Two of New Zealand's mental health units have been found to be in breach of United Nations guidelines.
Chief ombudsman Peter Boshier says while two units were in breach of UN guidelines, most are functioning well. Photo: RNZ /Dom Thomas
Chief ombudsman Peter Boshier has released reports on five secure acute mental health units after assessing them before Covid-19 restrictions began in March.
Two of them - at Wellington and Waitākere hospitals - breached the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, he said.
Wellington's unit used seclusion rooms as bedrooms because of over capacity. Boshier had recommended in 2017 that should stop.
"These rooms contain little more than a mattress, and are supposed to be used as a short-term measure for patients who are assessed as an imminent safety risk," Boshier said.
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 Capital and Coast District Health Board and Mental Health, Addictions and Intellectual Disability Service (MHAIDS) general manager Nigel Fairley said capacity issues at the Wellington unit would be addressed.
"We also recognise that work is needed to address TWOM (Te Whare o Matairangi Mental Health Inpatient Unit at Wellington Hospital) high occupancy, while also understanding that high occupancy is a national - rather than regional - issue indicative of increasing demand on acute mental health services across the country."
"MHAIDS works hard to strike a balance between supporting and treating clients with complex conditions, while ensuring the safety and protection of other vulnerable clients and staff," he added.
Boshier said Waitākere had been using its intensive care unit 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.
"While the patient had originally been moved to the ICU because of the risk of violence, there was no evidence this risk still existed."
Waitematā DHB said it could not comment on the specifics of the case in order to protect privacy, but "this patient posed a significant risk to themselves and others and was unable to be managed in an open environment".
Boshier has raised his concerns with Parliament, the Ministry of Health, District Health Boards, and the facilities themselves.
"We've talked time again about the need for mental health facilities in New Zealand to operate in a better way" - Peter Boshier
"You just can't contain someone in the intensive care unit of a facility like this for five months, in the way in which it occurred. It's just not right. It's not acceptable. It's not humane," Judge Boshier told Checkpoint.
"We've talked time and again about the need for mental health facilities in New Zealand to operate in a better way. And now we're beginning to get more terse, more strident, and say that there needs to be change in some of these facilities.
"It's time now, particularly in relation to those where we've made recommendations up until now and they've been accepted but not implemented. What is the Ombudsman to do, but to be increasingly requiring of accountability?
"Otherwise I think the public will lose confidence in the fact that we can achieve. We've got to be able to keep the public's confidence that we really do need to change."
Despite the criticism, he said some units were functioning well.
"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," he added.