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