Post on 01-Apr-2015
National Conference - HDC Advocacy ServiceConsent within the mental health legal frameworkHDC Mental Health Commissioner Update
25h July 2013
Dr Lynne Lane
Overview1. Role MHC at HDC2. Oranga Ngakau (2003, Mental Health Commission)
3. Mental health consumer rights4. Informed consent 5. Advanced directives6. Compulsory treatment7. Summary
Role of HDC Mental Health Commissioner
New role for HDC
• to monitor Mental Health & Addiction Services
• to advocate for systemic improvement
• June 2012 moved to Auckland Office of the Health and
Disability Commissioner (70 staff)
• MHC does not investigate complaints
• Focus on experience of consumers, their families and
whānau
Work Programme 2013-16
Consumers, tangata whaiora, families and
whānau
Foster key relationships
Develop national monitoring
framework with Ministry
Implement HDC monitoring programme
Implement new process of site
visits
Advocacy activities informed by monitoring
Independent advice to
Government and key stakeholders
• MHC Publication 2003
• Advice for service users
• Types of services• Compulsory
treatment• Consumer rights• How to complain
Mental Health Consumer Rights
The ten rights of consumers and the duties of providers.
1: to be treated with respect2: to freedom from discrimination, coercion, harassment,
and exploitation3: to dignity and independence4: to services of an appropriate standard5: to effective communication6: to be fully informed7: to make an informed choice and give informed consent8: to support9: to decide about involvement in teaching or research10: to complain
Oranga Ngakau page 27
Informed consentServices must inform consumer before treatment of:
• [likelihood of] benefits and [risk of] side effects of treatment• Other possible treatments• Active involvement of consumer and family/whanau in treatment decisions• Setting goals for recovery • Share clinical notes• Joint development of relapse planning
Oranga Ngakau page 28
Advanced DirectivesIncluded in the Code of Health and Disability Consumer Rights
• Statement setting out in advance the treatment you want, or don’t want if you are considered unable to give consent
• Must be given serious consideration • May be over-ridden
Oranga Ngakau page 28
The Mental Health (Compulsory Assessment and Treatment) Act
1992 • Enables compulsory assessment and treatment of people
with a mental health disorder (4000 at any one time)• Criteria include being at serious danger to yourself / others• Or seriously diminished capacity to take care of yourself.• Compulsory Assessment Order • Initial assessment, then reassess at day 5 and day 14• Can be treated without consent during this time• Can request a Judge to review the decision at any time• District Inspectors make contact to safeguard rights• Contact MOH for list of DIs
The Mental Health Act 1992 cont..
• Compulsory Treatment Order • At end of assessment period Psychiatrist makes
application to the Court if considered necessary• Inpatient or community based• Initially for a month• May be extended thereafter with a second psychiatrist
opinion for 6 months• May then be indefinite with 6 monthly reviews by
psychiatrist• Mental Health Review Tribunal - can reverse the
compulsory order (140 applications/year)
Oranga Ngakau page 33
Health and Disability Commissioner’s report released on psychiatrist’s use of ketamine to treat depression
• The Health and Disability Commissioner Anthony Hill has today released a report into a psychiatrist's use of ketamine on patients with treatment-resistant depression. Ketamine is only approved in New Zealand for use as an anaesthetic. However, unapproved use of approved medicines is permitted and is referred to as "off-label" use.
• Eleven patients were treated in 2010 and 2011 by the psychiatrist who was employed by a university and held a clinical position with Southern DHB. It was alleged that the treatment was part of the psychiatrist's research agenda and that patients had not given consent to participate in research.
• The Commissioner initiated his investigation after the case was referred to him by the National Health Board. None of the patients have complained about the treatment provided.
• The report concludes that the evidence did not support a finding that research was being undertaken or that the treatment, though uncommon, was experimental. Mr Hill also reports that the patients involved consented to the treatment.
• etc