Changing Times , Changing Places

The hospital whanau now dissipated into the community and the Henry Rongomau Bennett Centre. The staunch and hard-working staff of the Psych and LH. Divisions, the Main Office, the medics and the para-medics, the ancillary staff, the volunteers, the visitors, the bureaucrats, the students, the Official Visitor, the Press, the transients, the frightened and the bewildered, the manuwhiri and tangata-whenua, the young the old, the local farmers and wives, social sports teams from Porirua and Kingseat hospitals, touring drama, ballet and musical troupes all have come through the main gate and have since passed on to Elsewhere. 1

as a hospital, which provides a pictorial and narrative account of the environment, buildings, staff and patient activity, care and treatment, and the socio-political context of the time.Known as 'Garden City' for much of its life, the title 'From Garden City to Fountain City' was for some time the working title for this book, and is a phrase used by some of the authors here.We have tried to capture, too, the close relationships formed between the hospital at the local places and people in Te Awamutu and Kihikihi communities.It includes images and narrative accounts of the history of the Waikato Mental Health Services in the period, and expands upon information obtained about the building of the mental health institution, Tokanui Hospital, around 1910 through to the opening of the new Mental Health Unit, the Henry Rongomau Bennett Centre, in 1997.It also considers the wider context of mental health services beyond this date, and takes us, in some chapters, to the present.

Our approaches and methods
The authors of the various chapters in this book utilise a range of historical research methods, including archival and document research in appropriate libraries and repositories, the analysis of reports, publications, newspapers and official sources, including the collation of statistical information.Social history research is often based on a collection of unpublished and published materials that can shed light on the complex interactions of people in the past.Official sources, such as government documents or clinical medical notes, for example, are useful, but sometimes provide only the 'top down' view of the events of the past.Thus, other materials, such as personal writings and oral interviews, which can provide a broader perspective, are most valuable to the researcher.Therefore, importantly, the book also draws upon a set of oral histories collected as part of an oral history project about Tokanui conducted byTe Awamutu Museum between 2003 and 2005, as well as oral interviews and discussions conducted in an earlier phase of research.We have assembled a wide range of materials for some areas of the research, including photographic materials, in order to tell these stories.In our efforts to traverse the complex historical experiences ofTokanui and those interested in it, we also include a chapter which examines the media representations of mental health clients in the 1970s, and another which reflects on a museum exhibition.This history ofTokanui and mental health services in the Waikato region is not a commissioned history that offers a chronological account of the institution, but rather, it offers up a series of histories that each present another window on the past.Many hospital or institutional histories in the field of medical history have been sole-authored works which sometimes include oral or reflective accounts, such as Wendy Hunter Williams' history ofPorirua Hospital. 2Warwick Brunton also produced a history of mental health services in the South Island, focusing on Seaview Hospital, Hokitika and West Coast mental health services between 1872 and 1997. 3Although these books, and others, offer rich and detailed histories of their hospital sites, we faced quickly the enormous task of producing a history of an institutional site relatively close to the period of its closure.Recent history is often the most difficult to tell or capture in narrative.This problem, however, might also be a fine catalyst to include the sometimes raw and emotional responses of people still fairly close to the events and the place itself Thus, most significantly, this book is a multi-authored volume.We believe it most accurately reflects the different viewpoints and values of the large community of psychiatric workers, patients and their families associated with Tokanui.We have continually ensured our sensitivity towards the issues surrounding psychiatric treatment and hospitalisation, as well to individuals being written about from all aspects of this community.
For some readers, parts of this book will seem 'academic'.The invited authors who have all participated in this project to produce a book were given a wide brief to write the piece they felt comfortable to write; some of these individuals invited co-authors and contributors, while others relied on more academic conventions for their chapters.Some of the chapters are the result of academic scholarship at university level and reflect the expectations of historical scholarship.Others, such as the personal reflective pieces in Chapter Ten, are individual recollections by those intimately associated with Tokanui and mental health care across the period.Where possible we have included the published and unpublished viewpoints of clients of mental health services, as I explain below.It was important to us to produce a history with reasonably detailed endnotes and references, so we also include here a select List of Sources for readers and future researchers. 4e academic context for tnis book Histories of psychiatry have been part of a global trend in the social and cultural histories of medicine from the 1970s to the current moment.Historians interested in 'madness', 'insanity', institutions and medical professionals, and the institutional populations of the insane, have published their histories worldwide, often drawing upon the substantial archival productions of former institutions, sometimes dating back to the eighteenth century.5 For former or current clients of the mental health system, such an academic pursuit might seem divorced from the 'reality' of mental illness for its sufferers.And yet these historians do have the political interests of psychiatric survivors in mind.Since the 1970s, a powerful anti-psychiatry movement to consider mental illness as one aspect of the nineteenth-century industrialising state's tendency towards the 'social control' of so-called 'difficult' individuals and social groups, has inspired much of this historical analysis. 6Historians, then, have been concerned to find out if populations of those labelled 'mad' were sick, poor, transient, criminal, or a combination of these categories; in other words, how insanity and mental illness were understood or constructed at different historical moments began to drive social historical investigations of the medical field of psychiatry.? On the other side of the equation, some historians (and medical professionals with an interest in history) have also been interested in how medical professionals cared for people with mental illness, from psychiatrists, known as 'alienists', to mental health nurses.The caring professions and their histories too have benefited from these approaches to history. 8Importantly, this volume should be seen and interpreted within a much larger international and national body of historical scholarly work about the histories of mental health.It now takes its place among the decades of research around these histories, and the people, which have shaped academic and popular thinking about mental illness and its treatments.Sometimes, this scholarship is overlooked in favour of popular understandings of the asylum as an unremittingly 'bad' institution.Research reveals much that could be understood as positive about psychiatric institutions of the past.We simply want readers to think about how Waikato's mental health history is part of a much larger international story.

People witn mental illness
One aspect of this book that we feel strongly about is that it tells the stories of mental health from the perspectives of patients.The very word 'patient' is open to debate and discussion, a point articulated further in Chapter Seven.Instead of patient, we might say 'client', 'service user', 'survivor', 'sufferer', among other terms, but 'patient' also captures the dynamic we are evoking here in this book: a person who has become part of the medical model used to treat mental health clients over time, a sustained use of which is common in the historical literature.For example, Canadian historian of madness, Geoffrey Reaume, himself a former patient, or user of psychiatric services, writes sensitively about the histories of mental health patients. 9In his book Remembrance a/Patients Past, about Canadian mental health history, Reaume shows that the word 'patient' might be mobilised to re-examine medical notes from the patient's perspective, a project now undertaken by historians all over the world.By piecing together the inside worlds of institutionalised people, historians can convey something of the experiences not always written about from the patient's point of view, as Chapter Seven in this volume also suggests. 10 also understand that the term 'service user' is more appropriate when talking about the contemporary moment.While we did not commission an entire chapter from a current or former mental health services user, we have endeavoured to include oral and published accounts by former patients throughout the book, including one key section in Chapter Nine, focused on forensic psychiatry, contributed by one service user.Indeed, the many diverse stories of mental health patients at Tokanui across the twentieth century are represented through at least six separate chapters here.These chapters examine patient stories through oral and written accounts and clinical records, among other materials.We examine the first patients or inmates at Tokanui; intellectual disability to the 1930s, with a commentary on the period beyond this time; a psychiatrist's own perspective on changes in the treatment of mental illness over time through one clinical case; patients' journeys to and from Tokanui in the middle of the twentieth century, including their own reflections on mental breakdown and institutions; and representations of patients in the press of the 1970s; among other stories of mental illness.

The organisation of this book
We have organised this book using three parts, each of which coheres around a theme or collection of related aspects of the history ofTokanui and mental health.It begins with Part One: 'Histories of place and people: mental health and policies, training and personnel'.Here, in separate chapters, authors document and trace the early histories ofTokanui as a place of political, cultural and spiritual significance to Maori people; as an institution in a wider landscape of mental health in New Zealand, including its staff, and its legal and physical context; the education and training of nurses; and the intellectual disability population to 1935.Drawing on local, national and institutional histories, the chapters in this part feature the way that mental health was subject to legislative control, and how this had effects upon those committed for care and treatment.In Chapter One, Rovina Maniapoto Anderson shares with readers her whanau's close affiliation with and history of the land and its tangata whenua, most powerfully setting the scene for our stories, but also showing how history lives on in the hearts and minds of those who grew up near Tokanui.The European institutional models which came to dominate the spaces are examined by Michelle Campion in Chapter Two through the legal landscapes for mental health, with Campion showing how notions of mental health care and institutional treatment evolved and were part of a national system of healthcare.Campion again takes the lead in Chapter Three, with input from Catharine Cole borne and Kate Prebble, writing about the forms that early mental health took at Tokanui as an institution to the early 1930s.Campion takes us through a range of social histories of institutional life and work in a careful account of mental health in the period and people who shaped it.One of the most important aspects ofTokanui's history was the role played by intellectual disability in the formation of the spaces and ideas about institutional worlds.In Adrienne Hoult's Chapter Four, we find out more about intellectual disability (ID) in the formative years ofTokanui, with some final discussion of the role played by the ID sector in later years.Hoult also places her study in a much wider international perspective to show how ideas about intellectual disability were developing over time, and also in relation to notions of 'mental deficiency' and criminality, locating Tokanui firmly next to Waikeria Prison both spatially and in terms of their shared work.Finally in this part, Kate Prebble has produced a fine account of a long historical period of nursing training, showing how mental health nursing education was part of the story of mental health services.
Part Two, 'Treatments, Patients, Care and Control: Institutions and Change', reflects on treatment and institutional changes from the 1950s, the complex journeys made by patients who found themselves housed at Tokanui over the middle period of its operation, the role and importance of Maori mental health, and the relationship of forensic psychiatry to the wider functions of mental health in the region.In addition, Tokanui interacted with the prison system in New Zealand.These chapters draw upon archival research, biographies of staff, histories and first-hand accounts of clinical changes in psychiatry, drug therapies and practices.Eleni Nikolau's sensitive portrayal of a patient's clinical history allows her to reflect on changes in psychiatric practice over time in Chapter Six.Building on this story, but from the social perspectives of patients, Catharine Coleborne's Chapter Seven describes the 'journeys', both literal and figurative, taken by patients moving to and from Tokanui between the 1930s and the 1980s, using a selection of accounts, cases and interviews.Through a series of reflections and other sources, Chapter Eight discusses the impact ofWhai Ora or Maori wellness in mental health, a Tokanui innovation of national and international significance.Finally, in this part, a collaborative chapter by Suzette Poole, Ellie Wellington, Rees Tapsell, Jeff Symonds and a Service User provides us with a critical view of regional forensic services for mental health in the late 1990s to the recent past.
Part Three, 'Memories, Stories and Communities', reflects on Tokanui's history through the eyes of those who lived and worked on site in Chapter Ten, in a series of rich personal accounts ofTokanui, and also through the media's representations of mental health and patients in the twentieth century in Chapter Eleven by Alexander Brown.Chapter Twelve, written by those who were part of the closure ofTokanui, John Graham, Ken Jamieson, as well as Campion and Lambert, describes the story of the closure ofTokanui and the move to community-based care, also detailing the many community based agencies now devoted to caring for people with mental illness.The book concludes with a chapter from Lambert about 'Footprints on the Land', the exhibition ofTokanui's history held at Te Awamutu Museum in 2006.The many visitors to the exhibition also played a role in constructing aspects of its history for the curatorial team.Lambert, as a professional museum curator and knowledgeable historical researcher, has produced a fluent account of the way we might gain something by looking back at the way history is made, how it is shown and made visible, and the role of the museum exhibition in the forging of new memories.

final thoughts
Like the museum exhibition, and the many rich recollections and memories shared in this book, we hope to reach, touch and educate many readers with our collective approach to these stories, which we feel no one individual author could tell effectively.Gaps, omissions and oversights remain our own, and more research can always be conducted and fresh accounts of historical change written.Yet we hope that when considered together, these separate chapters inspire some different ways of thinking about the pasts ofTokanui, mental health services and mental illness, and also create a new and vital sense of compassion for all of those engaged in the important work to make mental wellness a priority.No institution or system of care is perfect, but the many people who aim high will always help to make life better for those people and their families who are dealing with mental illness.