title: When the mandatory second opinion fails to approve compulsory treatment.
abstract: OBJECTIVE
  To examine situations in which compulsory treatment was not approved by the second opinion required under New Zealand's Mental Health Act.
  
  
  METHODS
  Qualitative and quantitative analysis of 11 index cases where full approval of treatment was not given and of 33 matched controls.
  
  
  RESULTS
  The reasons for non-approval of treatment were diverse. Following non-approval, intensive consultation occurred, reflecting significant disagreement between clinicians. The process of resolution included discharge from the Act, patients consenting to treatment and alternative treatment plans. Compared with controls, index cases had significantly lower rates of being mentally well in the community over the subsequent year.
  
  
  CONCLUSIONS
  Non-approval marks a group of patients with very poor clinical outcome. Explicit processes are needed to manage non-approval of compulsory treatment plans.
authors.affiliation: Research Assistant, Faculty of Law, University of Otago, Dunedin, New Zealand.
authors.forename: Jessie
authors.initials: J
authors.lastname: Lenagh-Glue
authors.affiliation: Professor, Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Paul
authors.initials: P
authors.lastname: Glue
authors.affiliation: Professor, Faculty of Law, University of Otago, Dunedin, New Zealand john.dawson@otago.ac.nz.
authors.forename: John
authors.initials: J
authors.lastname: Dawson
keywords: Mental Health Act; New Zealand law; Second Opinion Psychiatrist; compulsory treatment; consensus; disease management; mental state; outcome; second opinion