Ross Bremner and the great mental health experiment

(First published in the Manawatu Standard and Nelson Mail, October 19).

The American economist Milton Friedman once said it was a great mistake to judge things by their intentions rather than their results. I was reminded of that quote when I read about the tragic series of murders perpetrated by the Waikato man Ross Bremner.

Bremner, you may recall, stabbed his mother to death and left his father critically wounded. He then drove to a remote settlement on Kawhia Harbour where he killed a harmless and helpless elderly couple, apparently at random, before taking his own life.

Obviously, Bremner was very seriously disturbed. He had been treated for schizophrenia at Waikato Hospital. His mother had called mental health services for help only two weeks before she died at his hands.

People who knew Bremner, including a neighbour who had worked in mental health, were worried about what he might do.

Presumably a coroner will investigate the circumstances of the four deaths.  If there was a failure of the system, as seems pretty clear, the people responsible must be held accountable.

In the meantime, we are entitled to ask some questions, such as: why was a man as disturbed as Bremner not in care, for his own wellbeing as well as the safety of others?

That brings me back to Friedman’s quote.  Until the 1980s, mentally ill people in New Zealand were mostly looked after in hospitals. Older readers will remember the names of these institutions: Tokanui, Sunnyside, Lake Alice, Porirua and Kingseat, to name a few.

They tended to be drab, depressing places where patients were managed rather than treated. I know this because my brother-in-law, who was schizophrenic, spent years in Porirua. I also once had an opportunity to observe things from the inside when mental health nurses went on strike and I responded to a call for volunteers to help.

It was an imperfect system, but patients had a roof over their heads, three meals a day and a warm bed to sleep in. They had companionship and nurses to ensure they took their medication. Their families didn’t have to fret constantly about whether they were okay.

Perhaps just as important, the mentally ill were sheltered from the stressful world outside the gates. The word asylum, after all, means a place of shelter and protection.

The nurses and orderlies seemed dedicated and caring and did the best they could in less than ideal circumstances. They were certainly not the stereotype sadists personified by the vindictive Nurse Ratched in One Flew Over the Cuckoo’s Nest.

But those hospitals no longer exist. Well-meaning reformers decided they were inhumane. Mentally ill people deserved to live independent lives in the community.

This suited the government bean-counters, because it relieved the state of the cost of maintaining all those big institutions with their expansive grounds and endless maintenance demands.

Closing them down and flogging them off also fitted the ideology of the time, which favoured cutting back the state sector. “Community care” was a convenient excuse to spend less on mental health – a perfect confluence of touchy-feely idealism and hard-headed fiscal management.

The transition happened with indecent haste and there were a lot of casualties. As in so many things, we lurched abruptly from one extreme to another. And we still haven’t got it right, as the recent events in the Waikato show.

The reforms worked for some patients, but many ended up living in squalid flats and boarding houses where they were left to fend for themselves. The least fortunate ended up on the streets.

In theory, someone was still supposed to make sure that those living on their own looked after themselves and took their medication. In practice, it doesn’t seem to have worked like that.

Bureaucrats and politicians love to waffle about providing “wrap-around support” for vulnerable people but it’s more preached than practised. Under the mantra of “community care”, the state was able to wash its hands of day-to-day responsibility for the mentally ill while maintaining the pretence that they were living more rewarding, fulfilling lives. 

I know that when my brother-in-law was living independently, he was essentially left to himself. When there was a problem, it was almost impossible to find anyone in “the system” who would take responsibility or even provide information to the family.

Mental health care became highly politicised. The Privacy Act was used not only to keep patients’ families in the dark, but as a shield to prevent scrutiny of the sector and to disguise its failings. 

I remember being angrily heckled by mental health professionals at a conference where I spoke as a journalist about the importance of transparency in the sector. At the time there had been several violent deaths caused by rigid adherence to privacy codes that prevented people from being told about potentially dangerous patients living in the community.

As recent events have reminded us, not all the casualties of the reforms were patients. They included ageing parents who felt forced to provide a home for unstable and often unmanageable adult children. It seems Ross Bremner’s hapless parents fell into this category.

What a dismal way to spend the last years of your life, desperately trying to care for unpredictable and potentially dangerous offspring and unable to get professional help when it was most needed.

Community care remains a good idea in principle. But if judged on its results rather than its intent, it has been, at best, a costly experiment in human terms. The people who died at Ross Bremner’s hands are the latest evidence of that.