When the mandatory second opinion fails to approve compulsory treatment.

<bold>Objectives: </bold>To examine situations in which compulsory treatment was not approved by the second opinion required under New Zealand's Mental Health Act.<bold>Methods: </bold>Qualitative and quantitative analysis of 11 index cases where full approval of treatment was not given and of 33 matched controls.<bold>Results: </bold>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.<bold>Conclusions: </bold>Non-approval marks a group of patients with very poor clinical outcome. Explicit processes are needed to manage non-approval of compulsory treatment plans. [ABSTRACT FROM AUTHOR]