministry also acknowledged that between 1950 and 1999, health and disability care settings were ableist. These settings did not always meet the needs of disabled people and people with mental health conditions.^[1194]

569.    At the inquiry’s contextual hearing, former Mental Health Commissioner and leader of the Global Network of Survivors of Psychiatry, Mary O’Hagan, said:

“Abuse and neglect have been a part of New Zealand’s mental health system since it was established in the 1840s. Much of the abuse was not due to the ethical lapses or incompetence of a few but to the routine practices of many”.^[1195]

570.    A long history of ableism and disablism exists in psychiatry specifically. The United Nations Special Rapporteur has said mental health care has often been used as a form of social control of people exhibiting ‘socially unacceptable behaviour’ and that the biomedical model has commonly been used to justify the State intervening in ways that limit an individual’s dignity, liberty or autonomy.^[1196]

571.    Although Lake Alice existed and operated at the tail-end of institutional psychiatric care in Aotearoa New Zealand, ableism was still evident in its systems and practices. The practice of institutionalisation within mental health care removes those with actual or perceived disability from society, rather than supporting them in their whānau and communities. Institutionalisation may result from discriminatory attitudes^[1197] and a desire for social control of undesirable behaviour.

572.    Dr Leeks and other medical professionals assessed and diagnosed the children and young people placed at Lake Alice with psychiatric and behavioural conditions. We have discussed how many of these children and young people were misdiagnosed and did not self-identify as being disabled or having a mental health condition. The medical diagnosis then provided a ‘justification’ for removing children and young people with perceived challenging behaviour from their whānau and communities or other State placements. This was considered necessary and desirable to allow such perceived psychiatric or behavioural conditions to be ‘fixed’.

573.    This approach to disabled people and people with mental health conditions views them as ‘unproductive’ members of society.^[1198] Ableist assumptions see people as having value if they can actively contribute to society and the economy in a socially acceptable way. Dr Leeks noted that this was a contributing factor behind his ‘treatment’. In an interview in 1976, he said, “If you want to get people back as economic units in society, then you get on with treating them – you don’t play therapeutic games with them”.^[1199]

574.    Disabled children and young people further experienced ableist and disablist views. We discussed previously how disabled children and young people were at greater risk of abuse and neglect within the unit, and experienced greater barriers to reporting abuse.

575.    The combination of the need to ‘fix’ both delinquent behaviour and perceived psychiatric and behavioural conditions provided a rationale for placement at Lake Alice. Rather than addressing the underlying trauma, abuse, cultural or other unique needs of the children and young people, Dr Leeks and medical professionals sought to diagnose, treat and ‘correct’ their perceived deficiencies.

576.    Lake Alice has closed, but this relationship between individual and whānau needs, behaviour and inappropriate responses is an issue that persists today and will be discussed in more depth in our final report.

Te kaikiri torowhare puta noa i te kāwanatanga - Institutional racism across government

577.    For Māori survivors, racist and discriminatory attitudes and policies contributed to them being placed in Lake Alice and the treatment they received there. Then, when children and young people Māori arrived in the institutions, they were disconnected from their whānau and experienced cultural neglect and racism. A staff member at Lake Alice, who was also a whānau member of Ngā Wairiki and Ngāti Apa, explained how Lake Alice was a State institution based on Western values.

“It’s a hospital; its government, they just move on in. They wouldn’t have done their research on what Māori thought it was, they would have just recreated a whole community. It was centralised and centred around a European/English way of psychiatry. It was set up to exclude, and put them out to pasture, in places out of public eye.”^[1200]

578.    Dr Moana Jackson told us how colonial ideas of European superiority underpinned the view that indigenous tamariki needed to be removed from their whānau to be ‘saved’, ‘civilised’ and ‘protected’ from themselves.^[1201]

579.    Institutional racism led to the disproportionate representation of children and young people Māori in the court system and State residences, both of which were significant referral pathways into psychiatric care facilities such as Lake Alice. Research shows NZ Police in the 1970s were more likely to apprehend and prosecute Māori children and young people than their Pākehā counterparts for similar offences.^[1202]

580.    Research the Crown commissioned in response to our inquiry concluded young Māori were more likely to be brought to the attention of the State, more likely to be criminalised, more likely to be taken into State care, more likely to be placed in a harsher environment, and less likely to receive intensive support while in care than their Pākehā counterparts.^[1203] For the children and young people at Lake Alice, racism would have further strengthened the rationale of State intervention and institutionalisation at Lake Alice.

581.    The Ministry of Health has acknowledged that institutional racism has contributed to the tūkino of Māori within psychiatric settings.^[1204] Systemic racism within Lake Alice, at both institutional and interpersonal levels, enabled the tūkino survivors experienced. Institutional and interpersonal racism led to Pacific children and young people being admitted to the unit and affected how they were treated while there. Cultural neglect was significant for Pacific survivors too. We heard Pacific survivors experienced both immediate and ongoing impacts on their connection to aiga or family, language, personal and cultural identity, and sense of belonging.

Ngā pānga o te mae takatāpui me te mae irawhiti - Impacts of homophobia and transphobia

582.    Despite the sexual revolution of the 1960s and 1970s, behaviour that reflected diversity of sexuality, gender identity or gender expression was still regarded as being outside acceptable societal norms in Aotearoa New Zealand in the 1970s.  It was seen by some as a mental illness.

583.    The attitudes of those responsible for the treatment at Lake Alice showed prejudice against the Rainbow communities. The hospital’s medical superintendent, Dr Sydney Pugmire, viewed homosexuality as a ‘mild schizoid’ form of schizophrenia; a thought disorder he felt could be reversed with early treatment.^[1205] Dr Pugmire produced a list for teachers of teenage behaviour that warranted a referral to a doctor.^[1206] For example, “The pupil who engages in homosexual activity, theft of female underclothing, indecent exposure or other obviously sexually deviant behaviour.”^[1207]

584.    In a submission to the select committee considering the Crimes Amendment Bill 1974, Dr Pugmire expanded on his personal beliefs on homosexuality saying, “Homosexual behaviour is not a normal part of the normal development of normal human beings and Freudian teaching on this subject is pathetic nonsense”.^[1208] He went on to say, “Homosexuality is but one of a great variety of bizarre thought disorders which can occur”.^[1209] These perceptions were not uncommon in society, but in the unit, clinical staff could use the language, tools and status of psychiatry to condemn and punish sexual and gender diversity.

Ngā āhuatanga mana me te whakapono ki ngā pūnaha hauora - Power dynamics and trust in health care systems

585.    The voices of some groups in society have been marginalised, but others exert far more influence, control and authority. In the 1970s, and today, doctors maintain positional power in society because of their medical expertise.^[1210] The tension created by this power and control dynamic is discussed further below. We found it a compelling factor that enabled abuse to occur at Lake Alice, allowed abuse to continue undetected, and resulted in a failure of accountability for the significant harm caused.

586.    The doctor–patient relationship involves a high level of trust and faith in the goodwill of the medical provider. At Lake Alice this relationship was paternalistic in nature with the children and young people seen as passive recipients of expert medical care. The dynamic was due, in part, to the biomedical view of health and the ableist underpinnings of psychiatry that saw patients as needing to be ’fixed’. Consent was rarely sought or documented from patients or their guardians, nor was it always considered necessary. Doctors and clinical staff were positioned as authority figures and experts who knew what was best for their patients. This created an inherent power imbalance, not only between the medical professionals and their patients, but between the medical professionals and parents, guardians and responsible agencies.

587.    This dynamic influenced the judgement of those responsible for the safety and protection of the children and young people at the unit. It meant children and young people making disclosures of abuse at Lake Alice were often not believed, especially by doctors and other medical staff. It also contributed to the inaction of responsible agencies.

588.    At Lake Alice, children and young people experienced violence justified as therapy and harsh discipline rationalised as a legitimate form of behavioural control. The fact these children and young people were housed in a psychiatric hospital meant a variety of medical tools were used to abuse them. The medical setting at Lake Alice is a compelling factor that contributed to the abuse. 

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