Kieran Moorhead – 23 October 2018
In the wake recent events and increased attention of ‘being sectioned’ we have put together a bit of information to hopefully dispel some myths and create more thoughtful conversations around mental health.
To be ‘sectioned’ is a colloquial way of referring to someone being assessed (and potentially treated) under the Mental Health (Compulsory Assessment and Treatment) Act. Most western countries around the world, including New Zealand, have adopted forms of legislation that set out rules and guidelines for people to receive compulsory community-based (and occasionally inpatient based) mental health treatment. This treatment is generally in the form of a medication regime and case-management care comprised of health professionals and a responsible clinician (usually a psychiatrist).
The criteria for being assessed under the Mental Health Act is surprisingly simple. It only requires that the person be ‘mentally disordered’ enough to warrant someone seeking out support from the local district health board and the person responsible for all mental health treatment orders in the region, also called the Director of Area Mental Health Services.
‘Mentally disordered’ is the language used by the Act, and the legislation defines a mental disorder as follows:
mental disorder, in relation to any person, means an abnormal state of mind (whether of a continuous or an intermittent nature), characterised by delusions, or by disorders of mood or perception or volition or cognition, of such a degree that it—
(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;
A lot of people begin the assessment process after involvement with police. This is because police are increasingly dealing with high numbers of mental health related callouts and are encountering people in high distress with complex life events occurring. This fact has not escaped the attention of health services who are trying to meet this crisis demand by triaging people to mental health care before police can be involved (through 111 call operators deferring people from police), and by having mental health training and potentially mental health staff available for police (though this is still a work in progress).
A person is always assessed by a responsible clinician (usually a psychiatrist working with the hospital), but it can also be another senior medical professional.
Once a person has been assessed it is up to the medical professional’s judgement as to whether they need to request a hearing for a compulsory treatment order. This hearing takes place in a court style set up in front of a judge, and is not usually in a courtroom but often in the hospital or even in someone’s own home depending on their social circumstances.
There are numerous legal and whānau supports available to a person who is undergoing the compulsory treatment order process. Including being granted a lawyer, having cultural considerations taken into account, and being given opportunities for appealing to a mental health review tribunal. You can read more about the process and rights here.
In 2016 in New Zealand 5,163 people were compulsory assessed or treated under the Act. 169,454 people (or 3.6% of the population) used specialist mental health services. And 6% of people using specialist mental health services were under compulsory treatment orders.
The effectiveness of compulsory mental health treatment is hotly debated with research suggesting that compulsory treatment orders may not actually improve outcomes for people, and there are concerns over the number of people and time spent on treatment orders increasing.
Other criticisms of compulsory treatment orders are:
- Māori are 3.5 times more likely to be subject to community treatment order.
- Compulsory treatment can become indefinite.
- Community treatment orders often have no clear records, with some people being on orders for over 20 years.
Despite the clear issues with compulsory treatment orders there are some positive aspects that do work well for people.
They do effectively mandate district health boards to provide people with support, and more often than not the support is comprehensive and of value to the person.
They also provide the person and whānau validation that their issues are serious and legitimate enough to warrant free mental health support. Due to how NZ’s mental health system is structured, being on a compulsory treatment order enables greater access to numerous government and non-government mental health and wellbeing services.
Current leaders in mental health including experts in mental health law, advocates, and those with lived experience of being under the Act believe that it is coercive and stigmatising. It gives medical professionals too much power over vulnerable people and perpetuates language and ideas that are discriminatory – that people are ‘dangerous’ and ‘lack insight’ into their own health needs.
For more detailed information about the Mental Health Act and the use of it in NZ you can read the Director of Mental Health’s Annual Report