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New Mental Health Act A 'Potentially Wasted Opportunity' - Healthcare Professionals
Ruth Hill, Reporter
Making special laws to control people suffering mental illness is as pointless as forcing people with diabetes to get treatment, claims one psychiatrist.
In an article published in The New Zealand Medical Journal today, a group of mental health professionals argue the new Mental Health Bill is just "the old act with some new lipstick".
New Zealand has wasted a "once-in-a-generation opportunity" to create a person-centric, human rights approach to its mental health legislation, in their view.
The bill - which had its first reading in October - came out of the 2018 Inquiry into Mental Health and Addiction.
That recommended replacing the out-dated 1992 Act with legislation reflecting a human rights-based approach and "supported decision-making" to minimise compulsory or coercive treatment.
However, Otago University psychiatry professor Paul Glue said while the new Bill promised "great things" with its discussion of patient-centred care and supported decision-making, but that appeared to be merely "semantics".
For instance, if people were found to lack capacity, then someone else could over-ride all their decisions - even those made earlier.
"The 'new' proposed act is essentially the old act with a few minor tweaks - it's essentially the old act with some new lipstick," Glue said.
The editorial, signed by a group of clinicians, academics and service users, said the new bill retained the same "stale notions of care, inefficiently using resources, promoting the status quo of substitute decision making, increasing stigma and risk in the community and lack of consistency with international conventions".
They say compulsory care directives are an oxymoron, "because care should be provided rather than compelled".
No need for mental health legislation - psychiatrist
Another co-author, Wellington psychiatrist Giles Newton-Howse, said the bill as it was currently written left the balance of power in the hands of clinicians like himself, which was wrong.
"I will be responsible for using this act if it's passed.
"If you give me a lever that looks and feels like the lever I've pulled for 20 years then I'm likely to pull it the same way."
By allowing clinicians to over-ride personal decision-making - and make "capacity assessments" in order to force someone to have treatment - the bill also breached New Zealand's obligations under the Convention on the Rights of Persons with Disabilities (CRPD).
There was no valid reason for making mental health legislation at all, any more than for making special laws to govern diabetes treatment or surgery, he argued.
Asked whether there was ever a case for compulsory treatment (to protect those who were a danger to themselves or others when acutely unwell), Newton-Howe said there was no evidence that legislation could prevent an incident of that kind.
"The logical error we all make is to take epidemiological data and presume we can apply it to individuals.
"To reframe your question - is it reasonable to require some people to take treatment for mental illness on the off chance, without any evidence, that it might prevent one individual from harming another?
"If we are concerned about harm to members of the public on the basis of epidemiological data - should we detain everyone with a significant alcohol or drug use disorder?
"Or require members of groups who we know engage in criminal behaviour to be compulsory managed in some way?
"So if you want to select a group of people who potentially pose a risk to others, those with psycho-social distress or serious mental illness wouldn't be at the top of my list - or anyone else's who stopped to think about it."
Psychiatrists and other mental health professions had a duty of care to provide healthcare when people lacked capacity, and they did not need an act to do so, he continued.
"The only real way to make this legislation comply with UN obligations - and in my humble view, common sense - would be to have no mental health legislation.
"Potentially you would have a Mental Capacity Act, that applies to all New Zealanders.
"That would require real bravery."
Meanwhile, there were things that could be done to improve this bill, he said, including removing all elements to do with forensic services and putting them in other legislation.
The article also recommends:
- placing supported decision making at the heart of the Bill
- adopting "advance directives" for all people experiencing psychosocial distress
Public submissions on the bill close on 20 December.
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