Mental health facilities unfit for purpose - Chief Ombudsman

The standards of cleanliness and maintenance were inadequate and needed to be attended to as a priority.
The standards of cleanliness and maintenance were inadequate and needed to be attended to as a priority. Photo credit: Getty

Two of three mental health facilities inspected last year have been found not fit for purpose and one of them urgently needs refurbishing.

In three reports released today, Chief Ombudsman Peter Boshier said Te Whare Ahuru in Hutt Valley and STAR 1 in Palmerston North needed improvement; the rebuilt Tiaho Mai Mental Health Inpatient Unit in Auckland was a fine example of a modern and therapeutic environment.

He said Te Whare Ahuru, based at Hutt Hospital and inspected in March last year, was not fit for purpose and needed to be upgraded as a matter of urgency.

He said the standards of cleanliness and maintenance were inadequate and needed to be attended to as a priority.

Boshier said there had been potentially degrading treatment there, such as an incident in which a patient was unable to get to a bathroom and had an "undignified incident" as a result.

"I am also disappointed about the ongoing use of non-designated rooms, including seclusion rooms, as bedrooms when the unit is over-occupancy. I consider this completely inappropriate," he said.

"In no other area of a hospital would you expect to see people sleeping in such environments, and nor do I expect to see service users in mental health facilities treated this way."

Boshier has recommended the issue of over-occupancy be addressed as a matter of urgency and that non-designated rooms should never be used as bedrooms.

Hutt Valley District Health Board (DHB) accepted 12 of the 18 total recommendations made by the chief ombudsman, partially accepted five and rejected one, according to the ombudsman.

The STAR 1 (Services for Treatment, Assessment and Rehabilitation) psychogeriatric unit at Palmerston North Hospital, inspected in September 2020, was also found to be not fit for purpose for a number of reasons.

Boshier said it was concerning that the use of restraint had increased since the unit was moved to a new location in June 2020.

He said the unit had an institutional feel and lacked space for group activities, had no dining room or kitchen for patients, no quiet communal areas, an unsafe outdoor area to which access was restricted and a small and poorly resourced patient lounge.

"My report makes two amended repeat recommendations to STAR 1 about the environment not being fit for purpose and not conducive to improving the wellbeing of the service users," he said.

"The environment was a reason given for the increased use of restraint in the unit. If not addressed, this may affect treatment and conditions."

MidCentral District Health Board accepted four of the five recommendations made and partially accepted the other, according to him.

Meanwhile, the rebuilt Tiaho Mai Mental Health Inpatient Unit on the grounds of Auckland's Middlemore Hospital, which was inspected in June last year, showed the positive impact of a purpose-built and fit for purpose facility environment, he said.

"I was pleased to find that the new facilities were light, modern, therapeutic, and considered in their design. In my opinion, it is a model for recovery and service user-centred care and the thoughtful design of the admission suite, in particular, is commendable."

However, Boshier said that although his report was largely complimentary, there were aspects of the unit's administration that needed addressing.

These included incomplete collation and reporting of seclusion and restraint data. In addition, voluntary service users had no information about the process for coming and going from the unit at will as they were entitled to.

He made 15 recommendations. Three of them were repeat recommendations from the previous inspection report in 2015. Counties Manukau District Health Board accepted all but one.

"Units such as these provide care for some of our most vulnerable and unwell people. It is crucial that they meet the standards of care and therapy we as a society expect," Boshier said.