Becoming heard : A study of the mental health and legal process that reproduces compulsory community treatment orders

Abstract

This thesis is about the use of Compulsory Community Treatment Orders (CCTOs) under the Mental Health (Compulsory Assessment and Treatment) Act 1992 currently administered by area health boards in Aotearoa New Zealand. The question I ask is, how are CCTOs reproduced? The study is a local and in-depth inquiry. It involves interviews with 21 participants represented in the CCTO mental health law process as service-users, psychiatrists, nurses, judges, lawyers, district inspectors and institutional advisor roles for consumer, family and Indigenous Māori interests. The study includes an observation of a CCTO court hearing. The thesis explains and explores the practices and interaction inbetween participants before, after and during the CCTO hearing event itself. I draw on the work Deleuze and Guattari, and others to develop and apply a conceptual framework for the research design and analysis. This framework enables a perspective that highlights the selection and arrangement of different elements (people, documents, place) and the relations in-between them in the production of CCTOs. My analysis offers an explanation how CCTOs are reproduced in a CCTO assemblage, in at least three ways. CCTO relations are characterised by ‘having a history’, ‘enabling conversations’ and ‘being heard’. These ideas are shown to have multiple meanings, and dominant meanings generate practices that serve the reproduction of CCTOs. A notion of ‘becoming-heard’ is offered as a way to re-conceptualise CCTO relations. Becoming-heard is a critique of the existing system that serves to reproduce CCTOs and emphasises un-actualised potential for service-users and other participants in these relations. Becoming-heard is creative; suggestive of the potential that exists in the dynamic process of living that includes becoming well. I explore a critical and creative approach to problematic CCTO use. The results contribute to existing research that highlights concerns about human rights and discrimination, and contested evidence of CCTO clinical effectiveness and social benefit. The study provides an example of how a relational-ontological perspective can be applied in mental health law settings. This thesis has implications for practices within the existing mental health and law system. There are future policy implications for re-imagining the role of law in mental health.