Intellectual Disability (Compulsory Careand Rehabilitation) Bill

This part covers the principles and general duties. Clause 14 talks about interpreters having to be provided. That is very important when we are talking about someone with an intellectual disability who may have difficulty in communicating anyway. I think that provision brings us back to talking about a definition of normal behaviour and the cultural setting in which it takes place. When any of us travel we are always struck by the different cultural and religious beliefs of the other countries that we travel in. It is important that interpreters are provided, to try to get appropriate information.

We can imagine the situation that occurs if someone is maybe involved in, say, a car accident, and the police turn up and see someone in the car behaving in an unusual manner. That could be because of a head injury that that person has sustained, or it could be because he or she has an intellectual disability or has used drugs. The police at the roadside cannot determine what the reason for that behaviour is, and people in such situations can sometimes end up in police care, where the police have to determine what is causing the behaviour. If we add a language problem to that as well, then we have severe difficulty in being able to sort out the cause of somebody’s behaviour. So it is really important that interpreters are provided.

Under clause 13 we have the statement that the powers are to be exercised with proper respect to a person’s cultural identity and personal beliefs. I am not too sure about the personal beliefs one, but, certainly, the cultural context in which somebody works with his or her language, religion, and ethical beliefs needs to be taken into account, because that may create behaviour that may be unusual to someone of a different cultural belief. Those are some of the clauses that are in this bill.

We have to look at the individual cases that we have had. I have talked to the police down in Marlborough about the problems they face. The police and our judges deal with the front line, and that may also include ambulance staff, although ambulance staff probably have more knowledge about intellectual disability than the police sometimes do. But in those situations it is quite difficult to understand why someone is behaving in the way that he or she is. If that person has an intellectual disability, then this legislation has to immediately begin to be implemented, and that means providing an appropriate assessment of the person and developing a care plan for him or her.

Under Part 2 we also see the principles governing decisions affecting children and young persons. In the case of people who have an IQ of 70 their intellectual ability remains completely stunted, so they do not develop the maturity or social ability to manage in society. It is far easier to be able to manage their care when they are children. It is when a child of 6 then becomes a 6 foot 2 inch man, who is extremely strong but remains with the intellectual capacity of a child of 6, that we have had some of the sad cases we have seen in the past that have led to the development of this bill—people like David Stephens, and the problems his parents had in coping with him. It is important that decisions affecting children and young persons should, where practical, be made and implemented within a time frame that is appropriate, so that families can move ahead and get a care plan for them.

Clause 9 talks about secure facilities.

I want to take a brief call on this part, which is actually quite a small part. Having not been part of the select committee process that went through the whole bill very thoroughly, I would like to ask about the area of interpreters. I am not sure what the intention of clause 14(2)(a)(i) is. It states an interpreter is to be provided if “the first or preferred language of the care recipient is Māori or another language other than English;”. The thing that worries me is the use of the word “preferred”, particularly as in New Zealand there are people who are obviously very fluent in both English and Māori. I am concerned, in particular, about the cost that could be incurred, especially if an interpreter is required for quite some time. I worry that health dollars may be diverted from where they perhaps should be spent, and be spent instead on something like the use of an interpreter when people who are quite capable of being understood in English say that they would prefer to be heard in a completely separate language. I wonder what thought the Health Committee gave to that when it was processing this bill.

We see that in other areas, particularly in the mental health areas where patients under compulsory care—[Interruption] Perhaps the Minister would like to take a call and tell me what went behind this measure. I was not part of the select committee process.

It was before my time in Parliament. Also, I still have not had an answer to my query about the term “rehabilitation”. It is all very well for the Minister to sit there and pass comments to other members of the Committee, yet she is not happy to stand up and answer valid queries that, I think, should be clarified.

My concern is about the spending of health dollars. I was about to say that in the compulsory care of people with a mental illness, the patients are able at every step of the way to appeal the process and use district inspectors to represent them when, in fact, the doctors presenting the other point of view usually do not have a lawyer representing them. Yet the money that is used for that comes out of the health budget. It comes out of the individual district health board budget for the appeal process, when the intention is that the money is to be spent on treating those patients, and not on legal bills.

Clause 14(2)(a)(i) raises a similar concern, and all I am asking for is clarification of that small provision. I do not object at all to subclauses 2(a)(ii) and (iii); they seem to be perfectly reasonable. But when somebody who is able to speak English perfectly well says he or she would prefer to be heard in another language, I just wonder why that is acceptable. Perhaps the Minister could answer that question for me.

Part 2 deals with principles and general duties. Once again, I cannot help but note in clause 11 the term “care recipient”. I think it is referred to four times in about six lines—which is double the number of words we need. It is good to see the Minister in the chair, and she may be able to take a call and explain the genesis of the somewhat redundant and wordy term “care recipient”, rather than the use of the term that most people in New Zealand—in fact, the world—know, which is “patient”, to mean a person who is receiving care or treatment. I would be very interested to hear what the Minister does have to say in that regard. She is nodding her head, so, as she is one of the leaders at the forefront of the politically correct brigade, it will be very interesting to hear what she has to say.

I will go on to clause 12, “Principles governing decisions affecting children and young persons”. Those principles do, indeed, seem thorough, and on the whole I concur with them. There is the point that wherever possible, the family, whānau, hapū, iwi, and family group of a child or young person should participate in the making of decisions affecting that child or young person, and, accordingly, regard should be had to the views of the family, whānau, hapū, iwi, and family group. There is absolutely no doubt about that. The tragedy down in the South Island arose when there was a lack of involvement by the family. It was simply not listened to, and a subsequent tragedy occurred when the young man killed his parent in that situation. So undoubtedly that is highly important.

But one of the questions that, hopefully, the Minister will take a call on is how, practically, she will ensure that those ideals are lived up to in reality. How does one provide the service, realistically? The Minister was one of a group that, in the 1990s, called shrilly, time and time again, for appropriate mental health services and facilities. Yet the reality of today is that we hear every day of the absolute mental health crisis in New Zealand and the lack of facilities. It is, indeed, an example of the forethought of Wyatt Creech, who brought this bill into the House, that provision was made for $50 million for both this bill and the Criminal Justice Amendment Bill (No 7) so that there would be money earmarked to ensure that appropriate facilities were there. However, in reality we do not see that, and I would be very interested if the Minister would take a call on that point.

I move on to clause 13, “Powers to be exercised with proper respect for cultural identity and personal beliefs”. Again, it is fine and appropriate to say that it is vital that proceedings are conducted with proper respect for the care recipient’s cultural and ethnic identity, language, and religious or ethical beliefs. I remember very well when I was a consultant at one of the hospitals and a woman from Iraq came in. She was a doctor, and there happened to be a senior doctor from Iraq in attendance. As a male gynaecologist I deferred to that individual to take the woman’s history and carry out the treatment—something I normally do not do. As it happened, the Iraqi senior doctor said the woman should be taken down to an operating theatre, but just beforehand she called me to say that she was caught up in the emergency department and to ask me to do the operation. I went in, only to find that a totally inappropriate operation had been ordered and the woman was anaesthetised. That operation was ordered by an overseas senior doctor whom I had organised to look after another Iraqi doctor. So, in practice, the reality of ensuring that cultural sensitivity does take place is very difficult.

I want to take a call in order to ask the Minister to take a call with regard to clause 12, “Principles governing decisions affecting children and young persons”.

💬 Hon John Tamihere: I raise a point of order, Mr Chairperson. My point of order is with regard to Standing Order 35(1): “A party must inform the Speaker of—(b) the identity of its leader and other office holders,”. We are led to believe that there has been a change in the leadership of one political party, and we ask whether the Chair or the Speaker has been advised. Could you confirm that the leader of the National Party has changed this afternoon? I think members are entitled to know.

The CHAIRPERSON (Hon Clem Simich): That is not a point of order.

If Mr Tamihere is trying to be humorous he should learn how to be humorous. People like me can be humorous but some people cannot.

The issue that concerns me is that when I look at clause 12 I think it is probably a take-off. Someone who is more familiar with the bill than I am may be able to help me. The structure in the clause is the same sort of structure we have with the Department of Child, Youth and Family Services, for example. I guess it is our consultation structure. I imagine that if the wording is not exactly the same it is probably similar to the wording we have in other legislation.

I come back to the point I made earlier on in Part 1 about how we will provide services and facilities to make sure that consultation happens. If the Minister is going to be relying on the Department of Child, Youth and Family Services, for example, to make sure that those consultations, etc. take place with families, whānau, hapū, and iwi, then I have serious concerns. We all know, both currently and indeed from history going back over a number of months and years, that the service is not so flash. So the Minister might care to take a call to assure the Committee that she has in mind some other department, organisation, or system to provide the service set down here under clause 12. We want to be assured of that because, as the Minister knows, we are supporting this bill.

Sitting suspended from 1 p.m. to 2 p.m.

Debate interrupted.