Forcing family involvement in patient care: legislative and clinical issues

Families have an important role in the recognition and treatment of mental illness in their family members. However, the extent to which families are consulted during compulsory assessment processes has received little attention. In 2000, mandatory family/whānau consultation was introduced in New Zealand. This paper reviews the extent of family consultation during compulsory assessment and surveys clinicians' views and experience.

All applications for compulsory assessment in a representative sample of districts were audited over a 2-month period. An email survey of clinicians investigated changes in their practice since the introduction of mandatory family consultation, their views and training experiences.

A total of 283 compulsory assessments were audited; 187 (66.1%) family/whānau consultations occurred and were completed by the assessing doctor 82.1% of the time. Of the remaining assessments, 12 did not appear consistent with the legally permitted exceptions to mandatory consultation. Some 88.6% of clinicians were aware of the legislative requirements about consultation. A significant percentage (54.7%) believed their practices had altered following legislative change.

Family/whānau consultation occurred in the majority of compulsory assessments. The introduction of mandatory consultation with family/whānau may have improved clinical practice in this regard, although training and guidelines issued at a similar time are also likely to have contributed to the change in practice.