A State of Mind

Mental Health and Human Rights Part 1

Shame, by FredArmitage, with Creative Commons LicenceNot all stories go away when the last interview is conducted, the last comment noted, when the final connections fade. Some linger because they defined a moment, or a decade – a vital arc of time – and remind us of a shame that’s never really shifted. They need to be retold because other people should know, have to know. I recently met a very well-respected psychiatrist for whom I’ve been editing almost eight years now – the vagaries of operating over the Internet simply meant we’d never crossed paths in all that time. I mentioned in passing that I grew up in Townsville, the second largest city in Queensland, northern Australia. He responded with a question: did I remember Ward 10B, the psychiatric wing of the Townsville General Hospital, did I know what happened there?

I did, and I also recalled a more recent echo.

This is a story that needs to be retold because it speaks to the concern I aired in a recent post that the media and the general public are still – in a new millennium, just as the future is supposed to beckon – disdainful of mental health, reluctant to give it the same consideration as physical injury, stuck in a past of shadows and shame. In this and the next post I’ll consider the relationship between mental health and the deprivation of human rights, first in relation to place and organization, and then in relation to individual and family. The sort of workaround, one of those ways of getting by and getting better, that I mentioned in my last post will come into play as the short series concludes.

For now, the outlook is a little more grim.

In 1973, the Townsville General Hospital established a psychiatric ward under the care of Director John Lindsay and Registrar Bevan Cant that was modelled as a therapeutic community, in partial response to concerns that mental health care be decentralised and deinstitutionalised. The aim was to offer an environment in which staff and patients were as close to equal as possible, and where patient problems were dealt with as part of a group.

This might sound beneficial, but even in the 1970s the concept was seen as outdated, with changes in social structures and patient needs cited against any adherence to a rigid model of practice. And Ward 10B, as it was designated, was chronically understaffed. By early 1975, the relatives of patients were starting to complain about a range of malpractice. But the experiment lasted even beyond Director Lindsay’s early retirement due to ill health in 1985, spluttering out only as the 1980s drew to a close.

The ward ended not with a bang, but with a whimper.

What makes this particular episode in psychiatric history truly disturbing is that in the course of its existence, 65 patients who passed through the ward died, with 27 suicides connected to ward practices. To give you a point of comparison, at that time Townsville had a population of around 100,000 – it wasn’t a particularly large town. The deaths were noticed. People talked about them, but the whole affair carried with it a sort of ghostly fear in the public mind

Questions, by weba, with Creative Commons licenceIn a 2002 edition of Health and History, Emily Wilson covered the situation with a degree of objectivity that would have been difficult, given that in the previous few years media coverage of the situation had been intense. A commission of inquiry led by W.J. Carter had also unearthed cases of neglect, physical abuse, verbal intimidation, the use of drugs to stupefy patients and the inclusion of committed patients in group therapy when only voluntarily committed patients were supposed to attend.

Throughout all this, even when public criticism had reached it peak in 1986 and 1987, the ward’s Director and Registrar seem to have genuinely believed that their methods were effective and humane. Not surprisingly, they were backed by at least 12 staff members who offered their somewhat sycophantic support at every turn, ensuring that the Director who replaced John Lindsay and abandoned the therapeutic community ideal resigned in less than a year.

As I’ve written before, the deprivation of human rights isn’t always obvious, but it does have a basis in the abuse of individuals by institutions, whether edifices like governments or hospitals, or social norms like labour practices. When institutions emerge and we accept their authority without a great deal of questioning, the path from incidental neglect to forceful abuse is not terribly difficult to tred.

Describing a two and a half year inquiry into mental illness and human rights undertaken in response to Ward 10B and other abuses in mental health care around the nation, Human Rights Commissioner Brian Burdekin spoke in 1993 of mentally ill Australians still not receiving access to resources, treatment, the results of research and protection of their basic rights. His main point makes for sobering reflection, even today:

The deprivation, discrimination, marginalisation and stigmatisation still suffered by the hundreds of thousands of Australians affected by mental illness is a national disgrace.

You might be thinking that time heals all wounds, that 15 years is a long time for reform. And in some ways it has been. The aging, disgraced Townsville General Hospital near the coast in North Ward is no more, replaced by a state-of-the-art edifice inland, close by the university and a new medical school.

But some things have stayed the same.

By 2005, all Queensland hospitals had been investigated by a commission of inquiry. The report issued makes for distressing reading, especially that part of the section on Townsville dealing with the Mental Health Service at the new hospital. In 2000 and 2001 the unit employed a Russian migrant, Vincent Berg, as a Resident Medical Officer. He arrived to serve as a psychiatrist when the unit was short staffed, and treated patients between January and October 2001. The only problem was that Berg had faked his credentials. He had no training and his lack of credible clinical judgement soon became apparent.

What is most distressing about this case is that Berg took several months of sick leave at the end of his year-long contract and was never sacked. His deception only became obvious after he left Townsville when his credentials were shown to be false by the Russian university at which he claimed to have studied and worked. No-one from the Townsville Hospital was even aware of the deception until November 2002, and staff waited until January 2003 to contact the police. In June 2003 the hospital management advised the police that it did not want to press charges against the bogus doctor.

So much for equal rights for mental health patients under the law.

A subsequent investigation found that at least one patient died from a fall probably related to an incorrect dose of medication prescribed by Berg. A small echo of Ward 10B.

State Of Mind (152/365), by Icky Pic, with Creative Commons licenceBut an even more disturbing aspect of both stories is that people with mental illness, and even those who think they might have mental illness, tend to doubt the validity of their own concerns. The doctor, the institution, the system, these are the holy trinity of medicine, the godhead of health care. Only God can judge. In the old hospital patient rights were abused and the patients themselves tended not to complain. That was left to their relatives. In the new hospital, that sort of self-deprecation became expected, institutionalised. When Vincent Berg’s former patients were contacted about their treatment they weren’t even told that he lacked qualifications.

Queenslandpeople used to say, and sometimes still do – is just a state of mind.

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