'Too many' forced into mental care

The Mental Health Commission wants a rethink on the use of compulsory treatment for people with mental illness, saying patients are being forced into treatment too often, and for the wrong reasons.

It believes the Mental Health Act is being misused in compelling patients living in the community to get treatment, and in forcing some to be detained in psychiatric wards where they are restrained or put in isolation.

The commission's latest publication, which is out today, looks at the human rights issues related to the use of legal compulsory interventions.

Chairwoman Ruth Harrison said the commission did not want to abolish compulsion, but wanted it to be confined only to emergencies.

Ms Harrison said a lot of "undefined language" was being used as a reason for prescribing compulsory treatment orders.

She cited one example where a patient - a published author - had told her assessing psychiatrist that she was working on her second novel. The psychiatrist, unaware of her background, noted that she had "grandiose delusions" in her case files.

"It could be written down, 'has grandiose delusions, lacks insight into her illness', and whammo, you're under a compulsory treatment order or you're under an in-patient order," said Ms Harrison.

She said cases such as Mark Burton - who stabbed and killed his mother days after being discharged from a mental health unit in 2001 - illustrate a "point-of-tension" for clinicians, families and the public when it comes to assessing the danger a patient posed.

"Danger to others is always going to be continually assessed, but it's not that easy to predict.

"You can't lock up everybody - and we're talking about 20 per cent of people who experience mental illness here - on the grounds that you might get it wrong for one person."

Auckland psychiatrist Dr David Codyre said the debate has been going on in the mental health service sector for some time.

"There's an expectation that services foster recovery, and part of fostering recovery is minimising the use of force, restraint and compulsion. On the other hand though there's an expectation that bad things don't happen when people have mental illness. What that tends to do is create a drive towards using compulsion."

Dr Codyre said killings by psychiatric patients tap into the heart of stereotypes around mental illness, and the horrifying nature of these deaths make a clinical argument difficult.

He said in instances where things go awry, the failing is in basic care provision, not in whether compulsion was used or not.

Hawkes Bay woman Susie Crooks, who received compulsory treatment for paranoid schizophrenia eight years ago, said "the treatment was far more harmful and damaging than the condition".

Ms Crooks, who now manages mental health agency The Lighthouse, said the treatment included physical restraints, forced medication and eight weeks of seclusion.

"My mother has paranoid schizophrenia, and I grew up in a home where madness was quite an accepted norm. But I have never gotten over the trauma of solitary confinement."

There is a myth that forced treatment died with the disappearance of big institutions like Kingseat Hospital, she said. In reality, there are still people today who go through the same experience she went through.

Ms Crooks said compulsion was an overused and ineffective tool.