Are mental health nurses meeting the requirements of second health professionals in presenting opinions to the court?
Authors: Muir Rachael , O'Brien Anthony , Butler Helen , Diamond Danielle 
Published: February 2023

Accessible Summary

What is known on the subject?

Mental health legislation is currently under review following recommendations for repeal and replacement.

Through the statutory role of the second health professional, mental health nurses are in a strong position to offer a unique clinical perspective, engagement and advocacy for tangata whaiora (person seeking wellness) and whānau.

Māori are more likely to be subject to a compulsory treatment order than non‐Māori.

Whānau involvement in care is a core element to well‐being from a Te Ao Māori (Māori world view) perspective.

What this paper adds to existing knowledge?

Understanding the level of whānau involvement in the MHA process.

Understanding challenges for nursing practice for consideration in the current review of MHA legislation.

Identification of the opportunity nurses have to contribute to reducing high rates of Māori under CTOs.

What are the implications for practice?

The current MHA review needs to include the resourcing required to support the clinicians practising in statutory roles.

More emphasis is needed to build the cultural knowledge and capability of the nursing workforce to integrate principles of a Te Ao Māori worldview into care delivery.

These learnings highlight the importance of nursing responsibility in the SHP role.

Introduction

Clinical practice within statutory roles is an important issue for the nursing profession. There is increasing involvement of nurses undertaking statutory roles and opportunities for nurses to advocate and offer their unique clinical opinion regarding the need for restrictive measures imposed by mental health act legislation.

Aim

The aim of this study was to analyse whether registered nurses who undertake the role of second health professional (SHP) within New Zealand's Mental Health (Compulsory Assessment and Treatment) Act (1992) (MHA) are meeting the expectations of that role.

Method

A retrospective analysis of 156 cases was undertaken of clinical reports completed by registered nurses. The reports were measured against an established competency framework modified to include MHA expectations for whānau (family) involvement.

Results

From a sample of 156 cases, 22 were identified as reviews of initial orders for assessment and treatment while 134 were opinions related to the application for a compulsory treatment order (CTO). In most cases, reports achieved a good standard. There were limitations in nurses completing the documentation to the required standard, and adaptations were evident in efforts to meet clinical and legal expectations. There was a significant absence of evidence of whānau consultation.

Discussion

Resourcing through education, support and ongoing development are required to ensure that nurses are equipped to meet the expectations of the legislation. There is an opportunity for nurses to influence decision‐making and support the reduction in use of community treatment orders. A review of the existing competency framework is required to include cultural approaches and involvement of whānau.

Implications for Practice

It is important to understand the factors that strengthen nursing practice to improve health outcomes and tangata whaiora and whānau experience. This study uses methods of clinical audit to describe current practice and establish an evidence base to measure change. It also offers important learnings for consideration within MHA legislation review and for nursing workforce development.