Two years ago, aged 18, she tried to kill herself and was placed under the Mental Health Act in Wakari psychiatric ward near Dunedin. During her stay she says she was diagnosed with depression, forced to have seven rounds of electroconvulsive therapy (ECT) and injected with sedatives.
Nothing was working; she was tired of being away from home and tried to kill herself again.
Emma (not her real name) says she was then pinned down by nurses, stripped naked and locked in a small room – part of a practice called seclusion – inside the forensic ward; the general psychiatric seclusion rooms were full. They had also run out of gowns.
On the hard floor there was no mattress or pillow, she says, despite these being mandatory items for patients in seclusion. Emma used a blanket to cover her body from nurses routinely peeping through the observation window.
She rested her head on the cardboard bedpan she’d been given to use as a toilet and relieved herself on the floor, she says.
At its birth, 22 years ago, the Mental Health (Compulsory Assessment and Treatment) Act of 1992 was radical. New Zealand had finally rid itself of the “loony bins” of Janet Frame’s era following a de-institutionalisation movement in the 1970s. Lobotomies and screaming patients chained to chairs were yesteryear. Seclusion replaced padded rooms and straitjackets. The future of humane psychiatry was now.
We charged forward but somewhere along the way our commitment to adequate mental health care faltered, say experts, including the ombudsman and our disability commissioner. In fact, things are so bad they’ve gained international attention. The United Nations Working Group on Arbitrary Detention visited last year, urging the Government to review the Mental Health Act and dubbing seclusion a form of torture that violates human rights law, particularly when mental illness or intellectual disability is concerned.
Advocacy groups have tried repeatedly over the past decade to ban electric shock therapy.
“We’re witnessing knock-on effects from a government that’s doing as little as possible to help mental health, including cutting back on funding and getting rid of the Mental Health Commission in 2012,” says Sarah Gordon.
She wrote a paper calling for the Mental Health Act to be reformed to avoid discrimination and it was published in the New Zealand Medical Journal last year.
The number of people on the jobseeker’s benefit due to psychological or psychiatric conditions has more than doubled since 2000 and there’s been a significant rise in police calls about attempted or threatened suicides.
“These interactions are complex and time-consuming, taking on average two to three hours to resolve,” says Assistant Police Commissioner Dave Cliff.
Police respond to almost 500 mental health jobs a week on average.
In a bid to help staff deal with this the Royal NZ Police College recently rolled out new mental health training for recruits.
“We’re witnessing a worsening epidemic that’s not only significantly affecting health services but a whole range of other agencies. Until we address it, the result – other than human misery and disability – is an overburdened health service and economic loss.”
The Southern District Health Board says Emma should complain to the board, not the media, so it can investigate her claims.
Emma isn’t comfortable with that: “There’s always the worry that since you’re the mentally unwell one, no-one will believe you.”
Despite Emma waiving her right to privacy and her claims being relayed (as asked) to the DHB, it wouldn’t confirm whether they were true or comment, saying: “For the integrity of any investigation process it is important that we avoid discussion on the matter.”
The DHB did agree to answer general questions around seclusion in email format.
Dr Brad Strong, the clinical leader of the Southern DHB, says people being put into seclusion are provided with basic necessities, a bed with bedding and a pillow.
“They also have access to drinking water, toilet facilities and a hand basin. Reading material or music can be offered depending on the clinical needs of the person. Most people are able to remain in their own clothes or they can change into hospital-supplied pyjamas.
“It is considered a temporary and infrequently used approach that can allow clients to calm and recover their emotional balance in a low stimulus environment.”
Research proves otherwise, says Disability Rights Commissioner Paul Gibson.
“For many people, seclusion has a detrimental effect and for those in permanent seclusion – there’s five people in New Zealand who’ve been locked up for a year – that’s even more detrimental.”
A range of patients who had been locked up under seclusion were spoken to for this article. Many were fearful of speaking openly.
The overall feeling was one of helplessness – “You’re virtually stymied in every way. It’s what I assume it feels like to be in prison but the irony of it is it’s not a crime to be mentally ill yet we end up getting treated like blimmin prisoners,” says Suzy Stevens, who experienced seclusion last year.
Stevens, who suffers from bipolar affective disorder and bouts of psychosis, was admitted into a psychiatric ward after her partner raised concerns about her behaviour and policemen “frogmarched” her straight into a seclusion room.
After six hours, a friend who worked for the DHB was alerted to Stevens’ seclusion and visited. At her behest, Stevens was given food and subsequently released.
In a former job, Stevens worked in the mental health sector and this made for an unsettling experience when she came under the act.
“People knew me, the manager of the unit knew me. It was like I’d stopped being who I was and was wearing the garb of a patient and therefore didn’t exist.”
Stevens left her mental health job – finding it too stressful – and now runs a cafe in the Bay of Plenty. What helps her come down from an intense high or balance out a depressing low is yoga, going for walks and aromatherapy. “I’m stuck in the world of psychiatric drugs but when I’m well I try and have that inner calm.”
There are alternatives to seclusion but they involve more resources. New York State has outlawed seclusion – nurses sit with those in agitation and distress.
Other hospitals have invested in sensory modulation – using sight, sounds, smells (essential oils), movement and items like weighted blankets and rocking or massage chairs. These help people learn self-soothing techniques and how to change their emotional and behavioural responses to stressful situations in positive ways.
We have to be cautious about being too quick to eliminate seclusion, says John Dawson, an Otago University professor who specialises in mental health law.
“The concern is that other means such as the over-medication of people may be used in critical situations as the alternative. Other approaches more harmful than seclusion could take its place.”
Director of Mental Health Dr John Crawshaw says he is aware of this in working towards ultimately eliminating the use of seclusion.
“Part of the challenge is you don’t want any perverse outcomes,” he explains. “We actually want to reduce the drivers that lead to seclusion and improve the outcomes for people who have significant challenges with mental health and addiction problems.”
In Janet Frame’s autobiography, An Angel at My Table, the author recounts her discharge from a mental hospital after more than 200 applications of ECT in the 1950s. She describes them as “each the equivalent, in degree of fear, to an execution, and in the process having my memory shredded and in some aspects permanently weakened”.
Today things are different.
Modern-day ECT is given “just like any other hospital operation”, says Crawshaw.
Administration is ongoing, usually twice a week, and patients are wired up so an electrical current can pass through the whole brain causing a brief intentional seizure.
The reason it works – although the claim that it works is hotly contested – remains a mystery. There are multiple theories such as that the seizure causes alteration of certain chemicals in the brain. Another suggests it adjusts the stress hormone regulation in the brain which affects energy, sleep, appetite and mood.
But passing a jolt of electricity through the brain isn’t without risk and many doctors think the side effects – permanent memory loss, confusion, disorientation – can outweigh any possible benefits.
Steve Green, the executive director of the Citizens Commission on Human Rights, has been petitioning for New Zealand to completely ban ECT – one petition which nearly went over the line in Parliament was to stop it being forced on pregnant women, the elderly and children. “Some people say it works as a last resort but how do you define that?”
In 2013, 253 people had ECT, according to the Director of Mental Health Annual Report, and 2341 treatments were administered – about nine per patient.
Of this number, 60 were deemed as not having the capacity to consent and were involuntarily treated. Another six were seen as having the capacity to consent but were still involuntarily treated.
Emma was involuntarily given ECT and says it was the most invasive treatment she had against her will. She was made to have it when she was suicidal and refusing medication. As is legally required, two psychiatrists had to agree it was in her best interests.
In her discharge sheets the hospital stated: “an improvement in physical depressive symptoms was objectively identified” and that “she also intermittently acknowledged some subjective improvements in feeling better in herself for short periods after ECT”.
“It’s terrifying to know someone is going to give your brain an electric shock and make you have a seizure,” Emma says. “I got used to it, though. It was twice a week. Basically you can’t eat the day you get it until after you’ve had it because you have to go under a general anaesthetic. You’re asleep while it actually happens. I did get pretty bad headaches afterwards and the first few times I threw up when I woke up . . . I experienced some memory problems . . . and I tend to assume any memory problems I have today, over a year later, are because of the ECT.”
Have you, a friend or family member experienced seclusion or ECT? Email jess.mcallen@fairfaxmedia.co.nz.
– Sunday Star Times
