A key part of the oversight of compulsory treatment of
mental health patients appears to fall short of acceptable
standards for exercising such power, a new book on New
Zealand's mental health law suggests.
Dunedin yesterday hosted the first of five conferences in
main centres to launch New Zealand's Mental Health Act in
Practice , which marks the law's 21st anniversary.
Co-edited by Prof John Dawson, of the University of Otago
faculty of law, the book raises concerns about possible
over-use of compulsory treatment orders, and Maori
overrepresentation in compulsory treatment, while concluding
the legislation itself is sound.
The book includes an audit of the use of a second
psychiatrist's opinion to approve compulsory treatment
orders, carried out in three unidentified district health
Findings were co-presented yesterday by Prof Paul Glue, head
of psychological medicine at the University of Otago, one of
six researchers who carried out the audit.
Every health board had different documentation procedures for
the process and among the three boards audited there were
differences in the information recorded.
For electroconvulsive therapy, 20% of cases audited had no
recorded justification for the decision, while 32% of drug
compulsion orders had no recorded justification.
Of the 438 cases studied, 3% were declined, while 8% were
Prof Glue said there was support from senior psychiatrists
around the country for creating a standardised New Zealand
assessment form to strengthen the process.
However, he cautioned against over-interpreting the findings,
saying more consideration was likely to be occurring than was
Follow-up for the minority of patients whose compulsory
treatment orders were declined was also lacking, he said.
The chapter of the book containing the audit said: ''A
significant proportion of the documentation appears to fall
short of the standards that would seem to justify the
exercise of power to compel patients to take medication they
have explicitly refused.''
Prof Dawson, in a press release, said compulsory treatment
seemed to have increased significantly in the past five
years, and it was unclear what was happening.
The book, whose authors include lawyers and psychiatrists,
calls for research into why the rates of compulsory treatment
appeared to be increasing.
It was possible increasing social deprivation could be a
factor, he suggested.