The Origins of Deinstitutionalisation in New Zealand: Exploring the Shift from Institutional to Community-Based Mental Healthcare

The Origins of Deinstitutionalisation in New Zealand
Author(s): Warwick Brunton

Source: Health and History, Vol. 5, No. 2, Histories of Psychiatry after
Deinstitutionalisation: Australia and New Zealand (2003), pp. 75-103
Published by: Australian and New Zealand Society of the History of Medicine, Inc
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The Origins of
Deinstitutionalisation in
New Zealand
Warwick Brunton
From the earliest planning of the original nineteenth-century

provincial lunatic asylums until around 1965, mental health policy-
makers and administrators in New Zealand endeavoured to tackle the
causes of 'institutionalisation', admittedly with limited success. Lofty
policy intentions gave way to the realities of severe socio-political, ther-
apeutic, staff, and capital constraints, as policy ideals were at odds with
the practicalities of running an institution. The institution's multiple
social functions of cure, care and custody took precedence over the
significant values of patient dignity, individuality and privacy. Institu-
tions imposed fundamental values like safety, order, neatness, cleanli-
ness, and occupation over lifestyle concerns such as variety, fashion
or homeliness. Effective individual care was juxtaposed with efficient
care for many. Benevolent principles were espoused from the power
relationships of paternalism and hierarchy that permeated a centralised
bureaucracy.
By exploring earlier aspects of the detrimental effects of institu-
tionalisation, the concept of deinstitutionalisation - the phase gener-
ally associated with psychiatric hospital closures - can be seen as an
extension of policy rhetoric that developed during the heyday of insti-
tutional psychiatry. The early identification of the problems of insti-
tutionalisation and attempts to combat this are also central features
of deinstitutionalisation, and this article explores some of those strong
threads in New Zealand's national mental health policy. I endeavour
to show that many policies for the development of New Zealand's psy-
chiatric services and policies of institutional reform aimed to address
problems of institutionalisation, that is, to prevent or to mitigate the
undesirable psychosocial effects of long-term residential care. I will con-
centrate on the identification of this problem and the changes that
occurred in New Zealand before 1965, and the start of the modern
era of deinstitutionalisation, and show that this was governed by the
dual and often competing interests of patient welfare and/or a curtailing
of the financial costs involved. Finally, I shall suggest that the generic
name for these changes was 'deinstitutionalisation' (see Figure 1).
Health & History, 2003. 5/2: 75-103 75
76 WARWICK BRUNTON
Figure 1: Determinants of Deinstitutionalisation.
The Origins of Deinstitutionalisation in New Zealand 77
As in many Western countries, special-purpose institutions known

at various times as lunatic asylums, mental hospitals and psychiatric
hospitals were once the mainstay of New Zealand's mental health ser-
vices. A network of provincial government-run (public) asylums was
established between 1854 and 1876. These were taken over and run
by a central government department from 1876 until 1972, when their
administration was devolved to elected local hospital boards. By 1900,
six public asylums served catchments areas that corresponded to for-
mer provincial boundaries. Only Ashburn Hall (1882), the sole pri-
vate institution, received patients from all over New Zealand. The
growth, location, and closure of general mental health facilities are
shown in Figure 2 (see next page).
At their peak, thirteen public and three private psychiatric hospitals
provided some 10,100 beds for those deemed to be psychiatric patients.1
At this time, these hospitals were expected to handle the majority of
psychiatric patients 'for many years to come'.2 Yet the hegemony of
psychiatric hospitals was slowly challenged, evidenced by the appar-
ent decision in 1963 to plan no more of them and the 1973 decision
to build no more institutional accommodation.3 In the wake of these
decisions, a national survey recommended that 26 per cent of all patients
with a psychiatric diagnosis be considered for placement in a range of
accommodation settings outside psychiatric hospitals.4 Follow-up to
the survey was haphazard but the momentum of institutional rundown
and closure increased during the 1980s under the twin pressures of laud-
able social objectives and fiscal imperatives. The word deinstitution-
alisation has been used in New Zealand for about twenty years to
describe these developments in psychiatric services,5 largely supersed-
ing the earlier descriptor of 'community care'.6 The term 'decarcera-
tion' has not generally been used as a synonym. Currently in New
Zealand, deinstitutionalisation invariably refers to the drastic down-
sizing or closure of psychiatric hospitals.7 Today, only three public psy-
chiatric hospitals and Ashburn Clinic still provide general mental health
services (mainly forensic, extended hospital and rehabilitation and/or
acute services) on their original sites. All do so on a greatly reduced
scale compared with years gone by. These remaining institutions take
their place among a myriad of integrated and community-based men-
tal health services.8
New Zealand has shared in the international interest in the medi-
cal, social and administrative history of psychiatry since the 1970s.9
Institutional psychiatry has been of particular interest in academic
research, and has partially eclipsed the earlier institutional perspective
of history-conscious mental health officials and professionals. The cor-
pus of knowledge remains a somewhat disparate collection of studies,
with an emphasis on local institutions and the professionalisation of
78 WARWICK BRUNTON
Figure 2: Psychiatric Hospitals (1854-2003) and General Psychiatric

Services (1 963) in New Zealand.
Notes for Figure 2:

1. The dates indicate when each institution was operational.
2. The main psychiatric hospital at Auckland was known at various times
as The Whau, Auckland, Avondale, Oakley and Carrington.
3. The map does not show intellectual disability hospitals. The closing date
shown for Nelson refers to the decision to transfer psychiatric services to Ngaw-
hatu and to retain the original site for intellectual disability purposes. Braemar
Hospital still serves that purpose on the same site. The starting date for Ngaw-
hatu refers to the initial transfer of psychiatric patients to Stoke Farm.
4. Sunnyside Hospital, Christchurch is now known as Hillmorton Hospital.
5. Queen Mary Hospital, Hanmer Springs, specialised in functional nervous
disorders. It is now operated by a private company and specialises in the treat-
ment of alcohol and drug dependency.
6. Public psychiatric hospitals for Nelson and Otago comprise separate cam-
puses. Hospitals in the same vicinity were administered as a group.
7. Ashburn Hall (now named Ashburn Clinic) is a private facility.
8. Outpatient clinics held at most psychiatric hospitals are not listed.
Sources: Department of Health, The Functions and Responsibilities of the Division of

Mental Health, Department of Health, New Zealand, The Division, Wellington, n.d.,
c. 1963; Board of Health, Psychiatric Services in Public Hospitals in New Zealand,
The Board, Wellington, 1960.
psychiatry supplemented by biographies of some significant officials

and former patients. The rich clinical and social information recorded
in patients' files at some psychiatric hospitals has been an attractive
source for social class and gender analysis, for instance, in the work
by Bronwyn Labrum about gender and the Auckland Asylum and in
Barbara Brookes' study of Seacliff Asylum.10 A steady stream of essays
by University of Otago postgraduate history students has been
brought together recently in published form to provide an unparal-
leled regional picture.11
The nineteenth and early twentieth centuries have fascinated New
Zealand scholars, but very few studies have crossed the threshold of
the therapeutic revolution in psychiatry. Hilary Haines and Max Abbott
traversed some landmarks of psychiatric deinstitutionalisation with-
out observing that, in its broadest sense, such policy originated from
institutional administrators themselves.12 Elsewhere I have attempted
to provide a national policy overview of the recent phase of deinsti-
tutionalisation.13 More regional case studies to span the institutional
past and the turbulent modern or post-institutional phase in New
Zealand would not only deepen knowledge in this field, but would
also probably be cathartic for those who participated in any capacity
in the process of deinstitutionalisation.
80 WARWICK BRUNTON
Deinstitutionalisation
Is there a word that can adequately describe the thrust of the plans
and policies outlined in this article? The Oxford Dictionary defines
deinstitutionalisation as 'the process or action of removing (a person)
from an institution, such as a mental hospital'. More important for
the purpose of this paper, the definition also includes removing a per-
son '... from the effects of institutional life'.14 Early wordsmiths seem
to have used deinstitutionalisation as shorthand for measures that
helped to break down the negative effects of insulated institutional com-
munities. J. W. Grime has been attributed with coining the word in
1934, apparently in the context of reforming mental hospital regimes
and conditions.15 More than twenty years later, a would-be English
wordsmith devised the word 'disinstitutionalisation'. The only clue pro-
vided about the meaning was mention of a Christmas shopping expe-
dition by a mentally defective hospital patient that suggested a process
of restoring patients' social links with the outside world rather than
destroying the institutional environment.16
The currently fashionable use of deinstitutionalisation to refer to
hospital downsizing and closure is an acquired meaning; it is certainly
not its only meaning. According to Leona Bachrach, who has written
extensively on the topic for many years, the reduction of psychiatric
hospital censuses is critical but only part of a wider process of dein-
stitutionalisation.17 George W. Dowdall has provided additional soci-
ological meanings, such as the shift of the State mental hospital from
a central to a more peripheral role in the mental health system and
the declining legitimacy of the State mental hospital as the taken-for-
granted caregiver for the seriously mentally ill.18 In a recent interna-
tional overview, Walid Fakhoury and Stefan Priebe suggest that
deinstitutionalisation should be regarded either as an historical pro-
cess or, more widely, as the general process of diminishing the role of
any institution, including all community-based institutions, in mental
health care.19 In 2001, the World Health Organization (WHO) sug-
gested that deinstitutionalisation was not the same as dehospitalisa-
tion.20 In that case, could not all measures that are intended to remove
the effects of institutional life, particularly the negative effects, be con-
sidered as measures of deinstitutionalisation?
Institutionalisation
Deinstitutionalisation is derived from 'institutionalisation' and 'insti-

tutionalise'. Institutionalise, in a broad sense, means to be brought up,
housed or trained in an institution, or the process of subjecting some-
The Origins of Deinstitutionalisation in New Zealand 8 1
one to institutional life, especially for a period of time, that results in

an unfitness for life outside an institution. Those people subjected to
this process can also show signs of the influence of institutional life.21
Negative psychosocial and behavioural effects of institutional life
on residents have been acknowledged in mental health literature for
many years. In 1859, John T. Arlidge condemned 'a gigantic asylum'
as a 'gigantic evil, and figuratively speaking, a manufactory of chronic
insanity'. But, as Scull says, it was not the only such expression of con-
cern.22 The five reference texts used in this article have been chosen as
markers because they shaped, or can be reasonably presumed to have
influenced and supported, policies for preventing or mitigating the
problems of 'institutionalisation' in New Zealand. No doubt other
works and journals aroused similar interest among policy-makers and
they may also have made some policy impact as well. Unfortunately,
this is now difficult to establish as the evidence of the intellectual pol-
icy networks that would have been found in relevant archives and
library collections has been lost, dispersed or destroyed.
The first two works, John Conolly's The Construction and Gov-
ernment of Lunatic Asylums and Hospitals for the Insane (1847) and
The Treatment of the Insane without Mechanical Restraints (1856),
appeared at a time when lunatic asylums were identified with the ther-
apeutic optimism of the non-restraint system. Two late Victorian
books - Die Kolonisirung der Geisteskranken, or The Colonization of
the Insane in Connection with the Open-door System, by Albrecht
Paetz (1893) and Charles Mercier's Lunatic Asylums: Their Organ-
isation and Management (1894) - were written amid the tide of ther-
apeutic despair and social stigma surrounding the growing number of
increasingly huge, custodial and impersonal institutions. Finally, the
World Health Organization Expert Committee on Mental Health's
third report, The Community Mental Hospital (1953), arrived at a time
of rekindled therapeutic optimism brought about by electro-convul-
sive therapy (ECT) and the prospect of psychopharmacology, both of
which were to change irrevocably the character of psychiatric hospi-
tals. WHO's advice was to spare the newly emerging nations of a post-
colonial world the bitter lessons of institutionalised patterns of psych-
iatric care experienced by developed countries.
Each of these five works, that span a century, consistently refers to
the undesirable effects that institutions could have on their inmates.
In the nineteenth century, Conolly believed that institutional care was
generally among the 'most efficacious parts of direct treatment', but
he also knew that asylums created 'oppressive influences'. Asylum staff,
and particularly the medical superintendent, had to prevent or rem-
edy large-scale 'irritability of the mind' lest patients slip into a state
of 'apathy or imbecility', hopeless dementia or torpor.23 Mercier wrote
82 WARWICK BRUNTON
of life-long 'hopeless dement[ia]\ He believed that institutional life

destroyed 'feelings of self-respect' and made many patients 'wretched',
and guarded against 'the love of idleness [that] grows by indulgence,
until all inclination to work disappears'.24 Paetz blamed the 'monotony
of institution life' for crippling the intelligence and depressing the spir-
its, 'so that reaction in either sphere becomes ever weaker and finally
fades away altogether'.25
In the twentieth century, WHO's report identified boredom, inac-
tion and regression into a 'dependent and infantile attitude'. By con-
trast, according to WHO, the non-institutionalised patient could be
distinguished by self-confidence, self-respect, personal identity, 'ini-
tiative, responsibility, and self-sufficiency'.26 These ideas had been fore-
shadowed in the nineteenth century. Conolly wanted his patients
'animated, active, and even industrious', with an 'intelligent and cheer-
ful expression', restored mental faculties and ready to converse.27 As
for Mercier, he sought signs of individuality, self-respect, comfort, and
happiness.28
In 1955, only two years after the publication of WHO's landmark
report, D. Martin gave the name 'institutionalisation' to the mental
and social process by which patients settled down and then became
resigned to institutional life and routines, and in their passivity lost
their individuality and initiative. He claimed that patients co-operated
with, or submitted to, the power of the institution to mould people to
suit its interests. They did so because of a combination of factors. Once
in hospital, patients were relieved of personal responsibility for their
mental problems. They were absorbed into the organised life of an insti-
tution that supplied their basic needs, organised their leisure, provided
them with routine work in utility departments, and punished those who
did not conform by transferring them to refractory wards. Doctors and
nurses, who were trapped by divided professional and managerial loy-
alties, were in too short supply to be able to offer individual care.29
Russell Barton maintained a clinical critique when he pathologised
institutionalisation as a neurosis in 1959.30 His analysis contributed to
the intellectual assault on psychiatric hospitals the following decade.
The history of psychiatry was revised by scholars such as Michel
Foucault, David Rothman, Klaus Dorner, and Andrew Scull, who inter-
preted the establishment and growth of asylums in Europe, the United
States and England as instruments of social control and professional
power, and not as the products of humanitarian reform and scientific
enlightenment.31 Radical social scientists and psychiatrists such as
Erving Goffman, Thomas Szasz, Thomas J. Scheff, and Ronald D.
Laing joined the attack upon institutions and medicine in general, and
psychiatric institutions and psychiatry in particular.32 Here the antipsy-
chiatry movement was formed.
Institutionalisation did not become a pejorative term until the 1960s.

By then, uncannily accurate accounts from the perspectives of a
patient - Janet Frame, at Seacliff, Sunnyside and Oakley Hospitals -
and a nurse - Marion Kennedy, at Porirua Hospital, c. 1945-55 - had
tellingly revealed many facets of institutionalisation, similar to those
exposes of mental hospitals in overseas fiction, biography and film.
Frame's Faces in the Water was used officially to inform psychiatric
hospital staff about the effects of institutionalisation.33 Kathleen Jones
and A. J. Fowles, in their analysis of the implications of long-term insti-
tutional care and custody, listed the following identifiable elements as
indicative of the negative effects of institutional care: a loss of liberty
and autonomy; depersonalisation; low material standards; and social
stigma.34 In the rest of this article, I would like to outline the ways in
which various twentieth-century policies in New Zealand can be seen
as a response to the problems of institutionalisation. In order to chart
these responses, I will look at New Zealand policy development and
implementation in five thematic sections: early New Zealand asylums
and the construction of an institutional environment; the era of cen-
tralised administration and its impact on policy decision making regard-
ing the perils of 'institutionalisation'; and the stagnation and redemption
of the centralised system through planning and development initiatives
and internal reforms.
Early New Zealand asylums

Following imperial precedent and practice in other settlement colonies,
lunacy became a matter of public policy in New Zealand in the early
years of the colony between 1840 and 1852. Similar arrangements to
those in England were applied to other parts of the British realm and
adapted to the circumstances of the settlement colonies. The public
policy framework for lunacy devised for England in 1845 was based
upon the recognition of lunacy as a distinct social problem. The State
intervened through comprehensive lunacy legislation, the mandatory
provision of a chain of county lunatic asylums as vehicles for intro-
ducing progressive medical practice, regulation of privately run mad-
houses, and the establishment of a specialised permanent bureaucracy.
The foundation of lunatic asylums in New Zealand was consistent
with the prevailing English preference for managing social problems
in special-purpose residential institutions with their own distinctive ther-
apeutic or management regime. New Zealand, like other colonial set-
tler colonies, was informed by the growing body of literature about
the ideal nature and function of each type of institution. Thus, the
lunatic asylum emerged along with general and specialist hospitals, infir-
84 WARWICK BRUNTON
maries, madhouses, workhouses, prisons, reformatories, boarding

schools and orphanages. Their colonial counterparts included provin-
cial (public) hospitals, industrial schools, gaols, benevolent refuges,
orphanages, old people's homes, and children's homes but not poor law
institutions. Special residential schools, or farm colonies for children
with special needs, TB sanatoria, inebriate institutions, and children's
health camps were later manifestations of the institutional principle.
The Crown colony and most provincial governments in New
Zealand associated proper treatment with lunatic asylums rather than
lock-ups or hospitals. Provincial governments were given the respon-
sibility of providing and monitoring facilities for care and treatment
within the requirements of national legislation and some national stan-
dards. The first two reference texts by John Conolly (1794-1866), the
leading English alienist and exponent of the non-restraint system at
Middlesex Asylum, Hanwell, England, were invaluable during this for-
mative phase. Colonial policy-makers accepted many of Conolly's ideas,
and provincial asylum authorities and newspapers of the period cited
his works authoritatively.35 The parliamentary library acquired Con-
olly's treatises between 1872 and 1876, at a time of heightened polit-
ical interest in national lunacy reform.36
Many of Conolly's ideas were adopted in early New Zealand asy-
lums, although every provincial asylum fell far below his recommended
limit of 360-400 beds.37 Several of the original asylums, like Sunnyside
(now Hillmorton Hospital) at Christchurch, followed a semi-domes-
tic character and style of architecture. In Figure 3 (see opposite page),
the quasi-domestic scale of the original building at Sunnyside (1863)
is apparent when compared with the superintendent's residence in front
of it. Only the partially built brick Whau Asylum at Auckland look
set to become massive and 'gloomy'.38 The first national guideline of
200-300 beds, set in 1877 after the central government took over the
management of asylums, would also have met Conolly's concern for
tranquillity, homeliness and individuality.39 The non-restraint system
was hailed as the epitome of practice in provincial asylums. After vis-
iting New Zealand, a distinguished Scottish alienist concluded in 1869
that 'humane, modern and enlightened views' pervaded asylum offi-
cials and 'every disposition existed to imitate, if not to rival, in their
arrangements, the asylums of the home country'.40
However, the noble aspirations of the non-restraint system were not
attained. In New Zealand, variable performance was partly 'a reflex
of the varying fortunes' of provincial treasuries.41 The heady therapeutic
optimism that surrounded the foundation of asylums and the intro-
duction of moral management soon wore off. Some forms of physical
restraint returned, but the activation aspects of moral management sur-
vived as beneficial for chronic as well as recoverable patients.
Figure 3: The quasi-domestic scale of the original building at Sunny-

side Asylum (1 863) is apparent by comparing it with the superinten-
dent's residence in front of it, c.1870.
Source: Canterbury Museum negative 5130.
The era of central administration
After the demise of provincial governments in 1876, the central gov-

ernment set up a department to run the system of lunatic asylums. This
organisation, known as the Lunatic Asylums Department (1876-1905)
and Mental Hospitals Department (1905-47), advised ministers on
mental health policy, administered mental health legislation and reg-
ulated private services. Following the merger of the Mental Hospitals
Department with the Department (now the Ministry) of Health in 1947,
the Division of Mental Hygiene/Health (usually referred to as the 'divi-
sion') carried on these functions, minus the management of mental hos-
pitals after 1972. The central government organisations were run by
an inspector-general (1876-1927), director-general (1927-47) or, after
1947, director of the Division of Mental Hygiene/Health of the Health
Department. Incumbents were required to be medical practitioners with
special qualifications or experience in psychiatry, and we shall meet
most of them in due course: F. W. A. Skae (1876-81); G. W. Grabham
(1882-86); D. MacGregor (1886-1906); J. F. Hay (1907-24); F. T.
(later Sir Truby) King (1924-27); T. G. Gray (1927-47); J. Russell
(1947-50); R. G. T. Lewis (1950-60); G. Blake-Palmer (1960-64); and
S. W. P. Mirams (1964-1979).
Top-down leadership and administrative continuity provided ways
of addressing problems of institutionalisation nationally. General pol-
icy pronouncements, operational policy directives issued as circular
memoranda, and staff rulebooks that set out detailed standards could
86 WARWICK BRUNTON
lead to systemic changes. Improvements could be effected through

direct management control of the nation's psychiatric institutions.
Under centralised bureaucratic management, system- wide policies usu-
ally trickled from front to back wards, from acute and convalescent
to long-stay patients, and from large to small and from newer to older
institutions. Marked discrepancies in standards were inevitable.
During the near-century of departmental administration, the policy
environment made it difficult for officials to withstand the various pres-
sures that disposed patients to institutionalisation. The department
operated within a political environment characterised by fickle pub-
lic attitudes that varied from apathy, suspicion, stereotypes and curios-
ity, tinged with spasmodic bursts of compassion. 'A sojourn in an
asylum leaves behind it a ban and disqualification', an early newspa-
per wrote of the stigma that girdled mental disorders, institutions and
committal.42
Mental health lacked a strong social and political lobbying power,
so State-run institutions were poorly resourced and overcrowded.
Intractable shortages of psychiatrists and attendants (psychiatric nurses)
narrowed officials' attention to the maintenance of essential care in
institutions. In 1962, the director stipulated that only when the qual-
ity and number of institutional staff had been increased could the cadre
of professional workers effectively extend a 'range and scope of ser-
vices within the community with good prospects of continuity'.43
Departmental ideals were often squeezed between the fiscal and
social objectives of public policy. For example, the proud tradition of
never turning away anybody who required treatment could fairly test
facilities to bursting point.44 With few respites, severe overcrowding
and building backlogs often reduced institutions across the country to
a 'hand to mouth existence' until the early 1960s.45 In 1947, the direc-
tor of Mental Hygiene, J. Russell, said that
bed-space will be quite enough for me to overcome in my time, and I will

see to that before I ever recommend expenditure on a Church or Recreation
Hall, etc.46
Simply trying to provide enough basic accommodation had to take

precedence over the modernisation of older facilities or the provision
of institutional amenities. 'The common-sense order' of providing bet-
ter housing for patients 'able to appreciate their environment' ahead
of those unable to do so was adopted.47 Russell took a similar line as
J. F. Hay had between 1907 and 1924, declaring that priority must go
to the 'best medical attention and treatment of Recoverable [sic] cases',
then 'the best institutional care' for other patients.48 Janet Frame recalled
that a recoverable or convalescent patient was 'treated as a person of
The Origins of Deinstitutionalisation in New Zealand 8 7
some worth, a human being'. Back ward patients tended to be 'for-

gotten people'.49
Therapeutic limitations also increased patients' susceptibility to insti-
tutionalisation before the 1950s. Lunatic asylums were established pri-
marily to care and to treat insane people, especially those who posed
a danger to themselves or to others, but they gradually acquired a catch-
all role in the light of changing social, medical and legal perceptions
of insanity. Most psychiatric hospitals eventually accommodated some,
if not many, persons who suffered from intellectual handicap/disabil-
ity or its older names of mental defect or mental subnormality. The
generic title 'mental hospital' included both New Zealand's psychiatric
hospitals and specialist residential institutions for intellectually disabled
people. These were known at different times as farm colonies, psy-
chopaedic hospitals, hospitals and training schools, or intellectual hand-
icap hospitals.50
Most patients faced little prospect of recovery and discharge: 'There
is no panacea', declared Hay in 1910. Treatment was directed with all
the understanding of the present state of science. 'This may not be
much, but it is all', he wrote.51 In 1875, 76 per cent of the country's
lunatics were deemed to be incurable. That number rose to 93 per cent
of the resident asylum population in 1905 but slowly fell to 60 per
cent in 1945, the eve of a new era.52 Even after therapeutic break-
throughs meant that 'there was no longer a one-way traffic', as Kennedy
put it, psychiatric hospitals were home for a large residue of chronic
patients.53 In 1961, 66 per cent of mental hospital patients had lived
there for five years or more.54 Long-term patients, who were sometimes
called 'chronics' or 'lifers', easily lost their pre-hospital familial and
social connections. More than 40 per cent of patients at Kingseat, a
rural psychiatric hospital in South Auckland, were never visited.55
Stagnation and redemption
The socio-political, fiscal and therapeutic environments placed enor-

mous strain upon institutional management and exacerbated the risk
of widespread institutionalisation. In 1877, Inspector-General F. W. A.
Skae complained that overcrowding had led to the 'attendant evils of
enforced idleness and loss of individual treatment', which was jeop-
ardising patients' mental well-being.56 Overcrowding locked adminis-
trators into a constant struggle to provide enough beds both to meet
increased demand and the accumulated backlog of chronic patients.
New Zealand asylums expanded in number and stagnated in quality,
just like those in other countries. The average size of English asylums,
for example, trebled from 297 beds in 1850 to 961 in 1900, and by
88 WARWICK BRUNTON
1930 had climbed to 1221. 57 New Zealand's asylums also expanded

like 'India-rubber balloons', as a Dunedin newspaper put it.58 The aver-
age size quadrupled from 104 beds in 1876 to 399 thirty years later.
The figure peaked in 1936 at 785 beds.59 A notional twentieth-century
limit of 1000-1100 beds lasted until 1961.60
Departmental administrators responded to the challenge of institu-
tionalisation in two main ways: through the general planning and devel-
opment of mental health services, and by making improvements to the
patients' quality of life. I shall consider each approach in turn.
Planning and development

The central department inherited from the provinces an accommoda-
tion crisis of major proportions. Only limited relief was possible from
mandated care outside institutions, but alternatives simply to 'institu-
tionalised' care were starting to be discussed. Provisions for single
patients, bonded placement and repatriation had been copied from
English to New Zealand law in 1868, and leave was first authorised
in 1882.61 Greater use of leave eased the pressure on bed-space, but
only 0.8 per cent of all patients were absent on leave in 1901.62 The
Scottish scheme of subsidised 'boarding out' offered potential relief,
and was a psychiatric equivalent of comparable concepts in penal and
social welfare systems, such as outdoor relief, parole or boarding out
of State wards. One-quarter of all registered lunatics in late nineteenth-
century Scotland boarded with and helped the families of crofters or
tradesmen.63 Boarding out was mandated in New Zealand in 1882,
but although provisions remained on the statute books, they were used
only rarely. Many patients lacked friends willing to take on the respon-
sibility, too few farmers were prepared to employ patients and the gov-
ernment offered no incentives.64 Most importantly, colonial society held
'an unreasonable aversion' to insane persons.65
The lack of a safety-valve, like boarding out, increased the pressure
on institutional accommodation and ensured the continuing detrimental
effects of 'institutionalisation' on patients. How might the rearrange-
ment of existing architectural spaces and asylum grounds be used to
alleviate the causes of institutionalisation inherent in a large asylum?
F. W. A. Skae found an answer in 'simple, homely, and inexpensive'
wooden cottages, like the one opened at Hokitika in 1879. Harmless
chronic patients generally preferred living in these than in 'a vast
Asylum'.66 But although Skae recognised the general potential of cot-
tages, they remained an adjunct to a capital program based on large
buildings in permanent materials, presumably because of a strong min-
ister's preference for that style.67
Different sized cottages were built at several asylums in an ad hoc

manner in the late nineteenth century. However, G. W. Grabham, who
succeeded Skae in 1882, was horrified to find grand corridor-style build-
ings underway at Auckland, Christchurch and Seacliff. He minced no
words in condemning the style but was unable to halt their construc-
tion.68 The asylums stayed within an increased ceiling of 500 beds, but
people just had to 'make the best' of the layout for many years to come69
as the large wards were not easily altered.70 Sunnyside, for example,
was stuck with wards of 65-106 beds.71
Such massive capital developments were a far cry from the emerg-
ing ideal espoused a decade later by Charles Mercier (1852-1919) and
Albrecht Paetz (1851-1922). In 1894 Mercier, the prominent English
alienist who wrote extensively on medico-legal matters, produced a
comprehensive guide to the planning and management of asylums.72
The department ordered a copy for its modest library the following
year.73 Paetz's work, published in 1893, was slower to gain official atten-
tion.74 Paetz ran a State asylum at Alt-Scherbitz, near Leipzig, an estab-
lishment comprising a central block for patients needing special care
and a series of villas for different 'colonies' or classes of patients who
worked on the farm and in the fields of the manor. Although not the
first colony for the insane in Germany, Alt-Scherbitz was probably the
best known among English-speaking alienists, thanks to an anonymous
review of his book in the Journal of Mental Science.75 The department
subscribed to this journal, and several senior officials received their own
copy as members of the Medico-Psychological Association. The depart-
ment eventually obtained a copy of Paetz's work and had it translated.76
Mercier favoured an asylum of 600 beds divided, ideally, into wards
of no more than ten beds, and a maximum of thirty beds, with some
four-five bed units and a generous provision of single rooms.77 Mercier's
views came too late to influence the design of the first new post-provin-
cial asylum at Porirua (1891-1901) built in the 'gallery' style, a design
that was said to have departed no 'further than experience then war-
ranted from the accepted English and American practice'.78 By 1896,
however, new accommodation in auxiliary buildings at Auckland and
Seacliff followed the 'pavilion' style of architecture that Mercier claimed
was generally preferred.79 These reforms were directed at rectifying the
effects of 'institutionalisation' brought about by large-scale asylum
accommodation.
Paetz, far more than Mercier, inspired major change in the plan-
ning of New Zealand asylums. Alt-Scherbitz Asylum had 830 patients
but buildings in the style of 'friendly, simple villas or country houses'
with twenty-five to fifty beds and many single rooms made for a human
scale.80 Paetz's villa style soon superseded the short-lived support for
pavilion-style architecture in New Zealand, and helped validate exper-
90 WARWICK BRUNTON
iments with cottages by transforming the idea into national policy. The
anonymous review of Paetz's book in the Journal of Mental Science
was the most likely source of information available to F. T. (later Sir
Truby) King, then medical superintendent of Seadiff Asylum (1889-
1920). King thought Paetz's 'complete Colony system' had potential,
so in 1897 he wrote to him requesting details.81 King was excited at
finding 'so easy and cheap a remedy' for overcrowding and non-clas-
sification.82 His superior, D. MacGregor, then had Paetz's work trans-
lated and made further inquiries. MacGregor was convinced that this
'new system' should be followed in any new asylums,83 and in 1903
this policy was approved.84
Paetz had made a convincing case for the villa system: villas cost
less to build and were easily replicated; patients felt at home in the
attractive surroundings; and classification and graduated freedom were
easily implemented.85 New Zealand experience subsequently confirmed
these and other benefits. Staff increased their therapeutic responsibil-
ity, which meant that more individual attention and treatment were
possible. Separate buildings reduced fire and sanitary risks, and the
wooden buildings could be erected quickly (see Figure 4 below).86
The villa system became a hallmark of New Zealand's mental health
system and was applied wherever and whenever possible. New villa
hospitals, like Tokanui (1912), intentionally avoided 'the institutional
Figure 4: The detached cottage (1 898), for newly admitted and conva-
lescent women patients at Seadiff (right foreground), stands in marked
contrast to the massive main building some distance behind it, c. 1915.
Source: Author's collection.
idea'.87 By 1969, 73 per cent (5681) of all psychiatric patients lived in

new villa-style hospitals, a figure that excludes villas in older psychi-
atric hospitals.88 As the system took hold, the standard villa evolved
into a typical fifty-bed unit with several separate dormitories, a scale
that reputedly avoided 'monolithic aspects'.89
However, the priority for well-appointed villas was given to new,
recoverable and convalescent cases. The 'beautiful' cottage for women
at Seacliff (1898) and another at nearby Waitati (1904) sold MacGregor
upon the idea of 'reception houses'.90 His successor, J. F. Hay, was
equally wedded to the notion.91 Hay knew the Scottish version of this
idea, which resembled the central block of Alt-Scherbitz and housed
the physically sick and those who required special mental care. By the
end of Hay's inspectorate, every mental hospital had a reception home
that was situated at some distance from the main buildings and
approached by a separate driveway. This spared newly arriving 'saner
and more self-respecting' patients the sight of 'untidy, obviously imbe-
cile or demented patients'.92 'Neuropathic hospitals', a refinement of
the reception home style, retained these features. The first, Hornby
Lodge (1922), catered for 'well-conducted ladies' and offered superior
facilities like private sitting rooms and special private nurses.93
Advertised as 'entirely detached curative sanatoria' (sometimes several
miles from the main campus), neuropathic hospitals aimed to promote
individual treatment. Their attractive grounds and amenities left 'lit-
tle to be desired' and avoided 'the appearance of an "institution"'.94
Figure 5 (see next page) shows a day room in the Wolfe Home, the
reception house at Auckland Mental Hospital, in 1925. It was attrac-
tively and tastefully furnished by contemporary standards.
A generally media-shy department tried to combat stigma by the
broad policy that Hay called the 'hospitalization [sic] of the institu-
tions'.95 Officials were first attracted to the hospital model in the 1880s
because 'insanity must be treated like any other disease'. MacGregor
identified the hospital model with scientific medicine and therapeutic
progress; the asylum with 'the safe-keeping of lunatics', and a 'hor-
ror' that deterred people from seeking early treatment.96
Hospitalisation encompassed several major policies. Firstly, between
1895 and 1944 attendants were slowly transformed into mental or psy-
chiatric nurses. They acquired all the professional trappings of gen-
eral nurses - a national training scheme, a registrable qualification,
uniforms, hierarchy, and badges. Secondly, the nomenclature changed.
From 1905 the term 'mental hospital', which sounded 'more scientific,
euphonious, and less compromising' than other terms, crept into offi-
cial parlance. 'Lunatic' and 'asylum' legally disappeared in 1911 and
institutions dropped 'mental' from their name in 1946.97 'Mental defec-
tive' faded from use after 1954.
92 WARWICK BRUNTON
Figure 5: Day room in the Wolfe Home, the reception house at

Auckland Mental Hospital, in 1925. Source: Author's collection.
The third major policy, of encouraging self-referral to mental hospi-

tals, was intended to eliminate the stigma of committal, which deterred
the 'more sensible and sensitive newly admitted patients' from seek-
ing help early.98 Committal always involved the courts, and sometimes
the police, and committed patients automatically lost their civil and
commercial rights. Progressive superintendents mustered professional
support, and voluntary admission entered the policy agenda in 1904
and became a major feature of new legislation in 1911." Self-referral
was used as an indicator of improved public attitudes. Voluntary admis-
sions rose steadily from 3 per cent of total admissions in 1912, until
in 1959 they exceeded committals for the first time.100 This gradual
process of increasing access to the community for hospital patients, as
well as the provision for voluntary committals, finally replaced the ear-
lier sole response to insanity as requiring only custodial care.
Although general hospital psychiatry was advocated in the 1890s,
it made little headway because specialist expertise was concentrated in
asylums. A legal framework existed for general hospital psychiatry, but
national politicians were loath to impose ideas upon local hospital and
charitable aid boards.101 During and after World War I, however,
women's organisations and other national bodies lobbied for 'halfway
houses' or other euphemisms for treating psychoneuroses outside men-
tal hospitals.102 As acting inspector-general (1924-27), King capitalised
on the mood, especially when hospital boards showed interest.103 His
proposal for outpatient *clinic[s] for nervous affections' carefully
avoided any implication of 'insanity, mental breakdown, or so-called

"border-line" trouble'.104 Wellington Hospital (1925) set the precedent
for clinics elsewhere by using mental hospital psychiatrists.
King's reform package also included transit care in metropolitan gen-
eral hospitals to avoid reverting to police cells and lock-ups. Graced
with the name of psychopathic wards, these 'observation blocks' bore
little resemblance to the sophisticated treatment centres of their
American namesakes, as an active therapeutic role was generally dis-
couraged.105 Local happenstance and fluctuations in the availability of
departmental psychiatrists resulted in haphazard outreach that grew
'like Topsy'.106 Seaview achieved a 'quite remarkable' regional service,
but that was unusual.107 In 1960, a Board of Health review criticised
the patchy range of acute inpatient and outpatient psychiatric services
in public hospitals. The major expansion then recommended forms the
backbone of today's regional network.108
The postwar therapeutic transformation that really put the 'hospi-
tal' into psychiatric hospital began to shorten the length of stay dra-
matically for patients. It also made a big difference in the use of leave
provisions, which rose from 5.5 per cent of the total mental hospital
population in 1942 to 11.7 per cent in 1965.109 Electro-convulsive ther-
apy, and then psychopharmacology, opened up the prospect of what
the WHO report termed 'the gradual return to social effectiveness', a
term that increasingly applied to long-term patients.110 The focus upon
rehabilitation was apparent in institutions through the trial and exten-
sion of new categories of professional or semi-professional staff who
would, in various ways, counteract the effects of 'institutionalisation'.
Occupational therapists (1940), psychiatric social workers (1948),
recreation/welfare officers (1955), hospital chaplains (1961), and domi-
ciliary psychiatric nurses (1961) ran structured programs and liaised
with community groups. They helped patients accept greater respon-
sibility for daily living and work as preparation for rehabilitation out-
side the hospital. Occupational therapists ran domestic skills units for
long-stay patients at some hospitals.111 Kingseat's Villa 6 became a reha-
bilitation centre for long-term patients, with each dormitory having
its own leader to organise points for an incentive scheme (1961). That
same year, industrial rehabilitation therapy began at Auckland.112
The report of the WHO Expert Committee on Mental Health added
weight to these policies for, and the practical implementation of, reha-
bilitation that were directly aimed at removing the effects of long-term
institutionalisation on patients. The New Zealand Health Department
Library accessioned this WHO report, as well as other WHO publi-
cations, and also incorporated the former Mental Hospitals Department
collection. The initial government response was made on the strength
of a WHO press statement at the time the report was released, and
94 WARWICK BRUNTON
probably some time before the report reached New Zealand's shores.
The director's marginalia indicated that the general thrust of the report
was compatible with existing policy directions, and its main features
were quickly endorsed. The report was distributed to individual insti-
tutions113 and became a reference point.114 Several of the WHO report's
specific suggestions were implemented during Blake-Palmer's direc-
torate, such as the establishment of day hospitals and of the first dis-
charge hostel, Cornwall House, Wellington, in 196 1.115 The living
conditions in the early discharge hostels approximated those of a board-
ing house.116 Guidelines set out the expectations of a therapeutic com-
munity.117 Other WHO ideas, like in-patients' or ex-patients' clubs, were
adopted at some hospitals.118 WHO's challenge to integrate male and
female patients was implemented at the admission unit at Seaview in
1962. Male and female patients fast developed a keen interest in cook-
ing and housekeeping.119
Internal reform
Improving living conditions and standards of care for all patients was
the second long-term departmental strategy to ameliorate the effects
of institutionalisation. This strategy was multi-faceted and included var-
ious measures such as increased liberty and autonomy; acknowledge-
ment of the individuality, dignity and privacy of patients; a maintained
comparability with general standards of dress, food and homeliness;
and the increased social acceptability of mental disorders and places
for its treatment. Progress was generally slow except during interspersed
periods of policy activity like those of 1925, 1947 and the early 1960s.
Such measures reflected a number of significant improvements in New
Zealand society. The following is a sketch of some of the internal prac-
tical responses and improvements that took place.
The references discussed throughout this article demonstrate how
the policies adopted in New Zealand were consistent with international
yardsticks. Take the principle of appropriate freedom of movement,
for example. Mercier believed 'that no restriction is justifiable that is
not required by the circumstances of the individual case\no Paetz's
' off en-thur-sy stem* [or open-door system] required freedom [freiheit]
as 'the rule, when possible, not the exception'.121 Paetz drew heavily
upon the open-door policy, which was a characteristic of the Scottish
system. MacGregor, by the time he would have received these two texts,
had already aligned himself with 'universal experience', which held that
the greatest possible freedom and regard to individual tastes for employ-
ment did far more good than drugs.122 Hay, too, noted how 'a large
measure of liberty' reduced attempts by patients to escape.123
The open-door policy was among 'salient factors' monitored by

inspections and statistical returns.124 In probable continuation of an
earlier trend, the percentage of patients in New Zealand confined to
airing courts (fenced exercise yards) fell from 39 to 18 per cent between
1922-45. Those patients with ground or outside parole privileges
increased from 14 to 38 per cent, while worker patients rose from 50
to 59 per cent.125 In a fully functioning villa hospital, Gray aimed to
have between 60 and 72 per cent of patients living in open wards.126
Consistent with WHO's emphatic view that patients must be assumed
to be trustworthy and 'to retain the capacity for a considerable degree
of responsibility and initiative', 68 per cent of mental hospital patients
were living in open wards by I960.127
Departmental administrators knew that patients reacted badly to
poor living conditions. G. W. Grabham maintained that 'cheerfulness
is essential for counteracting the depressing influences of asylum life',128
while Hay thought that homeliness certainly 'softened' the institutional
feeling.129 Again, these values were consistent with contemporary ref-
erence texts. Mercier's management objective was 'to approximate the
life of the insane to the life of the sane, as far as the approximation is
possible', so an asylum should have a 'comfortable and homelike air'.130
Paetz was anxious to avoid 'any resemblance to an asylum at all'.131
One way that New Zealand officials acted on these principles was
by putting female attendants in charge of male wards from 1900
onwards. The purpose of this policy was to cultivate a more refined
and homelier environment.132 Experience at Hokitika showed that under
the 'gentler influence' of female charge attendants, male patients were
quieter, better behaved and more willing to work. They were gener-
ally 'cleaner, more smartly clothed, and better served with meals'.133
Some newer psychiatric hospitals, like Ngawhatu or Kingseat, knew
no other system until the policy had to be reluctantly suspended in
1940 because of a desperate shortage of female nurses. The policy was
abandoned altogether in 1947 because of this continuing shortage.134
Without doubt the greatest single improvement in institutional liv-
ing conditions arose from the major reform package of Mabel Howard,
Minister of Health (1947-49), and J. Russell, director (1947-50). The
package included moves towards 'a much more comfortable and home-
like appearance' in facilities generally.135 Armchairs, tables and chairs
replaced solidly built furniture, and coloured bedspreads superseded
'universal white quilts' on wooden, not iron, bedsteads. Floral designs
replaced plain cream curtains and haircord runners were swapped for
floor rugs. Mirrors were installed in female wards and hairdressing
salons were set up in every hospital.136
Commissioning new villas was a slow but steady way of improving
conditions, but the older Victorian-era buildings all remained 'capable
96 WARWICK BRUNTON
of brightening up and of increased comfort'.137 In 1956, Auckland's med-

ical superintendent complained about the slow rate of progress, stat-
ing that '[pjeople from decent homes do not take kindly to cruel sanitary
conditions', and that large dormitories offended patients' privacy, which
was 'one of a person's most cherished privileges'.138 At Sunnyside in
Christchurch, 'every effort' was insisted upon to enliven the hospital's
'chaste and somewhat cautious' interior expanses of stone, cream or
white with 'other and relatively neglected bands of the spectrum'.139
Value was also placed upon policies that supported the notion of
individual care. Again, these were consistent with the ideals of the texts
explored here. Mercier longed for the time when 'management of
patients by the gross will give way to management of the individual'.140
Paetz was also adamant about personalised care. 'Unter gehoriger
Sonderung nach ihren individuellen Vershiedenheiten...' [appropriately
separated from others according to their individual differences], he
wrote, in calling for special occupation and classification that took
account of the individual differences in mental functioning, tenden-
cies, habits, and capabilities.141 Mercier believed that women took pride
in their appearance when they could see themselves in a mirror.142 Paetz
engendered a sense of occasion by allowing patients to wear special
clothes.143 Sixty years later, WHO strongly urged that 'every step' should
be taken to 'encourage the patient's self-respect and sense of identity,
even at the cost of considerable inconvenience'.144
Staff numbers, rosters, ward size, and prognosis all determined the
practical level of individual care and attention, but this occurred within
the operational policy set out in departmental rulebooks. Staff were
required to show proper respect in their relationships with each
patient,145 and doctors expected to know their patients individually. A
legal prompt from 1911 required that every committed patient was to
be reviewed annually, and the clinical state of every chronic patient
recorded six-monthly.146 Clinical patient files replaced cumbersome case-
books to improve clinical record-keeping on chronic patients.147
The real yardsticks of individuality were the matters that concerned
patients' dignity, privacy or pride. Take clothing, for instance. Until
the 1880s in New Zealand, it seems, patients could wear their own
clothes, but by 1913 the practice had virtually disappeared.148 Patients
in uniform were clearly part of an 'institutionalised' environment. In
1927, under ministerial direction, medical superintendents were
instructed to ensure that recoverable and new patients wore styles and
varieties of clothing like those worn by people on the outside. Newly
admitted patients could regularly wear their own clothes and lockers
were provided for the storage of personal effects.149 However, the pol-
icy was slower to reach the great majority of patients who were wholly
or largely maintained at State expense, and who wore their own clothes
only on visiting days or special occasions.150 'Objectionable looking'

moleskins were still issued at Auckland in 1936, nine years after they
were supposed to have been phased out.151 The director-general was
perturbed to find 'holey' socks, missing buttons and ill-fitting clothes,
which, he said in 1940, was evidence of neglect.152
Asked for ideas to improve clothes and footwear in 1945, medical
superintendents enthusiastically called for greater colour, attractiveness
and variety.153 Their suggestions were incorporated in the 'spectacular
improvements' of the 1947 reform package. Female patients were sup-
plied with underclothes and were allowed to make their own clothes
in the ward sewing room. Patients were also given a change of clothes
after work and night attire was introduced.154 Small laundries were
added so patients could wash their personal clothing.155 Men in some
wards were encouraged to shave daily if they wished.156 When patients
were given 'individual clothing, as far as is practicable', they took an
interest in their appearance and their behaviour improved.157
Discretionary spending was a symbol of autonomy. Patients' help
with menial tasks - on hospital farms, about the grounds, in laundries,
kitchens, workshops, and wards - provided mental stimulation and
physical activity. As the work was deemed to be therapeutic it was not
remunerated, although worker patients were rewarded with privileges
like parole, outings, entertainments, or extra food and tobacco. 'Maud',
the archetypal worker patient mentioned in Marion Kennedy's account
of Porirua in the 1940s, was allowed to wear her own clothes and was
given her own room that she adorned with knick-knacks.158 From 1918,
a few patients whose work saved the State from having to pay salaries
were paid gratuities.159 In 1924, patients whose maintenance payments
were up-to-date could draw up to 2s.6d. of their own funds to pur-
chase 'extras' or personal clothing.160 A 'comforts fund', set up in 1947,
extended to all patients deemed capable of appreciating it a small sum
to buy sweets, cakes, cigarettes, outings, or clothes.161 Entitlement to
social security benefits (1964) and wages for patients on work trial
were achieved with difficulty.162
Many of the practices showed the effort made to emulate 'normal'
community life as much as possible. Genteel manners were expected
subject, of course, to the mental condition of patients. Dignity, deco-
rum and self-pride were espoused in official standards for, say, bathing
or dining. For patients to eat their meals in a 'civilized manner', Skae
demanded that they be provided with white tablecloths, earthenware
and cutlery: horn spoons or enamel ware were generally unacceptable.163
A fresh bath should be run for every patient.164 Gray was affronted by
the last minute provision of toilet paper, soap and bedspreads before
his inspections.165 These aims were evident in the staff rulebooks that
regulated in detail good, or the 'ideal', practice from 1886-1971. 166
98 WARWICK BRUNTON
WHO advised that 'everything' must also be done for psychiatric

hospital patients to 'feel at home'.167 As part of this process, library buses
had started to call at mental hospitals after World War II. However,
providing the 'essentials for a good home community' was a long-term
program.168 Once the national accommodation crisis was over, halls and
other community amenities were constructed at hospitals that lacked
them. Chapels, libraries and pools were partly funded by subsidised
voluntary contributions. Director Blake-Palmer called this program 'the
architectural expression of the concept of a therapeutic community', a
favourite WHO term for the ethos of a community mental hospital.169
These illustrations of gradual improvements made over the years
show a determination by top officials to address, in many different
ways, some of the causes of institutionalisation among their charges.
Recurrent themes of the need for care and treatment characterised by
appropriate liberty, homeliness, respect for individuality, and social
acceptance can be derived from influential overseas texts. Such themes
became the values of the general course of New Zealand's mental health
policy and services. These values were manifest in strategic and oper-
ational policy and detailed standards of practice and procedure, and
influenced the planning and modification of institutional environments
and living conditions.
Conclusion
The running-down and closure of psychiatric hospitals in recent years

has been motivated, in part, by the desire to avoid some of the past
perils of institutionalisation. This process is generally called deinstitu-
tionalisation. The dictionary meanings of the root word 'institutional-
isation' include removing a person from the effects of institutional life
or from an institution itself. Both meanings are important because they
enable us to reconsider the starting points of the pathway of deinsti-
tutionalisation. Historians should at least consider the establishment
of rehabilitation services and community-based discharge hostels as part
of this narrative. And why not also include the first time that provi-
sion was made for probation or trial leave, boarding out, or the intro-
duction of psychiatric care treatment in general hospitals? If such
developments can be enfolded within the full meaning of deinstitu-
tionalisation, then what of other policies that were also intended to pre-
vent and ameliorate institutionalisation among psychiatric patients, even
within an institutional setting? This article has argued that such poli-
cies could also be included under the umbrella of deinstitutionalisation.
University of Otago
1. Department of Health, Submission to the Royal Commission of Inquiry into Hospital

and Related Services - Stage II, Psychiatric Services, vol. 2, 1972, appendices II - III. Figures
exclude psychopaedic hospitals.
2. Department of Health, A Review of Hospital and Related Services (hereafter Review),
The Department, Wellington, 1969, p. 97.
3. Deputy Director to Minister, 28 January 1963, Health Department Archives, Archives
New Zealand, Wellington, closed file H34528.
4. I. J. Jeffery & J. M. Booth, Survey of Patients in Psychiatric Hospitals, Department of
Health, Wellington, Special Report No. 47, 1974, p. 4. The proportion of patients may have
been higher had individual patients been independently assessed.
5. 'Deinstitutionalisation' was the theme of the Mental Health Foundation of New Zealand's
major national conference on the future of mental health services in 1985. The word crept
into official parlance soon after. See Department of Health, Review of Psychiatric Hospitals
and Hospitals for the Intellectually Handicapped, The Department, Wellington, 1986, p. 9.
6. Department of Health, Review, p. 107.
7. Leona L. Bachrach, 'Lessons from the American Experience in Providing Community-
Based Services', in Julian Leff (ed.), Care in the Community: Illusion or Reality*, Wiley,
Chichester, 1997, p. 23; National Library of Medicine, Cumulated Index Medicus,
Department of Health and Human Services, US, Public Health Service, National Institutes
of Health, National Library of Medicine, Bethesda, Washington DC, 1979, vol. 20, pp.
6604-5.
8. Janice Wilson, 'Mental Health Services in New Zealand', International Journal of Law
and Psychiatry, vol. 22, nos. 3^4, 2000, p. 219.
9. For a detailed historiography, see Warwick Brunton, A Choice of Difficulties: National
Mental Health Policy in New Zealand, 1840-1947, PhD thesis, University of Otago, 2001,
pp. 8-41. See also W. Ernst, The Social History of Pakeha Psychiatry in Nineteenth-Century
New Zealand', in L. Bryder (ed.), A Healthy Country, Bridget Williams Books, Wellington,
1991, pp. 65-84; Derek A. Dow, '"To Set Our Medical History into Order": An historiog-
raphy of health in New Zealand', Archefacts, April 1996, pp. 28-30.
10. Bronwyn Labrum, 'Looking Beyond the Asylum. Gender and the process of com-
mittal in Auckland, 1870-1910', New Zealand Journal of History, vol. 26, no. 2, 1992, pp.
125-44; Barbara Brookes, 'Women and Madness: A case-study of the Seacliff Asylum,
1890-1920', in Barbara Brookes, Charlotte Macdonald & Margaret Tennant (eds), Women
in History 2. Essays on Women in New Zealand, Bridget Williams Books, Wellington, 1992,
pp. 129-47.
11. Barbara Brookes & Jane Thomson (eds), 'Unfortunate Folk': Essays on Mental Health
Treatment 1863-1992, University of Otago Press, Dunedin, 2001.
12. Hilary Haines & Max Abbott, 'Deinstitutionalisation and Social Policy in New Zealand
1: Historical trends', Community Mental Health in New Zealand, vol. 1, no. 2, 1985, pp.
44-56.
13. Warwick Brunton, 'Mental Health: The case of deinstitutionalisation', in Peter Davis
&C Toni Ashton (eds), Health and Public Policy in New Zealand, Oxford University Press,
Oxford and Auckland, 2001, pp. 181-200; Warwick Brunton, 'Out of the Shadows: Some
historical underpinnings of mental health policy in New Zealand', in Margaret Tennant &
Bronwyn Dalley (eds), History and Social Policy, University of Otago Press, Dunedin, forth-
coming.
14. Oxford English Dictionary, 2nd edn, Clarendon Press, Oxford; Oxford University
Press, New York, 1989, vol. 4, p. 404.
15. George W. Dowdall, 'Mental Hospitals and Deinstitutionalization', in Carol S.
Aneshensel & Jo C. Phelan, Handbook of the Sociology of Mental Health, Kluwer Academic
/Plenum Publishers, New York, 1999, p. 521.
16. M. H. Armstrong Davison & C. Guy Millman, 'Letters to Editor', Lancet, vol. 269,
no. 2, 17 & 31 December 1955, pp. 1301, 1393.
1 7. H. Richard Lamb & Leona L. Bachrach, 'Some Perspectives on Deinstitutionalisation',
Psychiatric Services, vol. 52, no. 8, 2001, p. 1039.
18. Dowdall, 'Mental Hospitals and Deinstitutionalization', p. 520.
19. Walid Fakhoury & Stefan Priebe, 'The Process of Deinstitutionalization: An
International Overview', Current Opinion in Psychiatry, vol. 15, no. 2, 2002, p. 191.
100 WARWICK BRUNTON
20. World Health Organization (WHO), The World Health Report 2001, WHO, Geneva,
2001, p. 51.
21. Oxford English Dictionary, vol. 4, p. 404, and vol. 7, pp. 1047-8; New Shorter Oxford
English Dictionary, OUP, New York, 1993, vol. 1, p. 1383.
22. John T. Arlidge, On the State of Lunacy and the Legal Provision for the Insane,
Churchill, London, 1859, p. 102, cited in Andrew Scull, Social Order/Mental Disorder:
Anglo-American Psychiatry in Historical Perspective, University of California, Berkeley, 1989,
p. 244. See also J. Mortimer Granville, The Care and Cure of the Insane, Hardwicke &
Bogue, London, 1877, vol. 1, p. 120, cited in Kathleen Jones, Asylums and After: A Revised
History of the Mental Health Services from the Early 18th Century to the 1990s, Althone,
London, 1993, p. 120.
23. John Conolly, The Construction and Government of Lunatic Asylums and Hospitals
for the Insane, Churchill, London, 1847, pp. 39, 85; John Conolly, The Treatment of the
Insane without Mechanical Restraints, Smith, Elder & Co., London, 1856, pp. 65, 73.
24. Charles Mercier, Lunatic Asylums: Their Organisation and Management, Charles
Griffin, London, 1894, pp. viii, 79, 85, 208.
25. A. Erlenmayer, Die frie Behandlung der Gemuthskranken und Irren in 'Detachirten
Colonieen', J. H. Heuser, Neuwied, 1869, S. 7-8, cited in Albrecht Paetz, Die Kolonisirung
der Geisteskranken, Springer, Berlin, 1893, p. 22, and translated in Anon., '[Review of A.
Paetz], The Colonization of the Insane in Connection with the Open-door System...', Journal
of Mental Science (hereafter IMS), vol. 41, 1895, p. 699.
26. WHO, The Community Mental Hospital, WHO, Geneva, 1953, pp. 14, 18, 20, 22-3.
27. Conolly, The Treatment of the Insane, p. 65.
28. Mercier, Lunatic Asylums, pp. 6, 25, 29, 48.
29. Denis V. Martin, 'Institutionalisation', Lancet, vol. 269, no. 2, 3 December 1955, pp.
1188-90.
30. Russell Barton, Institutional Neurosis, John Wright & Sons, Bristol, 1959. The book
was remembered years afterwards as a cogent and succinct summary of the 'down side' of
institutional services. Author's personal communication with (the late) Dr S. W. P. Mirams,
Director, Mental Health Division, Department of Health (1964-79).
31. Michael S. Micale & Roy Porter, Discovering the History of Psychiatry, Oxford
University Press, New York, p. 7.
32. Joan Busfield, Managing Madness, Hutchinson, London, 1986, pp. 83-5.
33. Janet Frame, Faces in the Water, Pegasus, Christchurch, 1961; Marion Kennedy, The
Wrong Side of the Door, Harrap, London, 1963.
34. Kathleen Jones & A. J. Fowles, Ideas on Institutions, Routledge &c Kegan Paul, London,
1984, p. 200.
35. See Brunton, A Choice of Difficulties, pp. 78-9 for details.
36. General Assembly Library, Classified Catalogue of the General Assembly Library of
New Zealand, Government Printer, Wellington, 1872, p. 45, and 1876, p. 67.
37. Conolly, The Construction and Government of Lunatic Asylums, p. 10. Hanwell Asylum
had 1000 beds when Conolly went there in 1839.
38. Asylum Report, Auckland Provincial Government Gazette, 18 April 1874, p. 50.
39. Appendices to the Journals of the House of Representatives (hereafter AJHR), 1877
H-8, p. 6; Conolly, The Construction and Government of Lunatic Asylums, p. 10.
40. W. Lauder Lindsay, 'Suggestions for the Proper Supervision of the Insane and of Lunatic
Asylums in the British Colonies', British and Foreign Medico-Chirurgical Review, vol. 44,
1869, pp. 484-5.
41. Inspector of Asylums to Provincial Superintendent, 14 [?] July 1875, Otago Provincial
Archives, Archives New Zealand, Wellington, OP7/77.
42. Wellington Independent, 12 October 1871. See Brunton, A Choice of Difficulties, pp.
119-24, 149-51; AJHR, 1923, H-7, pp. 4-5.
43. AJHR, 1962, H-31, p. 60.
44. AJHR, 1965, H-31, p. 61.
45. Director to Commissioner of Works, n.d. [1954?], Mental Health Division Archives,
Archives New Zealand, Wellington, HMH26/9.
46. Acting Director-General to Medical Superintendent (hereafter Med. Supt), Seacliff,
22 October 1947, HMH 26/61.
47. AJHR, 1907, H-7, p. 24.

48. Acting Director-General, Circular, 15 August 1947, HMH25/21.
49. Janet Frame, An Angel at My Table: An Autobiography, vol. 2, Women's Press, London,
1984, pp. 109, 112.
50. The long-standing policy dispute over the merits of institutional programs for intel-
lectual disability between the department and the Intellectually Handicapped Children's
Parents Society is an important story in its own right, but lies outside this paper's focus on
psychiatric hospitals.
51. A/HR, 1910, H-7, p. 5.
52. Statistics of the Colony of New Zealand, 1905, p. 105; Institutional weekly reports,
Health Department Archives, Archives New Zealand, Wellington, W4415, ABQU, Box 617.
53. Kennedy, The Wrong Side of the Door, p. 261.
54. Department of Health, Census of Mental Hospital Patients, 1961, The Department,
Wellington, p. 2.
55. Zealandia, 4 October 1962.
56. Sunnyside Asylum Inspector's Book, 19 November 1877, Sunnyside Hospital Archives,
Archives New Zealand, Christchurch, CH 388/39.
57. Jones, Asylums and After, p. 116.
58. Southern Mercury, 14 April 1877.
59. Statistics of the Colony of New Zealand, 1876-1906; Institutional weekly reports,
W4415, ABQU, Box 617; departmental reports in AJHR.
60. AJHR, 1901, H-7, p. 3; Director-General to Minister, 2 May 1944, HMH8/0/1. The
ceiling was revised to +/- 850 in 1961. AJHR, 1961, H-31, p. 62. Major psychiatric hospi-
tals exceeded these limits as administrative entities, but their functions were sometimes spread
over several smaller campuses.
61. Lunatics Act 1868, ss. 48, 66-7, 69.
62. Statistics of the Colony of New Zealand, 1901, p. 95; Department of Health, Mental
Health Data 1965, The Department, Wellington, 1967, p. 9.
63. Harriet Sturdy & William Parry-Jones, 'Boarding-Out Insane Patients: The signifi-
cance of the Scottish system 1857-1913', in Peter Bartlett & David Wright (eds), Outside
the Walls of the Asylum, Athlone, London, 1999, pp. 86-114.
64. AJHR, 1881, H-13, p. 2 and AJHR, 1905, H-7, p. 2; Director-General to Minister,
17 October 1929, HMH8/8041; Commissioner of Pensions to Director-General, 13 May
1930, HMH3/7/1.
65. AJHR, 1892, H-4, p. 2.
66. AJHR, 1879, H^, p. 10 and AJHR, 1880, H-6, pp. 4-5.
67. New Zealand Parliamentary Debates (hereafter NZPD), 4 November 1879, [vol.] 33,
p. 61.
68. AJHR, 1885, H-10, p. 12, AJHR, 1886, H-6, pp. 6, 8.
69. AJHR, 1899, H-7, p. 3; Minister to H. Bourne, 6 May 1960, H34275.
70. AJHR, 1913, H-7, pp. 7-8.
71. B. E. P. McCullough, A Study of Endemic Typhoid Fever at the Sunnyside Mental
Hospital, Christchurch, Preventive Medicine thesis, University of Otago, 1934, pp. 70-3.
72. Mercier, Lunatic Asylums.
73. Minister to Agent-General, London, 31 May 1895, Inspector-General's Outward Letter
Book 6, p. 121, current whereabouts unknown. For an explanation of missing records, see
Brunton, A Choice of Difficulties, pp. 477-9.
74. Paetz, Die Kolonisirung der Geisteskranken. Mr Holger Steinberg of the Archiv fur
Leipziger Psychiatriegeschichte, Universitat Leipzig Klinik und Poliklinik fur Psychiatrie kindly
provided me with the text. Mr Andrew Crooks most helpfully translated parts of this work.
75. Anon., '[Review of A. Paetz], The Colonization of the Insane in Connection with the
Open-door System... ', pp. 697-703. For details of insane colonies in Germany, see H.C.
Burdett, Hospitals and Asylums of the World, Churchill, London, 1891, vol. 1, pp. 422-3.
76. AJHR, 1899, H-7, p. 3.
77. Mercier, Lunatic Asylums, pp. 4, 6, 25.
78. ibid., p. 6; AJHR, 1899, H-7, p. 3.
79. AJHR, 1897, pp. 2, 6; Mercier, Lunatic Asylums, p. 6.
80. Paetz, Die Kolonisirung der Geisteskranken, pp. 95, 146, 193.
102 WARWICK BRUNTON
81. Med. Supt Seacliff to A. Paetz, 28 October 1897, Healthcare Otago Ltd Archives,
Archives New Zealand, Dunedin, DAHI D264/20. Unfortunately the reply has not survived.
82. Med. Supt to Inspector-General, 3 September 1898, DAHI D264/20.
83. AJHR, 1899, H-7, p. 3.
84. NZPD, 18 September 1903, [vol.] 125, p. 605.
85. Paetz, Die Kolonisirung der Geisteskranken, pp. 23, 29, 34, 69.
86. AJHR, 1899, H-7, p. 3; Theodore G. Gray, The Very Error of the Moon, Stockwell,
Ilfracombe, 1958, pp. 64-5.
87. Inspector-General to Minister, 11 April 1910, HMH1910/345.
88. Department of Health, Review, 1969, p.161.
89. AJHR, 1913, H-7, p. 8; S.W.P. Mirams, The Central Plan', Mental Hospitals, vol.
12, no. 1, 1961, p. 27.
90. AJHR, 1899, H-7, pp. 3, 10, AJHR, 1905, H-7, pp 3^.
91. AJHR, 1907, H-7, p. 7.
92. AJHR, 1925, H-7, pp. 2-3.
93. Circulars, 16 February and 13 July 1922, Sunnyside Hospital Administration File
1921/43, current whereabouts unknown.
94. Circular [to general practitioners?], February 1928, Carrington Hospital Archives,
Archives New Zealand, Auckland, YCAA 1079/6F, File 5/16/-.
95. AJHR, 1923, H-7, p. 5.
96. AJHR, 1887 H-9, pp. 1-2.
97. AJHR, 1898, H-7, p. 8; Minister to Director-General, 4 June 1946 and replies, 12
June and 7 August 1946, H59508.
98. AJHR, 1900, H-7, p. 8.
99. AJHR, 1904, H-7, p. 3. See also Brunton, A Choice of Difficulties, pp. 193-5.
100. AJHR, 1948, H-7, p. 2 and AJHR, 1960, H-31, p. 77.
101. AJHR, 1898, H-7, p. 4; NZPD, 17 August 1900, 113, p. 72.
102. Director-General to Minister, 17 October 1929, HMH8/1041.
103. Director-General of Health to Inspector-General, 14 January 1925, HMH21/28/1;
Acting Inspector-General to Minister, 29 July 1925, HMH8/897.
104. AJHR, 1926, H-7, p. 1.
105. AJHR, 1929, H-7, p. 2; Director-General to Director-General of Health, 12 August
1946, H28449. See Minister to High Commissioner, London, 13 December 1943, HMH27/
32 on the war-time role of these units in treating returned servicemen.
106. Director to A. Sinclair, 10 September 1962, H28610.
107. Director to Med. Supt Tokanui, 21 July 1964, H35251.
108. Board of Health, Psychiatric Services in Public Hospitals in New Zealand, The Board,
Wellington, 1960, pp. 10, 18-19.
109. Statistics of the Colony of New Zealand, 1901, p. 95; Department of Health, Mental
Health Data 1965, p. 9.
110. WHO, The Community Mental Hospital, p. 19.
111. AJHR, 1962, H-31, pp. 69-70.
112. Franklin Times, 18 July 1962.
113. WHO press statement, 23 November 1953, n.d., and Deputy Director to Med. Supt,
Auckland, 19 October 1956, H28730.
114. Deputy Director reported in Christchurch Press, 15 April 1958 H28730; AJHR,
1957, H-31, p. 37 and AJHR, 1958, H-31, p. 43; Otago Daily Times, 6 May 1961;
Department of Health, First Submission to the Royal Commission of Inquiry into Hospital
and Related Services, Stage II, The Department, Wellington, 1972, p. 28.
116. Director to Med. Supt, Kingseat, 29 March 1965, H59649.
117. Division of Mental Health, An Introduction to Community Methods of Treatment
and Ward Management in the Psychiatric Hospital - Claybury Hospital England, The
Department, Wellington, c.1961.
118. AJHR, 1960, H-31, p. 81, AJHR, 1961, H-31, p. 59, AJHR, 1965, H-31, p. 63;
WHO, The Community Mental Hospital, pp. 13, 23.
119. AJHR, 1963, H-31, p. 69.
120. Mercier, Lunatic Asylums, p. vii, emphasis in original.
121. Paetz, Die Kolonisirung der Geisteskranken, pp. 69, 98.

122. AJHR, 1894, H-7, p. 5.
123. AJHR, 1907, H-7, p. 24.
124. AJHR, 1910, H-7, p. 7.
125. Unpublished institutional weekly reports (1922-45), Health Department Archives,
Archives New Zealand, Wellington, W4415 ABQU, Boxes 614-7.
126. Director-General to Director of Mental Hygiene, Brisbane, 25 November 1941,
H33030.
127. WHO, The Community Mental Hospital, p. 18; Director-General to Prime Minister,
1 August 1960, H30/1/5.
128. AJHR, 1886, H-6, p. 8.
129. AJHR, 1907, H-7, p. 20.
130. Mercier, Lunatic Asylums, pp. viii, 48.
131. Paetz, Die Kolonisirung der Geisteskranken, p. 95.
132. AJHR, 1900, H-7, p. 4, AJHR, 1904, H-7, pp. 3-4, 10.
133. AJHR, 1925, H-7, p. 11.
134. Director-General to Secretary, Public Service Commissioner, 29 May 1940, and Acting
Director-General to Secretary, Public Service Commission, 4 August 1947, HMH8/0/1.
135. AJHR, 1950, H-31, p. 25.
136. Circular, 10 February 1949, HMH26/8.
137. AJHR, 1947, H-7, p. 3.
138. Med. Supt's Annual Report, 1956, Carrington Hospital Administrative File 4/4 cur-
rent whereabouts unknown.
139. Director to Med. Supt, Sunnyside, 26 July 1962, H59834.
140. Mercier, Lunatic Asylums, p. viii.
142. Mercier, Lunatic Asylums, p. 29.
145. Brunton, A Choice of Difficulties, pp. 469-75.
146. Mental Defectives Act 1 91 1, s. 15; New Zealand Gazette, 29 February 1912, p. 891.
147. Circular, 23 August 1915, YCAA1079/lq.
148. AJHR, 1883, H-3, pp. 7-8; Med. Supt, Sunnyside, evidence to Royal Commission
into Sunnyside Mental Hospital, 1913, HMH1913/961, p. 244.
149. Minister's 'memo of directions', and Circular, 8 November 1927, HMH4/4/1.
150. Minister to Mrs H. S. Anyon, 5 June 1951, Mental Hospitals Department File
MH2/8/4, current whereabouts unknown.
151. Med. Supt, Auckland to Director-General, 23 September 1936, YCAA1079/91.
152. Circular, 27 June 1940, HMH Institutional Circulars, 1940-42.
153. Circular, 8 August 1945, and replies, MH2/8/4.
154. Circulars, 21 January 1948, MH2/8/4, and 10 February 1949, HMH26/8.
155. Director to Minister, 1 November 1949, HMH26/8.
156. Director to Editor, Truth, 3 June 1954, H33842.
157. AJHR, 1952, H-31, p. 25.
158. Kennedy, pp. 162, 184-5.
159. Circular, 16 December 1918, H36137.
160. Circular, 22 October 1924, YCAA1079/le.
161. Circular, 7 October 1947, HMH3/9/4.
162. Unnumbered Circular, 1 August 1961 and Circular MH1962/82, 19 June 1962,
H36137; Cabinet approval 21 September 1964, H32756; AJHR, 1972, H-53, pp. 340-1.
163. AJHR, 1877, H-8, pp. 18-19, 23 and AJHR, 1881, H-13, p. 5; Med. Supt, Auckland
to Inspector-General, 4 June 1925, YCAA1079/10d.
164. AJHR, 1877, H-8, pp. 15, 18-19, 22.
165. Circular, 27 June 1940, HMH Institutional Circulars, 1940-42.
166. See Brunton, A Choice of Difficulties, pp. 470-1.
168. Med. Supt, Seacliff reported in Otago Daily Times, 11 September 1959.
169. AJHR, 1961, H-31, p. 58; WHO, p. 19.

The Origins of Deinstitutionalisation in New Zealand: Exploring the Shift from Institutional to Community-Based Mental Healthcare

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The Origins of Deinstitutionalisation in New Zealand: Exploring the Shift from Institutional to Community-Based Mental Healthcare

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The Origins of Deinstitutionalisation in New Zealand

Author(s): Warwick Brunton

From the earliest planning of the original nineteenth-century

Health & History, 2003. 5/2: 75-103 75

Figure 1: Determinants of Deinstitutionalisation.

As in many Western countries, special-purpose institutions known

Figure 2: Psychiatric Hospitals (1854-2003) and General Psychiatric

Notes for Figure 2:

Sources: Department of Health, The Functions and Responsibilities of the Division of

psychiatry supplemented by biographies of some significant officials

Deinstitutionalisation is derived from 'institutionalisation' and 'insti-

one to institutional life, especially for a period of time, that results in

of life-long 'hopeless dement[ia]\ He believed that institutional life

Institutionalisation did not become a pejorative term until the 1960s.

Early New Zealand asylums

maries, madhouses, workhouses, prisons, reformatories, boarding

Figure 3: The quasi-domestic scale of the original building at Sunny-

The era of central administration

After the demise of provincial governments in 1876, the central gov-

lead to systemic changes. Improvements could be effected through

bed-space will be quite enough for me to overcome in my time, and I will

Simply trying to provide enough basic accommodation had to take

some worth, a human being'. Back ward patients tended to be 'for-

Stagnation and redemption

The socio-political, fiscal and therapeutic environments placed enor-

1930 had climbed to 1221. 57 New Zealand's asylums also expanded

Planning and development

Different sized cottages were built at several asylums in an ad hoc

idea'.87 By 1969, 73 per cent (5681) of all psychiatric patients lived in

Figure 5: Day room in the Wolfe Home, the reception house at

The third major policy, of encouraging self-referral to mental hospi-

avoided any implication of 'insanity, mental breakdown, or so-called

The open-door policy was among 'salient factors' monitored by

of brightening up and of increased comfort'.137 In 1956, Auckland's med-

only on visiting days or special occasions.150 'Objectionable looking'

WHO advised that 'everything' must also be done for psychiatric

The running-down and closure of psychiatric hospitals in recent years

1. Department of Health, Submission to the Royal Commission of Inquiry into Hospital

47. AJHR, 1907, H-7, p. 24.

121. Paetz, Die Kolonisirung der Geisteskranken, pp. 69, 98.

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