The Ministry of Health is being urged to step in following high rates of seclusion at two Bay of Plenty mental health facilities, particularly for Māori patients.
File pic Photo: 123rf.com
Te Toki Maurere in Whakatāne and Te Whare Maiangiangi in Tauranga were inspected by the Ombudsman in 2018 where concerning rates of seclusion were found.
Both are mental health inpatient units run by the Bay of Plenty District Health Board.
On Thursday, Chief Ombudsman Peter Boshier published reports of unannounced, follow up visits in July and August last year.
"My views on the use of seclusion are well-documented but I reiterate that I consider seclusion is a serious intervention with no therapeutic benefit and potentially harmful effects on patients," Boshier said.
"It concerns me greatly that reducing and eliminating its use seems to be making only slow progress, despite my regular calls for it to be stopped."
Concerns around seclusion practices were reported for both facilities.
A project team has been set up at Te Whare Maiangiangi to reduce high and increasing levels of seclusion since the Ombudsman's 2018 inspection.
But Boshier said progress had been slow.
While the number of hours spent in seclusion at the Tauranga facility has dropped from 1413 to 833, the 2021 inspection found the number of seclusions had increased from 59 events in six months to 85 events.
Peter Boshier has been making regular calls for seclusion within mental health units to be dropped. Photo: RNZ / Phil Smith
'No reason for Māori patients to be secluded more'
The Bay of Plenty DHB's Reducing Seclusion project team acknowledges that Māori were still over-represented in seclusion data.
"I have made a recommendation in my report that Te Whare Maiangiangi addresses its high use of seclusion, particularly as it relates to Māori," he said.
"This should simply should not be happening. There is absolutely no reason for Māori patients to be secluded more than any others. I urge the Ministry of Health to address this as a matter of urgency."
It followed similar concerns he had raised about the disproportionate seclusion of Māori patients in a report about Te Awhina acute mental health unit in Whanganui.
The Te Toko Maurere unit in Whakatāne also showed an increase in seclusions from 26 in six months in 2018 to 39 over six months in 2021.
The data showed seclusion was generally reducing over time.
He recommended that the unit improved its data-recording systems to ensure it was reliable and accurate following a discrepancy found between the seclusion data from the unit and the DHB.
"Reliable and accurate data is essential to ensure that the unit continues its progress towards reducing and eliminating the use of seclusion," Boshier said.
The inspections were carried out under the Crimes of Torture Act 1989.
DHB responds
The Bay of Plenty District Health Board said it would address seclusion and other issues raised by the Ombudsmen.
Mental health and addiction services business leader Jen Boryer said the DHB accepted the findings and has provided action plans to address the issues to the Ombudsman including Māori wellbeing
"The Bay of Plenty DHB is committed to the Health Quality and Safety Commission work on ensuring safety for all - "Zero Seclusion - Safety and Dignity for All".
Improvement had been made in recent years including the number of seclusion hours dropped by 41 percent at the Tauranga facility since the previous inspection, she said.
"A Clinical Nurse Specialist is also employed with a direct focus on seclusion reduction, and that role encompasses Safe Practice Effective Communication training with a focus on reducing seclusion for Māori.
"Significant work is also underway to support building business cases with clinical service plans outlining new models of care.
"The business case for a new unit to replace Te Toki Maurere is a top priority for the Bay of Plenty DHB."
The business cases were due for submission in a few weeks.
"As demonstrated by the strong and repeated recommendations within the reports, facility condition and design play an important part in supporting least restrictive practices and creating therapeutic environments," Boryer said.