Two NZ mental health facilities found in breach of UN convention against torture, cruel treatment

Two of New Zealand’s mental health facilities breached the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, according to the Chief Ombudsman.

Seclusion room at He Puna Wāiora Mental Health Inpatient Unit. Source: Supplied

The units in question are Wellington’s Te Whare o Matairangi Mental Health Inpatient Unit and the Waiatarau Mental Health Inpatient Unit at Waitākere Hospital.

The findings are part of separate reports into five secure acute mental health units, released today following unannounced inspections carried out earlier this year.

Across the board, the reports paint a damning picture of some of the things mental health patients are subject to in New Zealand.

The facilities also investigated were He Puna Wāiora Mental Health Inpatient Unit in Auckland, Tumanako Mental Health Inpatient Unit in Whangārei, and Kensington Centre Mental Health Inpatient Unit in Timaru.

Wellington’s Te Whare o Matairangi Mental Health Inpatient Unit currently uses seclusion rooms as bedrooms for patients when the unit is over capacity, which contain “little more than a mattress,” according to Chief Ombudsman Peter Boshier.

Seclusion rooms are meant to be used as short-term measures for patients who pose imminent safety risks, and Mr Boshier said their misuse is degrading and a breach of Article 16 of the Convention.

Nigel Fairley, from Capital and Coast District Health Board (CCDHB), said that seclusion rooms are used in non-restrictive ways during periods of high occupancy.

“High occupancy is a national – rather than regional – issues indicative of increasing demand on acute mental health services across the country,” Mr Fairley said in a statement.

The report into the mental health facility also found only four of nine recommendations made back in 2017 had been implemented.

These included fixing maintenance issues, a review and update to both its seclusion and restraint policies, only using seclusion rooms for emergency situations. As well as ensuring all staff are up-to-date with mandatory training requirements, for patients to attend multi-disciplinary team meetings and to receive copies of their care plan.

After three years, the CCDHB has reviewed and updated both its seclusion and restraint policies and solved the minor maintenance issues raised.

Mr Fairley, who runs CCDHB’s Mental Health, Addictions & Intellectual Disability Service, said significant progress has been made on implementing the findings, and blamed the increasing demand on mental health services on failing to address those yet to be achieved.

Waiatarau Mental Health Inpatient Unit at Auckland’s Waitākere Hospital was also housing a long-term patient in its intensive care unit.

The person subsequently missed out on approved unescorted leave, did not attend daily programmes, and had limited access to phone calls.

They were initially moved to the ICU because of risk of violence. However, at the time of inspection by the Office of the Ombudsman, there was no evidence of risks.

“Being contained in the ICU for an extended period was causing the patient as escalating sense of hopelessness, frustration and anger,” said Mr Boshier.

Waitematā DHB addressed the issue raised in its response to the Ombudsman’s findings, and said the patient was in ICU as they were difficult to manage and were unable to be transferred due to the risk to themselves, other patients and staff.

Mr Boshier said there was no evidence demonstrating updated risk assessments which pointed to keeping the patient in ICU for an extended period of time.

On Auckland’s North Shore, He Puna Wāiora Mental Health Inpatient Unit is making patients in seclusion rooms use cardboard receptacles as toilets.

The investigation into the facility also found there were no cordoned off areas for patients in seclusion to use the receptacle, and therefore could be viewed using their toilet through the door’s window and also via the observation room.

On average, patients are put in seclusion for 10 hours at the facility, and making them use cardboard toilets “exacerbates the degrading nature of the treatment,” said Mr Boshier.

It was recommended seclusion rooms have a private area for patients to go toilet and, should there be a limited risk of harm, they be allowed to access a proper toilet.

Cardboard toilet for patients in seclusion at He Puna Wāiora Mental Health Inpatient Unit. Source: Supplied

Waitematā DHB has rejected both of these recommendations. In a statement, it said patients in seclusion need to be observed frequently and it would not be possible to screen off areas within the room.

It also said there is no easy access to a proper toilet directly from seclusion, but where there is no risk, patients are transferred to ‘open seclusion’ which does have a toilet.

The Chief Ombudsman noted there is a bathroom directly adjacent to the facility’s seclusion room and “therefore is accessible.”

Cardboard receptacles are also used for patients in seclusion at Whangārei’s Tumanako Mental Health Inpatient Unit.

This also presented the same issue of privacy when going to the toilet, as patients are visible through a window in the room’s door.

It was recommended patients be allowed to use a proper toilet, where there is no risk, and this was accepted by Northland DHB.

Between June 1, 2019 and November 30, 2019, the average time spent in a seclusion room at Tumanako Mental Health Inpatient Unit was just under 30 hours.

The report into the Northland facility also found 58 per cent of its staff were out-of-date with their Safe Practice Effective Communication training.

The DHB did not specifically respond to this finding.

The facility had also identified 22 medication errors during a six-month period in 2019.

Fourteen were related to the administration of medication, of which 12 were described as near misses.

There were two events which resulted in no harm, three prescribing errors and five related to the storage of medication, which also resulted in no harm.

The Chief Ombudsman said the rate of medication errors was concerning, with the potential to cause significant harm.

Prior to the six-month period where the high rate of errors were found, a review had already been carried out into the unit’s medication issues.

Northland DHB said changes had already been made including implementing a programme of continuous monitoring and implementation of improvement strategies.

The investigation into Timaru’s Kensington Centre Mental Health Inpatient Unit found its seclusion and restraint policies were out of date and there was little evidence Māori models of care being delivered.

A restraint event observed during the investigation was poorly documented and lacked sufficient detail, according to the report.

It was recommended the facility update its seclusion and restraint policies, and a robust system for recording restraint incidents be implemented.

South Canterbury DHB accepted these recommendations.

The Chief Ombudsman said the country’s attitudes towards mental health are improving, which is reflected in investments to facilities such as the ones investigated, but that the reports show there is urgent work that needs to be done.

Mr Boshier did note some of the units are functioning well and providing a high level of care, and that relationships between staff and residents on the whole were positive.

The Ministry of Health was made aware of the Ombudsman’s concerns across the different facilities, and in a statement told 1 NEWS it is already working to remedy the potential breaches of the UN Convention.

It also acknowledged the pressure on the country’s inpatient mental health and addiction services, and said while it believes DHBs aim to provide high standards of care, it accepts the issues identified in the reports.