brief early autumn update

After finishing a rough draft of “one Woman Walking” (the book) back in November, which also coincided with the postponement of the Health Select Committee presentation, I felt a need to take some space from both Hikoi and kaupapa. It has been a time of enjoying summer; Tipi-raising and sleeping within; summer vege gardening (including my first attempt to grow kumara!); collecting native seed for a wonderful initiative in Miranda (Check out Te Whangai) and some massage. At the beginning of February I began to reorientate to both the presentation and the next step with getting the book published.
We agreed upon a date for the presentation, and I have invited Frank Bristol from Balance Whanganui and Teresa Rudgley from Whangarei to join me in meeting the HSC on March 12th.
Through pursuing funding options for publishing the book, I was pointed in the direction of the Ashton Wylie prize for unpublished manuscripts in the mind/body/spirit genre. The date for submitting manuscripts is 31st March, so it has been full steam ahead with both editing and preparations for the HSC meeting.
Of course bringing my consciousness back to both remembering the journey and being reminded of the kaupapa has re-enlivened my commitment to awareness-raising for change. I have been re-reading Paris Williams’ fantastic “Re-thinking Madness” Check out his website under that name. Paris has generously agreed to send through some of his slides for our presentation.
Please send us your supportive prayers/thoughts/blessings on March 12th

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HIKOI BLOG IN MADINAMERICA BLOGSITE
Hi All, I am delighted to report that I was invited to write a blog on Robert Wittaker’s op-ed blog site.http://www.madinamerica.com/ We have decided to serialise the story of the Hikoi. It is a most wonderful site. Please check it out and you will find the first instalment of the Hikoi story there

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PETITION PRESENTATION

Well, the deed is done!! Six months after setting off from Cape Reinga, I handed over the paper petition with 1053 signatures to Paul Hutchison, who presented it to Parliament today. I will hear back from the Health Select Committee, probably in just over a week, of when the petition will be considered by the Committee and will be invited to make a submission at that time.

Back in early March, when I diverted from the trail to Paeroa and Thames, where friends and supporters were keen for me to hold meetings, a friend of mine, highly talented potter and environmental and social activist, Mike O’Donell gave me one of his beautiful “story stones”: a small glazed pottery disc, and instructed me to carry it with me and place it in the centre of circles, or front of meetings, to carry everyone’s stories down the rest of the island.
Before setting off from the Rose Gardens yesterday morning, the 8 of us present blessed the stone with our own unique words and prayers of intent that the messages in the stone will touch the hearts of those in power to enact the changes that are so needed.
We gathered a handful of extra signatures from people we passed on the way into town, then stood with the banner on a corner of Lambton Quay, and below the cenotaph.
Then on into the parliamentary grounds at midday. Slowly extra people began to gather until there was about twenty of us with the trusty banner, including Monica, the banner-maker.
At 12.30 sharp the politicians arrived: Dr Paul Hutchison (National MP and chair of the Health Select Committee); Annette King (Labour Spokesperson for Health and member of the H.S.C.) Barbara Stewart (NZ First M.P. and member of H.S.C.); Dr Jian Yang (National M.P. and deputy chair of H.S.C.) and Louisa Wall (Labour M.P for Manurewa).
Paul Hutchison talked of the principle to “First, do no harm”, so I can see that phrase making its way into the supporting evidence!!
I was impressed by the humanness of the politicians and enjoyed bringing a little ceremony to the handover, by also handing over the “story stone” and a feather to represent the spirit of the land. I sensed a genuine openness in the politicians present to consider the issues seriously, so I truly feel optimistic that the petition may help bring about the beginnings of real change.

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WELLINGTONIANS PLEASE COME FOR HIKOI PICNIC/ PETITION PRESENTATION

LAST CHANCE TO SUPPORT THE HIKOI!!

Tomorrow the Hikoi officially ends with the walk to Parliament, gathering at the Rose gardens in the Botanical Gardens at 10.30, walking via Lambton Quay etc with the banner to the Beehive to arrive at 12 noon and present the petition to Paul Hutchison at 12.30pm near the Seddon Statue. Followed by a picnic on the Front lawns of the Beehive. WELLINGTON SUPPORTERS PLEASE COME!! Especially for the presentation if you can’t spare time for the entire event. Come colourful!!

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Annie is arriving in Wellington!!

Annie is arriving in Wellington!!

Come and join the celebration for the completion of Annies walk, at the hikoi picnic. Sign the petition, and join her as she presents it to parliament. The more the merrier, lets make our voices heard

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DSM5 new Psychiatric manual causing upsets

Here is a great article from Hearing Voices Network Uks page  I have written it out here . They are asking for comments on their page. There is a lot of heat on the Paychiatric community with the release of the new manual this year. What do you think?

DSM 5, the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – often referred to as the ‘psychiatric bible’ – has now been released in the wake of huge controversy and debate. The alternative classification system, ICD, is based on exactly the same principles. Some of the world’s most eminent psychiatrists have spoken out about the current system.

The former director of the US’s largest funding body for mental health research, the NIMH, recently described DSM as ‘totally wrong, an absolute nightmare’. The chair of the DSM 5 committee admitted that ‘We have been telling patients for several decades’ that the biological causes of distress are about to be discovered, but ‘We’re still waiting.’ Another senior psychiatrist said, ‘Patients deserve better.’ In the UK, clinical psychologists have challenged the use of diagnosis and the ‘illness’ model.

The Hearing Voices Network, alongside many of our professional allies in psychology and psychiatry, has serious concerns about the way we currently understand, categorise and respond to mental distress . We also recognise the confusion that can be caused when accepted facts, often presented to service users as truths, are challenged.

We believe that people with lived experience of diagnosis must be at the heart of any discussions about alternatives to the current system. People who use services are the true experts on how those services could be developed and delivered; they are the ones that know exactly what they need, what works well and what improvements need to be made. This statement outlines the main issues, as we see them, and invites people on the receiving end of a diagnosis to have a voice in this debate.

Main Issues

Psychiatric diagnoses are scientifically unsound:

  • No objective tests: Unlike most fields of medicine, psychiatric diagnoses are not provided on the basis of objective tests or measures.
  • They’re artificial: There is strong evidence that diagnoses do not represent meaningful clusters of problems or link to known biological abnormalities. Diagnoses are voted into existence by committee, representing opinion rather than scientific fact.
  • Drug company involvement: There is growing concern that new diagnoses are both suggested and shaped by (initiated by) drug company funded research and interests.
  • Unreliable: The diagnosis you receive from a psychiatrist is based on their opinion about what you have told them. Different psychiatrists often have different opinions about the same person, leading to multiple diagnoses. Two people with the same diagnosis may have nothing in common.
  • Limited explanation: Whilst diagnosis seems to provide an explanation for people’s problems, this isn’t the case. People are told they have ‘schizophrenia’ on the basis of their unusual thoughts, experiences, feelings & behaviour. If they then ask why they are having these unusual experiences, they are told it is because they have ‘schizophrenia’. This circular argument explains nothing.
  • Limited use: The issues raised above mean that diagnoses are a flawed basis for deciding on treatment, predicting outcomes and carrying out research.

Psychiatric diagnoses have damaging consequences:

  • Misses the point: Increasing evidence demonstrates mental distress is an understandable reaction to adversity, including: bereavement, loss, poverty, discrimination, trauma, abuse and victimisation. By focusing on ‘what’s wrong with you’, diagnoses can stop professionals asking ‘what’s happened to you’.
  • Missed opportunity: Psychiatric diagnoses can stop people addressing the links between social and economic policy and mental distress. Essential funds are used in the ongoing futile search for genetic markers instead of addressing the societal issues we know lead to mental health problems.
  • Disempowers: Psychiatric diagnosis ignores people’s own explanations for their distress and encourages them to defer to an ‘expert’ for treatment. Having your reality redefined in terms of illness and biology is an incredibly powerful experience that can set the scene for a lifelong psychiatric career.
  • Medication-focused: In diagnoses such as ‘schizophrenia’ treatment is primarily medication, which is becoming increasingly criticised for its harmful effects and lack of efficacy. Medication does nothing to address underlying difficulties.
  • Human rights: People are expected to accept diagnoses for fear of being labelled as ‘lacking in insight’ and having treatment forced on them, violating their basic human rights. Others may, understandably, hide their voices or visions to escape forced treatment – blocking them from receiving help to cope with their experiences.
  • Takes away hope: Diagnoses such as schizophrenia and personality disorder, seen as a life-long condition, can unnecessarily take away people’s hope for a meaningful recovery.
  • Discrimination: People diagnosed with ‘severe and enduring mental illnesses’ are often subject to stigma, discrimination and exclusion. They may have trouble getting insurance, security clearance to travel overseas, and difficulty fostering or adopting children.

A Way Forward

Finding the best way to support those of us who are suffering and struggling to cope without relying on diagnoses and the existing system is a challenge. It can be hard to see what is possible when all we have known is what is available. Still, we want to engage people with lived experience of diagnosis and our allies, in a discussion to create a way forwards.

Our initial ideas include:

  • Seeing mental distress as human and, ultimately, understandable: Rather than seeing voices, visions and extreme states as symptoms of an underlying illness, we believe it is helpful to view them as meaningful experiences – even if we don’t yet know what that meaning is. We believe it’s important to use human language when describing human experiences rather than medical terminology. Given the role of trauma and adversity, we need to start asking ‘what has happened to you?’ rather than ‘what is wrong with you?’
  • Keeping the person in the driving seat: We want people to have the freedom to define their own experience. Support should be based on need, not diagnosis. Equally, people need to access a wide range of alternatives to understand and manage their experiences. Medication is just one way, amongst many, that people may choose. We need information about the pros/cons of each approach – true choice and collaboration, no coercion.
  • Supportive communities: Mental distress is not just the domain of mental health services. Communities have an important role to play in supporting those who are struggling to cope. Community based options can run alongside, and as alternative to, psychiatry. Equally, these approaches must go hand in hand with greater awareness of the causal impact of social factors such as poverty, gender and racial inequalities, unemployment, deprivation and abuse, on mental distress

  See some other articles regarding the uproar here

 
and here
 
Things are certainly heating up
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Summary of Trends in Compulsory Interventions in NZ

This information was sent to us and one has to ask- isnt this a breach of human rights?

DIRECTOR OF MENTAL HEALTH REPORTS 2005-2010

SUMMARY OF TRENDS IN COMPUSORY INTERVENTIONS

Mental Health Foundation of New Zealand December 2011 

INTRODUCTION

 The Director of Mental Health has published six annual reports, which provide unprecedented narrative and statistics on compulsory processes in New Zealand’s mental health and addiction services. The Mental Health (Compulsory Assessment and Treatment) Act 1992, empowers the state to subject people with a mental disorder, who are deemed to be a serious danger to themselves or others, or who have a seriously diminished capacity to care for themselves, to compulsory assessment, followed, if deemed necessary,  by compulsory treatment in hospital or in the community. There are a number of human rights concerns highlighted in this paper. They include the position on this issue taken by the New Convention on the Rights of Persons with Disabilities, the increase in the use of compulsory treatment in New Zealand in the last twenty years, the variation in rates between District Health Boards (DHBs), and the low rates of success people have in challenging their status through the available legal avenues.

 Convention on the Rights of Persons with Disabilities

In 2006, the Convention on the Rights of Persons with Disabilities was passed by the United Nations and has since been ratified by the New Zealand Government. The Convention raises big questions about the legality of compulsory interventions in mental health which have yet to be seriously considered by the New Zealand Government.

  ‘Prior to the entrance into force of the Convention, the existence of a mental disability represented a lawful ground for deprivation of liberty and detention under international human rights law. The Convention radically departs from this approach by forbidding deprivation of liberty based on the existence of any disability, including mental or intellectual, as discriminatory. Article 14, paragraph 1 (b), of the Convention unambiguously states that ‘the existence of a disability shall in no case justify a deprivation of liberty’. Unlawful detention encompasses situations where the deprivation of liberty is grounded in the combination between a mental or intellectual disability and other elements such as dangerousness, or care and treatment.  Since such measures are partly justified by the person’s disability, they are to be considered discriminatory and in violation of the prohibition of deprivation of liberty on the grounds of disability, and the right to liberty on an equal basis with others prescribed by article 14.

 Legislation authorizing the institutionalization of persons with disabilities on the grounds of their disability without their free and informed consent must be abolished. This must include the repeal of provisions authorizing institutionalization of persons with disabilities for their care and treatment without their free and informed consent,  as well as provisions authorizing the preventive detention of persons with disabilities on grounds such as the likelihood of them posing a danger to themselves or others, in all cases in which such grounds of care, treatment and public security are linked in legislation to an apparent or diagnosed mental illness.  This should not be interpreted to say that persons with disabilities cannot be lawfully subject to detention for care and treatment or to preventive detention, but that the legal grounds upon which restriction of liberty is determined must be de-linked from the disability and neutrally defined so as to apply to all persons on an equal basis.’ (United Nations Human Rights Council, 2009).

 COMPULSORY TREATMENT ORDERS

 Trends over time

In 1954, 87.9 per 100,000 people were subject to compulsory interventions per month in New Zealand. By 1969 the rate had dropped to 70.1 per 100,000. Between 1969 and 1992 the numbers continued to decline. However, between 2005 and 2010 the rate rose to near 1954 levels. One of the Director’s Reports acknowledges that ‘the introduction of compulsory treatment in the community may have increased the rate of compulsory treatment’ (Ministry of Health, 2009, p 29). In the six years since the Director of Mental Health started his reports the number of the applications granted for all inpatient treatment orders increased by 23%, and the number of applications granted for community treatment orders increased by 32%.

 Comparisons with other jurisdictions

New Zealand and parts of Australia have very high rates of compulsory community treatment compared to jurisdictions with these powers in North America and Europe (Lawton-Smith, 2006).

 Comparisons between DHBs

There is a big variation between DHBs in the rates per 100,000 of people placed under compulsory treatment orders. For instance, in 2010 the rates of people on community treatment orders varied from 40 to 122 per 100,000, with an average of 77. In the same year the rates of people on compulsory inpatient orders varied from 1 to 33, with an average of 14. These variations are concerning and need further investigation.

 SECLUSION

 Seclusion is defined as locking a person alone in a room they cannot exit without the agreement of the clinical staff. Seclusion is traumatising for most people subjected to it. There are programmes  to reduce and eliminate seclusion in various countries including New Zealand. Overall, seclusion rates have stayed much the same since they were first included in the Director’s Reports in 2007 but some DHBs have significantly reduced their use of seclusion. Currently across the country around 17% of inpatients are placed  in seclusion.

 Ethnic and gender comparisons

The proportion of adults in inpatient units who are secluded varies considerably by ethnicity and gender. For instance, in 2010 28% of Maori male inpatients were secluded but only 17% of non-Maori males were secluded. Slightly more Maori females were secluded than non Maori males. This needs further investigation.

 Comparisons between DHBs

There is a huge variation between DHBs in the rates per 100,000 of people placed in seclusion. For instance, in 2010 the rates of people placed in seclusion varied from around 15 to around 250 per 100,000. The Director’s Reports do not provide a robust explanation for this variation.

 Office of the Ombudsmen

The Office of the Ombudsmen found a case of potential cruel and inhumane treatment in a mental health patient who had been in virtually constant restraint and seclusion for six years (Ombudsmen, 2009).  In response the Director of Mental Health responded he was ordering an urgent report (New Zealand Herald, 2009). In its subsequent annual report the Office of the Ombudsmen noted that it had taken the ‘unreasonably long period’ of 13 months for the patient to be moved to a more suitable facility (Ombudsmen, 2010).

 COMPULSORY ELECTRO-CONVULSIVE THERAPY (ECT)

 ECT is a controversial treatment where an electric shock to the brain is used to induce a seizure. Today it is usually used to treat severe depression, most frequently in women, particularly older women. Unlike other forms of compulsory treatment, compulsory ECT requires a second opinion from a psychiatrist appointed by the Mental Health Review Tribunal. There is no information on the outcomes of these second opinions. The total number of patients with ECT dropped from 356 in 2009 to 235 in 2010. The average percentage of people given ECT without their consent was 20%.

 Comparisons between DHBs

There is a large unexplained variation in rates of compulsory ECT between DHBs. For instance, in 2010 the percentage of compulsory ECT in relation to non-compulsory ECT varied from 35% to 3%, both in DHBs where there is a higher than average use of ECT.

 REVIEW OF COMPULSORY STATUS

 People under compulsory orders have two major avenues to legally challenge their compulsory status.

 Section 16 Reviews

During the assessment period, patients are entitled to have their status reviewed by the Family Court.  The percentage of people released under Section 16 ranged from 12.5% and 8.4% between 2005 and 2009.

 Mental Health Review Tribunal

The Mental Health Review Tribunal was established under the 1992 Act to consider people’s requests for review of their compulsory status and to release them if they no longer fit the criteria in the Act. The percentage of people who applied to the Review Tribunal for review who were released from their orders ranges from 7.4% in 2009 to 1.3% in 2010. These low percentages are concerning, particularly the 2010 percentage which is the lowest for the six year period of the Director’s Reports.

 

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