The use of restraints on mentally ill prisoners amounts to torture and undermines New Zealand's status as a civilised country, a leading lawyer says.
Nigel Hampton, QC, said a damning investigation into tie-down beds and waist restraints in jails showed the Corrections Department did not appear to have learned from previous inquiries into the care of severely ill people behind bars.
"It's inhumane and it's small wonder that it can be described as torture," he said.
"It's quite extraordinary that in a first world country which prides itself on its treatment of its citizens that this is happening."
Hampton, the patron of the prison reform group Howard League, said he was not yet convinced about Corrections' promises to overhaul mental health services in jails.
The report comes as Corrections is developing a specialised mental health facility in Auckland and invests more in mental health workers.
"We get the heads of Corrections saying it, saying it and saying it, and not doing it, doing it, doing it," Hampton said.
"They don't treat unwell people properly. It's as simple as that."
Boshier's investigation, released today, found five times where tie-down beds or waist restraints were used to manage severely at-risk inmates between July 2015 and June last year. The treatment of the prisoners had breached the United Nations' Convention against Torture and Corrections' own legislation.
The Corrections Department stressed that the cases were isolated and that the inmates had some of the most complex needs in the criminal justice and health systems.
But Boshier also raised broader concerns about the department's units for at-risk patients, in particular the "basic" training of staff, absence of privacy, and isolation. In some cases, severely ill inmates never received psychiatric treatment during their incarceration.
Generally, Corrections' management of at-risk prisoners around the country was "substandard and detrimental to their wellbeing", Boshier said.
Tie-down beds and waist restraints can only be lawfully used in New Zealand jails as a last resort and not as a punishment.
37 nights in cuffs
Boshier found that one inmate at Auckland Prison was tied to his bed for 16 hours at a time, 37 nights in a row. In all, the prisoner spent 592 hours in restraints, and sometimes soiled his bed. His limbs were not moved during the prolonged periods of restraint - a breach of the Corrections Act and Corrections' policies.
In 36 of the 37 nights, Corrections staff failed to get medical approval for the restraints - also a breach of the department's rules.
Corrections told investigators that the man had been tied down to prevent self-harm, but the Ombudsman said he was successfully managed during the daytime without restraints and by being observed by staff. The use of tie-down beds coincided with reduced staffing levels, Boshier said.
Boshier accepted the difficulty of managing high-needs prisoners, but said tying an inmate to a bed for up to 16 hours each day "as a way of managing resourcing pressures" was not appropriate.
Corrections Minister Louise Upston defended Corrections staff, saying they worked with inmates who had long-standing, complex mental health issues. The five cases highlighted in the Ombudsman's report represented "some of the criminal justice and health sectors' most challenging individuals", she said.
Upston said the prisoners "may well have died" without Corrections' intervention and the use of the restraints.
"The bottom line for Corrections must always be to maintain the lives of the people in their care, while treating them with dignity."
But she also said there were lessons for the department in the report, and she was pleased some of the recommendations had already been adopted.
Corrections admits mistakes
Corrections chief executive Ray Smith said today he ordered an immediate review of his department's policy on tie-down beds when he was made aware of the worst of the five cases. He also ordered a separate review by Corrections' chief inspector.
He accepted that mistakes were made in the use of the tie-down bed and said "its use crept from being a last-option to a tool for managing the prisoner's health and complex behaviours".
Smith also highlighted broader reforms by Corrections in the area of mental health, which included a new $300m facility and a $14m investment in extra mental health workers.
The Ombudsman's report also identified "inappropriate behaviours" by two Corrections staff members, which Smith described as "a failure of integrity" and not representative of "the patience and respect our staff take in such cases". One staff member has been sacked as a result of the inquiry.
"I have personally met with the prisoner concerned and discussed his care over this time," Smith said.
"Although he remains a complex prisoner to manage, he is responding well to a new health management plan and is not presently self-harming."
No doctors, no medication
In a separate case at Otago Corrections Facility, the Ombudsman found an inmate was continuously kept in a waist restraint with his hands tied behind his back. The cuffs were only removed for two hours a day and four hours a night. He was locked in his cell for 21 hours a day.
This treatment went on for 12 weeks before the prisoner was released, during which time he was not given his medication and not seen by a psychologist.
Boshier found it usually took weeks for a prisoner to see a psychiatrist. It was not known how often prisoners were denied their medication.
Smith said most of the Chief Ombudsman's recommendations had been accepted.
The findings needed to be seen in context, he said. Twelve out of 7000 prisoners tied down over the past three years was a "tiny proportion" of the total muster.
Chief Human Rights Commissioner David Rutherford said the report reinforced the value of independent prison inspectors.
The report was a "milestone" for preventative monitoring by inspectors, he said.
"Without the co-ordinated preventative monitoring activities ... these sorts of breaches would go undiscovered."
"Prisoner A" (Auckland Prison)
● Referred to the Mason clinic but denied admission.
● Self-harmed three times in prison.
● Spent 37 nights in a row on a tie-down bed, for 16 hours each time, when staff levels were low.
● Just one of these occasions was approved by a medical officer.
● Spent 592 hours restrained in total.
● Covered by a spit hood on one occasion.
"Prisoner E" (Otago Corrections Facility)
● Kept continuously in a waist restraint because of self-harming.
● Spent 12 weeks in restraints in total, with two hours off during the day and four hours at night.
● Locked in cell for 21 hours a day.
● Did not receive counselling or psychotherapy.
At Risk Units (ARUs)
● No privacy - staff and visitors can watch inmates on toilet or undressing.
● Prisoners in isolation with few interactions with staff.
● Basic training for staff.
● Prisoners restrained by legs, arms, chest for prolonged periods.
● Restraints used for discipline rather than preventing self-harm.
● Poor communication between Corrections and psychiatrists.
Where to get help:
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• Depression helpline: 0800 111 757 (available 24/7)
• Rainbow Youth: (09) 376 4155
• Samaritans 0800 726 666
• If it is an emergency and you feel like you or someone else is at risk, call 111.