The Press WEDNESDAY, JULY 27, 1938. Mental Hospitals

Press, Volume LXXIV, Issue 22464, 27 July 1938, Page 10

The Press WEDNESDAY, JULY 27, 1938. Mental Hospitals

The fact that the proportion of New Zealand’s population lodged in mental hospitals is high and tends steadily to rise is one that, of itself, should direct Parliament and public to consider more thoroughly the question of mental disease and the responsibility thrown on society. The lunacy figures for England and Wales (i.e., those covering all persons registered as insane, whether in public institutions or in private care) stood at 37 in each 10,000 of population for many years till 1935, when they rose to 38. The figures for Scotland are steady at 40; for Northern Ireland, they rose between 1933 and 1935 from 39 to 41. The New Zealand average figures, covering patients in mental hospitals at the end of each year, have moved, between 1932 and 1936, in the following upward steps: 1932. 1933. 1934. 1935. 1936. 44.85 47.07 47.70 48.97 49.60 Even the exclusion of “ voluntary boarders,” of whom since 1930 there have always been between 300 and 400, would only slightly alter these disturbing figures. But it must unfortunately be added that the annual reports on the mental hospitals of the Dominion supply no reassurance. More than that, their effect is to deepen the impression of the figures and to raise serious doubts whether the mental hospital system is being reorganised fast enough and comprehensively enough. The Minister In Charge of the Department of Mental Hospitals is of course aware that, by individuals and by certain organisations, the system is being sharply criticised. He is also aware that some of this criticism is uninformed and misdirected. But if he thoroughly studies the latest report submitted to him, for example, he will find it hard to deny that it contains prima facie evidence to warrant criticism. It is the least important part of this evidence that the report shows accommodation to be so far deficient that 7746 persons were housed, last year, where there was room for 7177 only; that there is reference to buildings that had to be abandoned as dangerous; and that (at Tokanui) the medical officer complains of the undesirable proxirhity of the admission wards and the chronic wards. It is more serious that a shortage of staff attendants appears to be general in the institutions: that references to the training of staff are few and suggest that quite obvious branches of instruction are new departures; and that the medical staffs are at a minimal level for efficiency, or below it. But .more serious still are other indications of backward methods. Throughout the report there are extraordinarily few references to methods of treatment, or improvements or introductions. The Director-General of Health refers dubiously to the insulin method, but only, it seems, to experiments reported from oversea. Dr. McKillop, from Christchurch, reports on the successful use of malarial treatment. The Porirua report gives an interesting and hopeful account of the opening of a small psychiatric ward in the Wellington Public Hospital; and this appears to be the most notable advance of the year. Elsewhere there are references only to out-patient psychiatric clinics. Otherwise, the method of treatment which receives most attention in the general and in the institutional reports is that known as occupational therapy; and what is said about it is not very encouraging. Although the Director-General observes that the effect of giving patients “ the pleasure of doing arts “ and handicrafts ” has been “ very striking ” in oversea hospitals—so much so that “many “ wards ... have lost their title to the term “ ‘ refractory ’ ” —he is obliged to lean on the hope that “ the day is not far distant when “ every patient will have some form of occupation, however elementary,” That is, he is obliged to hope that a beneficent method long familiar and proved .elsewhere will sooner or later be generally u?ed in New Zealand. Hopes of that sort are also confessions; and the impression conveyed is not much bettered by the Director-General’s reminder that, in New Zealand, “ our farms and gardens are much “ more extensive than those attached to British “ hospitals, and our patients engage in larger “ numbers in outside work.” The value of occupational therapy lies largely in the suiting of the occupation to the patient; it is not fully or certainly achieved by giving every physically fit patient a spade or a rake or a lawnmower. It should be added that the report contains - plentiful evidence that occupational therapy is a recent and gradual introduction in most New Zealand mental hospitals, that staff attendants who are qualified to assist arc few, and that most of the instructional work is done by volunteers from outside. More surprising are the indications, not at all infrequent or uncertain, of the extent to which common recreational facilities have only recently been provided. It is no very gratifying contrast that appears in innumerable references to farm, garden, orchard, and piggery improvements: many paragraphs read more like extracts from the report of a farm manager than of the superintendent of a mental* hospital. We have said enough, probably, to sustain the point that the Minister need look no further than the report submitted to him last month for cause to inquire thoroughly and urgently into the system for which he is responsible. But two moro considerations may be mentioned. There is not one word in the report to suggest that the patients’ diet receives any specialised or expert attention, unless allowance is made for the reform proceeding in Auckland, where, “ gradually ... as many wards as pos- “ sible will be provided with their own kit- “ chen,” a system which has helped to give the patients “ better and more varied menus.” Second, there is the astonishing Table VII, which assigns “ the principal causes . . . for the men- “ tal. breakdown in the admissions,” and which is. tagged with the easy admission that these are “ merely approximations.” It is possible to grant that attributions under such headings as “ Predisposed by previous attack ” or “ Mental “ stress,” or “ Disorder of nervous system.” or “ Other bodily affections,” are “ merely approxi- “ mations.” They are also almost valueless ones.