The devastating consequences of misdiagnosis

Put yourself in the shoes of someone who has had repeated head knocks through sport and knows their difficulties are due to those injuries. They seek help, but doctors dismiss their head trauma history and instead diagnose them with "mental health" conditions like bipolar disorder.

This happens far too often. People with probable CTE face a medical system that doesn't understand brain injury symptoms and defaults to psychiatric diagnoses instead.

"The worst thing about probable CTE to me is not the disease, it's not being believed." - Ange Murtha

If this sounds like your experience, you're not alone. There are medical differences between CTE and psychiatric conditions, and you deserve proper evaluation.

The Devastating Consequences of Psychiatric Misdiagnosisand Inappropriate Pharmacotherapy in Brain Injury

IMPORTANT DISCLAIMER

Educational and Advocacy Purpose: This document isprovided for educational and advocacy purposes only. It is intended to promote
informed discussion about systemic patterns affecting brain-injured individuals
in Aotearoa New Zealand and to synthesize current medical evidence and clinical
guidelines.

Not Medical Advice: This information does notconstitute medical advice. Individual medical decisions should always be made
in consultation with qualified healthcare providers who can assess the specific
circumstances of each patient. Do not stop, start, or change any medications
without consulting your doctor.

Not Legal Advice: This document does notconstitute legal advice. If you require legal advice about your specific
situation, you should consult a qualified lawyer. The discussion of legal
frameworks and potential implications is provided for general information only.

Advocacy Perspective: This analysis is written froman advocacy perspective by individuals who have observed patterns in the
treatment of brain-injured patients. While we have endeavored to present
evidence accurately and cite reputable sources, we acknowledge we are advocates,
not medical professionals or legal experts.

Evidence Sources: This document synthesizes researchfrom peer-reviewed medical journals, clinical practice guidelines, and
systematic reviews. Much of the robust clinical research originates from
international sources, particularly United States Department of Defense and
Veterans Affairs studies. While these studies provide valuable evidence,
individual circumstances may vary, and New Zealand clinical contexts may
differ.

Hypotheses and Observations: The "Pono and TikaPattern" is a conceptual hypothesis based on lived experience and
observation, not formal research. It represents a framework for understanding
certain experiences but should not be considered scientifically validated.

Healthcare Provider Respect: We acknowledge thathealthcare providers work under challenging circumstances and generally aim to
provide the best care possible. This document critiques systemic patterns and
institutional practices, not individual practitioners.

Individual Variation: Brain injuries are highlyindividual. Not all brain-injured individuals will experience the patterns
described here. Some individuals may genuinely benefit from psychiatric
medications. Each case must be assessed individually by qualified professionals.

Current Practice: Medical knowledge and clinicalguidelines evolve continually. Healthcare providers should refer to the most
current evidence-based guidelines and clinical judgment in their practice.

Rights and Remedies: While this document discussesrights under New Zealand law (including the Code of Health and Disability
Services Consumers' Rights, Privacy Act, and ACC legislation), the description
of these rights is for general information only. Specific application to
individual circumstances requires professional advice.

No Guarantees: This information is provided "asis" without any guarantees of completeness, accuracy, or timeliness. While
we have made every effort to ensure accuracy, errors may exist.

Personal Responsibility: Readers are responsible fortheir own decisions and actions. Neither the authors nor any associated
organizations accept liability for any consequences arising from the use of
this information.

If you have concerns about your medical treatment, please:

Discuss them with your healthcare provider first

1. Seek a second medical opinion if you remain concerned
2. Contact the Health and Disability Advocacy Service (free and independent) for
   support
3. Consider lodging a formal complaint with the Health and Disability Commissioner if
   you believe your rights have been breached
   
4. 
   
   
   
5. The Fundamental Problem: Misdiagnosis of NeurologicalInjury as Psychiatric Illness
   

The most critical issue facing brain-injured individuals inAotearoa New Zealand is not whether psychiatric medications can ever be used,
but rather the systematic misclassification of neurological symptoms as
psychiatric disorders. When healthcare systems—including ACC, District Health
Boards (now Te Whatu Ora), and private providers—default to psychiatric
diagnoses for brain-injured patients who exhibit communication difficulties,
they create a cascade of harmful consequences that can permanently impede neurological
recovery.

Brain injury produces genuine neurologicalsymptoms—including executive dysfunction, communication impairment, and
behavioural changes—that arise from structural brain damage, not from
psychiatric illness. However, when these neurological symptoms are misinterpreted
as psychiatric conditions, patients may be prescribed medications that:

Are contraindicated for use in brain injury

1. Interfere with the brain's natural healing processes
2. Impair cognitive function during the critical recovery period
3. Mask the true neurological nature of their condition
4. Result in denial of appropriate neurological treatment and rehabilitation
5. Lead to ACC claim denials based on psychiatric rather than neurological
   classification
   
6. This section examines the evidence regarding specificclasses of psychiatric medications and their effects on brain-injured
   populations. While much of the robust research originates from international
   sources (particularly United States Department of Defense and Veterans Affairs
   studies), the principles apply universally to brain injury management, and New
   Zealand healthcare providers have a duty under the Code of Health and
   Disability Services Consumers' Rights to provide care based on the best available
   evidence.
   

Benzodiazepines: Clear Contraindication in TraumaticBrain Injury

Official Clinical Guidelines

The joint Department of Defense (DoD) and Department ofVeterans Affairs (VA) Clinical Practice Guidelines explicitly recommend avoidingbenzodiazepines after traumatic brain injury. The 2016 VA/DoD guidelinesfor management of mild TBI specifically instruct clinicians to avoid
benzodiazepines and recommend non-pharmacologic alternatives, citing risks
including:

Potential for misuse and diversion

• Risk of addiction and physical dependence
• Cognitive impairment
• Interference with brain healing processes
• Worsening of persistent symptoms such as cognitive changes and decision-making
  ability
• Increased risk of worsening comorbid conditions
  
• (Earyes, L., Agimi, Y., & Stout, K. (2024).Benzodiazepine Prescription Patterns After Mild Traumatic Brain Injury in U.S.
  Military Service Members. Military Medicine, 189(9-10), 1931-1937.
  https://doi.org/10.1093/milmed/usad443)
  

Evidence of Harm

Multiple lines of research demonstrate that benzodiazepinesare deleterious for brain injury recovery:

Impairment of Neuroplasticity: Benzodiazepines havebeen documented to impede the extent of functional recovery in experimental
TBI. Studies consistently show that these medications interfere with
neuroplasticity—the brain's ability to reorganize and form new neural
connections necessary for recovery from injury.

(Frontiers in Neurology, 2023. "Are GABAergic drugsbeneficial in providing neuroprotection after traumatic brain injuries?")

Cognitive Effects: Research demonstrates thatbenzodiazepines result in cognitive impairment when plasma levels are at their
peak, with evidence of residual effects on cognition persisting after
administration. More concerning, evidence indicates that GABA agonists (the mechanism
by which benzodiazepines work) have adverse effects on neuroplasticity, raising
serious concerns about their use in patients recovering from TBI.

(Jha, R. M., et al. (2010). "The effect of sleepmedications on cognitive recovery from traumatic brain injury." Journal of
Head Trauma Rehabilitation, 25(1), 61-67.)

Sleep Medication Paradox: While benzodiazepines arefrequently prescribed for sleep disturbances following TBI, this practice
directly contradicts evidence showing they impair the cognitive recovery that
proper sleep should support. The literature consistently reports that benzodiazepines
cause cognitive impairment and demonstrate residual effects that interfere with
rehabilitation.

Mechanism of Harm: Following TBI, there is aparadoxical shift in GABA neurotransmission. Rather than producing the expected
inhibitory effects, GABA may cause paradoxical excitation post-TBI, which
explains the inefficacy and possible detrimental effects of benzodiazepines and
other GABA-A receptor agonists after brain injury.

(Frontiers in Neurology, 2023)

Clinical Reality vs. Best Practice

Despite clear guideline recommendations againstbenzodiazepine use in TBI, a 2024 study of U.S. military service members found
that 4.5% of patients with mild TBI filled benzodiazepine prescriptions while
under active medical treatment for their injury. This gap between
evidence-based recommendations and clinical practice demonstrates the ongoing
challenge of inappropriate prescribing in this vulnerable population.

Antipsychotic Medications: Evidence of Impeded Recovery

Typical Antipsychotics (Haloperidol): Strong Evidence ofHarm

The evidence regarding typical antipsychotics, particularlyhaloperidol, in brain injury recovery is substantial and concerning:

Cognitive Impairment: Multiple studies demonstratethat haloperidol exacerbates cognitive deficits induced by TBI. A landmark
study showed that injured rats treated with haloperidol performed significantly
worse in spatial learning tasks (Morris water maze) compared to vehicle-treated
injured rats, demonstrating that the drug actively impairs cognitive recovery.

(Wilson, M. S., Gibson, C. J., & Hamm, R. J. (2003)."Haloperidol, but not olanzapine, impairs cognitive performance after
traumatic brain injury in rats." American Journal of Physical Medicine
& Rehabilitation, 82(11), 871-879.)

Motor Recovery Impairment: Research by Feeney andcolleagues demonstrated that even a single administration of haloperidol after
TBI delayed motor recovery in adult rodents. Remarkably, when haloperidol was
administered to animals who had recovered normal function, it reinstated the
motor deficits—demonstrating the drug's powerful ability to disrupt brain
function after injury.

(Feeney, D. M., et al. (1982). Amphetamine, haloperidol,and experience interact to affect rate of recovery after motor cortex injury.
Science, 217(4562), 855-857.)

Chronic Administration Effects: Chronicadministration of haloperidol impedes behavioural recovery after experimental
TBI. Studies show that daily administration for 19 days significantly impaired
both motor and cognitive performance after cortical impact injury. Most
concerning, these deleterious effects persisted for up to 3 months afterdrug discontinuation, demonstrating long-lasting harm.

(Kline, A. E., Hoffman, A. N., Cheng, J. P., Zafonte, R.D., & Massucci, J. L. (2008). "Chronic administration of
antipsychotics impede behavioural recovery after experimental traumatic brain
injury." Neuroscience Letters, 448(3), 263-267.)

Mechanism of Harm: The damage caused by typicalantipsychotics appears related to their dopamine D2 receptor antagonism.
Dopamine receptors are expressed in brain regions often affected by TBI, such
as the frontal cortex and striatum. By blocking these receptors, antipsychotics
interfere with dopaminergic circuits that are critical for cognitive recovery.
This is further supported by evidence that dopamine agonists (like amantadine)
improve functional outcomes after TBI.

(Cataford, G., et al. (2024). "Cognitive and MotorFunction Effects of Antipsychotics in Traumatic Brain Injury: A Systematic
Review of Pre-Clinical Studies." Neurotrauma Reports, 5(1), 181-193.)

Clinical Guidelines: A 2024 systematic reviewconcluded: "Based on our findings, clinicians should avoid the continuous
use of haloperidol and risperidone until human studies are available." The
Administration for Community Living's guidance on psychopharmacologic
interventions for TBI recommends avoiding typical antipsychotics (haloperidol)
as they may hinder recovery.

Atypical Antipsychotics: A More Complex Picture

The evidence for atypical antipsychotics presents a morenuanced picture:

Risperidone: Like haloperidol, chronic administrationof risperidone has been shown to impair motor and cognitive function when given
daily after TBI. However, intermittent dosing (rather than daily
administration) appears significantly safer.

Safer Alternatives: Research suggests thatquetiapine, olanzapine, and aripiprazole do not result in the same degree of
motor or cognitive impairment as haloperidol or risperidone. These agents
appear to be safer alternatives when antipsychotic medication is deemed clinically
necessary, though caution and close monitoring remain essential.

Critical Distinction: The key factor appears to becontinuous versus intermittent dosing. Intermittent administration (e.g.,
before specific situations rather than daily) does not show the same
detrimental effects as chronic daily dosing.

The Clinical Dilemma

Agitation occurs in 31.7-52% of brain-injured patientsduring inpatient care and rehabilitation. This creates a genuine clinical
challenge: agitation can pose risks to patient and caregiver safety and may
impede rehabilitation participation. However, the use of antipsychotics to
manage this agitation must be carefully weighed against the evidence that these
medications may impair the very recovery process that rehabilitation aims to
support.

The fundamental question becomes: Is the agitation apsychiatric symptom requiring psychiatric medication, or a neurological symptom
of brain injury requiring neurological understanding and non-pharmacological
management?

Antidepressants (SSRIs): Mixed Evidence Requiring CarefulConsideration

Current Evidence Base

The evidence for selective serotonin reuptake inhibitors(SSRIs) in TBI is notably mixed:

Depression Treatment: SSRIs are widely recommended asfirst-line treatment for depression following TBI and are included in expert
consensus guidelines. Some studies show improvement in depressive symptoms,
while others, including a 2018 meta-analysis, found no significant benefit of
antidepressants over placebo for depression following TBI.

(Kreitzer, N., et al. (2018). "The effect ofantidepressants on depression after traumatic brain injury: a
meta-analysis." Journal of Head Trauma Rehabilitation.)

Cognitive Effects: The evidence regarding cognitiveeffects is equivocal. Some randomized controlled trials show detrimental
effects on cognition, while cohort studies show cautiously beneficial effects
on select measures of nonverbal cognition. Traditional depression outcome
measures may lose responsiveness when applied in TBI studies, potentially
underestimating treatment benefit or harm.

Neuroplasticity Considerations: SSRIs are theorizedto work through modulation of neuroplasticity and hippocampal neurogenesis.
Some research suggests SSRIs could help brain cells grow and survive after
trauma. However, other evidence raises concerns about effects on
neuroplasticity during the critical recovery period.

Critical Distinction

The key issue is not whether SSRIs themselves are inherentlyharmful to brain-injured patients, but rather:

Is depression after TBI being properly diagnosed as a neurological
consequence of brain injury, or misdiagnosed as primary psychiatric
illness?

1. Are SSRIs being prescribed to address legitimate post-injury depression, or to
   manage what are actually communication difficulties and behavioural
   symptoms of brain injury?
2. Is the "depression" actually the natural frustration response to
   the Pono and Tika pattern—intense frustration from seeing truth clearly
   while being unable to communicate effectively?
   
3. When a brain-injured patient exhibits frustration,agitation, or emotional dysregulation, these symptoms may reflect:
   

Executive dysfunction (neurological)

Communication impairment (neurological)

Natural emotional response to being disbelieved or dismissed

• Legitimate depression secondary to injury
  
• The distinction matters enormously for appropriatetreatment.
  
• 
  
  
  
• The Core Problem: Weaponizing Communication Difficulties
  

The most insidious harm occurs when the communicationdifficulties caused by brain injury—the impaired Tika—are used as evidence of
psychiatric illness rather than recognized as neurological symptoms. This
creates a self-reinforcing cycle:

Brain injury causes executive dysfunction and communication impairment

Patient struggles to articulate concerns in "acceptable" institutional
language

1. Communication difficulty is labeled as "psychiatric instability" or
   "difficult behavior"
2. Psychiatric diagnosis leads to psychiatric medication
3. Medications may further impair cognitive function
4. Further impairment reinforces "psychiatric" label
5. Legitimate neurological symptoms are dismissed as "mental health issues"
6. Appropriate neurological treatment is denied
   
7. Documentation Trail of Misdiagnosis
   
8. This pattern becomes particularly devastating whendocumented in medical records. Once a patient is labeled with psychiatric
   diagnoses, subsequent healthcare providers often accept these labels
   uncritically, leading to:
   

Denial of neurological assessment and treatment

Assumption that patient reports are unreliable due to "psychiatric" issues

• Dismissal of legitimate concerns as symptoms of mental illness
• Barriers to appropriate rehabilitation services
• Difficulty accessing ACC or insurance coverage for neurological treatment
  
• 
  
  
  
  
  
• 
  
• Medications That May Impair Recovery: Summary Table
  
• Based on current evidence, the following represents asynthesis of research on medications that may impair brain injury recovery:
  

Medication Class

Specific Agents

Level of Evidence

Effects on Recovery

Clinical Guidance

Benzodiazepines

Diazepam, Lorazepam, Clonazepam, Alprazolam, Midazolam

STRONG - Avoid

Impairs neuroplasticity, cognitive function, and functional recovery. Interferes with brain healing.

DoD/VA guidelines explicitly recommend avoiding in TBI. Use non-pharmacologic alternatives.

Typical Antipsychotics

Haloperidol

STRONG - Avoid for chronic use

Significantly impairs cognitive and motor recovery. Effects persist months after discontinuation.

Avoid continuous use. If essential, use lowest dose intermittently, not daily. Consider safer alternatives.

Atypical Antipsychotics

Risperidone

MODERATE - Caution

Daily administration impairs recovery. Intermittent use appears safer.

Avoid continuous daily use. Intermittent dosing safer if medication necessary.

Atypical Antipsychotics

Quetiapine, Olanzapine, Aripiprazole

LOW CONCERN

Appears safer than haloperidol/risperidone in preclinical studies.

May be considered when antipsychotic necessary. Close monitoring essential.

Anticholinergic Agents

Various

MODERATE - Avoid

May cause confusion. Impairs cognitive function.

DoD/VA guidelines recommend avoiding medications that cause confusion.

SSRIs

Sertraline, Citalopram, Fluoxetine, others

MIXED EVIDENCE

Benefits for depression unclear. Effects on cognition equivocal. Neuroplasticity effects uncertain.

Not contraindicated but requires careful assessment of whether treating true depression vs. neurological symptoms.

Phenytoin

Phenytoin

MODERATE - Caution

May adversely affect brain recovery in some studies.

Use only when clearly indicated for seizure control.

Sources:

Earyes et al. (2024), Military Medicine

Kline et al. (2008), Neuroscience Letters

Wilson et al. (2003), American Journal of Physical Medicine & Rehabilitation

• Cataford et al. (2024), Neurotrauma Reports
• Frontiers in Neurology (2023)
• DoD/VA Clinical Practice Guidelines (2016, 2021)
• Multiple systematic reviews and meta-analyses cited throughout
  
• 
  
  
  
  
  
• 
  
• The Path Forward: Proper Neurological Assessment inAotearoa New Zealand
  
• The solution to inappropriate psychiatric medication inbrain injury is not to prohibit all psychiatric medications, but rather to:
  

Recognize brain injury as a neurological condition requiring neurological assessment first, as supported by ACC concussion guidelines and
international best practice

1. Distinguish neurological symptoms from psychiatric illness through proper evaluation by appropriately qualified specialists

Understand that communication difficulties do not equal impaired judgment or psychiatric instability—a principle that aligns with the Code's
requirement to treat consumers with respect

1. Avoid medications with strong evidence of harm (benzodiazepines, typical antipsychotics with chronic dosing) as recommended by international
   clinical guidelines
2. Use medications cautiously when indicated, with clear therapeutic goals, informed consent, and regular monitoring as required under the Code

Prioritize non-pharmacological interventions including cognitive rehabilitation, environmental modifications, and appropriate support as first-line
management

1. Ensure accurate medical documentation that properly distinguishes neurological symptoms from psychiatric illness, meeting Privacy Act
   requirements for accuracy
2. Never use psychiatric diagnosis to dismiss or invalidate a patient's perceptions or concerns—doing so may breach the Code's requirements for
   respectful treatment and effective communication
   
3. Most critically, New Zealand healthcare systems (includingACC, Te Whatu Ora, and private providers) must stop using psychiatric diagnoses
   as a default explanation for brain-injured patients who exhibit the Pono and
   Tika pattern—enhanced moral clarity coupled with impaired communication
   ability. These individuals are not psychiatrically ill; they are neurologically
   injured and deserve appropriate neurological care as guaranteed under their
   rights in the Code of Health and Disability Services Consumers' Rights.
   

Resources for New Zealand Patients and Advocates:

Health and Disability Commissioner: www.hdc.org.nz

Code of Health and Disability Services Consumers' Rights: Available in 25
languages at HDC website

Advocacy Service: Free, independent support for health consumers—contact through
HDC

• Brain Injury Association New Zealand: Regional offices throughout Aotearoa
  providing advocacy and support
• ACC: Can be contacted about treatment coverage and rehabilitation services
• Privacy Commissioner: For concerns about inaccurate medical records
  (www.privacy.org.nz)
  

• 
  
• Legal and Ethical Implications in the New Zealand Context
  
• The systematic misdiagnosis of brain injury as psychiatricillness, coupled with prescription of medications that impede neurological
  recovery, raises serious questions under New Zealand law and within our unique
  healthcare framework:
  

Code of Health and Disability Services Consumers' Rights:The Code, which became law on 1 July 1996, grants specific rights to all people
using health and disability services in New Zealand. Right 4(2) requires that
services be provided with reasonable care and skill, and Right 6 requires that
consumers be given the information they reasonably need to make informed
choices. When brain-injured patients are:

Not informed that their symptoms may be neurological rather than psychiatric

Not advised that prescribed medications may impair neurological recovery

Not offered evidence-based non-pharmacological alternatives

• These practices may constitute breaches of the Code, whichfall within the jurisdiction of the Health and Disability Commissioner.
  
• ACC Framework Implications: New Zealand's AccidentCompensation Corporation operates on a no-fault basis, but claims can be
  declined when injuries are reclassified. The systematic pattern of:
  

Reclassifying brain injuries as psychiatric conditions

Using psychiatric diagnoses to decline neurological treatment coverage

Prescribing medications contraindicated for TBI while denying proper rehabilitation

• ...raises questions about whether ACC is meeting itsobligations under the Accident Compensation Act 2001 to provide fair and
  appropriate cover and treatment for accident-related injuries.
  
• Standard of Care: When international clinicalpractice guidelines (such as the joint US Department of Defense/Veterans
  Affairs guidelines) explicitly recommend avoiding certain medications
  (benzodiazepines) in TBI, New Zealand healthcare providers who prescribe these
  medications without documented justification may face questions about whether
  they have met the standard of care required under Right 4(1) of the Code.
  

Informed Consent (Right 7): Under the Code, consumershave the right to receive information that a reasonable consumer would expect
to receive, including an explanation of available options and the risks and
benefits of those options. Are brain-injured patients adequately informed that:

Medications prescribed for "psychiatric" symptoms may impair neurological
recovery?

Their symptoms may represent neurological damage rather than psychiatric
illness?

International clinical guidelines recommend avoiding certain medications after TBI?

• Alternative non-pharmacological interventions exist?
  
• Discrimination and Equity: Does the practice ofreclassifying brain-injured patients (particularly those from contact sports
  like rugby) as psychiatric patients constitute a form of discrimination that
  conflicts with Right 1 of the Code (the right to be treated with respect and free
  from discrimination)?
  

Privacy Act 1993 Considerations: When medical recordscontain inaccurate psychiatric diagnoses that should properly be documented as
neurological symptoms of brain injury, patients have rights under the Privacy
Act to request correction of inaccurate information. The systematic inclusion
of inappropriate psychiatric diagnoses in medical records may constitute a
breach of Information Privacy Principle 8 (accuracy of personal information).

Health and Disability Commissioner Jurisdiction:These systemic patterns fall squarely within the Health and Disability
Commissioner's mandate to:

Promote and protect the rights of health and disability services consumers

Investigate complaints about breaches of the Code

Make recommendations to prevent future breaches

Report to the Minister of Health on systemic issues

• Potential Institutional Liability: When institutionssystematically:
  
• Misdiagnose neurological injury as psychiatric illness
• Prescribe medications known to impede brain injury recovery
• Deny appropriate neurological care based on psychiatric classifications

Fail to provide informed consent about medication risks

• ...what are the legal consequences under the Code, ACClegislation, and potentially the common law duty of care?
  
• Te Tiriti o Waitangi Implications: Brain injurydisproportionately affects Māori and Pacific peoples in Aotearoa New Zealand.
  When these communities experience higher rates of TBI (particularly from
  contact sports and motor vehicle accidents) and then face systematic
  misdiagnosis and inappropriate treatment, this raises questions about equity of
  care and the application of Te Tiriti principles in healthcare.
  

These questions warrant serious consideration by healthcareinstitutions, ACC, the Health and Disability Commissioner, and the legal
profession. The patterns described in this document may constitute systemic
breaches that require investigation and institutional reform.

Conclusion

The evidence is clear that certain medications—particularlybenzodiazepines and typical antipsychotics with chronic dosing—impair recovery
from traumatic brain injury. However, the more fundamental problem is the
systematic misdiagnosis of neurological symptoms as psychiatric illness within
New Zealand's health and disability system.

Brain-injured individuals who exhibit the Pono and Tikapattern—enhanced moral perception coupled with impaired communication—are not
psychiatrically ill. They are neurologically injured patients whose symptoms
are being systematically misinterpreted, leading to inappropriate treatment
that may permanently impair their recovery and, in many cases, result in denial
of ACC coverage for appropriate neurological care.

Proper care in the New Zealand context requires:

Recognition of brain injury as a neurological condition requiring specialist
assessment

Compliance with the Code of Health and Disability Services Consumers' Rights

Appropriate neurological assessment and treatment

• Avoidance of medications with evidence of harm, consistent with international
  guidelines
• Non-pharmacological approaches as first-line management
• Understanding that communication difficulties do not invalidate perception or judgment
• Accurate medical documentation that meets Privacy Act standards
• Fair ACC assessment and coverage based on neurological rather than psychiatric
  classification
  
• Until New Zealand healthcare systems—including ACC, Te WhatuOra, and private providers—make these fundamental changes, brain-injured
  individuals will continue to be failed by institutions that mistake
  neurological injury for psychiatric illness, prescribe medications that impede
  recovery, deny proper neurological care, and breach the rights guaranteed under
  the Code of Health and Disability Services Consumers' Rights.
  

For Healthcare Providers: This analysis highlightsareas where current practice may not align with international evidence-based
guidelines or New Zealand legal requirements under the Code. Healthcare
providers are encouraged to review their practices regarding brain injury diagnosis
and treatment, ensuring informed consent processes adequately address
medication risks and alternative options.

For Patients and Advocates: If you believe you orsomeone you support has been misdiagnosed with a psychiatric condition when
symptoms are actually neurological consequences of brain injury, you have
rights under:

The Code of Health and Disability Services Consumers' Rights

The Privacy Act 1993 (to request correction of inaccurate medical records)

The Health and Disability Commissioner Act 1994 (to lodge complaints about
breaches of the Code)

• The Accident Compensation Act 2001 (to challenge inappropriate claim (decisions)
• The free Advocacy Service (accessible through the Health andDisability Commissioner) can provide independent support in navigating these
  processes.
• About This Document: This analysis was prepared topromote informed discussion about patterns affecting brain-injured individuals
  in New Zealand. It reflects an advocacy perspective based on observed
  experiences and synthesis of available evidence. Please refer to the disclaimer
  at the beginning of this document for important limitations and clarifications.
  

Version: November 2025
Contact: www.ctematterstome.org.nz • ctematterstome@gmail.com 🐕🐕