Saturday, October 22, 2016

Karl du Fresne: Ross Bremner and the great mental health experiment

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. 

Karl du Fresne blogs at published in the Manawatu Standard and Nelson Mail.


PGTips91 said...

Unfortunately the 'medical' care of the mentally ill falls way short, whether in an institution or in the community. Many mental health issues can be corrected more effectively with dietary interventions rather than prescribing drugs but this knowledge is kept hidden to protect the profits of the drug companies.

Moreover it is true that many mental health issues are made worse by medications, most of which are highly addictive with serious side effects, including making some people homicidal. Mostly the drugs are ineffective and known to be so but are prescribed none the less for want of the knowledge of better interventions.

Try kellybroganmd-dot-com for someone who is having great success in treating depression without drugs. Try googling the-aurora-colorado-tragedy-another-senseless-shooting-another-psychotropic-drug for some information on the known side-effects of psychotropic drugs.


Chuck Bird said...

Well informed article Karl. I used to work at the old Oakley Hospital in 1967 so I can vouch for most of what you say.

Drugs may be misused or wrongly proscribe but contrary to what Paul says they do have a place.

Paul do you have trouble reading the rules for this blog? It says no links.

Unknown said...

OMG Karl you have beautifully summed up all I have been saying for years about the dismal failure that is "community placement" of mentally ill people. How many deaths do we need to realise this approach just isn't working? I agree with all you have said re the old institutions....bring at least 2 or 3 back for the most severely ill, such as paranoid schizophrenics who are often very volatile and unlikely to adhere to medication regimes. Or failing that, allow charges of murder or manslaughter to be brought against those highly paid lunatics who allow these people out and about..having deemed them "rehabilitated" and able to live safely in society. How many more innocent people must die?????

Clunking Fist said...

"Moreover it is true that many mental health issues are made worse by medications, most of which are highly addictive with serious side effects, including making some people homicidal. Mostly the drugs are ineffective and known to be so but are prescribed none the less for want of the knowledge of better interventions."

And AIDS isn't caused by HIV, autism is caused by inoculations, the US government brought down the twin towers, chem trails control our minds, tin foil can protect us, etc.

Dafydd said...

I spent most of my working life inspecting premises for the insurance industry. In 1995 I was asked to have a look at the former Lake Alice mental hospital site because a Maori trust had bought the site to turn it into a forestry school; complete with millions of dollars worth of standing timber! When I got there I found a small abandoned town - houses, dormitory blocks, community halls, sporting facilities such as tennis courts and a swimming pool, even a few shops. I could not help but wonder where had all the people gone. A few months later I was made redundant and got a fill in job driving buses. I soon found out where all the mental patients had gone. "Released into the community" they were living in bus shelters and under bridges. But at least they were ideologically 'free' - no one to annoy them about taking a bath, being fed on time and no longer did they have to take the medications they hated. They were free like the rest of us to make their own choices and live life the way the rest of us did. Yeah, right. People like the Bremner's are simply collateral damage in Treasury's war to disband social services in the name of 'freedom'. Bang on Karl, well said!

Unknown said...

Well said Karl. We have a son who spent time in Tokanui. he was well cared for and safe, the staff were excellent. He was one of the early ones to be released into the community and it was not a success story! He has spent years with various service providers with caring staff trying to cope with crisis after crisis. Unfortunately there are some mentally ill people that just cannot cope with living in the community, they have limited life skills and really need to be in a protected environment. There are many families that have had tragic consequences as a result of not being able to get help for out of control adult children.

Doreen T