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Hospital 125th: Manawaroa - A personal recollection

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26/11/2018
By Sir Mason Durie. My first clinical experience in psychiatry occurred at the Palmerston North Hospital in 1964.

 
As a first year house surgeon I spent three months working in a newly established psychiatric service alongside Dr John Weblin.  Although intermittent outpatient clinics had been offered by visiting psychiatrists, Dr Weblin was the first full-time psychiatrist to be appointed to the Palmerston North Hospital Board.  In sharp contrast to the practices in large mental hospitals where I visited and worked as a medical student, the 1964 experience was sufficiently positive and inspiring to lead to a career in psychiatry.  I followed the advice of another Palmerston North doctor who was working as a psychiatrist in Montreal and in 1966 entered a four-year postgraduate programme at McGill University.
 
In 1969 plans for a ‘community based’ psychiatric facility at Palmerston North were underway.  It was part of a shift away from the large mental hospitals to units within general hospital settings and Palmerston North and Invercargill were seen as appropriate cities for introducing the new approach.    By 1970 Manawaroa had been established and Dr Weblin encouraged me to return to take up a position as one of two psychiatrists  I started in July that year –in the same week that the service had been officially opened.  Bill Stevens, was head nurse, John Gamby was the first clinical psychologist, and Angela Gilbert was senior social worker.  
 
The name Manawaroa was suggested by my grandfather and an uncle. Manawaroa has strong associations with early Manawatu history and implied a resolve to overcome disquiet and to establish peace and goodwill.  The alternate name bestowed by the Hospital was simply Ward 21. 
 
In the first year Manawaroa operated as an outpatient and day-patient facility – there was insufficient funding for inpatient care.  But the lack of beds led to some innovative approaches including nurses spending nights with families to help manage a disturbed parent and to avoid committal to a mental hospital.  Extensive use of day care also enabled hospitalisation to be avoided.
 
By 1972 twelve beds had been made available as well as a family room where parents and sometimes children could stay to help settle a frightened patient.  The family room was also used for families undergoing family therapy.  Other innovations were to follow.  A significant one included the employment of six older women who had no psychiatric training but were rich in compassion, common sense, and intuitive understanding.  They were able to support patients in ways that lay outside the scope of professional staff.  Similarly the employment of Massey University students to help with evening and night duties added a dimension that greatly increased the capacity for conversations that did not revolve around sickness or medication. 
 
New psychiatric treatments also saw the emergence of group psychotherapy, a lithium clinic, an eating disorders clinic, an ECT clinic, and in 1972 a Child and Family unit - transferred from the Division of Mental Hygiene to Manawaroa as part of a decentralisation process.   Dr Selwyn Leeks led the unit on a part-time basis – he was also employed at Lake Alice Hospital in charge of an adolescent unit.  Later the establishment of a home visiting team was able to respond to family crises, usually associated with a mental health problem.  In parallel the number of psychiatrists increased – Drs Avery, Bell, Cotter - as well as a number of psychiatric registrars and house surgeons on three monthly rosters.   
 
The original intention by the Government was to replace the out-dated mental hospitals with community facilities such as Manawaroa.  But Hospital Boards were ill-prepared for the task and had some difficulty justifying programmes outside the usual parameters of clinical psychiatry.  Staff at Manawaroa, however, championed a community centred approach and saw the need to link mental health with the wider parameters of health.  A liaison team accompanied physicians on ward rounds to add a mental health perspective to treatments, and a much-respected general practitioner, Dr Bill Duncan, joined the Manawaroa team.  He was able to establish close links with other GPs.  Regular meetings between a group of general practitioners and psychiatrists also brought two-way benefits extending the reach of psychiatric advice.
 
Two other developments also occurred within the Manawaroa context.  First, in response to concerns expressed by Maori, a model of care known as te whare tapa wha emerged.  It advocated an integrated approach that included spiritual, mental, physical and family dimensions and was subsequently adopted by Māori practitioners and others across the country.  Second, Manawaroa became ‘home’ for a group of five Māori community workers who provided health and social services to Māori in the wider Manawatu Horowhenua regions.  They were pioneers for kaupapa Māori health services. 
 
My term with Manawaroa ended in 1988 when I was invited to take up a position at Massey University.   Some years later Manawaroa was disestablished.  The inpatient beds were transferred back into the main hospital – but still known as ward 21.  Other semi-autonomous dimensions have also been added to the mental health services such as child and family services, community psychiatric services, and emergency services. 
 
In 2018 the Inquiry into Mental Health and Addictions echoed many of the same themes that had been part of the Manawaroa journey – an integrated health system, early intervention, closer links between primary and secondary health care, crisis services, and leadership based on community – rather than hospital – hubs.
 
‘Ko te manawaroa o Ngati Raukawa ki te pupuri i te whakapono me te rangimarie. ‘

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