Whānau living with distress need a safe place, not a punishment room, says Krissy Mackintosh — the co-founder of Hear4U, a Gisborne charity that advocates for men's mental health and suicide prevention.
Seclusion is a practice where a person staying in a mental health facility is confined to a room or space by themselves and is not able to leave.
Mental Health and Wellbeing Commission chief executive Karen Orsborn said the practice often occurred when people were experiencing high levels of distress or other emotions.
“We refer to the practice as solitary confinement because that is a better descriptor of what occurs.
“People are often traumatised by being locked in a room by themselves when they are feeling high levels of distress.”
The Commission considered all solitary confinement (seclusion) as traumatising and harmful, Ms Orsborn said.
“The Commission's wish to end solitary confinement in all mental health and addiction services was outlined in a submission to change the Mental Health (Compulsory Assessment and Treatment) Act 1992 in January 2022.
“The practice is outdated but is still allowed under current mental health legislation.
“There are other options that are more appropriate for people when they are experiencing high levels of distress, such as accompanying them into a quiet space, actively listening to their concerns and needs, learning about what happened to them, discovering their triggers and what calms them, offering them food or a drink and involving their whānau.
“The Health Quality and Safety Commission is leading a project to eliminate seclusion.”
Ms Orsborn said many mental health facility units around the country were old.
“They do not allow for contemporary care approaches and include seclusion rooms that are not fit for purpose.
“However, we believe seclusion is an inappropriate practice, irrespective of whether the rooms are old or new.”
Mrs Mackintosh said when a person living with distress was also under the influence of substances, in that moment, the way the person reacted and responded was amplified.
“They cannot control their actions and there comes a point where seclusion is necessary to help them rest. It needs to be in a space where they have no other distractions, interference — a safe place.”
An OIA response from Hauora Tairāwhiti to the Herald showed that between 2020 and 2021 there were a total of 69 episodes in the mental health ward where seclusion was used. Out of these, 14 episodes were for Pākehā and 55 for Māori. The total number of hours amounted to 1646.12.
Mrs Mackintosh said the number of hours was huge and ultimately it came down to how people were taught in their practices.
“For us, if somebody is already feeling down and needs seclusion, what is better than a warm bed and having someone come in and check on them every five minutes — reassuring them that ‘I am here when you are ready, you just need to rest' instead of putting them in a prison-like cell, which is traumatising.”
Mrs Mackintosh had worked with a lot of whānau who had been in seclusion in Ward 11 — Hauora Tairāwhiti ‘s mental health ward. They suffered from post-traumatic stress disorder as a result of being put in one of the rooms.
“They were terrified because they could hear somebody next door in the same scenario as they are but with a different diagnosis — like someone with schizophrenia screaming and yelling at night, amplifying what the other person in the next room was feeling; escalating the other person's distress.”
Many people were too terrified to seek further help because they feared how they would be treated, which was really sad and unfortunate.
Safe seclusion practice was important to assist whānau to heal their mind and body — “rest makes you see with clarity”, Mrs Mackintosh said.
“Obviously if somebody has to be repeatedly put in seclusion there is a deeper issue which needs to be addressed.
“Continuing to punish them by isolating them from the world and people who can help them is only making them feel more discriminated.
“It's like telling them‘we can't deal with you and we don't know what to do with you so we are going to put you over here in the ‘too hard basket' because right now you are a nuisance'.
“They wouldn't be in that situation if they didn't already have those negative thoughts.”
As a sufferer herself, Mrs Mackintosh said the one thing which had been more beneficial than having seclusion time was having a bed to rest in and continuing to see her family and loved ones.
“Don't isolate people when they are already so vulnerable and lonely within their wairua (spirit).
“Get them inside in a safe place. Maybe they need to have more specialist care, or supervision over those family interaction times to make sure family aren't triggering.
“Instead of seclusion rooms we need a safe space for families to learn as a unit with the person living with distress — a little room like an art workshop or a discussion room, a place where the person is distracted but can work together on a plan and a way forward.
“The isolation factor encourages the stigma we have in society regarding mental health.
“And people are too scared to seek help because they think they are very lonely and they are going to be put in a treatment box.”
Mrs Mackintosh was hopeful Hauora Tairāwhiti's new mental health unit would consider consulting with whānau living with distress before designing a seclusion room.
“The smell, atmosphere and lighting — these are all factors we need to take into account when creating a seclusion room. Punishing someone who is already unwell, vulnerable and self-destructing is not the answer. It never is.
“In the new design, we should have input from the community. I think the designers need to hear from people with lived experience rather than textbooks because that could be very beneficial to how these safe seclusion rooms are designed.”
At today's Hauora Tairāwhiti board meeting, the plans for the new building were shown. They included a “seclusion suite”.
Hauora Tairāwhiti chief executive Jim Green said mental health services in Tairāwhiti, or indeed New Zealand, did not utilise “solitary confinement”.
“People in seclusion are our most acutely unwell people. A person in seclusion is never left alone and is provided with intensive treatment and support.
“There has been substantial reduction in the use of seclusion in Tairāwhiti. The new mental health facility will be a significantly safer environment that will support the local effort to eliminate seclusion.”
Hauora Tairāwhiti's Te Ara Maioha mental health and addictions services group manager Sonya Smith said there were rooms being built in to the facility which would meet the specifications of safety and comfort for someone requiring compulsory care.
“There is a specific section in the new building for better supporting care when people are welcomed when they are in a distressed state, and another for ongoing care of those needing the most input to their care.
“These settings also will enable whānau to be alongside that care. Our new facility will be a major step up in the way we can faciliate safe, effective and appropriate care.”
If you need help
If someone in your whānau is in mental health crisis, please call Hauora Tairāwhiti Psychiatric Assessment Triage Team (PATT) on 06 867 2435.
If you are a family member of a loved one in distress, you can reach out to Yellow Brick Road New Zealand for support on yellowbrickroad.org.nz/or 0800 555 434.
Need to talk? Free call or text 1737 any time to speak to a trained counsellor, for any reason.
Call Lifeline any time on 0800 543 354.
Women's Refuge — Call the free crisis line on 0800 REFUGE or 0800 733 843.
In case of an emergency, where you or someone's life is under threat dial 111
What's Up – 0800 WHATSUP (942 8787) Phone counselling is available Monday to Friday, midday-11pm and weekends, 3pm-11pm. Online chat is available 7pm-10pm daily for 5-18 year olds.
Kidsline – 0800 KIDSLINE (54 37 54) for young people up to 18 years old. Open 24/7.
New maps exclude Ormond Rd from the NZTA’s ‘H’ permit system.