Heather Casey – The History of Mental Health Services in Otago
Heather Casey, retired Southern Mental Health Nursing Director, gave the Club a fascinating and thought-provoking insight into the history and development of mental health services across the Otago region. Her presentation covered a wide range of services, including dementia care, and highlighted how many of the challenges facing mental health services today have changed surprisingly little over the past 160 years.
From asylums to community care
During the Asylum Era (1860–1930), people experiencing mental illness were generally housed in large psychiatric hospitals, where the emphasis was on custody and containment rather than treatment and recovery. Overcrowding, staff shortages and unsuitable, poorly maintained buildings were common problems. Patients also faced considerable stigma, often being referred to as “lunatics” and ostracised by their communities.
The Otago gold rush brought its own challenges. A rumour circulated among potential immigrants that criminals were sent to Australia while the mentally ill were sent to New Zealand. Although exaggerated, there was some truth behind the saying. The pressures of gold fever, disappointment at failing to find gold, alcohol misuse, mercury poisoning and untreated infections all contributed to the demand for mental health care.
Dunedin’s first Lunatic Asylum operated from 1863 to 1884 on the site now occupied by Otago Boys’ High School. Many of its patients were men aged between 25 and 40, with Irish Catholic men frequently admitted for alcohol-related problems.
Seacliff and Cherry Farm Hospitals
Planning for Seacliff Lunatic Asylum began in 1876, and the hospital opened in 1884. Designed by architect Robert Arthur Lawson in an imposing Gothic Revival style, it was the largest building in New Zealand at the time. Unfortunately, the site was built on unstable bentonite clay, leading to serious ground movements and landslides. An 1887 landslip ultimately forced the demolition of the main block.
Sir Frederic Truby King, best known for founding Plunket, served as Seacliff’s long-standing medical superintendent. The hospital also became part of New Zealand literary history through its association with writer Janet Frame, who was a patient there.
One of the darkest events in Seacliff’s history occurred on 8 December 1942, when a fire broke out in the locked Ward 5 women’s wing, killing 37 female patients. New admissions ceased in 1964, when 1,365 patients were registered at the hospital, and it closed permanently in 1972–73, with remaining services transferring to Cherry Farm Hospital.
Cherry Farm, north of Dunedin, had opened in 1952 and accommodated more than 1,000 patients at its peak. Like many psychiatric institutions around the country, it eventually closed as New Zealand moved towards deinstitutionalisation, shifting care away from large hospitals and towards community-based services.
Changing attitudes and treatments
Heather also explored how wider social events influenced mental health and the way it was understood. Soldiers returning from the First World War suffered what was then called shell shock, now commonly associated with post-traumatic stress disorder (PTSD). During the Depression of the 1930s, unemployment, anxiety, financial hardship and a loss of self-worth contributed to further mental health difficulties. Soldiers returning from the Second World War were also affected by what was known as battle fatigue.
Social expectations placed additional pressures on both men and women. Women who struggled to maintain a household or care for their children could be regarded as mentally unwell, while men unable to provide for their families might also be judged as unstable.
Truby King made a significant contribution to the development of psychiatric care through his emphasis on classifying illnesses according to their symptoms and characteristics. Recognising that different conditions required different approaches helped pave the way for more targeted treatment.
Over the decades, treatments evolved as medical knowledge developed. Electroconvulsive therapy (ECT), lobotomy and later medicines such as lithium, chlorpromazine and antidepressants became part of the changing treatment landscape. LSD was also used experimentally in psychiatric treatment during the mid-20th century. From the 1980s onwards, community-based care expanded, reflecting a broader move towards supporting people outside institutional settings.
Heather noted that some treatments once associated with earlier eras, including ECT and carefully controlled psychedelic-assisted therapies, have attracted renewed interest in modern mental health care. New behavioural therapies and other treatment approaches continue to be developed and evaluated.
The challenges that remain
In Dunedin, Wakari Hospital has played an important role in mental health services, with Ward 10 opening in 1965 with 60 beds. Today, services extend across a broad range of needs, from acute psychiatric care to ongoing community support and dementia services.
Despite significant advances in knowledge, treatment and attitudes, Heather emphasised that many familiar challenges remain: staff shortages, suitable buildings, ongoing maintenance and the stigma and discrimination experienced by people living with mental illness.
Her presentation was a timely reminder of how far mental health care has progressed, while also highlighting the work still needed to ensure people receive appropriate care, dignity and understanding within their communities.
For those wishing to learn more, Heather recommended three resources:
Unfortunate Folk: Essays on Mental Health Treatment, 1863–1992, edited by Barbara Brookes and Jane Thomson (2001).
The historical display about Seacliff Lunatic Asylum at Wakari Hospital.
The iHeartRadio podcast Behind the Walls of the World’s Psychiatric Hospitals.
The Club thanked Heather for sharing her knowledge and bringing to life an important part of Otago’s social and medical history.