Mental health: overview

This chapter explains:

  • the processes and procedures for compulsory assessment and treatment under the Mental Health (Compulsory Assessment and Treatment) Act 1992
  • options for challenging decisions made under those processes, through reviews and appeals
  • a person’s rights under the Act, and how to make a complaint if any of these rights are breached.

The Main mental health legislation

When a person experiences mental illness they usually get to make their own decisions about their treatment. The Mental Health (Compulsory Assessment and Treatment) Act 1992 covers situations when it is considered a person needs treatment for their mental illness, but they do not agree to this.

If a person becomes a patient under the Mental Health Act:

Mental Health (Compulsory Assessment and Treatment) Act 1992, ss 57-59, 69, 110A

  • their right to refuse treatment can be overridden during various stages of the assessment and treatment process under the Act (see “Compulsory assessment process” and “Compulsory treatment orders” in this chapter)
  • they do not get to choose who will be in charge of their treatment (but do have the right to request independent psychiatric advice in order to get a second opinion)
  • they can be made to stay in hospital.

    Note: The responsible clinician should, wherever practicable, seek to obtain the patient’s consent to any treatment even when the treatment is authorised under the Mental Health Act without the patient’s consent.

Mental Health (Compulsory Assessment and Treatment) Act 1992, s 59(4)

Main principles of the Mental Health Act

The Mental Health Act:

  • defines the circumstances in which compulsory assessment and treatment can happen
  • emphasises community-based care, with hospitalisation only when necessary and in the least restrictive environment possible
  • places importance on respecting different cultural values and beliefs in a person’s assessment and treatment
  • emphasises consultation with family or whānau
  • sets out a person’s rights if they are being assessed or treated.

Definitions of key terms and descriptions of key people

Mental disorder

Mental Health (Compulsory Assessment and Treatment) Act 1992, s 2

The Mental Health Act defines mental disorder as:

  • an abnormal state of mind (whether of a continuous or intermittent nature), shown by delusions or disorders of mood, perception, volition or cognition, and
  • this abnormal state of mind means that either:
    • there is a serious danger to the person’s health and safety, or the health and safety of another person, or
    • the person’s ability to care for himself or herself is seriously reduced.

    Note: This definition is important because it is used to decide whether a person has a mental illness that could require them to be treated without their consent.

Delusions and disorders

These words are legal terms used to describe specific symptoms.

Delusions include holding false beliefs, for example, a person believing that they are related to royalty when they are not.

Disorders include:

  • disorders of mood (for example, being very depressed or on a “high”)
  • disorders of perception (for example, hearing voices or seeing things that no-one else is able to hear or see)
  • disorders of volition (for example, being unable to freely exercise will or control impulses)
  • disorders of cognition (for example, thinking processes such as memory or judgement being disturbed).

Proposed patient

A person becomes a proposed patient when an application is made to have them assessed under the Mental Health Act.

Patient

If, after a person has been assessed, the psychiatrist believes they have a mental disorder and requires them to undergo patient assessment, they become a patient under the Mental Health Act. Patient also includes a person who is subject to compulsory treatment order and special patients.

Special patients are those who can be detained in a hospital by an order made under the Criminal Procedure (Mentally Impaired Persons) Act 2003, the Criminal Procedure Act 2011, the Air Forces Discipline Act 1971 or the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003.

Responsible clinician

If a person’s assessment says that there are reasonable grounds for believing they have a mental disorder, they will be assigned a responsible clinician. This person is usually a psychiatrist and is responsible for a patient’s treatment while they are under the Mental Health Act.

Principal caregiver

This is a friend or family or whānau member who is, or appears to be, most directly concerned with a patient’s care. If a patient is not well enough to nominate someone or there is some disagreement about who their principal caregiver should be, then the Director of Area Mental Health Services (see the description below) should decide. Not everyone has a principal caregiver. If a patient does have a principal caregiver, the principal caregiver will be sent information about the patient’s legal status and treatment.

Director of Area Mental Health Services (DAMHS)

Directors of Area Mental Health Services (DAMHS) are appointed by District Health Boards and are responsible for the Mental Health Act in their area. If someone believes a person has a mental disorder they can apply to the DAMHS to have that person assessed (see “Compulsory assessment process” in this chapter). The DAMHS or a duly authorised officer (see the description below) will then arrange an assessment examination. DAMHS are also responsible for assigning responsible clinicians (see the description above).

Duly authorised officers (DAOs)

Duly authorised officers (DAOs) are health professionals with special responsibilities under the Mental Health Act. For example, DAOs can:

  • give advice about mental health services and how the Mental Health Act works
  • help with the assessment of proposed patients.

District inspectors

Mental Health (Compulsory Assessment and Treatment) Act 1992, s 2

District inspectors are lawyers with special responsibilities for safeguarding the rights of people under the Mental Health Act. For example, district inspectors must:

  • give a person information about the compulsory assessment and treatment process and their legal rights
  • arrange for a lawyer to represent a patient at a hearing if requested by the patient
  • help patients apply to the Family Court for a review of their case while they are being assessed
  • investigate complaints about breaches of a patient’s rights.

District inspectors also have a more general oversight role for mental health services. They visit and inspect psychiatric hospitals and services and can inquire into how they are managed and any aspect of patient care and treatment.

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