Reti ShaneDr SHANE RETI (Deputy Leader—National): Thank you Madam Speaker. It's a pleasure to support this bill which looks to amend the Mental Health (Compulsory Assessment and Treatment) Act which is actually quite old. There are several things this bill looks to do but I particularly would also like to talk to eliminating the indefinite treatment orders and actually speak just a little bit further about how one gets to be in the position where you have a compulsory treatment order (CTO) and then what we're trying to fix. Now the law recognises that people who have a mental health issue may not be competent to decide what is best for them and so compulsory treatment orders and involuntary orders are mechanisms to help people receive that attention. What's required here is it requires someone who's concerned about a person's wellbeing to make an application. The person needs to be over 18 and then that person can be assessed by a director of Area Mental Health Services. Just to be very clear of the nature of an illness that a person must have first of all they have to have a serious mental disorder characterised by delusions or by disorders of mood or perception or volition or cognition. So you know it's quite serious mental health. Secondly they need to pose a serious danger to the health or safety of themselves or others or have a seriously diminished capacity for self-care. Interestingly there also needs to be services available before a compulsory treatment order can be entertained. The responsible clinician can transfer a patient to a compulsory treatment order from an involuntary inpatient order or a CTO can be made by a judge. To get some scope as to how many people are involved in compulsory treatment orders we know that roughly 10000 people a year are subject to the mental health Act and that at any one time 102 people per 100000 are receiving compulsory treatment. I think what I found particularly interesting—I've delved into this in preparation for making this contribution—in the rates of compulsory treatment orders is the regional variation across the country more specifically by DHB and how we explain that. So as I look across all DHBs—and I'll break it down in a moment for Māori and non-Māori—there's quite a lot of regional variation per 100000 population for the number of compulsory treatment orders. The highest number of compulsory treatment orders per capita is actually Northland which surprises me a little bit. The least is South Canterbury and Wairarapa. So you'd have to sort of say Well how do we explain that?" How do we explain such a high incidence of CTOs in Northland—almost three times the lowest amount anywhere else in the country? If we then look at it for Māori and non-Māori there's roughly a threefold—or it's a multiplier of three—increase in Māori who receive compulsory treatment orders versus non-Māori. Again if we look across the country it turns out Waikato has the highest—again that average of three—at 3.91. Then I want to go to not the second but to the third and fourth—we might be able to explain that. Counties Manukau and then Auckland have the highest rate of Māori versus non-Māori—so again over three times. So Māori are much more out of proportion than others. But it's the second one that I'm interested in that I can't quite explain and that is Wairarapa. Now Wairarapa has the second highest incidence of Māori versus non-Māori of CTOs. I can't explain that. It's not what I would have thought intuitively from what I know of the demographics of that DHB my point here being that there's some story around compulsory treatment orders that vary region by region that gives us the opportunity with this bill to be nuanced to be more fine-tuned and to reduce those disparities. I'm not the only one pointing that out; there are a number of others. I will read here from a learned journal: "The numbers of compulsory treatment orders vary across the country. The fact that some regions show relatively low rates suggests scope exists to reduce the overall use of compulsory treatment [orders]." I look here in the last year at South Canterbury—South Canterbury is a well-performing DHB at the moment—with a total of 96 compulsory treatment orders per 100000 and then I look at Northland at 284 and so how do we explain that? The sum of it—that is probably Māori and again how do we explain that? How could we have three times more compulsory treatment orders per capita in Northland than in South Canterbury? I think that needs an explanation. I think there'll be that opportunity in select committee to delve deeper into these figures both total comparisons across the country and Māori versus non-Māori across the country DHB on DHB and make some of these changes—and we are—to that indefinite time period for compulsory treatment orders. I think it will give us the opportunity to have that really rich discussion to understand it figure it out and figure out what the interventions are. So we're in support of this bill and very much looking forward to the select committee particularly to officials who'll have more fine-tuned information—although this arrived as a written parliamentary question 30 minutes ago so it is kind of contemporary although they make the point that they're three months out from reporting the last year but this would seem to be the latest data and it's got some queries in it even here and now. So we are supporting this bill and very much looking forward to taking it to select committee and seeing how we can do a better job. Thank you."