There have been nearly 500 assaults a year at a facility for people with intellectual disabilities that has 12 beds.
The physical and sexual assaults at Dunedin's Ward 10A have sparked calls for better staffing and facilities, and come after Auckland's Mason Clinic reported "severe" health and safety risks.
Southland DHB initially refused to provide any information on incidents within the medium secure service ward of Wakari Hospital, which holds people with an intellectual disability or with both an intellectual disability and mental health issues.
The Herald complained to the Ombudsman, and information now released shows a high number of incidents over 2017 and 2018, including:
• 517 physical and 35 sexual assaults by patients on staff.
• 400 physical and two sexual assaults by patients on patients.
• 67 verbal threats or abuse made by patients against staff.
Assaults included kicking, slapping and punching, the DHB stated, and sexual assaults included "groping of breast" and "clutching of testicle". None resulted in hospitalisation, and were all considered "minor" or "minimal" in terms of harm.
The DHB declined to detail victims' sex and age, saying this could lead to patients being identified. Four patients were responsible for 137 incidents.
Generally, patients in the ward have broken the law (forensic patients) or are being treated under the Mental Health Act and have behaved in a way that posed a serious risk to themselves or others. Some have psychiatric disorders. Forensic patients aren't segregated from other patients.
In releasing the information, Melanie Naulls, Southern DHB's corporate solicitor, said most people admitted to the ward "are at the most severe end of the spectrum in terms of challenging behaviours, and these behaviours do not disappear on hospitalisation".
Work to bring down incidents across all mental health, addictions and disability (MHAID) wards is ongoing. A DHB report updated in January by a director of nursing outlined concerns about the state of buildings.
"We remain very concerned about the condition and layout of the inpatient wards on the Wakari site," stated the report, released under the Official Information Act. "These for the most part are original 1990s condition and do not support the delivery of safe (for patients and staff) contemporary acute and sub-acute mental health care."
Southern DHB's general manager for MHAID, Louise Travers, said beds in Ward 10A had been reduced by one to 12, and the bedroom converted to a sensory modulation room.
"Currently the service is part of a Ministry of Health project looking at optimal environments for people using [intellectual disability] facilities and this will include a stocktake of the current facility and a gap analysis to identify specifically what is required to meet the standards."
The Ministry contracts five DHBs and non-government organisations to provide forensic intellectual disability services, with 66 hospital-level beds across the country.
Problems go beyond Southland DHB. Last year the Herald revealed Waitematā DHB had warned the Director of General of Health about a "severe and urgent" situation at the Mason Clinic. Issues included intellectually disabled women sharing corridors with "predatory" men.
In February, Chief Ombudsman Peter Boshier announced twin investigations into how the ministry cares for the intellectually disabled, including how it records deaths in forensic facilities. The ability of the ministry to resource and plan services will come under the microscope, including whether facilities are good enough.
The New Zealand Nurses Organisation (NZNO) union has members working in Ward 10A. Organiser Celeste Crawford said the dated Wakari Hospital facilities were concerning, as was understaffing. Better training was needed, Crawford said, given the complexity of patients and behavioural problems.
"I understand there's no training in New Zealand specifically around working in intellectual disability services. We think that is something that really needs to be put in place."
Dr Amanda Smith of the Ministry of Health said a number of subgroups consisting of ministry and DHB staff would formulate plans for how care was delivered, staffing issues and facilities. A final plan is expected this year.
Last year IHC told the Herald the problems at the Mason Clinic reflected a health and disability sector in crisis, and widespread underfunding. Since then, the organisation has faced industrial action from staff employed to provide services for people with intellectual disabilities living in the community.
A spokesman for IHC declined to comment on the situation at Ward 10A, citing concerns about people with intellectual disabilities being portrayed as violent and abusive in some media reporting of the industrial action. IHC chief executive Ralph Jones has posted a message on the organisation's website, saying such representations are "demonising" and "in no way a fair representation of the people we support".