New Zealand’s Mental Health Bill 2024: A Step Forward or Dangerous Overreach?
BY ELLA IMRIE
Introduction
New Zealand’s mental health law is undergoing a pivotal transformation. The Mental Health Bill 2024 aims to replace the Mental Health (Compulsory Assessment and Treatment) Act 1992, which has long been criticised for being outdated, overly coercive, and misaligned with contemporary human rights obligations—particularly the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The Bill reflects a growing consensus that mental health legislation must move toward a more person-centered, culturally responsive, and rights-respecting framework. It arrives in the context of sustained public advocacy; the findings of the Waitangi Tribunal’s Hauora Report; and the recommendations of He Ara Oranga, the 2018 Government Inquiry into Mental Health and Addiction.
This article focuses on two key dimensions of the Bill: (1) involuntary treatment provisions, and (2) protection and recognition of Indigenous (Māori) rights. This article finds that in spite of some shortfalls, the Bill is a positive step forward on both of those regards and should be adopted.
I. Involuntary Treatment Provisions
A. Compulsory Treatment
The Bill represents a significant shift from the 1992 Act’s approach to involuntary psychiatric treatment. It underscores that State intervention in an individual’s mental health care is a grave step warranting careful oversight. Accordingly, the Bill introduces new guiding principles intended to ensure any compulsory care is person-centered and rights-respecting. For example, it explicitly promotes the person’s decision-making capacity and use of decision-making practices even during compulsory care.
Importantly, the Bill incorporates a capacity-based criterion for compulsory treatment – a welcome reform toward ensuring that a person who retains decision-making capacity is not easily subjected to forced care. This assessment considers their ability to understand, retain, and weigh information relevant to their treatment options. Under the new framework, an individual’s will and preferences (including cultural or whānau support preferences) must be taken into account wherever possible.
B. Alignment with International Standards:
Notwithstanding these improvements, questions remain about the Bill’s full compatibility with international human rights standards. The Convention on the Rights of Persons with Disabilities (CRPD) (which New Zealand has ratified) enshrines the right to equal recognition before the law and free and informed consent for medical treatment. The UN CRPD Committee has stated that impairment alone can never justify deprivation of liberty or forced treatment. The Bill stops short of abolishing involuntary treatment; it continues to permit compulsory care where a person’s capacity is impaired and certain risk thresholds are met. While some studies suggest that compulsory treatment can reduce hospital admissions for certain conditions, other research indicates that it may have limited impact on long-term outcomes and can lead to increased medication use without clear benefits . The experience of being subjected to compulsory care can also be deeply traumatic for individuals, often leading to feelings of violation and mistrust towards the healthcare system.
Furthermore, United Nations human rights bodies have called for an end to all coercive mental health measures as a matter of compliance with human rights. The Bill does not go so far; it instead seeks to minimise and better regulate compulsory interventions rather than eliminate them. In practice, its effectiveness will depend on the robust implementation of safeguards (e.g. access to legal counsel, independent tribunals, regular review of any compulsory order) and the investment in community services that can remove the perceived need for coercion.
II. Indigenous (Māori) Rights
A. Te Tiriti o Waitangi and Māori Perspectives in the Bill
The Bill breaks new ground by explicitly acknowledging Te Tiriti o Waitangi (Treaty of Waitangi) and incorporating Māori perspectives within the mental health legal framework. Clause 5 of the Bill enumerates provisions intended to give effect to Treaty principles. The Bill’s purpose and principles also reflect Te Ao Māori concepts: it uses the term tāngata whaiora (people seeking wellness) for mental health service users, and it emphasises holistic wellbeing and the involvement of whānau (family) in support of the person. In debates, Māori leaders in Parliament, such as Debbie Ngarewa-Packer, have praised the Bill’s intent to embed a human-rights approach that aligns with a whole-of-wellbeing model of care and provides measures to minimise coercion. By grounding the legislation in partnership and cultural recognition, the Bill takes a step toward honouring Tiriti obligations of partnership, participation, and active protection of Māori health.
B. Māori Overrepresentation in Compulsory Treatment: Risks and Progress
One of the most pressing issues prompting this legislative reform has been the overrepresentation of Māori in compulsory mental health treatment under the current regime. Māori have historically been subjected to compulsory detention or treatment at significantly higher rates than non-Māori, a fact viewed as a symptom of structural bias and unmet needs in the mental health system. Māori also experience seclusion in hospital settings at disproportionately high rates, and a large proportion of Māori tāngata whaiora under compulsory orders come from highly deprived communities. This legacy of inequity was highlighted in the Waitangi Tribunal’s Hauora Report and the 2018 Government Inquiry (He Ara Oranga), both of which found that the 1992 Act was applied in a manner that failed to protect Māori rights and resulted in grievous health inequities.
The new Bill directly tackles this concern by making equity a core objective: it explicitly directs that mental health legislation should strive to eliminate disparities for Māori. The hope is that a law developed in partnership with Māori – combined with a shift to more supportive, voluntary care where possible – will reduce the need for coercion and thus reduce the disproportionate impact on Māori.
Nonetheless, risks remain. If clinical practice and resource allocation do not change – if there are insufficient kaupapa Māori services, community supports, and early intervention options – Māori might continue to be subjected to coercive care at higher rates. Encouragingly, the Bill provides for improved data collection and reporting on the use of compulsory treatment.
Conclusion
New Zealand’s Mental Health Bill 2024 marks a critical evolution in mental health law, seeking to balance the protection of individual rights with the need to provide care for those who, due to severe distress, may temporarily require intervention without consent. These innovations are laudable and, if faithfully implemented, could set a new international benchmark for culturally-grounded, rights-based mental health legislation. That said, the importance of vigilant implementation, adequate resources, and ongoing review must be emphasised. The true measure of the law’s success will lie in practice.
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