There should be “no place for compulsory care” in the new Mental Health Bill, an academic specialising in human rights and legal coercion says.
Public submissions on the bill to replace the 1992 Act close on December 20.
But Associate Professor Sarah Gordon, a lived experience academic at Waikato University, said the bill as it was currently designed would not deliver the “transformational change” that was its intention.
“It is completely inconsistent with expert advice and international law and best practice.”
At its core, the new bill still allowed clinicians to over-ride patient decisions, she said.
“Community treatment orders have been proven to be not effective in their stated aim of reducing time spent in hospital and readmissions.
“So the response in the bill is a name change – from community treatment orders to community care orders!”
While the preamble to the bill mentioned “supported decision-making”, there was no mention of it in the Bill itself, Gordon said.
It appeared to set up “advance directives” as a tool for compulsory care.
“In fact, the purpose of advance directives is to say what you want to happen some time in the future so you don’t have to be subjected to compulsory care, which as I hope people will appreciate, is an oxymoron.”
New Zealand’s health system would need to change radically in order completely abandon “substitute decision-making” – someone else making decisions for a patient, Gordon said.
However, places which had done so had found reported more positive outcomes.
The bill did not meet the requirements of the Convention on the Rights of Persons with Disabilities, which was signed by the government almost 20 years ago, and had resulted in damning reports from UN inspectors about the country’s mental health legislation, she said.
However, a global UN report from 2021 praised one New Zealand provider, Tupu Ake – a peer-led alternative crisis admission service in South Auckland.
Gordon said her own recovery came down to “time” – yet the presumption in the legislation was that traditional decision-makers (clinical staff) had no time, particularly in a crisis.
“My experiences of where I have been supported to really truly recover have involved significant periods of time and people investing time in my recovery.”
Waikato University Associate Professor of Nursing Anthony O’Brien said New Zealand had one of the highest rates of community treatment orders in the world.
“This is not driven by rates of mental illness, or by our policy of community care. It is simply a practice that has become entrenched in mental health care over decades.”
Community treatment orders were used 4.5 times more frequently with Māori than with non-Māori and also more often in areas of high social deprivation.
“The research evidence for the efficacy of community treatment orders is quite unequivocal; there is no demonstrated benefit to the patient.”
It was disappointing that the bill had made no changes to the provisions for community treatment orders, despite the Ministry of Health’s undertaking to transform the mental health legislation, he said.
Important to get the law ‘right’ – minister
In a written response to RNZ, Mental Health Minister Matt Doocey said he “welcomed the discussion” over the bill and strongly encouraged people to put in submissions.
“It is absolutely important to me that we get this legislation right.
“The aim of the new bill is to modernise compulsory mental health care to support a rights-based and recovery approach. It is intended to be a critical safety net when urgent intervention is needed as a last resort.
“A key shift the bill makes is towards supported decision-making. This is why the bill introduces changes to empower people to make decisions about their own mental health care before they become unwell, or to the best of their ability if they become subject to the legislation.”
By Ruth Hill of rnz.co.nz
