In the heart of the sleepy Tasmanian town of New Norfolk, half an hour’s drive out of Hobart, lies the Willow Court Precinct. As you wander down the tree-lined streets of the township, the crumbling buildings of Willow Court come slowly into view. On the banks of the Lachlan River, right next door to the new supermarket complex with its perfectly rendered frontage, shiny signs and sparkling clean windows, sit three of the saddest, loneliest-looking buildings you’re ever likely to see. Not a single shard of glass can be found in any of the windows of the multistorey structures. The tallest of the three, Derwent House, sits at the front, facing the road, with an enormous gaping hole in its side, revealing a glimpse of the emptiness that lies within. Graffiti covers the internal and external walls. It looks like something from a horror movie, a scene from the apocalypse. These particular buildings are fenced off, but this is only a small part of an incredible complex that holds so much of Tasmania’s history.
On the other side of the road a sign on the gate that blocks the driveway proclaims ‘Willow Court: Gate opens 10–4’. Inside, the sense of abandonment and despair increases, despite the handful of people who walk through the courtyard. The gardens are overgrown and covered in rotting leaf litter. The carcasses of old vehicles clutter the yard haphazardly, their original paint colours peeking through the burnt orange rust to form a patchwork of colour. The buildings that surround the circular driveway are in only slightly better condition than those across the road. At least these do still have their windows, mostly. Some have been converted into antique shops and one advertises itself as a café. The rest are closed off, inaccessible to the public, hiding the secrets of the past behind locked doors. At the back of a cluster of tired-looking buildings a woman kneels in a garden bed in the centre of a small roundabout, trying her best to resurrect what was once maybe a nice space and is now just barren dirt. Through a dusty window a lonely figure can be seen sleeping on the dirt-covered floor of an empty room.
It hasn’t always looked so abandoned here. There was once a time when this courtyard bustled with activity. The buildings had glass in their windows, and across the road Derwent House had all of its walls intact. The gardens were maintained, the trees stood tall and majestic, there was a thriving vegetable garden to supply the kitchen. As I stand in the cluttered, overgrown courtyard, grey clouds gather in the sky and rain threatens to fall at any moment. I picture this place as it used to be, and I’m hit with a sudden realisation of just how lucky I was to succumb to my own mental illness after the Tasmanian Government closed this place in 2000, after 173 years of operation as the Royal Derwent Hospital, the state’s primary facility for the treatment of the mentally ill and insane.
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I’ve fought a lifelong battle with depression and anxiety, but it was in the summer of 2011–12 that I slipped into a bottomless pit of misery that I wasn’t sure I would ever be able to climb out of. I had just suffered my second miscarriage, and I was emotionally broken in the worst possible way. There was no brightness in my life any more, and I pulled away from my husband and our 18-month-old daughter, convinced that I was saving them from the heartbreak that my pathetic existence would inevitably cause. I spent my days in a trance, going through the motions but never really being in the moment. I would sit for hours in one spot, lost in the darkness, trapped in the abyss that was my mind.
Some people believe that depression is just feeling sad, crying too much, not being able to be happy. It’s not. It’s much more than that. Of course I cried in the beginning. For weeks I cried big, fat tears that fell with racking sobs that hurt my entire body. That was the healthy reaction to what I’d been through. It was after the tears stopped that I got sick. When my tears dried up, so did something inside me. I didn’t feel sad any more, I simply felt nothing. The numbness that engulfed me was all-consuming, like a fog that I couldn’t push through, no matter how much I tried.
Eventually I realised that I couldn’t keep going the way I was, and I dragged myself off to our family doctor. He asked a million questions, gave me a prescription for some magic little pink pills, and referred me to psychologist. I got some help. It was a long journey, but I fought off the worst of the depression and came out the other side in one piece. I will never be the same as I was before that period of illness, and I still have my bad days, but I’m here.
I’m not alone in my battle against the black dog of depression. The statistics surrounding mental illness are, frankly, terrifying. The World Health Organisation estimates that depression will be the number-one health problem around the world in a matter of just 15 years. Mental illness is already the number-one cause of nonfatal disability in Australia, and depression is the third-highest burden on our healthcare system. One in five Australians aged 16 to 85 are affected every year. Stop for a moment to think about that. What’s scarier still is that almost half of us, 45 per cent, will experience some form of mental illness in our lifetimes.
Despite these figures becoming more talked about, a stigma still surrounds mental illness that needs to be addressed. People don’t talk about it, and up to 65 per cent of people suffering a mental illness don’t receive treatment; they suffer alone because they are afraid to speak to their doctor. Many don’t even talk to their friends or family about what they’re going through because they fear discrimination and isolation. This stigma needs to be broken. It’s a throwback to the days of asylums and institutionalisation, a time when Willow Court was at its finest, and the treatment of mental illness was at its worst.
Willow Court, 2009
Almost 100 years to the day before my breakdown, another Tasmanian woman was suffering a similar depressive episode. Annie Amos was 51 years old on 21 March 1913, when her husband declared that he’d had quite enough of her melancholy moping around and had her committed to the New Norfolk Hospital for the Insane as a person of unsound mind. Her admission record could easily be confused with a description of my own depression, noting that she ‘wanders about the house aimlessly’ and ‘will take no interest in anything’. What happened to Annie after that is unclear, except that she didn’t recover in the same way that I did. Annie died, alone in the dark rooms of the asylum, on 11 June 1920. She was just one of the thousands of patients who were treated at the hospital in the 173 years that it operated. They each have their own story, and many of them are equally as sad as Annie’s.
The Royal Derwent Hospital began its long and sad life in 1827 as the New Norfolk Lunatic Asylum, an invalid barracks for convicts and the insane in Van Diemen’s Land. Only 35 kilometres from Hobart Town, tucked away in the town of New Norfolk, it was perfectly located for keeping the unsavoury characters away from the free settlers. The first invalid was admitted to the barracks in June 1827. A dedicated ward was built for ‘lunatics’ two years later, and began receiving admissions in April 1829. It was a further nine months before the first female patient was admitted to the lunatic ward, when Irish woman Judith Chambers arrived in January 1830.
In 1832, Lieutenant-Governor Arthur ordered the removal of invalids from the facility, and concentrated the facility’s services on the treatment of the mentally ill and insane. He commissioned a new set of buildings, which were completed in 1834, and increased the capacity of the facility to 310 inmates. In 1855 the facility was transferred from imperial to colonial ownership and, due to the closure of many of the penal institutions around Van Diemen’s Land, the number of patients rose dramatically. By the end of the nineteenth century, almost 400 patients were housed in the facility that was built to hold only 310.
By the time Annie Amos arrived in 1913, not a lot had changed. For many years the hospital was very different to what we think of as a healthcare facility today, and was staffed mostly by convicts and ex-convicts. The only free staff were the medical officer and the matron. There was very little understanding in the nineteenth century of mental illness or what caused it, and doctors relied on their moral conclusions and social norms to diagnose the symptoms they were presented with. Behaviour was often referred to as ‘sinful’, and the blanket term ‘lunatic’ featured in many of the patient files. Specialist training for the staff didn’t begin until 1919, and medical officers commonly brought with them their own prejudices towards convicts and the poor, allowing these to influence the care their patients received.
In the asylum, patients were classified according to the severity of their insanity, and were then allocated tasks that would occupy and, more importantly, discipline their minds. Those who behaved were granted time in the gardens for leisure and reflection, but for those who failed to comply with the instructions of the matron or the medical staff the treatment was harsh, and confinement in their dark, squalid cells was inevitable. This was a time before anti-depressants or antipsychotics had been developed, and the goal of treatment was either to subdue the patient enough to integrate them back into society or keep them locked up and out of harm’s way. Restraints were a popular measure, and the use of handcuffs and straightjackets was common practice. For those patients who required even more restraint, there were barred crib beds, torturous coffin-like wooden boxes with bars on all four sides that were just large enough for the patient to fit inside without allowing any movement.
Patients were powerless to speak up, and were treated as criminals, whether they were convicts or settlers. The majority of those admitted to the facility were poor, with little financial or family support to call upon. For the families, it was often seen not only as a place to cure and keep their relative safe, but also as a respite from the demands of caring for them. They were not going to complain about the conditions at the facility and risk having to take them home.
In the 1940s and 1950s scientists began to discover links between some mental illnesses and chemical imbalances in the brain. This led to experiments with drug treatments for mental illness, which eventually became the commonly prescribed drugs such as Zoloft and Prozac that are used quite successfully today. The availability of medication reduced the need to restrain many patients, but didn’t alleviate the poor conditions in the Royal Derwent Hospital. Complaints continued about the lack of government funding for the facility throughout the 1950s, 1960s and 1970s.
The first social worker, a position that is almost synonymous with health care of any variety today, wasn’t appointed until 1949. Is it really any wonder that former patients have reported that their voices went unheard? Many have spoken out in recent years to say that there was a gross disempowerment of the patients as well as the nurses, who were doing the best they could with a horribly outdated facility and barbaric policies. Today mental health advocates are calling for a formal apology to former patients for the conditions they lived under and the abuse they received. This call has so far gone unanswered.
A number of official inquiries have been held into the Royal Derwent Hospital over the course of its sordid history. The first, in 1883, made recommendations for drastic changes that were ignored, seemingly because the commission criticised the government for lack of funding. A new purpose-built facility in Hobart was continually proposed by commissioners, but was always rejected by the local community, which depended on it as one of the area’s largest employers. The last inquiry was held in 1979, and although the recommendations still went unanswered for the most part, this would be the beginning of the end for the Royal Derwent Hospital.
In the 1980s a global push began to investigate the need to deinstitutionalise mental health patients. Advocates for deinstitutionalisation argued that outcomes for patients could be improved by removing them from the hospital environment and allowing them some freedom and input into their care. Deinstitutionalisation liberated patients, and empowered them to make choices that would ultimately allow them to lead productive lives in their communities. With governments around the world struggling to meet the cost of running asylums that had seen massive rises in patient numbers, the idea of deinstitutionalisation was well received, and a slow shift began from hospital-based care to a community-based model.
As this model gained popularity around the world, facilities such as the Royal Derwent Hospital began to close their doors. During the 1990s a number of wards were closed as treatments were transferred from inpatient to outpatient facilities, and dedicated short-term psychiatric wards were established in the Launceston General and Royal Hobart hospitals. In Australia, Tasmania led the way and became the first state to deinstitutionalise all of the patients at the Royal Derwent Hospital in November 2000.
Hospitalisation now only occurs when a patient is acutely unwell and needs urgent intervention to prevent them harming themselves or others. It’s generally accepted that better care can be received, and better outcomes achieved, with the patient in a more familiar and comfortable environment. With a greater scientific understanding of what causes the imbalances in the brain that lead to mental illness, doctors today are in a much better position to treat these conditions. General practitioners are at the front line of mental health services today, and many of them are undergoing further training in this area that allows them to specialise in mental illness and provide even greater care for their patients.
Antidepressants, antipsychotics and mood stabilising medications have evolved since their initial development in the 1940s and 1950s, and are effective in treating a wide variety of mental illnesses, with 60 to 70 per cent of people with depression responding positively to antidepressants. Modern treatment involves more than just medication, though. Psychological treatment is provided by psychologists and psychiatrists and, although results can take weeks or months to become evident, such treatment can help reduce the symptoms of anxiety disorders and depression significantly. Other therapies, such as cognitive behaviour therapy, interpersonal psychotherapy, dialectical behaviour therapy and electroconvulsive shock treatment are all options available to improve the quality of life of patients. Community support is also vital, and includes education, rehabilitation and support groups.
Involuntary treatment today is rare. Patients will only be treated without their consent to prevent serious harm to themselves or others, and only on the recommendation of a psychiatrist. Today, Annie’s husband would not have dragged her to the asylum because she was depressed. He would have encouraged her to see their local doctor, who would ask her questions, do a mental health assessment, prepare a mental health plan, and probably prescribe some form of medication. They would then refer Annie to the appropriate community-based professionals who could help her in her recovery. Annie might have been allocated a case manager, someone to help her access the services she needed, and support her in her recovery. Or maybe she would have been placed in a community intervention program, where a team of mental health professionals would manage her care and visit her at home to ensure that she was getting the right treatment, the goal being to reduce the number of hospital admissions patients need. Whatever path her treatment took, it’s almost guaranteed that she would not have died locked inside a cold, dark hospital room.
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Why did Willow Court affect me so much? In truth, I’ve felt myself slipping away again lately, felt the shadows beginning to encroach upon the good things in my life. Despite taking my medication religiously, the sadness is coming back. It terrifies me, even more than last time because I know exactly how bad I can get, and I don’t want to go back there again. I know that relapse is an almost inevitable fact of life for anyone who suffers depression, but I don’t want to be that person. When I started out with the idea to explore the history of the Royal Derwent Hospital, it was because I’d always been fascinated with the buildings that I had seen behind the big besser-block fence across the road from my great-grandmother’s house when I was a child. I didn’t realise how much the stories of the patients like Annie would resonate with me.
Treatment of mental illness has come a long way since Annie died inside the dark, lonely halls of the hospital. This is why Willow Court got under my skin. I could have been Annie, locked away and forgotten, never to recover and never to leave. Instead, I will make an appointment to see my doctor and have my medication adjusted. I’ll schedule in some sessions with my psychologist. It will take time, but I know I will come out the other side of this. And just like before, I will do it at home, surrounded by people who love and care about me. But this time I will fight just that little bit harder, in memory of Annie Amos, who never got the chances for recovery that I am so lucky to have today. •
Tracey Clark is a full-time mum and part-time writer from Tasmania. She is studying a Master of Arts degree with Swinburne University of Technology.
