MENTAL HOSPITAL REFORMS

Evening Post, Volume CIX, Issue 119, 23 May 1925, Page 7

MENTAL HOSPITAL REFORMS

HIGHER STANDARD OF EFFICIENCY

TREATMENT IN EARLY STAGES

NO OVERCROWDING: BETTER CONDITIONS

BORDERLAND CASES: TREATMENT WITH SPECIAL CARE

A number of important and far-reaching reforms in the treatment and care of mental patients have been decided upon by Sir Maui Pomare, Minister in Charge of Mental Hospitals, and have been approved by Cabinet. It is considered by the Minister that when these advanced steps are completed, New Zealand will occupy, a foremost place in the world in dealing with mental cases—a similar position to that which independent visiting medical men have agreed that it holds in respect to general health matters. Special attention is drawn by the Minister in his statement to the new and more humane system to be adopted in dealing with new or suspected cases of mental and nervous trouble. Lodgment in police cells or prison is to be done away with. Special cottages, out of sight of the main mental hospitals, are to be erected, in which incipient or suspected cases can be observed and treated. The various reforms to be instituted are • outlined as follows by the Minister. .

"Since the close of last year it has become increasingly apparent, month by month, that active measures needed to bring the institutions and service of the Mental Hospitals Department up to a more satisfactory standard of efficiency and progress could not justifiably be deferred until the return in October next of the Inspector-General, Dr. Hay, who, in spite of ill-health, remained at his post until the middle of last year. "The Great War and its aftermath (conjoined latterly with Dr. Hay's illhealth) affected the maintenance of the standard previously arrived at by the Department in certain directions, and. retarded progress in other directions". The Inspector-General realised these things himself, and I know that no one will appreciate more than he will the measures which have been taken during the last te\v months to place matters on a better basis.

On Dr. Hay's departure for Home, Dr. Iruby King was asked to act as Inspector-General; but in view of the h c ea^y demands on his time as Director ?l Child Welfare, and as a member of the board of inquiry into mental defectives and sexual offenders, it was neither expected nor desired that ho should do more than act as adviser and referee— Dr. Pnns being given charge of the head office in Wellington, with a competent office staff. However, Dr.* King was ask-' ed ,n January to visit all the mental hospitals (both public and private) in order to look into matters thoroughly. As_ Mmiater-in-Cliarge, I visited all the institutions, accompanied in most cases by &ir Iruby King, and as* tho outcome of these investigations and subsequent conferences it was decided to take action m order—

OUTLINE OF THE REFORMS (a) To promote prompt recognition -of serious mental affections, and to encourage the adoption of suitable treatment in the early stages. " (b) To ensure the provision and use of improved methods of handling and dealing with mental patients, prior to and at the time of committal as insane, and to abolish temporary lodgment in prison pending decision. (c) J.o ensure the provision and better use of facilities for classification care, and treatment, especially in the case of the more recent, impressioni% sens.ltive> and curable patients. J?[, T° improve provisions in the wav of kitchens, laundries, etc. (c) To remove overcrowding. -. I (1) To correct any oustanding de- I lects of sanitation and ventilation. The policy decided upon includes : ESTABLISHMENT OP OUT-PATIENT CLINICS. 1""? 0! 1™0-3. 7 ill he estaMshed at the general hospitals and conducted by two medical men one drawn from the general hospital and one from the mental hospital. It ls intended that such clinics to be Wn as 'clinics for nervous affections shall be held weekly—without an Y implication of insanity, mental break<"ft. or so-called 'borderline' trouble ■w li- * Pr°]il cb ™a? brouSht before the Wellington Hospital authorities early sin the year, and was moat favourably imd sympathetically -received, both by the board and by D>. .Wilson, the Medical Superintendent. Indeed, Dr. Wilson said the_ clinic would be as welcome irom their point of view as it would be Ironi the purely mental standpoint, as he and his colleagues would benefit by a weekly coherence with a mental (specialist concerning such of their patients d.s might.present mental problems. Dr. Wjlsou saw no reason why the clinic should not bo established forthwith, as it would cost their Hospital practically nothing,, and-the advantages would certainly be reciprocal. Similar tentative overtures made in Auckland and Duuedm were received.in the same spirit, and the Hospital Board for North Canterbury (centred in Christchurch) has expressed its willingness to co-operate.

SUSPECTED CASES AVOIDING. DISTRESS AND HUMILIATION. "2. The safeguarding of ■ persons alleged to be of unsound mind from tho indignity, distress, and humiliation of being treated as delinquents or criminals, and under present conditions, lodged in prison pending decision as to their sanity or insanity; and in the case of committal to a mental hospital, the en sunng of proper and humane lodgment, care, and treatment of the patient until taken charge of by the mental authorities. "Arrangements are under way for the provision of suitable rooms in general hospitals where mental patients can be properly cared for, pending medico-legal examination until their transfer to a mental hospital, if committed as insane, instead of their being kept temporarily in police quarters. "In order to facilitate the provision and equipment of three bedrooms in each of the four centres, Cabinet has voted a sum of £2000^£500 for each of tho general hospitals. I feel sure that the hospital boards -will actively assist the Department in tliis direction. HOME-LIKE OBSERVATION LODGES "3. Preventing, new patients, as far ■w jKWriblj, iwa bjiog brought within

sight of the main asylum buildings or of the inmates, or into any kind oE contact or association with ordinary chronic patients until it has been ascertained by careful examination immediately on arrival, conducted at a. simple, attractive, and home-like entry lodge (out of sight of the asylum proper), that the particular patient is at the moment quite unsuitable for curative treatment at a seaside or other sanatorium, or in a special cottage or small villa on the nsylnm estate, and will not be harmed, at any rate in the meantime, by association with chronic patients in a suitable ward of the central institution.

"Obviously, any doctor presiding at the weekly clinic would appreciate being able to assure the incipient or. borderland mental patients who might attend that they- need have no anxiety as to being confronted with any painful or humiliating sights or sounds on their way to the institution; that on arrival they would receive immediate professional care and attention, and that they would be well lodged and treated with .every care and .consideration—including suitable rest in bed, or such occupation, recreation,' aud treatment as. might be deemed most conducive to their recovery. "In addition to such cottages or small villas_ as may now exist on the Mental Hospital Estates, we are providing small, private, comfortable home-like and attractive buildings, capable of accommodating not moro than twelve men or women, as the case may be, on a sanatorium basis. The sites of these cheerful and curative convalescent sanatoria will be_ chosen several miles from the parent institution, so as to avoid any socalled 'asylum association,' aud to convey rather the pleasant feeling and impression of a holiday health resort. It need scarcely be said that' these places will serve for much more than mere idling or recreation; they will provide in addition useful and interesting occupations for patients of both sexes, with a view to establishing proper discipline, infancy and early childhod, and the power of self-direction needed for the independent regulation of their own lives and conduct before beinn- discharged.

IMPROVEMENT IN DIET "4.—Systematic adjustment and improvement of diet to meet the varyin« requirements in mental hospitals. As great advances have been made in the science, practice, and economics of diet (especially ■as applied to feeding during infancy and early childhood, and the catering for armies and for persons boarded in schools, sanatoria, hospitals, etc.) it is gradually coming to be recognised that trained experts will have to be appointed m order to supervise and direct the feeding of all hospital patients—whether the evidences of illiiealth manifest themselves mainly on the bodily or on the mental side In either case—digestion and nutrition being almost invariably impaired—suitable • adjustment of food and feeding habits is a first essential, and must be provided lor. It is recognised that, while the scale of food and feeding in the general ■Und mental hospitals of the Dominion is liberal—indeed, generally beyond what is desirable, especially in regard to meat —systematic scientific adjustments to meet the needs itnd tastes of individuals must bo provided as one of the most essential features.' of all curative treatment of those sick in body ('medical' or ' surgical' cases), or in body and mind-so-called 'menial cases.' With this in view a professional dietitian has been appointed by .tile Mental Hospitals Department to organise, suporvise, and direct, in conjunction with the InspecforGonoral and the local Medical Superintendent, the feeding arrangements of all mental patients. This lady, after completing the three years' course in domestic science at Otago University, further , qualified herself by taking a special practical course of training as a hospital dietitian at Johns Hopkins University iSalliinore, the most advanced centre in the world for.practical and progressive dietetics. • •

As a. striking instance of tho need that may arise in mental hospitals for the use of advanced dietetics, so as to keep pace with recent progress in the science of healing, the case of diabetes may be cited. This disease (an occasional cause of insanity) has only recently come within the sphere of definite scientific medical control, through the introduction and employment of , insulin, conjoined with skilled and systematic dietetic adjustments. The same measures needed in this case to restore and maintain thn health of the body- are essential also for the restoration of the mind:. DENTAL TREATMENT. "s.—As the removal of septic foci in the mouth is an important matter n; connection with the treatment of mental diseases, a. dental surgeon has been ap- ! pointed to the Department; and whatever additional assistance is necessary will be arranged for and supervised by the Director o£ Dental Hygiene (Mr f A. Hunter.) PSYCHO-ANALYSIS AND SUGGESTIVE THERAPEUTICS. "6.—Much popular misconception exists in this connection. Knowing the use of analysis and suggestion- for 'shell-shock cases' (persons suffering from merely . functional nervous and mental disturbances due to '.shock') many people now imagine the same, kind of suggestion would convince an ordinary insane person that his delusions and I irrational fears and, suspicions jfeta:

groundless. Of course, no competent asylum physician fails to make good use of suggestion and persuasion; but the public ought to know that, after a fair .trial over a period of 40 years by the most eminent specialists, so-called 'expert suggestion' and hypnosis have proved to be of little or no efficacy in the treatment and cure of the hereditary, pathological, organic, and, toxic insanities, such as ordinarily come under treatment in mental hosuitals for insanity or border-line conditions. Indeed, Dr. Albert Moll, a leading authority on 'suggestion,' states expressly that the first, requisite for success is nearly normal mentality, and that even ordinary hysteria is rarely amenable to suggestive therapeusis. . However, with adequate provisions and facilities for proper classification, care- and treatment of the insane, such as are now being established, the public may rest assured that the doctors at the mental hospitals will leave no stone unturned to promote the recovery of their .patients—including the use of any reasonable therapeutic suggestion that may give an additional chance of success, however remote;

IMPROVING EXISTING HOSPITALS "Substantial provision has already been made by Cabinet for sanitary and other improvements, which are now under way, in connection with existing premises, 'for the erection of new buildings, and also for the acquisition of properties needed for carrying out the Dopartment's intentions in regard to sanatoria, etc. TRANSFER OF OFFICERS "In connection with the further organisation and development of the mental hospital service, the following transfers have been effected :— "Dr. T. G. Gray, medical superintendent, Nelson^ as medical superintendent, Avondale, vice Dr. R. M. Beattie on 32 months' leave of absence. "Dr. H. E. Jeffrys, medical superinent, Porirua, as medical superintendent, Nelson. "Dr. A. C. M'Killop, medical superintendent, Seacliff, as medical superintendent, Christclmrch, vice Dr. A. H. Crosby, retired after 28 years' service. "Dr. H. M. Buchanan, medical superintendent, Hokitika, as medical superintendent, Seacliff. "Dr. Whitton (of Oamaru) 1 has been given temporary charge of the Hokitika Mental Hospital. "In order to strengthen the medical staff we are obtaining the services of two well-qualified mental hospital physicians from the Old Country. "Sir Truby King has been given a practically free hand to carry out the whole of the programme."