It was back in November 1994, after he stabbed a bank teller for turning down a credit-card application, that 36-year-old Johnny Manu's future was sealed.

Remanded to the Mason Clinic in Auckland, which cares for the criminally insane, and recommended for hospital assessment and possible restricted patient status (which would have put him under a compulsory treatment order and shackled him into the mental health system), Manu was judged bad rather than mad and sentenced to two years in jail.

And he is not the only one of our most disturbed and vulnerable citizens who have been kicked out of the mental health system and are now in Paremoremo prison - after they have killed or raped.


Manu is in jail alongside some of the friends he was in hospital with back in the 80s, says his disillusioned family.

Manu, diagnosed a schizophrenic at 17 after holding a trimming knife to the throat of a shop assistant, then jumping over a post office counter to attack a teller, had a problem with authority. Over the next 20 years, as he moved between Te Atatu South and his girlfriend's place in Kaitaia, he was in and out of mental institutions until Carrington Hospital closed in 1991. He also accumulated a record for violence and robbery - much of it centred around mental health workers, banks, post offices and, lately, ACC.

In 1985, while a committed patient at Oakley Hospital (as Carrington used to be called), he escaped and dragged a woman along the asphalt at the Downtown bus terminal as he snatched her handbag, fracturing her skull.

Two years later he accepted a "contract" to stab a West Auckland man for $500. He just missed his victim's heart. He also attacked the wrong man.

Next he tried to cut his own throat and, during his two-year prison sentence for the stabbing, made several suicide attempts.

In July 1989, after robbing a bank, Manu was again remanded to Carrington, became suicidal and was transferred to Kingseat psychiatric hospital south of Auckland, where he broke a nurse's arm with a chair leg.

A year later, he was granted "leave" from Carrington and transferred to community care under the West Auckland mental health team. He punched a nurse after demanding drugs.

In 1992, Manu spent Christmas hallucinating at the Mason Clinic. At New Year he threatened to kill his de facto wife. Eighteen months later, after he had been in the system and on medication for 13 years, psychiatrists decided that Manu's continuing violence was not a result of his mental illness. They were not convinced even after he swallowed 7 to 14 tablets of Kemadrin - a drug given to counteract the side-effects of anti-psychotic medicine - and stabbed a bank teller that November, insisting - "Satan made me do that."


The diagnosis: Manu's risk did not relate to his psychiatric symptoms.

Although this was his third knife incident, he was not made a restricted patient. Instead, the Mason Clinic said: "We suggest to the court that a serious risk of harm to others remains (but not necessarily always in direct and causal relation to his underlying psychotic disorder)."

After serving half of his two-year sentence, Manu was settled in Kaitaia where he was relatively healthy for another year. But by 1997 he was back in Auckland under the West Auckland Community Care Team, assaulting a bank worker, threatening to kill and knifing himself. A request to have him admitted to the Mason Clinic was turned down. He went back to Kaitaia, forcing the West Auckland team to transfer him, but by September 1998 had returned to Auckland and was harassing workers at Work and Income. This time the West Auckland team could not find a local bed for him and arranged four nights' emergency housing at Charlhaven, an unregistered and largely unsupervised South Auckland boarding house. He was referred to the South Auckland Mental Health team for treatment.

Manu began ricocheting between Kaitaia and Auckland, demanding Kemadrin, staying at Charlhaven but looking for accommodation in West Auckland. In June, after a letter from ACC saying he no longer qualified for his independence allowance, he threatened a bank worker. Over the next few days he visited ACC offices in both South and West Auckland, asking for money. Then, after another letter from ACC on June 23, he cracked. The next day he was on the doorstep of Henderson ACC demanding to see Janet Pike. Twice she turned him away. The third time, not realising he had bought a carving knife from the nearby Warehouse, she took him into a private office, where he stabbed her to death.

Only then was Manu's chaotic life finally stopped by a sentence of life imprisonment.

The amazing thing about Manu's community care is that it worked at all. For nearly a decade he moved between regions and accommodation, trailed by psychiatric teams administering his medication. Because he was an informal patient he could - and did - refuse 24-hour supervised accommodation when it was offered in South Auckland. Because he was compliant in taking his medication and did not pose immediate problems, a compulsory order could not legally be initiated.

One of the biggest holes in his treatment came during the transfer of his case notes to South Auckland Mental Health. Because South Auckland did not obtain Manu's case notes from original sources, there was no accurate police summary of previous involvement with the courts. The Charlhaven boarding house was unaware that Manu had a history of violence, that he had stabbed people, that he had a psychotic illness and abused Kemadrin.

A compounding factor was lack of accommodation. Once mental hospitals shut, beds in the community - especially in Manukau - did not materialise. If there had been beds in West Auckland, the stabbing might never have happened.

The report also highlights how places like Charlhaven, which take care of the accommodation overflow, are minimally funded. While level four services (for the most needy) are funded by the Health Funding Authority at between $175 to $195 daily per client, the five unregistered and uncontracted boarding houses that supply 91 beds in South Auckland operate on around $280 per client per week.

Their standards are neither monitored nor regulated and mental health workers are uncertain about what information can be shared with non-registered providers without breaching patients' privacy rights.

Figures for Auckland mental health spending to July 1 this year show shocking iniquities. While local Auckland mental health contracts totalled $64.470 million and Waitemata (West Auckland and North Shore) $57.466, South Auckland services, with a similar 400,000-odd population level, trailed at $36.576 million.

Workloads are huge. Despite efforts by front- line mental health workers, many people fall through the cracks. In Manu's case, his allocated support worker never met him. All of which points to more Johnny Manu-style accidents just waiting to happen.

Says Dr David Chaplow of the Mason Clinic: "We have another 60 Johnny Manus that in actual fact we are managing ... and that's one of the issues, the continual tension: do we preventatively detain a person because of their propensity to get into trouble or do we release them, attempt to manage them and be blamed when they do get into trouble?"

But is waiting for people like Manu to kill, then pushing them into the prison service, fair or humane? "There's no question," says Dr Chaplow. "But the Mason Clinic is far too small for the demand. Our 60 beds have replaced 400."

John Monahan, quoted in Psychiatry and the Law, is clear: "To deny that mental disorder and violence are in any way associated is disingenuous and ultimately counter-productive." Sylvia Bell, a lawyer and co-author of a book on mental health law, agrees: "If Manu was schizophrenic, then trying to divorce his actions from his illness is abrogating responsibility to let mental health services off the hook. It is abusing the definition [of mental illness] to justify a policy."

The final paragraph in the 188-page report on Manu's case by district mental health inspector Phillip Recordon asks for public action. "The public have a right to ask why, if there is an ongoing mental illness requiring medication, whether or not that mental illness directly leads to acts of violence or not, is there not a section in the Mental Health Act which can 'protect' the public in one way or another."

Lawyers, doctors, civil libertarians and others involve themselves in endless discussion on definitions, rights. They can lose the commonsense perspective. The argument is simple: "He had an illness, he was a risk, why was he not under the act?"