Swarbrick ChlöeCHLÖE SWARBRICK (Green—Auckland Central): I think that all of us in this House would agree that at the very least the most basic thing that the mental health system can do is not cause more harm to the people who go through it. But perhaps the greatest irony of the original legislation which we are amending tonight as it passes I believe by consensus through the House is that whilst the mental health Act which we so colloquially refer to it as was actually the first part of New Zealand's health sector to legislate for patient rights it in fact has been found by a huge number of inquiries investigations reports and otherwise to undermine exactly those rights. In fact it's since been weaponised in way that has literally seen the United Nations Committee Against Torture—against torture—express concern at our country's practice which I'll get to in a minute.So what we regularly call the mental health Act is actually this law which outlines how and when we can detain people who are experiencing mental distress. So how does that happen? Well the Mental Health (Compulsory Assessment and Treatment) Act 1992—which I note Dr Shane Reti mentioned is substantially an outdated piece of legislation—describes itself as An Act to redefine the circumstances in which and the conditions under which persons may be subjected to compulsory psychiatric assessment and treatment" The Act then goes on to define—fast forward a bit—that mental disorder occurs when someone "(a) poses a serious danger to the health or safety of that person or of others; or (b) seriously diminishes the capacity of that person to take care of himself or herself;—and mentally disordered in relation to any such person has a corresponding meaning."The amendment that we are debating tonight doesn't do the full hog which is outlined in He Ara Oranga the report of the mental health and addiction inquiry. There were 40 recommendations inherent in that. And I also note that the supporting documentation that the Minister has tabled in the House today stipulates that this is one step towards a broader overall of the mental health Act which is so fundamentally necessary if we are going to get anywhere near towards a human rights - centred approach as was outlined as necessary in He Ara Oranga. What the Act presently allows and what this amendment seeks to change is that people declared as having this defined mental disorder—namely a danger to themselves or others or a diminished capacity to take care of themselves—are then legally allowed to be detained against their will and as other speakers have mentioned medicated against their will. Importantly however there is currently inside that Act no specific definition of what "capacity" means which leaves it open to interpretation and therefore as we've seen in that multiplicity of reviews to abuse.He Ara Oranga the 2018 mental health and addiction inquiry is often heralded in this place and the news media as kind of the first of its kind but if you dig a little deeper particularly into the reporting of the likes of Jess McAllen what you'll find is that it was not. There have been at least two other Government-triggered inquiries into the mental health system in the past few decades and historically those inquiries have been triggered by violence and substantive amounts of trauma.The 1988 Mason psychiatric report otherwise known as the Gallen inquiry was noted as being into "procedures used in certain psychiatric hospitals in relation to admission discharge or release on leave of certain classes of patients." Judge Mason importantly in this 1988 report noted the need for bicultural services particularly to serve Māori because the Western model—he noted at that point in time; the 1980s—did not acknowledge the breadth of hauora of culture of identity and the importance of recognising where somebody comes from their environment and who they are as to how they behave in the world.There was then a 1996 inquiry again by Mason—this time into "section 47 of the Health and Disability Services Act 1993 in respect of certain mental health services." These two inquiries essentially failed in the respect that they sought to pathologise and medicalise individuals who were going through the mental health system. They were quite narrow in that respect. They only looked at people who were already in the system and how that system was serving them based on preconceived notions of how it should be.But what He Ara Oranga did with groundbreaking terms of reference was it sought to recognise that people are part of society and in fact life experiences may cause may trigger may mitigate or may aggravate the expression of mental ill health and it showcased a need to move away from that pathologising and arguably dehumanising model. It also importantly explicitly for the first time referenced addiction particularly as a method of escapism away from some of the issues that people may be experiencing. As I noted there's a whole lot to unpack in the mental health and addiction inquiry. There were 40 recommendations. The Government accepted 38 of them on principle. Recommendation 34 is for the mental health Act as we colloquially bandy it about as to be entirely repealed and replaced. This amendment tonight does not do that but it does do the interim job of stripping away some of the most damaging and damning practices inside of our mental health system.Importantly actually under the 1992 Act family are required to be consulted before compulsory assessment and treatment but in He Ara Oranga the mental health and addiction inquiry it was reported this only happens 61 percent of the time—another massive failing. And as has been noted by other speakers this isn't a small thing. Around 10000 people are subjected to compulsory assessment and treatment every year and whilst not all seclusion is compulsory assessment and treatment and vice versa Māori are five times more likely in our mental health system to be subject to seclusion.Page 33 of He Ora Oranga makes this discrimination and the flow-on effects of it crystal clear in terms of its ramifications for those who may be seeking to access mental health treatment and it does so in this quote by a kaimahi Māori who said "whānau are fearful of our ministries fearful of mental health fearful of Oranga Tamariki taking their children fearful of police who take away their dads. Whānau are on the back foot before anything has happened just because they are Māori."In trying to unpack just how bad this problem is I think it's important to outline just how successive Governments have failed when it comes to this issue of these treatment orders. It was in 2015 when the UN Committee Against Torture expressed concern about the enormous amount of times comparatively that New Zealand was using this practice which led in April 2017 to the UN Office of the High Commissioner for Human Rights funding a report delivered by our Human Rights Commission which found that there was definitely oversight needed because there was an overreliance on goodwill for this "inherently degrading practice"—that's a quote from the report—and there was a high use particularly in prisons and you guessed it particularly towards Māori.Then in 2009 to around 2015-16 there was a reduction in the number of people who ended up being secluded but around 2015-16 that number jumped back up again by 6 percent. In May 2017 in response the then National Government actually created a national mental health quality improvement plan which was provided with $7.5 million to get as close to zero in the use of seclusion by the year 2020. That was last year and in fact what we've seen with data released last week is that there's been an uptick of 10 percent in seclusion in 2018 and a 9 percent increase in 2019. That's no small number because per 1000 beds we went from 6.9 in 2008 to 11.4 in 2019. There is so much more to do but this is an incredibly important piece of that puzzle."