AWA: Academic Writing at Auckland

Almost half of all New Zealanders will experience some form of mental distress in their lifetime. Mental distress falls on a continuum with some experiencing mild to moderate distress and others having much more severe experiences.  In New Zealand when a person is deemed to not have capacity to make decisions to care for themselves, legislation named the Mental Health Act can be used. This allows responsible practitioners to enforce treatment on distressed people who are danger to themselves and/or others. This treatment can include administering sedatives and anti-psychotic medication through an intramuscular injection. And, at times, being forced into seclusion. Seclusion is a small room, with no windows and a cardboard toilet with a mattress on the floor. These rooms are locked, and service users can be placed in these rooms for up to 8 hours at a time.

I have been sectioned under the Mental Health Act countless times over my 25-year journey with mental illness. While being under the Act I have had inpatient hospital admissions of up to a year in length. One experience that I remember clearly is the first time I was put on a long-term treatment order. This meant I had to stay in hospital for 6 months or more. I had a lawyer assigned to me and I had to appear before a judge. At that time, I was 17 years old and had some insight. I knew I needed hospital treatment. However, I had learnt that when treatment decisions were made solely by clinical staff, I felt frightened and scared. This fear escalated knowing nurses had the power to chemically and/or physically restrain me at any point and potentially put me into seclusion. But, if I wanted help I needed to accept these parameters.

This situation is paradoxical. On one hand, power is taken from the service user and given to clinicians which feels unjust and can be seen as a breach of human rights. It is important to point out that the UNCRPD states that seclusion is inhumane and an act of torture. However, in the same instance, a person can have some insight into their unwellness and know they need treatment. This results in a tension. This tension occurs when a service user recognises on some level they need help but are frightened, scared and angry that their decision-making rights are being taken away. In a way, a person must accept having no say in their treatment if they desire any treatment or help at all.

Another consideration is that many of the psychotropic medications that are administered forcibly have serious side physical side effects. Service users become more mentally well at the expense of their physical wellbeing. Treatment is dictated by clinicians who do not have to live with the poor physical health outcomes. When a person lacks capacity to see their unwellness, forcing treatment may bring comfort for family and friends. They may believe that their loved one is receiving the treatment deemed necessary. But, this is not always the case. Some families do not want their loved ones detained by the Act as they see the long-term consequences.

The Mental Health Act is currently being repealed and replaced with new legislation becoming law in 2027. In February of this year the Select Committee heard numerous oral submissions focused on how the legislation should be changed. Recommendations that were heard included, ending the use of seclusion and restrictive practices and adopting supported-decision making legislation. There was hope that the new legislation would be transformative. Unfortunately, the voices of many were not heard. There have been small, insignificant changes to the legislation, leaving many service users and their advocates disappointed and disheartened.

Most people in society would never contemplate what it is like being under the Mental Health Act. I think if more people did know, they would be shocked. Being locked in a mental health unit with no control over what happens to you, and your body is a truly unique and traumatising experience. Unfortunately, due to my extensive experience of the Act, I have become numb and blaze about being locked up in a ‘prison’. I have had to learn to accept this reality and find some semblance of peace within that reality, unfortunately.