A turning tide? Reflections on ideology and health service restructuring in New Zealand

Recycling former psychiatric hospitals in New Zealand: echoes of deinstitutionalisation and restructuring

This paper addresses a gap in the understanding of the geography of deinstitutionalisation: the fate of closed asylums. We contend that the closure process was an exercise in both deinstitutionalisation and welfare state restructuring, and examine discourses surrounding the re-use of two former psychiatric hospitals in New Zealand-Seaview in Hokitika and Kingseat near Auckland. Drawing on an analysis of media coverage and field observation, we consider former asylums as sites of celebrity. We find the shadow of stigma to be prominent, manifested directly in suggestions that the former hospitals be used as prisons and in the partial redevelopment of one as a 'horror theme park'. Indirectly, we see stigma reflected in the physical deterioration of the asylums prior to closure. While this stigmatising is attributable in the first instance to deinstitutionalisation, the evidence suggests strongly that it was co-opted and exploited by the forces of restructuring.

New Zealand children's health camps: therapeutic landscapes meet the contract state

This paper surveys the history and current status of children's health camps in New Zealand, and places these sites within the theoretical context of therapeutic landscapes. The first health camp was established in 1919, and the seven current camps provide respite, education and health care for approximately 4000 children each year. We analyse the health-place relations inherent in the health camp concept and suggest that the 'therapeutic landscape' idea developed by Gesler provides a useful framework to explain the development of camps as sites for enhancing child and family welfare. Specifically, we contend that changing understandings of health and children have been closely linked with changing perceptions of what is therapeutic about the camps. Survey data demonstrate that contemporary restructuring of the welfare state has recast the role of health camps and placed them in a precarious position in terms of both financial viability and public acceptability. We conclude that the current status of health camps is ambiguous given the pressures of deinstitutionalisation philosophies and the regulatory environment of formal contracts between funders and providers.

Contracting opportunities: interpreting post-asylum geographies of mental health care in Auckland, New Zealand

In New Zealand, the process of deinstitutionalization is continuing to unfold as a specific manifestation of welfare state restructuring rather than as a discrete process within the health care sector. In this paper we consider the geography of mental health care in Auckland, New Zealand's only metropolitan city. Here, a highly fluid and competitive housing market has profoundly (re)shaped the opportunities for community care. We report on findings from a survey of representatives of the key agencies providing mental health care in central Auckland. We argue that the re-placing of mental health care into the community has often involved the separation of residential and treatment issues, to the detriment of the communities, institutions and (especially) individuals involved. We trace this fragmentation back to the primacy of the ideology of restructuring over the philosophy of deinstitutionalization. We build our argument around a discussion of the Mental Health (Compulsory Assessment and Treatment) Act 1992 and the apparent subordination of the Act to the emerging of a 'contract state' and broader legislation, such as the Resource Management Act 1991, the Privacy Act 1992 and the Commerce Act 1986, which underpins the re-regulation of New Zealand society.

Long-term care restructuring in rural Ontario: retrieving community service user and provider narratives

This paper examines the extensive restructuring of community-based long-term care that was initiated in Ontario, Canada in 1996, and does so with particular reference to longstanding problems of provision in rural communities. Specifically, it draws on a case study focussed on two small rural towns to develop a 'situated understanding' of service-user and service-provider perspectives on service coordination issues and on service cuts, particularly as they affect the ability of elderly people reliant on publicly-funded community services to stay in their homes, to continue to 'age in place'. The general and specific antecedents of long-term care reform are considered prior to the presentation of the case study. General antecedents include the rapid aging of Canada's population and aggressive strategies to reduce government deficits, while specific antecedents flow from a decade of failed attempts to address longstanding issues of service coordination and from the ideologically-driven, free market stance of the provincial government elected in 1995. The analysis of interviews conducted with 14 community-service users and 17 providers suggests that the managed competition system introduced as the centerpiece of long-term care reform has resulted in increasing diversity and uncertainty on both sides of the service provision equation. Despite continued attempts by rural elderly people and their families to 'cut and paste' support packages, it seems that the restructuring of publicly-funded community services, combined with a substantial re-investment in long-term care facilities, will make some elderly people more vulnerable to institutionalization.

Consumerist ideology and the symbolic landscapes of private medicine

The consumption of health care has generally been examined by geographers in terms of patterns of service utilization by patients. The sites of service provision have been viewed as locations rather than as contributors to, and constituents of, urban landscapes. In this paper we argue that perspectives of the so-called "new" cultural geography can assist in interpreting the urban landscapes of health care. The case of accident and medical clinics in New Zealand is examined and used to argue that the underlying ideologies of private provision and consumerism is reflected in the symbols used in both the built environment and in advertising.