NZ psychiatry's community treatment orders 'violate' human rights conventions - researchers

A standard psychiatry practice used in New Zealand may violate international human rights conventions, says Otago University researcher Dr Giles Newton-Howes. Photo / Supplied

A standard psychiatry practice used in New Zealand may violate international human rights conventions, Kiwi and Australian researchers say.

Otago University's Dr Giles Newton-Howes and Associate Professor Christopher Ryan of the University of Sydney further argue community treatment orders (CTOs) may also be ineffective.

CTOs enable psychiatrists to force people with serious mental health symptoms to have treatment without consent - and in New Zealand these can be imposed even if the person refusing treatment understands and can weigh up its benefits and risks.

Writing in the British Journal of Clinical Psychiatry, the researchers say CTOs should not be used for such "competent" patients.

"We believe that using CTOs to force treatment on people who competently refuse it is a violation of the international conventions that our countries have signed up to and that the process is out of step with other health practices," said Newton-Howes, of Otago's Wellington-based Psychological Medicine Department.

Moreover, he added, it may be they do more harm than good.

"Forcing a competent person to have psychiatric treatment that they have decided they don't want is like putting a smoker into hospital because they won't give up."

Randomised controlled trials were usually regarded as the gold standard of whether or not a medical intervention is effective and, although there had been three of these on CTOs, none had showed any efficacy, he said.

"In other types of studies that have sometimes demonstrated benefit, it appears that the benefit comes when people are able to get more help.

"This suggests that it's the health service provided, not the CTO, that makes the difference.

"We need better funded and more integrated services, not the capacity to breach people's human rights to enforce treatment."

Mental Health Foundation chief executive Shaun Robinson said too many services continued to use non-therapeutic practices such as seclusion and restraint, causing distress to both patients and staff.

The use of these practices differed significantly between DHBs and across population groups, with Maori more likely to experience seclusion than Pakeha, he said.

"As a country we must take swift steps to reduce the use of compulsory treatment under the Mental Health Act, minimise the use of restraint and entirely eradicate the use of seclusion," Robinson said.

"We must not continue to accept that individuals experiencing mental health problems will inevitably become so unwell they will need to be hospitalised."

The Ministry of Health's deputy director of mental health, Dr Ian Soosay, said recent international evidence around the effectiveness of community treatment orders in preventing relapse and readmission was being debated internationally.

In New Zealand, community treatment orders were designed to reflect the shift to community treatment and away from hospital treatment, he said.

The ministry was currently leading work to explore the relationship between the Mental Health (Compulsory Assessment and Treatment) Act 1992 and human rights obligations under the New Zealand Bill of Rights Act 1990 and the Convention on the Rights of People with Disabilities.

"As part of this work we have looked at some of the recent research around the effectiveness of compulsory treatment orders - including community treatment orders - and their human rights implications," Soosay said.

The ministry expected to report back to the Ministerial Committee on Disability Issues before the end of July.

Elsewhere, there were a range of new initiatives and plans underway to support a reduction in the use of community treatment orders.