Submissions

To: Health Select Committee
Date: December 2024

Purpose

This submission’s primary purpose is to support the Bill's paradigm shift towards a human rights focus for tangata whaiora mental health, while simultaneously advocating for crucial amendments to ensure full compliance with New Zealand's obligations under the UN Convention on the Rights of Persons with Disabilities (UNCRPD). DPA aims to address concerns regarding involuntary treatment, coercive practices, institutionalization, and the protection of legal capacity for individuals experiencing mental distress.

Summary of DPA submission

DPA recognises the Mental Health Bill 2024 significant paradigm shift towards a human rights focus for tangata whaiora mental health. However, DPA advocates for the Bill to be passed with amendments to ensure it fully complies with New Zealand's obligations under the UN Convention on the Rights of Persons with Disabilities (UNCRPD).

A key concern is that certain clauses, despite the human rights focus, still uphold the ability of mental health services to compulsorily treat individuals as a primary option, rather than as a last resort, which DPA views as undermining the Bill's intent.

DPA highlights the pervasive stigma and prejudice faced by tangata whaiora, which creates discrimination and barriers to accessing necessary healthcare. DPA stresses the importance of tackling these attitudinal barriers to fully uphold the human rights of people with psychosocial disability/mental distress during treatment.

DPA also welcomes the inclusion of a Treaty of Waitangi clause, acknowledging the historical abuse and mistreatment of tamariki Māori, which has profoundly impacted mental health across generations.

A significant area of concern for DPA is the Bill's provisions for involuntary treatment and hospitalization. DPA argues that if retained as written, these clauses would violate UNCRPD Articles 12 (equal recognition before the law) and 14 (liberty and security). DPA recommends strengthening provisions emphasizing autonomy and self-determination, so that involuntary treatment is only permitted in "the most exceptional cases," with appropriate judicial oversight and the availability of community-based care alternatives. Furthermore, DPA is "extremely concerned" about the retention of coercive or restrictive practices (e.g., restraint, seclusion, forced medication), deeming them cruel, inhuman, or degrading treatment that exacerbates psychological distress and violates Article 15. DPA recommends prohibiting these as routine practices and incorporating strong safeguards against coercion.

DPA also critiques the Bill's continued promotion of involuntary treatment in institutional settings, emphasizing UNCRPD Article 19 (right to live independently and be included in the community) and Article 25 (right to health care without discrimination). DPA urges a shift from institutional care to community-based services and the integration of peer support and alternative therapeutic approaches. DPA advocates for revising decision-making provisions to support individuals in making their own choices rather than appointing substitute decision-makers, in line with the right to legal capacity under Article 12. Additionally, DPA recommends tightening clauses on administering electroconvulsive therapy (ECT) to children and young people, requiring stricter criteria and informed consent from the patient, even if under a compulsory treatment order.

Key Recommendation/Finding:

DPA recommends that provisions emphasizing autonomy and self-determination are strengthened meaning that involuntary treatment would only be permitted in the most exceptional cases, with appropriate judicial oversight and alternatives to hospitalisation, such as community-based care, being available.

Supporting Statement 1:

"The draft bill still allows for the involuntary hospitalisation and treatment of individuals with mental health conditions. If these clauses are retained as written, they will be in violation of UNCRPD Articles 12 (equal recognition before the law) and 14 (liberty and security)."

Supporting Statement 2:

"DPA is extremely concerned about the potential use of coercive or restrictive practices (e.g., restraint, seclusion, forced medication) which are retained within the current bill. These practices amount to cruel, inhuman, or degrading treatment, violating Article 15 (freedom from torture or cruel, inhumane, or degrading treatment or punishment)."