Overview of the mental health laws
Definitions of key terms and descriptions of key people
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, where
- this abnormal state of mind means that either:
- there is a serious danger to the person’s health and safety or to the health and safety of another person, or
- the person’s ability to care for themselves 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 of mood, perception, volition or cognition”
As we explained above under “mental disorder”, one of the necessary elements in the definition of “mental disorder” under the Mental Health Act is that you must have “delusions” or a “disorder of mood, perception, volition or cognition”. If you don’t have one of these mental states, then you don’t have a “mental disorder” and you can’t be made to have treatment under the Mental Health Act.
“Delusions” include having false beliefs – for example, a person believing they’re related to the British royal family when they’re not.
Here we explain and give examples of “disorders of mood, perception, volition or cognition”:
- Disorders of mood – A mood disorder could include, for example, being very depressed or being on a “high”.
- Disorders of perception – A perception disorder could include, for example, hearing voices or seeing things that no-one else can hear or see.
- Disorders of volition – “Volition” means free will, and so a “disorder of volition” is where you don’t have the power to consciously choose to do or not do something. This could include, for example, very serious depression that stops you speaking or moving for some time (sometimes called a “depressive stupor”, or “catatonic depression”), or when you hear voices telling you to do things (“command hallucinations”).
- Disorders of cognition – “Cognition” is all about thinking, knowing, understanding, remembering and so on. So disorders of cognition could include, for example, when your memory, judgement or other thought processes are disrupted by a psychotic state, or when they’re slowed right down by severe depression, or sped right up in a manic state.
Note: The definition of “mental disorder” in the Mental Health Act is all about the particular symptoms a person has, and not about whether they’ve been diagnosed by mental health professionals with a recognised mental illness, like “bipolar disorder” (manic depression).
A person becomes a “proposed patient” when an application is made to have them assessed under the Mental Health Act. They then have the patient rights that are set out in the Mental Health Act: see “Your rights as a mental health patient” in this chapter.
You’re a “patient” under the Mental Health Act, and so have all the rights of patients in the Act, when:
- a psychiatrist has assessed you as having a mental disorder and requires you to have compulsory assessment, or
- a judge has made a compulsory treatment order about you, or
- a judge in a criminal case has ordered you to be held under the Mental Health Act – this could happen after the judge has decided you’re “unfit to stand trial” because of your mental health, or after you’ve been found not guilty on the grounds of “insanity”, or if at any stage of the case the judge orders an assessment of your mental health.
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 (who is usually a psychiatrist) is responsible for a patient’s treatment while they are under the Mental Health Act.
The “principal caregiver” is the friend, or the family or whānau member, who is most directly concerned with a patient’s care. If the patient is not well enough to name someone, or if there is disagreement about who their principal caregiver should be, then the Director of Area Mental Health Services (see the description below) will 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 “The compulsory assessment process” in this chapter). The DAMHS or a “duly authorised officer” (see the description below) will then arrange an assessment examination. The DAMHS is also responsible for assigning responsible clinicians (see the description above).
Duly authorised officers (DAOs)
Duly Authorised Officers (DAOs) are health professionals – usually senior psychiatric nurses – with special responsibilities under the Mental Health Act. They’re appointed to be points of contact between mental-health services and the community. DAOs help with applications under the Act and arrange assessments. More generally, they provide information and assistance for anyone who has concerns about what mental-health services are available and about how the Mental Health Act works.
Your local District Health Board or GP will be able to give you contact details for DAOs in your area.
“District inspectors” are lawyers with special responsibilities for guarding your rights as a patient under the Mental Health Act. For example, district inspectors must:
- give you information about the compulsory assessment and treatment process and your legal rights
- arrange for a lawyer to represent you at a hearing, if you request this
- help you apply to the Family Court for a review of your case while you are being assessed
- investigate complaints about breaches of your rights.
District inspectors also have a more general oversight role for mental health services. They visit and inspect psychiatric hospitals and services. They can inquire into how those hospitals and services are managed and check on patient care and treatment.