Auckland's mental hospital for criminals has been told bedroom doors should generally be left unlocked but it is uncertain how to comply in full because of the extra staffing costs to maintain safety.
Chief Ombudsman Dame Beverley Wakem says in a report on Auckland's Mason Clinic, following a visit by inspectors, that unless patients are in formal seclusion, "they should not be locked in their rooms either during the day or overnight".
The periodic inspections are made under the Crimes of Torture Act to fulfil obligations to the United Nations to monitor secure hospitals. The Mason Clinic is one of five regional forensic mental health services in New Zealand.
The three higher security units of the Pt Chevalier clinic contain around 45 beds for mentally unwell patients from prisons, and offenders either found not guilty or not tried because they were unwell.
Based on 1995 Health Ministry guidelines, these patients' bedroom doors are locked overnight. But the ministry told the ombudsmen it did not support blanket door-locking; the guidelines were obsolete and would be reviewed.
If Mason patients need to go to the toilet overnight, they alert staff with a buzzer and are let out.
The Waitemata District Health Board, which runs the clinic, says Dame Beverley's recommendation raises issues of staff and patient safety - and staff numbers. Clinical director Dr Jeremy Skipworth said his clinic had moved away from blanket locking to a more individualised approach based on the assessment of risk for each patient.
But complex issues remained on whether more doors were left unlocked and what that meant for increased staffing needs and everyone's safety.
The Public Service Association declined to comment.
Dr Skipworth said many of the patients had come from New Zealand's highest security prison, at Paremoremo, where cell doors mostly were kept locked.
"We are dealing with a population who, for reasons not just of their mental illness, are regarded as high-risk individuals. There's no other forensic unit in New Zealand that takes as many people classified as maximum security prisoners as we do."
He said the clinic was legally obliged to provide a safe environment for its more than 100 inpatients and 450-plus staff (some of whom worked off-site).
One of the higher security units would need wiring of electronic locks in bedroom doors. He expected that, except for that unit, the clinic would comply with Dame Beverley's recommendation over the next few months.
The ministry's director of mental health, Dr John Crawshaw, told the Herald that although it did not support blanket door-locking, it recognised that where it had occurred, it would take some time to make changes.