Getting treatment
Hopefully, treatment will be a valuable part of your recovery. There are a variety of treatments, and you should have a choice.
Your health care worker
Medication
Agreeing to treatment – informed consent
Choosing someone to make decisions for you – enduring power of attorney
When you don’t consent – compulsory assessment and treatment
Seclusion
Your health care worker
- Ask your health worker about their role and how they can help you.
- Tell them what you need.
- Tell them that you want to be fully involved in decisions about your treatment and care.
- Tell them that you want your family to be fully involved in decisions about your treatment and care.
- Bring your family, friends or relatives to your appointments if you think they will help.
- Ask your health worker to explain your condition to family, friends or relatives who don’t understand.
- Ask to see another health care worker if you don’t get on with your present one.
Medication
Most people who use specialist mental health services will be offered medication.
Medications work differently on different people, and your psychiatrist may have to prescribe a few before you find one that is helpful. You may also be on more than one medication at one time.
Many people find taking medication helps their recovery. You may be surprised how many people you know take psychiatric medication.
When you are being offered psychiatric medication ask about:
- other options
- how likely it is to work and what the research shows
- how long it will it take for the medication to work
- how long you may need to be on the medication
- what the side-effects are – some people choose not to take the medications because they find the side-effects outweigh the benefits.
Tell your doctor if you are taking any other treatments or remedies as some of these may interact badly with psychiatric medications.
Things you can do to give the treatment a better chance of working well include:
- belief in your recovery
- being kind to yourself and doing things you enjoy
- going for walks or getting some form of exercise
- spending time with family and friends
- eating regular healthy meals
- avoiding too much alcohol, cigarettes or drugs
- doing relaxing things such as having a massage, having a warm shower, meditating or gardening
- learning about your condition and treatment.
Agreeing to treatment – informed consent
The Code of Health and Disability Services Consumers’ Rights states that all health providers must inform you of the benefits and side-effects of the treatments they offer you and tell you of other possible treatments.
Once they have given you this information, they need to get your consent before they treat you. An exception to this is if you are subject to compulsory assessment or treatment under the Mental Health Act where you lose the right to consent but retain the right to be informed.
In specialist mental health services, informed consent involves more than you passively agreeing to treatment. Your doctor and other mental health workers should actively involve you as an equal in all decisions about your treatment. This includes:
- sharing your clinical notes with you and enabling you to correct or add to them
- jointly developing a plan for your treatment including what should happen if you have a crisis
- letting you involve family
- setting your own goals for recovery.
Choosing someone to make decisions for you – enduring power of attorney
If you think you require more protection than what an advance directive will achieve, an enduring power of attorney lets you choose someone (such as a partner, close friend or relative) to make decisions for you or to act on your behalf if you lose your capacity.
The person you choose must be over 20 and they should know you well enough to understand what you would want in a particular situation.
if you are considering giving someone enduring power of attorney, talk to a lawyer to make sure you are fully informed about what it means.
If you have one, we recommend you attach a copy of your advance directive to the enduring power of attorney document.
Read our information for family, whānau on an enduring power of attorney.
Compulsory assessment and treatment
The Mental Health (Compulsory Assessment and Treatment) Act 1992 (the Mental Health Act) allows specialist mental health services to compulsorily assess, treat or hospitalise people who the Act defines as having a ‘mental disorder’. You must also be found to be a ‘serious danger’ to yourself or others, or to have a ‘seriously diminished capacity’ to take care of yourself.
Your doctor can release you from compulsory status at any time during the process of compulsory assessment and treatment.
Compulsory assessment can take place in an inpatient unit or a community mental health service. As well as the initial assessment, you are reassessed within 5 days, then again within 14 days.
During the assessment period:
- you will probably be given compulsory treatment
- you must be given a written statement of your rights under the Mental Health Act
- you have the right to ask a judge to review the psychiatrist’s decision that you need compulsory assessment and treatment at any time
- a district inspector (a lawyer appointed to safeguard your rights under the Mental Health Act) will come and see you if you are in hospital or write to you if you are at home – you can also ask them to visit you at any time during this period.
At the end of the assessment period, if the psychiatrist believes compulsory treatment is still needed, they will apply to the Court for a compulsory treatment order – either as an inpatient or in the community. You have a right to get a lawyer to represent you at the Court hearing and can apply for legal aid. A district inspector will also contact you to talk about the Court process, the possible outcomes, and things that you can do to prepare. Sometimes, district inspectors come to Court hearings.
A judge will decide if you should be on a compulsory treatment order or not, after hearing from you, your psychiatrist, your lawyer and perhaps others.
A compulsory treatment order gives the specialist mental health services the legal authority to treat you without your consent for a month from the date of the hearing. After that, the service has to see if you will consent to the treatment. If you do not wish to consent, the service will be able to continue to compulsorily treat you only if they obtain a second opinion from an approved psychiatrist.
The compulsory treatment order will last for up to 6 months. The psychiatrist has to review your status after 3 months. Before the order expires, the psychiatrist can apply to the Court again to get your compulsory treatment order extended for another 6 months.
After this you, can be on a compulsory treatment order indefinitely, but your psychiatrist must review your need to be on the compulsory treatment order every 6 months.
After the first review (3 months after the Court makes the order) and after each subsequent 6-monthly review, you have the right to apply to the Mental Health Review Tribunal to take you off your compulsory status – a district inspector or lawyer can tell you how to apply.
Most people who use specialist mental health services are not subject to compulsory treatment, and many people who are subject to compulsory treatment are released from it after some days or weeks.
If you are subject to compulsory treatment and don’t think you need to be, learn about the Mental Health Act and get help from a lawyer, district inspector or a trusted mental health worker. (You will probably get released more quickly if you appear to be co-operating.)
Seclusion
Seclusion means being placed alone in a room in a hospital with the door locked. You can only be secluded if you are subject to compulsory assessment or treatment.
All services must follow guidelines and standards on the use of seclusion and report to the Ministry of Health about their seclusion practice.
If you want to complain about being put in seclusion, contact a District Inspector.
