Intellectually disabled man held in 'cruel and inhuman' conditions in Government facility: Chief Ombudsman

Chief Ombudsman Peter Boshier: "I find that a curiously repressive way of managing behaviour."

A man living in effective seclusion for years at an intellectual disability facility has been held in "cruel and inhuman" conditions, the Chief Ombudsman says.

Peter Boshier has expressed "immense" concern about problems at four different forensic facilities in the Wellington region; the Haumietiketike intellectual disability unit, the Pūrehurehu and Rangipapa mental health units and the Tāwhirimātea rehabilitation unit.

At three of the facilities seclusion rates were much too high. Other issues included a person not being medically assessed for nearly 24 hours after being injured, and patients sleeping at the ends of hallways during renovations.

In a major finding, Boshier called on Capital & Coast DHB to do more for a man, called "Client A" in the report tabled in Parliament today, who is living at the Haumietiketike unit.

He likened the man's case to that of autistic and intellectually disabled man Ashley Peacock, who spent years living in a seclusion room at the Tāwhirimātea unit.

"It's not often that I go as far as saying that treatment amounts to [being] cruel and inhuman ... that's really because Client A has been secluded for such an unacceptably long time," Boshier told the Herald.

Repeat recommendations by his office had been made over the years to address the man's treatment, Boshier said, but not nearly enough had been done.

"Even when we called last Friday - that's the most recent call and inspection - we still have no assurance that his immediate, medium-term future is going to be improved."

Client A had challenging behaviour including violence, Boshier said, but other facilities in New Zealand had shown the response didn't need to be seclusion. He didn't blame the staff, who were also working in challenging conditions.

"I find it to be cruel and inhuman that you seclude someone in their own space, and they are only able to interact with anyone else through a wire mesh fence. And that is the only interaction they have. I find that a curiously repressive way of managing behaviour."

Client A's care was the subject of a previous Ombudsman report in 2014, which called for changes. A follow-up inspection in 2017 found he was still living in the same de-escalation bedroom he had been for more than five years.

The man was in the same room at the time of the latest inspection in 2020. Since two staff were assaulted the previous year he hadn't had face-to-face contact with staff or other patients, other than through a wire fence.

In the weeks after the 2020 inspection Client A was moved to new accommodation. Boshier visited in February to inspect the changes and speak to him.

"Their living area was more attractive and spacious, there was an activities room, and the use of a restraint belt means they could have contact with staff," Boshier said.

"However, while I acknowledge the progress made in the care of Client A, they were, as of February, still effectively in seclusion. They remained alone, in a locked area, unable to leave. If they needed to use the bathroom at night, then staff need to be called. Client A remained in conditions that are not fit for purpose."

The Ombudsman undertook another inspection last Friday, and discovered Client A had been moved back to his old living conditions because of renovations to install a kitchenette, expected to last at least eight weeks.

"He has been on this rollercoaster of unacceptable conditions, then some improvement, back to where he was. There is apparently a longer-term plan for him to be in a purpose-built facility. But it shouldn't have taken this long and so many repeat recommendations to begin to get traction," Boshier told the Herald.

The Chief Ombudsman's recommendations include that, as a matter of urgency, Client A is provided with daily access to fresh air, the chance to exercise, and have meaningful engagement with others. "Seclusion Room One" should also be decommissioned urgently, Boshier recommended, and seclusion rooms should never be used as bedrooms.

Karla Bergquist, Capital & Coast DHB's executive director for mental health, addiction and intellectual disability services, told the Herald Client A "has never been managed in seclusion - they were accommodated in a room in the de-escalation wing and provided with the best possible care".

"This person is now appropriately accommodated in a modified wing of the unit with a living area, activity area and bathroom."

Staff used their clinical judgment when deciding where to put patients, she said, and work hard to "strike a balance between supporting and treating people with complex needs, while ensuring the safety and protection of others being cared for".

The service had implemented many of the Ombudsman's recommendations in recent years, Bergquist said, but there were challenges, including high nationwide demand.

A new purpose-built, six-unit facility was being built next to the existing Haumietiketike unit and would be completed early next year. It will "enhance the quality of life for people through a personalised, flexible and safe environment", Bergquist said.

In July the Ombudsman released a highly critical report into the Ministry of Health's stewardship of facilities for the intellectually disabled, which found DHBs weren't properly funded to run the units.

"So the extent to which these facilities are overcrowded and not fit for purpose, you have to ask yourself, where the stewardship of the Ministry of Health actually is," Boshier said.