Report on an unannounced inspection of Haumietiketike Unit, Rātonga-Rua-O-Porirua Campus, under the Crimes of Torture Act 1989

Executive summary

Background

Ombudsmen are designated as one of the National Preventive Mechanisms (NPMs) under the Crimes of Torture Act 1989 (COTA), with responsibility for examining and monitoring the conditions and treatment of clients[1] detained in secure units within New Zealand hospitals.

Between 14 and 16 July 2020, two Inspectors[2] — whom I have authorised to carry out visits to places of detention under COTA on my behalf — made an unannounced inspection of Haumietiketike Unit (the Unit), which is located in the grounds of Rātonga-Rua-O-Porirua Mental Health Campus, Porirua. A focused follow up inspection was also carried out on 10 February 2021.   

Summary of findings

My findings are:

• Files contained the necessary paperwork to detain and treat the clients on the Unit.
• Clients spoken with felt safe and confirmed that they were treated with dignity and respect.
• The Unit’s Morning Hui was a positive initiative.
• Clients’ access to leave was well utilised and supported by Unit staff.
• The Unit was clean and tidy.
• Clients had good access to primary health care services.
• Leadership on the Unit was visible.
• Clinical supervision was actively promoted on the Unit and staff were supported to attend.
• The orientation package provided to new staff and student nurses was comprehensive.
• The recently introduced Positive Behaviour Support (PBS) training[3] for staff was well supported by the Unit leadership team.

The issues that needed addressing are:

• The client previously identified as living in a seclusion[4] room on a permanent basis (in 2014[5] and 2018[6]) had not had a change to their living arrangements at the time of the inspection. A follow-up inspection saw a change in accommodation. During both inspections, the conditions under which Client A was accommodated may have amounted to cruel and inhuman treatment, and a breach of Article 16 of the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (‘Convention against Torture’).[7]
• Seclusion Room One was not fit for purpose.
• New clients were being admitted into seclusion rooms.
• Night safety procedures[8] were not being recorded as seclusion events and the Night Safety Plan (NSP) paperwork was often a duplicate of the previous plan.
• The complaints process was not well advertised or easily accessible for clients.
• The Health and Disability Service ‘Code of Health and Disability Services Consumers’ Rights’ posters on display were not all in an accessible format.
• Clients did not routinely receive an up-to-date copy of their care plan.
• Clients were subject to overly restrictive practices and blanket restrictions, including lack of independent access to drinking water, hot drinks, and fresh air.
• Clients’ access to Unit activities, religious, and cultural support was limited.
• Clients were not able to use a telephone to contact the District Inspectors (DIs), independent of staff.
• A high proportion of medication errors occurred at the point of administration.
• The Unit had a high and increasing rate of staff turnover.

Recommendations

I intend to monitor the implementation of my recommendations, including conducting follow-up inspections at future dates.

Feedback meeting

On completion of the inspection, my Inspectors met with representatives of the Unit’s leadership team, to outline their initial observations.

District Health Board response

The Capital and Coast District Health Board (the DHB) received a copy of my provisional report and were invited to comment. The DHB responded and I have had regard to that feedback when preparing my final report.

The DHB’s letter and comments responded to a number of common themes from my inspections of the Unit and three other units in the DHB which were conducted at the same time[9], in particular around the use of seclusion rooms as bedrooms and ongoing reliance on night safety procedures (NSPs).

The DHB emphasised that they considered the reports provided evidence of unmet need within the forensic mental health services. The DHB noted the legal requirement to admit from court and the high acuity of the prison waitlist are such that the bed capacity in the forensic mental health service is continually exceeded. Many of the DHB’s responses to the recommendations also highlight significant financial pressure on the DHB and indicate the need for additional funding to achieve the recommendations. While I acknowledge that funding may be a barrier, my role as an NPM is to report on the conditions and treatment for people who are being detained, as they are at the time of the inspection. I intend to highlight my concerns with the Ministry of Health.

I also intend to conduct follow up inspections of all the Units, at which point I will be able to assess whether action to address my concerns has been implemented.