MENTAL HOSPITALS

Press, Volume LXXVI, Issue 22921, 18 January 1940, Page 10

MENTAL HOSPITALS

■ : —; Treatment: Medical And Therapeutic [By Our Special Representative.] v V

To a layman if appears'that really scientific treatment for the mentally deficient has been a comparatively recent development in the generaf system. Not much more than 40 years ago the outlook towards these unfortunates of society was in the main, purely negative: the aim of the system under which cared for was purely restrictive. The insane were ' consid"re r d mcurables and outcasts, a "™^™*»}™ e ™ t £ persist in uninformed quarters even But J h * n *£ ** e insane were thought to be dangerous; and the first consideration of the State, in its handling of this problem, was for the safety of the public. " ; The public was the first thought behind the building of ' thcJ gloomy asylums of former years «««»«* Zealand is only now. demolishing or altering. The second con SdeSon in the" old days was/the safety of the keepers; ». the third the protection of patients from the violence of other patientsi *• >

A different conception guides c the control of the system now. ; The reporter who made this inquiry t was permitted access to a special re- E port, not yet published, prepared by, r the Director-General of Mental •Hos- J pitals, Dr. T. G. Gray, to whom the . inquiry-is generally greatly indebted, t He says: -- * "I cannot assert that the dangerous patient has disappeared. We still have the paranoic, who seeks- revenge upon his imaginary,persecutors,* the epilep- } tic, with his unconscious impulse; ana , the melancholic who -. destroys his t family to' save them' from; a misery, » , akin to his own. But it may safely be. t said that the number of patients who t are dangerous, to "others while m an, s institution-does not amount to 2 per * cent, of the resident population. ■ - . r t Dr Gray; whose report ,was -made 2 some years ago; adds: ''The c of all delay in mental hospital 'reform -v has been the prison origin ,and . the , ( fruits thejepf;-and •while-, we. are •. ixp- E patient, and rightly impatient, wel*aye - to remember that most of-our insti- £ tutions were built in accordance with < the ideas of 1845-and earlier, and fur- j ther, that we have "for years been • waging war against the traditions, with 1 which.such-a systemi fortified itself; t These traditions are not in,the main < • * r

confined to the staff pf mental' hospitals: in -New Zealand they permeate every class in the country. One ventures to hope that the -present -widespread interest in mental hygiene will result in the diffusion of more knowledge of the problems connected with mental disease and the cultivation of a better co-operative spirit towards those who are in' attempting to solve some of them." It is safe to- claim that since Dr. 'Gray" wrote those words there has been a notable advance in New "Zealand in the last 10 years, and particularly in the last'five or six, when an improving economic situation ' allowed, the expenditure of more money on .the system and'on research and experiment in; treatment. An. acceleration of, this advance has followed the practice of sending men prominent in' the system overseas for inquiry and study, and the employment of men actually trained overseas in some of the great institutions in Scotland, England, and on, the Continent. Dr.' Gray himself went' overseas. From the observations ,of- these experts, the ' conclusion can safely be drawn' that New Zealand is keeping well • abreast' pi trends overseas and that the treatment given all classes of mental deficients under our system is as up-to-date as ■ possible. This'is a layman's opinion, of course, butit is-based.on a'fairly: wide.study, of the literature of the'probleni, and of actual, New Zealand practice*^

Individual Care, • The greatest possible segregation of cases, commensurate with economy and the actual welfare of patients and a high degree of "individualisation fn toe general scheme of accommodationand care, arebasic features of the treatment scheme as. a whole. Lmked with these, of course, are-cluneal, medical, and therapeutic methods of treat merit for cases warranting them. An authorities are bound to make the sad admSsio n , that for a great number of , the cases in our institutions there is no general method of or, for that matter, no special treatment, even, cSablfof 'ensuring any higH percentage of recoveries. For many hundreds there is absolutely *io P°ssibikty of xecovery. They are kindly cared for in the institutions, under the surveillance not only of the staff of the home, but through occasional outside visitation. The congenitelly deficient, the deformed (some terriblydef onned) can only be kept as decently as Possible, until they die. But wherever science and care can bring-about complete or partial cure for the diseased mind, it is being done. A great deal of the time of the institutions m New Zealand is taken up in-the treatment of these various recoverable classes-;-the alcoholic and drug cases, the epileptics, the shell-shock, sexual, and similar types, and the acute cases of short duration. The administrators of

the system look on this work as their most important, naturally, and it is a work that is being continuously, developed, experimented with, and vimproved on. ' . - That the system is not-backward in experiment along the most modern lines is shown at the Tokanui Mental

Hospital,'for instance, where an interesting experiment has-been7conducted in efforts to rehabilitate male schizophrenics (one of the types of mental disease) by intensive directional treatment. The .experiments ' are still ■ too much in their infancy to allow a final verdict, the authorities say, but a definite'improvement in conduct end personal .hygiene had been so notable that

the treated patients were taken from the refractory ward, and were well enough to be nursed in the' general admission ward. ' At Seacliff, the latest report of the department points out, the treatment of schizophrenia with" insulin was started. At the stage the reoort was-made figures relating to results would, it was claimed, be fallacious, but the results iad been most encouraging, in some cases'startling. ■" "The treatment • has its undoubted dangers, but despite this, it is a marked advance in the -treatment of these unfortunate v people." . The Otag- "edical School helped in that series of-cases. „ This treatment has been undertaken ' along lines similar to work of-thatvtype overseas. So a great deal is being .done to cure 'cases' suffering from one of.the most "unfortunate types of insanity. The reporter who made this inquiry was shown some of the experimental work of this sort at Christchurch and Auckland," and at Porirua. In one series of treatments, having good: results, the patients were * given -an injection Which, producing,-a■ severe- shock, -led

to a reaction and consequent lessening, if not removal, of'the case of the , derangement. At Auckland an expert, trained overseas,-'is supervising this important work., 1 - Routine Practices Little need be said of the ordinary routine treatment given to all patients able to undertake it, or for whom it is worth while—the daily exercises, the classes in physical.drill, games un<der qualified » instructors, massages, ultra-violet ray treatment, and so on. Not unimportant as part of tne ■ treatment is-the manual work undertaken by those who-can do it. And here, it should be emphasised, there is a belief that the inmates of mental ( institutions are forced.to work. That is far from the truth, - and this m- ( auirer'saw many patients in the various institutions, quite able to work, ( who were not doing-so because they refused. The inmates are encouraged to work in the laundries, the 1 fiilds, and the cook-houses because manual work, in thousands of cases, induces greater self-respect, cleanliness, and hope, -and because so many , of them ask for work / But there is ■ no compulsion. On the.other hand, 1 there is much competition for sonre jobs. A patient was met with, the assistant to the baker at one.of the North Island institutions, who had been a hopeless misfit and apparentiy until he showed a liking for his new 30b.' This job, far more than any other specialised treatment tried put on the boy,-has lead to a great*improvement, the authorities claim, in his . outlook and behaviour. ,

I Much good is also -attained through 'sports classes, particularly with such ( types as young girls-suffering from sex .abnormalities.* There.are young girls iat Sunnyside who on entering the institution were apparently imbecile-and' ; unable to co-ordinates-brain or limbs ( in action. Specialised* treatment and sports have so altered their condition , that they take part-in basketball com- , petition games with the greatest zest. , These girls often become - completely } recovered and leave, the institution, . under - some type of supervision 'if needed. How. far removed ,from: the. ,

old conception of an asylum is the scene at Sunnyside; - scores of girls playing basketball in an open field and over the way, as many youths at foot- , ball. • The staff provide the referees , and any supervision." While writing of Sunnyside one ought .to mention an important 'clinical, experiment ' being , undertaken there—the association of goitre with mental'deficiency. And of entertainment and' sport, mention ought to be made of the- weekly film show,'occasional concerts run by social workers and helpers, the outings in motor.-cars-for those who , are allowed out on parole-and for. others who go out; under ■ supervision: , ' Occupational therapy Mental hospital authorities all over New Zealand,' inspired by their own successes'and those of institutions overseas, pin a great deal of faith to the benefits of occupational therapy. The development, of "this: treatment consti-'

tiites one" of enc6^ : has?.m^e ,y -'M''? ; th'e-<c9'r^ , , : -'«tf'; i .'th'e" mentally deficient. Some.; .occupational; work," aimed -afcHeachingWe ■ prniciples, of some simpler trade; occupation or, handicraft to.patietits, ,has;Lbeen\done: in some •'= institutions .in • New - ■ Zealandon' a small-scale-forSoftie :years.cßut recently jsin- Great' BritainJitsysqope. has

been'enormously extended; untile > as one New?Zeaiahd- doctor* visiting «Eng~* 'land" "discovered, its spirit permeates whole hospitals;'; Now this iworkTisibe-: ing- extended v tb' all -institutions ; v nv New-Zealand: where it'can ,be applied,: already with intendents state,, to patients and : tp.the, general ; atnidsphere/<pf the» institutions

themselves.. Tours through all ; the: ' occupation ' blocks .indicated; why >:the authorities place i such reliance.: on the occupational r therapy. I :.yAt Sunnyside; where the -results have - already rbeen ? of 'great value,-- the" occupational block has recently : ; been" JVIale patients'' af e~- taught liWOodworkV; metal-; , work,:; weaving',- spinning; and:" which w -many*- ox them become so proficient thatmugh of their work is exhibited/iri :shows " about : the-dtyV; are -eases where, patients,- under this-training,, which, is in- the hands : of expert .tradesmeni; and instructors,. have/ achieved the . proficiency of .tradesmen and;

their to goodvuse.;? '■■;' .■:■:, One:. of .the. basic ideas :±>ehma-oc- :

;upational' therapy is that-in- achievng some- such work a --patient- grows ,0' have a greater sense of-responsibii-ty. • ■ ■ _.■ - - .; - „

Women -and young girlsvare engaged earning handicrafts at which.they ara sest suited. .This treatment;has-had some, surprising- results.. -Hopeless ;ases have developed artistic attributes

if a high order; many women ao nn< apestry, in which they take; grea >ride. Many learn • the 'rudiments o pinning" of wool. • All "this work 11 Lone under surprisingly little, super dsion other- than that of-the mstruc ors. This is-taken as one indicator rf the success 'of - the scheme; tti ctual work and achievement takes. th< aind away from its routine haoits ""he patients,ace given complete lati ude in'this-work; there is no eompul ion to undertake it intensively ant t is not done for-the sake of produp ng something for ■ profit It-mus erve greatly-to lift-some or. the-load if hopelessness one sees on the face. >f patients. Reports to the aepartmen >y medical superintendents are full o nraise for occupational- - therapy- am ven a- -layman can see how much th< reatment 'is • designed -to make hf lappier .for these unfortunates. Th< lew system will undoubtedly • lea( ome into useful lives outside the in titution.- , ; _ ' - ' , /_„„,. Not directly in the line of treat nent.'but. preliminary to it, and o; ome • importance; is the - work n-the clinics-attached to 4he-hospj als- in / the ' main centres. These. out >atient-clinics- do not, as .with mosi ither'activities of mental institutions or that'matter, receive the-apprecia ion they deserve from the public [•here, : those suffering from nervous .flections are able'to secure expert-ad dee without fearing any - implicatior

of insanity at all. These clinics were started in response to increased recog- ' nition of the .need for prevention of mental disorder that can be got at ' early in the day! Prospects for recovery, all authorities agree, are greatly enhanced if treated in the early stages. These clinics do work that prevents the decline of many nervous men and women into actual' insanity. Hundreds " of consultations take place a year. There-has been a big-annual increase, for instance, in the number of cases seen at the Christchurch clinic by Dr. A. C. -McKillop, the Medical Superintendent at Sunnyside. He also does similar work at Timaru. ' (To.be concluded.)