MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1945

Appendix to the Journals of the House of Representatives, 1946 Session I, H-07

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. 1946 NEW ZEALAND

MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1945

Presented to both Houses of the General - Assembly "pursuant to Section 78 of the Mental Defectives Act, 1911

The Hon. A. H. Nordmeyer, Minister in Charge of Mental Hospitals, Wellington. Wellington, 11th Jnne, 1946. SiR,-r-I have the honour to present my: annual report upon the work of the Mental Hospitals Department for the year ended 31st December, 1945. Statistical At the end of the year there were 8,794 names of persons upon our registers, including 40 patients at Ashburn Hall private licensed institution and 713 patients who were absent on probation in the care of relatives and friends. In actual residence on 31st December there were 8,041 persons —a decrease of 79 compared with last year —and of this number 7,673 were patients who had been committed and 368 were voluntary boarders. There were 1,477 patients and boarders admitted for the first time, an increase of 54 over the previous year, of whom 1,118 were the subject of a reception order and 359 were voluntary boarders. Of all classes of admissions we were able to discharge 1,200, or 62*08 per cent, calculated upon the number admitted, but no more than 760, or 39*32 per cent., were fully recovered at the time of discharge. This number does not represent the true recovery rate, as patients who are sent home to convalesce on probation often omit to send a medical certificate, in the absence of which we require to regard them for statistical purposes as " unrecovered." Voluntary Boarders Statutory provision for the admission of patients as voluntary boarders was first made in 1911, and the subjoined table shows how increasingly this method of admission has been used. The fact that the discharge rate for voluntary boarders was 85 per cent, calculated upon the admissions indicates that advice and treatment are being sought at the stage of illness when they can be most effective. One gratifying feature disclosed in the table is that in only a very small and diminishing number of cases does the illness progress to such a degree that the person is no longer fit to remain as a voluntary boarder and requires committal; it may well be that this is related to the efficacy of the more recently introduced physical methods of treatment.

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There is no doubt that the increased number of people seeking admission as voluntary boarders is in part due to the knowledge that such treatment is available and is likely in suitable cases to have surprisingly favourable results.

Accommodation The position in regard to accommodation was dealt with in some detail in my last annual report, which disclosed a deficiency of 751 beds, not taking into the 265 patients then accommodated temporarily at The Chateau and Wairakei. Towards the end of the year the essential services of water-supply, sewerage, and lighting at The Chateau were put out of action by the deposit of ash from the active eruption of Mount Ruapehu, and the matter of evacuation became an urgent necessity. It was indeed fortunate that at the moment when we required the accommodation the military convalescent depot at Raventhorpe, near Auckland, became available, and our patients were transferred there at a few hours' notice. A few weeks later we had similarly to evacuate Wairakei, which was situated in the centre of the extensive bush fires which swept the thermal area of the North Island, and our patients went to Raventhorpe, which now has approximately 300 of a patient population in addition to staff. It is unlikely that Raventhorpe can be adapted as a permanent mental hospital for adult patients, but it would be suitable, after the necessary alterations and repairs and additions, for housing cases of congenital mental deficiency, and in this regard it will meet a pressing need.

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Year. First Admission. Not First Admission. Total Admissions. Transferred to Keeister of Patients. Died. Discharged. Remaining on 31st December. Mi p. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 1912 6 17 23 0 0 0 6 17 23 1 3 4 0 0 0 4 3 7 1 11 12 1913 18 19 37 0 2 2 18 21 39 2 5 7 0 1 1 12 12 ' 24 5 14 1$ 1914 17 19 36 3 2 5 20 21 41 7 5 12 1 1 2 11 15 26 6 14 20 1915 15 17 32 1 2 3 16 19 35 3 4 7 0 1 1 8 14 22 11 14 25 1916 13 23 36 5 8 13 18 31 49 4 4 8 1 2 3 14 14 28 10 15 25 1917 14 21 35 1 13 14 15 34 49 6 6 12 0 1 1 10 23 33 9 19 28 1918 23 38 61 5 11 16 28 49 77 1 4 5 2 2 4 15 30 45 19 32 51 1919 31 39 70 5 19 24 36 58 94 3 3 6 0 2 2 26 42 68 26 43 69 1920 26 38 64 16 12 28 42 50 92 3 4 7 1 2 3 33 33 66 31 54 85 1921 39 39 78 11 15 26 50 54 104 2 3 5 5 1 6 38 41 79 36 63 99 1922 47 38 85 10 16 26 57 54 111 6 5 11 4 4 8 40 48 88 43 60 103 1923 44 50 94 15 21 36 59 71 130 3 6 9 3 3 6 47 47 94 49 75 124 1924 38 44 82 16 20 36 54 64 118 4 8 12 6 3 9 39 48 87 54 80 134 1925 64 59 123 15 34 49 79 93 172 10 15 25 6 3 9 60 63 123 57 92 149 1926 71 60 131 11 29 40 82 89 171 10 11 21 7 2 9 49 71 120 73 97 170 1927 70 70 140 25 32 57 95 102 197 8 6 14 5 12 17 75 58 133 80 123 203 1928 120 94 214 37 39 76 157 133 290 8 10 18 10 8 18 102 97 199 117 141 258 1929 102 63 165 50 43 93 152 106 258 11 3 14 9 9 18 119 110 229 130 125 255 1930 152 84 236 41 35 76 193 119 312 15 9 24 8 6 14 130 79 209 170 150 320 1931 166 98 264 43 36 79 209 134 343 11 14 25 11 7 18 159 102 261 198 161 359 1932 150 85 235 50 40 90 200 125 325 24 32 56 14 5 19 190 108 298 170 141 311 1933 112 109 221 53 32 85 165 141 306 11 14 25 5 4 9 121 107 228 198 157 355 1934 132 90 221 56 33 89 188 123 311 7 11 18 10 6 16 152 99 251 217 164 381 1935 130 87 217 40 55 95 170 142 312 18 20 38 19 10 29 151 116 267 199 160 359 1936 98 99 197 62 44 106 160 143 303 21 20 41 7 10 17 137 111 248 194 162 356 1937 103 91 194 64 45 109 167 136 303 14 7 21 6 10 16 163 122 285 178 159 337 1938 111 105 216 60 53 113 171 158 329 11 15 26 11 8 19 144 125 269 183 169 352 1939 131 103 234 63 72 135 194 175 369 22 21 43 16 15 31 157 130 287 182 178 360 1940 128 124 252 65 63 128 193 187 380 18 18 36 10 12 22 176 167 343 171 168 339 1941 93 104 197 48 58 106 141 162 303 11 9 20 10 13 23 140 151 291 151 157 308 1942 88 108 196 44 74 118 132 182 314 14 15 29 15 8 23 124 160 284 130 156 286 1943 95 126 221 66 87 153 161 213 374 2 8 10 13 14 27 115 159 274 161 188 349 1944 146 168 314 70 104 174 216 272 488 4 7 11 11 10 21 172 243 415 190 200 390 1945 1 178 181 359 90 112 202 268 293 561 9 8 17 20 8 28 244 272 516 185 205 390

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Porirua is being rebuilt on modern villa lines, and two of the new villas constructed in concrete each to house fifty patients are almost ready for occupation, but much requires to be done before those evacuated after the earthquake can be returned to Porirua. A commencement has been made with the erection of Lake Alice Hospital, near Marton, but it must be some considerable time before we can get relief by its occupation. We have fifty boys at Levin Farm, and, as soon as alterations now in progress are completed, we shall transfer more children from Nelson, which we hope to Vacate at an early date. Alterations, Additions, and Improvements Capital expenditure on new' buildings and improvements amounted to £208,987 during the year, and the following summary shows the principal items making up the total: — (1) Auckland (£7,307). —New building as training school for nursing staff and •occupational therapists has been erected, and additional class-rooms for occupational therapy have been completed. (2) Kingseat (£1,487). —Wood and coal sheds have been erected at staff residences? and roading and water supply services have been extended. (3) Marton (£44,696). —A new villa is in course of erection and several staff residences have been erected. A water-tower is being erected, and roading, watersupply,' and drainage work carried out. (4) Levin (£83,966). —The R.N.Z.A.F. station at Levin has been purchased for use as an institution for children whose parents are in the North Island. (5) Porirua (£45,867). —Demolition of the old main building has continued. Two new villas have been erected and equipped, and a start made on the erection of a new laundry. (6) Seacliff (£24,918). —A new villa at Waitati has been erected and equipped, and preliminary work at Cherry Farm was undertaken during the year. \ Shortage of Nurses The work of the Department is overshadowed by the continued shortage of nursing staff, and I regret to report that there has been no improvement, but rathetf- the reverse, since this time last year. At present we are 253 nurses and 85 men short of our authorized establishment, which throws an undue burden on existing staff and prevents them from receiving the amount of leave which is so necessary in the nursing profession. The status of our nurses was greatly enhanced by the recent legislation, which accords to them State registration, and a great deal has been done to improve their training, which is now subject to inspection by the Nurses and Midwives Registration Board. The standard of our training is reflected in the fact that our certificated nurses who proceed to general nursing training in the hospitals almost invariably do well above the average, and in this connection it is gratifying to record that Miss M. E. Little, now appointed Matron at Raventhorpe, was awarded the Silver Medal at Waikato Hospital as being the best nurse of her course. Salaries have recently been substantially raised, so that commencing trainees receive approximately £3 ss. per week in addition to board and lodging after deduction of all taxation. Unless there is an early improvement in the situation it may be necessary to extend our area of recruitment.

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Service Patients The movements of Service patients and boarders from the beginning of the war until the end of last year are shown in the following table :

In addition to service patients and boarders admitted to our hospitals, our Medical Officers are seeing and treating many cases of psychoneurosis, but, as previously stated, these cases are mainly reactive in origin, and the numbers may safely be expected to fall off before long. Medical Staff In July last I went to England in an endeavour to select suitable psychiatrists to fill the depleted ranks of our medical staff. The position in Britain was rather difficulty because there was there also a serious shortage of men with the necessary qualifications, and applications were all subject to embargo by the Central Medical War Committee. My representations were greatly helped by the sympathetic consideration of Sir Wilson Jameson, Principal Medical Officer at the Ministry of Health, and I was able to appoint six highly qualified medical men, who have now joined our service. It has been the practice in the Department in recent years to appoint final-year-medical students as locums during the vacation period, and some of the men who first became interested in this way in psychiatry have also joined the service, so that we are now better situated for medical staff than we have been for years. Nursing Examinations The following passed the Senior Mental Nursing Examination held in November,. 1945 : Passed top for Dominion : Nurse E. M. Wedding (Auckland). Auckland— Attendant: S. A. Nicklin. Nurses : I. Nelson, *E. M. Wedding. Kingseat — Attendants : R. J. G. Mack, D. J. Williams. Tokanui— Attendants : J. A. Steele, D. Young. Nurses : S. Bristowe, M. P. A. Power, B. M. Solly.^ Porirua — Attendant: G. p. Cathro, J. S. Shaw. Nurses : A. R. Biggs, E. I. McAuley, S. K. O'Donnell. Nelson — Attendants : A. C. Cole, K. Davis, D. W. Gill, J. Graham, P. L. Judge; E. L. Quinney, M. Thompson. Nurses : J. C. Cowan, P. M. Hayes, J. L. Russ, D. K. Roughton. Hokitika— Attendants : R. D. D. Monks. Nurses : B. E. Milner, M. Mulrennan, M. M. Williams.

* Passed with distinction.

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Admitted after Overseas Service. Admitted from Camps, &c., in New Zealand. Admitted 287 Discharged, recovered .. 129 Discharged, not recovered 48 Died .. .. .. .. 8 183 Remaining .. .. .. 104 Admitted .. .. .. .1 194 Discharged, recovered .. 92 Discharged, not recovered .. .. 38 Died .. .. .. .. 9 — 139Remaining .. .. .. .. 55-

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Christchurch — Attendants : J. F. Cullen, W. C, Grigor, R. F. McKersey, G. W. Robinson, W. G. Smith, R. D. Underwood. Nurses : S. E. Cheals, *M. W. Ellwood, B. M. James, D. L. Simmonds, M., P. Walker. Templeton Farm— Nurse : L. E. Frame. -Seacliff — Nurses : G. M. Hill, *R. M. McGregor, K. H. McLeod, T. Burke. Appreciation It gives me pleasure to express my appreciation of the loyal service rendered to the Department by my medical colleagues, by Mr. Sinclair, Chief Clerk, and the members of Head Office staff during the year. Theo. G, Gray, Director-General.

AUCKLAND MENTAL HOSPITAL Dr. Buchanan reports I have the honour to present my annual report for the year ended 31st December, 1945. During the war years and up to this last year much clinical and constructive work has been carried out, in spite of the serious shortage of staff and the increasing demands on the Medical Officers' time for extra mural work. Included in this latter are the Auckland Hospital Clinic, more and more requests for examinations of prisoners awaiting sentence, examinations of prisoners serving sentences, Military Pension Boards, and the review of old military pensioners. Physical Treatments Electric Convulsive Therapy. —This method has almost entirely supplemented the use of cardiazol, only 34 patients being treated with this drug. The electric •convulsive therapy is quicker, safer, and not so frightening. During the year considerable use was made of it, and in all, 130 patients were so treated. The results in many cases have been dramatically successful, and, this being known, many demands have been made by relatives to have electric convulsive therapy applied to unsuitable and deteriorated patients. This, at first, was acceded to in some instances, And naturally such groups bring down the percentage of cures. For this reason I have been unable to arrive at accurate statistics. The most striking results, as found elsewhere, are obtained in depressive cases including one or two G.P.I.s where depression has been a factor retarding recovery .after malarial therapy. Malarial Therapy.—This has been applied in all cases of G.P.I. When malaria was temporarily unobtainable for one case, penicillin was substituted. No improvement in the mental state resulted until later on we were able to institute malarial therapy. Pentothal Narcosis.—An increasing number of cases have been examined under this drug, which has been found most useful jn eliciting suppressed material and so giving a lead in the treatment in psychoneurotics, hysterics, and schizophrenia. The results often shorten the time taken in investigation. Occupational Therapy.—This work has been steadily expanding since its inauguration, and now there are nine classes in operation, each suited to the requirements of the type of cases to be treated.

* Passed with distinction.

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From these classes many persons are discharged outright, cured, or ready for probation, and an average of thirteen a month are passed on to general utility work such as sewing-room, kitchens, laundry, carpenter's, plumber's, or engineer's shops, &c. All boot-repairs are now done by an occupational class. The most striking benefits that are observable are that many wards are emptied of patients during occupational hours, that in deteriorated patients habit-training results in interest being evoked, that there is decreased necessity for restraint, and altogether there is a much more contented and happy community, which is good for both staff and patients.' We have benefited from the fact that the New Zealand Occupational Therapy School is established here. After a suitable amount of preparatory training, students are sent to many of the patients' classes, and this is of benefit to both trainees and patients —the former gain practical knowledge in the art of instruction, whilst the latter gain individual attention, which is of inestimable value, especially in recent cases. Since the inauguration of the Occupational Therapy School in 1940, twenty traineeshave been passed out, qualified by examination, to take up positions in mental and public hospitals throughout New Zealand. Sixteen students are at present undergoing their course of training. Construction. —The Nurses' lecture-room and Occupational Training School block have been completed, and this undoubtedly facilitates training. Some of the wards have been improved by the installation of sterilizers, and, in one case, a refrigerator. In this climate refrigerators are a real necessity throughout the hospital. A modern kitchen is now in use in female 6 ward, providing better and hotter meals for the patients. I hope soon to be in the position to forward you suggested plans for the installation of similar kitchens in other parts of the institution, and also comprehensiveplans for reconstruction of the more undesirable features in the hospital. Decentralization of the cooking is one of the first objectives. Once that is done, then we will beable to tackle the demolishing of the present main kitchen, and alter and improve theadjoining block containing the store and attendants' mess and sitting rooms. I am assured by the District Public Works Architect that there are great possibilities for modernizing the whole hospital, and that this could be done at considerably less cost than the construction of a new hospital elsewhere. During the year two new fowl-houses and a feed-shed were erected to replace buildings which had outlived their usefulness, and it is hoped that with the modern type of building and conditions there will be an improvement in the production of eggs for the hospital. Two cinema machines are now installed, thanks to the generosity of Mr. D. Stern and members of the Grey Lynn Ladies' Committee. Weekly programmes are carried out, and every help has been given towards this form of entertainment by Mr. Norman Hayward, Mr. D. A. Turner, and the Film Exchange Association. The patients* thoroughly enjoy the sessions. We have lost, by retirement, the services of Matrons Mayze and Redman, and Head Attendants McKenzie and Mackie. All these people had been here for many years and very definitely left their mark on, and to the advantage, of the hospital. It was very hard to let them go, but they certainly deserved a very well earned rest. Acknowledgments. —It is a great relief to have now a full staff of Medical Officers,, but the shortage of other members of the staff continues to be serious. It puts a very great strain on those working, and I feel deeply grateful to them all for the unselfish manner in which they have continued to carry out their work. I will also take the opportunity of thanking the Official Visitors and other friends, interested in the welfare of the hospital for their continued helpful and encouraging support. I would specially like to mention the name of Mrs. Teape (Official Visitor), who has been very regular in her visits to the hospital.

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KINGSEAT MENTAL HOSPITAL Dr. Tothill reports : I have the honour to submit my annual report for the year ended 1945. The total number of cases under care during the year was 974 with a weekly average of 798. Admissions numbered 167, of whom 56 were committed patients, 29 voluntary boarders, and 82 transfers from other institutions, mainly the Auckland Mental Hospital. The relatively high voluntary boarder admission rate shows an increased confidence in seeking treatment. Discharges numbered 44, 19 being committed patients and 25 voluntary boarders. In addition, 12 patients were transferred to other mental hospitals. A total of 46 deaths occurred, senility and circulatory diseases being the main causes. The weekly clinic at the Auckland Public Hospital has greatly increased, and many servicemen were given treatment. Consultations reached 840, with 171 initial examinations. Reports have been made on juvenile delinquents referred from the Children's Court and subsequent child guidance given when necessary. Several people have visited Kingseat Hospital for consultation and psycho-therapy as out-patients. The bulk transfer of patients has resulted in some overcrowding, and in several villas a day-room has had to be utilized to provide additional accommodation. As many of the older female patients have become too feeble to negotiate the stairs of the villas, an infirm dormitory has been created out of a day-room, and the vacated dormitory used for occupational therapy. It is hoped that single-storied infirm villas will be erected as soon as the building programme permits. In addition to the usual maintenance, the fire-fighting service has been improved, permanent water-mains extended, and more equipment installed in the sterilizing-rooms. The internal roading system is being tar-sealed in sections. Lawns have been laid down, and more trees planted in the orchard. The water-supply has been augmented by the installation of a pumping-station. A steam-boiler at the cow-byres now enables all cans to be sterilized. The vegetable-shed has been concreted and the gardens extended. Many thousands of shelter trees have been planted. A telephone has been installed in the nurses' home and wooden beds substituted for iron bedsteads. It is proposed to furnish the sun-room with suitable furniture. The Country Library Service is providing reading material at regular intervals. Concrete footpaths and coal-sheds have added to the amenities at the staff cottages. The occupational department has made steady progress, but accommodation is limited, more especially since day-rooms were converted into dormitories. Patients have enjoyed visits to the pictures, picnics, fishing expeditions, and bowling tournaments. Cricket, hockey, and tennis have been popular throughout the year. Until a* recreation hall is provided, dances and picture shows for the patients cannot be held. Throughout the war a shortage of staff has prevailed in spite of every effort by the Man-power authorities. The distance of this hospital from Auckland and the expense in travelling are likely to hinder the recruitment of staff, though the provision of indoor recreational facilities will no doubt have some beneficial effect. Since the last report Dr. Crawshaw has replaced Dr. Howie. Mr. Fowlie, who had been at this hospital since its inception, died in 1944. He devoted his life to its development, and nobody could have given more loyal service. To the visiting clergy, Official Visitor, hospital auxiliary, and ladies who conducted the arts and crafts classes I tender my sincere thanks. The nursing staff has worked long hours without complaint and deserve the highest praise for services well done.

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TOKANUI MENTAL HOSPITAL Dr. Hunter reports : I have the honour to submit my annual report for the year ending 31st December, 1945. The total number of cases under care during the year was 1,236, including 73 voluntary boarders. Admissions numbered 164, of whom 17 were transfers from other institutions and 39 voluntary boarders. Discharges were 56 patients under certificate, 30 voluntary boarders, and 13 transferred. There were 66 deaths. At the end of the year 1,031 patients, including 42 on probation and 40 voluntary boarders, remained on the register. These figures include Chateau and Wairakei. The out-patient clinic of the W aikato Hospital has been extended to two days per week and has served a useful purpose. It is appreciated by the patients and by the medical practitioners, who send cases for opinion and diagnosis. Consultations are also held once monthly at Rotorua Convalescent Home for returned servicemen. r: Examinations and reports are made also for the Waikeria Borstal Institution and the Child Welfare Department. The appointment of the Occupational Therapist has allowed the formation of three classes for women and one for the men. The interest which the patients have taken in these classes is revealed in the improvement in their mental condition. The building of an occupational centre will benefit a larger number of patients and increase the usefulness of the occupational therapy. During the year the hospital has lost a true friend in the death of the Official Visitor, Mr. Frank Findlay. M.P. His monthly visits were looked forward to, and patients appreciated very much his interest and advice in their welfare. It has been increasingly difficult to obtain sufficient nursing and attendant staff, and much overtime has been necessary. In my opinion, the only solution for a real improvement in the staffing position for attendants at this hospital lies in the erection of sufficient houses. A building-site has been selected near the hospital, and I hope that the erection of houses will be proceeded with as soon as possible. I hope that the new buildings which were under consideration when the war started will be proceeded with in the near future. The new boiler-house, laundry, bakery, and butcher-shop are a real necessity, as our present buildings and equipment are out of date and should be replaced as soon as possible. The building of the new boiler-house will necessitate the erection of separate kitchens and bathing facilities in the male wards, A, H, and C. This will bring the male side in line with the women's side, in which wards are self-contained. A new kitchen for male staff, with dining-room and recreation-room (large enough to accommodate a billiardtable) will be necessary and should be provided as soon as possible. The hospital is overcrowded to the extent of approximately 100 patients,' and two new villas, one for the men and one for the women, is urgently required. The access road to the hospital from the main highway remains in a very bad state, is corrugated, and a menace to any sick persons who require transport along it. The only solution appears to be to have this road tar-sealed. Wairakei and Chateau, which were branches of the Tokanui Mental Hospital, and were for women patients, continued to serve a useful purpose, but the eruption of Mount Ruapehu interfered so much with the light and water systems at the Chateau that it was necessary in December to transfer all the Chateau patients to Raventhorpe. With the exception of the gastro-enteritis epidemic from which the rest of New Zealand was suffering, the general health of the patients has been satisfactory. Special thanks are due to all members of the staff, who have worked under trying conditions and who have done their best throughout the year.

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PORIRUA MENTAL HOSPITAL Dr. Hart reports : I have the honour to submit my report for the year ending 31st December, 1945. The number of cases under care during the year was 1,691, of which 1,456 were committed patients, 232 voluntary boarders, and 3 remanded for psychiatric observation. Admissions, including 20 patients transferred from other hospitals, totalled 527, of which number 137 were voluntary boarders. "It is worthy of note that, excluding the usual transfers from other hospitals, over 27 per cent, of the admissions personally sought admission and treatment as voluntary boarders. During the year 312 persons were discharged and 125 deaths occurred. During the year considerable and additional extramural psychiatric work has been carried out by the medical staff in the psychiatric wards and clinics at the Wellington and Palmerston North Public Hospitals. These clinics enable the community to seek advice and treatment for incipient mental disorders, psychoneuroses, and many of the minor and major social maladjustments common to any community. These clinics have provided advice and'treatment for many ex-servicemen. Throughout the war the Army, Air Force, and Naval medical services have used the facilities of these clinics for advice and treatment in relation to their personnel^ During the past four years annual reports' have not been made, and it has been a period of new psychiatric methods and treatment. The hospital has kept abreast of the times and progress, and in one instance (electric narcosis) we have been the first in the Southern Hemisphere to institute this form of treatment. We have now treated over 500 cases with electric convulsive therapy, with excellent and, on occasions, dramatic results. A careful study has been made of the indications for the use of this treatment, and the extramural adjustment of these discharged patients has been followed whenever possible. The use of curare in conjunction with E.C.T. was instituted last year which enabled many elderly persons, or persons with impaired physical health or physical abnormality, to have treatment which without curare would have been, to say the least, hazardous. Apart from the curable effect of this treatment, E.C.T. has been found of considerable benefit in chronic disturbed patients. As previously mentioned, electronarcosis, or electricocoma, treatment was recently instituted. To date 35 patients have had or are receiving treatment. The results so far have not been co-related, and it is yet too soon to give a definite opinion as to the treatment value in psychiatry. Extensive use is being made of sub-coma insulin therapy, and of insulin and vitamin therapy in a wide variety of cases. The results of both types of treatment have been encouraging. Some results of the treatments given in this hospital have been from time to time published in the New Zealand Medical Journal. Since my last annual report a large section of the hospital has been demolished as a result of the earthquake of 1942. Although a number of our patients were at that time, •or shortly afterwards, transferred elsewhere, we still have to cope with the largest mental hospital admission rate in New Zealand. With reduced facilities and amenities and obvious inconveniences associated with demolishing and rebuilding, it has been an extreme tax and trial to all sections of the hospital staff to cope with an admission rate of over 500 per year, and at the same time endeavour to maintain a desirable standard of psychiatric treatment and care. Although during this period the living-conditions for patients have naturally fallen below what we would have wished, the period has been one of psychiatric progress. More positive and active psychiatric treatments have been given than ever before. At present the overcrowding is greater than at any time during recent years, the resident population being 1,152, whereas the scheduled accommodation is for only 821 persons. The building programme is being pushed on as fast as materials and labour will allow. An additional 100 beds should be available within two months. In addition to overcoming arrears of accommodation and making provision for the normal increases, it is hoped that the completion of the building programme will enable the return of many

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patients who were transferred in the emergency period following the earthquake, meeting as it would the wishes of the relatives, who are constantly asking, and as is only natural, desiring that their relatives be brought witbi n visiting distance of their homes. The staff shortage remains acute and, as far as nurses are concerned, is now as bad as at any time during the war period. The shortage of psychiatric or of women wishing to train as psychiatric nurses, would appear to be chronic and associated with the Dominion-wide shortage of female labour. Despite progressively liberal improvements in relation to pay and conditions, no improvement has occurred. The standard of treatment and care, in harmony with modern psychiatric methods, cannot be maintained unless some means are found to provide adequate female staff. Perhaps an immigration policy would attract from the British Isles a suitable type of prospective psychiatric nurse as it has done in the past. The progress in relation to the rebuilding is as follows : Villas 1, 2, 3 completed and occupied ; Villas 4 and 5 nearing completion, and should be occupied within two months. These five villas represent accommodation for over 250 patients. A new laundry block is at present under construction, and the contractors have made a start with Villas 7 and 8. Owing to the lack of labour and materials during the war years, the permanent hospital buildings have not been maintained at the required standard, and as soon as possible the accumulated work will be overcome. . The obsolete telephone system requires renewing, and it is hoped that the Post and Telegraph Department's recommendation concerning this will receive attention. Certain permanent hospital roads not involved in the new lay-out require repairs and sealing. Numerous minor works have been carried out during the year, such as the erection of a kitchen for F. Ward, a temporary fire-station, T.B. shelter at Montrose, &c. These and numerous other minor constructions and alterations were necessary following the demolition of the main building. Occupational work has been extended during the year, and a better organization of the work has followed the appointment of two qualified occupational therapists to the hospital staff, but the work is hampered and made difficult for patients and staff by the lack of accommodation. Additions to the medical staff during the year have placed this hospital in this respect in a better position that it has been in for many years. In conclusion, I wish to thank the members of the staff for their good work during the most difficult period in the history of this hospital.

NELSON MENTAL HOSPITAL Dr. Williams reports : I have the honour to submit my Annual Report for the year ended 31st December, 1945. The number of patients under care during this period was 1,203 of whom 1,162 had been admitted under a reception order and 41 were voluntary boarders. The admissions totalled 126, including 2 transferred from other hospitals and 22 voluntary boarders. We were able to discharge 42 patients, including 14 voluntary boarders, and 47 were transferred to other mental hospitals. There were 75 deaths, including 1 voluntary boarder. War and post-war conditions have inevitably been reflected in a postponement of many very desirable additions and improvements, and little more than maintenance work has been possbile. The majority of our male staff who left us for active service have returned, but there is a marked shortage of nurses, which has prevented the development of occupational therapy as we would have liked, and we hope that the prospective appointment of a trained occupational therapist will enable us to make greater progress in this direction.

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In this connection I must mention that a small orchard and garden has been established under the direction of the Matron, and this form of outdoor activity is very popular with our female patients. The old buildings at Nelson —they were erected in 1874—are in a state of dilapidation,, and as they are virtually beyond repair it is hoped that the plan for evacuating the children elsewhere can soon be carried into effect. I would draw attention to the antiquated telephone system at Ngawhatu and urgeits replacement by a modern automatic system with fire-alarm connection ; as it is, both telephone and the existing alarm are unreliable. An extra telephone-line to Ngawhatu is necessary so that a connection can beestablished between York's Valley and the nurses' home. A number of individuals and organizations continue to be generous with monetary and other gifts, particularly to our children, and this is very much appreciated. Therevenue from the canteen has enabled us to increase recreational facilities for thepatients, a matter of no small importance in view of the fact that we have not yet an entertainment or cinema-hall. To the staff generally for their co-operation I have to offer my sincere thanks.

HOKITIKA MENTAL HOSPITAL Dr. Childs reports : I have the honour to submit my report for the year ending 31st December, 1945. The number of cases under care during the year was 562 (267 males and 295 females)^ The admissions numbered 19 (10 males and 9 females) there were 14 transfers (1 male and 13 females), and 5 voluntary boarders, all males. Patients discharged were 18 (10 males and 8 females), voluntary boarders 7 (5 malea and 2 females), while there was 1 transfer, a male. There were 33 deaths (14 males and 19 females). At the end of the year 5 males and 3 females remained on probation. The health of the patients generally has been satisfactory. Dr. R. T. Hay was in charge of the hospital from 23rd August, 1945, to the end of the year. The Grey River Hospital Clinic has been held monthly, occasional visits made to patients at their homes, visits paid to the Westland Hospital, and consultations held here at the hospital. Owing to the shortage of staff there has been little opportunity for occupational therapy classes, but all patients capable have been suitably occupied in some way. The clergy have made frequent visits and held regular services. Mrs. Fane has performed the duties of Official Visitor in a capable manner. The usual routine of farming and gardening has been carried on with the usual satisfactory results. The painting gang has been fully occupied during the year and has done very useful work. The exterior of two villas " Wio " and " Porere " have been painted under Public Works Department contract. The usual maintenance work has been carriedoourt r including the rebuilding of two chimneys at Iringatau. The switch-receiver house was finished in February, but electrical apparatus has not yet been installed. " Egmont," a very old building, was demolished, and the site is to be used for a Medical Officer's residence. Recreations and amusements have played a substantial part in the life of the hospital, and I would like to thank the Hokitika Band for playing for the dances, and the Revue Society and others for entertaining the patients. A very successful picnic was held. I would like to thank various ladies' committees for holding outside functions for women patients. All returned men were welcomed back by the staff in a series of social functions. A telephone has been installed in the nurses' home, The canteen is now firmly established, and very popular.

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SUNNYSIDE MENTAL HOSPITAL Dr. McKillop reports : I have the honour to submit my report for the year ending 31st December, 1945. There were 1,735 persons (897 men and 838 women) under care during the year. The admissions by committal totalled 230 (112 men and 118 women), and 44 men and •6 women were transferred to us from other hospitals. We were able to discharge 126 patients (55 men and 71 women), and 73 were transferred to other institutions, leaving 1,441 patients under care at the close of the year. In addition to these committed patients, 170 voluntary boarders were admitted, of whom 152, or 89*4 per cent, were discharged, 6 required committal, and 7 died, leaving 75 under care on 31st December, 1945. The number of deaths was 95, the cause in 58 •cases being senile decay. The large increase in the number of voluntary boarders is due to the known favourable results of electro convulsive therapy, which was introduced to this hospital in 1943. These results have continued to be very satisfactory and indicate that involutional melancholies in particular have responded to treatment. The cases referred to in my report of 1943 have kept well and have resumed their usual occupations. During the year 191 cases were treated by electric convulsive therapy and 113 were discharged as recovered. The usual maintenance work has been carried out, and the painting gang has been •employed continuously throughout the year. Two villas at Templeton, the Lodge and .Villa at Hornby, and several wards at Sunny side have been renovated throughout. Now that the war is over it is hoped that money will be available to provide accommodation for male tubercular cases, senile patients, and better hospital facilities. The •occupational therapy building is much too small for its purpose, and it will be necessary to extend this very considerably if we hope to attain the standard of some of the other institutions in this respect. The farm and gardens have had a very successful year, though the drought during "the latter part of the year affected the vegetable situation very seriously. Clinics have been held twice weekly at the Christchurch Hospital and once a month •at Timaru Hospital. So many patients are now being referred to the clinic that it is •quite impossible to do justice to them in the time allotted. For the greater part of the year the medical staff consisted of Dr. O'Reilly and myself, but, fortunately, December brought a full medical complement. On the male side we are practically at full strength, but on the female side the staffing question has become very difficult. I cannot speak too highly of the way our nurses have faced the situationworking long hours and giving up their leave-days cheerfully when required to do so. To the Official Visitors and to the chaplains I tender my thanks for their regular visits and for the interest they have taken in the welfare of the patients.

SEACLIFF MENTAL HOSPITAL Dr. Brown reports : I have the honour to present my report for the year ending 1945. There were 1,023 patients on the register on the 21st January, 1945. During the year 197 patients were admitted, 92 were discharged, and 5 transferred to other hospitals. The total number of patients under care during the year was 1,220. Voluntary boarders under care were 76, and 27 remain. There were 110 deaths, the chief causes being senility. Because of the nature of the hospital, its age, and the insecurity of the ground, the maintenance of the fabric has always been difficult and costly. The war years, with their shortage of labour and supplies, have added to these difficulties. While the maintenance and engineering staffs have been fully occupied in making repairs and renovations, much

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remains to be done. The provision of a pumping system in the Evansdale Glen has relieved much of the anxiety about the water-supply; in periods when the reservoir at Double Hill has failed it has provided a supply which, if not ample, is sufficient for the needs of the hospital if great care is exercised in its use. The contractors havestarted on the demolition of the unsafe parts of the administrative block, and shortly the tower, with many of the ornamental turrets and battlements which made the building picturesque, will have disappeared. At Waitati a villa to accommodate 56 patients is nearing completion, and it is hoped to occupy it early next year. It will give comfortable and adequate accommodation for the elderly male patients for which it is intended and at the same time provide much needed relief in the male side at Seacliff. On its occupation, I hope to be able to evacuatethe worst dormitory of D Ward. At the rear of the new villa comfortable quarters are provided for the staff. The farm has had a satisfactory year, and the provision of a tractor has been a great boon. The gardener has kept the hospital well supplied with fresh vegetables. On the arrival, at the beginning of the year, of the necessary apparatus, electroconvulsant treatment was begun, and by now quite a number of patients have been given this form of treatment. -It is too soon to give figures or statistics in regard to it/ but the results here are much in keeping with those recorded in medical literature ; theresults in the affective psychosis have been very good, and, in the case of involutional l melancholias, almost startling. In cases of schizophrenia, the results have been disappointing, and I am still of the opinion that insulin shock, despite its difficulties and dangers, affords a better chance of recovery or of relief. Prefrontal leucotomy has been performed on three of our cases by Mr. Murray Falconer, Neurosurgeon. These patients suffered from, apparantly, chronic mental illnesses, they had not responded to other forms of treatment, and they showed great mental tension and grave depression. The operations were preformed in the neurosurgical unit of the Dunedin Hospital, and the patients were brought back to Seacliff afterwards as soon as they were fit to travel. None of them showed the dramatic and almost immediate recovery reported in some of these cases, but all three required a long spell of careful psychiatric nursing and re-education. Two of the cases have left the hospital, and the third was transferred to another hospital. While I am prepared to advise leucotomy only in a restricted number of cases, more cases might have been done if accommodation in Dunedin Hospital had been available. I would urge that in the new hospital at Cherry Farm the surgical unit be such that the operation can be done by a visiting neurosurgeon and the post-operative treatment carried out by the resident medical and nursing staff. I would like to emphasize that I do not think that any of these forms of treatment, be it insulin shock, electro convulsive therapy, or leucotomy, is in itself a complete treatment; in my opinion, far from it. The other resources of a mental hospital, psychiatric treatment from the medical staff, occupational therapy, and, above all perhaps, the proper nursing from a trained staff of psychiatric nurses and attendants, contribute a very large factor in the care of patient's even when they undergo these more specialized forms of treatment. I should like to resume insulin shock treatment, but until such time as there is a full nursing staff that is quite impossible. During this year, as during the other war years, the entertainment of the patients has not been what I would have liked. Petrol and travel restrictions have prevented the many concert parties and bands that entertained as in the past from visiting. While the weekly picture-show has gone on, a depleted and overworked staff has caused the cessation of dances except on very special occasions. The two victory days were such occasions, and we did out best to let our patients rejoice with their fellow-citizens. The annual sports were held as usual. A very occasional entertainment has been provided by Mr. Steven, of the Patients' and Prisoners' Aid Society, and I am deeply grateful to him for his help in this, as well as in many other directions.

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The clinics in the various public hospitals in the area have been conducted as formerly. Dr. Hay, my Deputy Superintendent, twice a month conducted a clinic in Kew Hospital in Invercargill, as well as acting in a consultive capa city at Balclutha and Gore Hospitals. I visited Dunedin Hospital at least twice weekly, and the provision of a clinic for servicemen and ex-servicemen necessitated a whole day's attendance on one of these days. An increasing number of patients have been seen at Oamaru Hospital, where I attend -once a month. It is fitting that I should put on record my thanks to a number of people who have been so helpful to this hospital and the patients. Mrs. R. E. S. Reeves and Mr. A. Steven, the Official Visitors, have visited consistently, and not only have they shown a keen and kindly interest in the patients, but also they have shown a sympathetic understanding of our present difficulties. The relationship between this hospital and Dunedin Hospital, with its associated Medical School, has been most cordial, and I am •deeply grateful for the help I have received from many members of their staffs. In particular, I would like to acknowledge my indebtedness to Professors D'Ath and Hercus, Dr. Watt, of the Medical School, and to Dr. Thomson, of the hospital; the latter's help with cardiological and x-ray examinations has been invaluable. Mr. Falconer's work in the performance of leucotomies has already been mentioned, and my -appreciation of his work should go on record. The depleted condition of the nursing staff is well known and its cause and possible remedy do not form a part of this report, but I must put on record the sterling work which has been done by that core of psychiatric nurses and attendants who stood by this hospital during this and the previous war years. To them and the Matrons and Head Attendants I can only express my admiration. The Chief Clerk, Mr. Sloane, has had as arduous a time as any other member of the staff because of existing conditions, and I have to thank him and the other members of his department. In March Dr. C. S. Moore joined the medical staff after service in the field and speedily proved himself an acquisition. In August Dr. Hay, my deputy, was seconded for duty at Hokitika Mental Hospital, and he has not yet returned. Dr. Cameron is at present •carrying on his duties. I wish to record my appreciation of the ungrudging work and loyal co-operation of these medical men.

Table I.—Showing the Admissions, Readmissions, Discharges, and Deaths in Mental Hospitals during the Year 1945 M. 3?. T. In mental hospitals, Ist January, 1945 .. .. .. .. 4,411 3,952 8,363 M. F. T. Admitted for the first time .. .. 557 581 1,118 \ aKn ■, Readmitted .. .. .. ..100 154 254/ a ° Total under care during the year .. .. 5,068 4,667 9,735 Discharged and died —- Recovered .. .. .. 165 295 460 Not recovered .. .. .. 106 118 224 Died .. .. .. .. 327 320 647 598 733 1,331 (Not including transfers : Males, 134 ; females, 133.) Remaining in mental hospitals, 31st December, 1945 .. .. 4,470 3,934 8,404 Decrease on 31st December, 1944 .. .. .. ~ .. 18 Increase on 31st December, 1944 .. .. .. .. 59 .. 41 Average number resident during the year .. .. .. 4,229 3,689 7,918

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Table II.—Admissions, Discharges, and Deaths with the Mean Annual Mortality and Proportion of Recoveries, Etc., per Cent. on the Admissions during the Year 1945

15

Mental Hospitals. In Mental Hospitals on 1st January, 1945. Admissions in 1945. Total Number of Patients under Care. Admitted for the First Time. Not First Admissions. Transfers. Auckland Kingseat Tokanui Levin Farm .. Porirua Nelson Hokitika Christchurch Seacliff Ashburn Hall* Totals M. F. T. 683 697 1,380 446 335 781 409 629 1,038 626 443 1,069 632 426 1,058 256 273 529 741 714 1,455 610 413 1,023 8 22 30 M. F. T. 117 116 1,233 22 22 44 48 49 97 1 .. 1 146 145 291 52 42 94 7 8 15 94 92 186 68 83 151 2 4 6 M. F. T. 24 37 61 3 9 12 3 8 11 25 51 76 2 6 8 3 1 4 18 26 44 21 16 37 1 0 1 M. F. T. 10 10 20 6 76 82 7 10 17 51 0 51 10 10 20 1 1 2 1 13 14 44 6 50 2 7 9 2 0 2 M. F. T. 834 860 1,694 477 442 919 467 696 1,163 52 0 52 807 649 1,456 687 475 1,162 267 295 562 897 838 1,735 701 519 1,220 13 26 39 4,411 3,952 8,363 557 561 1,118 100 154 254 134 133 267 5,202 4,800 10,002 Mental Hospitals. Discharged recovered. Patients discharged, transferred, and died. Discharged not recovered. s ! Transferred, j Died. Total discharged, transferred, and died. Auckland Kingseat Tokanui Levin Farm Porirua Nelson Hokitika Christchurch Seacliff Ashburn Hall* Totals M. F. T. 33 51 84 3 12 15 15 28 43 47 100 147 '9 11 20 3 2 5 35 56 91 20 35 55 M. T. T. 27 40 67 2 2 4 5 8 13 24 23 47 5 3 8 7 6 13 20 15 35 16 21 37 M. F. T. 12 87 99 5 7 12 7 6 13 8 6 14 42 5 47 1 1 56 17 73 3 2 5 0 3 3 M. F. T 49 61 110 27 18 45 26 37 63 74 45 119 50 24 74 14 19 33 35 60 95 52 55 107 0 1 1 M. F. T. 121 239 360 37 39 76 5% 79 132 153 174 327 106 43 149 25 27 52 146 148 294 91 113 204 0 4 4 165 295 460 106 118 224 134 133 267 327 320 647 732 866 1,598 Mental Hospitals. In Mental Hospitals on 31st December, 1945. Average Number resident during the Year. Percentage of Recoveries on Admissions during the Year. Percentage of Deaths on Average Number resident during the Year. Auckland Kingseat Tokanui Levin Farm Porirua Nelson Hokitika Christchurch Seacliff Ashburn Hall* .. Totals \ M. F. T. 713 621 1,334 440 403 843 414 617 1,031 52 0 52 654 475 1,129 581 432 1,013 242 268 510 751 690 1,441 610 406 1,016 13 22 35 M. F. ' T. 657 604 1,261 432 343 775 400 605 1,005 19 0 19 616 426 1,042 596 397 S93 245 265 510 672 647 1,319 582 381 963 10 21 31 M. F. T. 23-40 33-33 28-57 12-00 38-71 26-79 29-41 49-12 39-81 27-49 51-02 40-05 16-67 22-92 19-61 30-00 22-22 26-32 31-25 47-46 39-57 22-47 35-35 29-26 M. F. T. 7-46 10-10 8-72 6-25 5-25 5-81 6-50 6-12 6-27 13-03 10-56 11-42 8-39 6-05 7-45 5-71 7-17 6-47 5-21 9-27 7-20 8-93 14-44 11-11 0-00 4-76 3-23 4,470 3,934 8,404 4,229 3,689 7,918 25-11 41-26 33-53 7-73 8-67 8-17 * Private mental hospital.

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Table III. —Native Countries

Table IV.—Ages of Patients on 31st December, 1945

16

Countries. Auckland. Kingseat. , Tokanui. j £evm , Porirua. Nelson. England and Wales .. Scotland Ireland New Zealand Australian States France Germany Austria Norway Sweden Denmark Italy China Maoris Other countries Unknown Totals M. F. T. 82 62 144 17- 7- 24 19 7 26 480 475 955 29 16 45 10 1 11 2 4 0 4 2 i' 3 2 o' 2 3 2 5 32 26 58 41 24 65 M. F. T. 74 51 125 15 12 27 21 18 39 254 284 538 19 13 32 10 1 7 0 7 4 0 4 2 13 1 "i 2 2 0 2 8 8 16 23 15 38 9 0 9 at. f. t. 45 65 110 15 14 ' 29 17 22 39 290 445 735 7 25 32 10 1 12 3 2 0 2 10 1 2 2' 4 10 1 2 1 3 16 23 39 11 11 22 3 7 10 M. F. T. .10 1 2 0 2 47 '6 47 2 0 2 M. F. T. 79 54 133 22 15 37 23 11 34 446 351 797 29 11 40 0 1 1 10 1 101 2 1 3 12 3 33 20 53 17 9 26 M. F. T. 41 36 77 23 8 31 8 -4 •'•12451 356 -807 9 7 16. 101 10 1 10 1 3 6' 3: 11 2 10 1 11 9 20' 7 1 8 23 10 33 713 621 1,334 440 403 843 414 617 1,031 52 0 52 654 475 1,129 581 432 1.013 Countries. Hokitika. Christchureh. 1 Ashburn Hall Seacliff. (Private Mental Hospital). Totals. England and Wales Scotland Ireland New Zealand Australian States France Germany Austria Norway Sweden Denmark Italy China Maoris Other countries Unknown Totals M. F. T. 23 19 42 8 4 12 13 9 22 166 194 360 7 8 15 10 1 10 1 3 0 3 1 *2 3 4 0 4 15 32 47 H. F. T. 41 66 107 20 10 30 13 10 23 655 574 1,229 10 14 24 101 7 12' 19 4 4 8 M. F. T. 36 23 59 34 21 55 18 9 27 487 342 829 12 3 15 2 0 2 2 0 2 10 1 6 2 8 12 6 18 M. F. T. 12 3 10 1 10 20 30 10 1 M. F. T. 423 378 801 157 91 248132 90 222" 3,286 3,041 6,327 125 97 222 2 13". 8 3 11 14 0 14 6 0 67 2 9' 8 2 1010 3 13 9 5 14 108 100 208113 66 179 62 55 117'. 242 268 510 751 690 1,441 610 406 1,016 13 22 35 4,470 3,934 8,404

Ages. Auckland. Kings eat. Tokanui. Levin Farm. Porirua. Nelson. it. P. T. M. f. T: M. F. T. M. F. T. M. F. T. M. F. T. Prom 1 to 5 years .. 1 0 i 2 0 2 20 14 34 » 5 >j 10 „ 3 2 5 2 1 3 2 5 7 3 5' 8 47 36 83 „ 10 „ 15 „ 7 0 7 2 3 5 6 7 13 1 0 1 2 11 13 45 29 74 „ 15 „ 20 „ 18 12 30 11 5 16 8 10 18 12 0 12 21 10 31 40 27 67 „ 20 „ 30 „ 101 72 173 26 26 52 60 57 117 35 0 35 81 78 159 67 48 115 „ 30 „ 40 „ 142 115 257 62 58 120 75 93 168 4 0 4 138 80 218 107 58 165 „ 40 „ 50 ,, 154 127 281 78 75 153 70 124 194 123 87 210 77 55 132 „ 50 „ 60 „ 106 144 250 103 95 198 61 142 203 127 89 216 70 74 144 „ 60 „ 70 „ 113 98 211 100 89 189 85 111 196 105 68 173 65 50 115 » 70 „ 80 „ 50 36 86 44 36 80 39 59 98 48 37 85 28 35 63 „ 80 „ 90 11 7 18 6 12 18 3 5 8 6 10 16 6 6 12 Upwards of 90 Unknown 8 16 5 '3 8 3 4 7 9 0 9 Totals 713 621 1,334 440 403 843 414 617 1,031 52 0 52 654 475 1,129 581 432 1 ,013

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Table IV. —Ages of Patients on 31st December, 1945 —continued

Table V. —Length of Residence of Patients discharged "Recovered" during 1945

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17

Ashburn Hall Ages. Hokitika. Christchurch. Seacliif. (Private Mental Totals. Hospital). M. JP. T. M. P. T. M. J?. T. M. F. T. M. F. T. From 1 to 5 years 3 0 3 26 14 40 » 5 „ 10 „ 1 0 1 30 16* 46 3 5 8 91 70 161 „ 10 » 15 „ 1 3 4 50 24 74 3 4 7 117 81 198 » 15 „ 20 „ 3 3 6 67 46 113 20 10 30 200 123 323 ,, 20 „ 30 „ 12 18 30 178 140 318 71 39 110 3 '2 5 634 480 1,114 „ 30 „ 40 „ 40 28 68 110 115 225 112 53 165 790 600 1,390 „ 40 „ 50 „ 49 42 91 109 80 189 130 63 193 2 i 3 792 654 1,446 50 „ 60 „ 55 77 132 88 107 195 116 81 197 2 4 6 728 813 1,541 f, 60 „ 70 „ 57 65 122 78 99 177 89 85 174 2 7 9 694 672 1,366 „ 70 „ 80 „ 18 23 41 35 46 81 52 56 108 1 4 5 315 332 647 „ 80 „ 90 „ 3 4 7 5 14 19 11 10 21 3 2 5 54 70 124 Upwards of 90 0 1 1 1 3 4 0 2 2 1 6 7 Unknown 3 4 7 28 19 47 Totals 242 268 510 751 690 1 ,441 610 406 1 ,016 13 22 35 4,470 3,934 8,404

Length of Residence. Auckland. Kingseat. Tokanui. Levin Farm. Poriraa. Nelson. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Under 1 month 2 0 2 1 6 7 From 1 to 3 months .. 3 2 5 1 3 4 0 i 1 15 23 38 3 „ 6 „ .. , .. 3 2 5 0 2 2 1 3 4 17 35 52 1 "o 1 6 „ 9 „ 7 20 27 0 1 1 3 , 5 8 4 17 21 2 0 2 9 „ 12 „ 5 9 14 0 3 3 3 8 11 2 7 9 1 3 4 1 „ 2 years 8 10 18 0 2 2 5 5 10 6 9 15 1 5 6 2 „ 3 „ 0 3 3 1 0 1 2 4 6 1 1 2 1 1 2 3 „ 5 „ 3 3 6 1 2 3 1 1 2 2 1 3 5 „ 7 „ 0 1 1 1 i 2 7 „ 10 „ 0 1 1 0 i 1 0 'i 1 „ 10 „ 12 „ „ 12 » 15 „ 1 'o 1 Over 15 years 2 0 2 Totals 33 51 84 3 12 15 15 28 43 47 100 147 9 li 20 Ashburn Hall Length of Residence. Hokitika. Christchurch. SeaclifF. (Private Mental Totals, Hospital). M. P. T. M. F. T. M. F. T. M. F. T. M. F. T. Under 1 month 3 6 9 Prom 1 to 3 months 1 'o 1 4 3 7 4 *5 9 28 37 65 3 „ 6 1 0 1 5 7 12 3 5 8 31 54 85 „ 6 „ 9 0 I 1 11 7 18 1 8 9 28 59 87 „ 9 „ 12 2 17 19 8 7 15 21 54 75 1 „ 2 years 1 'i 2 8 13 21 3 6 9 32 51 83 2 „ 3 „ 2 1 3 0 1 1 7 11 18 3 „ 5 „ 0 5 5 1 2 3 8 14 22 5 „ 7 „ 0 2 2 1 4 " 5 7 „ 10 „ 1 0 1 1 3 4 „ 10 „ 12 „ 1 0 1 1 0 1 „ 12 „ 15 „ 0 1 1 1 1 2 Over 15 years 1 0 1 0 i 1 3 1 4 Totals .. 3 2 5 35 56 91 20 35 55 165 295 460

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Table VI. —Causes of Death, 1945

18

Causes. Auckland. Kingseat. Tokanui. Porirua. Nelson. I. —General Diseases Tuberculosis — M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. General 0 2 2 Lungs 1 1 2 1 2 3 0 3 3 2 i 3 4 0 4 Cancer 1 0 1 0 2 2 0 1 1 1 2 3 0 1 1 Toxaemia .. .. 1 3 4 0 4 4 Bacillary dysentary 0 1 1 Diabetes 112 Typhoid 0 2 2 Septicaemia 112 Graves disease Oil 1 '6 1 Diphtheria Congenital inanition 3 0 3 Ascariasis II. —Diseases of the Nervous System 12 3 Exhaustion * ' o i i Exhaustion of mania 12 3 4 0 4 Exhaustion of melancholia .. 0 1 1 oil General paralysis of the insane 2 0 2 1 0 1 2 0 2 7 i 8 Cerebral haemorrhage 6 5 11 0 1 1 2 2 4 0 1 1 Cerebral thrombosis 2 0 2 6 2 8 1 0 1 2 2 4 2 0 2 Epilepsy 1 0 1 2 13 10 1 11 Post encephalitic Parkinsonism i i 2 10 1 Organic brain disease o i 1 Oil Meningitis 0 1 1 Hemiplegia 10 1 Huntingdon's chorea 10 1 III.—Diseases oe the Respiratory System Pneumonia — Broncho 16 8 24 1 1 2 5 4 9 3 4 7 3 0 3 Hypostatic 1 5 6 1 0 1 0 1 1 Lobar 0 2 2 2 3 5 Bronchitis.. o i 1 1 *4 5 2 3 5 Pulmonary oedema IV. —Diseases oe the Circulatory System Heart disease 11 15 26 12 4 16 4 3 7 27 6 33 7 3 10 A^terio-sclerosis 1 1 2 0 1 1 V. —Diseases of the Digestive System Enteritis .. 0 3 3 0 1 1 5 6 11 9 6 15 8 3 11 Intestinal obstruction 0 2 2 1 0 1 Hepatitis .. Gastric ulcer 10 1 ). Peritonitis •• VI. —Diseases oe the Urinary System Uraemia Nephritis 1 0 1 Cystitis VII.—Old Age Senile decay 1 1 2 14 5 4 7 11 4 10 14 8 10 18 VIII. —External Causes Head injury 0 1 1 1 0 1 Suicide 1 0 1 1 '6 1 Asphyxia IX.—Died whilst on probation 2 3 5 12 3 6 2 8 1 0 1 Totals 49 61 110 27 18 45 26 37 63 74 45 119 50 24 74

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Table VI.—Causes of Death, 1945—continued

3—H 7

19

Ashburn Hall Causes. Hokitika. Christchurch. Seacliff. (Private Mental Total. Hospital). I. —General Diseases Tuberculosis— M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. General 0 1 1 10 1 1 3 4 Lungs 2 0 2 1 0 1 13 4 12 10 22 Cancer 0 2 2 2 2 4 4 10 14 Toxaemia 17 8 Bacillary dysentary 0 1 1 Diabetes 112 Typhoid 0 2 2 Septicemia .. ... 1 i 2 2 2 4 Graves disease 0 1 1 Diphtheria 10 1 Congenital inanition 3 0 3 Ascariasis 0 i 1 0 1 1 II. —Diseases of the Nervous System Exhaustion .1 0 1 1 13 4 Exhaustion of mania 0 "i 1 5 4 9 Exhaustion of melancholia .. 0 1 1 0 2 2 General paralysis of the insane 1 0 1 13 2 15 Cerebral haemorrhage 022 1 0 1 9 11 20 Cerebral thrombosis 0 "2 2 0 1 1 0 1 1 13 8 21 Epilepsy Oil 13 3 16 Post encephalitic Parkinsonism 10 1 Organic brain disease 0 i 1 1 3 4 Meningitis 0 2 2 Hemiplegia 1 0 1 Huntingdon's chorea 1 0 1 III. —Diseases of the Respiratory System Pneumonia— Broncho 1 1 2 2 1 3 3 2 5 34 21 55 Hypostatic 2 2 4 4 8 12 Lobar 2 0 2 2 i" 3 6 6 12 Bronchitis 2 4 6 Pulmonary oedema 14 5 IV. —Diseases of the Circulatory System Heart disease 2 6 8 5 9 14 14 9 23 82 55 137 Arterio-sclerosis 202 3 2 5 V.—Diseases of the Digestive System Enteritis 0 1 1 22 20 42 Intestinal obstruction 0 2 2 Hepatitis 1 0 1 Gastric ulcer 1 0 1 2 0 2 Peritonitis .. 1 0 1 1 0 1 VI. —Diseases of the Urinary System 1 Uraemia 1 0 1 1 0 1 Nephritis .. .. 1 0 1 1 0 1 Cystitis 10 1 VII. —Old Age Senile decay 4 6 10 23 35 58 24 32 56 0 1 1 69 105 174 VIII. —External Causes Head injury , . 0 1 1 Suicide 0 2 2 0 1 1 2 3 5 Asphyxia 1 0 1 IX. —Died whilst on probation 0 3 3 1 1 2 11 11 22 Totals 14 19 33 35 60 95 52 55 107 0 1 1 327 320 647

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Table VII.—Principal Assigned Causes of Insanity, 1945

20

Causes. Auckland. Kingseat. Tokanui. Levin Farm. Porirua. Nelson. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Alcohol 2 1 3 2 0 2 1 0 1 3 0 3 1 0 1 Arterio-sclerosis 3 4 7 0 1 1 4 6 10 Congenital 2312 35 10 4 14 7 7 14 1 1 1 14 10 24 36 24 60 Climacteric 0 1 1 Constitutional 47 47 94 3 8 11 2 2 4 51 *39 90 Endocrine disorder .. 0 3 3 Epilipsy 1 2 3 2 i 3 2 1 3 2 4 6 0 3 3 Ill-health 1 2 3 1 0 1 Involution 4 9 13 1 0 1 0 4 4 9 "7 16 1 0 1 Heredity 1 I 2 13 12 25 2 4 6 5 4 9 Mental stress 0 2 2 0 2 2 14 12 26 19 19 38 4 4 8 Organic brain-disease 3 4 7 6 3 9 2 1 3 Previous attack 24 37 61 3 9 12 0 2 2 25 51 76 1 4 5 Puberty or adolescence 1 0 1 1 0 1 Puerperal 0 3 3 0 4 4 Senility 26 29 55 2 5 7 5 7 12 33 46 79 4 9 13 Syphilis 6 2 8 1 0 1 1 0 1 4 1 5 Toxic 1 2 3 0 3 3 1 0 1 Trauma 1 1 2 Transfers 10 io 20 6 76 82 7 10 17 51 0 51 10 10 20 1 1 2 Totals 151 163 314 31 107 138 58 67 125 52 0 52 181 206 387 55 49 104 * Ashburn Hall Causes. Hokitika. Christchurch. Seacliff. (Private Mental Totals. Hospital). M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Alcohol 1 0 1 4 0 4 14 1 15 Arterio-sclerosis .. 6 4 10 1 1 2 14 16 30 Congenital 3 0 3 35 10 45 8 7 15 0 1 137 75 212 Climacteric 0 1 1 Constitutional 5 4 9 12 11 23 21 11 32 141 -122 263 Endocrine disorder 0 3 3 Epilipsy 1 1 2 2 2 4 1 "l ! 3 11 16 27 Ill-health 2 2 4 Involution 0 1 1 2 5 7 0 S ; 8 17 34 51 Heredity 2 0 2 0 2 23 23 46 Mental stress 13 23 36 15 22 37 65 94 159 Organic brain-disease 11 8 19 Previous attack .. 0 2 2 17 29 46 21 17 38 1 1 92 151 243 Puberty or adolesence 1 1 2 3 1 4 Puerperal 0 5 5 0 i 1 0 13 13 Senility 1 1 2 21 27 48 15 30 45 2 3 109 155 264 Syphilis 0 3 0 3 15 3 18 Toxic 1 1 2 6 8 Trauma 1 1 2 Transfers 1 13 14 44 6 50 2 i 9 2 0 2 134 133 267 Totals 11 22 33 156 124 280 91 106 197 5 4 9 791 858 1, ,649

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Table Ylll.—Showing the Admissions, Discharges, and Deaths from Ist January, 1876, to 31st December, 1945 (excluding Transfers) M. P. T. In hospital, 31st December, 1875 .. .. .. .. .. 482 254 736 Admissions .. .. .. .. .. .. .. 28,260 23,195 51,455 28,742 23,449 52,191 Discharged— M. F. T. Recovered .. .. .. 9,483 8,934 18,417 Not recovered .. .. .. 3,406 3,102 6,508 Died .. .. .. .. 11,383 7,479 18,862 24,272 19,515 43,787 Remaining on 31st December, 1945 .. .. .. .. 4,470 3,934 8,404

Table IX.—Summary of Total Admissions: Percentage of Cases since the Year 1876

21

— Males. Females. Both Sexes. Recovered 32-99 38-10 35-29 Unrecovered .. .. 11-85 13-23 12-47 Died 39-61 31-89 38-14 Remaining 15-55 16-78 16-10 , 100-00 100-00 100-00

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Table X.—Showing the Admissions, Discharges, and Deaths, with the Mean Annual Mortality and Proportion of Recoveries per Cent. of the Admissions, for each Year since 1st January, 1904

22

Year. Discharged. Died. Remaining Average Numbers resident. Percentage of Percentage of Admitted Not prov 31st December .Recoveries on Deaths on Average Recovered. Relieved Im 3d. in each Year. Admissions. Numbers resident. M. f. T. M. F. T. H. 5. T. M. F. T. M. J?. T. M. F. T. M. F. T. M. F. T. M. F. T. 1904 332 236 568 157 106 263 24 11 35 1 1 120 70 190 1,801 1,237 3,038 1,780 1,198 2,978 47 59 144-91 46 30 6-74 5-84 6-38 1905 360 251 611 149 121 270 29 24 53 147 67 214 1,836 1,276 3,112 1,796 1,232 3-028 41 39 48-21 44 19 8-18 5-44 7-07 1906 395 264 659 157 126 283 28 22 50 1 1 146 85 231 1,900 1,306 3,206 1,823 1,265 3,088 39 75 '47-73 42 94 8-01 9-08 6-71 7-48 1907 359 241 600 160 139 299 22 13 35 168 64 232 1,900 1,331 3,240 1,851 1,285 3,136 44 29 57-68 49 84 4-98 7-39 1908 426 318 744 180 146 326 19 12 21 1 1 148 74 222 1,997 1,417 3,414 1,894 1,346 1,404 3,240 42 25 45-91 43 82 7-81 5-50 6-85 1909 419 297 716 179 170 349 27 11 28 ,1 1 136 68 204 2,083 1,465 3,548 1,970 3,374 42 72 57-24 48 74 6-90 4-84 6-00 1910 474 314 788 182 145 327 9 27 56 186 97 283 2,160 1,510 3,670 2,028 1,445 3,473 38 40 46-18 41 50 9-17 6-71 8-15 1911 448 317 765 163 168 331 23 16 39 4 2 6 198 105 303 2,220 1,536 3,756 2,105 1,496 3,601 36 38 53-00 43 27 9-41 8-99 7^02 8-41 1912 458 381 839 184 141 325 17 44 61 11 5 16 193 87 280 2,273 1,640 3,913 2,146 1,551 3,697 40 17 37-01 37 74 5-61 7-57 1913 466 318 784 175 162 337 35 48 83 1 5 6 196 111 307 2,332 1,632 3,964 2,252 1,597 3,849 37 55 50-94 42 98 8-70 6-96 7-98 1914 509 359 868 207 162 369 27 29 56 6 9 15 193 88 281 2,408 1,703 4,111 2,309 1,641 3,950 40 67 45-12 42 51 8-36 5-36 7-11 1915 450 361 811 202 157 359 26 32 58 10 11 21 172 112 284 2,448 1,752 4,200 2,391 1,703 4,094 44 89 43-21 44 88 7-19 6-58 6-94 6-80 1916 518 361 879 160 171 331 35 34 69 7 8 15 209 80 289 2,555 1,820 4,375 2,483 1,768 4,251 30 89 47-37 37 66 8-42 4-52 1917 470 374 844 171 152 323 32 20 52 6 5 11 205 113 318 2,611 1,904 4,515 2,543 1,825 4,368 36 38 40-64 38 27 8-06 6-19 7-28 1918 437 402 839 142 141 283 17 36 53 12 12 24 274 174 448 2,603 1,943 4,546 2,602 1,899 4,501 32 49 35-07 33 73 10-53 9-16 9-95 1919 512 371 883 190 147 337 37 44 81 9 13 22 212 130 342 2,667 1,980 4,647 2,620 1,907 4,527 37 11 39-62 38 17 8-09 6-82 7-55 . 8-08 1920 455 418 873 162 148 310 27 37 64 6 10 16 210 166 376 2,717 2,037 4,754 2,674 1,980 4,654 35 63 35-22 35 51 7-85 8-40 1921 479 402 881 178 193 371 30 21 51 15 9 24 201 117 318 2,772 2,099 4,871 2,723 2,031 4,754 37 23 47,88 42 11 7-38 5-76 6-69 1922 453 386 839 156 157 313 32 20 52 10 8 18 211 184 395 2,816 2,116 4,932 4,996 2,747 2,062 4,809 34 44 40-67 37 31 7-67 8-92 8-21 1923 442 366 808 168 151 319 42 38 80 15 ' 5 20 194 131 325 2,839 2,157 2,789 2,079 4,868 38 00 41-25 39 48 6-95 6-30 6-67 1924 446 377 823 152 128 280 30 42 72 9 11 20 221 95 316 2,873 2,921 2,258 5,131 2,808 2,146 4,953 34 08 33-95 34 02 7-87 4-42 6-37 1925 445 430 875 144 175 319 29 37 66 23 17 40 201 123 324 2,336 2,423 5,257 2,830 2,203 5,033 32 36 40-69 36 45 7-45 5-57 6-43 1926 508 439 947 136 145 281 27 35 62 15 25 40 207 147 354 3,044 5,467 2,926 3,022 2,287 5,213 26 18 30-75 29 67 6-16 6-42 6-77 1927 531 414 945 157 128 285 40 42 82 14 9 23 217 132 349 3,147 2,526 5,673 2,373 5,395 29 56 30-91 30 16 7'-17 5-65 6-47 1928 506 450 956 115 134 249 40 40 80 17 13 30 207 161 368 3,274 2,628 5,902 3,120 2,459 5,579 22 72 29-77 26 04 6-63 6-55 6-59 1929 549 -407 956 145 144 289 30 28 58 22 16 38 227 153 380 3,399 2,694 6,093 3,215 2,495 5,710 26 41 35-37 30 23 7-06 6-13 6-65 1930 621 474 1,095 138 128 266 28 34 62 31 23 54 251 172 423 3,572 2,811 6,383 3,342 2,590 5,932 22 22 27-00 24 29 7-51 6-64 7-15 1931 587 476 1,063 127 120 247 29 30 59 20 30 59 221 199 420 3,753 2,908 6,661 3,503 2,696 6,199 21 64 25-21 23 37 6-31 7-39 6-76 1932 587 484 1,071 141 160 301 39 42 81 38 41 79 219 169 388 3,903 2,980 6,883 3,681 2,738 6,419 24 02 33-05 28 10 5-97 6-17 6-06 1933 563 554 1,117 117 144 261 35 27 62 28 22 50 221 124 345 4,065 3,217 7,282 3,809 2,932 6,741 20 78 25,99 23 36 5-80 4-23 5-16 1934 479 504 983 114 146 260 64 72 136 233 203 436 4,133 3,300 7,433 3,899 3,039 6,938 23 80 28-97 26 45 5-98 6-68 6-28 1935 567 502 1,069 117 136 253 72 55 127 229 206 435 4,282 4,357 3,405 7,687 4,003 3,111 7,114 20 63 27-09 23 67 5-72 6-62 6-11 1936 553 556 1,109 121 149 270 105 96 201 252 213 465 3,503 3,545 7,860 4,093 3,195 7,288 21 88 26-80 26 76 6-18 6-66 6-38 1937 557 567 1,124 180 179 359 121 110 231 261 236 497 4,352 7,897 4,112 3,272 7,384 32 32 31-57 31 94 6-35 6-61 7-21 6-73 1938 527 575 1,102 170 210 380 140 135 275 273 274 547 4,296 3,501 7,979 4,129 3,287 7,416 32 26 36-52 34 48 8-33 7-38 1939 603 595 1,198 147 181 328 132 125 257 251 209 460 4,369 3,581 7,950 4,106 3-320 7,426 24 38 30-42 27 38 6-11 6-30 6-19 1940 553 595 1,148 153 188 341 135 95 230 281 215 496 4,353 3,678 8,031 4,168 3,422 7,590 27 67 31-60 29 70 6-74 6-28 6-53 1941 605 637 1,242 128 186 314 130 130 260 297 260 557 4,404 3,738 8,142 4,192 3,474 7,666 21 12 29-09 25 20 7-08 7-48 7-27 1942 563 648 1,211 146 197 343 126 152 278 313 343 656 4,383 3,693 8,076 4,189 3,498 7,687 25 09 30-56 28 41 88 7-47 9-81 8-53 1943 550 658 1,208 138 223 361 138 119 257 281 263 544 4,376 3,746 8,122 4,181 3,513 7,694 25 09 33-89 29 6-72 7-49 7-07 1944 600 763 1,363 137 218 355 101 90 191 327 249 576 4,411 3,952 8,363 4,231 3,640 7,871 22 83 28-57 26 05 7-73 6-84 7-32 1945 657 715 1,372 165 295 460 106 118 224 327 320 647 4,470 3,934 8,404 4,229 3,.689 7,918 25 11 41-26 33 53 7-73 8-67 8-17 21,019 18,557 39,576 6,510 6,717 13,227 [2,235 2,193 4,428 9,236 6,589 15,825 ' Excluding transfers between institutions— -3,761 males, '3,210 females.

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Table XI. —Debits for the Financial Year 1945-46

23

— Auckland. Kingseat. Tokanui. Levin. Porirua. Nelson. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. Salaries, including 82,074 11 8 42,564 6 3 61,066 0 5 2,301 13 10 92,248 4 4 63,357 11 4 overtime Official visitors 46 4 0 14 11 8 Advertising, books, <fcc. 42 1 2 18* 6 5 11216 5 2' 1 7 4 14 1 3*18 9 Bacteriological research 221 5 0 5 12 6 8 2 6 226 1 6 32 1 6 Bedding and clothing 11,292 2 11 4,955 13 5 5,748 3 0 1,490 8 6 10,556 0 11 6,894 10 11 Buildings, including 893 3 7 975 18 2 1,221 3 7 89 16 3 476 1 0 706 17 9 additions, &c. Dental services 48 14 7 10 0 0 8 6 0 10 6 150 17 11 39 17 2 Farms, maintenance of 1,606 18 7 1,502 19 1 4,837 12 5 50 19 7 3,186 12 10 1,549 14 7 Fencing, draining, and 53 16 8 159 1 8 87 3 0 162 0 8 61 19 0 roading Freight, caxtage, and fro n cnnrf 112 3 11 327 19 6 699 1 2 52 6 3 393 17 2 366 11 4 Li d/llojJUI u Fuel, light, water, &c. 8,402 13 3 4,500 7 10 8,121 19 4 366 18 6 8,669 7 1 7,617 9 11 Funeral expenses 109 0 0 142 10 0 134 12 6 139 17 3 215 10 0 Furniture and fittings 1,056 8 11 1,645 12 9 627 16 11 247"il 8 508 14 2 1,204 14 2 Gardens and shrubberies 55 15 6 93 19 0 27 9 7 35 11 4 80 2 1 54 0 1 Laundry 337 12 6 265 12 7 532 15 2 22 10 2 356 2 2 301 12 2 Machinery repairs and 156 4 3 140 16 5. 517 4 7 17 2 204 8 1 165 12 9 stores Medical fees 758 13 1 135 10 10 254 5 9 0 10 6 886 12 7 147 2 9 Motor-vehicles — Maintenance of 30 13 2 96 18 8 365 14 2 20 0 9 285 14 5 180 5 2 Purchase of 283 13 0 119 0 4 719 12 6 722 13 11 Nursing staff uniforms 777' 2 5 252"l4 4 525 13 6 84 8 3 698 12 7 462 18 2 Office equipment 4 16 4 2 10 7 6 11 9 29 16 5 33 11 4 3 19 6 Patients, expenses connected with — Friends Gratuities O'IO 0 3 5 0 69 10 0 131* 6 9 Recreation 1,783 13 3 75i"ll 2 867 7 11 80*i9 4 886 18 8 856 6 5 Transfer 37 1 0 6 0 0 179 8 2 19 0 6 34 15 10 31 16 4 Postages, telegrams, Arc* 136 19 3 114 18 7 257 11 11 15 8 6 214 1 11 86 0 8 Oot. Printing and stationery 236 7 9 226 2 3 212 4 5 41 12 9 278 12 2 192 15 0 Rations 21,937 3 1 14,562 3 11 15,789 14 4 945 12 0 22,961 0 10 16,094 3 3 Rents and rates 5 11 2 1,303 11 1 7 12 6 Stores 2,602 5 4 1,096 14 5 1,024 17 1 356 3 11 2,651* 1 6 970 12 2 Surgery and dispensary 1,217 13 6 272 2 4 415 16 2 20 6 9 1,788 8 1 540 6 1 Telephone services .. 95 16 0 190 10 5 229 13 3 9 5 3 253 19 6 117 1 3 Transfer and removal 187 6 11 4 3 4 286 13 8 10 1 8 107 12 7 33 0 7 expenses Travelling-allowances 91 2 7 94 13 4 184 18 6 2 11 1 20 2 1 86 2 5 Travelling-expenses .. 338 15 11 28 5 9 328 10 10 19 8 7 129 9 2 69 2 6 Treatment in general hospitals— 55 1 0 Patients 20 0 0 7 0 0 11 5 6 Staff 3 0 0 2 2 0 33 13 0 5 10 0 3* 2 0 Compensation under 1,000 0 0 Workers' Compensation Act Payment of monetary 48 19 4 equivalent of leave due to deceased officers Grants to widows or 82 15 0 relations of deceased officers Contingencies and 251 19 11 36 11 11 11 15 8 526 18 0 66 8 10 miscellaneous Totals 137,025 7 2 75,180 9 5 106,318 13 9 6,436 1 11 151,116 12 0 103,374 17 8

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Table XI. —Debits for the Financial Year 1945-46 —continued

Table XIa.—Credits for the Financial Year 1945-46

24

• Hokitika. "Christ church. Seacliflf. Head Office. Totals. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. Salaries, including overtime 35,818 16 5 94,468 2 6 90,064 19 3 12,889 19 5 576,854 5 5 Official visitors 11 11 0 14 14 0 87 0 8 Advertising, books, <fec. 16 8 6 17 15 2 1616 4 62' 1 6 296 19 11 Bacteriological research, 14 6 11 14 19 10 5?2 9 9 Bedding and clothing 3,617' 5 5 11,237 15 5 6,268 9 0 62,060 9 6 Buildings, including additions, &c. .. 470 19 1 1,1-63 8 11 964 15 2 6,962 3 6 Dental services 8 16 6 98 16 0 21 5 0 370 6 2 Farms, maintenance of 868 1 6 2,427 3 2 4,138 2 2 20,168 3 11 Fencing, draining, and roading ' 3 18 11 98 17 0 162 7 3 789 4 2 Freight, cartage, and transport 57 19 1 548 13 0 535 14 4 3,094 5 9 Fuel, light, water, &c. 3,219 6 2 11,088 17 11 6,795 0 5 50 3 2 58,832 3 7 Funeral expenses 123 10 0 40 0 0 102 10 0 1,007 9 9 Furniture and fittings 266 4 6 837 13 11 746 19 3 12* 0 6 7,153 16 9 Gardens and shrubberies 12 14 8 106 3 6 40 18 3 506 14 0 Laundry 101 6 6 252 1 2 342 10 6 2,512 2 11 Machinery repairs and stores 101 12 10 273 17 8 497 17 1 2,059 0 10 Medical fees 66 19 0 584 14 1 434 4 10 3,268 13 5 Motor-vehicles — Maintenance of 81 14 7 370 19 5 347 13 8 17 11 0 1,797 5 0 Purchase of 1,252 18 9 172 8 4 3,270 6 10 Nursing staflf uniforms 298' 7 0 237 11 9 981 12 9 4,319 0 9 Office equipment 3 7 9 2 3 4 34 5 7 41. 12 1 162 14 8 Patients, expenses connected with —- Friends 100 0 0 100 0 0 Gratuities 13 1 3 217 13 0 Recreation 382 13 2 1,238' 2 0 1,125 0 7 7,972 12 6 Transfer 83 13 0 0 5 0 391 19 10 Postages, telegrams, &c. 4:1 1 0 151 7 3 152 7 6 143 16 7 1,313 13 2 Printing and stationery 130 3 3 262 13 5 161 4 1 78 10 6 1,820 5 7 Rations 9,453 1 5 22,608 7 1 17,810 16 6 142,162 2 5 Rents and rates 520 15 0 2 0 0 757'11 11 2,597 1 8 Stores 706* 5 4 2,667 18 2 1,995 8 3 14,071 6 2 Surgery and dispensary 307 2 5 563 13 8 354 18 2 5,480 7 2 Telephone services 75 10 10 175 15 11 212 1 6 137' 7 3 1,497 1 2 Transfer and removal expenses 165 15 5 87 3 0 33 9 4 4 3 9 919 10 3 Travelling-allowances 34 10 3 106 3 5 316 5 9 371 11 6 1,308 0 11 Travelling-expenses 83 7 4 80 15 5 137 15 9 294 15 7 1,510 6 10 Treatment in general hospitals— 104 17 9 Patients 5 18 6 0 12 9 5 0 0 StaflF .. 12 1 6 0 5 0 59 13 6 Compensation under Workers' Com1,000 0 0 pensation Act Payment of monetary equivalent of 38 4 1 87 3 5 leave due to deceased officers Grants to widows or relatives of 148 6 8 231 1 8 deceased officers Contingencies and miscellaneous 6 9 4 61 4 7 28 15 9 236 12 6 1,226 16 6 Totals 56,552 19 2 153,783 7 4 135,280 5 1 15,097 17 3 940,166 10 9

— Auckland. Kingseat. Tokanui. Levin. Porirua. Nelson. Receipts from maintenance* Receipts from farms Miscellaneous Totals £ s. d. 834 19 1 1,481 jlO 3 7,717 11 7 £ s. d. 151 0 0 1,772 6 10 3,557 8 10 £ s. d. 450 15 6 3,903 15 8 5,436 12 0 £ s. d. 10 '3 0 £ s. d. 2,276 6 1 1,792 5 10 9,149 16 0 £ s. d. 617 10 0 2,143 8 10 5,652 6 10 10,034 0 11 5,480 15 8 9,791 3 2 10 3 0 13,218 7 11 8,413 5 8 Hokitika. Christchurch. Seacliff. Head Office. Total. Receipts from maintenance* Receipts from farms Miscellaneous Totals £ s. d. 325 0 0 553 0 4 2,750 3 9 £ s. d. 678 2 0 3,513 3 3 8,132 13 6 £ s. d. 524 18 11 5,318 14 11 7,579 4 3 £ s. d. 3516 1 £ s. d. 5,858 11 7 20,478 5 11 50,021 15 10 3,628 4 1 12,323 18 9 13,422 18 1 35 16 1 76,358 13 4 * Outstanding accounts as at 31st March, 1939.

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Table XII. —Average Cost of each Patient per Annum

Table XIII.— Expenditure of Public Works Fund on Mental Hospital Buildings, etc., during the Financial Year ended 31st March, 1946

25

Mental Hospital. Average Number resident (inclusive of Boarders). Salaries. Bedding and Clothing. Buildings and Repairs. Farm. Fuel, Light, Water, and Cleaning. Provisions Auckland Kingseat Tokanui Levin .. Porirua Nelson Hokitika Christchuich Seacliff , Head Office Total average cost 1,337 814 a, 062 32 1,145 1,003 508 1,404 985 8,290 £ s. d. 61 7 9 52 5 10 57 10 0 71 18 7 80 11 4 63 3 4 70 10 2 67 5 8 91 8 9 1 11 2 £ s. d. 8 8 11 6 19 5 8 3 6 9 4 4 6 17 6 7 2 5 8 0 1 6 7 3 £ s. d. 0 13 4 1 3 11 13 0 2 16 2 0 8 4 0 14 1 0 18 6 0 16 7 0 19 7 £ s. d. 14 0 1 16 11 4 11 2 1 11 10 2 15 8 1 10 11 1 14 2 1 14 7 4 4 0 £ s. d. 6 5 8 5 10 7 7 12 11 11 9 4 7 11 5 7 11 11 6 6 9 7 18 0 6 18 0 0 0 1 £ s. d. 16 8 2 17 17 10 14 17 4 29 11 0 20 1 1 16 0 11 18 12 2 16 2 1 18 1 8 8,290 69 11 8 7 9 9 0 16 10 2 8 8 7 1 10 17 3 0 Surgery and Dispensary. Miscellaneous. 1 Total Cost per Patient (a). Repayments (6) (c). Net Cost per Patient (6). Net Cost previous Year. Decrease in 1945-46. Increase in 1945-46. Auckland Kingseat Tokanui Levin Porirua Nelson Hokitika Christchurch Seacliff Head Office Total average cost.. £ s. d. 0 18 3 0 6 8 0 7 10 0 12 9 1 11 3 0 10 9 0 12 2 0 8 0 0 7 3 £ s. d. 7 3 7 7 3 8 8 11 9 36 11 5 9 16 2 6 11 11 5 10 2 7 5 8 9 0 4 0 5 2 £ s. d. 102 9 8 92 7 2 100 2 3 201 2 7 131 19 7 103 1 4 111 6 6 109 10 8 137 6 10 1 16 5 £ s. d. 6 17 7 6 10 11 8 15 11 0 6 4 9 11 2 7 15 5 6 10 1 8 5 11 13 1 11 0 0 1 £ s. d. 95 12 1 85 16 3 91 6 4 200 16 3 122 8 5 95 5 11 104 16 5 101 4 9 124 4 11 1 16. 4 £ s. d. 59 4 11 58 4 8 59 3 6 90 *7 0 60 18 9 69 15 5 65 1 3 82 14 5 16 3 £ s. d. £ s. d. 36 7 2 27 11 7 32 2 10 32 i 5 34 7 2 35 1 0 36 3 6 41 10 6 0 10 1 0 13 3 8 3 2 113 8 2 8 10 1 104 18 1 69 6 8 35 11 5 Notes. —(«) Cost does not include interest and depreciation on land, buildings, &c. (b) Receipts from maintenance shown in Table XIa not included, (c) Contributions from Social Security Fund ceased as from 1st April, 1945.

Net Expenditure Mental Hospitals. for Year ended 31st March, 1946. £ Auckland 7,307 Christ church 701 Hokitika 43 Nelson and Stoke 1 Porirua 45,866 Kingseat 1,487 Seacliff 24,918 Tokanui 1 Marton 44,696 Levin 83,967 208,987

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Table XIV. —Total Expenditure of Public Works Fund for Building and Equipment at each Mental Hospital from 1st July, 1877, to 31st March, 1946

Approximate Cost of Paper.—Preparation, not given ; printing (518 copies, £105)

By Authority: E. V. Paul, Government Printer, Wellington. —1946. Price 9d.]

26

Mental Hospitals. 1877-1936. 1936-37. 1937-38. 1938-39. 1939-40. 1940-41. £ ' £ £ £ £ £ Auckland 234,122 842 5,658 907 7,118 2,659 Christchurch 343,313 23,970 16,397 6,784 17,252 13,326 Dunedin (The Camp) 4,891 Hokitika 92,487 7,580 2,097 1,140 26^793 10,233 Hornby 11,102 Motuihi Island 561 Napier 147 Nelson and Stoke 189,429 ,16 j 218 . 2,234 15^458 39^469 34^119 Puhitahi (Kingseat) 130,036 65,192 52,144 71,149 62,896 45,095 Seacliff 312,148 2,958 570 2,527 1,082 707 Tokanui 239,643 18,839 2,855 6,903 9,922 13,662 Waitati 32,321 Wellington 29,641 Wellington (Porirua) 346,529 6 j 510 20,*502 23 j 948 10!894 6 j 843 Marton Levin Totals 1,966,370 142,109 102,457 128,816 175,426 126,644 Total Net Expenditure Mental Hospitals, 1941-42. 1942-43. 1943-44. 1944-45. 1945-46. 1st July, 1877, to 31st March, 1946. £ £ £ £ £ £ Auckland 885 327 1,983 2,504 7,307 264,312 Christchurch 6,815 1,885 2,210 766 701 433,419 Dunedin (The Camp) 4,891 Hokitika 23 j 944 3,842 125 ' 180 " 43 168,464 Hornby 11,102 Motuihi Island 561 Napier 147 Nelson and Stoke 11j 957 i^oio 4 37 1 309,936 Puhitahi (Kingseat) 25,052 3,569 637 424 1,487 457,681 Seacliff 1,855 1,301 6,526 24,918 354,592 Tokanui 2,128 112 1 1 1 294,067 Waitati 32,321 Wellington 29,641 Wellington (Porirua) 7,193 3,485 83 j 253 20,623 45,866 575,644 Marton 519 6,680 44,696 51,895 Levin 83,967 i 83,967 Totals 79,827 15,531 88,732 37,741 208,987 1 3,072,640