Report on an unannounced follow up inspection of Te Whare Maiangiangi Unit, Tauranga Hospital, under the Crimes of Torture Act 1989 Primary tabs

Executive Summary

Background

This report sets out my findings and recommendations concerning the conditions and treatment of people detained in Te Whare Maiangiangi Acute Mental Health Inpatient Unit (the Unit), which was inspected on 16 and 17 August 2021. The Unit is located on the grounds of the Tauranga Hospital campus, Tauranga.

In the Unit, tāngata whai ora [1] receive acute mental health services provided by the Bay of Plenty District Health Board’s (DHB’s) Mental Health and Addiction Service (the Service).

This report has been prepared in my capacity as a National Preventive Mechanism (NPM) under the Crimes of Torture Act 1989 (COTA). Ombudsmen are designated as one of the NPMs under the COTA, with responsibility for examining and monitoring the conditions and treatment of detained people in the relevant places of detention. My responsibility includes hospital units in which people are detained.

This report examines the Unit’s progress implementing the 14 recommendations I made in 2018. [2] It also includes findings on the conditions and treatment of tāngata whai ora who are or may be detained in the Unit at the time of my follow up inspection on 16 – 17 August 2021, resulting in 16 recommendations.

I found that five of the 14 recommendations I made in 2018 had been achieved and nine had not been achieved.

Overall, during the follow up inspection I found that:

• Tāngata whai ora had the necessary legal documentation to be detained and treated in the Unit.
• As an alternative to smoking, vapes could now be used in the Intensive Psychiatric Care (IPC) area and were provided to tāngata whai ora at no cost. Vaping was allowed in the IPC courtyard, and education was provided on vaping and smoking.
• Visiting hours were generous and there appeared to be a measure of flexibility.

The issues that need addressing are:

• Seclusion rooms and the admissions/day room were still being used as bedrooms.
• Tāngata whai ora were being secluded in the IPC courtyard.
• The IPC area is outdated and no longer fit-for-purpose.
• The number of seclusion events in the Unit was high.
• The Unit, which was designated as an open unit, was locked at the time of inspection. This was not being recorded as environmental restraint.
• The courtyard on the ‘open’ [3] side of the Unit was locked throughout the inspection. This was not being recorded as environmental restraint. [4]
• There was no signage for entry and exit at the Unit for voluntary tāngata whai ora (or those tāngata whai ora with approved leave) or visitors.
• Tāngata whai ora spoken with said they did not feel the Unit communicated well or engaged them in their treatment. Tāngata whai ora and their whānau were not invited to attend their multi-disciplinary team (MDT) meetings. Treatment plans viewed by Inspectors were not completed or signed.
• The complaints process was not widely understood by tāngata whai ora or accessible independent of staff.
• There were no completed Consent to Treatment forms on the files of tāngata whai ora.
• Contact details for District Inspectors were not visible on the ‘open’ side of the Unit or the IPC area.
• Bedroom doors could not be locked independently of staff.
• There was no discrete bedroom area for female tāngata whai ora on the Unit to ensure privacy and safety.
• The Unit was not fit-for-purpose.
• The Unit regularly ran over capacity.
• Information about visiting hours for the Unit was inconsistent.
• Adequate privacy was not provided to patients when using the telephone on the ‘open’ side of the Unit or in the IPC area.
• Staff recruitment was an issue for the Unit.

As a result of my follow up inspection, I make 16 recommendations to improve the conditions and treatment of the Unit’s tāngata whai ora. Disappointingly, nine of these are repeat recommendations.

Recommendations 

As a result of my 2021 follow up inspection, I recommend:

Treatment

1. The Unit takes immediate steps to not use seclusion rooms and admissions/day rooms as bedrooms to accommodate tāngata whai ora. This is an amended repeat recommendation.
2. The Unit ceases the practice of secluding tāngata whai ora in the IPC courtyard, or any area other than a designated seclusion room. This is an amended repeat recommendation.
3.  The DHB upgrades the IPC area as a matter of urgency. This is an amended repeat recommendation.
4. The Unit addresses the high use of seclusion, with particular consideration given to seclusion rates of Māori.
5. The Unit records and reports all instances of environmental restraint.
6. The Unit ensures voluntary tāngata whai ora are fully informed of their right to enter and exit the Unit, and how to do so.
7. The Unit ensures that tāngata whai ora, and their whānau, are involved in treatment planning, including attending their MDT and developing their treatment plan.
8. The Unit ensures that the complaints process is clearly advertised throughout the Unit and all tāngata whai ora are able to raise a complaint independent of staff. This is an amended repeat recommendation.
9. The Unit ensures that tāngata whai ora have a signed Consent to Treatment form retained on their file. In circumstances where a tangata whai ora is unable or refuses to sign, this is documented. This is an amended repeat recommendation.
10. The Unit ensures that contact details for the District Inspector are displayed on the Unit and tāngata whai ora are able to contact the District Inspector independent of staff.
11. The DHB takes immediate steps to ensure that tāngata whai ora are able to lock their bedroom doors at any time, to improve their privacy and safety. This is an amended repeat recommendation.
12. The DHB ensures that accommodation is provided for female tāngata whai ora for privacy and safety. This is an amended repeat recommendation.
13. The DHB urgently resumes planning for a new build in line with best practice for the design of mental health facilities.
14. The Unit takes steps to ensure that visiting hours to the Unit are consistently referred to in all information available to tāngata whai ora and visitors. This is an amended repeat recommendation.
15. The Unit makes arrangements to ensure privacy for tāngata whai ora when using the telephone in the ‘open’ unit and IPC area. This is an amended repeat recommendation.
16. The DHB works with relevant agencies to develop and implement a workforce strategy to ensure appropriate staffing for the Unit.

Footnotes

[1] ‘Tāngata whai ora’ is used to refer to persons who are the subject of care, assessment and treatment processes in mental health.  It means ‘a person seeking health’. This term is often used interchangeably with consumer and/or service user. Return to text

[2] See OPCAT Report on an unannounced inspection to Te Whare Maiangiangi under the Crimes of Torture Act 1989, for my 2018 Report findings and recommendations. The DHB has a full copy of this report. Return to text

[3] The ‘open’ side of the Unit comprises a 20 bed open unit. Return to text

[4] Environmental restraint is where a service provider(s) intentionally restricts a service user’s normal access to their environment, for example where a service user’s normal access to their environment is intentionally restricted by locking devices on doors or by having their normal means of independent mobility (such as wheelchair) denied. Health and Disability Services (Restraint Minimisation and Safe Practice) Standards. Ministry of Health. 2008. Return to text