ORIGINAL ARTICLE THEORETICAL RESEARCH

Resituating Aotearoa New Zealand mental health legislation in the context of social and occupational justice

Kirk D. Reed1 and Brian Field2

1 Auckland University of ABSTRACT Technology, New Zealand 2 Midcentral District Health INTRODUCTION: Social work and occupational therapy mental health practitioners face a Board, New Zealand range of tensions in relation to statutory obligations in the context of maintaining a focus on the ideals of social or occupational justice.

APPROACH: The aim of this article is to highlight some of the complexities for social work and occupational therapy practitioners in an environment dominated by a medico-legal worldview. Those complexities include creating and maintaining a therapeutic relationship, adhering to legal obligations; and staying focused on professional values and beliefs. We have explored notions of social justice and occupational justice and undertaken a descriptive chronological review of Aotearoa New Zealand mental health legislation.

IMPLICATIONS: We have provided an insight in to some of the key factors that have influenced the development of mental health legislation in this country in relation to social and occupational justice. We have considered how the medico-legal worldview influences staying true to the notions of social and occupational justice and have made suggestions for change relative to practice and the legislation.

KEYWORDS: mental health; mental health legislation; Aotearoa New Zealand; social justice; occupational justice

Social work and occupational therapy advocating for service users/tangata whai practitioners in Aotearoa New Zealand ora in the context of a mental health system mental health services face a complex strongly influenced by dominant medical practice environment. The practice and legal worldviews. This context often environment is underpinned by a historical results in a form of social control over legal framework that is often in conflict with the population which is in conflict with a issues of social justice and occupational recovery paradigm. The term “recovery” justice. The aim of this article is to explore for people with mental health issues is not the notions of social and occupational new. McCranie (2011) highlights notions of justice, provide a descriptive chronological recovery can be traced back over 200 years AOTEAROA overview of New Zealand’s mental health to the work of Phillippe Pinel in the Paris NEW ZEALAND SOCIAL legislation and consider potential social asylums. In more recent times, the recovery WORK 29(3), 55–65. and occupational justice issues in relation paradigm has emerged from within the to practice. Our position is that social work survivor movement and the work of Patricia CORRESPONDENCE TO: and occupational therapy practitioners Deegan (1988) who wrote an account of her Kirk D. Reed are often faced with the challenge of illness and recovery experiences and argued [email protected]

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that recovery is different from psychosocial/ do to occupy themselves, including looking psychiatric rehabilitation. From an academic after themselves (self-care), enjoying life perspective, William Anthony (1991) from (leisure), and contributing to the social the Boston University Centre for Psychiatric and economic fabric of their communities Rehabilitation outlined a vision of recovery (productivity)” (Canadian Association of that continues to guide service delivery. Occupational Therapists, 2007, p. 181). The work of Rapp and Goscha (2012) in Situations where individuals are confronted the 1990s who were early advocates of the with socio-political barriers that impede recovery approach, developed the strengths participation in occupations are considered model. The strengths model is a widely instances of occupational injustice (Stadnyk used paradigm of practice that embodies et al., 2010). On the other hand, social the recovery approach. In Aotearoa justice as a notion, has existed in the New Zealand, the recovery paradigm western world for much longer and can be provides an overarching framework to guide traced back to ideas from Plato, Aristotle mental health service planning and delivery. and Socrates; it is seen as one of the key The recovery approach in the Aotearoa components of classical moral philosophy New Zealand landscape is defined as “creating (Hamedi, 2014). Social justice, in its broadest a meaningful self-directed life regardless sense, concentrates on the social nature of of challenges faced, that includes building humans in the context of society and social resilience, having aspirations and the relationships. Social justice has a major role achievement of these” (Te Pou, 2014, p. 5). to play in equity of access to the necessities Notions of recovery are embedded in of life in order for people to be functioning New Zealand documents such as the fully: it cannot be separated from human “Blueprint II: How Things Need to Be” (Mental rights (Durocher, Rappolt, & Gibson, 2014). Health Commission, 2012) and “Rising Situations where individuals do not receive to the Challenge: The Mental Health and equal access to resources and opportunities Addictions Service Development Plan 2012– are considered instances of social injustice. 2017” (Ministry of Health, 2012). Recovery Social justice and occupational justice places a premium on self-determination, are seen as complementary and have the human rights and empowerment. While concept of equity in common (Wilcock & the recovery approach appears core to Townsend, 2000), along with the need mental health service delivery, there is for just governance that encompasses the potential for disagreement when “fairness, empowerment and equitable the hegemony of the legal and medical access to resources, and sharing of rights worldviews and the recovery approach cross and responsibilities” (Wilcock, 2006, p. 4). paths. This is particularly the case when a A significant point of difference is that person is deemed in need of compulsory occupational justice places “emphasis on assessment and treatment or when the the importance of enabling participation focus of professions such as social work in meaningful occupation” (Durocher and occupational therapy differ from the et al., 2014, p. 421). The ideas of social and dominant worldview. occupational justice inform social work and occupational therapy practice respectively, The notion of occupational justice is but are likely to be in contrast to dominant relatively new and is focused on fairness, medico-legal views. In addition, practitioners equity and enabling participation in are faced with the tension of being “agents occupation for health and quality of life of the state” in the sense of likely being (Stadnyk, Townsend, & Wilcock, 2010; employed by a state funded organisation Wilcock, 2006). From an occupational that brings the expectation of operating therapy perspective, occupations are within legal frameworks. This may contrast meaningful to the individual and valued by with profession-specific views of advocating a culture and include “everything people for, and on behalf of, service users/tangata

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whaiora in access to resources, fairness, not created in a vacuum, but were firmly empowerment and participation in society. entrenched within British law, often at the peril of Te Tiriti’s intent and the values and The development of legislation in the mental beliefs that underpin Te Ao Máori2. Over health arena in Aotearoa New Zealand has time, mental health legislation has had a been influenced by a range of factors that different focus —from protection of the include: the dominance of western legal public, dealing with those causing social viewpoints, national and international problems, to an emphasis on consumer socio-political trends, advances in medical rights and services provided in a least treatment, government reforms, financial restrictive environment. The review of the constraints, professionalisation of the legislation in this article has been organised mental health workforce and the rise of the into these broad areas of focus. consumer movement. In addition, Te Tiriti o¯ 1 Waitangi has gained wider recognition and Focus on the protection of the acknowledgment in the health sector since public and “disposal” of people 1992 when it was first acknowledged in the with a mental illness health context by the then Minister of Health, Jenny Shipley (Reed, 2006). This has resulted Early mental health legislation had a focus in a significant move toward viewing health on the safe protection of the public from as a combination of social, cultural, economic people that were considered to have a mental and political factors (Reed, 2006). While it is illness. The Lunatics Ordinance (1846) not possible to explore all of the contributing was the first mental health law enacted in factors in depth, we have selected those Aotearoa New Zealand. This ordinance was we considered key. We envisage that an based on societal expectations to provide exploration of the historical legal context will for the safe custody and prevention of be helpful in practice, as often knowing what offences by persons who were regarded has gone before helps understand the current to be dangerously insane and for the care situation. In the next section, we will present and maintenance of persons of unsound a descriptive chronological overview of reasoning (Coleborne & Mackinnon, 2006; successive legislation and the key contributing Ernst, 1991). This legislative policy was factors that were pivotal to the establishment firmly embedded in Georgian and early of that legislation. Victorian English values where religion had a stronghold and people with a mental Mental health legislation in Aotearoa illness were believed to be tainted by the New Zealand devil. The Lunatic Ordinance was primarily concerned with the process of detaining In most countries, three forces work together dangerous people. to bring about social change. These comprise public opinion, the activities of voluntary In 1868, new mental health legislation (the and professional groups and the law. The Lunatics Act, 1868) was deemed necessary law depends upon public opinion which, due to the rapid development of regional in turn, demands that the law acts in the asylums and the recommendation of the 1858 public’s best interest and that the public obey Select Committee for a revision of so-called the law (Bilz & Nadler, 2014). Reviewing a lunacy laws (Brunton, 2005). The focus country’s laws provides an understanding of of the 1868 act was to provide legislation public opinion when a law was developed: about the sites where people who were our focus is to highlight the tensions between deemed to have mental health issues were social and occupational justice and the social housed and the care they were to receive control that the legislation attempts to whilst at these sites. This allowed for the create. As a colony of the British Empire, setting up of licensed institutions (often the laws of Aotearoa New Zealand were private residences), legislate for medical

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management for all asylums; and drew a and mental disability (Ball, 2010). The distinction between lunatics and lunatic Mental Defectives Act of 1911 seemed to patients (the latter referring to people be in response to pressure from medical already under care in an asylum). Essentially and educational authorities who sought this act was aimed at greater regulation legislation to bring people who were of what had been the ad hoc provision described as “subnormal”, under control. of care. The focus shifted away from the This change was influenced by the 1908 classification of what was termed “lunacy” British Royal Commission on the Care towards procedures for confinement in an and Control of the Feeble-minded (Hoult, effort to ensure greater accountability and 2007). The Royal Commission held the the more uniform provision of services belief that people described as subnormal (Campion, 2012). The changes of 1868 were responsible for many of society’s reflected societal demands and expectations problems such as alcoholism, prostitution, and concerns for the plight of those with poverty and crime (Campion, 2012). The mental health issues. 1911 act also included provision for out-of- hospital compulsory care and gave health Just over a decade later, in 1882, the Lunatics professionals a greater role in services Act of 1882 was passed with the main thrust beyond the hospital gate (O’Brien & Kydd, concentrating on public safety and the 2013). There were several amendments removal of dangerous people from the public to the Mental Defectives Act over the arena to places of detention. The new act next forty years. In the 1914 Amendment, allowed for the detention of people described an alteration included a section about a as “lunatics” based on evidence from family person managing their own affairs; this and friends when observation by designated acknowledged the societal shift towards the professionals proved to be inconclusive view that some service users were capable in determining whether detention was and therefore had the capacity to manage indicated (Campion, 2012). The main drive their own affairs. The Mental Defectives for this act was to continue to make insanity Amendment Act (1921) gave the Public a law and order issue where government Trustee the power to: take proceedings on had a central role (Campion, 2012). In 1908, behalf of “mentally defective patients,” the Lunatics Act came into force, which dissolve business partnerships of which concentrated on the detention of people who mental health patients were members, and were described as “dangerous lunatics.” One to administer property of mental health significant change in this new legislation patients (New Zealand Legal Information was the mention of treatment, implying that Institute, 1921). The 1921 amendment a mental health issue could be responsive assumed diminished capacity based on to medical interventions, but this did not mental ill health and gave authority to the seem to be a legal requirement. This further Public Trustee to make decisions on behalf reinforced Brunton’s (2005) view that what of the person under the act. was termed lunacy was seen as a law and order issue, rather than as a health condition During the period between World War One that could respond to medical treatment or and World War Two there were changes other interventions. in the way New Zealand society viewed the mentally unwell. This shift was in Focus on those perceived to be part due to the emergence of the eugenics movement. Eugenics was defined by causing social problems Galton (1907) as “the study of the agencies In the early 1900s, the Mental Defectives under social control that may improve or Act was passed and this was the first time impair racial quality of future generations the New Zealand Government articulated either physically or mentally” (p. 17n). the difference between mental illness The eugenics movement influenced psychiatry

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where eugenicists argued that “measures Focus on mental health facilities such as sterilisation and institutionalisation and service delivery of the mentally disabled as well as laws restricting immigration and marriage would Between 1954 and 1961 there were five Mental improve public health” (Dowbiggin, 1997, Health Amendment Acts that were, in part, p. vi). These notions influenced the 1928 a response to public allegations that the amendment to the act where a Eugenics government was neglecting mental health Board was established. The role of this facilities and that mental health staff were board was to monitor people under the abusing patients (Ball, 2010). As a result, act and manage the resources required to amendments were made to the legislation oversee this group. The Eugenics Board which included the compulsory appointment also introduced a new category, titled the of a suitably qualified doctor to a Medical “social defective,” where a person needed Superintendent role in each establishment. to be mentally deficient and involved in In addition, it became compulsory for anti-social behaviour to come under the act. any establishment that housed over one The societal view at the time was that the hundred “mentally defective patients” to social defective needed supervision for their have a medical officer living in residence own and society’s protection (Campion, (Prebble, 2007). In 1969 the new Mental 2012). In the Mental Defectives Amendment Health Act (1969) was introduced. This was Act 1935, there were three main changes. during a period of rapid change in mental Children were now included, in that minors health care both locally and internationally could be admitted to institutions in the (O’Brien & Kydd, 2013). The purpose of the same manner as adults; secondly, that the 1969 act was to substantially revise existing Director General of Health could grant legislation (Ministry of Health, 1984). These limited leave of absence to patients; and revisions were responses to a Board of finally, that protection was given against Health Committee Inquiry (1957–1960) that civil or criminal liability to persons acting had foreseen the deinstitutionalisation of under authority of the act (New Zealand psychiatric hospitals. The Board of Health Legal Information Institute, 1935). A further Committee recommended an increase in amendment to the act in 1951 increased psychiatric services provided at general the power of the state in relation to hospitals, an initiative that would reduce escaped patients and transfer of patients the reliance on institutions in the provision between institutions (New Zealand Legal of mental health care (Brunton, 2005). The Information Institute, 1951). The legislation act also relaxed formalities surrounding the to this point was largely characterised by admission of informal patients to hospitals ideas of social control, aimed at those who so as to align access to mental health services were considered to be “undesirable” or with entry procedures to general hospitals. not meeting society’s expectations, and In addition, provisions were introduced for removing them from the public eye into regular reviews of each committed patient. institutions. The idea that those with mental Significantly, the Mental Health Act of 1969 health issues were a risk to public safety was the first piece of legislation that had underpins the rationale for some of the specific sections relating to both custody and legislation, emphasising the need treatment, thus making treatment legally for legislation that protected society. binding (Ball, 2010). The legislation also reinforced society’s view that those with mental health Focus on the balance between issues were not able to manage their own consumer rights and least affairs, and needed to be taken care of. restrictive intervention The legislation allowed the state to have a significant role in the provision and The New Zealand Bill of Rights Act 1990 regulation of that care. was enacted to affirm, protect and promote

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human rights and fundamental freedoms in of other health professionals being considered Aotearoa New Zealand. The act also affirmed in tandem with doctors who had traditionally Aotearoa New Zealand’s commitment to been the sole decision makers. The act the International Convention on Civil and stipulated an initial period of compulsory Political Rights. When it was enacted, the Bill assessment and treatment at the end of which of Rights Act did not create any new rights a determination was made about whether the but merely confirmed existing common law person was subject to a compulsory treatment rights (New Zealand Ministry of Justice, order. During this period of compulsory 2013). However, the act did reiterate the assessment and treatment, the service user had following citizenship rights: a right to have his or her condition reviewed by a Family Court judge. Service users/tangata • not to be subjected to torture or cruel whaiora were permitted to seek this review treatment (section 9); on two occasions, either during the first period • not to be subjected to medical or of assessment under section 11 or at a later scientific experimentation (section 10); date under section 13 (Fishwick, Tait, & • to refuse to undergo medical O’Brien, 2001). The act allowed for more treatment (section 11); checks and balances and review procedures • to be secure against unreasonable to be established. These processes were aimed search and seizure (section 21); at protecting service users’ rights and ensuring • not to be arbitrarily arrested or that unnecessary incarceration did not take detained (section 22). place.

While the Bill of Rights does protect One of the consequences following the New Zealanders’ fundamental rights, it passing of the 1992 act, and to some should be noted that these rights could be extent facilitated by it, was a reduction in overturned by the Mental Health Compulsory psychiatric hospital beds and the closure of Assessment and Treatment Act (1992) and the stand-alone psychiatric hospitals. Although Mental Health (Compulsory Assessment and there were a number of other factors at Treatment) Amendment Act (1999). play, including the rise of the consumer movement and the increased efficacy of The Mental Health (Compulsory Assessment drug treatments, the so-called Gibbs Report and Treatment) Act 1992 was a watershed (Hospital and Related Services Taskforce, piece of legislation as it entrenched the 1988) played a major role. The Gibbs Report principles of compulsory assessment and advocated for closure of hospitals to reduce treatment in the least restrictive environment costs of government-provided services. In (community care), in conjunction with patients’ return this meant that options for long-term rights (Anderson, 2000). One of the key reasons inpatient care became scarcer, and shorter behind the act was to reduce the association periods of inpatient admission became more between criminal proceedings and inquiry into common. For those considered to need the mental state of patients, although it did a longer period of compulsory care, the lead to greater legal involvement in all aspects Community Treatment Order created the of the committal process (Bell & Brookbanks, means of providing compulsory care in the 1998). Legal involvement was aimed at community therefore meeting the policy and ensuring patient rights including advocacy, legislative requirements for care in a least and matters of informed consent were dealt restrictive environment (Bell & Brookbanks, with. The 1992 act also sought to elicit a greater 2005). It is interesting to note that, as hospital range of opinions in making determinations numbers reduced, numbers of people under about mental state than had occurred under compulsory provisions remained much the previous legislation. For example, in section same (O’Brien & Kydd, 2013), indicating 16 of the act, decision-making is both a judicial that the perceived need for compulsory and clinical procedure, with clinical opinions assessment treatment remained static.

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The final piece of Aotearoa New Zealand’s user rights and care and treatment in a least major mental health legislation which is still restrictive environment. We suggest that current, is the Mental Health (Compulsory there is a range of tensions that exist for Assessment and Treatment) Amendment practitioners and we believe that both social Act 1999. The new act retained up to three work and occupational therapy have a role assessment stages to the compulsory in advocating for change to the practice treatment order; a preliminary assessment, and legislative framework. Ideally, the a five-day assessment and a 14-day legal framework should be aligned with assessment. The preliminary assessment the recovery philosophy, which overarches is undertaken by a clinician, normally a New Zealand mental health service psychiatrist. If this assessment finds there is delivery. A recovery philosophy explicitly reasonable proof of a mental health problem, recognises service users’ experiences of then there could be further assessment adversity, including compulsory detention and treatment for up to five days. Before and treatment. The recovery paradigm also the end of the five-day period the clinician champions mental health services to give must decide whether a patient has a mental greater recognition to the service user voice, disorder that requires further assessment or even in situations of crisis where compulsory treatment. If this is the case, a patient can be treatment might be considered. We agree held for further assessment and treatment with Gordon and O’Brien (2014) that current for up to 14 days. By the end of this period legislation “is antithetical to recovery the clinician decides whether a patient is because it implicitly suggests that people well enough to be released (in which case no with mental illness pose such a degree of further compulsory treatment or assessment risk that this risk needs specific legislative is given). If not, the clinician must apply recognition” (p. 59). for a compulsory treatment order under section 14. During the two initial assessment Statistics from the Office of the Director of periods (the first for up to five days and the Mental Health indicate the total number second for up to 14) patients can apply to of people subject to both community and have their compulsory assessment status inpatient compulsory treatment is growing reviewed by a Family Court or District Court (Gordon & O’Brien, 2014). Following judge (Gordon & O’Brien, 2014). It has been an invitation from the New Zealand argued by Newton-Howes and Ryan (2017) Government, the United Nations Working that compulsory treatment orders may be Group on Arbitrary Detention conducted ineffective and force people with serious a country visit in 2014. In their report, mental health symptoms to have treatment the Working Group highlighted that the without consent and, as such, be a breach of Compulsory Assessment and Treatment Act their rights. 1992 is not effectively implemented to ensure that arbitrary deprivation of liberty does not In the next section we will link the occur. In practice, compulsory treatment descriptive chronological review of the orders are largely clinical decisions, and it legislation to issues related to social and is difficult to challenge such orders even occupational justice and make suggestions though the Mental Health Act guarantees for change informed by a social and the right to legal advice for all patients. The occupational justice perspective. Family Court, which makes compulsory treatment orders, does not specialise in mental health therefore relies heavily on Discussion medical reports completed by a psychiatrist Since inception in 1848, New Zealand mental and other medical professionals (United health legislation appears to be have shifted Nations Human Rights Commission, 2015). It from a focus on the safety and protection appears that Aotearoa New Zealand’s mental of society in general to a focus on service health legislation is in conflict with the

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philosophical approach taken by the United relationship with a service user has been Nations. As Newton-Howes and Ryan (2017) explored in social work (Gibbs, Dawson, & highlighted, the use of compulsory treatment Mullen, 2005) and nursing (Clearly, 2003). orders is out of step with current health We were unable to find any literature that practices and goes against the principles explored this issue in relation to occupational of recovery-oriented services. Their view is therapy. that it is the intervention that people receive rather than the treatment order that is most There is potential for social work and effective. occupational therapy practitioners to advocate for a least restrictive alternative to The tensions between complying with compulsory assessment and treatment orders current statutory obligations, maintaining that is more in line with recovery principles. a therapeutic relationship and acting as an This should include recognising the inherent advocate for service users/tangata whaiora potential in all people impacted by mental creates a difficult and often complex situation health issues and working together with for practitioners. The role of the Duly them in all decision-making processes about Authorised Officer (DAO), for example, is their recovery journey. This could include a statutory role under the legislation and is promoting and protecting individual’s sometimes performed by some social work legal, citizenship and human rights and and occupational therapy practitioners. The supporting individuals to develop social, DAO role creates a power imbalance between recreational, occupational, educational and the practitioner and client where the role vocational activities that are meaningful to under the act has the potential for conflict them. This advocacy role has its challenges with a service user/tangata whaiora advocacy when the current framework is weighed role, which is a similar tension faced by heavily towards medico-legal concerns social work practitioners in child protection wherein medication and incarceration are the and youth justice contexts. In the current predominant interventions. The potential of system social work and occupational therapy recovery-focused social and/or occupational practitioners may be working with service interventions needs to be promoted as being users/tangata whaiora under community as effective, if not more so than compulsory treatment orders. The power dynamics when treatment orders. therapeutically engaging with an individual under such an order in their own home has From a social work perspective, this would numerous complexities in building and mean greater acknowledgment of social maintaining an effective relationship. From models of care which are focused on an occupational justice perspective, further strengths, personal growth, quality of life, exploration is required on how compulsory general well-being, and where the effects of assessment and treatment regimens may mutual interactions of individuals are key. impact a person’s rights to participate in This would support an emphasis on the occupations of their choice, maintain their person-in-environment perspective (Saleeby, usual routines and habits and experience 1992), by focusing on addressing social meaningful occupation. We also suggest that justice issues related to equity and access there is a strong need to advocate for different to the necessities of life. This could include, approaches or alternatives to compulsory as Khoury and Rodriguez del Barrio (2015) assessment and treatment that are culturally suggest, re-connecting the person to valuable relevant. This is especially important in the resources in the community—friends, context of the obligations of the Te Tiriti, family, work, education, hobbies and peer Te Ao Máori and the over-representation of support. This may mean the social work Máori and Pacific peoples in mental health practitioner works with organisations or services. The conflict between statutory individuals to alter services to address access obligations and maintaining a therapeutic and equity of access to services so these

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services are more accommodating for those term planning related to work, education or considering engaging in a recovery process housing would support a person to function with or without access to the mental health as fully as possible in their community. system. The social work practitioner could more regularly act as a social connector, At a systems level, social work and encourager, advocate, system navigator, occupational therapy practitioners could decision maker, support person or family/ campaign for changes to the mental health whánau counsellor. legislation. This could include discouraging or ceasing the use of compulsory treatment From an occupational justice perspective, orders and promoting the vital role of there would be a greater focus on social and occupational justice in recovery- meaningful occupation and the person- oriented services that are more focused on occupation-environment perspective (Strong fair treatment of people with mental health et al., 1999). Being able to engage in activities issues. Ensuring that a person’s human of choice is a social and occupational justice rights are not breached is a key concern issue, a key role for occupational therapists for both professions. In relation to service and social workers is in identifying barriers delivery, there is a need to create change (social, financial, attitudinal, etc.) to in relation to service expectations and engagement and then reducing or removing reporting requirements. A stronger focus those barriers. This would include, as on recovery principles and on social and Synovec (2015) encourages, the occupational occupational needs will likely mean that therapist teaching and supporting the active service expectations related to the number of use of coping strategies to help manage people seen in a day by a practitioner, time the effect of symptoms of illness. Creating spent with an individual or the number of opportunities for people to engage in people on a caseload would need to change. activities that promote health and support a This would require a shift from financial wellness lifestyle by addressing barriers and or output measures to measures focused building on existing abilities would increase on recovery, and social or occupational opportunities to engage in meaningful outcomes rather than broad service level occupations is also a key role. This could outcomes. For practitioners, this would include supporting the identification of allow for increased flexibility; allow for an personal values, needs, and goals to enable individual’s needs to be met and increase informed, empowered and realistic decision professional autonomy to allow practitioners making, such as when considering housing, to develop relationships with individuals, education and employment options. In family/whánau and communities and, in concert, this would also involve addressing doing so, use a diversity of intervention socio-political barriers that may impede approaches that can be co-designed by the participation in occupations where a person service user and practitioner. is unable to contribute to their community through education or employment because These broad –based suggestions, both at a of factors beyond their control. Another area practice and systems level create a challenge of focus could be on providing information for occupational therapy and social work to increase awareness of community-based practitioners to see beyond practice as it is resources, such as peer-facilitated groups currently framed by dominant medico-legal and other support options. This would views. Our suggestions call on practitioners likely be a two-way process, working with to imbed their practice in the ideals of the these services to ensure that they reduce any recovery paradigm while developing their barriers to increase ease of access for people practice to alleviate social and occupational with mental health issues. Finally, working injustices across of the spectrum of mental in partnership with the individual and across health service delivery and associated agencies to support engagement in long- legislation.

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Conclusion Anthony, W. (1991). Recovery from mental illness. The new vision of the mental health system in the 1990s. The development of mental health legislation Psychosocial Rehabilitation Journal. 16, 11–23. Retrieved from http://www.apa.org/pubs/journals/prj/ in Aotearoa New Zealand appears to have Ball, C. A. (2010). Mental health legislation in New Zealand been strongly influenced by an English legal since 1846 to date: A discourse analysis. (Unpublished perspective at the expense of the obligations master’s thesis). Eastern Institute of Technology, outlined in Te Tiriti or consideration of the Taradale, NZ. Retrieved from http://repository.digitalnz. org/system/uploads/record/attachment/646/mental_ principles of Te Ao Máori. Early legislation health_legislation_in_new_zealand_from_1846_to_ was focused primarily on ideas of social date__a_discourse_analysis.pdf control with safety and protection of society at Bell, S. A., & Brookbanks, W. J. (1998). 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(1951). 1951 Wilcock, A. (2006). An occupational perspective of health No 47 Mental Defectives Amendment. Retrieved from (2nd ed.). Thorofare, NJ: Slack. http://www.nzlii.org/nz/legis/hist_act/mdaa19511951n 47275.pdf Notes New Zealand Ministry of Justice. (2013). New Zealand Bill of 1 Te Tiriti o¯ Waitangi (Treaty of Waitangi) considered to be the Rights Act 1990. Retrieved from http://www.justice.govt. founding document of New Zealand, signed in 1840 by nz/policy/constitutional-law-and-human-rights/human- representatives of the British Crown and various rights/domestic-human-rights-protection/about-the- Ma¯ ori (indigenous) chiefs. new-zealand-bill-of-rights-act/copy_of_new-zealand- 2 Te Ao Ma¯ ori is the Ma¯ ori world and includes language, bill-of-rights-act-1990 cultural processes and practices, sites of importance Newton-Howes, G., & Ryan, C. (2017). The use of community and connections to family and community. treatment orders in competent patients is not justified.

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