New Mental Health Bill - are we there yet?

In this article Sonya Russell, Director Mental Health and Addiction Sector Leadership, outlines progress by Parliament to repeal and replace the Mental Health (Compulsory Assessment and Treatment) Act 1992. 

With its 17 April report on the Mental Health Bill, the Health Select Committee has now passed the Bill back to Parliament to be finalised. This marks another significant step in Aotearoa New Zealand’s process to repeal and replace the Mental Health Act 1992. However, there are no wholesale changes to the Bill recommended in the report, despite many submitters stating that the Bill does not go far enough to meet its policy aims.

In preparing its report, the Committee considered 358 submissions and heard oral evidence from 89 submitters (read them on the Mental Health Bill page on the Parliament website). Following discussion, debate and advice, the Committee – representing all parties in Parliament – agreed on recommendations for amendments to the Bill.

The Select Committee has recommended some changes that strengthen the proposed legislation. Recommended improvements include that ‘advance directives’ and acknowledgement of the ‘dignity of risk’ are added to the guiding principles.

We acknowledge the Committee’s work to achieve agreement on the proposed changes. Their efforts and engagement with complex issues in mental health law and practice, weighing up different perspectives and values, are a sign of democracy at work.

At the same time, significant issues remain unresolved and hinder the Bill’s aims. The Committee report notes differing views on complex issues such as the use of seclusion in hospitals and retaining the use of compulsory orders in the community. The existing Mental Health Act will be replaced, but have we done enough to embed policy in law that will enable best practice consistent with modern human rights?

In our view, the Committee’s proposed amendments, particularly those regarding seclusion and compulsory community care orders do not go far enough.

This view is supported by the evidence, research, and advice provided by hundreds of individuals, organisations, experts and communities. A rich body of knowledge, and a source of ideas for ways to reduce and eventually eliminate the use of coercive practices in mental health services, is now available under ‘related resources’ on Parliament’s website, for all to draw on.

It is vitally important we continue to learn from people with first-hand experience of the Mental Health Act 1992. Their insights, ideas and approaches have potential to move us forward on pathways that are rights-based and offer safe alternatives to the use of coercive practices – they can guide both the development of the Bill, and the policies and practices that will see it implemented.

Following the next stage of the Bill’s development – the ‘second reading’ where Parliament debates the Bill considering the select committee’s report – it will then be open to amendments from any member of Parliament in a process known as the Committee of the Whole House.

We would like to see the Bill go further to uphold people’s human rights and freedom of choice and reduce the use of coercive practices. We would welcome consideration of alternative approaches to support people’s voluntary engagement with services in the community. The Committee’s report refers to a proposal to replace compulsory community treatment orders with community support commitments.

As recommended in our submission, we would still like to see a sunset clause to achieve an end to seclusion. To make this shift it’s important to understand what is standing in the way of committing to a fixed end date. It’s also important to learn from services who have successfully achieved lower rates of seclusion and compulsory treatment orders and share insights to shift practice.

Upholding rights and agency of people who need mental health support requires deeper consideration of these ideas and ways to apply them in practice. A modern Mental Health Act, to the greatest extent possible, must reduce coercive practices. We are not there yet.

Read the Commission's submission on the Mental Health Bill (PDF, 284 KB)

This commentary was first published by Horizon magazine