Mental Health (Compulsory Assessment and Treatment) Amendment Bill

We come first to the Mental Health (Compulsory Assessment and Treatment) Amendment Bill Part 1. This is the debate on clauses 4 to 12 and the Schedule, main amendments.

Mr Chairman, I won’t take too long just by way of introductory remarks, but this bill will be well-known to members of the House. It’s really an interim measure, pending a full review of the current legislation, but this addresses some immediate needs that have been identified by the He Ara Oranga report that looked into our total mental health administration. It called on repeal of the indefinite treatment orders—or, effectively, indefinite treatment orders—under the current legislation. It also effectively repeals the temporary provisions that allowed family members to attend explanations and meetings with patients by way of audiovisual link. It also allows assessments to be conducted, where necessary, by audiovisual link, and it allows appropriate restraint powers to be exercised by those escorting special patients to needed appointments, where restraint in transport is needed.

So this makes those immediate changes. It brings the legislation, such as it is, to a more human rights compliant sort of state, and that is a good thing. But otherwise, I look forward to the questions and the discussion.

Thank you very much, Mr Chair, and can I also acknowledge the health Minister and thank him for his time, being here today. I think, as the health Minister clearly outlined, it’s a fairly technical bill which makes a few important changes, and the National Party does support the bill.

There was some concern, though, in the select committee—and I suppose we did hear from submitters as well—we do want to move with technology. This bill clearly outlines the improved use of audiovisual link for those people who could be assessed and/or treated, and—as the Minister said—to include family and friends in the involvement of that.

With any change, and I suppose in the area of mental health, where we’re dealing with some very vulnerable people—I would like to hear from the Minister, is he assured that there are safeguards in place, that the use of audiovisual will be used for the benefit of the person involved? And what mechanisms are in place to ensure the reporting of audiovisual, the decision points where audiovisual was decided upon for that individual, and how that new practice will be reported back.

It is important that when these provisions that change the typical approach and mean that people aren’t physically present, that there are appropriate safeguards. There is provision for when a decision is made to use audiovisual technology, that that is recorded, and that the reasons for doing so are also recorded. I’m confident that there are safeguards in the bill in that respect.

Equally, there were changes to the transporting of special patients, the restraint or potential restraint in a vehicle. I think it would be helpful to understand what were the drivers of some of those changes around enhanced restraints of special patients? And also, again, to that idea of safeguards in reporting: how are we going to safeguard that those restraints are appropriate, and how will we ascertain the numbers or times restraints are used and whether that’s appropriate?

The reason why this has been provided for is there hasn’t previously been any provision or statutory power for those responsible for the care of special patients, in particular, and especially when they’re being transported, to exercise restraint powers. That has been a subject for comment by those responsible for inspecting mental health services, particularly forensic mental health services. The reality is that there are some special patients who are a danger to themselves and potentially to others, particularly if they are in the confined space of a motor vehicle.

So this has been introduced in order for there to be clear statutory provision to allow restraints to be applied so that people can be transported safely. This is for the purposes of bringing a patient before a court for their hearing or for a trial, or for bringing a person before the Parole Board for a hearing. In order for that to happen, there has to be a transport management plan—that’s provided for in new section 53A(2) set out in clause 9. That has to be approved by the Director of Mental Health. That transport management plan can authorise the restraint of the patient in the least restrictive way and the use of any other force that is reasonably necessary in the circumstances, and there are some other provisions there. In the end, in terms of preparing those transport plans, the Director-General of Health must issue guidelines for the purposes of developing those plans and for the execution of these powers. Once this legislation is passed, those guidelines must be in place within 12 months.

So a number of kind of braces and bootstraps are sort of being used to make sure every possible safeguard that can be in place for special patients to be transported is there and reflected in not only the legislation but the way it is implemented.

Thank you, Mr Chair. Part 1 also includes the elimination of the indefinite treatment orders. It has been said, for this part and other clauses, it’s the beginning of the Government’s commitment to repeal and replace the Mental Health Act. I was wondering if the Minister would be able to update the committee where that mental health inquiry recommendation is, of repealing and replacing the Mental Health Act, and when he thinks maybe that new bill will be introduced to the House?

I thank the member for the question. I can report that good progress is being made in the preparation of that legislation and I am hopeful that it will be introduced to the House very shortly. But that has been a big exercise, as the member will be aware, but hopefully a combination of this interim sort of change and the kind of permanent repeal of the current legislation, and its permanent replacement by more modern legislation, will give greater confidence not only to those who’ve been cared for in our mental health system but for those doing the caring as well. I assure the member that future is not far away.

Thank you, Mr Chairman. I wonder if we could get a little bit more definite timing than “very shortly”. It was certainly a very significant part of the submissions to the Mental Health (Compulsory Assessment and Treatment) Amendment Bill, that while submitters were pleased with the small changes in here, they were much more exercised by the overall repeal and replacement of the Act. I think a more definite timing than “very shortly” would be useful. If the Minister could give us a little bit more of an indication of where the progress is at and the time line for that final repeal and replacement. Thank you.

The member will be aware that the legislation—in addition to being commented on in the way described by that member, as in urgent need of replacement—is a comprehensive and complicated exercise. But we knew that there were shortcomings right now that really needed to be addressed as a matter of urgency. That is this legislation.

In terms of the long-term replacement, there is a consultation process under way specifically on that legislation. I expect that will be concluded in the early part of next year. That will form the basis of the drafting of the legislation. So, all going well, we’ll be in a position to have that new legislation at some point next year and, all going well, passed in 2023.

Thank you, Mr Chair. And thank you, Minister. The use of audiovisual link, as my colleague Matt Doocey has spoken about, was also quite a significant part of the submissions, in that family and friends particularly were very concerned that the justification must not be just that it is the fall-back, default, easiest position for officials. We heard, in the submissions, that they felt there needed to be very stringent reporting arrangements. I wonder if the Minister could just give us a little bit more information about those reporting requirements—whether it is just going to be the guidance through regulations, or more stringent requirements than that. Thank you.

And, just while the Minister is taking some advice on that, I think it’s a very important question from my colleague Penny Simmonds, to ensure that we do have the regime in place to identify when audiovisual link (AVL) is being used—also the recording of that, and also the reporting of that. I think, if the Minister could respond to that but also maybe take a step further, in how we are going to have some trust in the Ministry of Health reporting. We know the Minister was severely let down recently by some of the reporting about the mental health annual report. So it’d be nice to think that some of the changes in this bill that we are debating at the moment will appear in some reports that will be public facing and the public can have some confidence in what my colleague Penny Simmonds alluded to—that what we don’t want to see is mental health patients just sidelined, basically, and that they will just be sidelined by the use of AVL. I think it’s important, especially in a mental health context, that they are meeting their mental health professionals face to face, they are included in their care planning and assessment, and that they know that we are there for them and caring for them.

I thank both those members, Penny Simmonds and Matt Doocey, for their questions. I think the simple answer is that part of the director-general’s guidelines have to encompass the basis on which a decision to use audiovisual link (AVL) is made. And so that is why practitioners who are assessing a patient would need to apply the guidelines issued by the Director-General of Health, including when the physical presence of a patient isn’t practicable and the use of AVL technology is appropriate. So the director-general will develop the guidelines for that. But the second part of it is, too, there will be an obligation to report to the relevant director of area mental health services on that.

I think, as I understand it, the committee was keen to develop a comprehensive reporting requirement. Members of this House should expect that to be part of the legislation that is the permanent replacement to the current Mental Health Act. I agree with both of those members: there does need, for the purposes of assurance to both patients and their families, for there to be some clear basis on which involvement of a patient in a way that is other than face to face is recorded and that we also build up a reporting track—a record—of the way in which a power like that is used. So members can be reassured that, notwithstanding the provisions in this particular bill, it goes some way to address that question. The permanent replacement will properly address and provide a proper framework for just that particular question.

Thank you, Mr Chairman, and thank you Minister for that assurance. I wonder if the Minister could further outline to us what monitoring of that reporting might take place so that we can be sure that parts of the country are not applying the guidelines inconsistently with other parts of the country. Just the reporting of it is good, but if the reporting isn’t monitored and consistency achieved, then only half the job is done. Thank you, Minister.

I think the member raises a very good point. I think, a couple of things. First of all, the Director-General of Health is responsible for developing the guidelines, so they will be a set of national guidelines. The Director of Mental Health, obviously, will have an involvement in that and the Director of Mental Health is responsible for ensuring provisions in the current legislation are applied and applied consistently.

I think what will give further reassurance to members is the legislation introduced, yet to have its first reading—the Pae Ora (Healthy Futures) Bill—is about a truly nationwide health system, so that any inconsistency that might have been developed between the proprietors of mental health units at the moment, which are any one of the 20 DHBs, there will be a mechanism to ensure a greater consistency of application of national guidelines in the future in a way that we struggle to achieve at the moment.

Part 1 agreed to.

Part 2 Amendments relating to COVID-19