Mental Health Legislation.

Question 1

CAT Act

Answer 1

Compulsory Assessment and Treatment Act, 1992 - Defines circumstances/conditions under which persons may be compelled to undergo psychiatric assessment and treatment, also providing protection/rights

Question 2

CP (MIP) Act

Answer 2

Criminal Procedure (Mentally Impaired Persons), 2003 - Updates Part 7 C.J. Act (1985) – relates to mentally disordered persons involved in criminal proceedings.

Question 3

ID (CCR) Act

Answer 3

Intellectual Disability (Compulsory Care and Rehabilitation), 2003 - Provides courts with compulsory care options for persons who have an intellectual disability, who are involved in criminal proceedings

Question 4

PPPR Act

Answer 4

The Protection of Personal and Property Rights Act, 1988 - Utilised when person unable to make decisions for self or unable to communicate such decisions – loss of “capacity”.

Question 5

Six features of the 1992 Mental Health Act.

Answer 5

• Covers compulsory treatment only – not voluntary/informal clients
• No right to refuse treatment
• Force can be used
• Unable to choose treatment provider
• Can be made to stay in hospital
• Focus on community treatment – least restrictive environment

Question 6

Two part of Legal Definition of Mental Disorder.

Answer 6

1) An abnormal state of mind shown by delusions or disorders of mood, perception, volition or cognition;
2) The abnormal state of mind must be a serious danger to self or others or it must seriously reduce ability to look after self.

Question 7

Feature of the Legal Mental Disorder Definition.

Answer 7

• These are symptoms/phenomena – not diagnoses.
• The definition is legal – not medical.
• Can be continuous or intermittent.

Question 8

Exclusions of the Legal Mental Disorder Definition.

Answer 8

• Political, religious or cultural beliefs
• Sexual preferences
• Criminal behaviour
• Substance abuse
• Intellectual Disability

Question 9

Director of Area Mental Health Service

Answer 9

A director of Area Mental Health Services is responsible for the local administration of the act and is involved in such responsibilities as reviewing application for assessment; arranging assessment examination; appointing reasonable clinicians and duly authorised officers (DAO’s) for each patient; assuring rights, and providing education and training responsible clinicians and DAO’s.

Question 10

Duly Authorised Officers

Answer 10

Duly Authorised officers must be appointed in sufficient numbers to provide advice to the public about the ACT and also to provide practical assistance with patients. These officers must be appropriately trained and competent in dealing with mentally disordered. Those appointed to these positions are usually nurses experienced in metal health nursing.

Question 11

Responsible Clinicians

Answer 11

A responsible clinician has extensive responsibilities, including determining mental disorder in any person and being in charge of patients’ treatment. Such a clinician is assigned to every patient who is subject to compulsory assessment treatment and must be either an approved psychiatrist or some other registered health professional competent in ‘assessment, treatment and care of patients with mental disorder.’

Question 12

District Inspectors

Answer 12

The Ministry of Health considers the key to the District Inspector role is building and maintaining positive and appropriate working relationships with patients, staff and families/whānau of varying backgrounds and cultures. These relationships, together with those with fellow District Inspectors, the Director and Deputy Director of Mental Health, review tribunal and local police and courts, form the basis of all of the work carried out by District Inspectors.

Question 13

Section 7a.

Answer 13

Consultation with Family/Whanau - Medical Practitioner or Responsible Clinician to consult with family during compulsory assessment and treatment process. It is a two way on-going process.

Question 14

Section 8. a & b.

Answer 14

A (over 18) –application to DAMHS with assistance from DAO. Includes why the person believes there is a mental disorder present and relationship. “Proposed patient. Must be seen within last 3 days.
A - application
B - with medical certificate which says there is reasonable grounds for believing the client has a mental disorder

Question 15

Section 9.

Answer 15

Assessment examination (by psychiatrist or other medical practitioner). Proposed Pt to undergo assessment, examination. DAO arranges a psychiatrist to examine client. Police can assist(sec 41) if client refuses. Psychiatrist completes a Certificate of Preliminary Assessment (sec 10). There must be reasonable grounds to believe the client has a mental disorder and it is desirable that client can be required to undergo further assessment and treatment

Question 16

Section 10.

Answer 16

Certificate of Preliminary Assessment.

Question 17

Section 11.

Answer 17

First Period of Assessment and Treatment (5 Days). Can be hospital or community, determined by responsible clinician. Required treatment. Now legal a “patient”.

Question 18

Section 12.

Answer 18

Certificate of Further Assessment.

Question 19

Section 13.

Answer 19

Further Assessment and Treatment for up to 14 days. Decision as to fitness to be released from compulsory status. RC may release him at any time during 14 days.

Question 20

Section 14.

Answer 20

Certificate of Final Assessment.

Section 14a - Application to court for compulsory treatment order by RC.

Question 21

Section 16.

Answer 21

Review of Patients condition by Judge - Patient request.

Question 22

Section 18

Answer 22

Judge to examine pt where compulsory treatment order sought.
Application to Family Court for a Compulsory Treatment Order which is a court order made by a judge. Entitled to a lawyer.

Question 23

Section 28.

Answer 23

Compulsory Treatment Order. CTO. Family Court Judge must believe that client has a mental disorder ( legal) and compulsory treatment is necessary.

Question 24

Section 29.

Answer 24

Community treatment order. Outpatient treatment is appropriate.

Question 25

S.29 (3) (a)

Answer 25

Community Treatment Order – permits Responsible Clinician to direct that a patient subject to a CTO be treated as an inpatient for any one period of 14 days.

Question 26

Section 30.

Answer 26

Inpatient Treatment Order. If community treatment is inappropriate.

Question 27

Section 31.

Answer 27

Leave for Inpatients ( filled in by RC). Can be in force for up to 3 months.

Question 28

Section 34.

Answer 28

Court extension of Order if still not fit to be released from compulsory status

Question 29

Section 76.

Answer 29

Clinical Review of Persons Subject to CTOs. First review – within 3 months of order/subsequent reviews within 6 months of previous review.

Question 30

Section 111.

Answer 30

Powers of Nurse where urgent assessment required. Nurse may detain patient until medical practitioner examination – no more than 6 hours from the time nurse calls for a medical practitioner (psychiatrist or GP with mental health experience).
Nurse must inform person of the detention, complete a S.8A and document exact time and reasons i.e. grounds for believing person is mentally disordered. Client may inform family and may consent to take any medication prescribed.

Question 31

Youth and Children.

Answer 31

• If 16 years or older – treated as an adult for the purpose of giving consent.
• If under 16 –not old enough for own decisions and parents/legal guardians can make some decisions on behalf of them.
• Section 86 assessment exam of child under 17 should be conducted by child psychiatrist.

Question 32

Mental Health Act Right.

Answer 32

• Review by Judge or Review Tribunal
• Information
• Respect for cultural identity
• Interpreter
• Appropriate treatment
• Informed about treatment
• Refuse video or audio recording
• Independent psychiatric advice
• Legal advice
• Company
• Visitors and phone calls
• Send and receive mail

Question 33

PPPR Act Who?

Answer 33

Not specific legislation for mental health. Designed for persons who lose capacity to make and or communicate their own decisions. Commonly used:

• intellectual disability,
• dementia,
• serious mental illness
• serious traumatic brain injury.

Question 34

PPPR Act benefits.

Answer 34

Protection by appointment of EPA – Enduring Power of Attorney. Legal document ( signed and witnessed) specifying who is to make personal or property decisions if capacity lost. Two kinds of EPA – just property and/or personal care and welfare.