But in my experience when the money and resources shrink, sectioning to ‘ensure safety’ becomes a proxy for meaningful engagement.

That has been my own experience as a patient, and seems to accord with the statistics.

Over the 10 years from 2005 to 2014, use of section 29 community treatment orders rose from 60 per 100,000 population, to 85 per 100,000, increasing in a reasonably linear fashion year on year over that period. Some regions are much higher, in 2014 Northland DHB was the highest at 177, followed by Tairāwhiti DHB at 119 and Capital & Coast DHB at 111 (all per 100,000 population)

However the rates are much higher when you consider the gender and ethnicity of patients. In 2014 Māori men were subject to section 29 community treatment orders at a rate of 438 per 100,000, vs 116 for non-Māori men, or 3.8 times more likely. For women it was 195 per 100,000 for Māori women vs 62 for non-Māori women, or 3.1 times more likely.

When teams lack the resources to provide the levels of ongoing support required, they are more likely to have to resort to the Act to forcibly impose treatment. Which seems especially relevant for Māori – they are more likely to have difficulty accessing services, and therefore are likely to be more unwell on initial presentation. And when mental health services lack the resources to provide high quality culturally relevant support, they are more likely to use tools such as s 29 CTOs.

[All statistics from Director of Mental Health annual reports]