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Restricted patients in New Zealand: A failed social experiment with a hybrid form of civil/forensic compulsory mental health treatment
International Journal of Law and Psychiatry ( IF 2.479 ) Pub Date : 2021-11-30 , DOI: 10.1016/j.ijlp.2021.101762
Susanna Every-Palmer 1 , Alice Dunn 2 , James Foulds 3 , Iris Reuvecamp 4 , John Dawson 5
Affiliation  

Introduction

In 1992, New Zealand's mental health legislation created the distinct concept of a ‘restricted patient’ – effectively creating a pathway into forensic patient status, but via the civil committal process, without the patient passing through the criminal justice system en route. This regime was aimed at civilly committed patients who present “special difficulties” because of the danger they pose to others. It remains in force but has attracted little scrutiny.

Objective

This paper traverses the background to restricted patient status, and the legal regime, before describing and analysing, in anonymous form, the circumstances of all those declared to be restricted patients, and their outcomes, since the regime began. It then considers the continuing appropriateness of this legal regime in light of contemporary human rights principles.

Methods

We reviewed the records of every person placed under restricted patient status since the legislation came into force over a nearly 30-year-period.

Results

New Zealand's restricted patient status is rarely used. Only eight people have been subject to such orders (seven male, median age 45 years at the making of the order). All had a history of violent offending and had previously been forensic patients. None re-offended after becoming a restricted patient, but they spent longer as compulsory inpatients than patients unfit to stand trial or not guilty by reason of insanity. There is no evidence they were uniquely dangerous. The legal criteria, namely, that the person presented with “special difficulties”, are unclear and have been interpreted differently by the judiciary. They have sometimes included the risk of inadequate care being provided by mental health services.

Conclusion

Given the rarity with which restricted patient status has been used in New Zealand, the subsequent evolution and development of forensic services providing alternative pathways through care, and its problematic human rights aspects, we would not recommend equivalent restricted patient provisions to other countries. We suggest this hybrid form of civil/forensic compulsory mental health treatment is a form of arbitrary detention and incompatible with human rights norms. It should be omitted from New Zealand's next Mental Health Act.



中文翻译:

新西兰受限制的患者:一项失败的社会实验,采用民事/法医强制心理健康治疗的混合形式

介绍

1992 年,新西兰的精神卫生立法创造了“受限患者”的独特概念——有效地创造了进入法医患者身份的途径,但通过民事提交程序,患者在途中无需通过刑事司法系统。该制度针对因对他人构成危险而出现“特殊困难”的有民事责任的患者。它仍然有效,但几乎没有受到审查。

客观的

本文回顾了受限患者身份和法律制度的背景,然后以匿名的形式描述和分析了自该制度开始以来所有被宣布为受限患者的情况及其结果。然后根据当代人权原则考虑这一法律制度的持续适当性。

方法

自该立法生效近 30 年以来,我们审查了每个处于受限患者状态的人的记录。

结果

新西兰的受限患者状态很少使用。只有八人受到此类命令的约束(七名男性,下达命令时的中位年龄为 45 岁)。所有人都有暴力犯罪的历史,之前曾是法医患者。没有人在成为受限患者后再次犯罪,但与因精神错乱而无法接受审判或无罪的患者相比,他们作为强制住院患者的时间更长。没有证据表明它们具有独特的危险性。法律标准,即存在“特殊困难”的人,并不清楚,司法部门对此有不同的解释。它们有时包括精神卫生服务提供不充分护理的风险。

结论

鉴于新西兰很少使用限制性患者身份,法医服务随后的演变和发展提供替代性护理途径,以及其存在问题的人权方面,我们不会向其他国家推荐类似的限制性患者条款。我们认为这种民事/法医强制心理健康治疗的混合形式是一种任意拘留形式,不符合人权规范。新西兰的下一个心理健康法案应该将其省略。

更新日期:2021-11-30
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