321. This chapter discusses the legal mechanisms for entries into psychiatric and mental health care settings. It discusses the reasons survivors told the Inquiry they were admitted, and the shift from large-scale psychiatric institutions to local hospitals and community services.

322. The Inquiry heard from 321 registered survivors whose first entries into care were psychiatric and mental health care settings. Of those, 27 percent entered for troubled behaviour, 15 percent entered due to mental distress, 8 percent entered by State requirement due to unsafe environments including abuse at home, and 4 percent due to neglect by parents. Eight percent of survivors did not know why they entered. A further 8 percent were placed by their parents because they were unable to manage or care for them or for unknown reasons. Four percent of survivors reported they entered following recommendation by authorities. [424]

323. A small number of survivors said they had entered because they had disabilities and had no other options. Some survivors were placed into psychiatric and mental health settings because of societal responses to their sexuality. [425]

324. During the inquiry period, various legislation, such as the Mental Defectives Act 1911 and the Mental Health Act (Compulsory Assessment and Treatment) Act 1992, provided the legal framework for people entering psychiatric care settings. These Acts provided for admissions on a formal basis and admissions on an informal or ‘voluntary’ basis. However, the Inquiry heard that survivors felt there was often little, if any, difference between these two pathways. At the same time, formal processes and reasons for admission were not always made transparent to survivors, and some survivors still do not know why they were placed in these settings.

325. This chapter also discusses what grounds for admission the Inquiry views to be inappropriate, irrespective of the medical decision or socio-historical backdrop they occurred in at the time. The Inquiry considers, for example, that sexual orientation as being grounds for entry into psychiatric institutions and conversion treatment has always been inappropriate and harmful.

326. The Inquiry acknowledges that not all pathways into psychiatric and mental health care and support settings, and the care provided within these settings, were inherently wrong or abusive. However, the experiences the Inquiry has heard from survivors around their entries often reflected inappropriate and discriminatory reasons for admission, which was followed, in many cases, by abusive treatment.

327. The last section of this chapter considers how the shift away from larger-scale psychiatric institutional care towards more community-based mental health care and support services, affected pathways into care. Most of the evidence the Inquiry has received from survivors relates more to experiences of entering psychiatric care during the 1950s to the 1980s, in the more ‘institutional’ era of psychiatric care. This pattern aligns with findings from a report the Inquiry commissioned into the size of care groups.[426]

328. The Inquiry has heard less about survivors’ experiences of entering community-based mental health care and support services in the later part of the Inquiry period, particularly the 1990s.

329. Many survivors have disclosed engagement with mental health services as adults to address the impact of abuse they experienced in care when they were younger, such as experiencing mental distress. However, these survivors do not always go into detail about their subsequent pathways or experiences in these mental health settings.

Te whakanoho i ētahi ki ngā whare wairangi me ngā taurima hauora hinengaro
Placements into psychiatric and mental health care

330. Rates of admissions into psychiatric hospitals increased rapidly during the 1940s and 1950s, reaching a peak in the 1960s and falling gradually over the 1970s:

• in 1953, approximately 9,700 people (478 per 100,000 of NZ population)[427]
• in 1966, approximately 10,600 people (397 per 100,000 of NZ population)[428]
• in 1971, approximately 10,100 people (355 per 100,000 of NZ population)[429]
• in 1976, approximately 8,500 people (270 per 100,000 of NZ population)[430]
• in 1981, approximately 8,000 people (257 per 100,000 of NZ population).[431]

331. The ethnic makeup of people who entered psychiatric hospitals fluctuated over this period.

I piki te nui o ngā Māori i uru atu ki ngā whare wairangi me ngā taurima hauora hinengaro
Rates of Māori entering psychiatric and mental health care increased

332. As with disability care, whānau Māori have traditionally preferred to look after family members experiencing mental distress at home, rather than placing them in psychiatric institutions.[432] In 1909, Māori made up just over one percent of psychiatric inpatients nationwide, rising to 1.8 percent in 1938. Ten years later, in 1948, this had increased to 2.6 percent. This figure represented 20.8 per 10,000 population for Māori, while for non-Māori the figure was 51 per 10,000.[433]

333. However, from the early 1960s, both Māori and non-Māori rates of admission to psychiatric institutions increased.[434] Non-Māori admission rates stabilised in the mid-1960s and then declined during the 1970s and 1980s, but Māori rates of admission increased throughout the 1960s, stabilised in the 1970s, and rose again throughout the 1980s.[435]

334. From 1970 to 1987, tamariki Māori (10 to 19 years old) and rangatahi Māori (20-29 years old) were admitted to psychiatric care at a rate approximately one and a half times higher than non-Māori. The rate of rangatahi Māori admission, increased to approximately double the non-Māori admission rate in the mid-1980s.[436]

335. By the mid-1980s, Māori made up 14 percent of all psychiatric admissions despite making up only seven percent of the population.[437] From 1960 to 1990, while “non-Māori first-time admissions to psychiatric facilities had only slightly increased”, the Māori rate increased by more than 200 percent.[438] By the late 1990s, the high rates of mental distress and conditions among Māori were described as a crisis of “unprecedented proportions”.[439] In 1999, for example, 50 percent of forensic inpatient service users and 29 percent of community-based service users were Māori.[440]

336. The increase in Māori admissions was partly attributed to the worsening state of mental health among Māori, and Māori accessing mental health care at a later stage of distress. Scholars attribute the worsening state to a range of factors, including alienation from traditional whānau and hapū support systems, poor access to primary health care, a lack of culturally appropriate services, racism and poverty.[441]

337. The Inquiry heard from Māori survivors who were admitted to psychiatric care from social welfare settings.[442] Māori survivor Vernon Sorenson (Ngāti Tūwharetoa, Ngāti Rākau) was moved from a family home to Lake Alice Child and Adolescent Unit in Rangitikei, because he was too young to be placed at a boys’ home. He was later diagnosed with depression and given electric shocks. Vernon said:

“I was struggling a bit in the family homes, and I think Social Welfare wanted to put me into a boys’ home but I was too young. So, they sent Dr Selwyn Leeks to my home to assess me. I was finding it very hard in the family homes and I was crying when I was talking to Dr Leeks. He said I could get some rest at Lake Alice, and I would have no worries. So, I jumped at the chance.” ^[443]

338. Studies from the 1990s found Māori adults were more likely to be admitted to psychiatric units through the justice system, after coming to the attention of law enforcement agencies; Māori were about two to three times more likely to receive referrals from law enforcement agencies than non-Māori.[444]

Kāore i te tino mōhio  tokohia ngā purapura ora Pasifika i uru ki ngā whare wairangi me ngā taurima hauora hinengaro
Numbers of Pacific survivors in psychiatric and mental health care unclear

339. During the Inquiry period there was limited data on the admission of Pacific fanau (children), tagata talavou (young people) and tagata matua (adults) to psychiatric care or their duration of stay.

340. Data from 1984 showed that Pacific adults aged 15 years old and over were represented in psychiatric admissions at rates close to their proportion in the general population. Pacific tagata talavou and tagata matua comprised 2.3 percent of the national population but only two percent of admissions to psychiatric care.[445] However, research throughout the 1980s and 1990s found that Pacific patients who entered psychiatric care were more likely to be formally committed and were also more likely than non-Pacific people to be readmitted.[446] Leota Dr Lisi Petaia’s evidence to the Inquiry notes that one of the first interactions that Pacific Peoples usually have with mental health facilities is through the justice system.[447]

341. In 1999, seven percent of forensic inpatient users and five percent of community-based service users were Pacific Peoples. This figure indicates an overrepresentation in this mental health setting compared with the general population.[448]

Ngā āhuatanga ā-ture mō ngā whakaurunga ki ngā whare wairangi me ngā taurima hauora hinengaro
Legal mechanisms for admissions into psychiatric and mental health care

342. Survivors were typically referred by their family doctor or the courts to undergo psychiatric assessment, which could lead to informal, or voluntary admission into a psychiatric institution, or being formally committed under the Mental Health Act 1969 and its amendments that applied during the Inquiry period. Some survivors’ entry into psychiatric settings was initiated through their involvement with NZ Police, including arrest.[449]

343. When sharing their experiences with the Inquiry, survivors did not always discuss what legal ‘mechanism’ they entered mental health care settings through. Survivors told the Inquiry that the difference between formal and informal entry was also not clear.[450] A common theme was the lack of transparency surrounding their admissions and shifts between care settings.

Ngā whakaurunga tuohu, tuohu-kore hoki ki ngā taurimatanga mate hinengaro, wairangi
Voluntary and involuntary admissions into psychiatric and mental health care

344. The Mental Health Act in its amendments, together with related legislation, provided a clear statutory framework for entering psychiatric care.

345. Voluntary admissions to mental hospitals were increasingly common from the 1950s. This is attributed to the fact that the likelihood of receiving more effective treatment in psychiatric hospitals, compared to previous years, had increased in the public eye.[451] From 1955 to 1959 the rate of voluntary admissions reached 48 percent, and from 1960 to 1964, 71 percent of admissions to these institutions were voluntary.[452]

346. However, the Inquiry heard that, from the survivor’s perspective, there was often little difference between formal and ‘informal’ pathways, with many survivors questioning the voluntary nature of informal admissions. Survivors told the Inquiry that they were threatened with formal committal if they did not voluntarily engage with mental health services, admit themselves, or agree to certain treatments.[453]

347. Pacific survivor Rachael Umaga entered psychiatric institutional care. She described having an admission interview with a psychiatric registrar, which led to her admitting herself into care informally. Rachael discharged herself from the ward 15 days later but was readmitted three days later on a formal basis. Rachael told the Inquiry:

“On admission, I was made to sign a contract. This meant that I was sectioned under the Mental Health Act and was only permitted to go on escorted leave with a family member or a nurse.

At this time, I did not know the difference between informal and formal admissions. No one ever explained this to me. From what I understand, an informal process meant admission on a voluntary basis as opposed to a formal process which required being sectioned under the Mental Health Act under a compulsory treatment order.”^[454]

348. This also reflects what participants shared with the Confidential Forum for Former In-Patients of Psychiatric Hospitals established in 2005, which interviewed 493 individuals, most of them former psychiatric patients.[455] Some participants told the forum they had only consented to voluntary admission in the belief that if they did not, they would be committed involuntarily. Other participants spoke about being threatened that they would be sectioned (committed involuntarily) if they did not consent to particular treatments.[456]

349. Under the Mental Health Act 1969, anyone who was “mentally disordered” – meaning they were “mental ill”, “mentally infirm” (not applicable to children and young people), and / or “mentally subnormal” – and required detention in hospital for their own good or in the public interest, could be committed for compulsory psychiatric care.[457] The Mental Health Act 1969 was the first piece of legislation that had specific sections relating to both custody and treatment, thus making treatment legally binding.

350. Some survivors told the Inquiry that they were formally committed into a psychiatric institution by their family. A mutual factor appeared to be a lack of alternative options available within the community or for the whānau itself, to be able to support the individual in distress.[458] 

351. Lack of alternative treatment options could also influence doctors’ decisions to refer patients to more institutional psychiatric settings. For example, NZ European survivor Ms LU told the Inquiry that in her early twenties she was “very depressed” and her GP referred her to Lake Alice:

“He said one day, ‘I don’t want to do it … but I think I’m going to have to put you in Lake Alice for a little while’. He knew it was a bad place, but he had run out of treatment options and had no choice. I didn’t want to go to Lake Alice, but I think I would have consented to going at the time as it was my only option to treat my depression. I went to Lake Alice for six weeks as an in-patient. Lake Alice is the biggest mistake of my life. I don’t think I should have ever been there.”[459]

Ngā take mō ngā whakaurunga ki ngā taurimatanga mate hinengaro, wairangi
Reasons for admissions into psychiatric and mental health care

352. In the early part of the Inquiry period, psychiatry was still an emerging discipline. Psychiatrists lacked some of the tools and understanding of today, not only to diagnose and treat conditions, but also of difference and diversity.

353. Medical disciplines, including psychiatry, operated within a predominately Western healthcare system, driven by a biomedical model of understanding and approach to health, including mental health, and disability. This is discussed further in Part 4.

354. Prejudice and a lack of knowledge and understanding of different behaviours or conditions saw some people admitted to psychiatric institutions for reasons that the Inquiry would view as wholly inappropriate today – including admissions based on punitive, sexist, homophobic and racist attitudes and misunderstood behaviours.[460]

355. During the Inquiry’s State Institutional Response Hearing, Director-General of Health Dr Diana Sarfati acknowledged:

“Societal stigma against people with mental health conditions and learning disabilities was a contributing factor to people being placed in psychiatric settings during the 1950s–1970s, and I acknowledge that people (including children and young people) were placed in psychiatric hospitals and facilities for reasons that would not be acceptable today.”^[461]

Ngā whakahapatanga me ngā poautinitini
Trauma and adversity

356. Survivors told the Inquiry that prior to entering these settings or engaging with mental health services, they experienced trauma and adversity, including in childhood and adolescence.

357. Māori survivor Ms LW had been experiencing mental distress from the trauma of sexual abuse and was 18 when her mother took her to a doctor who sent her for assessment at Wellington Hospital; that same day she was placed at Porirua Hospital.[462] Like other survivors,[463] Ms LW described how an adult, in this case her mother, did all the talking to the professional; no one asked her to explain what she was experiencing.[464]

358. Most survivors who talked to the Inquiry about mental health pathways also had a history of State or faith-based care.[465] The majority of these survivors experienced trauma in these care settings.[466]

359. NZ European survivor Robert Donaldson experienced sexual abuse by Father Magnus Murray from age 7 to 17 years old, whom he had met through his family’s involvement with St Bernadette’s Church in Ōtepoti Dunedin.[467] After having a ‘breakdown’ as an adult in the 1980s, Robert was admitted to Cherry Farm Psychiatric Hospital in Ōtepoti Dunedin, where he suffered further physical abuse.[468]

Ngā take ā-whanonga, ā-io aro huhua, ā-whaikaha anō hoki
Behavioural reasons, neurodiversity, and disability

360. Neurodiverse children and young people and people with sensory, or learning disabilities, often came to the attention of authorities because of their behaviours. These behaviours could be wrongly labelled as naughtiness, delinquency or even contribute to diagnosis of a mental health condition, which could increase the likelihood of an individual being placed into a mental health care setting.[469] This was particularly the case for tamariki and rangatahi Māori, who were often placed into psychiatric care from home or social welfare care for behavioural reasons. As noted in Chapter 2, discriminatory and racist attitudes contributed to tamariki and rangatahi Māori being considered deviant and criminal, this also contributed to entries into psychiatric care.

361. For some survivors admitted into psychiatric care, authority figures (including medical professionals) did not try to understand what they were experiencing personally, why they were behaving in certain ways, or how they felt.[470] Māori survivor Terry King was admitted to Ngawhatu Hospital in Whakatū Nelson at 14 years old because he kept running away from his abusive home. He had suffered sexual and physical abuse from priests at St Joseph’s School in Waihi and St Mary’s School in Tauranga, as well as from his stepfather, however this abuse was ignored, and instead Terry was diagnosed as: “Feeble minded, with Schizoid Personality”,[471] almost one month after being admitted.”[472]

362. Some former staff of psychiatric institutions told the Confidential Forum that, on occasion, people with no diagnosed mental health conditions ended up in psychiatric hospitals due to capacity pressures in other care settings, including social welfare residences and disability care institutions.[473]

363. The Inquiry has heard from institutional witnesses and experts who describe incorrect placements at psychiatric hospitals. Former psychiatrists Dr Ken Bragan described how the courts sent ‘delinquent adolescents’ to Sunnyside Hospital. [474] Māori survivor Susan Kenny’s (Ngāti Apa) experience reflected this. Susan was sexually abused in her home from 9 years old and was placed in social welfare care at the age of 12 as she was constantly running away. While being moved between different girls’ homes, she was told that no one could control her, and she was labelled delinquent. She was sexually abused at Miramar Girls’ Home in Te Whanganui-ā-Tara Wellington before being moved to Kingslea Girls' Home in Ōtautahi Christchurch as she continued to run away and misbehave in class. At Kingslea she described being “heavily drugged” and recalled one minor incident that led to her admission into Sunnyside:

“One day at Kingslea, I can remember exercising in the courtyard and a shuttlecock went on the roof. I got up on a chair to get it. A staff member came and grabbed me, and I kicked back. I remember getting an injection. I think it was after that I went to Sunnyside.” ^[475]

364. The Inquiry also heard from a clinical psychologist, and former staff member at Holdsworth School in Whanganui, that boys were transferred from the school to Lake Alice Child and Adolescent Unit in Rangitikei as punishment for misbehaviour.[476]

365. Retired police aid youth worker Mr LX recalled a points system at Holdsworth School, which determined whether boys were sent home or released. He asked the principal what the negative points on the board meant and was shocked with the response: “Oh then that inmate goes to Lake Alice for treatment and let me tell you he comes back with a much better attitude."[477]

366. John Watson, a registered clinical psychologist and the former housemaster at Holdsworth School between 1972 and 1975, told the Inquiry that many boys were referred to Lake Alice as punishment for misbehaving, such as persistent running away and aggressive behaviour. Mr Watson disagreed with these referrals to psychiatric care, however his concerns were ignored:[478]

“At the time I was concerned at the reasons for the referrals to Lake Alice because I believed misbehaviour of this sort could be managed by the school. Regardless of how much the boys played up, I didn't think it was necessary to send them to a psychiatric hospital like Lake Alice”.

367. Many disabled children and young people spent time in psychiatric hospitals, including in special units or wards within these hospitals.[479] The Inquiry saw evidence of children being admitted to psychiatric hospitals due to epilepsy,[480] or in the case of one survivor with learning disability, seizure activity misdiagnosed as epilepsy.[481]

368. Neurodiverse people were also placed in psychiatric settings. For example, Porirua Hospital set up a unit for autistic people in the 1970s as this diagnosis began to increase.[482] Tāngata Turi Māori survivor Mr LF (Ngāti Maniapoto) who had Asperger’s syndrome was admitted to Sunnyside Hospital when he was 21 years old. He stayed at the hospital on and off over a period of approximately 11 years:

“I was visually misdiagnosed with schizophrenia and medicated accordingly. At no time was an interpreter used to ask me how I felt and what was happening to me. There was no support in terms of information and discussions with family at all.”^[483]

369. In a paper prepared for the Inquiry, Dr Olive Webb explained how until around 1980, children and young people with autism were often diagnosed with a psychiatric condition, “childhood schizophrenia”:

“The expected mode of intervention was medical, and that means, during these times, antipsychotic, sedating medication. The intense anxiety experienced by people with ASD would not be recognised as such, and escalations of behaviour would be seen as manifestations of psychosis. In keeping with treatment of people with psychiatric conditions, restraint and seclusion would occur to manage out-of-control behaviour.”^[484]

370. Michael Ferriss, director of the New Zealand chapter of Citizens Commission on Human Rights noted that a significant number of female State wards in Fareham House in Pae-Tū-Mōkai Featherston were admitted to Porirua Hospital for assessment, including with electroencephalogram (EEG), and were subsequently treated for epilepsy with an anti-convulsant drug that also acted as a sedative.[485]

371. Young girls at Fareham House in Pae-Tū-Mokai Featherston, who were predominately Māori, were given medication in an effort to “establish acceptable patterns of behaviour.”[486] The Inquiry heard that 20 to 30 percent of girls at Fareham House went on to be admitted to mental health hospitals.[487]

372. The Inquiry has received limited evidence on this practice; however, NZ European survivor Ms HV told the Inquiry:

“In common with many girls at Fareham House, I was sent to Porirua Psychiatric Hospital for an EEG, which apparently was abnormal and indicated I had epilepsy. I ended up being treated with epilepsy drugs, which I now know I never needed, as I never had epilepsy.”^[488]

373. Survivors’ experiences of Fareham House, and the medical abuse they suffered in Part 4.

Toihara ā-ia (ngā wāhine me ngā kōtiro)
Gender discrimination (women and girls)

374. The Confidential Forum and the Confidential Listening and Assistance Service observed that pathways into psychiatric settings could be gendered. Women and girls’ admissions sometimes reflecting prevailing societal norms and attitudes about women’s gender roles, mothering, pregnancy, miscarriage, childbirth and marital difficulties.[489] Societal norms and stigma around female sexuality also influenced entries, particularly in relation to perceived promiscuity.

375. NZ European survivor Ms SF shared with the Inquiry that a diagnosis of post-partum depression influenced her entry into a mental health care setting, however her diagnosis was later changed to something other than post-partum depression.[490] The Confidential Listening and Assistance Service found that young women admitted to psychiatric hospitals for post-partum depression often stayed for many years.[491]

376. NZ European survivor Ms AT told the Inquiry she went to two GPs to discuss her heavy, painful periods but both were adamant this was “all in [her] head”.[492] The second GP she saw referred her to Hastings Psychiatric Unit. Ms AT told the Inquiry:

“During my stay at Hastings Psychiatric Unit in 1985, I got frightened and confused. I did not answer or understand the questions the psychiatrist and student doctor were asking me. I told them that there was something not right with my uterus periods. I also did not know how to answer their silly questions that they asked me, you know, they asked me, ‘Do you hear voices?’ Well, of course I hear voices, I could hear them talking, you know? I didn't know what the hell they were on about. And then I was given my first antipsychotic medication there.”^[493]

377. Ms AT said that prior to discharge a large ovarian cyst was found and removed.[494] However, this marked her first admission of many into psychiatric institutions. Just as other survivors have told the Inquiry, Ms AT felt that by having a history of experiencing mental distress and being involved with mental health services has meant her “credibility is constantly being dismissed and denied”.[495]

Mae Takatāpui me te toihara
Homophobia and discrimination

378. Discrimination towards people with diverse gender identities and/or sexual orientation resulted in people from the Takatāpui, Rainbow and MVPFAFF+ communities being admitted to psychiatric institutions.[496] Until 1973, the Diagnostic and Statistical Manual of Mental Disorders categorised homosexuality as a mental health disorder. This, coupled with the criminalisation of homosexuality (until homosexual law reform was passed in New Zealand in 1986), established a pathway for Takatāpui, Rainbow and MVPFAFF+ communities into mental health institutional care settings.[497]

379. NZ European survivor Joan Bellingham told the Inquiry about the homophobic attitudes that contributed to her being admitted into psychiatric care. Joan went to Burwood Hospital in Ōtautahi Christchurch for nurses training at 18 years old. There, she experienced hatred and overt homophobia from the matron and staff once they found out she was gay. The matron told her homosexuality was wrong and said she would never be a nurse. The same matron later accused Joan of stealing drugs, which she said was completely false. It was after that accusation that Joan was told she needed treatment and was taken to Princess Margaret Hospital in Ōtautahi Christchurch, without any choice. Joan said:

“I didn’t have any clothes with me or anything. There was no choice in the matter. I was just told I that I was being admitted to Princess Margaret. I didn’t realise it at the time, but I would spend the next 12 or so years as a patient there.

“I was terrified and told them that this was a mistake, but they wouldn’t listen. They gave me drugs to quieten me down. I recall my mother also being deeply anxious I was in hospital and wanted to know why I needed to be there. But you didn’t question the doctor’s authority during those times. They were like gods. They thought I might have ‘neurotic personality disorder’. The worst part is that I never felt like I was given a genuine choice, or that the doctor was listening to me.” [498]

380. Pākehā survivor Dr Kyro Selket, who identifies as a gender non-conforming dyke, told the Inquiry that she had met many gay men who were put into Lake Alice Psychiatric Hospital in Rangitikei. At Lake Alice those gay men experienced medical abuse in the form of conversion techniques, for example, electric shocks.[499] Kyro described a gay couple being “tortured with electric stuff” at Lake Alice Psychiatric Hospital:[500]

“They’d been in Lake Alice for years. They were put there because they were queer. Their families put them there. I mean, as people said later, ‘Before conversion therapy, we had Lake Alice and Carrington’.”[501]

381. Fuimaono Karl Pulotu-Endemann, the first registered Pacific psychiatric nurse in New Zealand, witnessed MVPFAFF+ people being placed in psychiatric care as a result of their sexual and gender identities.[502]

382. Religious attitudes that conceptualised homosexuality as a mental health issue also forced Takatāpui, Rainbow and MVPFAFF+ to engage in psychiatric care and treatment, particularly for Pacific Peoples. Pacific and Palagi survivor Mr UB shared his experience with the Inquiry:

“One of the pastors led a prayer session in which church leaders laid hands on me and prayed for my ability to choose ‘the right path’ in life. I was referred to a mental health professional based at Southland Hospital. I attended a counselling session where a discussion was had about the incompatibility between being gay and the beliefs of the church. It wasn’t particularly condemnatory; it was also completely unsupportive.”^[503]

Te neke ki ngā hōhipera ā-rohe me ngā ratonga ā-hāpori
Shift to local hospitals and community services

383. From the 1970s, psychiatric experts increasingly stressed the importance of community and outpatient care for people experiencing mental distress. As in the disability sector, the shift to the provision of community care and services was slow.[504] By 1981, 48 percent of patients in psychiatric hospitals were people with a learning disability.[505]

384. By 1999, almost all large-scale mental health institutions had closed their doors. Cherry Farm Psychiatric Hospital in Ōtepoti Dunedin closed in 1992, Tokanui Psychiatric Hospital located in south of Te Awamutu closed in 1998 and Kingseat Hospital in Karaka closed in 1999.[506] Mental health services largely devolved to wards at local hospitals, and a range of smaller-scale community providers, including support services provided by non-government organisations, offering residential care or specialist programmes.[507]

385. Inpatient teams, such as in psychiatric wards attached to general hospitals, made up a smaller part of the mental health system, undertaking close observation, intensive investigation or intervention.[508] After leaving hospital, some survivors entered supported living residences in the community and may have accessed hospital-based services during the day as outpatients, or been readmitted for a period of time to a mental health ward or unit.[509]

386. Given the multidisciplinary nature of the mental health and addiction sectors over time, a range of teams (including community mental health teams) may have been involved in an individual’s pathway through the mental health care system.

387. While Māori mental health programmes and service providers began to emerge from the 1980s,[510] State psychiatric and mental health services were predominately Eurocentric and not culturally responsive to tāngata whaiora.[511]

388. The monocultural nature of mental health services also meant that they were often not culturally safe for Pacific Peoples and their families and presented language and cultural barriers.[512] Cultural safety for Pacific Peoples could also include religious safety. One study published in 2000 on the experience of eight Pacific service users within a mental health setting found religious safety was often not achieved, particularly in the context of inpatient services such as acute wards. Author Malo Vito described a cultural religious difference that contributed to incorrect interpretations:

“Any type of religious or cultural behaviour which might be deemed over the top, delusional or psychotic in a psychiatric service would be just eccentric, or extreme within Pacific Islands communities. Pacific Islanders’ vocal praise and worship could be seen as ranting and raving within the confines of an acute ward.” [513]

389. 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.” [514]

390. 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 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”.^[515]

Ngā ratonga oranga hinengaro tūhura mō ngā tāngata kua hāmenehia ki tētahi taihara ā-ture
Forensic mental health services for individuals charged with a criminal offence

391. During the 1990s regionally based forensic psychiatric services were developed which existed at the interface of the mental health and criminal justice sectors.[516] This pathway was significant for survivors experiencing mental distress, and / or with learning disability and / or neurodiversity, where it was relevant to their offending.

392. Entry into forensic services involves an individual being charged with a criminal offence and subsequently being referred to this specialised mental health setting for assessment and treatment.[517] Sometimes individuals were transferred from prison to mental health settings, including forensic wards, because they were considered unwell and in need of treatment.[518]

393. A 1999 review of forensic services found that most service forensic users have offences that are classed as ‘serious’ (violent or sexual). The review also found that the most common referral pathway into this setting has been through the courts, with prison being the second highest referral source.[519]

394. While forensic service users can be inpatients or community-based, forensic services remain more institutionally focused compared to other adult mental health services.[520]

395. The 1999 review found all but one inpatient service user was ‘under legislation’, such as the Criminal Justice Act 1985 or the Mental Health (Compulsory Assessment and Treatment) Act 1992.[521] While 41 percent of outpatients had informal or voluntary legal status, many had previously been inpatients under one of these Acts.[522]

Ngā whakataunga mō ngā whakanohonga ki ngā whare wairangi me ngā taurima hauora hinengaro
Conclusions on placements into psychiatric and mental health care settings

396. Survivors could be referred by their family doctor or the courts for psychiatric assessment, leading to voluntary or formal admission. For many survivors, it was not clear what legal status they entered psychiatric care under, due to the age they were admitted or the lack of transparency surrounding their admission. Coercion from those in positions of power, to ‘voluntarily’ admit oneself, was also common.

397. Psychiatry was an emerging discipline in the 1950s. At that time psychiatrists lacked some of the tools and understanding available today, not only to diagnose and treat conditions, but also some societal attitudinal advances in accepting difference and diversity.

398. Children and young people with neurodiversity or trying to cope with the effects of trauma could come to the attention of authorities because of their behaviours. These could be wrongly labelled as naughtiness, delinquency or even contribute to diagnosis of a mental health condition and increase the likelihood of an individual being placed into a mental health care setting. Many survivors who entered mental health institutions, including as adults, had experienced previous trauma, including in both State and faith-based care.

399. Survivors’ experiences often reflected discriminatory reasons for admission including ableism, disablism, racism, and homophobia. For example, homophobia and discriminatory attitudes towards Takatāpui, Rainbow and MVPFAFF+ communities influenced pathways into psychiatric institutions.

400. Whānau Māori have traditionally preferred to look after tāngata whaiora at home, rather than place them in psychiatric institutions, despite the lack of adequate support provided by the State. In 1948, Māori remained under-represented in psychiatric institutions. Māori admission rates to psychiatric institutions increased significantly over the Inquiry period, with high rates of mental distress among Māori being described as a crisis of ‘unprecedented proportions’ by the 1990s.

401. Māori mental health programmes and service providers began to emerge from the 1980s. State psychiatric and mental health services were predominately Eurocentric and not culturally responsive to tāngata whaiora.

402. The monocultural nature of mental health services also meant they were often not culturally safe for Pacific Peoples and their families, with language and cultural barriers present. Limited data exists on the experiences of Pacific Peoples in psychiatric and mental health care settings. From the mid-1970s, Pacific Peoples were more likely to be formally committed to in-patient or residential mental health facilities and were more likely than Pākehā to be readmitted into psychiatric settings. Often, the first interaction that Pacific Peoples had with the mental health sector was through the justice system.

403. By the late 1990s, almost all large-scale mental health institutions had closed. Mental health services were largely devolved to hospital-based services and a range of smaller-scale community providers, including support services provided by non-government organisations offering residential care or specialist programmes.

Footnotes