NZ mental health care petition

_____________________________________________________

In July 2021, following the recommendations of the “Inquiry into Mental Health and Addiction,  Parliament passed the first reading of the “Mental Health (Compulsory Assessment and Treatment) Amendment Bill”. This deals with precisely the same subject as my petition (which is still before parliament).

In this letter (see below) to the parliamentary members who spoke to the bill, I point out that here they are just tinkering with the various clauses in the 1992 Mental Health Act  - whereas the debate really ought to be about the fundamental, philosophical changes to New Zealand’s  treatment of  schizophrenia that came with that legislation. 

For 150 years our mental health legislation was founded exclusively on charity – whereas now we are only concerned about the medical treatment of the mentally ill. The all-deciding stumbling-block here is that chronic schizophrenia is incurable - as all textbooks will confirm.  Medical treatment, any treatment, can only lighten the burden on the patients of its terrible symptoms.  

Clearly, today we are back with a controversy similar to one we had during the 19th century, namely whether to follow the Moral Treatment of the Insane (please Google this) – or whether to follow the medical faction’s ideas of “treating” the illness.

Dear legislators,

I have read the Hansard report of the debate about the amendments suggested to the 1992 Mental Health (Compulsory Assessment and Treatment) Act 1992. .  In your contribution to the debate, each and every one of you appears to completely misunderstand what mental health legislation is all about. Each and every one of you blithely and earnestly ploughs ahead, raising and debating the many problems on hand : compulsory treatment orders, detainees under forensic mental health services, indefinite treatment orders, consent and patients’ ability to participate in decisions, human rights, etc.. There are many more problems which you, as it happens, do not mention at all in your debate though these are also directly caused by the 1992 Act, such as the shortage of psychiatric inpatient beds,  the chaotic and dangerous state of affairs in our acute mental health units, the fact that a full 20% of our total prison population are mentally ill (read schizophrenic) – whereas before 1992 it was illegal to commit a schizophrenic sufferer to prison, the problem of our many single, homeless people of whom probably at least 70% are schizophrenic – whereas before 1992 these lived in pleasant, open, well-maintained villas in our comfortable, residential hospitals.

But not one of you seems to understand that each of these problems is directly and exclusively caused by one mental condition only, namely human insanity, functional dementia, schizophrenia. Fact is (but none of you seems to comprehend it), if it weren’t for this terrible mental condition we simply would not need mental health legislation!!  The only reason for having mental health legislation is legally, efficiently and charitably to be able to deal with individual cases of schizophrenia.  We have no similar physical health legislation, do we?  That is because we do not need it for physical illnesses – where patients are not insane. 

And none of you seems to remember that until the 20th century humankind recognised only one mental illness, namely lunacy (now known as schizophrenia). Depressions and neuroses were just  human individual mood and behaviour differences.  Schizophrenia differs qualitatively from all other mental illnesses in that its sufferers are insane.  Saying this,  I am fully aware that probably half of our chronic schizophrenic cases are not, and do not appear as, insane; but in their acute psychotic state they most certainly were – and we cruelly refuse to accept that also in their “settled” mental state these unfortunate fellow human beings are in a lifelong, nightmarish, mental groove which they simply cannot lift themselves out of. 

Unwittingly,  Anae Neru Leavasa in his final comments is being terribly cruel with his fulsome praise of the “recovery and well-being model” for schizophrenia. As all textbooks will inform you,  schizophrenia is incurable – and by lazily rubberstamping this most drastic proposal from the Ron Patterson report,  parliament is now about to legislate that schizophrenia must be, not just may be as at present, but must be treated according to this model!! 

But is it not terribly despicable behaviour to suggest seriously to a patient that he/she can be cured from an incurable illness??  The use of the “recovery model” for schizophrenia has caused, is causing, many more suicides among sufferers from the illness :  despairing fellow human beings (often with some insight)  who so hope things for them could return to the way they were before their illness – but simply cannot pull themselves up  by their  shoelaces  to follow the well-meaning “recovery programmes”, “addiction-fighting plans”, etc.,  presented to them from so-called mental health experts who are often in cohort with the patient’s family - and so take their own lives. This can be compared with physiotherapists telling a mountain biker with a broken neck in his wheelchair : “You’ll be fine – just follow our advice, our plans, our regime  – you’ll be back on your bike in no time”.  Can you think of anything more cruel from a therapist than that, Dr  Leavasa??  Schizophrenic suicides differ qualitatively from depression suicides – and that is not at all understood by the Paterson commission. The former are caused by despair – the latter by depression. 

I have read all 219 pages in the Paterson report. Nowhere is this mentioned. Nowhere do the words insanity, dementia or schizophrenia even appear.   Worse : nowhere will you find any mentioning of the very specific problems caused by these conditions. These are never actually health problems as such – they are exclusively behavioural, social or criminal. This, of course, was the reason why the treatment of this illness for the first 100 years naturally came under the Department of Justice. It was transferred to the Health Ministry only in 1948 (as the Division of Mental Hygiene) – and only in the 1970s was it divided up between our many DHBs.  

The Te Ara Oranga  report is a long-winded, terribly vague treatise on something the Commission calls “mental well-being”  - which basically has nothing whatsoever to do with mental illness.  The report suggests that this peculiar concept exists on a “continuum”. This is manifestly wrong : There is a qualitative line between insanity and sanity. Long before we invented psychiatrists this line was determined in a court of law, in doubtful or controversial cases by a jury. . The report further claims (Chapter 1) that schizophrenia is just a “challenge”  -  where you may win or lose, depending on your strength and character. This perfectly shows just how precious little understanding the Paterson Commission has of the condition. Nicky Stephens did not take his own life because he wasn’t strong enough to stand up to a challenge. He died because he was despairing and misunderstood in his nightmarish groove of schizophrenia from which there can be no escape. 

Our philosophy about the treatment of schizophrenia is now diametrically opposed to the philosophy we had  for 150 years – until the enactment of the 1992 Act. The treatment arising from previous legislation was wholly charitable  -  whereas  since 1992 we have endeavoured to treat the illness scientifically. As legislators you will find it of great interest (at least if you are genuinely concerned about mental health!!!) to examine a period in the 19th century when we similarly found ourselves with medical doctors wanting to “treat”  schizophrenic patients  - while lay people (like yours truly) just wanted to provide asylum and charitable treatment. You will find out about this absorbing phenomenon if you Google articles about  “Moral Treatment of the Insane”.  

Since The Lunatics Ordinance 1846 our philosophy was to have psychiatric hospitals available where every mentally ill person could find a place to eat and a roof over his head,  i.e. a place of refuge where you would be admitted as of right – for the duration of your life, if necessary and if you wished. This was a godsend for tens of thousands of New Zealanders for 150 years. The only thing schizophrenic sufferers cannot do is to organise their own lives in our industrialised cities the way sane people so gladly do it. Modern psychiatry detests the very notion of  institutionalisation of our schizophrenic population– but sufferers of the illness crave it and love it .  All they need and want is to be away from a  “community” with which they have nothing in common, away from our busy,  industrialised society the rest of us so love and thrive in. And they also need friendly, humane people around them who will accept them as they are – together with their weird thoughts. 

This they enjoyed for 150 years as a legal right. Then we, for exclusively ideological reasons, destroyed those many perfectly functioning, residential psychiatric hospitals, with their thousands of inpatient beds, all fully staffed with psychiatrists, psychologists, specialist nurses, social workers, occupational therapists, etc. The thousands of permanent residents were discharged “into the community” – never mind the cynical breach of the 150-year old social contract our NZ society had had with the chronic sufferers of schizophrenia (most of whom are non compos mentis) and their families. I remember clearly how grateful parents of middle-aged schizophrenic sons and daughters were,  that when they no longer had the strength to care for them the NZ society promised to properly care for them for the rest of their lives. You legislators are now tinkering with the 1992 Act  - but are obviously ignorant about what you are doing.  Are you even aware that it was contingent on the enactment of the 1992 Mental Health Act (which replaced all previous mental health legislation), that the discharge of the thousands of schizophrenic sufferers could become legal?? 

The Ron Paterson report is a longwinded, vague, disjointed, useless treatise on “Mental well-being”. It does not give us one single, practical solution to any of our many serious mental health problems. There is nothing to hang your hat on. Its most drastic recommendation was the replacement of the 1992 Act – that you legislators are now so earnestly debating. In January 2019 I wrote what turned out to be the only published, authoritative, in-depth critique of that recommendation : Open letter to David Clark.  I attach it herewith for your information.

Yours sincerely,

Andy Espersen

My petition is now (February 2020), being considered by the NZ  Parliament. 

I have written yet another lobbying letter to support it.  In the letter I refer to an article by me published on the blog site of Karl du Fresne, a

well-known NZ freelance journalist. Here I suggest that human insanity is essentially a judicial problem  -  and not an health matter.

Dear party spokespersons for Justice and Health,

I am writing this letter in support of my petition, that of Andy Espersen and 261 others, at present before Parliament. You will agree that my petition also has high relevance to the repeal of the Mental Health (Compulsory Assessment and Treatment) Act 1992 and its replacement which has now been agreed to in principle by Government, following a recommendation from the recent Inquiry into Mental Health and Addiction. For practical reasons, in 1948 the treatment of schizophrenia was moved from Justice Department to Health department (as the Division of Mental Hygiene)   -  but not until 1973  did the mental hospitals come directly under the hospital boards.

I put it to you that for two reasons both organic and functional dementias fundamentally and essentially remain a judicial matter  -  it is not really an health issue. Firstly because it involves taking away the liberty of a free citizen  -  and secondly because both types of mental conditions are incurable.  The NZ Human Rights Commission tacitly recognised this when in August 2018 it drew attention to the fact that many people suffering from the senile dementias are illegally locked up and treated in our many dementia wards, now run by the private rest home industry.  Habeas Corpus principles are blithely ignored.

It follows logically that our treatment of dementia must be charitable  -  can only ever be charitable.  We do this by extending hospice care to its sufferers.

Traditionally, i.e. till 1992,  both functionally and organically demented patients  were committed to care in a court of law.  The 1992 Mental Health Act forces our psychiatrists to decide whether or not to apply the legislation in a particular case of dementia. This places an unfair burden on our psychiatrists and their DHB employers -  who now often find themselves facing legal proceedings for allegedly wrong decisions made. Before the legislation changes in 1992 Government shouldered that responsibility   -  as we had clear and unequivocal legislation governing these matters.

It is my belief that the 1992 Act is in fact illegal.  Legislation must treat citizens evenly and fairly, mental health legislation being no exception. The crucial question behind our original legislation (the Lunatics Ordinance of 1846) was the overarching importance of determining whether a citizen was demented or not.  If so, the law would apply  -  if not, it wouldn’t.

Karl du Fresne,  our foremost independent journalist and senior social and political commentator, kindly offered me space on his blog for publishing an article by me. This article is somewhat critical of Ron Paterson’s report  -   and calls for a public debate on the issue  (which, indeed, Paterson’s report also calls for). Sadly, this debate did not eventuate.  Here is a link to my article  -   with its ensuing comments :

https://karldufresne.blogspot.com/2020/02/guest-post-andy-espersen-on-treatment.html

I openly encouraged du Fresne’s readers to write comments  - and I forwarded the article to the Mental Health Foundation, hoping (in vain) for a comment from here.   These comments are most revealing and interesting, as you will perceive. Commenters agree with me that our chronically mentally ill sufferers experienced multiple, detrimental effects from the closure of residential, psychiatric hospitals in the 1990s  -  and  from the cynical 1992 change of philosophy dealing with them.

I respectfully request that Parliament now accepts this letter and my article (with its comments) as relevant evidence, and as a basis for discussion, in its deliberation on the forthcoming changes to our mental health legislation.

Yours faithfully,

Andy Espersen, petitioner

This petition is now closed

The NZ Mental Health Care Petition attracted 261 signatures.  It was handed to Nick Smith, MP for Nelson, on April 1st, 2017. 

You may follow the petition through its stages on the NZ Government's official web site, www.parliament.nz/en/pb/petitions/

The petition reads :

We, the signatories, respectfully request that the House recommend that the Government establish a Royal Commission

to report on harm to our schizophrenic population from changes inherent in the Mental Health

(Compulsory Assessment and Treatment) Act 1992 - 

and on harm from the closure of residential, psychiatric hospitals in the 1990's.