HEALTH PLANNING and Kor RESEARCH UNIT Christchurch

rR, HEALTH PLANNING and E koR RESEARCH UNIT Christchurch A BRIEF HISTORY OF ALCOHOLISM TREATMENT SERVICES IN NEW ZEALAND, 1965-1983 Tor Wainwright September 1985 Planning and Research Series No. 19 L ---------------------- --------- A BRIEF HISTORY OF ALCOHOLISM TREATMENT SERVICES IN NEW ZEALAND, 1965-1983 Tor Wainwright S Health Planning and Research Unit P.O. Box 1876 Christchurch Planning and Research Series No. 19 September 1985 The Health Planning and Research Unit has staff funded by both the Canterbury Hospital Board and the Department of Health. ACKNOWLEDGEMENTS This review could not have been undertaken without the co-operation of the people involved in alcoholism co-ordinating committees and treatment agencies throughout New Zealand who responded to the request for information - their help was very much appreciated. Particular thanks to Helen Orchard, Tom Joll, Roy Johnston, Clint Miller, Patsi Davies, Gary Harrison. I The advice and support of Dr Elisabeth Wells of the Christ- church. Clinical School and of colleagues in the Health Planning and Research Unit is gratefully acknowledged, as is the work of Julie Fussell and Maureen Parkyn in typing the drafts. and final copy, and Lesley Symingtons work in getting the report printed. The responsibility for any errors in the final report remains that of the author. CONTENTS Page 1. INTRODUCTION AND METHODOLOGY 1 2. THE DEVELOPMENT OF THE DIFFERENT TYPES OF FACILITY 2 a) Introduction b) The psychiatric hospitals c) Other hospital board services d) The N.S.A.D. centres e) The Salvation Army Bridge Programme f) Other voluntary agencies 3. THE DEVELOPMENT OF SERVICES WITHIN EACH REGION, 1965 - 1983 6 - Auckland, Northland and Coromandel - Tauranga and Whakatane - Waikato - Gisborne and Hawkes Bay - Taranaki - Manawatu - Wairarapa - Wellington - Nelson and Blenheim - Canterbury - West Coast - Tirnaru and Oamaru - Otago - Central Otago - Southland 4. ADMISSIONS OVER TIME TO INPATIENT FACILITIES LINKED TO THE HEALTH DEPARTMENTS PSYCHIATRIC REGISTER 34 5. EVENTS SINCE 1983 38 REFERENCES 39 I LIST OF TABLES Page TABLE 1 Summary of Alcoholism Treatment Services in New Zealand, 1953 - 1983 21 a) Psychiatric Hospitals b) Other Hospital Board services C) The NSAD Centres d) The Salvation Army Bridge Programme Network e) Other Voluntary Agencies (by Region) TABLE 2 Admissions to Psychiatric Hospitals and 35 Psychiatric Units Within General Hospitals for Alcoholism and Alcoholic Psychosis, 1964 - 1982 (First Admissions and Readmissions Combined) TABLE 3 First Admissions as a Percentage of all 37 Admissions for Alcoholism and Alcoholic Psychosis, Selected Hospitals, 1964 - 1982 1. 1. INTRODUCTION AND METHODOLOGY Treatment facilities for alcoholism have sprung up rapidly in New Zealand over the past ten to fifteen years. This paper, which is part of a larger study, attempts to sketch the outline of this growth; a full account of the personalities and events of this period is still to be written. The aim of the larger study is to investigate the trends over time in the utilization of alcoholism treatment services in New Zealand, using data obtained from the New Zealand Health Departments psychiatric register (see Wells and Wainwright, 1985). This register, which was set up in 1967, can provide information on the admission histories of cohorts of individuals through time. Since changes in hospital admission figures are very much dependent on changes in the services available at each hospital, information was sought on the opening and closing dates of alcoholism treatment services around New Zealand, to aid in the interpre- tation of the data used in the main study. This historical data forms the basis of the present paper. The ALAC Directories of Treatment Services and national newspaper clipp- ings from 1978 to 1983 (using the Health Departments clipping service) were used to compile an initial list of facilities. In late 1983 letters were sent to individual treatment agencies and co-ordinating bodies asking for information on their local area. Admission figures for inpatient services administered by the hospital boards and several other organisations was obtained from the Health Departments yearly Mental Health Data series, and information on hospital board outpatient admissions for 1983 was obtained from a compilation of figures made by Helen Orchard, research officer of ALAC. Admission figures for agencies not linked either to the Health Departments psychiatric register or to ALACs data collection system for outpatient centres were not sought. Part 2 briefly outlines the development of the different types of facility: psychiatric hospital units, other hospital board services, the NSAD centres, the Salvation Army Bridge network, and other voluntary agencies. A brief description is given in Part 3 of the services that were set up within each region between 1965 and 1983. This information is summarised in Table 1. In Part 4 published inpatient data from the Mental Health series are summarised to show changes over time in admission patterns for individual hospitals and units. 2. 2. 1 THE DEVELOPMENT OF THE DIFFERENT TYPES OF FACILITY a) Introduction The evolution of New Zealands alcoholism treatmentfacilities mirrors the changes that have occurred over time in our societys attitudes towards the alcoholic. The view, common in the late nineteenth and early twentieth centuries, that the only hope for the drunkard lay in hard work and prayer, was embodied in the early Salvation Army institutions on Rotoroa and Pakatoa Islands, which the Army ran in conjunction with the Justice Department. Apart from the care given to psychotic or demented alcoholics by the psychiatric hospitals as part of their general psychiatric treatment, Salvation Army homes provided the only help available specifically for the alcoholic until after the second world war. In 1946 Alcoholics Anonymous came to New Zealand, bringing a new view of alcoholism as a disease which needed treatment, rather than a problem solely for the courts or churches. With other interested individuals, AA formed the National Society on Alcoholism (NSA, later NSAD), a national body that worked actively towards the general social acceptance of alcoholism asa major health problem. The gradual success of this campaign, boosted by the setting up in 1976 of the Alcoholic Liquor Advisory Council, had by the early 1980s resulted in the establishment of hospital board treatment facilities in most areas of the country, as well as the upgrading and expansion of Salvation Army services and an upsurge of activity by other voluntary organisations. The spread of new services is still continuing, albeit with somewhat less emphasis on the medical aspects of treatment and more interest in the contribution of other disciplines, such as behavioural psychology, family-orientated social work and community-based preventive work. b) The Psychiatric Hospitals Since their inception in the late nineteenth century, all the major psychiatric hospitals have provided a basic service for people suffering from acute alcoholic psychosis or long-term alcohol-related dementia. However their willingness to accept people for detoxication or for the treatment of alcohol dependence has fluctuated over time, dependent largely on the personal interest of a few individual staff members. Growing public pressure in the 1950s from the National Society on Alcoholism and other bodies led the Minister of Health to request hospital boards to provide better services for alcoholism treatment. Little came of this, however, probably partly because psychiatric hospitals at that time (and until 1972) were administered not by local hospital boards but by the Health Department, and perhaps partly because the psychiatric setting was not always seen by those lobbying for better treatment for alcoholism as the most appropriate place for such treatment. In the vacuum created by a lack of inpatient treatment facilities and in response to growing public demand, Queen Mary Hospital at Hanmer Springs began to specialise in the treatment of alcoholism, taking referrals from around New Zealand. This hospital, established later than the main psychiatric hospitals, had previously admitted people on a voluntary basis only for psychoneurotic conditions. Many of the alcoholism referrals came from NSAD centres and general practitioners, and by 1972 the hospitals programme was aimed solely at people with alcohol problems. 3. The passing of the Alcoholism and Drug Addiction Act in 1966 made formal provision for the voluntary or involuntary committal of people to a registered institution for the treatment of alcoholism. This Act, which came into force on January 1st 1969, acted as an incentive for the establishment of programmes in several psychiatric hospitals, notably Sunny .- side and Kingseat. The development of programmes in the other psychiatric hospitals registered under this Act appears to have been more variable over time and place. Admission and discharge information on patients has been collected from all New Zealand psychiatric hospitals (both public and private) by the National Health Statistics Centre since 1953, and reported in a yearly series Mental Health Data. From 1967 this information was compiled in the form of a psychiatric register at NHSC (see Table la, p.21). c) Other Hospital Board Services General hospital psychiatric units: during the 1960s and early 1970s many hospital boards opened psychiatric units within their major general hospitals. From 1967 onwards information from these

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