Mental Health (Compulsory Assessment and Treatment) Amendment Bill

I present a legislative statement on the Mental Health (Compulsory Assessment and Treatment) Amendment Bill.

ASSISTANT SPEAKER (Hon Jacqui Dean): That legislative statement is published under the authority of the House and can be found on the Parliament website.

I move, That the Mental Health (Compulsory Assessment and Treatment) Amendment Bill be now read a first time. I nominate the Health Committee to consider the bill.

The bill before us amends the Mental Health (Compulsory Assessment and Treatment) Act and is a very significant step. That’s a 1992 piece of legislation—so now nearly 30 years old. It’s a piece of legislation that has come in for a fair amount of criticism, not the least of which was from a mental health and addiction review commissioned by this Government in 2018, in a review that reported at the end of that year. As members will know, that report, known as He Ara Oranga, made 38 recommendations for change, and the Government agreed to accept 36 of them. One of the recommendations was specifically in relation to this piece of legislation. The recommendation was that the whole legislation should be rewritten, and we are in the process of doing that.

But this amendment bill touches on a small number of provisions—some of the more insidious provisions—provisions that are regarded as breaching human rights and going against the Treaty of Waitangi. So that is why we thought we should bring this on with some expedition so that we make those changes so that the law in relation to the detaining of people under this compulsory piece of legislation is somewhat more civilised than it is at the moment.

As I said, this is just one of a group of recommendations made by the committee, the review group putting together He Ara Oranga, to improve our mental health sector. There’s no question: it was very, very poorly run down over many years. When the new Government arrived in October 2017, it made a priority to get on with reviewing, doing a stocktake to see what the problems were, and actually starting to make change. I’m very pleased to see the progress that has been made.

I don’t hear a lot talked about it publicly at the moment. A lot of people are saying not much has changed; a lot has changed—a lot has changed. Nearly 400 new full-time equivalent roles have been added to our mental health system to assist people. Those with mild to moderate mental health needs actually now can get some help—all funded by the Government. There is a huge capital works programme to rebuild some of the acute facilities in our system. That work is under way. It’s not acknowledged by a lot of people. It’s not acknowledged by those opposite, who ran the system down, but it’s actually very important. Now we have yet another fulfilment of a recommendation. Add to that the establishment of the Mental Health and Wellbeing Commission; add to that the establishment of the Suicide Prevention Office—none of it acknowledged by members opposite.

They bury their heads in the sand because they don’t want to know that it’s happening, because they so badly ran down the system they are terrified that it’s going to now start to get better. This amending legislation is just another arrow in our quiver to improve the mental health system.

The sorts of things that it does make sure that those parts of the current legislation that are in breach of people’s basic human rights—especially in relation to indefinite treatment orders—change. We will not have them anymore. This amending legislation will do away with indefinite treatment orders. That’s what the sector asked for, that’s what the review group in He Ara Oranga recommended, and that’s what we’re doing. We’re doing that at the same time as we are doing a full rewrite of the mental health (compulsory assessment and treatment) legislation.

So those indefinite treatment orders will now go. It will not be possible to get them. It’s important because many people—particularly Māori, NGOs, clinical staff, lawyers, academics, and many others—have criticised the fact that those indefinite treatment orders represent such a breach of basic human rights and also a breach of the Treaty of Waitangi. There will not be that sort of arbitrary detention. If people are to be committed for compulsory treatment, there will be a review date. People are treated properly and civilly, as you would expect for their human rights to be properly observed. Those indefinite treatment orders will go. Any compulsory order for treatment will have to be reviewed at the end of a 12 month period, at the very least. That will make a big difference.

The second thing that this amending legislation amends is the ability for those patients who are under a compulsory treatment order who need to be transported to be transported safely. There will be some ability to provide some restraint so that it is safe for themselves, those accompanying them, and those providing the transport—drivers and the like. So that’s a safety thing, and that has been recommended. Others have suggested—brought to the Government’s attention—that, actually, in the interests of safety for those people, we need to make that change. There are those who are detained because they come under the forensic mental health services, and we need to know that as they are being transported, if they pose a risk or are a danger to themselves, they can be transported safely. There’s only a small number of people to whom that sort of provision applies, but it needs to be put in place.

The amendment enables agencies experienced with the type of transport, such as the Department of Corrections, to be able to do so, to provide that assistance, to provide whatever reasonable restraint is needed to do so, so that their staff, and, indeed, anybody else travelling at the same time, are kept safe. There are safeguards. The safeguards include to make sure that there is a requirement that it is absolutely necessary, that it is the least restrictive option, that people are kept safe, and that the use of the power to do so is reported to the Director of Mental Health. And you’d expect that in this more human rights oriented and more civilised approach to mental health treatment.

The other amendment included in this is, really, a continuation of what was provided for under the COVID legislation, and that is to allow a family member participating in a hearing in relation to a patient who is detained under these compulsory treatment orders to attend via video means or audiovisual means. The feedback on that was extraordinarily positive. Family members found it much easier for them to participate. Patients themselves appreciated having a family member present, and, actually, I think those running a particular hearing found it useful to have family members able to attend by those sorts of means. It might seem like a small technical change; actually, it makes a huge difference to those who have to go through this particular experience.

On that basis, I again acknowledge this is just yet a continuation of the incredible amount of work that is being done by this Government—the $1.9 billion programme, over five years, to rebuild our health services, which were so badly run down by the previous Government. It is very good to see this. It’s a principled piece of legislation, it’s a positive piece of legislation, and it’s a very positive programme to improve our mental health services, so badly and appallingly neglected by the previous Government. I’m very proud to stand here and commend this bill to the House.

Thank you very much, Madam Speaker. It’s a pleasure to rise in support of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill in its first reading, a bill that National would support. I was going to come down and just deliver a fairly perfunctory speech on what is a very technical bill but after that last speech from that Minister—that is a Minister under pressure who used his opportunity to talk about a bill to defend his Government’s performance in mental health and had the audacity to talk about the last Government’s performance in the mental health sector. Well, I tell you, what the public can do is go back and look at the mental health annual report for every year of the last National Government, and that will tell you numbers engaging in specialist services, that will tell you numbers engaging in community services, that will tell you waiting times, consumer experience surveys, and that will even tell you suicide statistics.

Yet under this Labour Government, who apparently, according to the Minister who’s just taken his seat, are the ones who saved the mental health sector, well, under their reporting, we’ve waited two years, Now we’ve got the annual report for 2018 and 2019, so two years in one report that is 15 pages smaller than a report that we produced for one year. No numbers engaging with statutory services, no numbers engaging with mental health services, no data on waiting times, no data on consumer experience, no data on suicide statistics. So that Minister can state his Government’s performance, but they told us they were going to be the most open and transparent Government—

ASSISTANT SPEAKER (Hon Jacqui Dean): Order! I’m waiting for the member to reference the bill.

Thank you very much, Madam Speaker. The Mental Health (Compulsory Assessment and Treatment) Amendment Bill, that National supports, goes some way for one of the Government’s recommendations. Of course, this bill will eliminate indefinite treatment orders. But I would argue, although this bill is important, that it’s a bill that got introduced under a lot of haste because there was a lot of pressure on that Minister, there was a lot of pressure on the Government, because, of course, the recommendation was to repeal and replace the mental health Act. Yes, remember those recommendations? Forty-eight of them, and only about four or five of them have been delivered. Yes, this bill goes some way towards that recommendation, but it’s very much a stocking filler.

This Government rode into power in 2017 on the back of a lot of people’s pain and mental health. They promised a lot. And yes, this bill does respond to one of those recommendations, but people turned up by their thousands from that mental health inquiry sharing their stories. Whānau and family turned up sharing their personal stories. They felt listened to; they felt heard. So where is the action from this Government? Yes, this bill goes some way, but it’s only a small step in the right direction. This Government has got a lot to live up to.

Parts of this bill it is important that we do modernise. We learnt some very valuable lessons under COVID. And under the COVID-19 Response (Further Management Measures) Legislation Act 2020, there was an ability to use audiovisual links to allow family members and some professionals to attend sessions, whether that be around assessment and care planning. And I think we’ve learnt that that is the right way forward, because what we do know is that with the recovery model, we need to put the individual and we need to put their family at the centre of that care. Anything that could improve the participation of individuals and their family in their care, the National Party supports, and that’s why we support removing the sunset date for technical and audiovisual link amendments. We think there is a move to modernise and use technology so that individuals and families can be part of their care.

We also support the part of the bill that looks to minimise the risk of harm to patient or public when transporting forensic patients who are “special patients” defined under this Act. We also agree with eliminating indefinite treatment orders. I think when you work through the current process where people who are deemed not fit to be released under their compulsory treatment order and then to be classed as indefinite, I think that doesn’t bode well for the future care of that individual. It’s not good for their human rights. And I think the ability to have that 12-month review is important because, ultimately, what we are talking about here is a time where every 12 months the professionals will check in with that individual. They’ll check in with the family as well to understand what’s going well and what’s going not so well in their care, as well.

Just to conclude, the National Party supports this bill. There’s a lot of good technical changes in this bill. But I repeat: that wasn’t normal, what we heard from a Minister today. That was a Minister under pressure. This Government has promised a lot in mental health. I hope they deliver for many vulnerable New Zealanders and their families. But when we see what was revealed over the weekend—data missing from annual reports, Government officials talking openly about taking out data because it was seen as negative to the Government’s performance—that is concerning. The public quite rightly needs to have confidence in our public sector. That Minister needs to take responsibility and ensure his ministry knows that shouldn’t be acceptable. Thank you, Madam Speaker.

The question is that the motion be agreed to.

Thank you, Madam Speaker. Early in my first term in Parliament, the inquiry into mental health and addiction visited us in Invercargill, and I can still remember quite vividly the stories people and families told about their contact with the mental health system. So when the inquiry’s report came out, one of the recommendations that they made was that the Mental Health (Compulsory Assessment and Treatment) Act be repealed and replaced. What they were suggesting was that it be replaced with something that was much more modern in its approach to human rights, and it raised a whole lot of issues around consent and people’s ability to participate in decisions about their care. While it is going to take some time to work through those—because it’s really important we get them right—one of the things that’s really, really important is that there are two or three urgent issues that we need to address right now, and that’s what this bill is about. The first one is about indefinite treatment orders. These have been widely criticised because of the issue of somebody being detained and treated, potentially against their will, for long periods of time without the right to be able to be seen before a court.

So just going through what actually happens in terms of these treatment orders, what normally happens is a relative or the police or some other person will put in an application for a compulsory treatment order and a judge will need to consider that application and talk with that person within, ideally, about 14 days, about their care, what their views are, but also listen to the views of the person’s doctor and other health professionals. And if it is indeed deemed that they do need to have compulsory treatment, then a hearing is heard, where, basically, the medical team as well as the patient get to be there to consider and talk about what needs to happen. The issue is that the maximum duration of one of those treatment orders is six months, but it can be renewed for a further six months. The issue of concern is that after those six months it can be continued indefinitely, and what this legislation does is require that the order be reviewed at the end of each 12-month period instead of having somebody under compulsory treatment for a very, very long period of time.

So it’s an important bill. It makes a small change but is incredibly important for sustaining the human rights of those that are under compulsory treatment. I commend this bill to the House.

Thank you, Madam Speaker. It’s a pleasure to support this bill which looks to amend the Mental Health (Compulsory Assessment and Treatment) Act, which is actually quite old. There are several things this bill looks to do, but I particularly would also like to talk to eliminating the indefinite treatment orders, and actually speak just a little bit further about how one gets to be in the position where you have a compulsory treatment order (CTO), and then what we’re trying to fix.

Now, the law recognises that people who have a mental health issue may not be competent to decide what is best for them, and so compulsory treatment orders and involuntary orders are mechanisms to help people receive that attention. What’s required here is it requires someone who’s concerned about a person’s wellbeing to make an application. The person needs to be over 18, and then that person can be assessed by a director of Area Mental Health Services. Just to be very clear of the nature of an illness that a person must have, first of all they have to have a serious mental disorder characterised by delusions or by disorders of mood or perception or volition or cognition. So, you know, it’s quite serious mental health. Secondly, they need to pose a serious danger to the health or safety of themselves or others, or have a seriously diminished capacity for self-care. Interestingly, there also needs to be services available before a compulsory treatment order can be entertained. The responsible clinician can transfer a patient to a compulsory treatment order from an involuntary inpatient order, or a CTO can be made by a judge.

To get some scope as to how many people are involved in compulsory treatment orders, we know that roughly 10,000 people a year are subject to the mental health Act, and that at any one time 102 people per 100,000 are receiving compulsory treatment. I think what I found particularly interesting—I’ve delved into this in preparation for making this contribution—in the rates of compulsory treatment orders is the regional variation across the country, more specifically by DHB and how we explain that. So as I look across all DHBs—and I’ll break it down in a moment for Māori and non-Māori—there’s quite a lot of regional variation per 100,000 population for the number of compulsory treatment orders. The highest number of compulsory treatment orders per capita is actually Northland, which surprises me a little bit. The least is South Canterbury and Wairarapa. So you’d have to sort of say, “Well, how do we explain that?” How do we explain such a high incidence of CTOs in Northland—almost three times the lowest amount anywhere else in the country? If we then look at it for Māori and non-Māori, there’s roughly a threefold—or it’s a multiplier of three—increase in Māori who receive compulsory treatment orders versus non-Māori. Again, if we look across the country, it turns out Waikato has the highest—again, that average of three—at 3.91.

Then I want to go to not the second but to the third and fourth—we might be able to explain that. Counties Manukau and then Auckland have the highest rate of Māori versus non-Māori—so again, over three times. So Māori are much more out of proportion than others. But it’s the second one that I’m interested in that I can’t quite explain, and that is Wairarapa. Now, Wairarapa has the second highest incidence of Māori versus non-Māori of CTOs. I can’t explain that. It’s not what I would have thought intuitively from what I know of the demographics of that DHB, my point here being that there’s some story around compulsory treatment orders that vary region by region that gives us the opportunity with this bill to be nuanced, to be more fine-tuned, and to reduce those disparities.

I’m not the only one pointing that out; there are a number of others. I will read here from a learned journal: “The numbers of compulsory treatment orders vary across the country. The fact that some regions show relatively low rates suggests scope exists to reduce the overall use of compulsory treatment [orders].” I look here in the last year at South Canterbury—South Canterbury is a well-performing DHB at the moment—with a total of 96 compulsory treatment orders per 100,000, and then I look at Northland at 284, and so how do we explain that? The sum of it—that is probably Māori, and again, how do we explain that? How could we have three times more compulsory treatment orders per capita in Northland than in South Canterbury? I think that needs an explanation. I think there’ll be that opportunity in select committee to delve deeper into these figures, both total comparisons across the country and Māori versus non-Māori across the country, DHB on DHB, and make some of these changes—and we are—to that indefinite time period for compulsory treatment orders. I think it will give us the opportunity to have that really rich discussion, to understand it, figure it out, and figure out what the interventions are.

So we’re in support of this bill and very much looking forward to the select committee, particularly to officials who’ll have more fine-tuned information—although this arrived as a written parliamentary question 30 minutes ago so it is kind of contemporary, although they make the point that they’re three months out from reporting the last year, but this would seem to be the latest data and it’s got some queries in it even here and now. So we are supporting this bill and very much looking forward to taking it to select committee and seeing how we can do a better job. Thank you.

Thank you, Madam Speaker. I rise in support of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. I really want to acknowledge Minister Andrew Little for his genuine commitment, I think, to making the changes that are necessary so that as a society we can start conceiving and perceiving of, and orient ourselves towards, a much more health recovery and social wellbeing model of mental health. The discourse, our expectations, and the importance that we place on health and wellbeing have changed over time, and it is time, therefore, to make those legislative changes to reflect a more contemporary kind of definition.

So the amending bill here before us tonight goes some way to doing that, and it does so in three specific ways—all of which have been mentioned, but each one has an element that I’d like to emphasise. When we talk about eliminating indefinite treatment orders, it also includes, really importantly, the right to refuse medical treatment. That’s no less important when a person may be experiencing a period of mental unwellness but is nevertheless competent, than what it is for any other person.

Secondly, when we talk about minimising the harm to the patient or public when transporting forensic patients, I think it’s really important to note that this amendment allows for the least restrictive restraint, only when absolutely necessary, and it’s not related to whether a person has a mental health condition but it’s related to their offending and their risk of escape and posing a safety risk.

Thirdly, clause 5, which amends section 9 to provide for a family member or another person connected with the welfare of that proposed patient the ability to link in by audiovisual link, is incredibly important. Currently, unless a family member is able to be there in person, that proposed patient isn’t able to have that support, or a second person isn’t able to be cognisant of what’s going on and of that process. So I think those are three really important aspects.

So, again, the bill before us tonight takes an important step. It’s congruent with this Government’s commitment to mental health. I commend this bill to the House.

I think that all of us in this House would agree that at the very least, the most basic thing that the mental health system can do is not cause more harm to the people who go through it. But perhaps the greatest irony of the original legislation which we are amending tonight as it passes, I believe, by consensus through the House, is that whilst the mental health Act, which we so colloquially refer to it as, was actually the first part of New Zealand’s health sector to legislate for patient rights, it in fact has been found by a huge number of inquiries, investigations, reports, and otherwise to undermine exactly those rights. In fact, it’s since been weaponised in way that has literally seen the United Nations Committee Against Torture—against torture—express concern at our country’s practice, which I’ll get to in a minute.

So what we regularly call the mental health Act is actually this law which outlines how and when we can detain people who are experiencing mental distress. So how does that happen? Well, the Mental Health (Compulsory Assessment and Treatment) Act 1992—which I note Dr Shane Reti mentioned is substantially an outdated piece of legislation—describes itself as “An Act to redefine the circumstances in which and the conditions under which persons may be subjected to compulsory psychiatric assessment and treatment,” The Act then goes on to define—fast forward a bit—that mental disorder occurs when someone “(a) poses a serious danger to the health or safety of that person or of others; or (b) seriously diminishes the capacity of that person to take care of himself or herself;—and mentally disordered, in relation to any such person, has a corresponding meaning.”

The amendment that we are debating tonight doesn’t do the full hog, which is outlined in He Ara Oranga, the report of the mental health and addiction inquiry. There were 40 recommendations inherent in that. And I also note that the supporting documentation that the Minister has tabled in the House today stipulates that this is one step towards a broader overall of the mental health Act, which is so fundamentally necessary if we are going to get anywhere near towards a human rights - centred approach, as was outlined as necessary in He Ara Oranga. What the Act presently allows and what this amendment seeks to change is that people declared as having this defined mental disorder—namely a danger to themselves or others or a diminished capacity to take care of themselves—are then legally allowed to be detained against their will and, as other speakers have mentioned, medicated against their will. Importantly, however, there is currently inside that Act no specific definition of what “capacity” means, which leaves it open to interpretation and therefore, as we’ve seen in that multiplicity of reviews, to abuse.

He Ara Oranga, the 2018 mental health and addiction inquiry, is often heralded in this place and the news media as kind of the first of its kind, but if you dig a little deeper, particularly into the reporting of the likes of Jess McAllen, what you’ll find is that it was not. There have been at least two other Government-triggered inquiries into the mental health system in the past few decades, and historically those inquiries have been triggered by violence and substantive amounts of trauma.

The 1988 Mason psychiatric report, otherwise known as the Gallen inquiry, was noted as being into “procedures used in certain psychiatric hospitals in relation to admission, discharge, or release on leave of certain classes of patients.” Judge Mason, importantly, in this 1988 report noted the need for bicultural services particularly to serve Māori, because the Western model—he noted at that point in time; the 1980s—did not acknowledge the breadth of hauora, of culture, of identity and the importance of recognising where somebody comes from, their environment, and who they are, as to how they behave in the world.

There was then a 1996 inquiry, again by Mason—this time into “section 47 of the Health and Disability Services Act 1993 in respect of certain mental health services.” These two inquiries, essentially, failed in the respect that they sought to pathologise and medicalise individuals who were going through the mental health system. They were quite narrow in that respect. They only looked at people who were already in the system and how that system was serving them based on preconceived notions of how it should be.

But what He Ara Oranga did, with groundbreaking terms of reference, was it sought to recognise that people are part of society and in fact life experiences may cause, may trigger, may mitigate, or may aggravate the expression of mental ill health, and it showcased a need to move away from that pathologising and, arguably, dehumanising model. It also, importantly, explicitly for the first time referenced addiction, particularly as a method of escapism away from some of the issues that people may be experiencing.

As I noted, there’s a whole lot to unpack in the mental health and addiction inquiry. There were 40 recommendations. The Government accepted 38 of them on principle. Recommendation 34 is for the mental health Act, as we colloquially bandy it about as, to be entirely repealed and replaced. This amendment tonight does not do that, but it does do the interim job of stripping away some of the most damaging and damning practices inside of our mental health system.

Importantly, actually, under the 1992 Act, family are required to be consulted before compulsory assessment and treatment, but in He Ara Oranga, the mental health and addiction inquiry, it was reported this only happens 61 percent of the time—another massive failing. And as has been noted by other speakers, this isn’t a small thing. Around 10,000 people are subjected to compulsory assessment and treatment every year, and whilst not all seclusion is compulsory assessment and treatment and vice versa, Māori are five times more likely in our mental health system to be subject to seclusion.

Page 33 of He Ora Oranga makes this discrimination and the flow-on effects of it crystal clear in terms of its ramifications for those who may be seeking to access mental health treatment, and it does so, in this quote by a kaimahi Māori, who said “whānau are fearful of our ministries, fearful of mental health, fearful of Oranga Tamariki taking their children, fearful of police who take away their dads. Whānau are on the back foot before anything has happened, just because they are Māori.”

In trying to unpack just how bad this problem is, I think it’s important to outline just how successive Governments have failed when it comes to this issue of these treatment orders. It was in 2015 when the UN Committee Against Torture expressed concern about the enormous amount of times, comparatively, that New Zealand was using this practice, which led in April 2017 to the UN Office of the High Commissioner for Human Rights funding a report, delivered by our Human Rights Commission, which found that there was definitely oversight needed because there was an overreliance on goodwill for this “inherently degrading practice”—that’s a quote from the report—and there was a high use, particularly in prisons and, you guessed it, particularly towards Māori.

Then in 2009 to around 2015-16, there was a reduction in the number of people who ended up being secluded, but around 2015-16 that number jumped back up again by 6 percent. In May 2017, in response, the then National Government, actually, created a national mental health quality improvement plan, which was provided with $7.5 million to get as close to zero in the use of seclusion by the year 2020. That was last year, and in fact what we’ve seen with data released last week is that there’s been an uptick of 10 percent in seclusion in 2018 and a 9 percent increase in 2019. That’s no small number, because per 1,000 beds we went from 6.9 in 2008 to 11.4 in 2019. There is so much more to do but this is an incredibly important piece of that puzzle.

Thank you, Madam Speaker. I rise on behalf of the ACT Party in support of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill at its first reading. We support the intention of this amendment, which is as follows: “to improve the protection of individual rights and the safety of patients and the public and enable more effective application of the [Act]”. So I think it’s important to outline what the change is supposed to be doing—what problem it is to be solving—but, importantly, to step back and ask: what is the Act that it is actually amending? It’s amending the Mental Health (Compulsory Assessment and Treatment) Act.

Now, that Act was introduced in 1992, and the Associate Minister of Health at that time said that this was an honest attempt to achieve more regularity in the admission of people with mental disorders who themselves, in a very rare circumstance, seek committal, but it is rarely for those who pose a serious danger to the health and safety of themselves or others, and who have a seriously diminished capacity to recognise that. We’re talking about very vulnerable people. So that is what we are debating today.

When we change a law, I think it’s always good practice to ask what we are actually seeking to solve. One of the amendments that the ACT Party supports is one that was brought in under COVID, which is this idea that you’re able to enable patients and family members, people concerned with someone’s care, to have the admission looked at via audiovisual link, not needing to be done in person. I think that was a very good change to make at that time, and it’s something that we should seek to continue, and that’s what that change is about, because it looks like it’s supposed to expire; so, really, we’re just extending it.

There is always, though, an issue when an Act looks like it is to breach or come close to breaching someone’s rights under the New Zealand Bill of Rights Act, and so ACT always takes seriously a change to a law that would limit the right that “Everyone [who is] deprived of liberty shall be treated with humanity and with respect for the inherent dignity of the person.” I note that that was outlined in the Attorney-General’s report on this bill. And that’s because this amendment also, apart from audiovisual links, seeks to make a change that a person, while they’re being transported, could be restrained with reasonable force.

We’d like to note that, during the select committee process, we’d like the definition of reasonable force to be tested. I think it’s very, very important that, when we’re talking about vulnerable people, we are standing up for their rights and their inherent dignity. It’s the inherent dignity of every individual. So we’d like to see what that use of reasonable force would look like. But while we were reading through the Attorney-General’s report, we did note that the Attorney-General had consulted on that matter and had deemed that the rights of the individual would still be upheld even with that change to use reasonable force. So, on those grounds, we’d like to make our concern noted, but we do support the intention of the bill. Thank you.

Thank you, Madam Speaker. I rise to speak in favour of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. This bill is aiming to address some pressing issues as we move to repeal and replace the mental health Act. The initial amendments are, obviously, intended to improve the protection of individual rights, the safety of patients and the public; and to enable the Act to work more effectively. What we’re seeing here is—a few main points—as we’ve heard from colleagues in the House, one of the key points is it will eliminate indefinite treatment orders, which will require courts to review the situation of the patient or person concerned every 12 months. We have agreement across the House that this is something that’s long overdue and necessary.

The second point of importance is the transporting of forensic special patients, and I just wanted to explain a little bit about the forensic special patient. These are people who have been, potentially, acquitted of the crime on insanity grounds or found unfit to stand trial, or, perhaps, prisoners transferred to hospital for mental care. They obviously do deserve effective and ethical care and management, but what we’re looking at is that these are patients who from time to time do need to be transported, and from time to time they may need to be restrained or in some way supported in order to keep themselves or the public safe. It’s really important that this is not related to their mental health condition but it’s related, rather, to their offending behaviour and the potential for them to, potentially, attempt to escape, for example. As I’ve said, a small number of these patients do pose a risk to the public safety, and as a result, I do commend this bill to the House.

The next call is a five-minute call.

I am pleased to be speaking in support of this Mental Health (Compulsory Assessment and Treatment) Amendment Bill. In doing so, I’m particularly mindful of the sensitivity of this legislation in that it deals with people when they’re at their most vulnerable, and so it’s vitally important that the amendments have the right balance between protection of individual rights as well as the safety of patients and the public.

When looking back on the history of the Mental Health (Compulsory Assessment and Treatment) Act 1992, I note that there have been a number of serious concerns raised in 2014, in 2016, and, again, in 2017 regarding the lack of alignment with the Act and the rights of persons with disabilities. When I looked at some of the consultation that had taken place in the build-up to this bill, I again note that those that had been consulted with have been NGOs, clinicians, academics, researchers, and mental health professionals, and I’m reminded that the hīkoi for hope for disabled people, which came to Parliament quite recently, stressed the need for “nothing for us without us”. So I would hope that the consultation process as it proceeds through the select committee stage will indeed ensure that the consultation is taken to people who have been subjected to the mental health Act, and, as our colleague Dr Reti noted, there are 10,000 people per year.

Given how incredibly topical and important mental health issues are for our communities, and the comments that our colleagues have spoken about, with the skyrocketing numbers of New Zealanders who are finding it hard to access the support they need, this amendment is particularly timely. We’ve already spoken today about our concerns around mental health reporting being sanitised to remove negative statistics, and where the excitement seems to be mainly around Budget allocations and announcements, rather than actual outcomes or improvements being measured, we should perhaps be at least pleased that this is something tangible that is going to occur.

So, given that, we are particularly pleased to see the amendments around eliminating indefinite treatment orders. We are mindful of the changes that need to occur around minimising the risk of harm to patients and public, and, of course, COVID has given us all the opportunity to see how we can make much better use of audiovisual links, so that amendment is also supported. So I’m pleased to speak in support of the amendment.

I call Shanan Halbert—a five-minute call.

Tēnā koe, Madam Speaker. I take this call this evening in the absence of the Māori Party. We’ve heard vibrantly tonight that Māori are an important part of this conversation, and we know—and as a Māori man I stand here this evening knowing that me and my whānau are twice as likely as non-Māori to suffer from poor mental health—that we are overrepresented, that we are disadvantaged within the system, and that we need help. What I don’t want to hear this evening is when politics comes into the discussion that we are having in mental health. Now is the time to get on with it. Now is the time to make a difference.

I remember very fondly the 2017 election. It was my first election against Minister Coleman at that time and the challenges that he faced. But as we move forward, the difference that this bill does, and it is a step in the right direction after multiple announcements—and just going back to my colleague, the last speaker, discussing the announcements. I say: does the Youth Mental Health Group feel any differently to the $1 million that the Minister has announced towards their mental health support and running a better system? What about the $4 million dedicated to Rainbow youth mental health services? Yes, they do feel different. It’s about us making steps and more steps and more steps to ensure that we address the challenges within our mental health system that we face. We’re going to get on. We want to get on with this.

So what this bill does is it starts to make three particular steps. And the one that I find most important this evening is the elimination of the indefinite treatment orders that are outlined within this bill, the changes that it makes. It means each Māori male that is out there that is within an indefinite treatment order have hope that they can be reconsidered every 12 months, that they can be reviewed, and that hope is really, really important. When you’re in a situation of difficult mental health, you already feel hopeless, and this is another step to give them hope. So this evening, I commend this bill to the House.

I rise today in the House to take a call on the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. As a medical doctor who has had part of his training in both inpatient and outpatient clinics, I do support the bill introduced by the honourable Minister Andrew Little. I want to start, first of all, by acknowledging the many people who work in the mental health workforce, as well as those who are the consumers of the mental health services. It’s not easy working in the sector and it’s even harder being a patient and being a consumer of these services.

This bill picks up some of the recommendations that were made as part of the He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction. What it does is it empowers patients and their families, as well as the workforce involved in mental health services. First of all, for the patients and their families, it ends the widely criticised indefinite treatment, which is a serious breach of human rights.

The bill requires that the orders be reviewed every 12 months for as long as the duration of compulsory treatment. Secondly, for the patient’s family what it does is it allows for family members and their caregivers to be present via a video link or an audio link, which means that the family can be involved in their care and also be involved in the decision making, which wasn’t the case previously. And thirdly, for the staff members, as my colleague Sarah Pallett has mentioned, it also has a provision for the use of reasonable force or restraint when required to protect patients, and public safety, and to enable transport. This is quite key for people who work in mental health services because it makes sure that their lives are not endangered, as well as the lives of the patients and the public. So I think on all three fronts, whether it’s the patients, their whānau, or the staff, this bill is really good, and I would like to support it. Thank you.

I rise on behalf of the National Party and as the MP for North Shore. I speak on the first reading of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. National supports this bill. We support this bill because it makes a number of important amendments, including protecting of individual rights and safety of patients and the public; it eliminates indefinite treatment orders, which we’ve discussed this evening; it also minimises harm, not only for patients but also for the public when these individuals are being transported, particularly forensic patients; and it also introduces some audiovisual aspects, and makes these amendments permanent.

The mental health of New Zealanders is one of the most important issues that this House will address in the coming decade. I acknowledge that this is a difficult and complex area, but the Government has a role to support those individuals, families, communities, and those on the front line, whether they be in social, education, or part of our health response.

We have a mental health crisis in New Zealand. We must act together across this exceptional country to take decisive action to make improvements that will build resilience, save lives, and reduce the burden that falls on our families and those within our communities when the system fails.

This bill is being created following the Government’s recent inquiry into mental health and addiction services, a report that highlights significant action is required in order to start to turn the dial. I have been fortunate in my work before becoming an MP for the North Shore to work alongside passionate clinicians within our forensic mental health unit in my own home electorate under the Waitematā District Health Board. These clinicians do amazing work under what are often very challenging circumstances, and I wish to acknowledge them and thank them for their ongoing contribution.

I also want to share my personal perspective on this bill as a front-line volunteer ambulance officer with St John Ambulance who only last week was responding to a 111 emergency call to deal with another mental health incident. Thirty percent of the call-outs that we received on the shift I undertook last week involved mental health incidents, and this reflects the significant pressure that our system is under and the critical need for action, not talk, to help our fellow Kiwis, many of whom are young men.

A special call-out to my fellow paramedics, emergency medical technicians, first responders, extended care paramedics, and intensive care paramedics, who, alongside our police, are the front line in responding to this mental health crisis and are often picking up the pieces—often when it’s too late. First responders are overwhelmed by demand and under-resourcing and the inability to provide a sustainable pathway to help people on their road to recovery, a battle that is seeing call volumes skyrocket and pressure on our community and hospital services constantly at capacity.

This bill recommends amendments that will enable a more effective application of the Act, and this is welcomed. In particular, it focuses on three key aspects. Compulsory treatment orders: the bill will remove indefinite compulsory treatment orders, something that has been criticised in terms of its potential to breach human rights. This is where a patient is required to have treatment for their mental disorder, and the changes that have been put in place allow these orders to be put in place and extended by a clinician by up to 12 months. I also acknowledge the conversation raised by my good colleague Dr Shane Reti. There is significant variation across this country in regards to the treatment that is provided to these patients, and that is a concern that we all need to work together to address.

The second aspect of the bill, in terms of amendments, is minimising the harm when these patients are being transported. Again, I wish to acknowledge our mental health workforce, those individuals that sit in the back of an ambulance when they are transporting our forensic mental health patients to hospitals and other facilities. This is a challenging role. This is a role in which many of our healthcare professionals put their own personal safety at risk and often are the subject of harm within the workplace. It is our responsibility as a system and as a House to protect these individuals who are making such a significant contribution for our country. Currently, the Act does not permit the use of force, including restraint, when transporting these patients, which, obviously, as I’ve just discussed, poses a significant risk for not only the patient but the staff travelling with that patient and also the public, should that patient leave the vehicle.

Lastly, I wish to talk about the amendment in regards to audiovisual links being allowed to be permanent. I’m pleased to see this amendment within the legislation. As we’ve all experienced the challenges of the last 12 months, I think this is common-sense legislation, and in particular around new section 34C(2), inserted by clause 8, which recognises the benefit of such technology, and I welcome that.

It is important to bring this back, I guess, as an electorate MP, to the local electorate. No community within this country is immune from the burden that mental health illness brings, and my electorate on the North Shore is no different. I, like many New Zealanders, are concerned with the slow pace of change in the area of improving our mental health services and what seems to be a lack of urgency to transform a system in such desperate need. The ask is simple of this Government: outline the plan to implement the recommendations, confirm the timeline, fund it, and execute. Irrespective of where our political loyalties lie, we require action, not talk, in this area.

As a member of the Health Committee, I look forward to rich discussion on this bill as it passes through. As we said before, the National Party support this bill. I commend this bill to the House.

Thank you, Madam Speaker. It is a privilege to take this short call and the last call of this first reading of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. I just want to acknowledge, again, as everyone has the He Ara Oranga work done in 2018, and I just want to acknowledge them for the equity lens that they provided, as well, in their consultations—Professor Ron Paterson, Sir Mason Durie, Dean Rangihuna, Dr Jemaima Tiatia-Seath, Josiah Tualamali‘i, and also Dr Barbara Disley.

💬 Hon Member: They did a good job.

Amen; amen to that. When we clinicians start off our careers in the health workforce, we swear an oath that says “first do no harm.” I think this bill adds to that, where we are trying to get to the stage where we minimise that and do no harm to our patients.

What they found in that inquiry was to, again, look at the human rights approach, promote supported decision-making, and a recovery and wellbeing model, and it is all about the equity and holistic approach to this bill. So I’ll be brief. I support this bill into the House. Thank you.

Motion agreed to.

Bill read a first time.

The question is, That the Mental Health (Compulsory Assessment and Treatment) Amendment Bill be considered by the Health Committee.

Motion agreed to.

Bill referred to the Health Committee.

The House is suspended for the dinner break and will resume at 7 o’clock this evening.

Sitting suspended from 6.01 p.m. to 7 p.m.