KEY POINTS:
Years ago in this column I pointed out that our so-called mental health system was in complete disarray and that the people managing it seemed to be more mentally incompetent than those they set out to treat.
I suggested that unless something was done - and smartly - more innocent lives would be lost or seriously traumatised. Obviously nothing has changed.
My greatest concern then was, and still is, that the people who suffer most from the system's wrong-headed obsession with the concept of "community care" are the mentally ill themselves.
Many so afflicted are still being condemned to lives of fear, anxiety and distress because the safety, security and comfort of an institution is no longer available to them - a place where they can live free of the pressures of modern-day life, with which even those of us without mental problems from time to time have trouble coping.
A report in this newspaper on Saturday revealed that seriously ill people are being discharged from Auckland's acute mental health clinic despite having nowhere to go.
In a report to their union, the Public Service Association, Auckland mental health staff have pointed out the gap they believe exists between Auckland's acute mental health clinic's policy, and its day-to-day practice.
They said there was an unwritten tenet within the Te Whetu Tawera clinic that short admissions indicated competent practice/treatment and that lengthy admissions indicated the opposite.
Managers at the city's 58-bed acute mental health facility actively pressured mental health workers to discharge patients, despite knowing the discharges were often not in the patients' best interests, they said.
The rehabilitation facilities the discharged patients should be moved to were invariably full. Such a practice was "high-risk" and compromised the welfare and safety of the patients, leaving staff expected to make "stupid" decisions that would be detrimental to their patients' health.
But the Auckland District Health Board's regional director of mental health services, Ian McKenzie, told the Weekend Herald the report was wrong to assert patients were being discharged with nowhere to go.
Nor did he think there was a culture of encouraging short stays at the unit.
So whom do we believe? The staff, obviously, because angry and frustrated staff members back up what they say with fatal examples, among them:
* One patient discharged from the unit was told there was a year-long waiting list for the rehabilitation facility needed and subsequently committed suicide.
* Another entered the unit after a suicide attempt, made another suicide attempt while at the facility, then entered into a suicide pact with a fellow patient. Despite obvious signs of intent to cause self-harm, that patient was discharged to the street and was found dead just a short time later.
Yet all Mr McKenzie can do is point to a Ministry of Health review last year which said: "Rather than focusing on structural change, we should be improving the competence of all our clinical staff."
What utter bollocks. The problem is not with clinical staff, it is with the flawed ideology that rules mental health services and the consequent lack of facilities to cater for the long-term and sometimes irretrievably mentally ill.
Ten years ago, mental health leaders in Britain and the United States admitted that the politically correct attempt to redefine mental illness and to treat the mentally ill "in the community" had not worked, and they have returned to institutional care for many.
The thoroughly discredited "institution bad, community good" litany has never made sense. I spent a few months in Kingseat Hospital back in the 1970s. I was desperately sick and in need of a haven and I remember with gratitude the gentle care I received there.
My mother-in-law spent the last five years of her life at Sunnyside Hospital in Christchurch. She, too, found herself unable to cope "in the community" and spent what were probably the most cosseted years of her life at Sunnyside, cared for by a dedicated, professional, compassionate staff.
In the past decade or so, scores - if not hundreds - of psychiatric patients have not survived the trauma of having nowhere safe to live; and many of those who do survive live lives of abject misery.
Lately there has been controversy over the number of homeless sleeping rough in downtown Auckland.
You can bet that most of them are mentally incapable or disturbed, and in kinder times would have been given a safe, long-term haven in an institution.
We have specialist institutions for those with broken limbs, cancer, heart and any number of other physical diseases; for mothers and babies; for children. Why on earth can't we have adequate institutions for those of us with broken minds?
