Compulsory community care increasing

22 March 2013

Rates of compulsory care for mental health patients have increased steadily over the past six years.

Since the Ministry of Health began publishing figures in 2006, the clinical use of community treatment orders for compulsory care has gone from a stable 57 to 60 orders per 100,000 of population to 83 per 100,000 in 2011.

The Mental Health (Compulsory Assessment and Treatment) Act defines when a person may be required to undergo compulsory psychiatric assessment and treatment. The Act aims to ensure that vulnerable individuals and the public are both protected from harm, and defines the rights of the patient and proposed patients.

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“Data published by the Ministry of Health suggest that use of the Act is increasing in New Zealand,” says senior lecturer with The University of Auckland’s School of Nursing, Anthony O’Brien. “The latest figures show the highest rates of compulsory care since the Ministry began publishing figures.”

He says use of Section 11 (used in acute crisis) shows no significant increase, but the use of community treatment orders shows a steady increase.

The figures also show significant geographic variation in the use of these community treatment orders with Waitemata District Health Board using 151 orders per 100,000 – almost five times the rate of the lowest user (Canterbury DHB with 33 orders/100,000).

“The overall increases are concerning given the ‘closer to home’ strategic direction of the Mental Health Commission outlined in the recent Blueprint ll documents,” says Mr O’Brien.

The Blueprint document ‘Making change happen’ states that “Our current community mental health and addiction resources are a success story of the last decade” (Pg 137)

“If we are able to continue to make that claim, we will need to address the increase in the use of community treatment orders,” he says. “There may be a variety of reasons underlying the reported data. Recent changes in the system of reporting may mean that recent data is now more accurate and that the lower rates of previous years were an under-estimate.”

Another possibility was that shorter lengths of inpatient stay may lead to people being discharged with higher levels of symptoms and un-met need, says Mr O’Brien. In some district health boards, clinicians are becoming more risk averse and so are using the compulsory provisions of the Act to compel service users into treatment.

“Whatever the reasons, and they are likely to be multiple, nurses need to be continually vigilant about the use of compulsion in mental health care,” he says.