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“Laying the ogre image to rest”

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Description: These images were taken by the Evening Standard, the first of which was published on the 19th of July 1986. They depict newly appointed medical superintendent of Lake Alice psychiatric hospital Dr Stephanie de Fresne.

The caption read: “DR Stephanie de Fresne ‘Sometimes in these sort of jobs, you end up banging your head against a brick wall.’”

Article by Judith Thompson:

“LAKE Alice psychiatric hospital has been battling its ogre image for years.

On a bleak winter's day, the "lock up place" looks foreboding to say the least Inside, it's a different story.

And its new chief wants to break down the barriers separating hospital and community to debunk the myths surrounding it. De-institutionalisation is her watchword.

Dr Stephanie de Fresne, medical superintendent, looks the down-to-earth-type.

She was appointed in May and although she has the credentials, she has never considered herself a "behind-the-desk" administrator.

"My main skills are in clinical work with patients. I'm not terribly highly organised so no doubt there'll be a lot of paperwork that won't get done for a while."

Nevertheless, she's keen to make a go of a job she considers a challenge, one that "certainly needs to be done".

"I can see positive steps for me to take. Sometimes in these sorts of jobs, you end up banging your head against a brick wall. But I've had admirable support from the Wanganui Hospital Board and the area health board so I think things will go well'

The Nelson-born 37-year-old planned a career in psychiatry "for no particular reason" except perhaps the experience of a close friend who became mentally ill.

"I saw the kind of services she was getting and they were so was getting and they were so inadequate I felt then that I wanted to make psychiatry my field."

She completed a bachelors degree in anthropology and psychiatry at Victoria University before going on to Otago University for her medical degree. In 1976 she went to Scotland for four years to do psychiatric training.

She went to Wanganui Hospital as its first psychiatric officer in 1982 after an 18-month stint at Palmerston North's psychiatric unit, Manawaroa.

She was virtually in charge of developing the whole psychiatric service at Wanganui which she guesses is what made her a popular choice for the new job.

So what's Lake Alice's new chief got up her sleeve? Deinstitutionalisation – putting patients back into the community - tops the list.

Social workers at Manawaroa recently sent out a newsletter called Thoughts. A snippet from it reads:

"Now that the Health Department has handed Lake Alice over to the Wanganui Area Health Board, it's very probable that Lake Alice patients will be returned here to a community that is far from prepared to provide for their needs. Who is responsible?"

Their concern is genuine and Dr de Fresne was quick to join them "It's got to be one of our main tasks. Over the years this place has become institutionalised partly because of its geographical isolation, but also because of attitudes.

She says it isn't just the community that has to change its mind about mental illness. Nurses, too, need to take a second look at their role in patient care.

"Much of the nursing practice here has the central aspect that patients are here for a long time, that this is their home.

"That sort of attitude tends to produce babying nurses. There has to be more patient autonomy and self-care in the hospital

Patients have enormous resources to cope and take care of themselves, even when they're very ill.

The obvious need related to de- institutionalisation, she says, is that, as patients move, "the money and staff should move with them"

But the difficulties with this are even more obvious. The community's willingness to support ex-patients is just one of them.

"You can only de- institutionalise a place like Lake Alice at a speed the community is willing to accept.

"Because we have the national security unit here, people are prejudiced against the hospital. А lot of people think of Lake Alice as the lock-up place and the community is scared we'll be sending dangerous people to live next door to them.

But her optimism dispels the doubts

"We certainly won't be just uplifting the lot and dumping them straight back into the community.

"In a way, I think it (de- institutionalisation) is actually happening already. Breaking down community resistance has started.

"Lake Alice has been battling its ogre image for years but tolerance is coming forward. The establishment of psychiatric units in or near general hospitals 15 years ago for example has brought the problem much closer to the community already.

Now it's just aa matter mar of more education, more change in attitude, more debunking of myths.

"The problem is simply that mental illness is very frightening and we assume patients are a kind of alien species.

"But when it happens to people themselves, members of their family or their friends, then suddenly they have to face up to it and cope with it, and through doing so they realise mental health patients are just people who need support.”