Mental Health (Compulsory Assessment and Treatment) Amendment Bill

Thank you, Madam Speaker. Thank you for the opportunity to say a few words on this bill, the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. I think it is fitting, given this week is Mental Health Awareness Week, that we progress this bill. It is a bill that updates outdated aspects of 30-year-old legislation. The bill seeks, essentially, to improve the protection of individual rights and the safety both of patients and the public by enabling a more effective application of the Mental Health Act. One of the ways in which it does that is by eliminating indefinite treatment orders. I think, when we think about the way we’ve conceived and we’ve conceptualised mental health over the last 30 years, we’d all agree that basic human rights and our idea of that within the environment of mental health have changed. Basic human rights should be afforded to all New Zealanders, regardless of their circumstances, and this principle should inform the legislation that we make in this House.

I’d like to just take a moment to read out a quote from one of the 53 submissions that we received on this bill, relating to this specific sort of aspect of it. The submitter said, “I’ve been under the compulsory treatment order for the last five years. Medication has caused bad side effects that affects my ability to work. I have been stable the whole time but when I asked my doctor how long I will be under the compulsory treatment order? He said that I would be on it for years and years and years. This has caused me to feel trapped and extremely powerless. Eliminating the indefinite treatment order gives me hope that one day I will get my life back.” So, again, this reiterates the principle that we are talking about.

This legislation is another step on the journey towards what I believe is a fairer society for all, and, as such, I have no hesitation to commend this bill to the House.

Thank you, Madam Speaker. Well, it’s a real pleasure to stand and speak in support of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill in this second reading. I had the privilege of sitting on the Health Committee, listening to the submissions, reading the submissions—the 53 submissions—and listening to the oral evidence given by 15 submitters here in Wellington and by video conference. There were both organisations submitting but also individuals, such as the submission that the speaker from the other side of the House quoted from, and they were heartfelt submissions and very sobering submissions that made us realise just how important this work is that we do here.

So this bill has three main parts to it, as the speaker before me, Dr Tracey McLellan, touched on: eliminating the indefinite treatment orders; and, secondly, minimising the risk of harm to patient or public when transporting forensic patients who are special patients, as defined under the Act; and also an amendment to the audiovisual link, and that carries on from what appeared to be successful use of audiovisual technology in the COVID-19 response in 2020. I’d like to also acknowledge the officials that were involved in these amendments: the Director of Mental Health and his team. I’d have to say, they were incredibly respectful and incredibly generous in their time that they gave us, talking through how things operated. I was enormously impressed with how they dealt with us in the select committee and also with the issues that were brought up by the submitters, so I absolutely want to acknowledge them.

As the previous speaker said, the indefinite treatment orders were an issue that many wanted to submit on. One of the submitters criticised the indefinite treatment orders as a breach of human rights; and, indeed, at a very individual level, we can tell from the submission that the member from the other side of the House read out how incredibly difficult it is for individuals that are under one of these orders. So it really is life-changing for a number of these people. There were some submissions about the length of time to review the compulsory treatment orders at the end of each 12 month period for the duration of the order. Some submitters thought that, perhaps, six-monthly would be more appropriate but, on balance, we stuck with the 12 month review period, but we thank those that took the time to explain why they thought perhaps the six months might be more appropriate.

The bill seeks to minimise the risk of harm to the patient and public and also the staff that are involved in transporting patients. This is a very sensitive area where obviously we want to ensure that the minimum of restraint is used that is necessary, but there are times when forms of restraint have to be used both for the patient’s safety and also for the safety of staff and public. So this was a welcome change in the bill.

The audiovisual link amendment was one that exercised quite a lot of discussion. It’s interesting how things have changed since COVID. Things that we might never have considered appropriate by video conference have now become mainstream, and the audiovisual link submissions talked about the concern around whether this might become the default position and whether there might be a temptation to just always think that that is the mode that should be used. And while we acknowledged and many of the submitters acknowledged how valuable it might be for family members or caregivers of a patient to be able to be present by audio or video link, they wanted to be sure that it would be done with the preference and best interests of the patient or the proposed patient and in a manner which removed barriers for in-person attendance in a way that was productive rather than restrictive. So we were very pleased that we were able to debate that.

I would like to read from one of the submissions. This person said, “As someone who has been admitted to three psychiatric hospitals during my youth, I feel like my comments and recommendations here may be of use”, and they certainly were. “I definitely agree with having someone there that is familiar with you and your life when the mental health assessment is read out.” He goes on to say, “someone familiar should be invited to listen and support the patient receiving care. I had no familiar face or even a familiar voice when I was admitted to any of the psychiatric hospitals I’ve been to”. And so if the use of audiovisual equipment enables much better support for the patient, then of course we should be trying to adopt that technology.

The amendment to the bill comes within a broader setting of the work programme to repeal and replace the Mental Health Act, and many of the submitters commented on that. Many of the submitters commented on their concern that perhaps they didn’t see the context of these bill amendments within the wider repeal that was occurring. Some submitters were concerned at the time that was being taken for that full and wider repeal and replacement of the Mental Health Act to occur. And so we need to be very mindful that while many of the submitters were pleased to see these amendments, they were also eager and, in fact, quite forceful in their encouragement that this wider repeal and replacement of the Mental Health Act should occur.

Perhaps, just turning our minds to more general thoughts around the mental health of New Zealanders—we know what an incredibly important issue this is for us. Certainly Mental Health Awareness Week brings that to the fore, but the fact that we are in COVID lockdowns again also brings it to the fore. We are seeing skyrocketing numbers of at-risk New Zealanders who are finding it increasingly hard and difficult to get the support they need from mental health services. We know that waiting times for children to access services have ballooned. The number of children having to wait over two months to see a counsellor has almost doubled in the past three years. The Government came to power promising great things around mental health, around child poverty, and around housing, and you would have to say that scrutiny of the Government’s actions on these key issues does not bode well for this Government.

This week an independent review was released. The independent review, interestingly, was undertaken by Grant Robertson, so you would have to say there is a great deal of defensiveness and concern about any daylight being shone on the outcomes of mental health in this Government. So while it has been pleasing to be part of the select committee that scrutinised and, I think, improved this bill—particularly around things that we spoke about in terms of reporting, around the use of audiovisual and reporting, around the use of restraint—there are certainly much broader, much wider issues around the mental health area that need to be addressed and hopefully will be addressed in the repeal and replace of the Mental Health Act in the fullness of time, and I hope that I am able to be part of hearing the submissions on that, because we do definitely need to hear from the people that are most impacted. Thank you, Madam Speaker.

It’s a pleasure of mine, on Mental Health Awareness Week, to speak on the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. As part of the Health Committee, we got quite a few submissions from across the board, and it was good to see people who not only were consumers of the mental health system but also who were the providers. It was great to see a very comprehensive discussion on the amendments that are proposed in this bill.

Some of the key things that the bill proposes, first of all, is eliminating the indefinite treatment orders and making them 12 months before they get reviewed again—at least—which is a big step, because for a lot of people, about 2,500 to 3,000 people a year, they can be on these indefinite treatment orders for a long time without actually having a review, so this makes a huge difference to that.

In addition to that, the one that I was quite pleased to see was the inclusion of AV—audiovisual—links to be able to provide a link for the family members and support services to be part of that assessment when they can’t be there face to face. But it was good to also see that there was a discussion around it, because some people were worried about the fact that it shouldn’t become the default way of doing things, because, technically, there should be people available face to face. But it is good to know that there is that option available, at least in these times when we are going through COVID.

So as a bill that has been thoroughly looked at through the Health Committee and has had a lot of people give input into it, I would highly recommend this bill to the House and I look forward to the next round of conversation on this bill. Thank you.

Kia ora. It’s a pleasure to rise in support of this bill, the Mental Health (Compulsory Assessment and Treatment) Amendment Bill, during Mental Health Awareness Week. Take time to kōrero. Mā te kōrero, ka ora. I rise on behalf of our spokesperson for mental health, Chlöe Swarbrick, who is one of many holding it down for the rest of us in Tāmaki-makau-rau. Ngā mihi mahana ki a rātou katoa.

This bill came through the Health Committee; so I was privy to the submissions made. And, like many of the submitters, we look forward to the Government implementing the recommendations made from its own inquiry into mental health and addiction, in the report He Ara Oranga—in particular, the full repeal and replacement of the Mental Health Act that the Government has committed to. We understand there’s a huge job already going on with the full reform of the health system; so, in the meantime, this discrete piece of the work makes progress on some key areas.

Our outdated mental health system has a legacy of pathologising particular people. We’ve seen this in the hearings for the Conversion Practices Prohibition Legislation Bill and Births, Deaths, Marriages, and Relationships Registration Bill, where we are still experiencing the homophobia, biphobia, transphobia, and interphobia that is the legacy of rainbow identities being misdiagnosed as mental disorders. It is not our diverse genders, sexualities, and sex characteristics that leads to anxiety, depression, self-harm, and suicide; it is the discrimination against us. Rainbow groups such as Te Ngākau Kahukura, OutLine, InsideOUT, RainbowYOUTH, Gender Minorities Aotearoa, and PATHA have all identified the rise in mental health concerns just in the last few weeks because of those hearings, as anti-trans lobbyists use this national platform and their considerable privilege to deny the humanity of our takatāpui, trans, non-binary, and intersex whānau and to spread hate and misinformation against some of the most marginalised people in our communities. Until we amend the Human Rights Act, though, and sort out some hate speech laws, there’s little to stop them doing so.

Māori, of course, have always been a target, and in specific ways, as our spirituality and ability to communicate with our ancestors, one of many parts of our culture, was misdiagnosed as a mental disorder. Because of the disproportionate impact of institutional racism against tangata whenua, He Ara Oranga acknowledged the importance of using Māori health models such as Te Whare Tapa Whā, amongst many, and reconceptualising mental health provision: Taha hinengaro, our psychological and mental wellbeing; taha tinana, our bodily integrity; taha whānau, our relationships and connections to the families of both our birth and our choosing; and taha wairua, our spirituality, our interconnectedness with all things in the universe. None of these is separate; they are all intertwined.

So mental health and wellbeing is impacted on by many factors: whether someone has a warm, dry home that is accessible and affordable, with security of tenure; whether they have enough income to live in dignity, with food security; whether they are free from violence and harm; whether they have access to the healthcare and support that they need, when they need it. The mental health system cannot create mental wellbeing for our people by itself; it must work with other Government and community organisations, must work with whānau, hapū, iwi, Māori collectives and providers. It should not be up to the police to be part of the front line in dealing with the crisis of mental health. Someone who is suicidal should not have to spend the night in jail because there is nowhere else for them to go.

So, number one: this bill eliminates, as my colleagues have said, indefinite treatment orders by requiring the courts to review an order at the end of 12 months. Māori are currently four times more likely to be placed under this Act than non-Māori, and three times more likely to be under these indefinite orders. So this one thing alone will have a huge, huge impact on us.

Number two: minimising the risk of harm when special patients are being transported. This is really, really important for making sure that the least restrictive option is used, to prevent harm and protect people who are involved in this process, and we support this with the expectation that staff are properly trained in de-escalation and control and restraint techniques to do this properly, and also to identify, if transport can’t be done safely, that there are alternatives.

So, of course, number three: if COVID did anything, it showed us how much of our lives can actually be done online. This enables consultations and assessments to be done online, but also for whānau to join, because they can’t always be there in person, for lots of different reasons. So that makes part of that participation more accessible. So we really support the COVID sunset clause being removed. We do agree with our colleagues who have earlier said that this needs to be monitored. Kanohi ki te kanohi, face to face, is always the preference—always—and so it’s really important for transparency that it is recorded why, in any circumstance that face to face is not used, and why audiovisual link is used for the best interests of those patients.

Finally, number four: improves the administrative efficiency of the Act, because, if we must have laws, it seems a very low bar that we would want them to be efficient.

So, in conclusion, we look forward to the overhaul of the entire mental health and addictions Act, and in the meantime this is progress and we commend this bill to the House. Kia ora.

Thank you, Madam Speaker. I was unsure whether I’d get the final call on the last sitting day, but here we are.

I rise on behalf of the ACT Party in support of the second reading of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. I want to take the time to acknowledge that this week is Mental Health Awareness Week and, if I may, just ask everybody to please check in with family and friends that you may never suspect could be suffering from a mental health challenge, because it could be your conversation, today or any other day, that is the conversation that helps pull them from a dark place. We know that there are many people who struggle every day, up and down New Zealand, with mental health issues. Whether it’s from mild anxiety or whether it’s from serious post-traumatic stress disorder or sexual violence trauma that they may never have told anybody about, there are people who suffer in silence and I think they need to be acknowledged.

But we also need to acknowledge that there’s a continuum of care in New Zealand for mental health, and I think this bill goes to show some of that more serious side to New Zealand that we don’t necessarily see. This is talking about people who have had indefinite treatment orders, and this bill seeks to change that by allowing treatment orders to be reviewed every 12 months. I think that’s important, and that’s why the ACT Party supports this bill, because we believe in the inherent right and dignity of every New Zealander. We wish to see people having safe and humane treatment. I note that the legislative statement notes that the mental health and addiction report He Ara Oranga highlighted that this Act was not consistent with international rights commitments, so it’s very important for us to bring our laws in line with our human rights.

I want to acknowledge the submitters who took the time to submit to the select committee on this legislation. I know it’s not easy for people to express to Parliament, to politicians, to people of the public their thoughts, especially when it comes to their own mental health. I want to thank the members who did so, because that helped to show to the members of the committee the real-life stories and the people that will be affected by this law change. I will keep my speech short, but I commend it to the House, thank you.

[Member stands to seek the call]

Apologies to the member. This debate is interrupted and is set down for resumption next sitting day. The House stands adjourned until 2 p.m. on Tuesday, 19 October. Good afternoon.

Debate interrupted.

The House adjourned at 4.57 p.m.