Laban Luamanuvao Winnie: Mental Health (Compulsory Assessment and Treatment) Amendment Bill — First Reading 
Laban Luamanuvao Winnie: Mental Health (Compulsory Assessment and Treatment) Amendment Bill — First Reading 
[Volume:661;Page:9585] 
Hon LUAMANUVAO WINNIE LABAN (Labour—Mana) 
: 
 I move  
That the Mental Health (Compulsory Assessment and Treatment) Amendment Bill be now read a first time. 
 At the appropriate time I intend to move that the bill be referred to the Health Committee for consideration. 
Kia ora talofa lava and warm Pacific greetings. It is my great pleasure to bring this bill to the attention of the House. The purpose of this bill is to strengthen and clarify the current legislation. In the 17 years since the Mental Health (Compulsory Assessment and Treatment) Act of 1992 was passed the understanding treatment and care of mental health patients have developed and improved. However the law has stood still. This bill will address what is seen by many in the field as a gap in the current legislation. The gap relates to the role of families. The 1992 Act made limited provision for the involvement of families. This bill extends and strengthens the role of families of patients experiencing mental illness. 
Dr Peter McGeorge a psychiatrist and chair of the Mental Health Commission summed up the issues this bill addresses when he wrote a booklet entitled  
The legal framework for family inclusion in child adolescent and youth mental health and addiction services.  
He wrote: “Everyone knows that families are important. However understanding their importance in the recovery of family members who have experienced mental illness is only relatively recent.” 
Dr McGeorge went on to say that the Mental Health Commission is concerned to see that families are included in the mental health assessment and treatment processes of family members. This is because the commission knows not only that families can be of enormous assistance but that families suffer along with their loved ones. Dr McGeorge’s views are echoed by other mental health service providers support and consumer groups and families who have loved ones in mental health care. 
During my preparation of this legislation I read and consulted widely. I met with Dr Peter McGeorge and other psychiatrists Dr Jan Pryor the Chief Families Commissioner; staff and legal advisers of the Office of the Health and Disability Commissioner; Florence Leota chief executive officer of Supporting Families in Mental Illness New Zealand; Taone O’Regan manager and members of Atareira—formerly the Schizophrenia Fellowship—which provides mental health support for families and whanau; and many others working in the mental health field. I have also listened to many consumers and many families who have had family members in mental health care. There is wide approval from those people for this bill. 
Let me now outline the specifics of the Mental Health (Compulsory Assessment and Treatment) Amendment Bill. The bill amends section 7A of the Mental Health (Compulsory Assessment and Treatment) Act 1992. Section 7A of the Act provides for family or whanau involvement with individuals who have been dealt with under the Act. Currently the practitioner usually a psychiatrist or a responsible clinician must consult the whanau or family of the proposed patient or patients unless it is not reasonably practicable or it is not after consultation with the patient deemed to be in the best interests of the patient. The practitioner must also apply any guidelines or standards set down by the Director-General of Health. 
This bill adds two further subsections to section 7A. The first new subsection subsection (6) seeks to clarify the entitlements of the family or whanau once the practitioner has decided to consult them. These entitlements include information about the particular illness in question; information about the likely effects of treatment; inclusion in the planning implementation and review of care; consultation about discharge; and the right to seek a second opinion. 
The second new subsection subsection (7) provides for inclusion of the family of whanau to a certain degree whether or not the practitioner has made the decision to include the family. This provision means that the family or whanau is entitled to have general information about mental illness and the ability to provide relevant information about the family member’s history and it reinforces what other parts of the Act have already stipulated including cultural religious or ethnic factors and individuals’ beliefs about the role of family or whanau. 
The point of these changes first and foremost is to clarify the rights and responsibilities of families and whanau in relation to their family member being cared for under the Act. The legal advice received from the Ministry of Justice courtesy of the Attorney-General the Hon Chris Finlayson on this bill was to ensure that it was consistent with the New Zealand Bill of Rights Act 1990. It concluded that the bill appears to be consistent with the rights and freedoms affirmed by the New Zealand Bill of Rights Act. We also received correspondence from Marie Shroff the Privacy Commissioner who supports the overall goal of this bill. 
Under the amended legislation families and whanau have specific rights such as the right to information about the care and treatment of their loved one about the specific form of mental illness the person is suffering from and about mental illness in general. With better access to information families and whanau will be better informed about mental illness in general and therefore better able to give support that in many cases will offer opportunities for recovery. 
Families and whanau will also have the right to be involved in all stages of the care of their loved ones including when that care should end. Importantly they also have the right to seek a second opinion. The hope of this bill and these measures is that they will lead to a more informed and empowered family unit that will possess the tools to be more involved in the care of their loved one and more resilient in the face of mental illness. 
The ultimate goal is not just to assist in the recovery of the mental health patient but also in the potentially beneficial side effect of creating more resilient and caring families. Greater involvement by family and whanau in the care of a mental health patient creates a win-win situation for all including the professionals involved. Treatments that include a greater involvement of the patient’s family have been shown to produce superior and stable outcomes and have significantly reduced symptoms and related problems including family problems. 
There is good evidence showing that when a family is involved in assessment and treatment the outcomes are improved for the family member. Family inclusion presents a far more holistic approach to mental health recovery. Far from being focused solely on the individual in the context of care this approach recognises that the needs of the individual experiencing mental illness must be met within the context of the family or whanau. It focuses on the families’ opportunities and abilities for change. Although the focus on the individual rights of a patient is important the value of individuals reconnecting with others and their families in particular is still underemphasised and undervalued. The therapeutic value of this needs to be strengthened in the ordinary routines of clinical practice. 
The Mental Health Commission commissioned a literature review on child and adolescent mental health and family inclusive practices in 2007. The review found that including families aids the therapeutic approach by including an insider’s perspective on care. It creates a better understanding of the problem agreement on treatment components and with fewer internalising and externalising behaviours it improves clinical outcomes and reduces symptoms. These views received strong support when workshopped around the country by the Mental Health Commission. 
The need for a change towards more family-inclusive practices in the care of mental health patients has been known for some time. In  
Te Kokiri: The Mental Health and Addiction Action Plan 2006-2015 
 a Ministry of Health publication two of the specific actions identified related to this area. The plan makes the call to implement initiatives that recognise the importance of family and whanau. It also calls for initiatives that respond to the needs of family and whanau such as assessment and referral to appropriate supports and services education on the recovery process and the hearing of family views about the responsiveness of services. 
On a personal note prior to entering Parliament I worked as a family therapist and counsellor for over 20 years and I served from 1993 to 1996 on the board of the Mental Health Foundation. It was my professional experience that the involvement of family in the treatment of cases where there was mental illness family violence sexual abuse and other difficult and complex issues led to better outcomes than where individual treatment options were undertaken without any family involvement. It was John Donne who wrote: “No man is an island entire of itself; every man is a piece of the continent a part of the main;”. 
I say in conclusion that it is my hope that this bill will go a long way to addressing the need for greater family inclusion in the caring for and recovery of mental health patients by fixing a gap in the current legislation. I commend this bill to the House.