Towards Changing Compulsory Community Mental Health Treatment in New Zealand: Shining Light on How Community Treatment Orders Are Produced

In this paper, we use a constructed scenario to illustrate making a compulsory community treatment order in the New Zealand context. Drawing on publicly available documentation, we outline the existing mental health law framework that produces community treatment orders and emerging complex problems of their high, increasing and disproportionate use. We provide examples of human rights, indigenous and clinical effectiveness research that appear to be destabilising the existing mental health law framework. We argue assemblage theory (Deleuze & Guattari) is a useful theoretical tool to unpack the making and continued use of compulsory community treatment orders in the context of complex destabilising and stabilising influences. This is followed by an outline of the concept of assemblage with reference to the constructed scenario, focusing on processes, practices, places, types of knowledge, roles, documents and how they connect to produce certain effects that both enable and constrain participants’ actions. In the New Zealand context, we examine the potential for assemblage theory to generate new ways of thinking about compulsory mental health treatment in community settings by challenging perceived limitations and revealing opportunities for participants to act otherwise. We conclude with a proposal for further research shaped by this theory that explores the making of actual community treatment orders to reveal where there is potential to change existing relations towards more positive effects for participants.

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Community treatment orders are (somewhat) effective: Their future in the context of rights-based mental health law

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867418791300 ◽

2018 ◽

Vol 53 (1) ◽

pp. 11-12 ◽

Cited By ~ 3

Author(s):

Christopher James Ryan

Keyword(s):

Mental Health ◽

Community Treatment ◽

Health Law ◽

Community Treatment Orders ◽

Mental Health Law

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Child Psychiatry Perspectives: Response to the “Mental Health Treatment for Minors” Section of the Mental Health Law Project

Journal of the American Academy of Child Psychiatry ◽

10.1016/s0002-7138(09)62217-2 ◽

1979 ◽

Vol 18 (4) ◽

pp. 696-698

Keyword(s):

Mental Health ◽

Child Psychiatry ◽

Mental Health Treatment ◽

Health Law ◽

Health Treatment ◽

Mental Health Law

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7. Mental Health Law

Medical Law ◽

10.1093/he/9780198825845.003.0007 ◽

2019 ◽

pp. 351-419

Author(s):

Emily Jackson

Keyword(s):

Mental Health ◽

Community Treatment ◽

Health Law ◽

Persons With Disabilities ◽

Mental Health Law ◽

Mental Health Act ◽

Independent Review ◽

History Of ◽

Human Rights Act ◽

The Uk

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. This chapter discusses mental health law in the UK. It begins with a brief history of mental health law and policy. This is followed by discussions of: admission to the mental health system; treatment of the mentally ill under the Mental Health Act 1983; Deprivation of Liberty Safeguards (DoLS) and Cheshire West, and Community Treatment Orders. It also looks at the implications of the Human Rights Act and the UN Convention on the Rights of Persons with Disabilities (UNCRPD) for mental health law. It also considers the conclusions of the Independent Review of the Mental Health Act 1983.

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Does Having a Chronic Physical Condition Affect the Likelihood of Treatment Seeking for a Mental Health Problem and Does This Vary by Ethnicity?

The International Journal of Psychiatry in Medicine ◽

10.2190/pm.42.4.f ◽

2011 ◽

Vol 42 (4) ◽

pp. 421-436 ◽

Cited By ~ 3

Author(s):

K. M. Scott ◽

J. Kokaua ◽

J. Baxter

Keyword(s):

Mental Health ◽

New Zealand ◽

Mental Disorders ◽

Physical Condition ◽

Mental Health Treatment ◽

Treatment Seeking ◽

Health Treatment ◽

Physical Conditions ◽

Ethnic Subgroups ◽

Chronic Physical Conditions

Objective: The comorbidity of mental disorders with chronic physical conditions is known to have important clinical consequences, but it is not known whether mental-physical comorbidity influences mental health treatment seeking. This study investigates whether the presence of a chronic physical condition influences the likelihood of seeking treatment for a mental health problem, and whether that varies among ethnic subgroups in New Zealand. Methods: Analyses were based on a subsample ( n = 7,435) of The New Zealand Mental Health Survey, a nationally representative household survey of adults (response rate 73.3%). Ethnic subgroups (Maori and Pacific peoples) were oversampled. DSM-IV mental disorders were measured face-to-face with the Composite International Diagnostic Interview (CIDI 3.0). Ascertainment of chronic physical conditions was via self-report. Results: In the general population, having a chronic medical condition increased the likelihood of seeking mental health treatment from a general practitioner (OR: 1.58), as did having a chronic pain condition (OR: 2.03). Comorbid chronic medical conditions increased the likelihood of seeking mental health treatment most strongly among Pacific peoples (ORs: 2.86–4.23), despite their being less likely (relative to other ethnic groups) to seek mental health treatment in the absence of physical condition comorbidity. Conclusion: In this first investigation of this topic, this study finds that chronic physical condition comorbidity increases the likelihood of seeking treatment for mental health problems. This provides reassurance to clinicians and health service planners that the difficult clinical problem of mental-physical comorbidity is not further compounded by the comorbidity itself constituting a barrier to mental health treatment seeking.

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A systematic review and meta-analysis of predictors and outcomes of community treatment orders in Australia and New Zealand

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867420954286 ◽

2020 ◽

pp. 000486742095428

Author(s):

Steve Kisely ◽

Dong Yu ◽

Saki Maehashi ◽

Dan Siskind

Keyword(s):

New Zealand ◽

Meta Analysis ◽

Linguistically Diverse ◽

Community Treatment ◽

Culturally And Linguistically Diverse ◽

Community Treatment Orders ◽

Indigenous Status ◽

Compulsory Community Treatment ◽

Treatment Order ◽

Community Treatment Order

Objectives: Australia and New Zealand have some of the highest rates of compulsory community treatment order use worldwide. There are also concerns that people from culturally and linguistically diverse backgrounds may have higher rates of community treatment orders. We therefore assessed the health service, clinical and psychosocial outcomes of compulsory community treatment and explored if culturally and linguistically diverse, indigenous status or other factors predicted community treatment orders. Methods: We searched the following databases from inception to January 2020: PubMed/Medline, Embase, CINAHL and PsycINFO. We included any study conducted in Australia or New Zealand that compared people on community treatment orders for severe mental illness with controls receiving voluntary psychiatric treatment. Two reviewers independently extracted data, assessing study quality using Joanna Briggs Institute scales. Results: A total of 31 publications from 12 studies met inclusion criteria, of which 24 publications could be included in a meta-analysis. Only one was from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be subject to a community treatment order. In addition, those from a culturally and linguistically diverse or migrant background were nearly 40% more likely to be on an order. Indigenous status was not associated with community treatment order use in Australia and there were no New Zealand data. Community treatment orders did not reduce readmission rates or bed-days at 12-month follow-up. There was evidence of increased benefit in the longer-term but only after a minimum of 2 years of use. Finally, people on community treatment orders had a lower mortality rate, possibly related to increased community contacts. Conclusion: People from culturally and linguistically diverse or migrant backgrounds are more likely to be placed on a community treatment order. However, the evidence for effectiveness remains inconclusive and limited to orders of at least 2 years’ duration. The restrictive nature of community treatment orders may not be outweighed by the inconclusive evidence for beneficial outcomes.

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