Mental Health (Compulsory Assessment and Treatment) Amendment Bill

Hon LUAMANUVAO WINNIE LABAN (Labour—Mana) Link to this

I move, That the Mental Health (Compulsory Assessment and Treatment) Amendment Bill be now read a first time. At the appropriate time I intend to move that the bill be referred to the Health Committee for consideration.

Kia ora, talofa lava, and warm Pacific greetings. It is my great pleasure to bring this bill to the attention of the House. The purpose of this bill is to strengthen and clarify the current legislation. In the 17 years since the Mental Health (Compulsory Assessment and Treatment) Act of 1992 was passed, the understanding, treatment, and care of mental health patients have developed and improved. However, the law has stood still. This bill will address what is seen by many in the field as a gap in the current legislation. The gap relates to the role of families. The 1992 Act made limited provision for the involvement of families. This bill extends and strengthens the role of families of patients experiencing mental illness.

Dr Peter McGeorge, a psychiatrist and chair of the Mental Health Commission, summed up the issues this bill addresses when he wrote a booklet entitled The legal framework for family inclusion in child, adolescent and youth mental health and addiction services. He wrote: “Everyone knows that families are important. However understanding their importance in the recovery of family members who have experienced mental illness is only relatively recent.”

Dr McGeorge went on to say that the Mental Health Commission is concerned to see that families are included in the mental health assessment and treatment processes of family members. This is because the commission knows not only that families can be of enormous assistance but that families suffer along with their loved ones. Dr McGeorge’s views are echoed by other mental health service providers, support and consumer groups, and families who have loved ones in mental health care.

During my preparation of this legislation I read and consulted widely. I met with Dr Peter McGeorge and other psychiatrists, Dr Jan Pryor, the Chief Families Commissioner; staff and legal advisers of the Office of the Health and Disability Commissioner; Florence Leota, chief executive officer of Supporting Families in Mental Illness New Zealand; Tāone O’Regan, manager, and members of Atareira—formerly the Schizophrenia Fellowship—which provides mental health support for families and whānau; and many others working in the mental health field. I have also listened to many consumers and many families who have had family members in mental health care. There is wide approval from those people for this bill.

Let me now outline the specifics of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. The bill amends section 7A of the Mental Health (Compulsory Assessment and Treatment) Act 1992. Section 7A of the Act provides for family or whānau involvement with individuals who have been dealt with under the Act. Currently the practitioner, usually a psychiatrist or a responsible clinician, must consult the whānau or family of the proposed patient or patients unless it is not reasonably practicable or it is not, after consultation with the patient, deemed to be in the best interests of the patient. The practitioner must also apply any guidelines or standards set down by the Director-General of Health.

This bill adds two further subsections to section 7A. The first new subsection, subsection (6), seeks to clarify the entitlements of the family or whānau once the practitioner has decided to consult them. These entitlements include information about the particular illness in question; information about the likely effects of treatment; inclusion in the planning, implementation, and review of care; consultation about discharge; and the right to seek a second opinion.

The second new subsection, subsection (7), provides for inclusion of the family of whānau to a certain degree whether or not the practitioner has made the decision to include the family. This provision means that the family or whānau is entitled to have general information about mental illness and the ability to provide relevant information about the family member’s history, and it reinforces what other parts of the Act have already stipulated, including cultural, religious, or ethnic factors, and individuals’ beliefs about the role of family or whānau.

The point of these changes, first and foremost, is to clarify the rights and responsibilities of families and whānau in relation to their family member being cared for under the Act. The legal advice received from the Ministry of Justice, courtesy of the Attorney-General, the Hon Chris Finlayson, on this bill was to ensure that it was consistent with the New Zealand Bill of Rights Act 1990. It concluded that the bill appears to be consistent with the rights and freedoms affirmed by the New Zealand Bill of Rights Act. We also received correspondence from Marie Shroff, the Privacy Commissioner, who supports the overall goal of this bill.

Under the amended legislation families and whānau have specific rights, such as the right to information about the care and treatment of their loved one, about the specific form of mental illness the person is suffering from, and about mental illness in general. With better access to information, families and whānau will be better informed about mental illness in general and therefore better able to give support that in many cases will offer opportunities for recovery.

Families and whānau will also have the right to be involved in all stages of the care of their loved ones, including when that care should end. Importantly, they also have the right to seek a second opinion. The hope of this bill and these measures is that they will lead to a more informed and empowered family unit that will possess the tools to be more involved in the care of their loved one and more resilient in the face of mental illness.

The ultimate goal is not just to assist in the recovery of the mental health patient but also in the potentially beneficial side effect of creating more resilient and caring families. Greater involvement by family and whānau in the care of a mental health patient creates a win-win situation for all, including the professionals involved. Treatments that include a greater involvement of the patient’s family have been shown to produce superior and stable outcomes, and have significantly reduced symptoms and related problems, including family problems.

There is good evidence showing that when a family is involved in assessment and treatment, the outcomes are improved for the family member. Family inclusion presents a far more holistic approach to mental health recovery. Far from being focused solely on the individual in the context of care, this approach recognises that the needs of the individual experiencing mental illness must be met within the context of the family or whānau. It focuses on the families’ opportunities and abilities for change. Although the focus on the individual rights of a patient is important, the value of individuals reconnecting with others and their families in particular is still underemphasised and undervalued. The therapeutic value of this needs to be strengthened in the ordinary routines of clinical practice.

The Mental Health Commission commissioned a literature review on child and adolescent mental health and family inclusive practices in 2007. The review found that including families aids the therapeutic approach by including an insider’s perspective on care. It creates a better understanding of the problem, agreement on treatment components, and, with fewer internalising and externalising behaviours, it improves clinical outcomes and reduces symptoms. These views received strong support when workshopped around the country by the Mental Health Commission.

The need for a change towards more family-inclusive practices in the care of mental health patients has been known for some time. In Te Kōkiri: The Mental Health and Addiction Action Plan 2006-2015, a Ministry of Health publication, two of the specific actions identified related to this area. The plan makes the call to implement initiatives that recognise the importance of family and whānau. It also calls for initiatives that respond to the needs of family and whānau, such as assessment and referral to appropriate supports and services, education on the recovery process, and the hearing of family views about the responsiveness of services.

On a personal note, prior to entering Parliament I worked as a family therapist and counsellor for over 20 years, and I served from 1993 to 1996 on the board of the Mental Health Foundation. It was my professional experience that the involvement of family in the treatment of cases where there was mental illness, family violence, sexual abuse, and other difficult and complex issues led to better outcomes than where individual treatment options were undertaken without any family involvement. It was John Donne who wrote: “No man is an island, entire of itself; every man is a piece of the continent, a part of the main;”.

I say in conclusion that it is my hope that this bill will go a long way to addressing the need for greater family inclusion in the caring for and recovery of mental health patients by fixing a gap in the current legislation. I commend this bill to the House.

Dr PAUL HUTCHISON (National—Hunua) Link to this

Thank you very much for the opportunity to speak on what I consider is a very, very important member’s bill, the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. I also thank the Hon Luamanuvao Winnie Laban for introducing this bill, and I acknowledge the extensive work and effort she has put into it. I say from the depths of my heart that I admire enormously the contribution that Winnie Laban has made to this Parliament, her sincerity, her intelligence, and the vast experience she has in this field through a long history of practising as a family counsellor.

Although I absolutely agree with the sentiment behind this amendment bill, and the Government fully supports the underlying principle of it—to strengthen family and whānau involvement and provide support when a family member is assessed or treated—we will not be supporting the bill, because we believe that the current legislation is actually quite sufficient. I will go into detail about why that is, and I hope members will listen. Firstly, I have personally thought a lot about this bill and have done my best to consult widely and discuss it with others, including a current mental health commissioner. Secondly, we consider that the existing Mental Health (Compulsory Assessment and Treatment) Act 1992, and in particular section 130, as amended by the Mental Health (Compulsory Assessment and Treatment) Amendment Act 1999, provide the appropriate framework and fulfil the requirements of this bill.

The amendment Act of 1999 was one of the first that I was personally involved in when I came into Parliament. I know that a huge amount of work was put into that, and in my view it was one of the very worthwhile pieces of work that the Labour Government did, ably assisted by Her Majesty’s most loyal Opposition at the time. Section 7A of the Mental Health (Compulsory Assessment and Treatment) Act, which was inserted in 2000 by the 1999 amendment Act, provides that the medical practitioner or responsible clinician “must consult the family or whānau of the proposed patient or patient.” unless “consultation—is not reasonably practicable; or is not in the best interest of the proposed patient or patient.” I must say that a huge amount of effort has been put into the work related to what is not reasonably practicable or in the best interest of the patient. Secondly, the practitioner “must consult with the patient or proposed patient” with regard to the best interests issue. Paramount and fundamental to that legislation are the concerns, well-being, and safety of the patient. Inherently, there has to be a balance between best clinical practice, patients’ and relatives’ rights, and ultimate patient well-being.

It is fundamental to point out that section 130 of the 1992 Act allows the Director-General to promulgate standards from time to time. They include “Guidelines for the purposes of this Act; and standards of care and treatment of patients.” The guidelines and standards have had a huge amount of consultation and work, and that should not be underestimated. The problems I see with this current amendment is that, if anything, on balance it is not necessary, and it could erode patients’ rights where they have already been extremely well protected. Closely aligned to the original Act is the Health Information Privacy Code 1994 and the Code of Health and Disability Services Consumers’ Rights. Both have had enormous consultation and have been worked up over a period of time.

When the amendment that inserted section 7A was put into place, submitters included the Privacy Commissioner, the family law section of the New Zealand Law Society, the Principal Family Court Judge, the Mental Health Foundation, the Mental Health Commission, the Royal Australian and New Zealand College of Psychiatrists, and many, many others. Further to that, the Health and disability services (general) Standards and various core standards that give effect to the general standards were promulgated by the Director-General of Health as recently as 2008. Those revised standards were the culmination of extensive collaboration with many groups—consumers, providers, Government and non-government agencies, and the ministry—that took place over a 3-year period. They were extremely well-thought-out. In my view, these existing standards satisfactorily accommodate the amendments that occur in this current bill. There already is an existing right to a second opinion that is clearly expressed in the Act as amended in 2000. I sincerely believe that the current legislative framework is appropriate, and that the bill does not add anything practical to what is already in law.

What is fundamentally important, however, is the way in which the current law is put into practice. Again, in my view, that depends on the proactive vigilance of clinicians to practise up to the standards and guidelines that are already there. Clinical reality requires that each patient, their family, and their whānau are treated according to their unique circumstances, and it is impossible to accommodate that entirely by further legislation. Sometimes emergency situations will not allow a second opinion before a patient’s life is put into danger. Clearly, sometimes it is totally appropriate that family and whānau are not directly involved—for example, in cases of incest or violent abuse within a family that is repeated, and where direct harm could occur to the patient.

I once again sincerely thank the Hon Luamanuvao Winnie Laban for introducing this bill, but I, personally, sincerely believe that the current legislation provides very well-thought-out and balanced protections, and it would be inappropriate to introduce these further amendments. If anything, what really is needed is constant revision of the best-practice guidelines between the Royal Australian and New Zealand College of Psychiatrists, families, whānau, consumers, and the Mental Health Commission. In my view, that would be the most useful approach.

Hon JIM ANDERTON (Leader—Progressive) Link to this

The announcement to the House that the National Party will not be supporting the Mental Health (Compulsory Assessment and Treatment) Amendment Bill is a continuation of a well-worn record that is high on rhetoric but abysmally low on practical action. If the member who just spoke, Paul Hutchison, is trying to convince himself or anyone else that the relationship between families and the mental health system is hunky-dory and everyone is happy with it, then he is living on a different planet than most of us who have to deal with mental—

Hon HEATHER ROY (Deputy Leader—ACT) Link to this

I rise to speak on the first reading of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. The ACT caucus spent a lot of time thinking about and considering this bill. We commend the Hon Winnie Laban for this initiative. It is entirely appropriate that we have this debate in this very serious manner. I know that members in the House do take this issue extraordinarily seriously.

We have traversed the wide range of issues within our caucus, from the privacy concerns right through to the right of family members to have access to information. The ACT Party will be splitting its vote on this bill, and Sir Roger Douglas will speak later in support of it. The other four ACT members will be opposing the bill, and I will come to the reasons for that in a moment.

The debate is not about the stigma of mental illness. The debate is about the involvement of family in the treatment of their loved ones. Dr Paul Hutchison very carefully and thoughtfully outlined the law as it currently stands, and I support the comments that he made. Clinicians do their very best, under very difficult circumstances in many cases. Despite the figures and the research that both the Hon Winnie Laban and the previous speaker Jim Anderton spoke of, not all families function well, sadly, and not all are supportive of their loved ones who have a mental illness. Sadly, sometimes there does not seem to be very much love in the equation. We have to think very carefully about how to have a safe situation for all patients when they suffer from a mental illness and are not responsible for their actions.

After having worked for a short time in the area of psychiatry and after talking to a number of clinicians who are involved today, I say that sadly this bill has the potential to have unintended consequences that I do not think any member in this House would be happy with. For people who are suffering from a mental illness and who are in an abusive situation, whether it is violence, sexual abuse, or a number of other abusive situations, their family situation is not ideal and the requirement for a clinician to consult family members is not always appropriate.

The law as it stands, as Dr Paul Hutchison outlined, allows for consultation with families, and involvement where appropriate, and the decision is allowed to be made by the clinician, himself or herself. It is very important to remember that they are the experts in this case. If in deciding to consult the family, we are then very rigid and prescriptive about what must follow, in some instances clinicians might sadly decide that it is all too hard and not consult the family, when in fact it might well be the best course of action. For MPs who are not faced with the consequences and the troubles that many people face on this daily basis, that would be totally inappropriate. We also discussed the Privacy Act at length in our caucus. This Act is often used inappropriately, it is often used misleadingly, and it is often used as a tool sometimes to prevent information from being passed on. Although that is the case, it would be inappropriate for us to cast that situation and impose a change in the law in the Mental Health (Compulsory Assessment and Treatment) Act as it stands at the moment. The issue there would be that we should deal with the Privacy Act and the implications it might have on certain situations, this one being amongst them.

In summary, the ACT Party will be voting four in opposition to this bill, and one in favour. The four members who will be opposing it feel that in practical terms nothing is likely to change with this legislation. Nobody is precluded from consulting families at the moment—good clinicians already do so. Sadly we fear that the unintended consequences that may result from the bill may see clinicians less likely to consult families, rather than more. Thank you.

KEVIN HAGUE (Green) Link to this

Talofa lava to my friend and colleague the Hon Luamanuvao Winnie Laban. I congratulate her on bringing the Mental Health (Compulsory Assessment and Treatment) Amendment Bill to Parliament.

The Green Party will support this bill going to the Health Committee. We are a party that bases all of our policies on a charter. One of the principles of that charter is ecological wisdom. When we think of ecology we think, of course, about the natural environment and the connections between all of the species and the elements of the natural world. But the idea of ecology and ecological wisdom transcends that. It says, effectively, that everything is connected to everything else. That is the truth, whether we are talking about the relationships between people and their environment, or different aspects of a person’s health.

In the health sector in New Zealand for quite some considerable time we have worked to a holistic model of health. It is perhaps best encapsulated by Professor Mason Durie with his whare tapawhā model. It talks about four interrelated dimensions of health: tinana, hinengaro, wairua, and whānau. Effectively, the model is saying each of those dimensions of a person’s health is intimately related to each of the others, and no person can be healthy without all of them being in harmony. That means that a person’s family or whānau relationships impact on their mental health and their emotional health, hinengaro. But it also works the other way, in that a person’s mental health or emotional health impacts on the relations that they have with their family or whānau. This bill addresses that point directly. I am pleased that even those members in the House who have so far indicated that they will be voting against the bill—I am saddened to hear that, and I will talk about it in a moment—understand and appreciate the importance of that connection.

I refer briefly to a couple of the core documents. First of all is the second New Zealand mental health plan, Te Tāhuhu, which sets out some of the objectives of the plan in relation to family and whānau: “The importance of family and whanau is recognised in the development of an outcome statement for whanau and friends who support people with, and who are affected by mental illness”. There is “Increased recognition that service users live in whanau and communities and that mental illness and addiction impacts on whanau” and there is the “Inclusion of family/whanau in treatment”. Those are some of the objectives of our mental health services plan. Two goals amongst the five of the Mental Health Commission are to “reduce stigma and discrimination involving people and their families experiencing mental illnesses and/or addictions”, and to “help families to support members who have experience of mental illness and/or addictions in ways that promote their recovery and sustain family life”. All through the documents setting out our plan for mental health, we acknowledge the role of families and whānau and we look to support it. Most important, Platform, which is a coalition of non-governmental organisations in mental health, talks about mental health and addiction problems also affecting families and whānau, who must be considered part of any journey to recovery.

There is widespread recognition of the importance of family and whānau, both in creating a person’s mental health and also in the recovery from mental illness. So why are we here debating this bill if Dr Paul Hutchison is correct and the existing law already sets out a platform for that to occur? The reason we are here today debating this bill is that it is not occurring. Any member of this House who has had any dealings with mental health services will be familiar with countless examples where a person’s recovery from mental illness would have been assisted by the involvement of their family and whānau, but that has not occurred, for spurious reasons. Dr Hutchison has been present on the select committee when we have heard that very evidence. Sure, the concerns raised by Dr Hutchison and Heather Roy are appropriate to be debated, but the appropriate place to do that is in the select committee, and that is why this bill should go forward.

HONE HARAWIRA (Māori Party—Te Tai Tokerau) Link to this

Tēnā koe, Mr Assistant Speaker. Hoi nō e mihi ana au ki te kaikōrero kātahi anō kua mutu mai i te Rōpū Kākāriki, e kōrerohia i ngā kōrero mō te tangata, tōna wairua, tōna hinengaro, tōna tinana, me tōna whānau. Nō reira, tēnā koe e te rangatira e mutu nei i tēnā kōrero.

[Greetings to you, Mr Assistant Speaker. I want to acknowledge the speaker from the Green Party who has just concluded, for the references he made in his speech to a person’s spirituality, mentality, body, and family. So I acknowledge him for that comment.]

Last week, at a hui on Māori mental health up in Whangarei, Te Rau Hinengaro: The New Zealand Mental Health Survey was released. It found that one in three Māori suffer from mental disorders during his or her lifetime, with anxiety, mood, and substance disorders being the main ones. To nobody’s great surprise, those mental disorders are more common for Māori, and particularly for Māori on low incomes and living in poor neighbourhoods. Again, to no one’s great surprise, only half of those Māori with a serious disorder get the treatment that non-Māori get.

We know from our own family histories that poor information and a lack of involvement from whānau lead to breakdowns in relationships and situations of distress, and that can led to devastating results—for example, our young Māori aged 15 to 24 are twice as likely to die by suicide than non-Māori. That is why the Māori Party will be supporting the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. It will allow people to have access to information about the treatment that one of their whānau may be getting, to be involved in the decision making about the treatment, to be fully involved in the planning of care, to be informed about the possible side effects of treatment, and to be consulted about discharge plans. We know that whānau support during treatment leads to better outcomes for tangata whaiora and better outcomes for the whānau, and we sincerely hope that this bill will properly recognise the importance and significance of whānau support to the person, his or her family, and the wider community.

This bill is about best practice, and it is about taking collective responsibility for the health and well-being of our own. This bill is about whānau ora, and for that reason we are proud to stand alongside the Hon Luamanuvao Winnie Laban in supporting this bill. Kia ora tātou.

Hon Sir ROGER DOUGLAS (ACT) Link to this

I rise to support the Mental Health (Compulsory Assessment and Treatment) Amendment Bill being referred to a select committee. I do so not because I necessarily support all the detail of the bill; rather, I support the right of the patient—or, in this case, the right of the close relative—to know, except in the most exceptional circumstances. This, I believe, is a fundamental right and it needs to be widely debated. I think that it needs to be debated not just within the mental health area but within the total health system.

The fact is that important information is persistently withheld and concealed in the New Zealand medical market place. Why is this? The answer is simple. In the medical market place, people soon discover that it is in their own self-interest to withhold information. Why is this? It is because they do not view patients as the principal buyers of health care. Their principal customers are hospitals, physicians, Governments, and third-party institutions such as insurance companies, so they tend to serve them rather than serve the patients.

There is another reason why patients frequently do not have access to information on the quality of providers. Medical associations, physicians, hospitals, and Governments have made it difficult for patients to get information about quality. Avoiding quality comparisons has become almost a matter of professional ethics, as we saw at Wanganui Hospital. Doctors are reluctant to openly criticise the judgment of their colleagues, yet the price an individual pays for a wrong choice is much, much higher in respect of medical services. That information, including mental health information, is the key to avoiding these circumstances. We have to look only at this article in the Listener to understand the cost of these sorts of errors.

The most important conclusion that flows from the fact that the medical market place is complex is the necessity to create an institutional environment in which experts find it in their own self-interest to give all of us accurate information and good advice. Information, and how we provide it, is vital. The hope that some of these issues—as they relate not only, I would hope, to mental health but also to the wider health area—can be debated is the reason that I support this bill’s referral to a select committee.

Hon RUTH DYSON (Labour—Port Hills) Link to this

This is a rare occasion, and I do not know who will feel more uncomfortable, Sir Roger or me, because I agree with him, but only on this specific issue of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. I genuinely acknowledge the ACT Party for taking this issue seriously, to the point of splitting a party vote. I just wish that National had taken this bill seriously. This should be one of the issues that are above petty political point-scoring. In fact, Jenny Shipley and Helen Clark were absolute leaders in this area in saying that mental health issues in general, people with mental health challenges, and their families should not be the subjects of point-scoring or media-baiting in Parliament or outside the House. They led a change of attitude in parliamentarians towards people with mental illness. I do not very often pay tribute to Jenny Shipley either, but on this issue she certainly deserves it. I wish National members had done that tonight.

I must say that I found the absolutely patronising tribute from the chair of the Health Committee, Dr Paul Hutchison, totally inappropriate. For someone of Winnie Laban’s standing in this House and in the community to have that sort of absolutely patronising tribute addressed to her during the first reading of this bill was entirely inappropriate. I have been waiting for the Minister who is responsible for mental health issues, Dr Jonathan Coleman, to take a call. I was at a function last year, not long after he was appointed to his ministerial position, and he had heard from Supporting Families in Mental Illness that the existing legislation as written and intended was great, but as delivered was not meeting the needs of families. He heard the plea that the Supporting Families in Mental Illness code of family rights should be put into law. Jonathan Coleman told that gathering that he would back it. Well, here it is. That is what Winnie Laban’s bill is. It is the—[Interruption]

I raise a point of order, Mr Speaker. Jonathan Coleman just called me a liar, and I ask you to ask him to withdraw and apologise.

The ASSISTANT SPEAKER (Eric Roy) Link to this

The member will leave the Chamber.

MICHAEL WOODHOUSE (National) Link to this

Despite that attack on the integrity of members on this side of the House, I will start this call the way I intended, and that is to commend the member Winnie Laban for bringing the Mental Health (Compulsory Assessment and Treatment) Amendment Bill to the House, even though I do not support its passage. I think it reflects the member’s concern about the importance of communication with whānau as an important component of the therapeutic relationship for those who are mentally ill.

Frankly, I think it is an insult to this House for the member Ms Dyson to suggest that simply because the members of this party do not support the bill that that somehow undermines the importance of that relationship. I am sure that concern was precipitated by, or heightened by, the submissions that the Health Committee heard in 2009 on a petition that called for a number of things to happen in mental health. The petition was tabled by a woman whose son had committed suicide, and who was supported by her general practitioner, whose son had also tragically committed suicide. I know the Health Committee was greatly moved by their submissions and listened very carefully to the experts in this area, particularly in respect of communication. We heard from the Privacy Commissioner, the Mental Health Commission, and the Health and Disability Commissioner, among others.

Mr Hague asserts that the reason this bill is necessary is that although members here assert that the existing legislation provides for whānau involvement, the clinicians are not doing so sufficiently to satisfy the expectations and the wishes of the family. I guess there is some basis for that position, based on what we heard in the select committee in relation to this submission. The Mental Health Commission stated in its submission that more often than not, where the lack of communication has been causing families distress it is usually the interpretation of the Privacy Act by the professionals that is the problem. That was backed up by the Privacy Commissioner and the Health and Disability Commissioner, who indicated that our mental health professionals had much greater power to include families and whānau than they were doing.

Let us have a look at the bill as it is worded, because everybody on the other side of the House believes that it would somehow strengthen the family’s right to access to information and communication. Well, it will not. New section (6) in clause 5 goes to the essence of this bill. It states: “Where a practitioner has decided to consult the family or whānau of a proposed patient … the family or whānau is entitled to—” certain things, and it goes on to list those things. However, the prerequisite factor is that the practitioner has to first decide that that is appropriate. Now that is exactly what we have in the existing legislation, so this is a noble but flawed attempt to make changes to involve family. It simply will not change the status quo.

Now I will move to whether it is appropriate to change the status quo. We all have a vested interest in our families. I am sure many members of this House have experienced the stress and trauma of a loved one who has suffered mental illness, and they would not wish that on anybody, but the fact is that there are many dysfunctional situations where it is not appropriate for family or whānau to be involved, and that is because that is the wish of the patient. What this bill would do—even putting aside my criticism about the flawed aspect of it—is to completely undermine the autonomy and the rights of the patient to decide who and how they are involved in their care. For that reason I think there are some serious problems with the New Zealand Bill of Rights Act in this area. I certainly cannot agree with Sir Roger Douglas. The member described that as a reason for supporting the bill. Actually, it is an equal reason for opposing it, because the bill undermines the rights of the individuals. I applaud the member for her concern about the involvement of family and whānau, which, despite Ms Dyson’s tirade, I think we all support. There is nothing patronising about that. But I cannot support this bill in its current form.

Dr RAJEN PRASAD (Labour) Link to this

I also am pleased to take a call in support of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill, and I acknowledge my friend and colleague the Hon Luamanuvao Winnie Laban for her excellent work in gaining support for this bill, for checking it out with lots of important and informed people outside the House, and for talking to us as colleagues and then bringing the bill to the House in this way. I say to Winnie that that is an excellent model for doing this work, and I thank her for that.

There are several reasons why I strongly support this bill, and I urge those who have already made up their minds to think just a little bit more, because many of the problems that Government members are raising are precisely what select committees are for. There is no pretence that this bill has it absolutely right—no bill ever has. A bill’s passage through a select committee, with the help of officials and other submitters, strengthens it before it is brought back to the House, so that is where the bill should go. The fundamental problem that has been identified by this bill remains. Why is it that the people in the know have supported the Hon Winnie Laban in bringing the bill as far as this? They are saying that there is a problem and that it ought to be resolved. This is a wonderful process for doing this, and I urge members to think through this a little bit more and send the bill to the select committee.

There are several reasons why I support this bill. One is that it puts the interests of families right at the centre, and it says more to them in some of the clauses, in terms of the rights that the bill introduces, about getting involved and really engaging in the needs of families and whānau where mental health is concerned. We know from any amount of work that is being done with families that that collective is the most powerful force there is to enable all its members to do well and to be the best that they can be. Consequently, the same applies when mental health issues arise for family members. The best information often comes from family members, and in any case they are required to support this.

So this bill sets about strengthening the ability of families to have information, to participate, and to be the best that they can be. It is inconsistent that we still have some parts of our legislation—and the primary Act that this bill refers to does so as well—that frustrate some families in terms of participating. It certainly puts a lot of power and authority in the hands of the practitioners—the psychiatrists and psychologists. That ought to be balanced out as well; they do not always have it right, as I shall demonstrate. The power that is in the hands of the practitioners ought to be balanced by some of the rights that families have to ask questions, to receive information, and to be there for their family members who require mental health treatment.

This is also a time when a family and family members are most vulnerable. This is when mental health issues emerge, and this is when one needs families more than ever before. What this bill does is find quite a nice balance on a number of levels, in terms of the expertise of psychiatrists, and the needs of family members and of others. It is for those reasons that it ought to be supported.

Perhaps the most powerful evidence that I can find for supporting what this bill is trying to do is what the 2007 report of the Confidential Forum for Former In-Patients of Psychiatric Hospitals reported, and some members may recall that this forum was chaired by the present Governor-General. Many family members presented at those private forums, and it is what they said that was most important. These are the risks that even now we need to prevent, and clearly a select committee should look at this bill again from that perspective. I will quote from what family members told the confidential forum. Members will recall that this is about what their family members who had been in psychiatric hospitals had—

Hon LUAMANUVAO WINNIE LABAN (Labour—Mana) Link to this

I thank members for their expressions of support for the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. First, I would like to respond to the comments of Dr Paul Hutchison, Michael Woodhouse, and Heather Roy about involving abusive families with their loved ones, and the unintended consequences of that—for example, breach of privacy. Let me quote directly from the Mental Health (Compulsory Assessment and Treatment) Act. Section 7A(2) of that Act states: “A practitioner must consult the family or whanau of the proposed patient or patient. This subsection is subject to subsection (3).” Subsection (3) states: “Subsection (2) does not apply if the practitioner has reasonable grounds for deciding that consultation—(a) is not reasonably practicable; or (b) is not in the best interests of the proposed patient or patient.” This bill does not change the existing legislation whereby a psychiatrist is not required to consult the family or whānau. It is the responsible clinician or psychiatrist who ultimately decides whether family intervention is appropriate.

I also mention that this bill is about strengthening and clarifying family inclusion. The Attorney-General gave his legal opinion, which was that the bill does not contravene the New Zealand Bill of Rights Act. The Privacy Commissioner supports the goal of this bill to equip families with the tools that they need in order to look after their loved ones.

I express deep appreciation to the deputy chairperson of the Health Committee, the Hon Ruth Dyson, for her wise counsel and support. I thank the Hon Tariana Turia and Hone Harawira for the support of the Māori Party for this bill. I thank Kevin Hague from the Greens in terms of tinana, hinengaro, and wairua. I say thank you very much to Sir Roger Douglas. I really appreciate his willingness to meet with me and to challenge me, and I appreciate his commitment to family inclusion and, more important, to there being access to information in the health sector across the board. I acknowledge all the organisations, including Atareira and Supporting Families in Mental Illness, and all the beautiful families who are caring for loved ones with mental illness and watching this debate on television around the country. It is their stories and experiences that have motivated this bill, our bill.

In conclusion, I say this is simple legislation with an important purpose, which is to strengthen and clarify the current legislation. The 1992 Act made limited provision for the involvement of families. This bill clarifies, extends, and strengthens the role of the families of patients who are experiencing mental illness, by amending section 7A of the Act. The point of these changes is, first and foremost, to clarify the rights and responsibilities of the family and whānau in relation to their family member who is being cared for under the Act. I would really appreciate the support of the House for this bill to go to the select committee. It is a democratic process. It will enable input from families, consumers, providers, and psychiatrists. It is my hope that this bill will go a long way towards addressing the need for greater family inclusion—forget about the rhetoric—in the caring for and recovery of mental health patients, our loved ones, by fixing a gap in the current legislation. I commend this bill to the House.