Asylums and mental hospitals

In the 1860s and 1870s, provincial governments opened asylums. Patient were given less restraint than before and encouraged to work and be involved in community activities. This system followed closely to the English model. The earliest of these institutions were small and near city centres, while later in the century they became immense hospitals built in secluded locations, such as Seacliff Lunatic Asylum.^[13] Some patients were admitted to these institutions for being difficult, confused, or because there was no other place for them.^[14]

The treatment patients received in these asylums was inconsistent and staff had no medical training. However, some innovators like Frederic Truby King in 1887 introduced better food for patients and more discipline for staff.^[15] The ward size was shrunk and patients given more freedom. Treatment, however, still remained cruel by modern standards.^[16]

In 1911, it became possible for people to admit themselves to asylums (now called Mental Hospitals) and patients were referred to as inmates instead of lunatics. This reduced some of the public stigma around mental illness. Separate parts of the hospitals were also reserved for diagnosis and early treatment. Hospitals were designed around multiple buildings so that patients of different age and sex could be more easily separated.^[17]

By 1916, halfway houses were being built to provide accommodation for veterans with 'shell shock' (post-traumatic stress disorder), which sometimes led to substance abuse. The public sympathy for these returned servicemen also helped improve the public image of mental illness. These halfway houses were also used for more minor mental health concerns and took some pressure off the mental hospital system. Psychiatry started to be practiced as a medical science and outpatient visits were also started. However, in the medical and public consciousness, there was still a division between people suffering from illness or bad experiences and the incurably insane.^[17]

In the 1930s, a number of medical procedures were introduced, including brain surgery, induced insulin coma, and electroconvulsive therapy.^[18] While once thought miraculous, they were discontinued due to negative side-effects and questionable health benefits. In the late 1930s, almost a quarter of patient admissions were voluntary. Treatment became free from 1939 in the now-renamed 'psychiatric hospitals.' Trial releases into society became more common but were still far from being the norm. In the 1940s, the roles of social worker and occupational therapist were introduced.^[19] Janet Frame, a famous New Zealand writer, was held at the asylum during the 1940s and was wrongly diagnosed as a schizophrenic.^[20] By 1969, a quarter of all mental patients were still in then-outdated asylum era buildings that lacked the design improvements from the previous 50 years.^[17] From the 1960s on, new hospitals epitomised the village-asylum atmosphere in name and design, contrasting with the old asylum model.

Treatment in the community

From the 1960s, patients were encouraged to take charge of their own care, ideally in the community. No extra beds were provided in psychiatric hospitals from 1973 on, and a push towards community care (outside of hospitals) was introduced. This was intended as a cost saving measure but was also due to the poor reputation of the hospital system. By the 1990s, almost all psychiatric hospitals were shut down, sometimes with the consent of their patients. The government still provided funding, but now through multiple agencies and charities.^[21] Patients were either transferred to remaining hospitals, or to residential care or supported accommodation in the community. People with intellectual disabilities moved to new lives in the community with care provided by a range of community agencies.

The 1990s also saw the separation of intellectual handicaps from mental health services,^[22] and more attention was paid to Māori, who were over-represented in the mental health system. From 2012 on, the Health and Disability Commission has overseen the integration of New Zealand's response to mental health issues. LGBT people have more mental health issues than the general population today in New Zealand. As in many countries, homosexual people were historically committed to mental institutions and given 'treatment' for what was believed to be a mental illness.^[23] About 4,000 people in New Zealand are committed to compulsory-detention on the grounds of a mental disorder every year.^[8]

From the 1980s on, there has also been attempts to reduce the stigma of sufferers of mental illness or at least draw attention to their situation. In 1981, the band Blam Blam Blam satirised New Zealand's optimistic self-image with the song 'There is no depression in New Zealand', which also mentions the use of the drug Valium.^[24] John Kirwan, a famous All Black, has openly spoken of his battle with depression and is actively involved in mental health and depression awareness campaigns in New Zealand. He has written about his depression in the books All Blacks Don't Cry and Stand by Me.^[25] There are guidelines for the media when dealing with mental health issues.^[26]

Youth suicide

While New Zealand's suicide rate is comparable with similar countries, the youth suicide rate is much higher.^[31] Before the mid-1980s, the suicide rate increased with age, however, after this time the pattern has reversed. By the mid-1990s, people aged 15–34 had suicide rates of over 25 per 100,000, while rates for those over 45 years old fell to 13 per 100,000.^[32] This fell to the still unusually high 16.9 per 100,000 in 2015.^[33] Many reasons contribute to New Zealand's high youth suicide rate, including child poverty, high rates of teenage pregnancies, or family unemployment. New Zealand also has a record of high rates of bullying in school.^[2] It has also been argued that as economic inequality in New Zealand has grown, there has been a dramatic increase in the youth suicide rate.^[34][35]