Intellectual Disability (Compulsory Careand rehabilitation) Bill

Clause 29 provides for the assessment of inmates and former special patients. Subclause (1) states: “A superintendent of a prison may apply to the co-ordinator to have an inmate assessed under this subpart, if the superintendent has reasonable grounds for believing that the inmate has an intellectual disability.” One of the problems in that is talking about people who have an intellectual disability, people who have a mental illness, and people who have committed offences. Those situations can all go together: just because somebody has an intellectual disability does not mean that that person cannot have a mental illness, and vice versa.

Sometimes that makes it very difficult to determine the level of care, and where that person should most appropriately be placed. Some people end up in prison, and it is not really recognised that they have an intellectual disability until they get into that strongly supervised environment. At that point, the superintendent can ask for an appropriate assessment of those prisoners, so that they can get the appropriate level of care. Until this bill is passed, it is not possible to put someone from a prison into an intellectual-disability, compulsory-care situation, because we need the legislative framework to be able to do that.

There has also been concern for those who have been in the Kimberley Centre and Braemar Hospital, which were psychopaedic hospitals, where a lot of children have been placed, who then grew into adults. Having those people placed in the community has been a very slow process, because the hard end of the process has been reached—placing those who have very high, complex needs and challenging behaviours.

It is good to see this bill here today, because the Health Committee reported it back in April 2001. It could be said that that is only 2½ years, but it is a very long time to wait for legislation so that the services can be developed around it and facilities built to care for people with behavioural problems bad enough to land them before the courts or in prison. The Rt Hon Wyatt Creech, who was Minister of Health at the time this bill was promoted and during the first stages of its passage through Parliament, earmarked $20 million for its development. The Health Funding Authority—which, to its detriment, this Government merrily scrapped; instead, setting up 21 district health boards, which are all running over budget, and developing 21 different levels of care throughout the country—initiated a service development process that included the development of best-practice indicators for the specialist support of people with high and complex behavioural needs.

That is what needs to happen. There needs to be specialists who can arrange appropriate assessments for people who are considered to have an intellectual disability, and, if necessary, ensure that the proposed care recipient stays within a facility. If a compulsory-care order is to be imposed, there needs to be a determination, when an assessment and examination is undertaken, that the person has an intellectual disability. Under clause 32, on finishing the assessment of the proposed care recipient, the specialist assessor, or assessors, sends a report of the results through to the courts.

It is important that we understand the differences between those who actually do the assessments, and who the most appropriate people are to do them. If the condition is a mental health one, then it should be a psychiatrist, because the appropriate level of care for people who have committed offences is an appropriate specialist. There was quite a bit of debate in the select committee about the most appropriate people to do assessments of intellectual disability, and psychologists were considered.

Clearly, Part 4 is again getting into the machinery and teeth of this bill, because it deals with the compulsory care and rehabilitation of inmates and former special patients. I note that clause 29 refers particularly to “Application for assessment of inmate and former special patients”. I am once again reminded of the work done by Dr Sandy Simpson, one of New Zealand’s most eminent psychiatrists, back in 1999. He really pointed out for the first time the enormity of the problem of psychiatric patients and those with intellectual disabilities—or a combination of both—within our penal system. Unfortunately, it is a very real problem that neither the mental health facilities available in New Zealand nor its prison system have been able to cope with at any stage. It is a huge problem, it does require focus, and maybe the Minister will take a call and for a moment outline what she is planning to do to bring this issue forward, because it is a very serious problem for New Zealand, and certainly requires to be dealt with.

However, Part 4 does attempt to provide a mechanism whereby inmates or former special patients can apply for assessment. It is a fairly rigorous process, and by its very nature it must be. In fact, every application under clause 29 must be accompanied by a certificate from a person who is either a medical practitioner or a psychologist, and who has examined the person to be assessed within 3 days immediately before the date of application. Again, the time sequence is absolutely all-important.

I am a little concerned in that I understood earlier on that the Royal Australasian College of Psychiatrists did advocate that there be either two psychiatrists or—in the case of an intellectually disabled individual—a psychologist, making sure that the findings are appropriately peer-reviewed, but I do not know whether this provision actually ensures that that happens. A lot of this assessment work can be extremely hard to be objective in, and I think there is considerable use in having peer review and quality control mechanisms in place all the time to ensure that these assessments are carried out expertly and also within time.

I refer to clause 34 where, once again, “Timing for, and place of, assessment” is emphasised. In fact, the assessment of a proposed care recipient must take place within 7 days after the receipt of the application under section 29. In many respects, it would be better to emphasise that the assessment should take place just as soon as possible, and not necessarily within 7 days. As I mentioned earlier, with the practical delays that inevitably occur from time to time, preventable tragedies have often occurred. Rather than putting it the way it is—“within 7 days”—I think there would be some sense in having those time limits very much directed towards efficiency and expediency throughout.

I note in clause 36, “The fact that an inmate who is charged with, or convicted of, an offence is also a proposed care recipient or a care recipient”—and, my word, there are those two terms again; four words for the price of two; they just seem to pop up all over the place with this politically correct Government—“does not—(a) prevent the inmate from being taken to—(i) the trial or hearing of that offence; or (ii) any sentencing for that offence;”.

The question was put that the amendments set out on Supplementary Order Paper 160 in the name of the Hon Ruth Dyson to Part 4 be agreed to.

Amendments agreed to, and Part 4 as amended agreed to.

Part 5 Status and rights of care recipients