Posts by Neil
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Hard News: Dirty Politics, in reply to John Farrell,
I think the verdict passed by the PM on Kiwibuild is clear. It’s been a failure, many people have been trying to point this out to the government for sometime. Much like the proposed changes to mental health the risk is middle class capture.
Kiwibuild subsidised property developers to build houses for the middle class.
Current proposed mental health reforms will funnel money into the worried well and not the most at need.
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Overall I tend to suspect the the govt may be replicating the Kiwibuild debacle with mental health – trying to throw $2b at a sector in desperate need but which they know little about.
The inquiry skipped along the surface of the most fundamental issues such as risk vs autonomy and ignored those who urgently need more resources – those with the most severe mental health issues who are the most vulnerable.
From the UK review:
We have heard many anecdotal reports that, over time, there has been a shift in the perception of what is ‘acceptable risk’ among professionals, which may have contributed to the rise in the use of the MHA. This appears to have been driven by professionals’ fears – often arising from court cases – that a decision not to detain someone, or to allow them out from hospital whilst under their care, may lead to serious incidents and, at the most extreme, deaths, resulting in a subsequent summons to a coroner’s court to defend their decision.
This probably is true for Orange Tamariki as well – people at the coal face are petrified of legal consequences of making the wrong judgment call.
The UK review is very good but I feel the big problem with it will be it gives two types of solutions – one expensive and try other not so. I doubt any government will opt for the most expensive.
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Hard News: Dirty Politics, in reply to ,
I have an extended family member who has been on a constant cycle of needing to be taken to hospital by the police for treatment, then when he gets well he starts fighting for his autonomy again, until the next major episode. There must be some middle ground somewhere.
Not uncommon. I’ve seen it quite a few times. People come into hospital, get well, go home, stop taking medication, get unwell, back into hospital. With illnesses such as psychosis every episode of unwellness reduces future functionality and reduces the effectiveness of medication so repeated cycles are very damaging over and above immediate consequences.
More funding to community mental health teams to resource more active outreach and crisis intervention is much needed. That’s essentially what the UK review concluded – the way to reduce compulsory treatment isn’t to change the law but to properly fund acute community mental health teams. Something our government isn’t currently proposing.
There’s a community team called ACOS – which is an assertive outreach team that can check in on people every day and spend decent periods of time with them. That service could easily be expanded to cover not just the most difficult cases they presently deal with.
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Hard News: Dirty Politics, in reply to ,
The police can drop charges by just dropping the charges! whats so hard to understand about that? If someone commits a criminal offence the police can arrest them, they can detain them, they can get an approval from the courts to remand them to a hospital. They do not have to follow thru with a prosecution! That will not change.
There would have to be some new legal provision for a court to remand someone to a mental health unit without any form of assessment by a mental health team. I think most would agree the justice system shouldn’t have such power.
Perhaps I’m not making myself clear. I’m supposing a possible repeal of the Act and consequent loss of compulsory assessment and treatment. The consequences of that would be the justice system would have no ability to detain someone for the purpose of having mental health assessment or treatment. A person with a mental health issue may just get stuck in the criminal justice system.
The UK mental health act has just recently been reviewed and has some worthwhile consideration of such issues:
We considered carefully whether we should rule out the use of detention where a person has capacity to consent to their admission, but does not consent. We recognise that there are human rights arguments in favour of this, but we do not think that those arguments are strong enough for such a large change at this stage. We think that a much greater debate is needed, involving service users, to see whether society is willing to accept the consequences of someone’s refusal to be admitted, especially where the consequence is the person’s death. The debate also needs to consider whether a person’s right to refuse to be admitted is given greater weight than the risk that the person might pose to other people.
(pg 112)
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Hard News: Cabinet and the Reeferendum, in reply to ,
Yes, plus a smaller number exposed to meth while in the womb. There’s still not much support for fetal alcohol alcohol syndrome let alone meth.
Although often lots of compounding factors and I generally get to see those with lots of severe compounding factors but there is a degree of permanent brain damage.
Not so much depressive as anti-social, poor impulse control. But there’s often a learnt component as well if they’re from a violent family background and been to prison.
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Also, if the police cannot have someone assessed by a mental health team they then have no basis on which to drop charges as they themselves are not able to undertake a mental health assessment to determine if a mental health issue was involved or not. That they can’t is of course a deliberate safeguard.
At present someone can only be placed under the act if they have a mental disorder AND they are either a risk to themselves or to others or both. Treatment has to be provided in the least restrictive manner possible.
A very small percentage of people with mental health issues are placed under the act and most often for short periods of time. The high risks that a small number of people face will not go away if there is no compulsory assessment and treatment and could very well be exacerbated by such a move.
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Hard News: Dirty Politics, in reply to ,
What you said is that the police can arrest someone who commits a crime. And they don’t have to follow thru with prosecuting them. That wouldn’t change under the proposals.
At present though the Police do not have to charge some one with an offense in order to detain them and have them assessed by mental health services if they believe there is a mental health issue involved.
Possible changes to the Act could remove that option leaving the police to deal with it as a legal issue not a mental health issue.
The next problem would be if some one was charged for an offence committed because of mental illness and they refused treatment - what should happen? They continue through the criminal justice system possibly to prison?
I don’t think there’s any non- controversial solution to these sorts of dilemmas but at present I’m seeing quite a lot of “mental health act takes away peoples’ rights” without any discussion of the possible consequences of not having the act.
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Hard News: Cabinet and the Reeferendum, in reply to ,
Unlike say meth addiction, which is likely to cause brain damage, make you socially isolated and you could wind up in jail.
One of the many tragedies of meth will be the legacy of a cohort young people with meth related brain damage moving through the education and health services. For many it will be on top of other social and psychological vulnerabilities.
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Hard News: Dirty Politics, in reply to ,
One way around that is to change what prisons are.
I gather that the govt is looking at extending forensic mental health services in prisons.
But at one extreme of a possible mental health act reform is the removal any form of compulsion. The argument being that no one should be detained on the grounds of mental illness.
Under the current act if a young man with no previous mental health history assaults members of the public they can be detained by the Police if they believe the person may be mentally unwell – and not charged with an offence – and transported either to ED or the cells to be assessed by a psychiatrist.
If that provision under the act were not there the only option for the police would be to charge the person for assault and they would then be dealt with in the justice system.
Rumour has it that any review of the Act may focus on introducing capacity and treatability but none of it is straight forward.
Prior to any reform the govt should lunch a major education campaign which could include dramatisations of actual complex scenarios that occur in acute mental health for the public to get a sense of the dilemmas and risks involved. Most people will have seen fly on the wall documentaries on Emergency Departments and other areas of health but there’s been no equivalent for acute mental health.
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Hard News: Dirty Politics, in reply to Sacha,
Unless you want to avoid certain players.
I haven’t heard that the govt has any issues with existing community mental health services. I’m not sure they know much about them. But if true it would be an extremely expensive remedy to duplicate an entire service and probably unfeasible given that lack of mental health professionals.