Holisitic approach needed for Māori mental health, practitioners say

12:00 pm on 14 July 2021

Two leading Māori mental health practitioners want to see major changes to compulsory treatments when the government replaces the Mental Health Act.

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File photo. Photo: RNZ / Richard Tindiller

The He Ara Oranga report of the Mental Health and Addiction Inquiry found New Zealand had extremely high rates of compulsion, including community treatment orders and seclusion, compared with other countries.

And Ministry of Health reporting shows Māori are nearly four times as likely to be subject to a community or inpatient treatment order than non-Māori in Aotearoa.

The government will release a public consultation document later this year to help replace the Mental Health Act - the legislation behind forced treatment.

Dr Diana Kopua (Ngāti Porou), a Fellow of the Royal Australia New Zealand College of Psychiatry, thinks compulsory treatment should be stopped altogether.

"Most people who are on a CTO [compulsory treatment order] are refusing the treatment that they are offered, and what they are assessed as is lacking insight. What we are not considering is institutional racism actually causing a lack of insight for us as practitioners."

She told RNZ that incorporating Māori knowledge systems into education, health and social services in Aotearoa would make a huge difference to Māori with mental health problems.

"I do understand that they refuse to be treated by that person or that service, but there's no choices for those people right now."

Micheal Naera (Te Arawa) has spent 20 years working in mental health in Aotearoa and believes the current legislation does not support whānau to use cultural models of care.

"The legislation excludes kaupapa Māori. Whilst it acknowledges that there is the treaty, what they failed to look at is the implementation of that in practice."

The Mental Health and Addiction directorate has said new legislation must provide measures to minimise compulsory or coercive treatment, recognise the spirit and principles of Te Tiriti o Waitangi, have a human rights-based approach, promote supported decision-making and align with the recovery and wellbeing.

Currently, community treatment orders are the least restrictive form of compulsory treatment and allow people with mental health disorders to remain at home.

University of Otago Psychological Medicine senior lecturer Dr Ben Beaglehole told RNZ there can be advantages.

"Patients are more likely to remain involved with psychiatric services, they're more likely to accept visits from their caseworkers and they're more likely to accept medication."

But they do lose freedoms.

"Although they are living in the community they no longer have the right to refuse their psychiatric treatment, they no longer have the right to refuse visits from a caseworker if they would prefer that that person didn't visit them."

In 2019, 60 percent of community treatment orders in Aotearoa were indefinite, but they are not granted lightly.

Assessments take about a month and include multiple expert opinions and consultation with family before a final decision is made by a judge.

The latest Ministry of Health reporting shows the Northland District Health Board has the highest rate of community treatment orders per capita in the country.

The DHB isn't sure exactly why this is, but it said its numbers were now trending downwards.

The region has some of the country's highest levels of deprivation and the He Ara Oranga report highlighted the link between deprivation and increasing levels of mental distress.

The DHB's clinical director of mental health and addictions, Margaret Aimer, said the orders were only used when staff were really worried about someone.

"It's not our default go-to position - being under the Mental Health Act. We've got about 3,500 people that we are seeing in any one day on our caseload but only a bit under 300 of those are on community treatment orders."

She said there were strict criteria, and the person had to have a mental health disorder diagnosis and be a serious risk to themselves or others and showing self-neglect.

The orders have to be reviewed within certain timeframes, over weeks and then months.

"What we are working on is to ensure that those conversations between the clinicians, the health professionals and the person under the Mental Health Act and their whānau are good discussions, they're robust, [and] there's a really good sharing of information."