1. National Conference - HDC Advocacy Service Consent within the mental health legal framework HDC Mental Health Commissioner Update 25 h July 2013 Dr Lynne Lane

2. Overview 1.Role MHC at HDC 2.Oranga Ngakau (2003, Mental Health Commission) 3.Mental health consumer rights 4.Informed consent 5.Advanced directives 6.Compulsory treatment 7.Summary

3. 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

4. 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

5. MHC Publication 2003 Advice for service users Types of services Compulsory treatment Consumer rights How to complain

6. Mental Health Consumer Rights The ten rights of consumers and the duties of providers. 1: to be treated with respect 2: to freedom from discrimination, coercion, harassment, and exploitation 3: to dignity and independence 4: to services of an appropriate standard 5: to effective communication 6: to be fully informed 7: to make an informed choice and give informed consent 8: to support 9: to decide about involvement in teaching or research 10: to complain Oranga Ngakau page 27

7. Informed consent Services 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

8. Advanced Directives Included 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

9. 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

10. The Mental Health Act 1992 cont.. Compulsory Treatment Order At end of assessment period Psychiatrist makes application to the Courtif 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

11. 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