A literature review carried out by the University of Otago into perspectives on compulsory treatment, with a focus on the people who are subjected to compulsion and a focus on tāngata whaiora (people with lived experience of mental distress), has found there is little research in Aotearoa and globally that puts their story at the center.
The stock-take of research is the first of its kind in its field, and the Mental Health Foundation (MHF) believes the findings are worrying for anyone involved in reshaping our mental health legislation.
“If we are to come to a greater understanding of the impacts of compulsory treatment on those subjected to it, tāngata whaiora and particularly Māori and Pasifika must be at the heart of future discussions. This is crucially important now, ahead of the repeal and replacement of the Mental Health Act next year,” MHF Policy and Advocacy Manager Olivia Stapleton says.
The repeal and replacement of the Mental Health (Compulsory Assessment and Treatment) Act 1992 was an action spurred by recommendation 34 of the national mental health inquiry and resulting report: He Ara Oranga.
The report found recommendation 35 (which called for an informed national discussion) must happen for recommendation 34 (repeal and replace) to be carried out in an informed manner.
The MHF acknowledges these discussions must consider how compulsory treatment orders (CTOs) are being used.
“We know some people believe CTOs have helped them, but when you dig deeper into the ‘why’ we often find it’s because being under a CTO meant they also had better and faster access to mental health services. This suggests it’s not the restrictions of the order that they value, it’s the access to care and services that a CTO provides. People shouldn’t have to give up their autonomy to access treatment. On top of this we know many people find CTOs hugely traumatic,” Ms Stapleton says.
One service user described how future legislation must put them at the heart of decision-making.
“People living with mental distress are capable and know themselves best. Tāngata whaiora know what alternatives to CTOs look like. It's about giving options, empowering, and supporting and making sure people's voices are heard.”
That sentiment is shared by the MHF.
“As an organisation heavily informed by lived experience communities we know that home and community-based supports that are peer led, culturally responsive, trauma-informed, and that empower people managing their distress and recovery, are the best way forward. We know the solutions lie with the lived experience community and with Māori”, MHF Chief Executive Shaun Robinson says.
“We need to have greater trust in people’s ability to heal themselves and know what they need, but we must also ensure they are supported on this journey. Building access to that support must go hand in hand with a major shift away from compulsion,” Mr Robinson says.
The report Privileging the focus and voices/voices and focus of tāngata whaiora: Mental health act review and replacement was funded by Te Whatu Ora (formerly Te Hiringa Hauora) and supported by the Mental Health Foundation of New Zealand. It was prepared by researchers Alison Schneller, Sarah Gordon, Katey Thom, Gabrielle Jenkin, Stella Black, Kerri Butler, Susanna Every-Palmer, and Giles Newton-Howes at the University of Otago.
The report discusses the broader context for mental health law and system transformation in Aotearoa New Zealand, encompassing a review of key information to tell a story which centers tāngata whaiora voices (people with lived experience of mental distress). He Ara Oranga generated two recommendations in relation to the MHA: Repeal and replace the MHA (recommendation 34) and Encourage [stakeholders] to engage in a national discussion to reconsider beliefs, evidence and attitudes about mental health and risk (recommendation 35). The Government accepted He Ara Oranga and responses have identified that new legislation itself won’t be transformative—it must be supported by changes in practice.
The MHA repeal and replace law seeks to enact recommendation 34, to repeal and replace the Mental Health (Compulsory Assessment and Treatment) Act 1992 so that it reflects a human rights–based approach, promotes supported decision-making, aligns with the recovery and wellbeing model of mental health, and provides measures to minimise compulsory or coercive treatment.