Office of the
Director of
Mental Health
Annual Report
2013

Disclaimer
The purpose of this publication is to inform discussion about mental health services and outcomes
in New Zealand, and to assist in policy development.

This publication reports information provided to the Programme for the Integration of Mental
Health Data (PRIMHD)(see Appendix 2) by district health boards and non-governmental
organisations. It is important to note that, because PRIMHD is a dynamic collection, it was
necessary to wait a certain period before publishing a record of the information in it, so that it is
less likely that the information will need to be amended after publication.

Although every care has been taken in the preparation of the information in this document, the
Ministry of Health cannot accept any legal liability for any errors or omissions or damages resulting
from reliance on the information it contains.

A note on the cover
‘Strange natural life’ by Fraidoon Aziz

Fraidoon Aziz was born in Baghdad, Iraq. He moved to New Zealand in January 2001 and has been
a regular visitor to Vincents Art Workshop. His paintings have developed and often have a focus on
previous memories of his home country or have themes of peace and harmony. He says, ‘I like it in
New Zealand, it makes me happy. New Zealand is very nice; all green, everywhere!’

The artwork is titled, ‘Strange Natural Life’. It depicts a New Zealand landscape with a river
running through it, seagulls and a sunset.

Vincents Art Workshop is a community art space in Wellington established in 1985. Although a
number of people who attend have had experience of mental health services or have a disability, all
people are welcome. Vincents models the philosophy of inclusion and celebrates the development
of creative potential and growth. Website: www.vincents.co.nz

Citation: Ministry of Health. 2014. Office of the Director of Mental Health
Annual Report 2013. Wellington: Ministry of Health.
Published in December 2014
by the Ministry of Health
PO Box 5013, Wellington 6145, New Zealand
ISBN 978-0-478-44448-3 (print)
ISBN 978-0-478-44449-0 (online)
HP 6074
This document is available at www.health.govt.nz

This work is licensed under the Creative Commons Attribution 4.0 International licence. In essence, you
are free to: share ie, copy and redistribute the material in any medium or format; adapt ie, remix, transform and build
upon the material. You must give appropriate credit, provide a link to the licence and indicate if changes were made.

Foreword
Tēnā koutou.
Nau mai ki tēnei te tuaiwa o ngā Rīpoata ā Tau a te Āpiha Kaitohu Tari
Hauora Hinengaro mō te Manatū Hauora. Kei tēnei tūnga te mana
whakaruruhau kia tika ai te tiaki i te hunga e whai nei i te oranga
hinengaro. Ia tau ka pānuitia tēnei ripoata kia mārama ai te kaitiakitanga
me te takohanga o te apiha nei ki te katoa.
Welcome to the ninth Annual Report of the Office of the Director of Mental Health. The main purpose
of the report is to present a range of information and statistics that serve as barometers of quality
for our mental health services. Active monitoring of services is vital to ensuring New Zealanders are
receiving quality mental health care.
In this year’s report there is a focus on people; those who seek mental health assistance, and the
dedicated individuals who provide it. Ultimately, it is ‘the people’ who make the sector, and who the
sector is there to serve. This focus is emphasised by the new addition of ‘voices’ through the report,
profiling individuals from different vantage points in mental health.
Consistent with the focus on people, the word ‘patients’ in this report has been replaced with the
more inclusive term ‘people’. Promotion of mental health is about changing attitudes, and part of this
process is about changing the language that is used to speak about people who experience mental
health issues.
Another new feature of the report is the inclusion of statistics on Māori and the use of section 29 of the
Mental Health Act (Compulsory Assessment and Treatment) Act 1992 (the Mental Health Act). It is my
hope that the publication of this information will further emphasise the need for the sector to engage
in meaningful action to address the disparity of mental health outcomes for Māori in New Zealand.
While the sector currently faces some significant challenges (for example, addressing the high rates
of Māori under the Mental Health Act), this report also presents some important success stories. For
example, in 2013 waiting times decreased, approximately 80 percent of people surveyed were satisfied
with the treatment they received, and 91 percent of long-term service users had a relapse prevention
plan. In addition, in 2013 the use of seclusion in inpatient units continued to decline – providing
evidence that district health boards are changing their cultures and practices in regard to assisting
individuals in acute distress.
Since taking up the position of Director of Mental Health in November 2011, I have been consistently
impressed by the dedication and spirit that people in the mental health sector bring to their work. I
see my role as an opportunity to provide leadership that supports this commitment and builds on the
good work that has already been done.
Looking to the future, our Office will continue to review and improve the processes and guidance
related to the administration of the Mental Health Act, always with the aim of making a meaningful
contribution to the mental health conversation in New Zealand.
Noho ora mai,
Dr John Crawshaw
Director of Mental Health
Chief Advisor, Mental Health
Office of the Director of Mental Health Annual Report 2013
iii

E hara taku toa i te toa taki tahi, engari he toa taki tini.
Our greatest hope for the health of wha¯nau lies in our collective strength.
‘There is no health without mental health.’

World Health Organization
iv
Office of the Director of Mental Health Annual Report 2013

link to page 3 link to page 9 link to page 11 link to page 11 link to page 11 link to page 12 link to page 12 link to page 12 link to page 13 link to page 14 link to page 16 link to page 18 link to page 18 link to page 18 link to page 20 link to page 22 link to page 24 link to page 24 link to page 26 link to page 27 link to page 33 link to page 36 link to page 44 link to page 50 link to page 53 link to page 57 link to page 59 link to page 65 link to page 66 link to page 69 Contents
Foreword iii
Executive summary
ix
Introduction 1
Objectives 1
Structure 1
Context 2
The Ministry of Health
2
Rising to the challenge
2
From ‘patients’ to people
3
Specialist mental health services
4
The Mental Health (Compulsory Assessment and Treatment) Act 1992
6
Activities for 2013
8
Mental health sector relationships
8
Cross-government relationships
8
District inspectors
9
Special patients and restricted patients
10
The Mental Health Review Tribunal
12
Ensuring service quality
14
Consumer satisfaction surveys
14
Waiting times
15
Relapse prevention plans
16
Use of the Mental Health Act
17
Māori and section 29 of the Mental Health Act
23
Seclusion 26
Electroconvulsive therapy
34
Serious adverse events
40
Death by suicide or suspected suicide
43
The Alcoholism and Drug Addiction Act
47
Opioid substitution treatment
49
References 55
Appendix 1: Additional statistics
56
Appendix 2: Caveats relating to PRIMHD
59
Office of the Director of Mental Health Annual Report 2013
v

link to page 58 link to page 66 link to page 66 link to page 66 link to page 66 link to page 66 link to page 66 link to page 67 link to page 67 link to page 67 link to page 68 Table 19: Outcomes of applications for granted orders for detention and committal, 2004 to 2013
48
Table A1: Outcome of Mental Health Act applications received by the Mental Health Review
Tribunal, 1 July 2012 to 30 June 2013
56
Table A2: Results of reviews under section 79 of the Mental Health Act held by the Mental Health
Review Tribunal, 1 July 2012 to 30 June 2013
56
Table A3: Ethnicity of people who identified their ethnicity in Mental Health Review Tribunal
applications, 1 July 2012 to 30 June 2013
56
Table A4: Gender of people making Mental Health Review Tribunal applications, 1 July 2012 to
30 June 2013
57
Table A5: Applications for compulsory treatment orders (or extensions), 2004 to 2013
57
Table A6: Types of compulsory treatment orders made on granted applications, 2004 to 2013
58
viii Office of the Director of Mental Health Annual Report 2013

Executive summary
• In 2013, a record number of people accessed specialist mental health and addiction services
(154,378 people, or 3.5 percent of the New Zealand population). Most (91 percent) of these people
accessed services in the community. A small proportion of service users (approximately 6 percent1)
had contact with compulsory assessment and/or treatment under the Mental Health (Compulsory
Assessment and Treatment) Act 1992 (the Mental Health Act).
• Māori are over-represented under the Mental Health Act. In 2013, Māori were 2.9 times more likely
to be under a community treatment order (section 29 of the Mental Health Act) than non-Māori.
Reducing the disparity in mental health outcomes for Māori is a priority action for the Ministry of
Health and district health boards.
• In 2013, waiting times for mental health services decreased, consumer satisfaction was rated around
80 percent and approximately 91 percent of long-term service users had a relapse prevention plan.
• In 2013, the use of seclusion in adult inpatient units continued to decline, providing evidence that
district health boards are changing their cultures and practices in regard to assisting individuals
in acute distress. However, Māori are still over-represented in the seclusion figures. In 2013, Māori
were 3.7 times more likely to be secluded than non-Māori in an adult inpatient setting (per 100,000
population).
• In 2013, 253 people received electroconvulsive therapy (ECT) in New Zealand mental health services.
Those treated received an average of nine administrations over the year. Women were more likely to
receive ECT than men, and older people were more likely to receive ECT than younger people.
• For the first time, information on serious adverse events reported to the Health Quality and Safety
Commission (HQSC) by district health boards has been included in the Annual Report. In 2013,
mental health and addiction services reported 161 serious adverse events to the HQSC.
• Approximately 500 New Zealanders die by suicide every year. A total of 493 suicides is recorded
in the mortality database for 2011. Approximately 40 percent of those who died by suicide or
undetermined intent (aged 10 to 64 years) were mental health service users. Mental disorders are a
significant risk factor for suicidal behaviour.
1. This figure is 8 percent when taken from a total of mental health service users (122,438) (excluding those who sought
assistance from addiction services only). Source: PRIMHD data, extracted on 23 October 2014.
Office of the Director of Mental Health Annual Report 2013
ix

Introduction
Objectives
The objectives of this report are to:
• provide information about specific clinical activities that must be reported to the Director of Mental
Health under the Mental Health (Compulsory Assessment and Treatment) Act 1992 (the Mental
Health Act)
• report on the activities of statutory officers under the Mental Health Act (such as district inspectors
and the Mental Health Review Tribunal)
• contribute to the improvement of standards of care and treatment for people with a mental illness
through active monitoring of services against targets and performance indicators led by the
Ministry of Health (the Ministry)
• inform mental health service users, their families and whānau, service providers and members of
the public about the role, function and activities of the Office of the Director of Mental Health (the
Office) and the Chief Advisor, Mental Health.
Structure
This report is divided into three main sections. The first section (‘Context’) provides an overview of the
legislative and service delivery contexts in which the Office operates. The second section (‘Activities for
2013’) describes the work carried out by the Office in 2013. The final section (‘Ensuring service quality’)
provides statistical information, which covers the use of compulsion, seclusion, reportable deaths and
electroconvulsive therapy during the reporting period.
Office of the Director of Mental Health Annual Report 2013
1

Context
The Ministry of Health
The Ministry of Health improves, promotes and protects the mental health of New Zealanders by:
• providing whole-of-sector leadership of the New Zealand health and disability system
• advising the Minister of Health and the Government on mental health issues
• directly purchasing a range of important national mental health services
• providing health sector information and payment services.
Over the last 50 years,
Ministry groups play a number of roles in leading and supporting
New Zealand mental
mental health services. The Clinical Leadership, Protection and
health services have
Regulation business unit monitors the quality of mental health
moved from an
and addiction services and the safety of compulsory mental health
institutional model to
treatment, through the Office of the Director of Mental Health and
provider regulation groups.
a recovery model that
emphasises community
The Sector, Capability and Implementation business unit supports the
treatment.
implementation of mental health policy through the Mental Health
Service Improvement and Māori Health Service Improvement groups.
Clinical and policy leaders from these groups collaborate with the Policy business unit to advise the
Government on mental health policy and to implement policy.
The National Health Board is responsible for the funding, monitoring and planning of district health
boards (DHBs), including the annual funding and planning rounds. The Office of the Chief Nurse works
to optimise the contribution of nursing to Government objectives and to the health and wellbeing of
New Zealanders.
All of these Ministry teams have representation in the Mental Health Governance Group. The
Governance Group was established in 2012 by the Director of Mental Health. The Governance Group
allows the Director to collaborate closely with colleagues from across the Ministry, enabling different
business units to work effectively together to reach mental health objectives.
Rising to the challenge
Over the last 50 years, New Zealand mental health services have moved from an institutional model to
a recovery model that emphasises community treatment. Compulsory inpatient treatment has largely
given way to voluntary engagement with mental health services in a community setting.
In 2012 the Cabinet approved Rising to the Challenge: The Mental Health and Addiction Service
Development Plan 2012–2017 (Ministry of Health 2012e). This document builds on improvements to this
model of mental health care by providing a strategic direction for mental health service improvement
over the next five years.
Rising to the Challenge outlines key actions to build on and enhance mental health service delivery,
with the aim of improving wellbeing and resilience, expanding access and decreasing waiting times.
2
Office of the Director of Mental Health Annual Report 2013

Rising to the Challenge also targets disparities in mental health outcomes for certain groups,
including Māori, Pacific peoples, refugees, and people with disabilities. Implementation of Rising
to the Challenge is the responsibility of the Ministry, DHBs, other government agencies, and non-
governmental organisations (NGOs) contracted to provide mental health and addiction services.
From ‘patients’ to people
Promotion of mental health is about changing attitudes, and supporting a positive culture shift around
mental health issues. Part of this process involves changing the language used to speak about people
who experience mental health issues, particularly language that positions people with mental health
issues as different or ‘other’.
In line with this approach, the word ‘patients’ in
A well-informed New Zealand
this report has been replaced with the word ‘people’
public will create an inclusive
(where practicable). This change is a gesture towards
culture of participation, equality
normalising mental health issues and de-emphasising
and fairness, allowing each person
the difference between those who seek mental health
the space to prosper, thrive and
services and other New Zealanders.
realise their potential.
Mental health promotion is an invaluable intervention
for people who experience mental illness. A well-informed New Zealand public will create an inclusive
culture of participation, equality and fairness, allowing each person the space to prosper, thrive and
realise their potential (Ministry of Health 1996).
Sector voices
Kieran Moorhead – Consumer leader at Changing Minds
Hello, my name is Kieran Moorhead and I am a consumer leader at Changing
Minds, working with the three metro district health boards in Auckland.
Consumer leadership was born out of the consumer movement. It represents the
shift from paternalistic ‘do what I say’ approaches towards a more collaborative,
recovery-focused model.
As a consumer leader my role is to advocate for groups and communities on a
systemic and policy-making level and drive towards positive change in mental health services.
The purpose of consumer leadership is to work towards the equal distribution of collective power and
to champion the voices of consumers.
Examples of the influence of consumer leadership are:
• increasing the use of peer support services
• communicating with DHBs about successes and service gaps
• ensuring there is collaboration and shared decision-making in mental health services
• promoting personalisation and self-directed care.
The most important qualities I need as a consumer leader are the ability to recognise the diverse range
of human experiences and the fundamental belief that people can live fulfilling and meaningful lives.
Consumer leadership is a growing role in the mental health sector. I am excited to be involved in the
future of our health services and how wider society views mental health.
Office of the Director of Mental Health Annual Report 2013
3

Specialist mental health services
Many people experiencing mental illness are supported by their general practitioner (GP) or another
primary health care provider. Specialist mental health services provide support to people whose needs
cannot be met by a primary care provider. In 2013, 154,3782 people (3.5 percent of the New Zealand
population) engaged with a specialist mental health or addiction service.
Figure 1: Number of people engaging with specialist services each year, 2002 to 2013
Number of clients
160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
0  2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013


Year
Source: PRIMHD data, extracted on 3 October 2014
Figure 1 shows that the number of people engaging with specialist services steadily increased from
2002 to 2013. The rise in specialist service users could be due to a range of factors, including better
data capture, increased NGO reporting, a growing New Zealand
population,3 improved visibility of and access to services, and
In 2013, 154,378 people
stronger referral relationships between providers.
engaged with a specialist
mental health or addiction
DHBs are responsible for funding, planning and providing specialist  service.
mental health services for their respective populations. Mental
health services are provided directly by DHBs, or indirectly by contracting between DHBs and NGOs.
In most DHB areas, directly provided specialist mental health services include hospital mental health
care and community mental health services. NGOs provide a range of significant mental health
services in each area, which can include alcohol and other drug treatment, kaupapa Māori services,
family support, supported accommodation and home-based support.
Most people access
Most people access mental health services in the community. In 2013,
mental health services
91 percent of specialist service users accessed only community mental
in the community.
health services (Figure 2). The remaining 9 percent accessed a mixture of
inpatient and community services. The proportion of people who receive
In 2013, 91 percent
treatment in the community has increased by 5 percent from 86 percent
of specialist service
in 2002.
users accessed only
community mental
health services.
2.  If people seen by addiction services only are excluded, the total number of people who engaged with a specialist mental health
service was 122,438. Source: PRIMHD, extracted 23 October 2014.
In addition, data on clients aged over 65 years is incomplete as health services for older people in the Central and Southern
regions do not report to PRIMHD.
3.  Between 2002 and 2013, the total New Zealand population increased by approximately 13.4 percent.
4
Office of the Director of Mental Health Annual Report 2013

Figure 2: Percentage of service users accessing only community services, 1 January to
31 December 2013
Inpatient and
community
services 9%

Only community
services 91%
Note: Includes NGOs.
Source: PRIMHD data, extracted on 2 September 2014
Sector voices
Leah Cooper – Social worker
Tēnā koutou katoa, ngā mihi mahana ki a koutou. Nō England, Wales, Ireland ōku
tīpuna. Kei te mahi au i Te Whare o Matairangi. He kaimahi a iwi ahau. Ko Leah
Cooper tōku ingoa. Kia ora koutou.
I am a social worker at Te Whare o Matairangi, the adult acute mental health ward
based at Wellington Hospital. We have a team of three social workers within a
wider multidisciplinary team, which I feel privileged to be part of.
The social work role is hard to define; however, the International Federation of Social Workers
describes social work as focusing on social change, problem solving and empowerment of people who
are working towards wellbeing. Social work intervenes at the points where people interact with their
environments, using the underlying principles of human rights and social justice.
A large part of my role is liaising with the support networks of patients: family, friends, community
mental health teams and non-governmental organisations. Family members often find the
experience of a loved one being hospitalised extremely stressful. It is important to support families
by acknowledging their distress, as well as providing education around mental illness in order to
normalise what has happened. It is crucial to always maintain hope in recovery and this is something
that I hold on to, often when tāngata whaiora and their families cannot.
I was drawn to this role as I have a strong sense of social justice. A large number of the people I see are
impacted by poverty, racism, sexism and experiences of significant trauma, often in childhood.
I really enjoy the diversity of my role. Each day is different; as is every family and individual I work
with. Mental health issues affect many people from all walks of life. The people are the reason I am
drawn to this work. It is amazing to see people’s recovery in the often short period of time they are with
us in the unit. The people I work for are remarkable in their resilience and strength. People always have
the potential for change and I am able to see this in my work and to be a small part of the journey.
Office of the Director of Mental Health Annual Report 2013
5

The Mental Health (Compulsory Assessment
and Treatment) Act 1992
The Mental Health (Compulsory Assessment and Treatment) Act 1992 defines the circumstances under
which people may be subject to compulsory mental health assessment and treatment.
The Mental Health Act provides a framework for balancing personal rights and the public interest
when a person poses a serious danger to themselves or others due to mental illness.
The purpose of the Mental Health Act is to:
redefine the circumstances in which and the conditions under which persons may be subjected
to compulsory psychiatric assessment and treatment, to define the rights of such persons and to
provide better protection for those rights, and generally to reform and consolidate the law relating
to the assessment and treatment of persons suffering from mental disorder.4
The ‘Ensuring service quality’ section provides data on the use of the Mental Health Act.
Administration of the Mental Health Act
The chief statutory officer under the Mental Health Act is the Director of Mental Health, appointed
under section 91 (the Director). The Director is responsible for the general administration of the Mental
Health Act under the direction of the Minister of Health and Director-General of Health. The Director
is also the Chief Advisor, Mental Health, and is responsible for advising the Minister of Health on
mental health issues.
The Mental Health Act also allows for the appointment of a Deputy
The Mental Health Act
Director of Mental Health. The Director’s functions and powers
provides a framework
under the Mental Health Act allow the Ministry to provide guidance
for balancing personal
to mental health services, supporting the strategic direction of Rising
rights and the public
to the Challenge and a recovery-based approach to mental health.
interest when a person
poses a serious danger to
In each DHB, the Director-General of Health appoints a director
themselves or others due
of area mental health services (DAMHS) under section 92 of the
Mental Health Act. The DAMHS is a senior mental health clinician,
to mental illness.
responsible for administering the compulsory treatment regime
within their DHB area. They must report to the Director of Mental Health every three months regarding
the exercise of their powers, duties and functions under the Mental Health Act (Ministry of Health
2012b).
In each area, the DAMHS will appoint responsible clinicians and assign them to lead the treatment of
every person subject to compulsory assessment or treatment (Ministry of Health 2012a). The DAMHS
will also appoint competent health practitioners as duly authorised officers to respond to people
experiencing mental illness in the community who are in need of intervention. Duly authorised
officers are required to provide general advice and assistance in response to requests from members
of the public and the New Zealand Police. If a duly authorised officer believes that a person may be
mentally disordered and may benefit from a compulsory assessment, the Mental Health Act grants
them powers to arrange for a medical examination (Ministry of Health 2012c).
4. Mental Health (Compulsory Assessment and Treatment) Act 1992, long title.
6
Office of the Director of Mental Health Annual Report 2013

Protecting the rights of people subject to compulsory treatment
Although each DAMHS is expected to protect the rights of people under the Mental Health Act in their
area, the Mental Health Act also provides for independent monitoring mechanisms. The Minister of
Health appoints qualified lawyers as district inspectors under section 94 of the Mental Health Act to
protect the rights of people under the Mental Health Act, investigate alleged breaches of those rights
and monitor service compliance with the Mental Health Act process. District inspectors are required
to inspect services regularly and report on their activities monthly to the Director of Mental Health.
From time to time the Director can initiate an investigation under section 95 of the Mental Health Act,
in which case a district inspector is granted powers to conduct an inquiry into a suspected failing in a
person’s treatment under the Mental Health Act or in the management of services (Ministry of Health
2012b).
The Mental Health Act also provides for the appointment of the Mental Health Review Tribunal, a
specialist independent tribunal comprising a lawyer, a psychiatrist and a community member. If a
person disagrees with their treatment under the Mental Health Act, they can apply to the Tribunal for
an examination of their condition and of whether it is necessary to continue compulsory treatment.
Where the tribunal considers it appropriate, the person may be released from compulsory status.
Sector voices
Sue Mackersey – Director of area mental health services
Kia ora. I am Sue Mackersey, director of area mental health services for the Bay of
Plenty District Health Board. I have been a specialist psychiatrist for over 20 years.
All DAMHS are senior mental health clinicians. Most, but not all, are psychiatrists.
My role provides a point of contact between the Office of the Director of Mental
Health and the local DHB mental health and addiction services. I keep the Director
informed about the use of the Mental Health Act in the Bay of Plenty and any
significant issues we are experiencing in the delivery of services. DAMHS make sure
that each patient has a responsible clinician and that there are duly authorised officers available at all
times.
DAMHS are involved in a range of governance roles so that they can influence decision-making about
resourcing of local services. In delivering safe and high-quality services, the challenge is often getting
adequate resourcing.
There are many relationships that a DAMHS needs to have, such as with the district inspectors, police
and courts. The most important relationships I have are with people who are in our service and their
family or whānau. I need to ensure that every person subject to compulsory assessment and treatment
has care provided by our service in accordance with the legislation. People under the Mental Health
Act, family, whānau and district inspectors let me know about issues that need rectifying.
To help me perform my role I am fortunate to have a team of experienced clinicians in the Bay of Plenty
who are committed to providing high-quality care.
Office of the Director of Mental Health Annual Report 2013
7

Activities for 2013
Mental health sector relationships
The Director of Mental Health visited each DHB mental health service at least once during the
reporting year. These visits give the Director an opportunity to engage with the services and get an
understanding of the particular constellation of challenges that the local mental health service is
facing, while offering Ministry support and oversight.
The Office of the Director of Mental Health also maintains collaborative relationships with many
parts of the mental health sector, attending and presenting at a large number of mental health sector
meetings each year.
Cross-government relationships
The Office of the Director of Mental Health maintains strong relationships with other government
agencies to support good clinical practice and client-centred services for people with mental health
and addiction problems.
In 2013 the Office of the Director of Mental Health worked with a number of agencies on a wide range of
projects, including:
• the Youth Crime Action Plan
• implementation of new youth forensic mental health and alcohol and drug services
• the Vulnerable Children’s Action Plan
• the Gateway Assessments programme
• implementation of the Autism Spectrum Guidelines
• the Prime Minister’s Youth Mental Health Project
• the interface between the youth justice system and mental health and addiction services.
Relationship with the Department of Corrections
The Ministry works closely with the Department of Corrections to improve the health services provided
to people detained in prisons. People detained in prison often have complex mental health needs,
which may require more intensive support than Corrections health services can give as a provider of
primary health care. Regional forensic psychiatry services support Corrections to access and treat
prisoners with complex mental health needs. Prisoners may be transferred to a hospital for treatment
in a therapeutic environment where necessary.
Relationship with New Zealand Police
People detained in police custody often have complex mental health needs. In addition, although
DHB mental health services operate emergency intervention teams, police are often required to be
the initial response to people whose mental illness appears to contribute to the person being a danger
to themselves or to others. It is therefore important for police and DHB mental health services to
maintain collaborative relationships.
8
Office of the Director of Mental Health Annual Report 2013

District inspectors
The Minister of Health appoints lawyers as district inspectors under section 94 of the Mental Health
Act to ensure people’s rights are upheld during the compulsory assessment and treatment process.
District inspectors work to protect specific rights provided to people
District inspectors
under the Mental Health Act, address concerns of family and whānau, work to protect people’s
and investigate alleged breaches of rights, as set out in the Act.
rights under the Mental
Health Act.
The Office of the Director of Mental Health’s responsibilities in
relation to district inspectors include:
• coordinating the appointment and reappointment of district inspectors by the Minister of Health
• managing district inspector remuneration
• receiving and responding to monthly reports from the district inspectors
• organising twice-yearly national meetings of district inspectors
• facilitating inquiries under section 95 of the Mental Health Act
• implementing the findings of section 95 inquiries by district inspectors.
The role of district inspectors
District inspectors are required to report to the DAMHS within 14 days of inspecting mental health
services. They are also required to report monthly to the Director of Mental Health on the exercise
of their powers, duties and functions. These reports provide the Director with an overview of mental
health services and any problems arising from them.
Section 95 reports completed by 31 December 2013
The Director will occasionally require a district inspector to undertake an inquiry under section
95 of the Mental Health Act. Such inquiries are generally focused on systemic issues across one
or more mental health services. A typical result of these inquiries is that the district inspector
makes recommendations. The Director will consider the recommendations and audit the DHB’s
implementation of relevant recommendations.
The Director will also act on any recommendations that have implications for the Ministry of Health
and/or the mental health sector generally. The inquiry process is not completed until the Director
considers that the recommendations have been satisfactorily implemented by the DHB and, if
appropriate, by the Ministry and all DHBs.
No section 95 inquiries were completed during 2013. A section 95 inquiry remained ongoing from 2012,
and another inquiry was initiated during late 2013. Table 1 shows the number of completed section 95
inquiry reports received by the Director of Mental Health between 2003 and 2013.
Table 1: Number of completed section 95 inquiry reports received by the Director of Mental Health,
2003 to 2013
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
1
2
1
4
1
1
3
2
1
1
0
Number of district inspectors
As at 31 December 2013 there were 34 district inspectors appointed throughout New Zealand. One
senior advisory district inspector is appointed to provide leadership and advice to the other district
inspectors. A list of current district inspectors is available on the Ministry of Health website
(www.health.govt.nz).
Office of the Director of Mental Health Annual Report 2013
9

Sector voices
Barry Wilson – District inspector
Hello, I’m Barry Wilson and I’m a district inspector for mental health covering
Auckland and Northland regions.
The role of the district inspector is unique to New Zealand. District inspectors are
statutory officers acting in a watchdog role for people’s rights under the Mental
Health Act. We are there to ensure that every person subject to compulsory
assessment and treatment under the Mental Health Act is cared for in accordance
with the Mental Health Act’s requirements.
For me, the challenge of the job is about building successful relationships, both with people receiving
treatment (in hospital and in the community) and with the dedicated staff who serve their needs.
Most of the time I am dealing with very vulnerable people. If a person feels that I can assist his or her
situation I must, above all, maintain lines of communication and remain alert to the person’s concerns.
‘Active listening’ is a key requirement of the job.
Features of a month’s work might include:
• ensuring a person’s objection to staying in hospital is heard by a judge
• ensuring a mother’s voice is heard by a person’s responsible clinician
• conducting an inquiry into whether a person who died had received appropriate medical treatment.
In visiting mental health facilities, I’m acting as the ‘eyes and ears’ of the Director of Mental Health.
It is my role to inform the Director of any irregular patterns that may be emerging; for instance, the
excessive use of restraint or seclusion in a mental health unit.
I have been a district inspector for nine years. My longstanding interest in civil liberties has helped to
sustain me in this interesting and important role.
Special patients and restricted patients
Special patients and restricted patients are covered by Part 4 of the Mental Health Act. Their treatment
is provided in accordance with either the Mental Health Act or the Criminal Procedure (Mentally
Impaired Persons) Act 2003.
Special patients include:
• people charged with, or convicted of, a criminal offence and remanded to a secure hospital for a
psychiatric report
• remanded or sentenced prisoners transferred from prison to a secure hospital
• defendants found not guilty by reason of insanity
• defendants unfit to stand trial
• people who have been convicted of a criminal offence and both sentenced to a term of
imprisonment and placed under a compulsory treatment order.
Restricted patients include people detained by a court order because of the special difficulties they
present from the danger they pose to others.
Special and restricted patients are detained in the care of one of the five regional forensic psychiatry
services throughout New Zealand. These services develop management plans to progressively
reintegrate these people into community settings as treatment improves their mental health.
10
Office of the Director of Mental Health Annual Report 2013

The Director of Mental Health has a central role in the
Special patients found not
management of special patients and restricted patients. The
guilty by reason of insanity
Director may direct their transfer under section 49 of the Mental
may be considered for a
Health Act, or grant leave for any period not exceeding seven
change of legal status if it
days for certain special and restricted patients (section 52).
is determined that their
detention is no longer
Longer periods of leave are granted by the Minister of Health
necessary to safeguard the
(section 50) and are available to certain categories of special
patients. The Director briefs the Minister of Health when
interests of the person or the
requests for leave are made.
public.
The Director must also be notified of the admission, discharge or transfer of special and restricted
patients, and certain incidents involving these people (section 43). The process for reclassifying
special and restricted patients differs according to the person’s particular status, but always requires
ministerial involvement.
Special patients found not guilty by reason of insanity may be considered for a change of legal status
if it is determined that their detention is no longer necessary to safeguard the interests of the person
or the public. Applications for changes of legal status are sent to the Director of Mental Health. After
careful consideration, the Director will make a recommendation to the Minister about a person’s legal
status.
Table 2 shows the section 50 long-leave applications, revocations and change of status applications
processed by the Office of the Director of Mental Health during 2013.
Table 2: Number of Ministerial long-leave, revocation and reclassification applications for special and
restricted patients, 1 January to 31 December 2013
Number of applications
Type of request
Initial ministerial section 50 leave applications
7
Initial ministerial section 50 leave applications not approved
1
Ministerial section 50 leave revocations
2
Further ministerial section 50 leave applications
27
Change of legal status applications approved
3
Change of legal status applications not approved
1
Total
41
Note: No applications were received in 2013 for restricted patients or defendants unfit to stand trial.
Source: Office of the Director of Mental Health records
Prisoner transfers to hospital
Once a person has been sentenced to a term of imprisonment, any compulsory treatment order relating
to the prisoner ceases to have effect. Remand prisoners may remain on a pre-existing compulsory
treatment order, but it is unlawful to enforce compulsory treatment in the prison environment. If
compulsory assessment and/or treatment is required, section 45 of the Mental Health Act provides for
the transfer to hospital of mentally disordered prisoners. Section 46 allows for voluntary admission to
hospital with the approval of the prison superintendent. Services are required to notify the Director of
Mental Health of all such admissions.
Table 3 shows the number of people who have been transferred from prison to hospital under either
section 45 or section 46 from 2001 to 2013.
Office of the Director of Mental Health Annual Report 2013
11

Table 3: Number of people transferred to hospital from prison under sections 45 and 46 of the Mental
Health Act, 2001 to 2013
Year
Number of prisoners
Number of prisoners
transferred to hospital for transferred to hospital
compulsory treatment (s 45)
voluntarily (s 46)
2001
134
4
2002
96
0
2003
113
2
2004
121
1
2005
117
8
2006
128
16
2007
98
2
2008
80
2
2009
120
12
2010
105
11
2011
85
4
2012
84
3
2013
132
5
Source: Manual data provided by DHBs
The Mental Health Review Tribunal
The Mental Health Review Tribunal (the Tribunal) is an independent tribunal empowered by law to
review compulsory treatment orders, special patient orders and restricted patient orders. If a person
disagrees with their legal status or treatment under the Mental Health Act, they can apply to the
Tribunal for an independent review of their condition.
The Tribunal comprises three members, one of whom must be a lawyer, one a psychiatrist and the
third a community member.
A selection of the Tribunal’s published cases is
If a person disagrees with their
available to the public on the New Zealand Legal
legal status or treatment under the
Information Institute website (www.nzlii.org/nz/
Mental Health Act, they can apply
cases/NZMHRT). These cases have been carefully
to the Tribunal for an independent
anonymised to respect the privacy of the individuals,
review of their condition.
family and whānau involved. The intention of
publishing important and helpful cases is to help the public to have a better understanding of the work
of the Tribunal and of mental health law and practice.
The main function of the Tribunal is to review the condition of people in accordance with sections 79
and 80 of the Mental Health Act. Section 79 relates to people who are subject to ordinary compulsory
treatment orders, and section 80 relates to the status of special patients. During the year ending
30 June 2013, the Tribunal heard 102 cases of contested treatment orders. In five cases (5 percent), a
person was deemed fit to be released from compulsory status.
The Tribunal has a number of other functions under the Mental Health Act, including reviewing
the condition of restricted patients (section 81), considering complaints (section 75) and appointing
psychiatrists authorised to carry out second opinions under the Mental Health Act (sections 59–61).
12
Office of the Director of Mental Health Annual Report 2013

Under section 80 of the Mental Health Act, the Tribunal makes
During the year ending
recommendations relating to special patients to the Minister
30 June 2013, the Tribunal
of Health or the Attorney-General. It is for the Minister or
heard 102 cases of contested
Attorney-General to determine whether there should be a
treatment orders. In five cases
change to a special patient’s legal status.
(5 percent), a person was
deemed fit to be released from
The Tribunal may also investigate a complaint if the
compulsory status.
complainant is dissatisfied with a district inspector’s
investigation. If the Tribunal decides a complaint has
substance, it must report the matter to the relevant director of area mental health services (DAMHS),
with appropriate recommendations. The DAMHS must then take all necessary steps to remedy the
matter.
For more information about the Tribunal’s activities for the year ending 30 June 2013, see Appendix 1.
Sector voices
Phyllis Tangitu – Mental Health Review Tribunal member
Te Arawa te waka
Matawhaura te maunga
Rotoiti te roto
Tamateatutahi me Ngāti Kawiti ōku hapū
Ko Pikiao ahau.
Tēnā koutou katoa.
Kia ora. My name is Phyllis Tangitu and I am the community member of the Mental Health Review
Tribunal.
I was a deputy member of the Tribunal for 12 years and in 2012 I was appointed as the key community
member. I am a mum to three sons, nanny to three beautiful mokopuna and partner to Wi. My
experience in mental health comes from having whānau experience mental health issues and 20 years
of work in the mental health and addiction sector.
The principal function of the Tribunal is to consider the condition of a person who has applied for a
review of their treatment order. The Tribunal comprises three members: a lawyer (by convention the
conveyor), a psychiatrist and a community member. At a hearing, members of the Tribunal will review
a person’s file, listen to the evidence presented of a medical, legal, personal and family nature, clarify
the key issues for that person’s present and future mental health and wellbeing and come to a decision
regarding whether the person’s condition justifies the order to which he or she is subject.
We are a quasi-judicial board; however, it has been important that individuals, families and whānau
understand the process and are welcomed to a hearing. It is also important that the hearings are
located in a comfortable environment and there is respect and acknowledgement paid to any cultural
needs the person and their family or whānau may have (eg, opening with a mihi/greeting or karakia).
The Tribunal has used cultural practice during hearings, and has encouraged families and whānau to
participate in the hearing process.
Office of the Director of Mental Health Annual Report 2013
13

Ensuring service quality

As a sector we are all working together to get better mental health care to more people sooner. Central
government, district health boards, non-governmental organisations, international bodies (such as the
United Nations and World Health Organization) and independent watchdogs (such the Office of the
Ombudsman and district inspectors) all work in collaboration to
achieve this goal.
As a sector, we are all
working together to get
Actively monitoring the performance of DHBs and NGOs is
better mental health care to
vital to ensuring service quality and safety. The Ministry and
more people sooner.
wider government set goals and targets for the sector aimed
at improving outcomes for the people who use mental health services. Reporting from the sector is
integral to this process, as it allows the Ministry to measure progress against these goals.
This section presents statistics on a number of mental health indicators concerned with general
mental health service use, as well as compulsory care under the Mental Health Act.
Statistics include consumer satisfaction surveys, waiting times, relapse prevention plans, the
Mental Health Act, Māori and section 29 of the Mental Health Act, seclusion in inpatient units,
electroconvulsive therapy, serious adverse events and opioid substitution treatment.
Consumer satisfaction surveys
Since 2006, National Mental Health Consumer Satisfaction Surveys have been conducted as part of
measuring DHB service quality and consumer outcomes. Survey participants are people who received
treatment from specialist mental health community services in DHBs around New Zealand.
In summary, in the 2012/13 fiscal year:
• 80 percent of people surveyed agreed with the statement ‘overall I am satisfied with the services I
received’.
In 2006 half of the DHBs in New Zealand participated in the survey, gathering a total of 596
respondents. Since then, participation has grown to the point that in 2013 all 20 DHBs participated,
attracting a total of 3282 respondents.
Survey results
In the 2012/13 fiscal year, 80 percent of respondents either agreed or strongly agreed with the statement
‘overall I am satisfied with the services I received’ (Figure 3). Another 10 percent gave an in-between
rating, 4 percent disagreed and 6 percent strongly disagreed.
14
Office of the Director of Mental Health Annual Report 2013

Figure 3: Responses to the statement ‘overall I am satisfied with the services I received’
Strongly
disagree
6%
Disagree
4%
In between
10%
Strongly
Agree
agree 44%
36%
Source: National Mental Health Consumer Satisfaction Survey 2012/13
In addition to overall satisfaction, other results were that:
• 61 percent of respondents agreed with the statement ‘as a result of the services I have received, I feel
that I do better in my personal relationships’
• 82 percent agreed that ‘I feel comfortable asking questions about my medication and treatment’
• 80 percent agreed that ‘staff have helped me to remain living in the community’
• 85 percent agreed that ‘there is at least one member of staff who believes in me’.
Waiting times
Waiting times are a measure of how long ‘new’ clients wait to been seen by mental health and addiction
services. ‘New’ clients are defined as people who have not accessed mental health or addiction services
in the past year.
Waiting times reflect the length of time between the day when a person is referred to a mental health or
addiction service and the day when the person is first seen by the service.
By 30 June 2015, DHBs are required to meet a sector-wide target where 80 percent of people referred
for non-urgent mental health or addiction services are seen within three weeks, and 95 percent of
people are seen within eight weeks.
The sector continues to approach this goal. In the 2012/13 fiscal year, 78 percent of all clients of mental
health and addiction services were seen within three weeks and 93 percent were seen within eight
weeks (Figure 4).
Office of the Director of Mental Health Annual Report 2013
15

Figure 4: Percentage of people seen by mental health and addiction services within three and eight
weeks, 2012/13 fiscal year
> 3 weeks
> 8 weeks
22%
7%
< 3 weeks
< 8 weeks
78%
93%
Source: PRIMHD data, extracted on 25 September 2013
Relapse prevention plans
In 2007, the Director-General of Health introduced a health target requiring that at least 95 percent
of people who have used mental health and addiction services for over two years must have a relapse
prevention plan.
In summary, in 2013:
• 91 percent of long-term service users across the country had a relapse prevention plan, up from
59 percent in 2007 (Figure 5)
• 6 of the 20 DHBs achieved the 95 percent target.
In 2013, 91 percent of long-term
service users across the country
A relapse prevention plan identifies the early warning
had a relapse prevention plan,
signs for a person. It identifies what the person can do for
up from 59 percent in 2007.
themselves and what the service will do to support them.
Ideally, the person will develop their own plan with support from their clinician and their family and
whānau. The plan represents an agreement between parties. Each plan will vary according to the
individual involved. Each person will know of (and ideally have a copy of) their plan.
DHBs reported twice during 2013. The first reporting period covered 1 January to 30 June and the
second 1 July to 31 December. Figure 6 shows the results of DHBs’ reporting for the 2013 calendar year.
During 2013, 6 of the 20 DHBs achieved the 95 percent target for both reporting periods.
Figure 5: Percentage of long-term service users with a relapse prevention plan, 2007 to 2013
Percent
91%
100
90
80
70
60
50
40
30
20
10
0
2007
2008
2009
2010
2011
2012
2013

Year
Source: DHB quarterly reporting data
16
Office of the Director of Mental Health Annual Report 2013

Figure 6: Percentage of service users with a relapse prevention plan, by DHB, 1 January to
31 December 2013
Percent
100
Target
90
January to
80
June 2013
70
July to
60
December 2013
50
40
30
20
10
0
Lakes
Auckland
Southern
Taranaki
Waikato
Canterbury
MidCentral
Northland
Tairawhiti
Wairarapa
Waitemata
West Coast
Whanganui
Bay of Plenty
Hawke’s Bay
Hutt Valley
Capital & Coast
Counties Manukau
South Canterbury
Nelson Marlborough
DHB
Source: DHB quarterly reporting data
Use of the Mental Health Act
The Mental Health Act defines the circumstances under which people may be subject to compulsory
mental health assessment and treatment. It provides a framework for balancing personal rights and
the public interest when a person has a diminished capacity to care for themselves or poses a serious
danger to themselves or others due to mental illness.
In summary, in 2013:
• 10,270 people (approximately 8 percent of specialist mental health service users) came into contact
with the Mental Health Act
• on a given day in the year, approximately 6340 people were subject to either compulsory assessment
or compulsory treatment under the Mental Health Act
• use of the Mental Health Act varied across district health boards
• males were more likely to be subject to the Mental Health Act than females
• people aged 25 to 34 years were the most likely to be subject to compulsory treatment, and people
over 65 years of age were the least likely
• Māori were more likely to be under the Mental Health Act than non-Māori.
The Mental Health Act process
The compulsory assessment and treatment process begins with a referral and an initial assessment by
a psychiatrist. If the psychiatrist believes a person fits the criteria for the Mental Health Act and needs
to be further assessed, the person will become subject to compulsory assessment under the Mental
Health Act.
Office of the Director of Mental Health Annual Report 2013
17

Compulsory assessment
Compulsory assessment can take place in
Initial
either a community or a hospital setting.
assessment
There are two periods of compulsory
assessment, during which a person’s clinician
may release them from assessment at any
time.
First period of
assessment (s11)
During the assessment period, people are
(up to five days)
obliged to receive treatment as prescribed by
their responsible clinician.
Second period of
The first period (section 11 of the Mental
assessment (s13)
Health Act) is for up to five days. The second
(up to 14 days)
period (section 13) can last up to 14 days.
Following the first two assessment periods,
Application to the court
an application can be made to the Family
for a compulsory
or District Court (section 14(4)) to place the
treatment order (s14(4))
person on a compulsory treatment order.
(up to 14 days)
At any time during the compulsory
assessment process, the person (or someone
acting on their behalf) can request a judicial
review to review their condition and
Community
Inpatient
determine whether it is appropriate that they
treatment order
treatment order
continue to receive assessment under the
(s29)
(s30)
Mental Health Act.
A judicial review consists of a hearing in the District Court. Based on information provided by
clinicians, a judge will decide whether the person should continue to be compulsorily assessed.
During 2013, there were approximately 1157 applications considered under section 16 of the Mental
Health Act. Of this total, an order for release of the person from compulsory status was issued in 35
cases (5.3 percent of the applications that proceeded to hearings).5
Compulsory treatment
There are two types of compulsory treatment orders. One is for treatment in the community (a section
29 order) and the other is for treatment in an inpatient unit (a section 30 order). An inpatient treatment
order can be converted into a community treatment order at any time by the person’s responsible
clinician.
The Mental Health Act provides a
A responsible clinician may also grant a person leave
framework for balancing personal
from the inpatient unit for treatment in the community
for up to three months (section 31).
rights and the public interest when
a person has a diminished capacity
Most people subject to compulsory treatment access it
to care for themselves or poses a
in the community (approximately 88 percent in 2013)
serious danger to themselves or
(sections 29 and 31).
others due to mental illness.
5. Data extracted from the Ministry of Justice’s Case Management System as at 26 June 2014.
18
Office of the Director of Mental Health Annual Report 2013

Statistics
During 2013, approximately 10,270 people came into contact with the Mental Health Act
(approximately 8 percent of all specialist mental health service users in 2013). On average, 6340 people
were subject to either compulsory assessment or compulsory treatment on a given day.6
In New Zealand in each month of 2013, on average:7
432
10 people
people per month were subject
Section 11
per 100,000
to an initial assessment under
population
s11 of the MHA
389
9 people
Section 13
people per month were subject
per 100,000
to a second period of assessment
population
under s13 of the MHA
263
6 people
Section 14(4)
people per month were subject
per 100,000
to an application for a compulsory
population
treatment order under s14(4) of the MHA
In New Zealand on a given day in 2013, on average: 8
3569
80 people
Section 29
people on a given day
per 100,000
were subject to a
community treatment order
population
530
12 people
Section 30
people on a given day
were subject to an
per 100,000
inpatient treatment order
population
156
3 people
Section 31
people on a given day
per 100,000
were on temporary leave from
an inpatient unit
population
Compulsory assessment and treatment by DHB
Table 4 shows the average number of people per month required to undergo assessment and treatment
for each DHB in 2013. Table 5 shows the average number of people subject to a compulsory treatment
order on a given day in 2013, with data again broken down by DHB. The figures that follow also present
the average number of people on a compulsory treatment order on a given day, but focus specifically
on community treatment orders (Figure 7) or inpatient treatment orders (Figure 8).
6.  PRIMHD data, extracted on 21 July 2014.
7.  Manual data provided by DHBs, except for Auckland, Counties Manukau, Southern, Taranaki and West Coast, which is
PRIMHD data, extracted on 8 August 2014.
8.  Manual data provided by DHBs, except for Auckland, Counties Manukau, Southern, Taranaki and West Coast, which is
PRIMHD data, extracted on 14 August 2014.
Office of the Director of Mental Health Annual Report 2013
19

Table 4: Average number of people per 100,000, per month required to undergo assessment under
sections 11, 13 and 14(4) of the Mental Health Act, by DHB, 1 January to 31 December 2013
DHB
s 11
s 13 s 14(4)
DHB
s 11 s 13 s 14(4)
Auckland
11
10
7
Northland
14
14
13
Bay of Plenty
10
7
5
South Canterbury
9
7
4
Canterbury
11
11
7
Southern
8
6
4
Capital & Coast
12
11
8
Tairawhiti
12
11
8
Counties Manukau
9
8
5
Taranaki
8
5
3
Hawke’s Bay
10
8
4
Waikato
12
8
7
Hutt Valley
12
12
5
Wairarapa
5
1
0
Lakes
8
6
6
Waitemata
8
8
6
MidCentral
10
7
4
West Coast
9
5
4
Nelson Marlborough
9
7
4
Whanganui
12
8
5
National average
10
9
6
Note: Manual data supplied by DHBs has been used for most DHBs. This decision was made after issues with
2013 PRIMHD data were identified. These issues will be addressed, with the intention of returning to
PRIMHD for future Annual Reports.
Source: Manual data provided by DHBs, except for Auckland, Counties Manukau, Southern, Taranaki and West Coast
which is PRIMHD data, extracted on 14 August 2014
Table 5: Average number of people per 100,000, on a given day subject to sections 29, 30 and 31 of the
Mental Health Act, by DHB, 1 January to 31 December 2013
DHB
s 29 s 30 s 31
DHB
s 29 s 30 s 31
Auckland
93
7
–
Northland
177
8
6
Bay of Plenty
46
9
5
South Canterbury
79
23
14
Canterbury
58
20
6
Southern
71
15
3
Capital & Coast
100
25
3
Tairawhiti
114
3
9
Counties Manukau
69
16
4
Taranaki
60
4
1
Hawke’s Bay
47
4
2
Waikato
100
8
4
Hutt Valley
66
9
1
Wairarapa
80
8
0
Lakes
117
2
6
Waitemata
80
5
0
MidCentral
59
9
7
West Coast
66
11
5
Nelson Marlborough
76
12
2
Whanganui
86
37
1
National average
80
12
3
Note: Manual data supplied by DHBs has been used for most DHBs. This decision was made after issues
with 2013 PRIMHD data were identified. These issues will be addressed, with the intention of
returning to PRIMHD for future Annual Reports.
Source: Manual data provided by DHBs, except for Auckland, Counties Manukau, Southern, Taranaki and West Coast
which is PRIMHD data, extracted on 14 August 2014
20
Office of the Director of Mental Health Annual Report 2013

Figure 7: Average number of people per 100,000 on a given day subject to a community treatment
order (section 29 of the Mental Health Act), by DHB, 1 January to 31 December 2013
Rate per 100,000
250
200
150
100
National average
50
0
Lakes
Auckland
Southern
Taranaki
Waikato
Canterbury
MidCentral
Northland
Tairawhiti
Wairarapa
Waitemata
West Coast
Whanganui
Bay of Plenty
Hawke’s Bay
Hutt Valley
Capital & Coast
Counties Manukau
South Canterbury
Nelson Marlborough DHB
Notes: Confidence intervals (for 99 percent confidence) have been used to aid interpretation. Where a DHB region’s
confidence interval crosses the national average, this means the DHB’s rate was not statistically significantly
different to the national average.

Manual data supplied by DHBs has been used for most DHBs. This decision was made after issues with 2013
PRIMHD data were identified. These issues will be addressed, with the intention of returning to PRIMHD for
future Annual Reports.
Source: Manual data provided by DHBs, except for Auckland, Counties Manukau, Southern, Taranaki and West Coast
which is PRIMHD data, extracted on 14 August 2014
Figure 8: Average number of people per 100,000 on a given day subject to an inpatient
treatment order (section 30 of the Mental Health Act), by DHB, 1 January to 31 December 2013
Rate per 100,000
70
60
50
40
30
20
10
National average
0
Lakes
Auckland
Southern
Taranaki
Waikato
Canterbury
MidCentral
Northland
Tairawhiti
Wairarapa
Waitemata
West Coast
Whanganui
Bay of Plenty
Hawke’s Bay
Hutt Valley
Capital & Coast
Counties Manukau
South Canterbury
Nelson Marlborough DHB
Notes: Confidence intervals (for 99 percent confidence) have been used to aid interpretation. Where a DHB region’s
confidence interval crosses the national average, this means the DHB’s rate was not statistically significantly
different to the national average.

Manual data supplied by DHBs has been used for most DHBs. This decision was made after issues with 2013
PRIMHD data were identified. These issues will be addressed, with the intention of returning to PRIMHD for
future Annual Reports.
Source: Manual data provided by DHBs, except for Auckland, Counties Manukau, Southern, Taranaki and West Coast
which is PRIMHD data, extracted on 14 August 2014
Office of the Director of Mental Health Annual Report 2013
21

Compulsory treatment by age and gender
During 2013:
• people aged 25 to 34 years were the most likely to be subject to a compulsory treatment order
(177 per 100,000) and people over 65 years of age were the least likely (51 per 100,000) (Figure 9)
• males were 1.5 times more likely to be subject to a compulsory treatment order (105 people per
100,000) than females (69 people per 100,000) (Figure 10).
Figure 9: Number of people per 100,000 subject to compulsory treatment order applications
(including extensions), by age group, 2004 to 2013
Rate per 100,000
200
180
25–34
160
35–44
140
45–54
120
15–24
100
Total
55–64
80
60
65+
40
20
0–14
0  2004  2005  2006  2007  2008  2009  2010  2011  2012  2013



    Year
Source: Ministry of Justice’s Integrated Sector Intelligence System, which uses data entered into the Case Management
System (CMS). The CMS is a live operational database, and figures are subject to minor changes at any time.
Figure 10: Number of people per 100,000 subject to compulsory treatment order applications
(including extensions), by gender, 2004 to 2013
Rate per 100,000
120
Male
100
Total
80
Female
60
40
20
0  2004  2005  2006  2007  2008  2009  2010  2011  2012  2013



    Year
Source: Ministry of Justice’s Integrated Sector Intelligence System, which uses data entered into the Case Management
System (CMS). The CMS is a live operational database, and figures are subject to minor changes at any time.
22
Office of the Director of Mental Health Annual Report 2013

Sector voices
Patrick Pora
Questions by Kieran Moorhead (consumer leader)
What was the experience like when you were first undergoing the Mental
Health Act process?
I was first under the Mental Health Act about nine years ago. At the time I was
regularly using methamphetamine which is when I first started becoming
unwell and experiencing symptoms of psychosis. During that time one of my
family members began the process of me going under the Mental Health Act.
I decided that I didn’t want to be a part of the group of my old school friends who were using meth;
I wanted to get out of that life and stop doing the same old things. I broke away from the people that
influenced me to become unwell. Now I’m trying to help people and represent them.
What has it been like being under the Mental Health Act?
It does really help, there are good times and bad times being under it – like the medication side effects
– and I’d like to eventually lower my medication but I know it’s all about balance. I hope to be able to
leave the Mental Health Act in the future, and get out and do things and help people. I have awesome
people around me that really care about me and always try and help me out. Family supporting you is
really important.
How did you find the mental health services when you were first using them?
It was the mental health people that were helping me. I didn’t have my family at the time, so I treated
them like my family.
I do feel safer and securer being under the Mental Health Act. With the support that I have had it’s
easier for me to get up, go for a walk, have a run and socialise with other people.
I’m here to support people that are under the Mental Health Act. I’d like to be a role model for people,
give them support and help them out.
Māori and section 29 of the Mental Health Act
This section presents data on Māori under community treatment orders (section 29 of the Mental
Health Act) in 2013. This is the first time information of this kind has been published in the Annual
Report. It is intended that this information will further underline the need for the mental health sector
to engage in meaningful action to address the disparity of mental health outcomes for Māori in New
Zealand.
In summary:
• during 2013 Māori were 2.9 times more likely to be under a community treatment order than
non-Māori (section 29 of the Mental Health Act)
• the ratio of Māori to non-Māori subject to section 29 varies by DHB
• reducing the disparity in mental health outcomes for Māori is a priority action for the Ministry of
Health and DHBs.9
9. This action is outlined in Rising to the Challenge (Ministry of Health 2012f). In addition, reducing the number of Māori subject
to section 29 of the Mental Health Act will be an indicator in forthcoming 2014/15 Māori Health Plans for every DHB.
Office of the Director of Mental Health Annual Report 2013
23

The high rate of Māori on compulsory treatment in New Zealand is a complex issue. Māori make up
approximately 15 percent of New Zealand’s population, yet they account for 25 percent of all mental
health service users. 10
The national mental health prevalence study, Te Rau Hinengaro
During 2013, Māori were
(Oakley Browne et al 2006), showed that Māori experience the
2.9 times more likely to
highest levels of mental health disorder overall. They are also more
be under a community
likely to experience serious disorders and co-morbidities than other
treatment order than
population groups.
non-Māori.
Other demographic features relevant to the high rate of Māori service
users include the youthfulness of the Māori population (approximately half of the population is under
25 years of age) and the disproportionate representation of Māori in low socioeconomic groups (two-
thirds live in deprivation deciles 7 to 10).
Analysis has shown that these demographic factors do not completely account for the high rate of
Māori with serious mental illness (ie, if Māori had the same age structure and level of socioeconomic
privilege as people in other groups, their rates of mental disorder would still be higher) (Oakley Browne
et al 2006). In addition, Māori experiencing mental health issues tend to present to health services at a
later stage of illness, when the need for treatment is more acute.
What other factors are involved in this disparity?
Elder and Tapsell (2013) emphasise that more research is needed to better understand the Māori
experience of the Mental Health Act and why Māori are over-represented in compulsory treatment.
They suggest that the following are important questions for the sector to consider.
• Are Māori receiving differential treatment in the mental health system?
• How can we build a more culturally competent workforce and reduce cultural bias from
formulations of mental illness?
• Are whānau of tāngata whaiora being sufficiently engaged by mental health services?
It is clear that the sector needs to be actively engaged with these questions in order to bring about
better outcomes for Māori. However, when asking these questions it is important to keep in mind the
significant improvements in the service provision to Māori that have been achieved over the last few
decades.
One of these improvements is the establishment of dedicated kaupapa Māori services in certain areas
around New Zealand. In 2013 Māori access rates to services exceeded the access rates of other groups
(5.65 percent of Māori accessed mental health services in 2013, compared with 3.43 percent of non-
Māori11). These higher access rates are likely to be a contributing factor to higher rates of Māori under
section 29.
Māori and section 29 of the Mental Health Act by DHB
Figure 11 shows variation around the country in regard to the disparity between Māori and non-Māori
subject to community treatment orders, with the Māori to non-Māori rate ratio ranging from 0.7:1 (West
Coast) to 5:1 (Bay of Plenty). DHBs whose Māori rate is significantly higher 12 than the New Zealand rate
include Auckland, Bay of Plenty, Counties Manukau and Waikato (all of which have a large population
of young Māori, the group most at risk for serious mental health problems).
10. PRIMHD data, extracted on 19 March 2014. This priority applies to both voluntary service users and those under the Mental
Health Act.
11. PRIMHD data, extracted on 19 March 2014.
12. Statistical difference was calculated with a 99 percent confidence interval.
24
Office of the Director of Mental Health Annual Report 2013

These numbers are difficult to interpret as it is hard to indicate what an ideal rate ratio would be for a
given population or DHB. What these numbers do make clear is that in-depth, area-specific knowledge
would be useful for understanding the particular disparities around the country and what could be
done at a local level to address them.
Figure 11: The rate ratio of Māori to non-Māori under section 29 of the Mental Health Act, by DHB,
1 January to 31 December 2013
Rate ratio of Ma¯ori:non-Ma¯ori
8
7
6
5
4
3
National average
2
1
No difference (1:1)
0
Lakes
Auckland
Southern
Taranaki
Waikato
Canterbury
MidCentral
Northland
Tairawhiti
Wairarapa
Waitemata
West Coast
Whanganui
Bay of Plenty
Hawke’s Bay
Hutt Valley
Capital & Coast
Counties Manukau
South Canterbury
Nelson MarlboroughDHB
Notes: New Zealand total is a unique client count – it is not a sum of the DHB figures. Some clients were under section 29
at more than one DHB.

While some data quality concerns have been identified for 2013 PRIMHD data on section 29, the ethnicity rate
ratio of the data set remains stable.

Confidence intervals (for 99 percent confidence) have been used to aid interpretation. Where a DHB region’s
confidence interval crosses the national average, this means the DHB’s rate was not statistically significantly
different to the national average.
Source: PRIMHD data, extracted on 22 August 2014
Future focus
Reducing the disparity of Māori mental health outcomes is a priority for the Ministry (Ministry of
Health 2012e). Publishing data on Māori who are under section 29 is a good first step towards gaining a
better understanding and awareness of Māori over-representation under the Mental Health Act. To add
to this, the Director of Mental Health intends to publish more comprehensive data on Māori who are
under the Mental Health Act in future Annual Reports.
The Director of Mental Health will continue to work alongside DHBs and other Ministry and
government groups to ensure the best possible mental health outcomes are being sought for Māori in
New Zealand.
Office of the Director of Mental Health Annual Report 2013
25

Sector voices
Hinemoa Elder – Psychiatrist
Kia ora koutou katoa, ko Parengarenga te moana, ko Tawhitirahi te maunga, ko
Awapoka te awa, ko Te Aupouri, Ngāti Kuri, Te Rarawa me Ngāpuhi nui tonu ōku
iwi. Ko Hinemoa Elder tōku ingoa.
My name is Hinemoa Elder and I am a psychiatrist. From time to time in my clinical
work I am involved with assessing and treating people under the Mental Health Act.
The Mental Health Act process can be set in motion at a time when someone
is perceived to be thinking and behaving in unusual and distressing ways. These concerns can be
self-identified, but more often they come from others such as friends and whānau. My job in these
situations is to ensure that the supports outlined in the law are put in place to reduce stress and
suffering for the person, their whānau and community, in addition to ensuring that appropriate
decisions are being made for the person regarding their health and the law.
I am also a deputy psychiatrist member of the Mental Health Review Tribunal. Together with legal and
community members we hold reviews for people treated under the Mental Health Act who wish to be
removed from compulsory status.
Whether working as part of a multidisciplinary team using the Mental Health Act or as a Tribunal
member, I continue to question how the Mental Health Act could be used to better serve Māori. Māori
are treated at higher rates under the Mental Health Act. Does this fact denote the appropriate use of the
law given that there are higher rates of serious mental illness in the Māori community, or is there some
other reason? Accurate reporting of Mental Health Act ethnicity data from around Aotearoa will give
us a better picture of the variability of the use of this law and provide a platform for quality research to
address these important questions.
While the Mental Health Act does not have specific mandated sections regarding working with Māori,
respect for cultural identity and the importance of recognition of ‘whānau, hapū and iwi’ links are
emphasised. The Mental Health Act also notes that ‘proper respect’ be paid to language. The extent
to which te reo Māori is offered as part of this legal process is not known and is another area ripe for
investigation.
Seclusion
Seclusion is ‘where a consumer is placed alone in a room or area, at any time and for any duration,
from which they cannot freely exit’.13
In summary, in adult mental health services in 2013:
• the number of people secluded decreased by 29 percent since 2009
• the total number of hours spent in seclusion decreased by 50 percent since 2009
• men were almost two times more likely to be secluded than women
• people aged 20 to 30 years were more likely to be secluded than other age groups
• Māori were more likely to be secluded than non-Māori.
The Health and Disability Services (Restraint Minimisation and Safe Practices) Standards came into
effect on 1 June 2009 (Standards New Zealand 2008b). The intent of the standards is to ‘reduce the use
13. The Health and Disability Services (General) Standard (Standards New Zealand 2008a).
26
Office of the Director of Mental Health Annual Report 2013

of restraint in all its forms and to encourage the use of least
Seclusion should be an
restrictive practices’.
uncommon event and should
be used only when there is an
In addition, reducing (and eventually eliminating) seclusion
imminent risk of danger to
is one of the goals of the Ministry’s service development plan,
the individual or others and
Rising to the Challenge (Ministry of Health 2012e).
no other safe and effective
Seclusion is provided for in section 71 of the Mental Health
alternative is possible.
Act. Seclusion can only occur where, and for as long as, it is
necessary for the care or treatment of the person, or for the protection of other people.
Seclusion rooms must be designated by the DAMHS and can be used only with the authority of a
person’s responsible clinician. The duration and circumstances of each episode of seclusion must be
recorded in a register, which must be available for review by district inspectors.
Seclusion should be an uncommon event and should be used only when there is an imminent risk
of danger to the individual or others and no other safe and effective alternative is possible. Seclusion
should never be used for the purposes of discipline, coercion or staff convenience, or as a substitute for
adequate levels of staff or active treatment.
The Ministry of Health guidelines on seclusion (Ministry of Health 2010) identify best practice
methods for using seclusion in mental health acute inpatient units. The intent of the revised guidelines
is to progressively decrease and limit the use of seclusion and restraint for mental health service users.
Te Pou o Te Whakaaro Nui (National Workforce Centre for Mental Health, Addiction and Disability)
supports the national direction set by the Ministry of Health for seclusion and restraint reduction
by using evidence-based information, such as the ‘Six Core Strategies’ of the National Technical
Assistance Centre (Huckshorn 2005). Te Pou works with DHBs to support their local initiatives. Further
information and stories of emerging good practice can be found on its website (www.tepou.co.nz).
Changes in the use of seclusion over time
Since 2009, when the seclusion reduction policy was introduced, the total number of people secluded
in adult services nationally has decreased by 29 percent. The number fell by 13 percent between 2012
and 2013.
Since 2009, the total number of seclusion hours for people in adult
Since 2009, the total
services nationally has decreased by 50 percent. Between 2012 and
number of seclusion
2013, the decrease was 21 percent.
hours for people in adult
services has decreased by
Figures 12 and 13 show a decrease in the number of people
50 percent. Between 2012
secluded in adult services (for ages 20 to 64 years) and in the total
and 2013, the decrease was
number of seclusion hours since 2007.
21 percent.
The declining trend for both the number of people and the total
number of hours spent in seclusion aligns with one of the goals of Rising to the Challenge (Ministry of
Health 2012e), to reduce and eventually eliminate the use of seclusion and restraint in New Zealand.
Office of the Director of Mental Health Annual Report 2013
27

Figure 12: Number of people secluded in adult services nationally, 2007 to 2013
Seclusion reduction
policy introduced
Number of people
1400
1200
1000
800
600
400
200
0  2007
2008
2009
2010
2011
2012
2013



Year
Source: Office of the Director of Mental Health Annual Reports, 2007 to 2012. For 2013 PRIMHD data was used, extracted
on 8 July 2014.
Figure 13: Total number of seclusion hours in adult services nationally, 2007 to 2013
Seclusion reduction
policy introduced
Number of hours (000)
100
90
80
70
60
50
40
30
20
10
0  2007
2008
2009
2010
2011
2012
2013



Year
Source: Office of the Director of Mental Health Annual Reports, 2007 to 2012. For 2013 PRIMHD data was used, extracted
on 8 July 2014.
Seclusion in New Zealand mental health services
Between 1 January and 31 December 2013, 7146 people spent time in New Zealand adult mental health
units (excluding forensic and other regional rehabilitation services). This represents 199,142 bed nights.
Of this total of 7146 people, 768 (10.7 percent) were secluded at some time during the reporting period.
As the same people were often secluded more than once (on
During 2013, 768 people
average 2.4 times), the number of seclusion events in adult services
were subject to seclusion
was higher than the number of people secluded (1851 events for
in adult mental health
adult clients).
units in New Zealand,
representing a total of 1851
Across all services, including forensic and youth services, 968
seclusion events.
people across all age groups experienced at least one seclusion
event. Of those secluded, 70 percent were male and 30 percent
were female. The most common age group for those secluded was 20 to 24 years (see Figure 14), and a
28
Office of the Director of Mental Health Annual Report 2013

total of 106 young people (under 19 years) were secluded during the 2013 year, representing a total of
311 seclusion events.14
Figure 14: Number of people secluded in all mental health units, by age group, 1 January to
31 December 2013
Number of people
180
160
140
120
100
80
60
40
20
0  0–19  20–24  25–29  30–34  35–39  40–44  45–49  50–54  55–59  60–64  65+

   Age group (years)
Source: PRIMHD data, extracted on 8 July 2014
The length of time spent in seclusion varied considerably. Most seclusion events (74 percent) lasted for
less than 24 hours. Figure 15 shows the number of seclusion events by duration of the event.
Figure 15: Distribution of seclusion events in all mental health units, by duration of the event,
1 January to 31 December 2013
Frequency
400
350
300
250
200
150
100
50
0
0–1
1–2
2–3
3–4
4–5
5–6
6–7
7–8
8–9
9–10
48+
10–11
11–12
12–13
13–14
14–15
15–16
16–17
17–18
18–19
19–20
20–21
21–22
22–23
23–24
24–35
36–47
Hours
Source: PRIMHD data, extracted on 8 July 2014
Seclusion by DHB
All DHBs except for Wairarapa (which has no mental health inpatient service) use seclusion.15
In 2013 the national average number of people secluded per 100,000 population was 29, and the
average number of events per 100,000 population was 70.
14. A total of 37 young people were secluded in the country’s specialist facilities for children and young people (in Christchurch,
Auckland and Wellington). There were 143 seclusion events reported for this group of young people.
15. If a person in Wairarapa requires admission, they are transported to Hutt Valley or MidCentral DHB, and any seclusion
statistics in relation to these patients appear on the corresponding DHB’s database.
Office of the Director of Mental Health Annual Report 2013
29

As Figures 16 and 17 show, seclusion data varied widely across DHBs. Such variation is likely to be due
to a number of factors, including:
• differences in seclusion practice
• geographical variations in the prevalence and acuity of mental illness
• ward design factors, such as the availability of intensive care and low-stimulus facilities
• staff numbers, experience and training
• use of sedating psychotropic medication
• the frequent or prolonged seclusion of one person, distorting seclusion figures over the 12-month
period.
Because it is difficult to measure and adjust for these factors, it can be useful to compare an individual
DHB’s performance over time in addition to considering the adjusted comparisons between DHBs
made in this Annual Report.
Figure 16: Number of people secluded in adult services (aged 20 to 64 years), per 100,000 by DHB,
1 January to 31 December 2013
People per 100,000
160
140
120
100
80
60
40
National average
20
0
Lakes
Auckland
Southern
Taranaki
Waikato
Canterbury
MidCentral
Northland
Tairawhiti
Wairarapa
Waitemata
West Coast
Whanganui
Bay of Plenty
Hawke’s Bay
Hutt Valley
Capital & Coast
Counties Manukau
South Canterbury
Nelson MarlboroughDHB
Note: Confidence intervals (for 99 percent confidence) have been used to aid interpretation. Where a DHB region’s
confidence interval crosses the national average, this means the DHB’s rate was not statistically significantly
different to the national average.
Source: PRIMHD data, extracted on 8 July 2014
30
Office of the Director of Mental Health Annual Report 2013

Figure 17: Number of seclusion events in adult services (aged 20 to 64 years), per 100,000 by DHB,
1 January to 31 December 2013
Events per 100,000
300
250
200
150
100
National average
50
0
Lakes
Auckland
Southern
Taranaki
Waikato
Canterbury
MidCentral
Northland
Tairawhiti
Wairarapa
Waitemata
West Coast
Whanganui
Bay of Plenty
Hawke’s Bay
Hutt Valley
Capital & Coast
Counties Manukau
South Canterbury
Nelson Marlborough

DHB

Note:   Confidence intervals (for 99 percent confidence) have been used to aid interpretation. Where a DHB region’s
confidence interval crosses the national average, this means the DHB’s rate was not statistically significantly
different to the national average.
Source: PRIMHD data, extracted on 8 July 2014
Seclusion and ethnicity
As a population group, Māori experience the greatest burden due to mental health issues in New
Zealand.
In 2013, Māori were 3.7 times more likely to be secluded in adult services than people from other ethnic
groups (per 100,000 population). Of the 768 people (aged 20 to 64 years)
In 2013, Māori were
secluded in adult services during 2013, 36 percent were Māori.
3.7 times more likely
Figure 18 shows seclusion indicators for Māori and non-Māori during 2013.
to be secluded than
Māori were secluded at a rate of 78 people per 100,000, and non-Māori at a
people from other
rate of 21 people per 100,000 population.
ethnic groups.
Reducing and eventually eliminating the use of seclusion for Māori is a priority action in Rising to the
Challenge (Ministry of Health 2012e).
Te Pou supports the Ministry initiative outlined in Rising to the Challenge. Information on initiatives
and strategies for reducing the use of seclusion with Māori can be accessed on Te Pou’s website
(www.tepou.co.nz).
Office of the Director of Mental Health Annual Report 2013
31

Figure 18: Seclusion indicators for adults (aged 20 to 64 years) in adult mental health services, Māori
and non-Māori, 1 January to 31 December 2013
200
People secluded
180
per 100,000 population
160
Seclusion events
per 100,000 population
140
Average duration
120
per event (hours)
100
80
60
40
20
0
Ma¯ori Non-Ma¯ori Total
Source: PRIMHD data, extracted on 8 July 2014
Figure 19 shows the percentage of inpatients secluded in acute adult services, for Māori and non-Māori
males and females in 2013. This figure indicates that a greater proportion of Māori were secluded than
non-Māori, and that across all ethnicities men were more likely to be secluded (13.7 percent) than
women (7.5 percent).
Figure 19: Proportion of adult inpatients (aged 20 to 64 years) secluded in adult mental health
services, for Māori and non-Māori males and females, 1 January to 31 December 2013
Percent inpatients secluded
20
Ma¯ori
18
Non-Ma¯ori
16
Total
14
12
10
8
6
4
2
0 Males Females
Source: PRIMHD data, extracted on 8 July 2014
Figure 20 shows the proportion of Māori secluded in general adult mental health services (for ages
20 to 64 years) from 2007 to 2013. Nationally since 2007 the number of people secluded has decreased
by 33 percent. Consistent with the declining national rate, the number of people secluded who identify
as Māori has decreased by 28 percent between 2007 and 2013.
32
Office of the Director of Mental Health Annual Report 2013

Figure 20: Proportion of Māori and non-Māori aged 20 to 64 years secluded in general adult mental
health services nationally, 2007 to 2013
Number of clients
1200
Non-Ma¯ori
Ma¯ori
1000
800
600
400
200
0 2007  2008  2009  2010  2011  2012  2013


  Year
Source: PRIMHD data, extracted on 8 July 2014
Seclusion in forensic units
Specialist inpatient forensic services are provided in five regions: Northern, Midland, Central,
Canterbury and Otago, with a smaller inpatient forensic service in Whanganui.16 Forensic services
provide mental health treatment in a secure environment for prisoners with a mental disorder, and for
people defined as special or restricted patients under the Mental Health Act.
In 2013, 98 people were secluded in forensic units (down from 118 in 2012), contributing to a total of
786 seclusion events. The average duration of a seclusion event in a forensic service increased from
28.3 hours in 2012 to 34.4 hours in 2013.
Table 6 presents the seclusion indicators for the 2013 calendar year. These indicators cannot be
compared with adult service indicators because they do not reflect the same client base. The rates
of seclusion of the relatively small group of people in the care of forensic services can be affected
by individuals who were secluded significantly more often than others. In particular, one person
accounted for 344 (44 percent) of the 786 seclusion events over the reporting period.
Table 6: Seclusion indicators for forensic services, by DHB, 1 January to 31 December 2013
DHB
Number of
Number of events
Average duration
clients secluded
per event (hours)
Canterbury
21
524
26
Capital & Coast
6
8
30.2
Southern
9
38
105.5
Waikato
26
81
37.9
Waitemata
35
131
45.4
Whanganui
2
4
30.8
Total
99
786
34.4
Source: PRIMHD data, extracted on 8 July 2014
16. The Whanganui inpatient unit comes under the Central retion’s forensic services.
Office of the Director of Mental Health Annual Report 2013
33

Sector voices
Anne Brebner – Te Pou
Supporting district health boards to reduce seclusion
Here at Te Pou we continue to support DHBs using the Six Core Strategies
(Huckshorn 2005) as an evidence-based methodology that supports a whole-of-
system change.
More than half of the DHBs are using this methodology to promote less restrictive
practices. In practice visits, I can see real shifts in staff perceptions of tolerance
for people using a more personalised aspect to self-management; some examples are using sensory
modulation as a method to calm and soothe, some are incorporating cultural practices such as kapa
haka to help manage the need for loud, expressive emotion.
I am hearing about more practices that incorporate family and whānau in ways that are innovative and
really do support personalised care. How much these practices truly reduce the trajectory that may
have ended in seclusion, we may never really be able to measure; however, clinical stories definitely
reinforce the view that some people who previously have had multiple seclusion events are managing
in innovative ways to have an acute admission that no longer includes the use of seclusion. The DHBs
are to be congratulated for supporting such practice change.
There are many resources on the Te Pou website that can be used to support reduced restraint and
seclusion (www.tepou.co.nz).
Electroconvulsive therapy
Electroconvulsive therapy (ECT) is a therapeutic procedure in which a brief pulse of electricity is
delivered to a person’s brain in order to produce a seizure. ECT can be an effective treatment for
various types of mental illness, including depressive illness, mania, catatonia and other serious
neuropsychiatric conditions. It is often effective as a last resort in cases where medication is
contraindicated or is not relieving symptoms sufficiently. ECT can only be given with the consent of
the person receiving it, other than in certain carefully defined circumstances.
In summary, in 2013:
• 253 people received ECT (5.7 people per 100,000)
• a total of 2341 treatments of ECT were administered
• those treated received an average of 9 administrations of ECT over the year
• women were more likely to receive ECT than men
• older people were more likely to receive ECT than younger people.
ECT is administered under anaesthesia and with muscle relaxants by
While ECT remains
medical staff in an operating theatre. The person goes to sleep under
controversial, a 2004
anaesthesia and wakes unable to recall the details of the procedure.
independent review
The most common side effects of ECT are confusion, disorientation
concluded that it
and memory loss. Confusion and disorientation typically clear
continues to have a place
within an hour, but memory loss can be persistent and in some cases
even permanent (American Psychiatric Association 2001; Ministry of
as a treatment option in
Health 2004).
New Zealand.
Significant advances have been made in improving ECT techniques and reducing side effects over
the last 20 years. Despite these improvements it remains a controversial treatment. In 2003, the
Health Select Committee recommended that a review be undertaken, independently of the Ministry
34
Office of the Director of Mental Health Annual Report 2013

of Health, on the safety and efficacy of ECT and the adequacy of regulatory controls on its use in New
Zealand. The review concluded that ECT continues to have a place as a treatment option for consumers
of mental health services in New Zealand, and that banning its use would deprive some seriously
ill people of a potentially effective and sometimes life-saving means of treatment. The report of the
independent review is available on the Ministry of Health website (www.health.govt.nz/publications).
In 2009 a consumer resource was created as part of the 2003 Government response to the Health
Committee’s report on petition 1999/30 of Anna de Jonge and others regarding ECT (Ministry of Health
2009). The ECT consumer resource is available on the Ministry of Health website (www.health.govt.nz/
publications).
Number of patients treated with ECT
The number of people treated with ECT in New Zealand has remained relatively stable since 2006, with
around 200 to 300 people receiving the treatment each year (Figure 21).
Figure 21: Number of people treated with ECT in New Zealand, 2005 to 2013
Number of people
350
300
250
200
150
100
50
0
2005 2006  2007  2008  2009  2010  2011  2012  2013


  Year
Source:  Office of the Director of Mental Health Annual Reports, 2005 to 2012. 2013 data is from PRIMHD, extracted
on 8 July 2014 except for Hawke’s Bay which provided manual data.
A total of 253 people received ECT during the year ending 31 December 2013. Table 7 shows the total
number of people who received ECT from 1 January to 31 December 2013, by DHB of domicile.17 The
total number of treatments administered over this period was 2341, with a mean of 9 treatments per
person.
17.  The number of people treated with ECT in 2013 is presented in Table 7 by DHB for the area where the person lives (DHB of
domicile). These statistics are presented in this way because some DHBs do not perform ECT; instead, people in that area are
referred to other DHBs for ECT treatment. Presenting the figures by DHB of domicile therefore gives a better picture of the
rates of ECT treatment prescribed by DHB. Other ECT statistics are by DHB of service.
Office of the Director of Mental Health Annual Report 2013
35

Table 7: Number of people treated with ECT, by DHB of domicile, 1 January to 31 December 2013
DHB of domicile
Number of people
Total number
Mean number of treatments
treated with ECT
of treatments
per person (range)
Auckland
15
118
7.9 (1–24)
Bay of Plenty
14
141
10.1 (1–30)
Canterbury
33
292
8.9 (1–23)
Capital & Coast
29
129
3.9 (1–35)
Counties Manukau
23
226
9.8 (2–31)
Hawke’s Bay
8
73
9.1 (5–19)
Hutt Valley
5
78
15.6 (11–19)
Lakes
24
120
5 (1–25)
MidCentral
13
191
14.7 (2–46)
Nelson Marlborough
2
13
6.5 (5–8)
Northland
4
40
10 (1–22)
South Canterbury
2
11
5.5 (3–8)
Southern
18
172
9.6 (1–41)
Tairawhiti
1
4
4 (4–4)
Taranaki
1
5
5 (5–5)
Waikato
32
388
12.1 (2–52)
Wairarapa
1
9
9 (9–9)
Waitemata
27
303
11.2 (1–24)
West Coast
3
26
8.7 (8–10)
Whanganui
2
3
1.5 (1–2)
Unknown
1
1
1 (1–1)
New Zealand
253
2341
9 (1–52)
Notes: This table does not include ECT figures for individuals receiving treatment with health
services for older people in the Central and Southern regions. Health services for older people
in these regions do not report to PRIMHD.

In 2013, 16 people were seen out of area:
• Auckland DHB saw one person from Waitemata
• Canterbury DHB saw two people from South Canterbury, one from Waitemata and three from
West Coast
• Counties Manukau DHB saw three people from Auckland
• Hutt Valley DHB saw one person from Capital & Coast and one from Wairarapa
• MidCentral DHB saw one person from Whanganui
• Northland DHB saw one person from an unknown area
• Southern DHB saw one person from Nelson Marlborough
• Waikato DHB saw one person from Lakes.

If a person was seen while living in two DHB areas, they were counted twice. The New Zealand
total of 253 is a unique count and not a sum of this column in the table as the New Zealand
total excludes individuals who were counted by more than one DHB.
Source: PRIMHD data, extracted on 8 July 2014 except for Hawke’s Bay which provided manual data
The rate of people treated with ECT by DHB of domicile is presented in Figure 22. The national rate of
people receiving ECT treatment was 5.7 per 100,000 in 2013.
36
Office of the Director of Mental Health Annual Report 2013

As Figure 22 shows, the rate of ECT treatments given varies regionally. Several factors contribute to
such variation. First, regions with smaller populations will be more vulnerable to annual variations
(according to the needs of the population at any given time). In addition, people receiving continuous or
maintenance treatment will typically receive more treatments in a year than those treated with an acute
course. ECT is indicated in older people more often than in younger adults because older people are
more likely to have associated medical problems contraindicating medication. Finally, populations in
some DHBs have better access to ECT services than others, which is likely to influence the rates of use.
Figure 22: Rate of people treated with ECT, by DHB of domicile, 1 January to 31 December 2013
People per 100,000
45
40
35
30
25
20
15
10
5
National average
0
Lakes
Auckland
Southern
Taranaki
Waikato
Canterbury
MidCentral
Northland
Tairawhiti
Wairarapa
Waitemata
West Coast
Whanganui
Bay of Plenty
Hawke’s Bay
Hutt Valley
Capital & Coast
Counties Manukau
South Canterbury
Nelson Marlborough DHB
Note:   Confidence intervals (for 99 percent confidence) have been used to aid interpretation. Where a DHB region’s
confidence interval crosses the national average, this means the DHB’s rate was not statistically significantly
different to the national average.

As the numbers of people receiving ECT by DHB are so small, it is difficult to make meaningful comparisons
between DHBs as rates per 100,000 population.
Source: PRIMHD data, extracted on 8 July 2014 except for Hawke’s Bay which provided manual data
Consent to treatment
Section 60 of the Mental Health Act describes the process required for obtaining consent for ECT.
Either the person’s consent or a second opinion from a psychiatrist appointed by the Mental Health
Review Tribunal is required.18 In the latter case, the treatment must be considered to be in the interests
of the person.
This process allows for the treatment of people too unwell to consent to treatment. Clinicians are
advised to make the decision about whether ECT is in the interests of the person after discussing
the options with family and whānau and considering any relevant advance directives the person has
made.19
During 2013 six people were treated with ECT who retained decision-making capacity and refused
consent. Table 8 shows the number of treatments administered without consent during 2013.
18.  The psychiatrist must be independent of the person’s clinical team.
19.  Refer to the Guidelines to the Mental Health (Compulsory Assessment and Treatment) Act 1992 (Ministry of Health 2012d),
available on the Ministry’s website (www.health.govt.nz).
Office of the Director of Mental Health Annual Report 2013
37

Table 8: ECT not consented to, by DHB of service, 1 January to 31 December 2013
DHB of service
Number of people
Number of
Number of people
given ECT who did
administrations
given ECT, who had
not have the capacity
not able to be capacity and refused
to consent
consented to
consent
Auckland
4
48
0
Bay of Plenty
4
50
0
Canterbury
1
17
3
Capital & Coast
2
17
0
Counties Manukau
^
^
^
Hawke’s Bay
2
13
0
Hutt Valley
2
82
3
Lakes
4
21
^
MidCentral
9
63
0
Nelson Marlborough
0
0
0
Northland
^
^
^
South Canterbury
0
0
0
Southern
5
79
0
Tairawhiti
0
0
0
Taranaki
1
5
0
Waikato
14
141
0
Wairarapa
−
−
−
Waitemata
12
95
0
West Coast
−
−
−
Whanganui
−
−
−
New Zealand total
60
631
6
Notes: The data in this table cannot be reliably compared with the data in Table 7 above, as
this data is for DHB of service, and Table 7 presents data for DHB of domicile.

The total number of ECT treatments not able to be consented to decreased from 690
treatments in 2012 to 631 treatments in 2013. One factor explaining this decrease is the
exclusion of data from Northland and Counties Manukau who did not supply this data
for the 2013 Annual Report.

A dash (–) indicates the DHB does not perform ECT: people are sent to other DHBs for
treatment.

^ indicates the DHB did not report its data to the Ministry for the 2013 reporting period.
Source: The Ministry of Health is currently unable to provide this data from PRIMHD. DHBs supplied manual data.
Age and gender of patients treated with ECT
Information on the age and gender of people who were treated with ECT in 2013 is presented in Table 9
and Figure 23. For this data, age group was determined by the individual’s age at the beginning of their
treatment. The majority of people (61 percent) treated with ECT were aged over 50 years in 2013.
Of the 253 people who received ECT treatment in 2013, 165 (65 percent) were women and 88 (35 percent)
were men. The main reason for the gender difference is that more women present to mental health
services with depressive disorders. This ratio is similar to that reported in other countries.
38
Office of the Director of Mental Health Annual Report 2013

Table 9: Number of people treated with ECT, by age group and gender, 1 January to 31 December 2013
Age group (years)
Female
Male
Total
15–19
3
2
5
20–24
3
3
6
25–29
6
2
8
30–34
4
3
7
35–39
11
9
20
40–44
12
11
23
45–49
16
10
26
50–54
19
9
28
55–59
14
8
22
60–64
15
16
31
65–69
18
0
18
70–74
11
8
19
75–79
12
3
15
80–84
10
4
14
85–89
8
0
8
90–95
3
0
3
Total
165
88
253
Note:   This table does not include ECT figures for
people receiving treatment with health services
for older people in the Central and Southern
regions. Health services for older people in
these regions do not report to PRIMHD.
Source: PRIMHD data, extracted on 8 July 2014, except for Hawke’s Bay DHB, which provided manual data
Figure 23: Number of people treated with ECT, by age group and gender, 1 January to
31 December 2013
Number of people
35
Male
Female
30
25
20
15
10
5
0
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85–89
90–95
Age group (years)
Note:   This table does not include ECT figures for people receiving treatment with health services for older people in the
Central and Southern regions. Health services for older people in these regions do not report to PRIMHD.
Source: PRIMHD data, extracted on 8 August 2014, except for Hawke’s Bay DHB, which provided manual data
Office of the Director of Mental Health Annual Report 2013
39

Ethnicity of people treated with ECT
The numbers presented in Table 10 suggest that Asian, Māori and Pacific peoples are less likely to
receive ECT than those of European ethnicity. However, the numbers involved are so small that it is not
statistically appropriate to compare the percentages of people receiving ECT in each ethnic group with
the proportion of each ethnic group in the total population of New Zealand.
Table 10: Number of people treated with ECT, by ethnicity, 1 January to 31 December 2013
Ethnicity
Number of people treated with ECT
Asian
9
European
213
Māori
20
Pacific
6
Other
5
Total
253
Note: This table does not include ECT figures for people
receiving treatment with health services for older people
in the Central and Southern regions. Health services for
older people in these regions do not report to PRIMHD.
Source: PRIMHD data, extracted on 8 July 2014, except for Hawke’s Bay DHB, which provided manual data
Serious adverse events
Serious adverse events (SAEs) relating to clients of DHB mental health services are reported to the
Health Quality and Safety Commission (HQSC) in accordance with the requirements of the national
reportable events policy.20 The Office of the Director of Mental Health collects information on serious
adverse events involving people under the Mental Health Act, including deaths.
In summary, in 2013:
• 161 serious adverse events were reported to the HQSC by mental health and addiction services
• 126 events involved suspected suicide, 18 events involved serious self-harm and 17 events involved
serious adverse behaviour
• 47 deaths of people under the Mental Health Act were reported to the Director of Mental Health.
Of these deaths, 9 people were reported to have died by suicide or suspected suicide and 38 were
reported to have died by other means, including natural causes.
The purpose of reporting
The purpose behind the reporting of SAEs is to encourage DHBs to
serious events is for
identify and review incidents with the aim of preventing similar
events in the future. Ultimately the reporting requirements exist
DHBs to review the
to promote a reflexive process around serious events, helping to
incidents with the aim
ensure safer and better mental health care for New Zealanders into
of preventing similar
the future.
incidents in the future.
In the time since the HQSC took over the public reporting of SAEs, the number reported to the HQSC
has grown considerably: from the first report in 2007, when 182 such events were reported, to 2013,
when almost 650 were reported. This growth is not because the frequency of SAEs has increased, but
rather because DHBs have improved their reporting systems and cultures, with the result that a greater
number of incidents are being reviewed.
20. For more information on reporting, please see the Health Quality and Safety Commission website (www.hqsc.govt.nz).
40
Office of the Director of Mental Health Annual Report 2013

In 2013, the HQSC released its first report specifically related to serious incidents that involved clients
of mental health and addiction services.21 However, both the HQSC and the Director of Mental Health
recognised that it would be more appropriate for these SAEs to be included in this Annual Report, to
put them in association with the wider mental health and addictions sector.
In 2013, a total of 161 serious adverse events were reported to the HQSC by mental health and addiction
services. Of those events, 126 (78 percent) were cases of suspected suicide, 18 (11 percent) were cases of
serious self-harm and 17 (11 percent) were cases of serious adverse behaviour.
Table 11 shows a breakdown of the events reported to the HQSC during 2013 and Table 12 shows the
number of events reported by each DHB. It is important to note that comparisons between individual
DHBs are problematic as high numbers may only indicate that a DHB has a good reporting culture
(rather than a significantly high number of serious events). In addition, DHBs that manage larger and
more complex mental health services are likely to report a higher number of adverse events.
Table 11: Number of serious adverse events reported to the HQSC, 1 January to 31 December 2013
On
Absent
Inpatient approved without
Type of event
Community
unit
leave
leave Total
Suspected suicide
117
3
3
3
126
Serious self-harm
6
9
0
3
18
Serious adverse behaviour
4
9
0
4
17
Total
127
21
3
10
161
Source: Data reported to the HQSC by DHBs
Table 12: Number of serious adverse events reported to the HQSC by DHB, 1 January to
31 December 2013
Number of
Number
DHB
events
DHB
of events
Auckland
17
Northland
2
Bay of Plenty
1
South Canterbury
0
Canterbury
22
Southern
12
Capital & Coast
12
Tairawhiti
2
Counties Manukau
14
Taranaki
4
Hawke’s Bay
9
Waikato
4
Hutt Valley
6
Wairarapa
0
Lakes
3
Waitemata
29
MidCentral
8
West Coast
6
Nelson Marlborough
8
Whanganui
2
New Zealand total
161
Source: Data reported to the HQSC by DHBs
21. For the 2012/13 fiscal year, 177 incidents were reported, including 134 cases of death by suspected suicide of mental health and
addiction service users within 28 days of contact with that service.
Office of the Director of Mental Health Annual Report 2013
41

Reportable deaths under the Mental Health Act
Section 132 of the Mental Health Act requires that the Director of Mental Health be notified within
14 days of the death of any person or special patient under the Mental Health Act, and that such
notification identifies the apparent cause of death.22
If the circumstances surrounding a death cause concern, the DHB may initiate an inquiry. The Director
of Mental Health can also initiate an investigation under section 95 of the Mental Health Act, and
in rare cases the Minister or Director-General of Health can initiate an inquiry under section 72 of
the New Zealand Public Health and Disability Act 2000. The Director of Mental Health has a role in
ensuring that recommendations are followed up by district health boards.
In 2013 the Director of Mental Health received notification of 47 deaths of people who were under the
care of the Mental Health Act at the time of death (Table 13). Nine people are reported to have died by
suicide or suspected suicide, and two of these deaths have been confirmed as a suicide by the coroner
at the time of writing this report. The Ministry is yet to receive coroners’ reports for the other seven
people who are suspected to have died by suicide.
In 2013, 38 people are reported to have died by other means while receiving treatment under the
Mental Health Act, including by natural causes and illness unrelated to the individual’s mental health
status.
Table 13: Outcomes of reportable death notifications under section 132 of the Mental Health Act,
1 January to 31 December 2013
Reportable death outcome
Number of notifications
Suicide
2
Suspected suicide
7
Other deaths
38
Total events
47
Note: A person is recorded as having died by suicide when
the coroner has made a finding of suicide.
Source: Office of the Director of Mental Health records
22. Any suicides or suspected suicides of people under the Mental Health Act also come under the serious adverse event
reporting requirements of the HQSC.
42
Office of the Director of Mental Health Annual Report 2013

Sector voices
Janice Wilson – Chief Executive, Health Quality and Safety Commission
Over the last year the Health Quality and Safety Commission has been
increasingly working with the Director of Mental Health in order to improve the
quality of services in the mental health and addictions sector. Two examples of
this work are the establishment of the Suicide Mortality Review Committee, and
the process of learning from adverse events.
The Suicide Mortality Review Committee has been established as an 18-month
trial, with a main aim of collecting a set of information on every suicide death in
New Zealand, to improve our knowledge about people who die by suicide. The Committee will also
review three sub-groups with particularly high rates of suicide: Māori youth, users of specialist mental
health and addiction services, and men aged between 25 and 64 years.
The Director of Mental Health and the Commission are also working together on how we can learn
from serious adverse events that have involved users of mental health and addiction services. We are
developing tools and resources to support providers in the review of these events, so that lessons can
be learnt and – where possible – steps taken to prevent similar events from occurring in future.
As a psychiatrist myself, I acknowledge the difficulties associated with tackling these two challenging
areas, but I see these as vital steps that are part of our responsibilities.
Death by suicide or suspected suicide
This section provides a brief overview of suicide and deaths of undetermined intent among people who
use specialist mental health services for 2011. Data from 2011 is used because it can take over two years
for a coroner’s investigation into a suicide to be completed.
In summary, in 2011:
• 493 suicides were recorded in the mortality database
• approximately 40 percent of those who died by suicide or undetermined intent (aged 10 to 64) were
mental health service users
• mental disorders were a significant risk factor for suicidal behaviour
• males were more likely to commit suicide than females
• younger people were more likely to commit suicide than older people.
Suicide is a serious concern for New Zealand. Around 500 New Zealanders die by suicide every year;
which also affects the lives of many others – families, whānau, friends,
Around 500 New
colleagues and communities.
Zealanders die by
New Zealand is one of 28 countries with a national strategy to address
suicide every year.
suicide, the New Zealand Suicide Prevention Strategy 2006–2016 (Associate
Minister of Health 2006). It also has the New Zealand Suicide Prevention Action Plan 2013–2016
(Ministry of Health 2013a) which represents the next step in the Government’s commitment to
addressing New Zealand’s unacceptably high suicide rates.
With funding of $25 million over four years to implement 30 actions, the Suicide Prevention Action
Plan aims to expand existing services, to make these more accessible and to support communities to
prevent suicide.
The focus of this subsection is on people who died by suicide with a history of contact with specialist
mental health (including alcohol and other drug) services in the year prior to their death. People with
Office of the Director of Mental Health Annual Report 2013
43

no history of mental health service use in the year prior to death are
Mental disorders are a
referred to as ‘non-service users’, although it is acknowledged that
significant risk factor for
some non-service users may have used mental health or alcohol and
suicidal behaviour.
other drug services at some earlier time in their lives.
Prevalence of suicide in the population23
At the time the data was extracted, there were 493 suicides recorded in the mortality database for
2011.24 A further 18 deaths of undetermined intent were recorded and are included in this report. Of
this initial total of 511 deaths, 45 involved people aged 65 years and over. These deaths are excluded
from the following discussion.
Table 14 shows the remaining 466 deaths by suicide or deaths of undetermined intent. Within this
total, 185 (40 percent) of the people had contact with specialist mental health services in the year
prior to death. Mental disorders (in particular, mood disorders, substance use disorders and antisocial
behaviours) are a significant risk factor for suicidal behaviour (Beautrais et al 2005).
Table 14: Number and age-standardised rate of suicides, by service use, ages 10 to 64 years, 1 January
to 31 December 2011a
Number
Age-standardised rateb
Deaths due to intentional self-harm
Service users
177
124
Non-service users
271
7
Total
448
12
Deaths of undetermined intent
Service users
8
6
Non-service users
10
0
Total
18
0
Total deaths
Service users
185
129
Non-service users
281
7
Total
466
12
Notes: a Service user denominator excludes service users with unknown age

b Age-standardised rate is per 100,000, standardised to the WHO
standard population aged 0–64 years.
Source: Ministry of Health mortality database, extracted on 22 July 2014
Changes in number of suicides over time
Figure 24 shows the changes in the rates of suicide by service users and non-service users between
2001 and 2011.
23. The statistics discussed here cover only people under 65 years of age because in the Central and Southern regions, older
people’s mental health treatment was provided by health services for older people rather than mental health services and is
not necessarily recorded in PRIMHD. Deaths of children under 10 years have also been excluded because they are unlikely
to be caused by suicide. The data was drawn from information provided to the Ministry’s national mortality database and
PRIMHD.
24. These numbers are subject to change. The mortality database is a dynamic collection, and changes can be made even after the
data is considered nominally final.
44
Office of the Director of Mental Health Annual Report 2013

Figure 24: Age-standardised rate of suicides, by service users and non-service users, ages 10 to 64
years, 2001 to 2011
Age-standardised rate per 100,000
250
200
150
Service users
100
50
0
Non-service users
2001  2002  2003  2004  2005  2006  2007  2008  2009  2010  2011


Year
Notes:  Age-standardised rate is per 100,000, standardised to the WHO standard population aged under 65 years.

The service-user population is much smaller than the total population of non-service users and will therefore
produce rates more prone to fluctuation from year to year.
Source:   Ministry of Health mortality database
Sex and age in relation to suicide25
As shown in Table 15 and Figure 25, approximately 3.3 times as many males as females died by suicide
in 2011. Forty percent of both females and males who died by suicide in 2011 were service users. Of
those service users who died by suicide in 2011, 24 percent were female and 76 percent were male.
Table 15: Number and age-standardised rate of suicide, by service use and sex, ages 10 to 64 years,
1 January to 31 December 2011a
Sex
Service usersb
Non-service users
Total
Number
ASR
Number
ASR
Number
ASR
Male
141
178.1
216
11.2
357
17.9
Female
44
70.1
65
3.4
109
5.5
Total
185
129.1
281
7.3
466
11.7
Notes: ASR = age-standardised rate
a Suicide includes deaths of undetermined intent. The age-standardised rate is per 100,000, standardised
to the WHO standard population 0–64 years.
b Service-user denominator excludes service users of unknown age.
Source: Ministry of Health mortality database, extracted on 22 July 2014
25.  The term ‘gender’ has been used for all other reporting measures in this report. However, the mortality database uses ‘sex’ in
relation to suicide statistics, and this section follows that convention.
Office of the Director of Mental Health Annual Report 2013
45

Figure 25: Age-standardised rate of suicide, by age group, sex and service use, ages 10 to 64 years,
1 January to 31 December 2011
Age-standardised rate per 100,000
350
300
Male service users
250
200
150
100
50
Female service users
Male non-service users
0
Female non-service users
10–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
Age group (years)
Note: The age-standardised rate is the rate per 100,000 standardised to the WHO standard population under 65 years.
Source: Ministry of Health mortality database
As shown in Table 16 and Figure 25, the age-standardised rate of suicide among female and male
service users in 2011 was highest for the age group of 25 to 29 years, at 167 per 100,000 ASR and 329 per
100,000 ASR respectively.
When considering these numbers it is important to note that because these age-standardised rates are
derived from a small service-user population, they are highly variable over time.
For female and male non-service users, the rate of suicide was highest in the 20 to 24 years age group,
at 6.6 per 100,000 ASR and 20 per 100,000 ASR respectively.
Table 16: Number and age-standardised rate of suicides, by sex and service use, ages 10 to 64 years,
1 January to 31 December 2011
Service users
Non-service users
Female
Male
Female
Male
Age band
(years) Number
ASR Number
ASR Number
ASR Number
ASR
10–19
5
45.7
14
104.1
17
5.9
33
11.0
20–24
6
102.2
22
267.3
10
6.6
32
20.0
25–29
8
166.7
22
328.5
5
3.5
16
11.4
30–34
4
83.4
14
226.5
5
3.7
19
15.2
35–39
3
58.5
11
172.0
6
4.1
18
13.7
40–44
4
75.4
14
216.8
2
1.3
19
13.3
45–49
7
150.9
17
305.4
3
1.9
24
16.1
50–54
3
79.6
12
276.2
7
4.7
20
14.2
55–59
3
108.7
9
311.0
6
4.7
19
15.4
60–64
1
50.9
6 304.4
4
3.4
16
14.0
Notes: Includes deaths of undetermined intent.
ASR = age-standardised rate
Source: Ministry of Health mortality database, extracted on 22 July 2014
46
Office of the Director of Mental Health Annual Report 2013

Ethnicity and suicide
As Table 17 indicates, among people using mental health services in 2011, the age-standardised
rate of suicide was higher for Māori (116 per 100,000 service users) compared with Pacific peoples
(74 per 100,000 service users). The age-standardised rate of suicide for those in the category of other
ethnicities was 133 per 100,000 service users.
Table 17: Number and age-standardised rate of suicides and deaths of undetermined intent, by
ethnicity and service use, ages 10 to 64 years, 1 January to 31 December 2011
Ethnicity
Service users
Non-service users
Total

Number of
deaths
ASR Number of
deaths
ASR Number of
deaths
ASR
Māori
48
115.6
71
12.3
119
22.9
Pacific
7
74.0
20
7.8
27
11.7
Other
130
133.2
190
5.9
320
10.0
Total
185
129.1
281
7.3
466
11.7
Note: ASR = age-standardised rate
Source: Ministry of Health mortality database
Service users who died by suicide during 2011
During 2011, 185 service users died by suicide. Of this total, 4 service users died while an inpatient,26
7 died within a week of being discharged27 and 39 died within 12 months of discharge.28
An overview of service users dying by suicide, 2001 to 2011
Over the 10-year period from 2001 to 2011, 1793 service users died by suicide.29 Of this total, 23 service
users (1 percent) died while an inpatient, 111(6 percent) died within a week of being discharged and 462
(26 percent) died within 12 months of discharge.
Of the 1793 service user suicides from 2001 to 2011, 1525 service users were receiving treatment from
a specialist service community team in the 12 months before death, and 387 patients were receiving
treatment from a specialist alcohol and drug team in the 12 months before death.
The Alcoholism and Drug Addiction Act
The Alcoholism and Drug Addiction Act 1966 (ADA Act) provides for the compulsory detention and
treatment of people with severe substance dependence for up to two years at certified institutions.
In summary, in 2013:
• 75 orders were granted by the Family Court for either detention or committal under the ADA Act
• 59 of the granted orders were for voluntary detention (section 8) and 16 were for involuntary
committal (section 9).
In October 2009 the Prime Minister announced a review of the ADA Act as part of a range of initiatives
to reduce harm from methamphetamine. The Law Commission released its report Compulsory
26.  This figure is determined from the number of people who died on the same day as they had an inpatient activity. This
approach to classification has been taken to mean here that they were still in the context of an inpatient unit on the day of
death.
27.  Excluding those who received treatment on the day of death.
28.  Excluding those who received treatment on the day of death and those who died within a week of being discharged from an
inpatient service.
29.    Includes deaths of undetermined intent.
Office of the Director of Mental Health Annual Report 2013
47

Treatment for Substance Dependence: A review of the Alcoholism and Drug Addiction Act 1966 in
October 2012 (New Zealand Law Commission 2012). In 2012 a bill to repeal and replace the ADA Act was
developed.
Section 8 of the ADA Act allows a person who is dependent on alcohol or another drug to voluntarily
apply to the Family Court for detention in a specified institution that is certified under the ADA Act
(detention). Section 9 of the ADA Act applies when another person (such as a relative or the police)
makes an application to the Family Court for the person to be committed to a specified institution
that is certified under the ADA Act (committal). Section 9 applications must be accompanied by two
medical certificates.
Ministry of Justice statistics on the use of the ADA Act are available from the beginning of 2004. Table 18
details the outcomes of applications under the ADA Act to the Family Court. Table 19 shows the number
of orders granted for detention under section 8 and for committal under section 9 of the ADA Act.
Table 18: Number and outcomes of applications for detention and committal, 2004 to 2013
Application outcome
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Application granted or granted with consent
72
79
77
71
75
71
69
74
72
75
Application dismissed or struck out
5
3
4
1
2
3
3
1
2
3
Application withdrawn, lapsed or
discontinued
3
9
2
6
1
4
9
5
9
8
Total applications for s 8 and s 9 orders
80
91
83
78
78
78
81
80
83
86
Note: The table presents applications that were disposed at the time of data extraction at 26 June 2014.
Source: Ministry of Justice’s Case Management System (CMS). The CMS is a live operational database. Figures are subject
to minor changes at any time.
Table 19: Outcomes of applications for granted orders for detention and committal, 2004 to 2013
Number (and percentage)  Number (and percentage)
Total number
Year
of section 8 applications
of section 9 applications  of applications
granted for detention
granted for committal
granted
2004
44 (92%)
28 (85%)
72
2005
49 (96%)
30 (79%)
79
2006
60 (98%)
17 (77%)
77
2007
52 (100%)
19 (76%)
71
2008
63 (98%)
12 (86%)
75
2009
49(98%)
22 (81%)
71
2010
55 (96%)
14 (58%)
69
2011
59 (97%)
15 (75%)
74
2012
61 (97%)
11 (58%)
72
2013
59 (95%)
16 (64%)
75
Note:   The table presents applications that were disposed at the time of data extraction
on 26 June 2014.
Source: Ministry of Justice’s Case Management System (CMS). The CMS is a live operational database. Figures are subject
to minor changes at any time hereafter.
48
Office of the Director of Mental Health Annual Report 2013

Sector voices
Erin Watts and Brighid Galvin– Mental health nurses
Hello, my name is Erin Watts (left) and my colleague’s name is
Brighid Galvin (right). We are both registered nurses practising
within the scope of mental health.
Together we provide a home-based detox service in Dunedin.
The aim of the service is to provide safe, managed withdrawal
for people who are substance dependent. As mental health
nurses we are holistic in our approach and offer a brief
intervention service that is recovery and strengths based.
To receive support from the detox service, people can self-refer or be referred by GPs, community
mental health teams or other alcohol and other drug services. We work in partnership with people’s
GPs who provide us with medical support.
With detox it is not always appropriate to treat people in their home environment (ie, when there’s no
support person at home, when the environment is not suitable or when the person has a past history
of withdrawal seizures). In these cases it is possible for people to be treated in a respite setting and we
purchase these beds from the Ashburn Clinic.
Things we love about being mental health nurses are the wide variety of people we work with, the
privilege of going into people’s homes and the autonomy of the role. Mental health nurses work across
a variety of settings, from inpatient to community. Over the years there has been a big shift in where
services are provided, with most mental health nurses now caring for people in the community.
Some of the challenges include the frustrations of clients not being able to be attended to now
(managed withdrawal is a planned intervention which requires careful steps in order to be safely
implemented) and the difficulty of providing a service for the homeless. It is a great job which allows us
to work alongside clients towards their experience of wellbeing.
Opioid substitution treatment
Opioid substitution treatment (OST) is a well-established treatment that involves prescribing opioids
such as methadone and buprenorphine with naloxone (suboxone) as a substitute for illicit opioids.
In summary:
• during 2013 over 5000 people were being treated in New Zealand for opioid dependence
• most people (73 percent) received treatment from specialist addiction services in 2013
• the Ministry would like more people to be receiving treatment from their GP
• in 2013, approximately 26 percent of OST patients were in GP care
At the end of 2013,
• suboxone is increasingly being used in New Zealand to treat opioid
5158 people were being
dependence
treated in New Zealand
• people aged 30 to 60 years are the most likely to be receiving OST.
for opioid dependence.
The Director of Mental Health is responsible for approving qualified
practitioners to prescribe controlled drugs for the treatment of drug dependence under section 24 of
the Misuse of Drugs Act 1975.
Office of the Director of Mental Health Annual Report 2013
49

In 2012 the Director of Mental Health began a review of the process and criteria for prescribing
controlled drugs under section 24. This work aims to:
• establish greater governance and oversight around prescribing
• ensure all prescribers are appropriately qualified
• mitigate drug diversion.
This work continued through 2013 and is expected to be completed in early 2014.
The Director of Mental Health undertakes regular site visits to opioid substitution services. The
Director’s role in OST service quality and safety is supported by regular meetings with the National
Association of Opioid Treatment Providers and other Ministry of Health teams with an involvement
in OST.
In 2013, 16 DHBs, one NGO, one primary health organisation and
Opioid dependence is a
one general practice provided specialist OST services for national
coverage. In addition, a number of individual GPs were authorised to
complex health condition
provide OST to clients stabilised in treatment.
that often requires long-
term treatment and care.
At the end of 2013, 5158 people were being treated in New Zealand for
opioid dependence. Of this total, 3745 (73 percent) were at specialist
services 1362 (26 percent) were in GP care and 51 (1 percent) were in prison. There has been a
17.4 percent increase in the number of clients reported to be receiving OST since 2007.30
The use of buprenorphine with naloxone (suboxone) for OST
Since 1 July 2012 PHARMAC has funded buprenorphine with naloxone (suboxone) for both
detoxification and maintenance for people who are dependent on opioids. This funding has given a
welcome choice in opioid substitution treatment. With suboxone the risk of diversion and misuse is
lower than for methadone. In addition, suboxone is safer in overdose and can be given in cumulative
doses lasting several days, rather than the daily dosing regimen required for methadone.
The number of people being prescribed suboxone has more
The number of people
than tripled over the last two years, increasing from 71 people in
being prescribed suboxone
December 2011 to 360 at the end of 2013 (Figure 26).
has more than tripled
since 2011.
Figure 26: Number of people prescribed suboxone, 2008 to 2013
Number of people
400
350
300
250
200
150
100
50
0
2008 2009 2010 2011 2012 2013

Year
Source: Data provided by OST services in six-monthly reports
30. Data from OST six-monthly reporting to the Director of Mental Health, which began in 2007. The increase in the number of
clients may also be due to services adjusting to the new reporting measure and improving their reporting.
50
Office of the Director of Mental Health Annual Report 2013

The ageing population of OST clients
Opioid dependence is a complex health condition that often requires long-term treatment and care.
People aged 30 to 60 years are the biggest client group for OST services.
OST clients are an ageing population. The number of people aged
A more holistic approach
between 45 and 59 years who are receiving OST has increased by
to recovery will help to
52 percent since 2007 and is now larger than the age group of
improve outcomes for
30 to 44 years (previously the largest group of OST clients)(Figure 27).
people who are opioid
In addition, there is now more emphasis on managing co-existing
dependent.
medical and mental health problems for OST clients. This more
holistic approach will help improve outcomes for people who are opioid dependent.
Figure 27: Number of OST clients, by age group, 2008 to 2013
Number of people
3000
2500
45–59 years
30–44 years
2000
1500
1000
500
19–29 years
0
60+ years
2008 2009 2010 2011 2012 2013

Year
Source: Data provided by OST services in six-monthly reports
Shared care with GPs
OST services in New Zealand are provided by specialist addiction
Primary health care is
services and primary health care teams. Opioid substitution
preferred for the long-term
treatment aims to support clients to lead a life that is as normal as
management of stable
possible within the constraints of treatment. For this reason, the
clients receiving OST.
primary health care setting is regarded as the best environment for
the long-term management of stable clients receiving OST.
Office of the Director of Mental Health Annual Report 2013
51

Figure 28: Number of people receiving treatment from a specialist service, GP or prison service,
2008 to 2013
Number of people
6000
Number of clients in prison
GP places
5000
Specialist places
4000
3000
2000
1000
0  2008  2009  2010  2011  2012  2013


Year
Source: Data provided by OST services in six-monthly reports
Ideally, the Ministry would like to see a service provision of 50:50 between specialist care and primary
care, with more people being seen in general practice (as for any other long-term chronic condition
such as diabetes or asthma). This would enable specialist services to concentrate on initiating
people onto OST and on treating those with complex co-morbid health issues and those in high-risk
situations.
Metro Auckland and Canterbury DHBs continue to get closer to this goal (Figure 29). In 2013 Bay of
Plenty and Northland joined Capital & Coast, Nelson Marlborough, South Canterbury and Waikato
DHBs in attaining 25 percent or more people receiving OST in primary care.
Figure 29: Percentage of people receiving OST treatment with specialist services and GPs,
by DHB, 2013
Percent
100
GP
90
Specialist service
80
70
60
50
40
30
20
10
0
Lakes
Auckland
Southern
Taranaki
Waikato
Canterbury
MidCentral
Northland
Tairawhiti
Wairarapa
West Coast
Whanganui
Bay of Plenty
Hawke’s Bay
Capital & Coast
South Canterbury
Nelson Marlborough
DHB
Source: Data provided by OST services in six-monthly reports
52
Office of the Director of Mental Health Annual Report 2013

Nationally the number of general practitioners authorised to prescribe OST dropped by 10 percent
from 666 in 2012 to 596 in 2013. Although the number of clients being transferred to GP care remains
consistent,31 from time to time clients de-stabilise and return to the specialist service. In addition, a
number of clients remain at specialist services, even though they are ready for GP care, for one of three
possible reasons: a general lack of GPs means that a position is unavailable; GPs are not keen to take on
OST clients; or clients want to stay with the specialist service due to the financial benefit.
OST in prison
In 2006 the Department of Corrections revised its Methadone Maintenance Treatment Policy to
allow all people who were on an opioid substitution programme before they were imprisoned to be
maintained on treatment while in prison. 32
The number of people receiving treatment for opioid dependency in prison has reduced from 83 in
2010 to 64 in 2013. 33
Entry to and exit from OST
Entering, staying in and exiting opioid substitution treatment are important indicators of an
individual’s recovery journey, but reaching each of these points does not in itself constitute recovery.
Recovery is a process rather than a single event, which takes time to achieve and effort to maintain.
Recovery involves accruing positive benefits as well as reducing harms, and moving away from
uncontrolled substance use and its associated problems around health, wellbeing and participation in
society.
Recovery is a process rather
At the end of 2013 there were 40 people waiting for OST compared
than a single event, which
with 60 in 2012 and 80 in 2011. However, the number of people on
takes time to achieve and
a waiting list is not a good measure of unmet demand, as people
effort to maintain.
tend not to seek treatment if they perceive there is little chance
of accessing it in the foreseeable future. The Ministry continues
to work closely with specialist services and DHB planners and funders to resolve the issue of waiting
times for people who require specialist service interventions.
The year 2013 saw a record number of people choosing to withdraw from OST programmes (see
Figure 30 below). It was also the year in which the lowest number of people were involuntarily
withdrawn from OST due to behaviour that jeopardised the safety of the individual concerned or
others (including staff).
In 2013, 36 people receiving OST treatment from specialist services died from a range of causes,
including natural causes and accidents. Two clients died as a
consequence of an overdose related to the use of other substances.
2013 saw a record number
The use of other substances, particularly sedatives (such as alcohol
of people choosing to
and benzodiazepines), in combination with opioids significantly
withdraw from OST
increases the risk of death by respiratory depression and overdose.
programmes.
However, this risk is usually less than the risk arising from
increasing substance use if a client is withdrawn from OST medication against their wishes.
31.  Number transferred was 278 in 2008, 228 in 2009, 225 in 2010, 219 in 2011, 227 in 2012 and 231 in 2013.
32.  Prison Opioid Substitution and Managed Withdrawal Protocol 2007.
33.  Data from six-monthly reports, collected on December of the mentioned year
Office of the Director of Mental Health Annual Report 2013
53

Figure 30 shows the reasons why clients withdrew from OST specialist services from 2008 to 2013.
Figure 30: Client withdrawal from OST programmes, voluntary, involuntary or death, 2008 to 2013
Percent
100
Client deaths

14 20  15 10  10  9
90
3
Involuntary withdrawal
80
Voluntary withdrawal
13
11
19
21
17
70
60
50
40
30
20
10  73
69
67
69
73
88
0  2008  2009  2010  2011  2012  2013


Year
Source: Data provided by OST services in six-monthly reports
Sector voices
Jeremy McMinn – Consultant psychiatrist and addiction specialist
I’m Jeremy McMinn, the current clinical lead for opioid substitution in Lakes
DHB, Rotorua. I also work as a psychiatric advisor for the Accident Compensation
Corporation.
Addiction is a fascinating field. Treatment involves both mental and physical
health care challenges. There are often complex ethical dimensions around risk/
benefit and autonomy/paternalism.
This is particularly the case in the treatment of opioid dependence – where for
most people, giving up the drug habit is rarely successful without a period of substitution using
methadone or buprenorphine.
Care that is provided well dramatically changes lives in ways that go far beyond just the individual
person’s health. Families can be reconstituted; children thrive with their parents’ stability;
employment rises and crime falls. Treatment is a great combination of being effective and cheap –
it even pays itself back with an estimated $6 gain for every $1 spent.
I have worked in addiction for over 10 years, most of this in Wellington. I am a certified consultant
psychiatrist through the College of Psychiatrists and addiction specialist through the College of
Physicians.
For the last two years I have co-chaired the National Association of Opioid Treatment Providers. The
Association works hard to advocate for our patients while making sure treatment is provided wisely
(within the right dose ranges and sensible dispensing restrictions).
The immediate future for opioid addiction is to achieve better prescribing of opioids by all doctors
– prescribing that includes safeguards to prevent new cases of addiction. Our collective medical
professionalism and the ability of New Zealand’s health systems to rise to challenges stand us in good
stead to respond to this opportunity.
54
Office of the Director of Mental Health Annual Report 2013

References
American Psychiatric Association. 2001. The Practice of ECT: A task force report (2nd ed.). Washington, DC:
American Psychiatric Association.
Associate Minister of Health. 2006. New Zealand Suicide Prevention Strategy 2006–2016. Wellington: Ministry of
Health.
Beautrais AL, Collings SCD, Ehrhardt P, et al. 2005. Suicide Prevention: A review of evidence of risk and protective
factors, and points of effective intervention. Wellington: Ministry of Health.
Department of Corrections. 2007. Over-representation of Māori in the Criminal Justice System: An exploratory
report. Wellington: Department of Corrections.
Elder H, Tapsell R. 2013. Māori and the Mental Health Act. In J Dawson and K Gledhill (eds), New Zealand’s Mental
Health Act in Practice. Wellington: Victoria University Press.
Huckshorn KA. 2005. Six Core Strategies to Reduce the Use of Seclusion and Restraint Planning Tool. National
Association of State Mental Health Program Directors. URL: www.wafca. org (accessed 23 September 2013).
Ministry of Health. 1996. Inquiry under Section 47 of the Health and Disability Services Act 1993 in Respect of Certain
Mental Health Services. Wellington: Ministry of Health.
Ministry of Health. 2004. Use of Electroconvulsive Therapy (ECT) in New Zealand: A review of efficacy, safety, and
regulatory controls. Wellington: Ministry of Health.
Ministry of Health. 2009. Electroconvulsive Therapy (ECT) in New Zealand: What you and your family and whānau
need to know. Wellington: Ministry of Health.
Ministry of Health. 2010 Seclusion under the Mental Health (Compulsory Assessment and Treatment) Act 1992.
Wellington: Ministry of Health.
Ministry of Health. 2012a. Guidelines for the Role and Function of Directors of Area Mental Health Services.
Wellington: Ministry of Health.
Ministry of Health. 2012b. Guidelines for the Role and Function of District Inspectors Appointed under the Mental
Health (Compulsory Assessment and Treatment) Act 1992. Wellington: Ministry of Health.
Ministry of Health. 2012c. Guidelines for the Role and Function of Duly Authorised Officers under the Mental Health
Act 1992. Wellington: Ministry of Health.
Ministry of Health. 2012d. Guidelines to the Mental Health (Compulsory Assessment and Treatment) Act 1992.
Wellington: Ministry of Health.
Ministry of Health. 2012e. Rising to the Challenge: The Mental Health and Addiction Service Development Plan
2012–2017. Wellington: Ministry of Health.
Ministry of Health. 2013a. New Zealand Suicide Prevention Action Plan 2013–2016. Wellington: Ministry of Health.
Ministry of Health. 2013b. PRIMHD: Mental health data. URL: www.health.govt.nz/nz-health-statistics/national-
collections-and-surveys/collections/primhd-mental-health-data (accessed 16 September 2013).
New Zealand Law Commission. 2012. Compulsory Treatment for Substance Dependence: A review of the Alcoholism
and Drug Addiction Act 1966. Wellington: New Zealand Law Commission.
Oakley Browne MA, Wells JE, Scott KM (eds). 2006. Te Rau Hinengaro: The New Zealand Mental Health Survey.
Wellington: Ministry of Health.
Platform Charitable Trust. 2013. NGO Stories & Statistics. Wellington: Platform Charitable Trust.
Standards New Zealand. 2008a. Health and Disability Services (General) Standard. Wellington: Standards Council.
Standards New Zealand. 2008b. Health and Disability Services (Restraint Minimisation and Safe Practices)
Standards. Wellington: Standards Council.
Office of the Director of Mental Health Annual Report 2013
55

Appendix 1:
Additional statistics
The Mental Health Review Tribunal
During the year ended 30 June 2013, the Tribunal received 207 applications under the Mental Health
Act. Table A1 presents both the types of applications received and the outcomes of these applications.
Table A1: Outcome of Mental Health Act applications received by the Mental Health Review Tribunal,
1 July 2012 to 30 June 2013
Case outcome
Section  Section  Section  Section
Total
79
80
81
75
Deemed ineligible
8
0
0
0
8
Withdrawn
78
4
0
0
82
Held over to the next report year
15
2
1
0
18
Heard in the report year
93
6
0
0
99
Total number of cases
194
12
1
0
207
Source: Annual Report of Mental Health Review Tribunal, 1 July 2012 to 30 June 2013
During the year ended 30 June 2013, the Tribunal heard 99 applications that had been received during
the reporting year, and 9 applications held over from the previous reporting year, under section 79 of
the Mental Health Act. The results of those cases are reported in Table A2.
Table A2: Results of inquiries under section 79 of the Mental Health Act held by the Mental Health
Review Tribunal, 1 July 2012 to 30 June 2013
Result of Mental Health Act section 79 inquiry
Number of cases
Not fit to be released from compulsory status
97
Fit to be released from compulsory status
5
Total
102
Source: Annual Report of Mental Health Review Tribunal, 1 July 2012 to 30 June 2013
Table A3 shows the ethnicity of the 176 people for whom ethnicity was identified in an application to
the Tribunal in the year ended 30 June 2013.
Table A3: Ethnicity of people who identified their ethnicity in Mental Health Review Tribunal
applications, 1 July 2012 to 30 June 2013
Ethnicity
Number  Percentage
NZ European
119
68
Māori
40
23
Pacific
6
3
Asian
4
2
Other
7
4
Total
176
100
Source: Annual Report of Mental Health Review Tribunal, 1 July 2012 to 30 June 2013
56
Office of the Director of Mental Health Annual Report 2013

Of the 207 Mental Health Act applications received by the Tribunal during the year ended 30 June
2013, 126 (61%) were from males and 81(39%) from females. These gender figures are broken down in
Table A4.
Table A4: Gender of people making Mental Health Review Tribunal applications, 1 July 2012 to
30 June 2013
Type of application submitted to the Tribunal
Total number  Gender
Number
(and percentage)
Applications by people subject to community treatment orders
140 (68%)
Female
63
Male
77
Applications by people subject to inpatient treatment orders
54 (26%)
Female
16
Male
38
Applications by people subject to special patient orders
12 (6%)
Female
2
Male
10
Applications by people subject to restricted person orders
1 (0%)
Female
0
Male
1
Source: Annual Report of Mental Health Review Tribunal, 1 July 2012 to 30 June 2013
Ministry of Justice statistics
Table A5 presents data on applications for a compulsory treatment order from 2004 through to 2013.
Table A6 shows the types of orders granted over the same period.
Table A5: Applications for compulsory treatment orders (or extensions), 2004 to 2013
Number of
Number of
Number of
applications
applications
Number of
applications
Number of
Year
for a CTO, or
granted, or  applications
withdrawn,
applications
extension to  granted with  dismissed or
lapsed or
transferred to
a CTO
consent
struck out
discontinued
the High Court
2004
4423
3863
100
460
0
2005
4302
3682
100
520
0
2006
4268
3643
109
515
1
2007
4557
3916
99
542
0
2008
4557
3969
103
485
0
2009
4586
4038
54
494
0
2010
4751
4156
74
520
1
2011
4801
4215
70
516
0
2012
4843
4331
71
441
0
2013
5038
4578
66
394
0
Note:   The table presents applications that had been processed at the time of data extraction
on 26 June 2014. The year is determined by the final outcome date.

CTO = compulsory treatment order
Source: Ministry of Justice’s Integrated Sector Intelligence System, which uses data entered into the Case Management
System (CMS). The CMS is a live operational database, and figures are subject to minor changes at any time.
Office of the Director of Mental Health Annual Report 2013
57

Table A6: Types of compulsory treatment orders made on granted applications, 2004 to 2013
Number of
Number of
Number of orders
compulsory  compulsory
recorded as both
Number of
Number
community
inpatient
compulsory  applications
of granted
treatment
treatment
community and
where type
applications for
orders (or
orders (or
inpatient treatment  of order not
Year
orders
extension)
extension)
orders (or extension)
recorded
2004
3863
1832
1534
117
380
2005
3682
1575
1439
92
576
2006
3643
1614
1384
91
554
2007
3916
1713
1335
116
752
2008
3969
1841
1429
119
580
2009
4038
2086
1565
104
283
2010
4156
2239
1614
105
198
2011
4215
2255
1677
89
194
2012
4331
2427
1680
75
149
2013
4578
2630
1752
62
134
Notes: The table presents applications that had been processed at the time of data extraction on 26
June 2014. The year is determined by the final outcome date.

Where more than one order type is shown, it is likely to be because new orders are being
linked to a previous application in the Case Management System.
Source: Ministry of Justice’s Integrated Sector Intelligence System, which uses data entered into the Case Management
System (CMS). The CMS is a live operational database, and figures are subject to minor changes at any time.
In 2013, 5038 applications for a compulsory treatment order or extension to a compulsory treatment
order were dealt with in the Family Court. Of these applications, 4578 (91 percent) were granted,
66 (1 percent) were dismissed and 394 (8 percent) were withdrawn.
Of the 4578 applications granted, 2630 (57 percent) resulted in compulsory community treatment
orders and 1752 (38 percent) in compulsory inpatient treatment orders. A combination of compulsory
community and compulsory inpatient treatment orders was made for an additional 62 (1 percent)
applications. For the remaining 134 (3 percent) applications, the type of compulsory treatment order is
not recorded in the Case Management System.
58
Office of the Director of Mental Health Annual Report 2013

Appendix 2:
Caveats relating to PRIMHD
The Programme for the Integration of Mental Health Data, or PRIMHD (pronounced ‘primed’), is
the Ministry of Health’s national collection for mental health and addiction service activity and
outcome data for mental health consumers. PRIMHD data is used to report on what services are being
provided, who is providing the services, and what outcomes are being achieved for health consumers
across New Zealand’s mental health sector. These reports enable mental health and addiction service
providers to undertake better-quality service planning and decision-making, at the local, regional and
national levels (Ministry of Health 2013b). PRIMHD reports are invaluable for facilitating important
conversations and debates about mental health issues in New Zealand.
In 2008, reporting to PRIMHD became mandatory for DHBs. In addition, from this date an increasing
number of NGOs began reporting to the PRIMHD database. As of December 2012, 228 NGOs were
reporting to PRIMHD, representing 90 percent of all NGO funding (Platform Charitable Trust 2013).
Because of both its recent introduction and the enormous complexities of creating and maintaining a
national data collection, the following caveats need to be kept in mind when reviewing the statistics
generated using PRIMHD data.
• Shifts or patterns in the data after 2008 may reflect the gradual adaptation of service providers to the
PRIMHD system, in addition to, or instead of, any trend in mental health service use or consumer
outcomes.
• PRIMHD is a living data collection, which continues to be revised and updated as data reporting
processes are improved. For this reason, previously published data may be liable to amendments.
• Statistical variance between services may reflect different models of practice and different consumer
populations. However, inter-service variance may also result from differences in data entry
processes and information management.
• To function as a national collection, PRIMHD requires integration with a wide range of person
management systems across hundreds of unique service providers. As the services adjust to
PRIMHD, it is expected that the quality of the data will improve.
• For the 2013 Annual Report, manual data supplied by DHBs has been used for 15 of the 20 DHBs for
reporting compulsory assessment and treatment under the Mental Health Act. This decision was
made after issues with 2013 PRIMHD data were identified. These issues will be addressed, with the
intention of returning to PRIMHD for future Annual Reports.
• Mental health and addiction services for older people are funded as mental health and addiction
services in the Northern and Midland regions but as health services for older people in the
Southern and Central regions. PRIMHD mainly captures mental health and addiction services and
occasionally captures data on health services for older people, which means that data on clients
aged over 65 years (including services for older people) is incomplete.
• The quality and accuracy of statistical reporting relies on consistent, correct and timely data entry
by the services that report to PRIMHD.
• The Ministry of Health is actively engaged in a continuing project to review and improve the data
quality of PRIMHD. This project is considered a priority given the importance of mental health
data in providing information about mental health service use and outcomes, and in generating
conversations and public debate about how to improve mental health care for New Zealanders.
Office of the Director of Mental Health Annual Report 2013
59

60
Office of the Director of Mental Health Annual Report 2013

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