ACC system a 'money game'

DEAN KOZANIC/Stuff.co.nz

Christchurch man David Kerr says ACC is playing a "money game, not a people game". 

A Christchurch man left disabled and unemployed after a back injury four years ago says his dealings with ACC have left him demoralised.

Once a proud, hard-working electrician, David Kerr said his life had become a "living hell" and at times he was reduced to tears by pain and frustration.

He was left in agony with two crushed spinal discs when he was injured lifting the ramp of a trailer while working at South City Mall in May 2011.

He received surgery a year later but it made no difference, he said.

Two weeks ago, Kerr's weekly ACC payments of $841 were suspended.

His condition was "no longer the result of personal injury" but from degeneration, a letter explained.

A quote from his surgeon was included as evidence for the decision.

"I believe this is multi-level disc change probably on the basis of anatomy, ligamentous laxity and smoking," it said.

The decision left Kerr frustrated and perplexed.

In his view, the word "probably" cast doubt on the organisation's evidence for its position.

"It just doesn't add up."

To have his injury accepted for four years, and then suddenly denied was impossible to accept, Kerr said.

DEAN KOZANIC/FAIRFAX NZ

David Kerr, 53, has had his ACC payments stopped after a back injury four years ago.

"It was considered and accepted as an injury, and now, it's like 'he's been there too long - let's get rid of him'." 

He contacted a lawyer to apply for a review of the decision, but the process was cut short when he realised it would cost him $5400.

This week, he received his first disability allowance from Work and Income – $23.23 a week.

Kerr, a self-confessed workaholic, father and grandfather, said he was desperate to get back to his job to earn a decent living for his family. 

"My biggest fear is I will lose everything."

A spokesperson from ACC said the decision to suspend Kerr's entitlements was based on "independent medical opinion from his [Kerr's] orthopaedic surgeon, supported by medical information and notes contained on Mr Kerr's file including those from his GP".

An independent review process was available "in which the client has the right to engage representation at the level they choose".

Barrister and ACC legal specialist Warren Forster said Kerr's case was a perfect example of how the ACC system denied people access to justice.

"There is a large group of people who can't afford medical evidence, can't afford a lawyer and don't know the law and are, in effect, denied access to justice because of those factors." 

There are more than 300,000 people living with a disability caused by an accident, according to the latest Census data.

ACC provides support for 10,000 to 12,000 people.

"So, there are another 290,000 people - not being supported for their injury - and we don't know why," Forster said.

"In my view it is more likely there is a problem and it's because they have not had access to justice."

Forster was a lead researcher with a team from the University of Otago Legal Issues Centre which investigated the ACC appeals process and delivered a report to Minister for ACC, Nikki Kaye, earlier this year.

The report, on more than 500 ACC decisions, identified barriers to accessing justice faced by people disputing ACC decisions. 

"There's a very complicated, well-funded system to support ACC legal cases, and there's nothing for claimants."

The group recently received $150,000 in funding from the Law Foundation to provide a full report on measures to rectify the problems. Forster expected the report would be ready mid next year.

Kerr said his experience with ACC had created huge stress in his 26-year marriage and left him feeling isolated and hopeless.

"It's a money game, not a people game." 

 - Stuff

New Zealand vaccine reaction reporting:

If you or your child has a reaction, DO NOT rely on your doctor, nurse or anyone else to report your reaction. 

Go to the Centre for Adverse Reactions Monitoring and download the vaccine reaction form. Do not JUST supply the form alone. Put together a detailed email or word document, and tell them everything that happened. 

Set your email programme to deliver a receipt when the CARM website receives it, and another when the email is opened. 

Ask for acknowledgement of the documents, as well as the CARM number for your case. If more than one reaction is reported (one after each of three injections) there should be three separate numbers allocated. 

https://nzphvc.otago.ac.nz/carm/

CARM | New Zealand Pharmacovigilance Centre nzphvc.otago.ac.nz Analysis↑ The CARM database provides New Zealand-specific information on adverse reactions to medici...

Abused Children May Get Unique Form of PTSD

Joe Mikos / Getty Images

Child abuse scars not just the brain and body, but, according to the latest research, but may leave its mark on genes as well.

The research, which was published in the Proceedings of the National Academy of Sciences, suggests that abused children who develop post-traumatic stress disorder (PTSD) may experience a biologically distinct form of the disorder from PTSD caused by other types of trauma later in life.

“The main aim of our study was to address the question of whether patients with same clinical diagnosis but different early environments have the same underlying biology,” says Divya Mehta, corresponding author of the study and a postdoctoral student at the Max Planck Institute of Psychiatry in Munich, Germany.  

To find out, Mehta’s team studied blood cells from 169 people in Atlanta who were participating in the Grady Trauma Project.  Most were in their late 30s to mid 40s and were African American; some had been abused as children but all had suffered at least two other significant traumatic events, such as being held at gun- or knife point, having a major car accident or being raped. On average, the participants experienced seven major traumas. Despite these events, however, the majority were resilient: 108 participants never developed PTSD.

Among the 61 that did, 32 had been abused as children and 29 had not.  The authors examined their blood cells, looking for genetic changes that distinguished people with the disorder who had been abused from those who had not. To focus on changes associated with PTSD diagnosis rather than trauma exposure alone, they looked for differences not seen in the resilient group.

MORE: How Child Abuse Primes the Brain for Future Mental Illness

These genetic alterations are known as epigenetic changes: chemical differences that don’t mutate the DNA itself but affect how actively and efficiently the genes are made into proteins. By either silencing or activating genes, epigenetic changes can influence everything from brain development and functioning to the risk for certain diseases. While not necessarily permanent, some of these changes can last a lifetime and some can even be passed on to the next generation.

“In PTSD with a history of child abuse, we found a 12-fold higher [level] of epigenetic changes,” says Mehta.  In contrast, people who experienced trauma later in life showed genetic effects that tended to be short-lived, and did not permanently alter the function of the genes.

“It’s a very interesting paper,” says Moshe Szyf, professor of pharmacology and therapeutics at McGill University in Montreal, Canada, who studies epigenetics. “The important thing about this paper is that it looks at PTSD that has different life histories. One group has a life history of child abuse and the other doesn’t and we see a completely different functional genomic appearance.”

Understanding the different ways that people can develop PTSD could have implications for how the condition is treated. The epigenetic changes were mostly different between the two groups, even if both sets of aberrations ultimately resulted in PTSD, suggesting different ways to potential treat the PTSD depending on its origins.“This study implies that it is essential to take into account the trauma history of an individual,” says Mehta, “Individuals with the same diagnosis might need different treatments depending on their environmental endowments together with their genetic predispositions.”

MORE: Psychological Abuse: More Common, As Harmful As Other Child Maltreatment

Indeed, at least with depression, which is another condition with links to traumatic experiences, some studies found that a childhood history of maltreatment was associated with a reduced response to antidepressants and some other therapies.

“The question is, if indeed the problem is in the DNA, can we reverse this program and do we have tools to reverse that?” says Szyf. “I’m very interested in that and we’re doing some experiments in animal models.” The group is using drugs that can affect gene expression, such as some cancer treatments, for example, to figure out whether they can help to reverse harmful epigenetic changes like those leading to PSTD-like symptoms in animals.

Dr. Elisabeth Binder, the principal investigator of the current research and research group leader at the Max Planck Institute, says, “If individuals have been abused as children, they end up having psychiatric diseases that might be biologically different. The way you got to the disease is as important as the disease itself.”

MORE: Child Abuse Pediatricians Recommend Basic Parenting Classes to Reduce Maltreatment and Neglect

Still, since the researchers compared child abuse to other types of trauma that typically occurred when participants were in their early 20s, Mehta says it’s impossible to say whether it was simply the early timing of the child abuse or something unique to being mistreated by caregivers that accounted for the different pattern of changes she and her colleagues found. Other research showed both that early trauma is particularly significant and that child abuse can have an especially pernicious effect on the developing brain, but it’s hard to disentangle them. In addition, it’s possible that early trauma and the damage associated with it work synergistically in contributing to the response to trauma. For example, studies on Romanian orphans show that the longer an infant is kept in an abusive and neglectful setting, the greater the damage to IQ and the higher the risk of psychiatric problems.

Whether these genetic markers can reliably be related to childhood trauma and then used to help guide treatment, isn’t clear yet. But the results suggest that such refined strategies might at least be possible. Depending on the patient’s experience, for example, trauma linked to childhood abuse may respond better to certain drugs acting on one pathway, while adult-onset trauma, such as being a victim of rape, might require targeting a different set of genes or proteins.  The more we understand how trauma does harm, the better able we will be to reverse the damage or even actually prevent it from causing disease.

MORE: How Terror Hijacks The Brain

Szalavitz's latest book is Born for Love: Why Empathy Is Essential — and Endangered. It is co-written with Dr. Bruce Perry, a leading expert in the neuroscience of child trauma and recovery.

UN disappointed in John Key's child abuse stance

The United Nations child advocacy group says it is disappointed Prime Minister John Key isn’t backing a cross-party plan to tackle abuse.

Last week Social Development Minister Paula Bennett released a discussion paper – titled Every Child Thrives, Belongs, Achieves – which included suggestions such as mandatory reporting of abuse and giving priority treatment to younger families.

Labour deputy leader Annette King said rather than political posturing, a cross-party consensus was needed.

“It is time that the political divide was closed in terms of putting children first,” she said.

Mr Key this morning told TVNZ’s Breakfast he did not think it was an issue where parties could agree because of the wide-ranging funding decisions involved.

“I think that’s tricky because ultimately it’s about spending decisions across a whole lot of different areas that you need to consider.”

Mr Key said while all parties agreed abuse rates were too high there was no silver bullet and that was why the Government put the green paper out there for discussion.

“Ultimately, parties are going to have to go and campaign on what they believe is the right solution to those problems.”

United Nation Children’s Fund (Unicef) national advocacy manager Barbara Lambourn said it was disappointing Mr Key was not supporting the call for a bi-partisan approach.

“Making children’s issues a political football with arguments about which party will claim to have the solution is not what New Zealanders need to hear,” Ms Lambourn said.

“It’s clear from all the information we have about the conditions in which child abuse can thrive, that government and community agencies need to work more closely to achieve results.

“We’d like to see that reflected by politicians, the people who make the big calls, working together to make sure that any plan for children is agreed by consensus, properly resourced and sustainable for the long term,” Ms Lambourn said.

Ms King said it was a blow to hear Mr Key dismiss a cooperative approach.

“If he is not prepared to take the advice of another political party, then I am asking him to listen to the growing chorus of parents,experts and practitioners in the field of child development and welfare,” she said.

“They are telling us – the politicians – to get over ourselves and stop the bickering.

“They are saying loud and clear that New Zealand needs a long-term solution to the problems of child abuse and children’s underachievement – and that requires the whole country to work together.”

Last week’s green paper said two children were physically, sexually or emotionally abused every hour, with 21,000 cases of abuse and neglect in 2009/10, and 13,315 avoidable hospital admissions the previous year.

More than 47,000 children under the age of 16 lived with a victim of family violence in 2010, while 15 percent of children under 18 years needed support and intervention at any one time.

Of those, 15 percent were children who were significantly more at risk of poor life outcomes such as learning and behavioural difficulties, mental and physical health problems, alcohol and drug dependency, criminal activity, imprisonment, poor education achievement and employability.

General Anesthesia And The Human Brain:

General Anesthesia And The Human Brain: How Going Under May Impact Cognitive Function

Under general anesthesia, the human brain can undergo changes in activity, structure, and overall cognitive function.  Wikimedia Commons 

If you’ve ever had surgery, your anesthesiologist has likely told you to count back from 100. You don’t get too far before you’ve drifted off. Hours later, you wake up from the “reversible coma” often unaware of whatever happened during the surgery. But what happens when the body, specifically the brain, goes through this procedure, and why are we unable to feel pain or remember anything?

Anesthesia Dosage

In the U.S., 40 million anesthetics are administered to patients every year, yet many questions still surround the drugs and their effects. Anesthesia, as a procedure, is considered successful when a patient has successfully experienced amnesia, analgesia, muscle relaxation, and loss of consciousness. However, going with a dose that’s too low or too high has also caused patients to wake up in the middle of surgery, while others have experienced postoperative cognitive decline.

For surgery, the recommended dose of general anesthesia is at least 1 minimum alveolar concentration (MAC) — the standard measure signifying the concentration of anesthesia in vapor. Fifty percent of people who inhale 1 MAC of anesthesia don’t move in response to a pain stimulus, and studies suggest it takes lower concentrations of anesthetic to induce unconsciousness than it does to prevent movement in response to surgery.

[Related: 7 Memory Biases You Didn't Know Existed]

Dosing is contingent on two factors: the patient’s health profile and the anesthetics and sedatives that are used. Anesthesiologists use a combination of drugs, including xenon gas, sevoflurane, propofol, and midazolam to achieve an anesthetic state — they must also be on hand at all times to constantly monitor patients’ vital signs. So far, through research involving functional magnetic resonance imaging (fMRI), researchers have learned that different drugs and doses cause different effects in the brain. Here’s what they do.

Anesthesiologists use infusion pumps to deliver medications. Smithpie, CC BY-SA 3.0

Your Brain On Sevoflurane

Sevoflurane is often used to induce or maintain unconsciousness in patients undergoing surgery, and doses lower than 1 MAC of the inhaled anesthetic agent are enough to affect memory-related regions of the brain. These regions include the primary visual cortex and its association cortex, which translates the information gathered into complex representations.

A 2007 study published in the journal Anesthesia and Analgesia, for example, found that only 0.25 MAC sevoflurane could increase levels of cerebral blood flow (CBF) in the brain’s occipital lobe, where the visual processing centers reside. This increased CBF influences how brain cells try to survive as well as the way they perform their designated tasks, such as thinking, ultimately slowing everything down.

[Related: Contrary To What You May Think, Men And Women's Brains Aren't That Different]

Another study from 2008 arrived at similar results. After administering 0.5 MAC of sevoflurane, researchers saw changes in CBF within the frontal and parietal lobes, which house brain regions responsible for memory and sensory functions. This in turn brings more oxygenated blood to the brain, which researchers speculate results in memory loss. However, so much oxygen can also overflood the region and damage neural tissue.

These findings are consistent with what researchers already know about the effects of general anesthetics. Sevoflurane and other anesthetics trigger a nerve impulse when they make contact with the synapses in the brain. Under normal circumstances, these signals would then be sent from the primary regions to the secondary, and finally to the tertiary regions where multiple types of stimuli are combined and processed. However, when that signal comes from an anesthetic, the anesthetic is believed to build on each synapse it passes throughout this chain, eventually affecting all regions with a larger effect.

Your Brain on Propofol and Ketamine

The widely used anesthetic propofol (a hypnotic drug) not only causes unconsciousness but amnesia too. Researchers believe propofol binds to GABA receptors, which are involved in controlling sleep and alertness.

A 2011 study published in the European Journal of Anesthesiology suggested that rather than suddenly switching off, consciousness actually fades away. The study found consciousness resides in the connections between multiple parts of the brain, not just one single region, and that an anesthetized brain was first affected in the midbrain where there’s an abundance of GABA receptors. Once propofol binds to these receptors, it mimics and enhances the effects of GABA, thus inhibiting cellular activity. Consciousness fades as the drug spreads outward to different regions of the brain.

[Related: Where Drowsiness Comes From In The Brain]

Along with propofol, anesthetists often give patients anesthetics with an analgesic effect. While these are sometimes opioid painkillers, other times they’re the drug ketamine. While in lower doses, this drug turns the brain highly active, in higher doses it’ll have the opposite effect. Ketamine is a dissociative anesthetic, which means it doesn’t make patients completely unconscious. Rather, it inhibits their senses, judgement, and coordination for up to 24 hours.

Ketamine doesn’t induce amnesia or forgetfulness, Dr. Theodore Henderson, founder of the Neuro-Laser Foundation and Neuro-Luminance in Denver, Colo., told Medical Daily in an email. He said the drug blocks NMDA receptors, which are critical to learning, memory, locomotion and neural plasticity.

Together these drugs work on patients by sedating them and providing painkilling benefits.

Drug ampoules contain small amounts of medications. Smithpie, CC BY-SA 3.0

The Developing Brain On Anesthetics

Children who are exposed to anesthesia only once can be at a higher risk of neurodevelopmental problems and changes in brain structure. A recent reviewpublished in the journal Pediatrics found children under 4 years old who received general anesthesia prior to undergoing surgery were more likely to experience problems with language comprehension; have a lower IQ; and exhibit decreased gray matter density in regions toward the back of their brains — specifically in the occipital lobe and cerebellum, which coordinates and regulates muscular activity. The drugs used on these kids, some of whom underwent multiple early-life surgeries, included sevoflurane, isoflurane, and halothane.

[Related: 8 Facts About Anesthesia Everyone Should Know]

Another study from 2012 found children who underwent anesthetic surgeries before age 3 were also twice as likely to develop learning disabilities, including long-term language and reasoning deficits before the age of 10. However, the researchers saw there weren’t any observed differences when it came to behavior, visual tracking, attention, or fine and gross motor function.

In all, these studies highlight the need to look for better methods for administering anesthesia for children — researchers are working on it.

The Aging Brain On Anesthesia

Those who undergo surgery later in life most often do so for health-related issues more often than cosmetic. But with age also comes a longer recovery time. Older patients can take up to six months to recover from anesthesia following a surgery, according to a 2013 study. In part, this recovery takes so long because elderly patients are more likely to experience slight changes in their mental capacity, which may place them at higher risk for dementia — as much as 35 percent higher, the study found. Researchers believe this is because anesthesia causes inflammation to neural tissues. In turn, this increases a person’s chances of developing postoperative cognitive dysfunction (POCD) or precursors to Alzheimer’s disease, such as beta-amyloid plaques.

These findings suggest the elderly could use a lower dose of anesthesia before undergoing surgery. After all, they’re more prone to other health conditions, such as hypertension, diabetes, and heart disease, and might even be taking drugs to treat these conditions. Complications could arise from either of these factors when a person is put under.

[Related: Anesthesia May Have Long-Term Effects When Used On Babies]

The Future Of Anesthesia

Researchers have gotten loads of insight regarding the effects of anesthetics on the brain thanks to fMRI. Yet despite knowing they can reliably put someone to sleep during surgery, without causing pain, they still don’t know every detail regarding how anesthetic drugs work. This compilation of studies suggests the brain undergoes changes in an anesthetic state, and that these drugs — if not used properly — can be harmful to patients. But until further research is completed to map the brain under anesthesia, we won’t know the best approach to dealing with them.

The Heresy of Materialistic Psychiatry: Electroconvulsive Injury (ECI): Electroconvulsive Injury

Electroconvulsive Injury (ECI)

Electroconvulsive Injury (ECI) is a specific form of Diffuse Electrical Injury (DEI) that is induced by so-called Electroconvulsive Therapy (ECT). The scientific medical literature also refers to DEI by other names, such as  electric shock syndrome or post electric shock syndrome. The main difference between DEI and ECI is that ECI is rarely acknowledged by the medical community because it is purposely administered by medical personnel rather than occurring through an accident or as an acknowledged assault with possible subsequent criminal charges. Although, the assault is usually acknowledge when ECT is administered due to political and terrorist activity, which is commonly done without anaesthesia, muscle relaxant or oxygenation. However, when this type of injury is purposely administered by medical personnel, the existence of symptoms, which are the same as other diffuse electrical injuries, is usually denied and the reporting of these symptoms is sometimes even suggested as a symptom of a mental illness.

Diffuse electrical injury is often, but not always, accompanied by visible thermal damage. This rarely happens with electroconvulsive injury because conductive gel lowers skin resistance and prevents the skin from being burned by the high voltages. However, autopsy studies have shown that thermal damage is sustained to the brain. Since this is usually not possible to detect until after death, it is rarely acknowledged.

In addition to the use of conductive gel to prevent visible signs of harm, anaesthesia and muscle relaxants are used to mask the initial reaction to sustaining such an injury to the head. The anaesthesia and muscle relaxants also often raise the seizure threshold, which means even more electricity is used to induce the desired convulsion, thereby increasing the severity of the injury. 

The amount of electricity used to induce an electroconvulsive injury (ECI) (i.e. 220 to 450 Volts) through electroconvulsive therapy (ECT) is above the amount of electricity reported (i.e. 110 to 240 Volts) in the majority of cases of accidental diffuse electrical injury resulting from low voltages (i.e. < 1000 Volts). The injury from ECT is often much more pronounced than other diffuse electrical injuries because the path of the electricity is directly through the brain in addition to being a larger amount of electricity. 

Path related symptomatology from ECI, such as headaches and migraines, would be expected. Since the majority of persons who suffer from a diffuse electrical injury report muscle aches, muscle spasms or twitches, general fatigue, general physical weakness, and general exhaustion, this would also be expected in those who suffer from a electroconvulsive injury. Other less common symptoms reported from diffuse electrical injury, such as weight gain or loss, back problems, dizziness, lack of physical coordination, extreme physical sensitivity, sensitivity to light, excessive perspiration, excessive thirst, and particularly heart palpitations, and especially muscle cramps would be expected to be more prevalent in electroconvulsive injury due to the path of the electricity and the resulting convulsion, even though the convulsion is masked by anaesthesia and muscle relaxants. 

It also seems reasonable that the following list of reported symptoms from diffuse electrical injury would be even more prevalent in such an injury sustained directly to the head, as in the administration of Electroconvulsive Therapy (ECT):

• general forgetfulness
• insomnia or other sleep disorders
• fear of electricity
• personality changes
• increased emotional sensitivity
• unexplained moodiness
• memory loss - short term
• unusual anxiety
• reduced attention span/loss of concentration
• lack of motivation
• sexual dysfunction
• easily confused
• unexplained sadness
• feeling of hopelessness
• increased temper
• nightmares
• panic attacks
• crying spells
• inability to cope
• cognitive losses (loss of reasoning skills)
• lack of usual communication skills
• random fears
• general disorientation
• aggressive behaviour
• marital or family problems (that did not exist prior to injury)
• memory loss - long term
• fear of crowds

In addition to these symptoms that are acknowledged as related to diffuse electrical injury (DEI), persons who have sustained a electroconvulsive injury (ECI) through electroconvulsive therapy (ECT) also report a high degree of docility and being easily controlled. Since these are seen by the perpetrators of this type of assault as being some of the most beneficial effects of ECT, these symptoms are dismissed as much as the acknowledge symptoms from the same injury sustained accidentally or by an acknowledged assault. Due to being docile and easily controlled, the victims of such assaults usually remain under the medical “care” of their assailants. Although many of these assailants are completely ignorant of the serious damage they are inflicting and the medical research into diffuse electrical injury, some are well aware of the injuries they are inflicting.

Please take a minute to save some people and sign our Petition · BAN THE USE OF ECT IN NZ · https://www.change.org/p/new-zealand-government-ban-the-use-of-ect-in-new-zealand?recruiter=108623255&utm_campaign=twitter_link_action_box&utm_medium=twitter&utm_source=share_petition … 

ECT Resources Center by Peter R. Breggin M.D.

ECT Resources Center by Peter R. Breggin M.D.

Lake Alice abuse govt statements

Psychiatric Patients—Abuse Claims

6. TARIANA TURIA (Co-Leader—Māori Party) to the Attorney-General: Will the Government commit to establishing a settlement process to respond to claims being made by former patients of Porirua and other psychiatric hospitals, along the lines of the inquiry headed by Sir Rodney Gallen into abuses at Lake Alice Hospital; if not, why not?

Hon Dr MICHAEL CULLEN (Attorney-General): No; the Government’s view remains that the claims are materially different in important respects.

Tariana Turia: Does the Government accept that the claims now being made by former patients of Porirua and other psychiatric hospitals are essentially similar to the claims made by the former patients of Lake Alice Hospital for which the Government has paid compensation; if not, why not?

Hon Dr MICHAEL CULLEN: No, the Government does not accept that. There are a number of differences: the Lake Alice Hospital claims allegations related to a confined period; the claimants were all treated by the same doctor; contemporaneous medical records enabled the circumstances to be well established and verified; and also, of course, an approach was made in that case for discussion in terms of allowing people’s stories to be heard. There are, therefore, some significant differences. Obviously, we shall await what happens through the court legal process.

Dr Jonathan Coleman: Who took the decision to withhold $35,000 from the compensation awarded to Mr Paul Zentveld by Sir Rodney Gallen, and did that person or persons also order similar amounts to be withheld from the 87 other second-round claimants in the Lake Alice Hospital case?

Hon Dr MICHAEL CULLEN: I cannot be certain of this, but my recollection is that that was a collective decision in the end, and was not the decision of an individual Minister.

Tariana Turia: Why has the Government decided to force the victims of mistreatment, who have already been severely traumatised, to go through the torment of court procedures in order to seek justice; and would the taxpayer-funded costs be better used to reach settlement with the claimants?

Hon Dr MICHAEL CULLEN: I accept these cases are always extremely difficult. I do not deny the issues around the way people feel about their experiences. But one of the more difficult issues that always comes into play in these kinds of considerations is what was generally accepted at the time these things occurred, not what is the general acceptance at the present time as to what should have occurred. If we do not actually ask the former question, the Government could be liable for an extraordinary wide range of compensation across an extraordinary wide range of issues.

Tariana Turia: Does the Government accept that the claims now being made by former patients at Porirua and other psychiatric hospitals are evidence of a widespread culture of violence and abuse towards psychiatric patients that existed between the 1950s and the 1980s; if not, why not?

Hon Dr MICHAEL CULLEN: There have been many changes in culture. We regarded it as normal in the 1950s and 1960s to lock up large numbers of people in mental hospitals, perhaps for the remainder of their lives—sometimes, merely because they had an intellectual disability, not any form of mental illness. These days we do not accept such forms of treatment or behaviour as being within the norms of a modern society. That does not mean to say the Government should be paying compensation to everybody who was kept in a mental hospital in the 1950s and 1960s. We have to be very careful here about how practices and attitudes have changed over time.

@johnkeypm afraid to have a Royal Commission into child abuse in NZ

9. Domestic Violence and Child Abuse—Call for Royal Commission

9. JAN LOGIE (Green) to the Prime Minister: Does he stand by his reported comments that the Government would need to seek advice before deciding whether a Royal Commission into domestic violence and child abuse, which Owen Glenn has offered to fund, was necessary?

Rt Hon JOHN KEY (Prime Minister) : I stand by my actual response to the question, which was “We need to consider all of the issues of what might come out of the royal commission.” That is something I have not taken advice on yet.

Jan Logie: Why does the green paper not deal directly with domestic violence, given that every year police attend 73,000 domestic violence call-outs, and report that 70 percent of these cases also involve child abuse?

Rt Hon JOHN KEY: I think if the member wants a very detailed answer, she really should put the question down to the Minister for Social Development. But what I can say is that the green paper on vulnerable children actually tangentially deals with that issue, because, by definition, vulnerable children are often subject to domestic violence.

Jan Logie: How can he tell this House that the Government is serious about domestic violence, when it has recently closed the family violence unit in the Ministry of Social Development, cut funding to domestic violence education programmes, and reduced funding for the family violence sector to a state of chaos?

Rt Hon JOHN KEY: Firstly, I reject the statements made by the member. I would not even put them as questions; I really would put them as statements. But let me just say this: in terms of the work we have undertaken in 2012 alone, the white paper on vulnerable children, which will be released later this year, has had over 10,000 submissions, which we will be looking closely at. The Health Committee has initiated an inquiry into preventing child abuse and improving children’s health outcomes. Obviously, there is the ministerial committee that is being led and co-chaired by Bill English and Tariana Turia, and there is an Expert Advisory Group on Solutions to Child Poverty. They are examples of just some of the background work we are doing that is informing the policies that the Government has been operating.

Jan Logie: Given all the international evidence indicates—as well as our local police statistics indicate—a direct link between domestic violence and child abuse, given the evident severity of this problem in New Zealand, which is getting worse, and given the evident poor institutional response, how can the Prime Minister not commit to support an inquiry to find a long-term, sustainable solution to domestic violence, including child abuse?

Rt Hon JOHN KEY: I think we take issue with the statement by the member that it is getting worse. The information we have is it is probably levelling off. In terms of the work the Government has been doing, there are many, many strands of that. But if the purpose of the member’s question is to ask whether the Government supports Owen Glenn using part of the very generous $80 million donation he has made to fund a royal commission of inquiry, then the answer to that is, no, we do not support that. The reason for that is that it is my own view that that is an incredibly generous act from Owen Glenn, but he would be better to spend the money on on-the-ground solutions within at-risk communities, because, frankly, this country has had a lot of inquiries over the last decade, and we need to move towards some practical solutions. He should use his money for that.

Jacinda Ardern: Does he agree, then, that the inquiry into the determinants of well-being for Māori children by the Māori Affairs Committee, the inquiry into preventing child abuse and improving children’s health outcomes by the Health Committee, the Expert Advisory Group on Solutions to Child Poverty—the Children’s Commissioner’s expert’s group—and the green paper process on vulnerable children mean we have the evidence we need, but the issue lies in the Minister allocating in the Budget a mere $6 million to respond to all of this work?

Rt Hon JOHN KEY: No. What I think is that there are a variety of different strands of information gathering and inquiring going on. And, frankly, having another one is probably not going to take us very far. This country has an issue when it comes to domestic violence, it has an issue when it comes to child abuse, but, actually, if Owen Glenn wants to spend $80 million—and it is an incredibly generous donation—I think if he went out to South Auckland and spent that money on the ground, in that community, he would make a bigger difference.