Kirsty Johnston is an investigative reporter at the New Zealand Herald.

Locked in isolation: Lack of clarity around patient seclusion

Ombudsman’s inspectors can’t say how many in long-term isolation as calls mount for nature-lover’s release.

An unknown number of patients are held in long-term seclusion in New Zealand institutions.

Inspectors from the Ombudsman's Office, who monitor the issue, say they do not know the exact number, but there are more.

The lack of clarity around patient seclusion emerged after the Herald yesterday revealed the case of autistic man Ashley Peacock, who has been confined to an isolated area of a Capital and Coast District Health Board unit in Porirua for five years - despite warnings it breaches his human rights.

Yesterday, calls mounted for an end to Mr Peacock's seclusion and transfer to a placement in the community where he could have specialised care.

Documents show at least one other case exists at the same site - in a different mental health unit, Haumiatiketike - where an intellectually disabled man has been under a seclusion order for at least two years. The health board refused to elaborate on his case due to "privacy issues".

Over the past five years, inspectors have noted about five long-term seclusion cases in mental health facilities. But they say a "substantial number" of areas are not monitored, including community-based homes for the disabled, aged-care units and other compulsory care facilities.

Chief Crimes of Torture Act inspector Jacki Jones said they had come across several long-term cases where people lived in seclusion rooms - usually with just a mattress and scant personal items.

"It's not an acceptable situation for anyone to be living in, not just Ashley.

"Seclusion is considered a short-term intervention and should never be used as a long-term solution to house patients considered high risk, or high needs."

Ms Jones said her office did not have the resources to look at private detention facilities such as dementia units, so did not know exactly how many cases there were.

"Those people are part of a vulnerable group who are more likely to be subjected to cruel and inhumane treatment." Discussions were ongoing about how to extend monitoring to private environments.

Ashley Peacock, with his father Dave, and one of two nurses who constantly keep watch over him, feeding horses in a paddock near Porirua's Regional Rehabilitation Unit. Photo / Mark Mitchell
Ashley Peacock, with his father Dave, and one of two nurses who constantly keep watch over him, feeding horses in a paddock near Porirua's Regional Rehabilitation Unit. Photo / Mark Mitchell

Disability Commissioner Paul Gibson said worse cases than Mr Peacock's were likely, because many disabled people did not have anyone to advocate for them and were unable to do it themselves.

"They are the most vulnerable of the vulnerable. It is much harder for them to get out of the system than anyone else," he said.

Mr Gibson said the law needed to change around the way disabled people were deprived of liberty, as it was too difficult to challenge decisions made by clinicians.

The Human Rights Commission is investigating seclusion and restraint practices in New Zealand with funding from its international body, secured after an international torture body visited and also noted concerns.

Previously, the Ombudsman has suggested to the Ministry of Health it build some secure, individualised units for patients with high and complex needs considered candidates for seclusion. They have not been built.

Dave and Marlena Peacock with a portrait of their son Ashley Peacock. Photo / Mark Mitchell
Dave and Marlena Peacock with a portrait of their son Ashley Peacock. Photo / Mark Mitchell

Director of Mental Health Dr John Crawshaw said there was individual funding available for such cases. He said seclusion rates had dropped by 32 per cent, with 7091 people spending time in seclusion last year.

Mr Peacock, 37, has spent five years in seclusion, half of that time in a 10sq m room. He loves nature and a review says being locked up may be contributing to his aggression.

Yesterday, the Labour Party and the Greens added their voices to the chorus of experts calling for him to be transitioned to a community setting, as recommended by a review. They asked the minister intervene to ensure it happened urgently.

Associate Health Minister Sam Lotu-Iiga said he would not issue a directive.

"I've been given reassurances that [the health board] are working closely with the family, on a solution," he said.

Mr Peacock's family have approached media concerned a remedy for his situation was taking too long.

Patients in isolation

What is the problem?

Vulnerable people, including the mentally ill and disabled, are being kept in long-term seclusion, the medical term for solitary confinement.

The practice is judged a breach of human rights by the UN and regarded as a form of torture.

Why has it come to light?

The family of an autistic man named Ashley Peacock came to the Herald with their story, after their son was kept locked in seclusion for five years, despite reports saying he should be let out.

What are the authorities doing?

The use of seclusion is declining. But those charged with monitoring the problem, the torture inspectors from the Ombudsman's office, say it is a problem, and the extent of its use is unknown.

What do those in power think?

The Human Rights Commission and the Ombudsman have repeatedly raised concerns about Ashley's case (and others). Grant Robertson, of Labour, wrote a letter to the Health Minister, Jonathan Coleman, asking him to intervene.

The minister passed on responsibility to his associate minister, Sam Lotu-Iiga, who said he will not get involved.

Kevin Hague, from the Green Party, wants an inquiry into mental health, saying this is one of a long list of problems.

- NZ Herald

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