Indefinite compulsory treatment orders come to an end

As we prepare to welcome in 2024, we’d like to acknowledge the very important step taken at the end of 2023 to eliminate indefinite compulsory treatment orders. The Mental Health (Compulsory Assessment and Treatment) Amendment Bill passed its third reading in October 2023, representing a crucial step to ensure patient safety until the whole Act can be replaced.

Andrew Little, the Health Minister at the time, acknowledged indefinite treatment orders as a “serious breach of human rights” and that the Mental Health Act has been widely criticised for being “out of step with Te Tiriti o Waitangi and New Zealand’s other domestic and international human rights commitments.”

The elimination of indefinite treatment orders is a significant policy reform that stakeholders and “He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction” (November 2018) have clearly called for. Indefinite treatment orders discriminate against people with mental health challenges, are tantamount to arbitrary detention, and restrict access to justice. These are significant and substantial restrictions placed on people’s rights, including the right to refuse medical treatment.

Consistency with Te Tiriti o Waitangi

The elimination of indefinite treatment orders is consistent with mana whakahaere and mana tāngata principles. It supports the enablement of Māori aspirations for health and independence by addressing the inequities of Māori, who are more likely to be subject to an indefinite treatment order and have their rights and independence potentially restricted for longer than appropriate or necessary. This amendment is also consistent with Te Tiriti o Waitangi principles of equity and active protection.

Lived experience of indefinite treatment orders

We talked to Dennis, a peer support worker who uses his own lived experiences to work across many services supporting people experiencing mental health challenges. It’s been many years since had his own experience of being put under a treatment order, but it still lives strong in his memory.

He recalls the feelings of powerlessness, frustration and not being heard that it engendered for him. While it did give him easier access to services, the sense of invasion and force – such as having to see his psychiatrist and workers at the hospital where he had experienced trauma – made things more difficult. Many of the people he works with now are under treatment orders, or the threat of them if they don’t comply with treatments, and have similar feelings of intrusion, powerlessness, hopelessness, devastation and loss of control.

The ending of indefinite community treatments orders will be met with happiness and relief by many. Dennis feels this is definitely a step in the right direction towards eliminating restrictive and harmful practices.

The details

Clauses 6, 7, 8, 10 and 12 of the amendment will eliminate the possibility of indefinite compulsory treatment orders that have no regular independent court review. This provision requires a responsible clinician to make an application for extension of a compulsory treatment order every 12 months after the first two extensions have been granted. A court must review the application for an extension, including an examination of the patient, before granting an extension to the order. This requirement will strengthen protections for individuals subject to compulsory treatment orders to reduce the potential for arbitrary detention and restrictions on their individual rights for longer than necessary or appropriate.

Te Pou resources

Te Pou has a range of resources to support people who are being assessed or treated under the Act, and their whānau. These resources include a short video outlining the process of the Act, a booklet on the rights for people being assessed or treated under the Act, a booklet for family and whānau of people going through the process, and a detailed set of videos from a District Inspector who is responsible for protecting the rights of people receiving treatment under the Act.

Te Pou has also developed a series of e-learning modules to support the workforce in application of the 2022 changes to the Mental Health (Compulsory Assessment and Treatment) Act Guidelines.

The intent of the e-learning package is to support the workforce in adopting a person-centred, human-rights based approach to situations where the Act is used. In this series there are three e-learnings, the first e-learning is a general introduction to the changes for anyone in the health workforce, the second for the mental health workforce and the third for the specialist mental health workforce who administer the Act. Mental health workers can access the e-learnings via the Te Pou website.