Waitematā DHB's Mason Clinic. Photo: Google Maps
It is unacceptable that painful restraint methods are still be used to control people with intellectual disabilities at the Mason Clinic in Auckland, the chief ombudsman says.
In his just released report into the clinic's forensic intellectual disability unit, chief ombudsman Peter Boshier notes it is one of the only mental health services still using wrist locks and prone floor restraint, in which staff members use their own bodies to immobilise patients.
The clinic says physical restraints are the most effective way of establishing and maintaining a safe environment.
However, Boshier says that is not good enough, especially since the Waitematā District Health Board made a commitment in 2018 to phase them out within two years.
He says there are other de-escalation techniques that would be less painful for patients.
"I understand that some individuals have challenging behaviour but there are other de-escalation techniques and methods available that would reduce the risk of pain for care recipients," Boshier said.
"The clinic's own policy states that the use of wrist locks and prone restraints will be eliminated by 2020. But they were still being used in April 2021. This is not good enough. At the very least the clinic should implement its own policy to ensure that restraint training aligns with human rights standards."
In a statement, Te Whatu Ora said wrist locks and prone restraints, while used sparingly, were sometimes necessary in situations where care recipients were likely to harm themselves or others.
It was working with the SPEC National Governance Group to develop training solutions for these circumstances, it said.
"Our combined efforts in this area will provide valuable guidance around the use of wrist lock and prone floor restraints in the future," a Te Whatu Ora spokesperson said.
Chief ombudsman Peter Boshier. File photo. Photo: RNZ /Dom Thomas
The Ombudsman's report acknowledged the clinic's implementation of therapeutic methods to calm care recipients including the use of sensory items, activities and cultural support.
However, Te Whatu Ora said these techniques were "not robust enough" to provide the high level of safety required in its setting.
Other issues identified at the unit included that some patients, predominantly female, were routinely placed in other units due to capacity issues.
The clinic's senior management told the Ombudsman female care recipients were often sent to other units due to the layout of the Pōhutukawa unit, a lack of gender separation and significant risks posed by male patients.
This meant some female care recipients were receiving mental health care rather than intellectual disability care, Boshier said.
"In my view, it is inappropriate for care recipients to be placed in other units due to operational and environmental constraints within the service. I will be monitoring this in future inspections."
The Pōhutukawa unit provides assessment, care and rehabilitation for people with intellectual disabilities who have committed a criminal offence.
All care recipients in the unit require a "medium-secure" level of care or higher.
Care recipients and their families spoken to during the Ombudsman's report on the clinic were satisfied with their services and approaches, Te Whatu Ora said.
"Care recipients' views of the Unit were positive and they felt staff treated them with dignity and respect. Whānau spoken with were also positive towards staff and the treatment their whānau received," it said.