Thousands of NZers subject to compulsory mental health assessments, Māori disproportionately affected

Marc Wilson

Psychology writer·New Zealand Listener·

20 Apr, 2026 06:06 PM3 mins to read

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Māori, 17% of the population, account for 37% of assessments and 40% of treatment orders under the Mental Health Act’s compulsory assessment and treatment order provisions. Image / Getty Images

Hot off the press, with little fanfare, comes the “Office of the Director of Mental Health and Addiction Services Regulatory Report” for the year to June 30, 2024. Recently published, but maybe not so hot, then.

Two headline items concern data on rates of compulsory assessment and treatment and
the use of seclusion under the Mental Health Act. If someone is experiencing serious mental health issues but is unwilling to seek or accept help voluntarily, they can be subject to compulsory assessment and/or treatment. The first step is assessment by a medical professional to determine whether there is good reason to think they’re experiencing a “mental disorder”.

If the determination is that the person is mentally unwell, the medical professional can issue a certificate mandating further assessment and treatment for 14 days. If the person is still sufficiently unwell, a compulsory treatment order can be made by a judge requiring further treatment for up to six months in their home or community (a community treatment order) or in a hospital or other facility (an inpatient order). It is a last resort when someone is experiencing serious mental illness.

The Mental Health Foundation’s website describes the legislation in more detail. It highlights that 31 New Zealanders are subject to the act each day (one every 46 minutes, although the year in question is not stated), and argues this effectively criminalises them, because of the involvement of legal authorities (a judge), and limits their autonomy in deciding their assessment or treatment.

The foundation notes that at a time when our mental health services are seriously stretched, this is an unfortunate way for people to gain help that should ideally be more easily accessible.

A bill to replace the Mental Health Act, which includes changes intended to minimise the use of compulsory care and shift it towards a rights-based, recovery approach, is currently before Parliament.

The director of mental health’s report notes that in 2023-24, 15,467 people were required to undergo assessment (so, 42 a day) and 9622 were subject to a compulsory treatment order (26 a day).

What really stands out is that Māori, 17% of the population, account for 37% of assessments and 40% of treatment orders.

A total of 561 people experienced seclusion, spending a combined 25,000 hours in isolation. Seclusion is when someone is placed somewhere they cannot freely leave, on their own, for any length of time. It should occur only under the Mental Health Act or the Intellectual Disability Act.

Eight people experienced particularly protracted seclusions, accounting for more than 40% of seclusion time, in 2023-24. The report says this presents serious issues around trauma and human rights for these people, and the director of mental health, Dr John Crawshaw, has commissioned a review of those cases.

There are cases where seclusion is necessary for the care and treatment of the person or because they’re an active risk to themselves or others. Its use involves a multi-step process, initially with two clinicians and final authorisation by a third.

It’s not the same as going to the naughty step because you’ve been a nuisance; it should be a last resort when all other reasonable alternatives have been exhausted.

The good news, as the report shows, is the number of people secluded and the time they were secluded for is continuing to decline. In fact, rates of seclusion have almost halved since 2009, which coincides with the introduction of a policy aimed at reducing its use.

So, it’s not ideal, but its use highlights the tricky balance of safety against dignity and autonomy.

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