Coercive treatment for mental illness reform long overdue

From RNZ

New guidelines from the World Health Organisation calling for an end to compulsory and “coercive” treatment for mental illness should be a wake-up call for New Zealand, mental health experts say.

A senior lecturer at Otago University, Sarah Gordon, who specialises in legal coercion and human rights, said the new report’s findings were consistent with New Zealand’s own Mental Health inquiry He Ara Oranga, which showed services need to move away from their entrenched reliance on coercive treatment orders.

“Everyone is quite clear our system is broken and until the recommendations of the inquiry are actually implemented, we won’t see general systemic change.”

The Mental Health Act is currently being revised for the first time since it came into effect in 1992, which was another reason services were so outdated in many cases, Gordon said.

New Zealand’s rates of compulsory treatment were high, due in part to the over-use of community treatment orders, which were “difficult to challenge and often become indefinite treatment orders”.

“The abolishment of substitute decision-making [compulsory treatment] does not equate to the abandonment of support. You still provide support – but in a different way.”

Her colleague at Otago, psychologist Paul Skirrow, said compulsion was necessary in some cases – where people were too ill to consent or understand their treatment – but compulsory treatment orders were overused, in his view.

“And not just overused, but not used in a good way – we’re not working with families, working with people to keep them in hospital for the shortest possible period. The fact they are reforming the Act right now, shows we’re not doing it right.”

The new guidelines from the World Health Organisation, calling for a human rights-based approach to mental health care, were long overdue, he said.

“People really struggle to assert their rights in mental health services. We see a lot of restraints and seclusion happening up and down the country and people not having access to justice. So I really think human rights approaches are the way forward.”

New Zealand also had “a legal imperative” to adopt a human rights approach, with its commitment to the UN Convention on the Rights of People with Disabilities, he said.

Skirrow, who is also executive advisor to the New Zealand College of Clinical Psychologists, said there needed to be more emphasis on psychological treatments to aid long-term recovery, rather than just drugs to treat symptoms.

“The way that human rights approaches work is they remind us we’re treating people, rather than symptoms and disorders.”

NZ operation praised

The WHO report cites Tupu Ake, in South Auckland, as an exemplary example of a people-based service.

The peer-led operation in Papatoetoe, run by Pathways for Counties Manukau DHB, records higher satisfaction with care – and shorter average lengths of stay – than at hospital units.

Pathways operations manager Ross Phillips said he hoped the Government could realise its own ambition and fulfil all the recommendations to come out of He Ara Oranga.

“If they really get behind the recommendations that they agreed to in that and start to fund and support the growth of it, we will see more community-based options that are person-centred and recovery-orientated and that do meet the criteria of what the WHO were trying to achieve with the Quality Rights Programme.”

Pathways operates a similar programme in Christchurch, while other providers run peer-led services in Waikato and the North Shore, but most regions had nothing like this to offer people in mental distress, he said.

If people were properly supported and engaged in discussions early, compulsory treatment orders would not be necessary.

“We need to do this before they are at that point where they are in a state of such distress that they may not have that ability to decide.

“We could do that through advance directives or there are other protections to make sure people’s voices are heard, like engaging family and whānau through the process to ensure people still have some authority over what services they receive, even if they are acutely unwell at the time.”

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