New Zealand's Chief Ombudsman is calling for urgent action after reports of "cruel and inhumane" treatment at some of the country's high-risk mental health units.
Peter Boshier's role under an international human rights convention is to inspect places of detention, where people are unable to leave at will.
Today, Boshier revealed reports on five secure acute mental health units inspected before the Covid-19 restrictions began in March.
Key investigation findings:
• Two of the facilities inspected were in breach of the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.
• Te Whare o Matairangi Mental Health Inpatient Unit at Wellington Hospital continued to use seclusion rooms as bedrooms when the unit was over capacity, despite recommendations in 2017 that this practice should stop.
• The Waiatarau Mental Health Inpatient Unit at Waitakere Hospital was using its intensive care unit (ICU) as long-term accommodation for a patient. The patient was missing out on approved unescorted leave, was unable to attend daily programmes, and had limited access to phone calls.
• Other problems common to many of the units included overcrowding, unduly restrictive practices, low staffing levels, and lack of privacy for patients using the toilet.
Speaking about the patient who was moved to ICU, Boshier said while they had originally been shifted because of the risk of violence, there was no evidence this risk still existed.
"What was clear from clinical notes was that being contained in the ICU for an extended period was causing the patient an escalating sense of hopelessness, frustration and anger.
"It is my opinion that the long-term accommodation of the patient in the ICU amounted to cruel or inhuman treatment under Article 16 of the Convention."
Boshier said seclusion rooms contained little more than a mattress, and were supposed to be used as a short-term measure for patients who were assessed as an imminent safety risk.
Putting patients in seclusion rooms for no reason other than a shortage of accommodation had the potential to cause significant physical and psychological impacts, he said.
"I consider the ongoing use of seclusion rooms and other spaces as bedrooms amounted to degrading treatment and a breach of Article 16 of the Convention."
The Chief Ombudsman said he had raised concerns with Parliament, the Ministry of Health, District Health Boards, and the facilities themselves.
"[I] will continue to do so to ensure that vulnerable people are treated with dignity and respect that meets international expectations."
"As a nation, we are moving in the right direction in recognising mental health as a significant issue, and investing in improving the mental health of our citizens. But these reports show there is still urgent work to be done."
On a more positive note, some of the units were functioning well in caring for their highly vulnerable patients, Boshier said.
"Relationships between staff and residents were on the whole positive, and patients generally had good access to activities and health care services. Most of the units also encouraged visits from whānau, which is an important aspect of treatment and recovery."
Capital & Coast DHB and the Mental Health, Addictions & Intellectual Disability Service (MHAIDS) say the seclusion rooms were only used when "absolutely necessary".
"TWOM has 30 bedrooms – plus two additional rooms which are able to be used for seclusion or sensory modulation when absolutely necessary," said MHAIDS general manager Nigel Fairley.
"During periods of high occupancy, these rooms can be used in a non-restrictive way to accommodate and support clients appropriately and safely to prevent time spent in a less safe environment – such as an ED or uncontained community setting."
Fairley said the DHB recognised that work was needed to address TWOM's high occupancy.
MHAIDS had made some significant progress on implementing the Ombudsman's previous recommendations – including ensuring safe staffing levels and mix of disciplines, ongoing staff training and upskilling, and providing appropriate access to a phone, Fairley said.
In a statement from Waitematā DHB, it said the DHB was fully committed to providing safe and secure treatment facilities for mental health in-patients.
The DHB said it had addressed a number of recommendations, including case reviews for extended stays, plans by a lead psychologist to assist with management of difficult behaviour and a more streamlined complaints process.
Speaking to the patient who was shifted to ICU, they said: "While the DHB cannot comment on the specifics of this case in order to protect privacy, this patient posed a significant risk to themselves and others and was unable to be managed in an open environment."
The Herald is seeking further comment from the Ministry of Health.
Reports have been published on the following units:
Where to get help:
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youth services: (06) 3555 906
• 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
• Helpline: 1737
If it is an emergency and you feel like you or someone else is at risk, call 111.