Pssst - don't mention asylums

(First published in The Dominion Post, February 9.)

We should always cherish the lone voice – the individual bold enough to go against the flow and to speak out against conventional wisdom when conventional wisdom has got it wrong.

Andy Espersen of Nelson is such a voice. I’ve never met him, but I’ve been reading his letters to the papers for years.

Like most lone voices, Espersen is a single-issue crusader. In his case, the issue is mental health. His consistent and persuasive message is that New Zealand made a grievous mistake when it shut down its mental hospitals three decades ago.

Unlike some lone voices, Espersen is not a crank. He spent 40 years working in mental hospitals as a staff nurse and psychiatric social worker (he’s in his 80s now), so he’s no armchair theorist.

In his most recent letter to this paper, he asked whether the mental health inquiry ordered by the new government would dare question the policy of de-institutionalisation and the airy-fairy concept of community care for the mentally ill.

I suspect he knows the answer to his question. Although prime minister Jacinda Ardern has promised nothing will be off the table in the inquiry, community care is such an ideological sacred cow that no one, other than Espersen, even considers the possibility that the old way might have been better.

My prediction is that activists will do their best to ensure that the inquiry focuses on the supposed “drivers” of mental illness. These will include poverty, racism, colonisation, homelessness and homophobia. In other words, they will want to make it all about victims.

No one will want to talk about the virtues of the old “asylums”, because the word is deeply unfashionable. But they were given that name for a reason. An asylum is a place that provides sanctuary. That’s why we talk about political prisoners seeking asylum and asylum-seekers who have fled from unsafe countries.

An asylum was a place where the mentally ill were guaranteed a warm bed, three meals a day, medical care and company, if they wanted it. There were nurses to ensure they took their medication. It wasn’t an ideal existence, but it was safe and secure.

In the 1980s, however, mental health professionals decided the system was inhumane. Hospitalisation was little better than imprisonment, they argued. The mentally ill were entitled like everyone else to live independently and autonomously.

Wrapped in the warm embrace of that amorphous thing called the community, they would be liberated to fulfil their true potential as human beings.

It didn’t seem to matter if they were incapable of cooking, shopping, managing their finances, holding down a job, washing their clothes or showering. And so they ended up living in squalid flats, boarding houses and caravan parks where there was no one to ensure they took their meds. At best, a nurse or mental health worker might check on them occasionally.

It was an ideologically driven change, but the government bean-counters and deconstructionists liked it because it meant the closure of all those big, expensive old institutions.

Doubtless this bold experiment worked for some people, but its negative consequences can be seen in frequent heart-breaking newspaper reports about acutely ill patients living in the community who have committed murder or suicide. Ironically, the victims of their mad rage are often the people who are closest to them and care most about them – their families.

If you missed the last such newspaper story, don’t worry. They’re like buses – there’ll be another one along soon.

There’s a recurring pattern to the human tragedies described in these accounts. Usually they have stopped taken their medication. They may be abusing illegal drugs or alcohol. Often they are living in chaotic circumstances. None of this would happen if they were in a hospital.

Their families are driven to despair. Pleas for help fall on deaf ears or get swallowed up in a cumbersome and unresponsive bureaucracy.

The system allows district health boards to wash their hands of difficult patients the moment they’re out the door. Too often it’s left to the police to pick up the pieces.

Coroners repeatedly make recommendations about how the system needs to be improved. The authorities solemnly nod in agreement, then ignore them.

The prison system ends up bearing part of the burden too. Espersen estimated last year that there were about 2000 mentally ill prisoners who should be in mental hospitals.

As he said in one letter, "We as a society ought to be ashamed". The mental health inquiry has an opportunity to do something about this - but will it?