THE PRESS TUESDAY, OCTOBER 11, 1988. Tragic hospital mess

Press, 11 October 1988, Page 20

THE PRESS TUESDAY, OCTOBER 11, 1988. Tragic hospital mess

The reasons for the tragic mess described in the Mason report on psychiatric services need to be sorted out rapidly. The centre of attention is not necessarily the Auckland Hospital Board, the board’s senior executive staff, the Health Department, the Justice Department, or the Government; to all of these some of the blame for the treatment of forensic psychiatric patients must be attached. The main concern has to be for present and future psychiatric patients. The report was about psychiatric patients who have come into contact with the criminal justice system. The damning evidence and views given in the Mason report will reflect, mostly unfairly, on all the psychiatric services throughout New Zealand. Taboos and fears have long existed in the community about mentally ill people. Those worried about the care offered to relatives needing psychiatric treatment will find support in the report for their worst nightmares. Many of their fears may be misplaced; but, while the blight remains, their views must be coloured.

The Auckland Hospital Board is clearly the most culpable, but one of the most notable matters to come out of the report is that there has been an unwillingness on the part of any Government or local body agency to accept responsibility for the provision of the care of the forensic psychiatric patients. It has been a classic example of buck-passing. The Government has chosen devolution of health services as a way to resolve some health-care problems. There is considerable room for scepticism about whether this will just have the effect of producing more powerful local bodies which refuse to take responsibilities under the direction of Government policies. Mr Caygill has now written to the Auckland Hospital Board requiring certain measures to be taken. The board has been given a month to respond. The Minister’s powers are fairly limited. He can, as a last resort, dismiss the Auckland Hospital Board. He cannot dismiss any executive or medical staff of the hospital. Under the State Services Act, the board may dismiss only its chief executive. It would be up to the chief executive to dismiss any further staff. If the Minister were to use his last-resort power and dismiss the board, a long administrative and perhaps legal wrangle would probably follow before anything much could be resolved. Time is not

on the side of those requiring psychiatric care. The Minister is wisely using his powers of persuasion to get changes made quickly. The Auckland Hospital Board seems not to have got much right lately. The Cartwright inquiry into cervical cancer treatment was similarly damning of the board. Clearly, insufficient professional consultation and insufficient peer review were used to correct problems. The dreadful debacle over the Maori unit at Carrington Hospital was also the responsibility of the board. The belated admission that people of radical attitudes had seized control of the unit was but a late reflection of what had been apparent for some time.

Some principles should be established to make sure that mistakes are not repeated. The continuation in office of some or any board members will remain subject to election; basic questions about the ultimate responsibility for looking after the criminally insane need addressing immediately. The practice of employing unqualified people in positions of responsibility for the care of patients and for social work with patients' should be stopped as soon as possible. With the best of intentions, some hospitals have been employing people who do not have the appropriate training in social work or for other positions of great responsibility to make it easier to treat Maori people. Hospitals should be culturally sensitive to Maori people; but the hospital has the responsibility for the care of patients and, whatever the ethnic origin of its staff, they should have a grounding in the disciplines associated with care of people in hospitals. A review of such appointments should eliminate some of the predictable troubles.

The criticisms made by the Mason report are already having an effect on the esteem in which psychiatric services are generally held, just as the Cartwright inquiry report has damaged the estimation of the medical profession generally. Only the Government can sort out the Auckland situation to complete satisfaction. The board can go only so far. As well as acting in the best interests of patients, the Government should act to preserve confidence in the system of health care, not to mention New Zealand’s international reputation. Neither will stand many more shocks like those of the Mason and Cartwright reports.