Intellectual Disability (Compulsory Careand rehabilitation) Bill

In speaking to Parts 6 to 11, although the substantial part of the bill may have been dealt with, these other parts of the bill are pretty important. They deal with reviews of conditions and the status of care recipients. Part 7, “Inspections and inquiries”, is a hugely important part in terms of quality control, and also deals with complaints about breaches of rights, and inquiries by district inspectors. Then we go on to Part 8, “Authority to take and detain care recipients”. Subpart 2, “Inquiry by High Court Judge”—

💬 Hon Ruth Dyson: It is Subpart 2 in Part 7.

Absolutely, that is quite right. I do not want to be too tedious in the way I go through this, but I point out that Part 7 is in two parts—Subpart 1, “Inspections, investigations, and inquiries by district inspectors”, and Subpart 2, as the Minister quite rightly pointed out, deals with inquiries by a High Court judge.

Part 8 is “Authority to take and detain care recipients”, “Authority to detain under court orders”, and “Authority to take care recipients who escape or disobey court orders”—I would like to make some comments about that in a moment. Part 9 has mainly procedural provisions, such as which court to go to, and it is about the jurisdiction of the Family Court, which is all-important in many respects. Part 10 refers to “Relationships with other Acts”, because this bill—along with the Criminal Justice Amendment Bill (No 7)—is integrally related to a variety of other Acts, including orders under the Protection of Personal and Property Rights Act, orders under the Children, Young Persons, and Their Families Act, and certain orders under the Criminal Justice Act, which prevail over orders under this Act. There are a lot of interrelated connections, all inextricably linked up.

Part 11 refers to “Administration”. One would hope that administration under this Labour Government would be efficient and have timelines with it, but sadly, as we have seen right throughout, in the very way that this bill was brought to Parliament—it has “Legislative History, 5 October 1999”, on the back, and here we are on 21 October 2003—the Labour Government has allowed this highly important, very necessary legislation to wallow, then suddenly, under urgency, it has finally brought it before the House. So there is some number of very important parts that we are taking as one.

I want to comment on the “Authority to take and detain care recipients” in Part 8, and on what was required, because there are some very important implications in clause 109, “Authority to admit and detain under orders”. It states: “A care manager has authority—(a) to admit a care recipient to a facility in accordance with the care recipient’s court order or a notice of designation given by the co-ordinator under section 63(2); and (b) to take all reasonable steps to detain that care recipient in the facility during the period the designation is in force.”

Clearly, care managers have to take all the reasonable and possible steps they can. From time to time there is the difficulty of the facilities not being able to contain people. Clause 110 deals with the “Meaning of a care recipient who has escaped”. That is a practical matter, because from time to time they do escape, no matter how hard the vigilance. That leads to some very difficult reciprocal actions.

It is good to put these last parts together, because they really do cover the administration of the Act and the details of what happens when someone has been placed under a compulsory care order. Interesting terms were developed for the bill, such as that of the “specialist assessor”, and the “co-ordinator”. The coordinator has to send copies of certificates to certain persons, and needs to notify everybody about what happens to a care recipient when a compulsory care order changes or expires, when somebody goes on holiday, or when there is a variation to the order. There will need to be variations to compulsory care orders, because people who may have become out of control in their behaviour—due to environmental issues or to other things happening in their lives—may settle down with appropriate care, and changes will then be sought to compulsory care orders. The coordinator and the court will have regard to a specialist assessor’s certificate, so a specialist assessor will come and reassess somebody.

Of course, the person’s intellectual disability is not going to change. The situation is not like that of mental health, where somebody becomes unwell and, with appropriate care, treatment, and medication, can become well again. In the situation of intellectual disability we are talking about challenging and complex behaviours. The issue is whether we can change behaviour, and therefore improve a situation.

I remember another patient whom I dealt with when I went to see his mum and dad. There seem to be quite a few cases where mothers and fathers have become elderly but have children they have looked after all their lives—children who, because of their disabilities, remain children intellectually and continue to be in need of care. I will never forget going into that house. The mother had developed Alzheimer’s dementia, and the quite elderly father was having a great deal of difficulty coping. They had a son—who I think was about 52 at the time I met them, because his parents were in their 80s—who had never been known to any support services at all. I walked into that situation, thinking: “Oh my goodness!”. That man could just dress himself and tie his shoelaces, but that was about it. The parents had never had any help, and he used to follow his father around, two steps behind. That is how the father coped. Everywhere that dad went, he went.

That was fine in that situation, but then one of his parents went into care and the other parent died. That situation was very similar to the other I mentioned, but different in respect of which parent died first. When that man was put into a care facility in the community, people were incredibly intimidated because he would be two steps behind them. Of course, the women in the home became very upset because he followed them around so closely, and some of the carers became very upset. His behaviour had been conditioned by his parents as it was their way of coping, but it was very difficult to manage him in an ordinary care facility. There was a need for specialised education, support, and caring in this case, to make those around that man understand that he was not being intimidating or trying to upset them but just showing a conditioned behaviour. That is an example of some of the things we see.

As a geriatrician I was asked to assess people in Ngawhatu Psychiatric Hospital. Those people who had intellectual disabilities had reached their 60s and 70s, and the hospital wanted to place them in rest home care. But some of the behaviours that had been conditioned by their many years of institutional care in psychiatric institutions proved totally inappropriate for a rest home situation. I remember one gentleman who, whenever he got really upset about anything, just picked up a chair and biffed it across the room. That was his way of getting attention in that environment, but it was certainly not very appropriate in any other environment—especially a rest home environment.

People with intellectual disabilities need specific care facilities in order for their behaviour to be managed. If that gentleman had picked up the chair and hit someone with it, he would have ended up before the courts and come under the provisions of this bill. In those situations, the status of special-care recipients must be clearly identified.

The question was put that the amendments set out on Supplementary Order Paper 160 in the name of the Hon Ruth Dyson to Parts 6 to 11 be agreed to.

Amendments agreed to, and Parts 6 to 11 as amended agreed to.

Bill reported with amendment.

Third Reading